1. A. Osgood-Schlatter disease (osteochondrosis of the tibial tuberosity)
- An inflammation of the area just below the knee where the patellar tendon attaches from the kneecap to the shinbone (tibia) (AAOS, 2023)
- Affects kids during their preadolescent growth spurt: in the tweens (10 to 13) for girls and the early teens (12 to 14) for boys. At this stage, a child‘s bones are typically growing faster than the muscles and tendons. As a result, the muscles and tendons have a tendency to become tight. The condition is caused by the constant pulling of the patellar tendon on the area below the knee where the tendon attaches
B. What’s happened in your knee?
- An overuse injury caused by chronic avulsion of the unfused apophysis of the tibial tubercle.
- The proximal tibial physis usually closes during adolescence.
- As it ossifies, it is prone to avulsion because it changes from stronger fibrocartilage to weaker columnar cartilage before becoming bone
- With repetitive contraction of the quadriceps muscle (e.g., from jumping, squatting, using stairs), the patellar tendon begins to pull away from the tibial tubercle (Roth & et.al., 2012)
C. Presenting symptoms
- Pain at anterior or center of knee, below patella
- Gradually dull, achy pain and usually related to activities
- Popping or crackling sounds in the knee when you climb stairs or stand up and walk after prolonged sitting
- Pain at night
- Pain during activities that repeatedly bend the knee (jumping, squatting, running, and other exercise involving weight-lifting)
- Pain related to a change in activity level or intensity, playing surface, or equipment (AAOS, 2023)
D. Why it will happen on your knee?
- Male
- Sudden skeletal growth (physiopedia, n.d.)
- Doing sports activities with repetitive jumping and sprinting
- Obesity, which places increased pressure on the knee joint (reduced joint space and increased Q angle, thus compromising the kinematics of this joint)
- Patella taping or brace to reduce patella loading
2. A. Jumper’s knee (Patella tendinitis)
- Inflammation of your patellar tendon ()
- Results from tiny tears in the patellar tendon, starting from the quadriceps muscle and extending downward (Gemas, 2015)
- The resulting pain can interfere with daily activities, such as climbing stairs or sitting in a car, as well as sports activities (Mount Elizabeth Hospitals, n.d.)
B. What are the symptoms presented? (Mount Elizabeth Hospitals, n.d.)
- Pain and tenderness at the base of the kneecap, especially while kneeling or getting up from a squatting position
- Sporadic pain that worsens as the damage to the tendon gets worse
- Swelling or burning sensation in the kneecap
- Bruising or redness, especially if there has been an injury
- Discomfort from daily activities that require bending and straightening of the knee
C. What makes the pain happen to your knee?
- Tight Quadriceps and hamstring muscles, which can increase the strain on the patellar tendon.
- Muscle imbalance with stronger muscles pulling harder on the patellar tendon or asymmetric lower limb’s strength.
- Malignment of the lower limb including conditions such as bow legs, knock knees and flat feet.
- Increased tension in the patellar tendon, which can occur when tendon growth cannot keep up with the growth of the lower leg. This is known as Sinding-Larsen-Johansson disorder, where the tendon pulls on the bottom tip of the kneecap.
- Obesity, which places increased pressure on the knee joint.
- Chronic illness such as kidney failure, rheumatoid arthritis or diabetes which can affect blood flow to the knee and weaken the tendon.
- Poor jumping and landing technique, due to the way the quadricep muscles contract.
3. A. Sinding Larsen Johansson Syndrome (SLJS)
- Is a juvenile osteochondrosisand traction epiphysitis affecting the extensor mechanism of the knee which disturbs the patella tendon attachment to the inferior pole of the patella
- Is an overuse injury due to repetitive jumping, landing during adolescents growth spurt
- Is a self-limiting syndrome, complete recovery can be expected with closure of the patella growth plate
B. Presenting symptoms
- Tenderness at the bottom of the patella and along the patellar tendon
- Resisted knee extension may elicit pain
- Localized soft tissue swelling
- Pain worsens with exercise, stair climbing, squatting, kneeling, jumping and running
- Relieved by rest
- May report that they limp after exercise
- May be unilateral or bilateral
- Maybe will have patellar sleeve avulsion fracture
C. How physiotherapy can help to relieved the symptoms?
- Pain relief management (PRICE)
- Electrotherapy (Ultrasound, Tens)
- Soft tissue manipulation to release the tight muscle (Quadriceps and Hamstring)
- Stretching exercises (Such as Quadriceps and Hamstring)
- Strengthening exercises (such as vastus medialis oblique and other muscles)
- Patient education on activity modification
Prepared by: Choo Siew Wen Your Physio Klang