What I Wish I Knew When I Had Osgood-Schlatter Disease
Key insights: 60-second read
- Osgood-Schlatter Disease is not simply "growing pains" - growth itself is a normal physiological process and shouldn't automatically be considered the cause of pain. Rather, growth can expose underlying mechanical factors that contribute to symptoms.
- The hidden contributor may be lower back dysfunction - stiffness through the mid-to-lower back can influence the way the lower limb moves and functions, potentially creating a chain reaction that increases stress around the knee.
- You don't necessarily have to wait until you stop growing - by addressing the mechanical factors that may be contributing to your symptoms, along with the appropriate exercises, Osgood-Schlatter symptoms can sometimes improve within weeks rather than persisting for years.
- The bump may remain even after the pain resolves - the characteristic bump at the top of the shin is a response of the bone to abnormal repeated loading. It may remain permanently, but that doesn't mean it has to remain painful.
- Posture may be another important piece of the puzzle - prolonged sitting, slouching, and lounging positions can place repeated stress through the lower back and may contribute to the mechanical dysfunction that ultimately affects the way the knee is loaded.
We need to stop thinking of Osgood-Schlatter disease as "growing pains." If you or your child have experienced this condition and been told that you need to wait until you grow out of it, then this guide is for you.
I want to emphasise this point again: Osgood-Schlatter disease shouldn't automatically be considered a consequence of growth. Yes, growth can play an important role, but it doesn't tell us the whole story. From a physiotherapy perspective, it can be more useful to think of Osgood-Schlatter disease as a mechanical problem that growth and increased activity can expose. When we identify and address those mechanical contributors, symptoms can often be improved with the right approach and exercises.
And I should know - I've experienced it myself. I had Osgood-Schlatter disease in both knees from the ages of 14 to 17. I was given the same advice that many young people are still given today: "You'll grow out of it." But with what I now know as a physiotherapist, having treated hundreds of people with musculoskeletal conditions, I believe there were mechanical factors contributing to my symptoms that could have been addressed much earlier. In hindsight, it should have taken weeks to improve rather than years.
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It's Not "Growing Pains"
The traditional explanation is that because you're growing, certain parts of your body become more vulnerable to pain. On the surface, this seems to make intuitive sense, and it has become a convenient explanation for many different types of musculoskeletal pain. But it doesn't necessarily tell us the whole story.
"Normal things shouldn't cause abnormal things to happen. Growing is normal. Developing knee pain is not normal."
If growth were the primary cause of Osgood-Schlatter disease, it raises an obvious question: why do people experience pain on one side more than the other? Growth isn't necessarily perfectly symmetrical, but asymmetries are a normal part of human development. So rather than assuming that growth itself is causing the pain, it makes sense to consider what other factors may be contributing.
The way I think about Osgood-Schlatter disease is this: growth isn't necessarily the cause, but it can create a period of increased vulnerability. Those changes can then expose pre-existing or developing mechanical dysfunction such as stiffness, tightness, weakness, altered movement patterns, poor posture or inefficient mechanics.
Key Concept: Osgood-Schlatter disease can be viewed as a mechanical issue rather than something you have to endure until you stop growing. Addressing the relevant mechanical contributors may help improve symptoms rather than simply waiting for them to settle on their own.
The Hidden Cause: Lower Back Dysfunction
One of the biggest clinical observations I've made when treating Osgood-Schlatter disease - and one that closely mirrors my own experience - is that there can be an important hidden contributor further up the chain: dysfunction through the mid-to-lower back.
I appreciate that this can sound strange at first. Your back is up there, while your knee is somewhere else entirely. So how could the two possibly be connected? The answer lies in the way the body functions as a connected system. Stiffness and restriction through the lower back can influence how the lower limb moves and how forces are distributed through the leg. The nerves responsible for controlling the muscles of the leg originate from the lower spine, and changes in spinal function can potentially influence how those muscles perform and how load is distributed through the knee.
