Katherine Worsnick, PA-C explains Prolotherapy injection treatment for Osgood-Schlatter Disease.
A conversation with a concerned parent will usually begin like this. “My son/daughter was just diagnosed with Osgood-Schlatter Disease. They are recommended rest and months of physical therapy. He/she is an elite soccer player and he/she cannot afford to miss that much time off the field. Is there anything you can do?”
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. Young athletes will usually go to the doctor because they have severe knee pain.
- Osgood-Schlatter Disease 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.
“No one seems to know how long the recovery will be or even if this is the right diagnosis.”
Another concern that this parent may express is what we have heard from many parents. “No one seems to know how long the recovery will be or even if this is the right diagnosis.”
An accurate means of diagnosing Osgood-Schlatter disease compounds the problem for clinicians who are not experienced in seeing this disorder.
Doctors writing in the journal Archives of orthopaedic and trauma surgery recognized this problem and 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)
Osgood-Schlatter Disease is chronic knee pain
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 (a bone spur) 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 in our experience gets the athlete back many weeks even months before standard physical therapy
We have been using Prolotherapy in the treatment of Osgood-Schlatter for more than 25 years. In the research below you will see studies including a double blind study that showed that dextrose Prolotherapy significantly reduced the amount of pain Osgood-Schlatter suffered with.
- Prolotherapy injections, by stimulating the repair of of the quadriceps tendon and ligament attachments to the tibial tubercle restores strength to this area and the athlete can go back to all their activities
- Prolotherapy in our experience gets the athlete back many, many weeks even months before standard physical therapy.
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.
In our research overview A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain published in the journal Clinical medicine insights. Arthritis and musculoskeletal disorders. We highlighted several studies in patients with athletic injury resulting in tendinopathy unresponsive to conservative treatment.
- In one double-blinded study, young athletes aged 9–17 years with Osgood–Schlatter disease were randomized to dextrose injection, control injection, or to a noninjection (supervised exercise) group. Dextrose prolotherapy patients had substantially greater pain reduction during sport activity than either group at follow-up, with many pain-free during sport involvement. At one year, 84% of the dextrose-treated knees were pain free compared to 46% of the lidocaine-treated knees.(2).
That study which appeared in the medical journal Pediatrics also suggests:
- “Our 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 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)
This study was published in the medical journal Journal of foot and ankle research by doctors at the School of Surgery, University of Western Australia. This research goes on to say:
“The analysis also suggests Prolotherapy injections provide equal or superior short, intermediate, and long-term results to alternative treatment modalities, including eccentric loading exercises for Achilles tendinopathy, Platelet-rich plasma for plantar fasciopathy and usual care or lidocaine injections for Osgood-Schlatter disease.”(4)
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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. [Google Scholar]
2. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016 Jan;9:CMAMD-S39160. [Google Scholar]
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. [Google Scholar]
4 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. [Google Scholar]