Ross Hauser, MD explains Prolotherapy injection treatment for Osgood-Schlatter Disease.
Osgood-Schlatter Disease (OSD) is a disorder involving painful inflammation of the bone, cartilage and/or tendon at the top of the shinbone where the tendon from the kneecap attaches to the shin bone.
- OSD usually strikes active adolescents at the beginning of their growth spurts.
- Growth spurts can begin any time between the ages of 8 and 13 for girls, and 10 and 15 for boys.
- Sports requiring a lot of jumping, kneeling and squatting make young athletes particularly susceptible, as it is felt that stress on the bone from the tendon tugging on it during activities such as sports, leads to Osgood-Schlatter disease.
An accurate means of diagnosing Osgood-Schlatter disease compounds the problem. Doctors in Japan called for a heightened awareness of risk factors that could predispose children to Osgood-Schlatter disease. They advised doctors to be alerted to growth or height, body weight, body mass index, tightness of the quadriceps femoris and hamstring muscles, muscle strength during knee extension, and flexion. 1
At the end of each of the long bones in the child’s arms and legs is a growth plate made of cartilage. Since cartilage isn’t as strong as bone, stress on the cartilage can cause it to become swollen and irritated. Osgood-Schlatter occurs when the tendon from the kneecap (patellar tendon) pulls very forcefully on the growth plate of the large bone (tibia) below the knee.
The child’s body may try to close that gap by creating new bone growth or calcification of the tendon where it attaches to the tibia or shin bone, resulting in a bony lump in that area. This lump can be very painful, especially when hit or with activities such as kneeling.
Treating Osgood-Schlatter Disease
The chronic knee pain that results from Osgood-Schlatter disease is usually exacerbated by physical activity, especially running and jumping. As a result, the most common treatment physicians recommend for young athletes is simply rest and cessation from playing sports. Needless to say, although this advice has become accepted practice, it is not popular, especially considering that Osgood-Schlatter disease can last until the bones stop growing. That can be a very long time to wait and not participate in a favorite sport.
Some other possible recommendations include:
- An X-ray to examine the area where the patella tendon attaches to the shinbone, and to look for calcification of the attachment
- Over the counter pain relievers and/or oral anti-inflammatories
- Physical therapy to stretch the quadriceps
- Wearing a pad over the knee for protection
- Wearing a patellar tendon strap to try and keep the tendon from moving during activities.
- Bracing to reduce strain on the tibial tubercle
When the above modalities fail to bring relief and the condition becomes chronic, surgical intervention may be recommended. Surgery often has its complications, and this particular surgery to remove the calcified areas may leave the patient with circulation issues below the knee.
Prolotherapy for Osgood-Schlatter Disease
As explained in the video by Ross Hauser, MD, Prolotherapy is an injection technique that stimulates soft tissue repair. Independant research has found it safe and effective:
- “Prolotherapy injections are a safe and effective treatment for Achilles tendinopathy, plantar fasciopathy and Osgood-Schlatter disease”2
- The injections at the tendon attachments were documented in the medical journal Pediatrics:
- “results suggest superior symptom-reduction efficacy of injection therapy over usual care in the treatment of Osgood-Schlatter disease in adolescents. A significant component of the effect seems to be associated with the dextrose component of a dextrose/lidocaine solution.
- Dextrose injection over the apophysis (The apophysis is a site of tendon or ligament attachment) and patellar tendon origin was safe and well tolerated and resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than usual care.3
Prolotherapy’s injection technique causes a mild inflammatory response that stimulates the body’s immune system. This boosts blood flow to the damaged areas, and causes an influx of reparative cells to come in to heal the weakened tendon attachment and cartilage. It even stimulates the body to lay down collagen, which is what the tendon and cartilage are made of. This new collagen causes a strengthening of the tendon, the tendon attachment, the cartilage, and the weakened soft tissue in the treated area. In short, Prolotherapy gives the body the resources it needs to repair.
An extremely safe and effective natural medicine treatment, Prolotherapy stimulates repair where the patellar tendon attaches to the tibial tubercle, and causes the tendon to strengthen. Once the tendon reaches normal strength, the athlete can go back to their normal activities. Prolotherapy can get the young athlete back long before the standard of rest, physical therapy or the wait and see approach.
1 Nakase J, Goshima K, Numata H, Oshima T, Takata Y, Tsuchiya H. Precise risk factors for Osgood-Schlatter disease. Arch Orthop Trauma Surg. 2015 Sep;135(9):1277-81. doi: 10.1007/s00402-015-2270-2. Epub 2015 Jul 2.
2 Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. Journal of Foot and Ankle Research. 2015;8:57. doi:10.1186/s13047-015-0114-5.
3 Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter Disease. Pediatrics. 2011;128(5):e1121–e1128. doi: 10.1542/peds.2010-1931.