When you combine these mechanical factors with growth and high levels of physical activity, previously well-tolerated movement patterns can become less tolerant. The knee may then become the area where symptoms ultimately show up, even though the contributing factors may exist further up the chain.
Exercise 1: Lower Back Release
Before changing anything, I recommend performing a simple test. Choose an activity that reliably aggravates your knee - perhaps stairs, squats, lunges or running - and take note of how your knee feels. Then grab a foam roller, lacrosse ball or rolled-up towel.
How to Do the Lower Back Release
- Position: Place the roller or ball anywhere from the base of your rib cage down towards your lower back, working on either side of your spine rather than directly over the spinal bones.
- Find the spots: Gently recline backwards over the roller. Roll slightly towards one side and then the other. You're looking for areas that feel stiff, tight or restricted, rather than simply searching for the most tender spot. Pay particular attention to areas where you notice a difference in mobility or restriction from one side to the other.
- Hold: When you find an area that feels particularly stiff or restricted, stay there for around 30 seconds to one minute. Allow the roller to apply gentle pressure while taking a few relaxed breaths.
- Systematic search: Slowly move the roller up and down and continue looking for other areas of restriction. Spend a little more time on areas that feel noticeably thicker, stiffer or more restricted than the corresponding area on the other side.
- Retest: Stand up and immediately repeat the same activity that previously aggravated your knee. Pay attention to whether anything has changed.
If improving the mobility of your lower back changes your knee symptoms, even slightly, your back may be a contributing factor to your Osgood-Schlatter symptoms. This is why the test-and-retest approach can be so useful: rather than just performing an exercise because someone tells you it should work, you can see whether it actually changes your symptoms - especially when some of the concepts might sound a little far-fetched in the beginning.
Exercise 2: The Couch Stretch
The next step is to consider whether tightness around the hip and quadriceps is contributing to increased tension around the front of the knee. The couch stretch is a useful way of addressing both the quadriceps and hip flexors at the same time.
How to Do the Couch Stretch
- Setup: Position your knee into the corner where a wall meets the floor, or use the seat of a chair if kneeling is uncomfortable. Your shin should be relatively vertical with your foot pointing upwards. If the full position is uncomfortable, modify the setup using a chair or bed - you don't need to force yourself into a completely vertical position.
- Position: Keep your back relatively straight and gradually extend through your hip as far as is comfortable. You should feel the stretch through the front of your thigh and/or hip. Don't force the position - the aim is to find a tolerable level of tension rather than an aggressive stretch.
- Contract-relax: Gently squeeze your glutes and push your foot backwards into the wall, or contract your quadriceps, for around 5-10 seconds. Relax, then allow yourself to move slightly further into the stretch if it feels comfortable.
- Repeat: Continue with the sequence of gently contracting, relaxing and moving slightly further into the position until you stop noticing any further change in mobility.
- Retest: Repeat the activity that normally aggravates your knee and see whether your symptoms or movement have changed.
The Posture Piece
This is the piece I wish I'd understood when I was a teenager. If you've identified a connection between your lower back and your Osgood-Schlatter symptoms, the next question should be: why did my back become stiff or restricted in the first place?
"One of the main reasons behind why this part of the spine becomes dysfunctional is that it's often a hidden consequence of the boring shapes and postures we repeatedly put that part of our back into."
I know - posture isn't exactly exciting. It's not particularly glamorous, and it's probably not the advice most teenagers want to hear. But it matters. For many young athletes, the issue may not be that they're playing sport. It's that they're combining regular sporting activity with hours of slouching on the couch, gaming or studying in positions that repeatedly place the lower back into the same flexed or hinged position.
In my own case, my posture was terrible. I would slouch all the time. I'd slide down into a chair until the back of my head rested against the back of the chair, effectively creating a constant hinge through my spine. Over time, this contributed to the way my lower back was functioning. Add in the fact that I was growing rapidly and playing a lot of sport, and my knees ultimately became the area that struggled to tolerate the way things were functioning.
