OSD is most commonly characterized by the big tibial tubercle and pain on activities like kneeling or repeated jumping. OSD arises from a strong pull of the quadriceps muscle on the tibial tubercle during a child’s growth spurt. This normally occurs around the ages of 9 – 16 years old. This strong pull occurs in sports that require a quick, strong contraction of the quadriceps, like in soccer, martial arts, and basketball.
The quick, strong pull on the tibial tubercle has an avulsion-fracture like effect (when a small bone fragment breaks away from the main bone mass) that would cause an inflammation of the periostium. However, with the child being actively involved with the sport, this effect is magnified as the action is repeated. The frequency and repetitive nature of the sport doesn’t allow the periostium to recover and thus causes a chronic inflammation on prominence of the tubercle. This leads to a constant, persistent pain, especially on impact. This pain will not only limit the child’s performance in the sport, preventing them from excelling, it would also cause a lot of inconveniences later on in their growing years.
- RICER regime (Rest, Ice, Compression, Elevation, and Referral).
- Oral NSAIDs or injection of NSAIDs directly over the painful area
- Ultrasound guided Extracorporeal Shock Wave Therapy (ESWT) by a sports physician to break down scarred tissues and allow for the tubercle to heal
- Stretches and improving muscle control through physiotherapy
- Assessing for biomechanical factors that may cause OSD by sports physiotherapists to prevent recurrence of pain and to maximise the child’s performance in their sport
The best way to prevent the onset of OSD is to ensure adequate stretching and good control of the quadriceps. Adequate prehab should thus be a key before starting any form of sport. | MCR