Introduction
Osgood-Schlatter disease is an inflammation in the area just below the knee where the tendon from the kneecap attaches to the shinbone (tibia). It is the common cause of knee pain in growing children and young teenagers. It develops mostly during growth spurts.
During the growth spurts of adolescence, certain muscles and tendons grow quickly and not always at the same rate. With physical activity, differences in the size and strength of the quadriceps muscle can put more stress on the growth plate near the top of the shinbone. The growth plate is weaker and more prone to injury than other parts of the bone. As a result, it can become irritated during physical stress and overuse. The irritation can result in a painful lump below the kneecap. This is the main sign of Osgood-Schlatter disease.
Osgood-Schlatter disease is typically diagnosed in adolescents during the beginning of their growth spurts. Growth spurts usually start between ages 8 and 13 for girls, and between ages 10 and 15 for boys. Teenage athletes who play sports that involve jumping and running are more likely to develop the disease.
In most cases, Osgood-Schlatter disease can be treated successfully with simple measures, such as rest and over-the-counter medication.
Signs & symptoms
Knee pain and swelling just below the kneecap are the main indicators of Osgood-Schlatter disease. Pain usually worsens during certain activities, such as running, kneeling and jumping, and eases with rest.
Yet, the common symptoms of Osgood-Schlatter disease include:
- Knee or leg pain
- Swelling, tenderness, or increased warmth under the knee and over the shinbone
- Pain that gets worse with exercise or high-impact activities, such as running
- Limping after physical activity
Causes
Osgood-Schlatter disease most commonly occurs in children who participate in sports that involve running, jumping, or twisting like basketball, volleyball etc.
Osgood-Schlatter disease tends to affect boys more often than girls.
Pathophysiology
The condition is caused by multiple submaximal avulsion fractures of the patellar tendon attachment to the tibial tubercle, when the tibial tubercle is in the apophyseal stage and the secondary ossification centre has appeared.
The tibial tubercle develops as a secondary ossification centre that provides attachment for the patellar tendon. Bone growth exceeds the ability of the muscle-tendon unit to stretch sufficiently to maintain previous flexibility leading to increased tension across the apophysis. The physis is the weakest point in the muscle-tendon-bone-attachment (as opposed to the tendon in an adult) and therefore, at risk of injury from repetitive stress. With repeated contraction of the quadriceps muscle mass, especially with repeated forced knee extension as seen in sports requiring running and jumping (basketball, football, gymnastics), softening and partial avulsion of the apophyseal ossification centre may occur with a resulting osteochondritis
The appearance and closure/fusion of the tibial tubercle occurs in the following sequence pattern:
- Tibial tubercle is entirely cartilaginous (age < 11 years)
- Apophysis forms (age 11 to 14 years)
- Apophysis fuses with the proximal tibial epiphysis (age 14 to 18 years)
- The proximal tibial epiphysis and tibial tubercle apophysis fuses with the rest of the proximal tibia (age > 18 years)
Diagnosis
Physical exam w.s.r to knee for swelling, pain, and redness. In some cases, X ray is taken to rule out other potential causes of knee pain.
Osgood-Schlatter disease usually resolves on its own after the growth spurt period. Until then, treatment is focused on relieving symptoms, such as knee pain and swelling. Treatment typically involves:
- Icepacks on the affected area two to four times a day, or after doing physical activity
- taking over-the-counter pain relievers, such as ibuprofen or acetaminophen
- resting the knee or reducing physical activity
- wrapping the knee or wearing a knee brace
- stretching
- Physical Therapy
- Surgery in very rare cases
Some children may be able to participate in low-impact activities, such as swimming, as they recover. Others may need to stop participating in certain sports for several months so their bodies have time to heal properly.
Prognosis
The prognosis is usually excellent. The disease is usually self-limiting and is resolved once the growth of bones is complete and the tibial tubercle apophysis ossification.
Complications
Osgood-Schlatter disease usually doesn’t cause any long-term complications. In rare cases, children with the disease may experience chronic pain or ongoing swelling.
Disease & Ayurveda
Sandhichyuta/Bhagna
Nidana
Kshata
Purvaaroopa
Not mentioned
Samprapti
Due to kshata, Vaata vitiates at the site immediately and causes severe pain, unbearable for the person to move. Along with Vaatakopa, the Pitta-Rakta gets vitiated, when injury or kshata is there and causes the disease.
Lakshana
Atitivraruja – Unbearable pain
Slathasandhi – Unstable joint
Divisions
Not mentioned in the case of knee joint
Prognosis
Krichrasaadhya
Chikithsa
Samana
Snehana
Bandhana
Immobilisation
Sodhana
Daahakarma for pain relief in some cases
Commonly used medicines
Dhanwantharam Kashayam
Vidaryadi Kashayam
Sapippaleekam Churna
Gandhatailam
Bala Tailam
Brands available
AVS Kottakal
Home remedies
To ease pain and discomfort of knee joint:
- Rest your knee.Discontinue the activity that caused knee bursitis and avoid movements that worsen your pain.
- Take over-the-counter pain relievers.Short-term use of an anti-inflammatory drug, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), can help relieve pain.
- Apply ice.Apply an ice pack to your knee for 20 minutes at a time several times a day until the pain goes away and your knee no longer feels warm to the touch.
- Apply compression.Use of a compressive wrap or knee sleeve can help reduce swelling.
- Elevate your knee.Prop your affected leg on pillows to help reduce swelling in your knee.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
Fried non vegetarian foods
- To be added
Light meals and easily digestible foods
Freshly prepared Non vegetarian and seafoods
Green gram, soups, sesame oil, warm fresh goat’s/cow’s milk, ghee etc.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Nuts and dry fruits in small quantity.
Behaviour:
Stick onto immobilisation and rest advised.
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid day sleep and sitting awake late night.
Yoga
In acute injuries, fractures and inflammations, the person should be advised to take rest at the time of injury.
After healing and regaining normal health, specific yogacharya including nadisuddhi pranayama, bhujangaasana, pavanamuktasana, suryanamaskara etc is recommended depends on the site of injuries and condition of healing.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Suryanamaskara
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK441995/#_article-26359_s5_
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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