What to Do About It
- Check your sitting posture: Try to avoid constantly collapsing through your lower back. Sit upright and use appropriate support behind your back where needed.
- Be aware of your lounge habits: The way you spend hours on the couch can matter. Try not to spend prolonged periods in the same deeply slouched position.
- For parents: Have a look at how your child sits when they're gaming or watching TV. Are they repeatedly collapsing into their lower back? If so, gently bring it to their attention rather than constantly telling them to "sit up straight."
- Prioritise global loading: Managing Osgood-Schlatter isn't necessarily just about stretching and strengthening. It's also about considering the cumulative load placed on the body through sport, activity and prolonged postures.
The bump at the top of the shin may never completely disappear. It represents a bone response to repeatedly altered loading and can eventually become a permanent prominence. But you don't need the bump to disappear to feel better. The pain can resolve completely while the bump remains as a reminder of what happened. In other words, the bump shouldn't matter if we resolve the underlying cause.
Osgood-Schlatter disease shouldn't be dismissed as "growing pains." Growth can create a period of increased vulnerability, but there may also be underlying mechanical factors contributing to why symptoms develop and persist - and those are factors we can potentially influence.
The three pieces of the puzzle are:
- Address the hidden lower back dysfunction - work on the stiffness and restrictions that may be influencing the way you load your knee.
- Free up the tissues above your knee - restrictions through the quadriceps and hip flexors may increase tension around the front of the knee.
- Change the postures that may be contributing to the problem - treatment and exercises are less likely to provide lasting results if the same aggravating postures and loading patterns are continually repeated day after day.
It took me three years to get rid of my Osgood-Schlatter disease because no one ever talked to me about these factors. I hope this information helps you or your child understand the condition from a different perspective and, hopefully, get on the road to improvement much sooner.
- Grant
Frequently Asked Questions
How long does it take to resolve Osgood-Schlatter with these techniques?
If lower back dysfunction and postural habits are contributing to your symptoms, some people may notice significant improvement within a few weeks. Consistency is important - both with the mobility work and with changing the postural habits that may have contributed to the problem. Rather than simply taking a "wait until you stop growing" approach, the aim is to address the mechanical factors that may be contributing to the symptoms.
Can I still play sport with Osgood-Schlatter?
Yes, in many cases you don't necessarily have to stop playing sport. However, it's important to listen to your symptoms and manage your overall load appropriately. If an activity causes significant pain, consider modifying the activity or reducing its intensity. The test-and-retest approach can also be useful: if improving your back mobility changes how your knee feels, that provides useful information about the factors contributing to your symptoms.
Will the bump ever go away?
The bump at the top of your shin may never completely disappear. It represents a bone response to repeated loading and can eventually solidify into a permanent bony prominence. But you don't need the bump to disappear to feel better. The pain can resolve completely even when the bump remains. Ultimately, it's more useful to focus on pain, function and your ability to participate in the activities you enjoy rather than the appearance of the bump.
What if I don't have any lower back pain?
Most people with Osgood-Schlatter don't necessarily experience lower back pain. The dysfunction I'm referring to can be subtle or relatively symptom-free - you may not actually feel anything in your back, even if its mobility or function is influencing the way you move and load your lower limb. That's why the test-and-retest approach can be so useful. Even without back pain, improving lower back mobility may potentially change your knee symptoms and provide useful information about whether it is contributing to the problem.
One key insight from this video
"Normal things shouldn't cause abnormal things to happen. Growing is normal. Developing knee pain is not normal. Osgood-Schlatter disease can involve mechanical factors that may be improved with the right perspective and appropriate exercises."
Need personalised guidance for your knee pain?
If you would like help making sense of your knee pain, injury, or general musculoskeletal dysfunction, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
