OsGood Schlatter's Disease Indicated by Red Knot on Knee

Red Knot Under My Knee on Shin

It is common for young athletes to experience adolescent knee pain in the form of a tender bump on their shin bone, just under the knee. This knot below the knee in young athletes is known as Osgood Schlatters. When older athletes develop a bump on the tibia, it is more likely to be patella tendonitis.

The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded in muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.

The knee is an incredibly complex joint that goes through a tremendous range of motion. It has many muscles that cross the knee joint to help control its movement while walking, running, squatting, or going up and down stairs. All of this movement occurs while supporting your body weight. The internal components of the knee include several strong ligament structures that prevent excessive shearing motions. Likewise, we have several strong muscles that cross the outside of the knee joint including the quadriceps, hamstrings, and gastrocnemius muscles.

Causes of Osgood Schlatters

Osgood Schlatters is an overuse condition or injury. It is caused by the repetitive pulling of where the patellar tendon attaches to the tibia just below the knee. It is more common in young athletes because they are at an age where their bones are growing faster than their muscles and tendons. Since this is the case, the muscles and tendons tend to tighten, making an injury to the patellar tendon more likely.

During activities that involve a lot of running, the quadriceps muscles pull on the patellar tendon. The repetitive stress from these activities can sometimes cause the tendon to pull away from the tibia, resulting in the inflammation of the surrounding soft tissues that then show up as a red knot under the knee. Infections are unlikely without trauma and most of the time your child's body will try to close the gap with new bone growth, resulting in a bony bump under the knee.

Patella Tendonitis

The causes of patella tendonitis are the same as Osgood Schlatters. Repetitive stress from high-intensity activities such as running injures the patellar tendon. The difference, however, is that the patellar tendon pulls away from the tibia in Osgood Schlatters and in patella tendonitis, tiny tears appear all over the patellar tendon. Your body will try to repair the tears, but if it can't and the tears multiply, it causes pain from inflammation of the small tissues and the tendon becomes weaker.

Osgood Schlatters and patella tendonitis can both be treated the same way. To avoid surgery, it is best to immediately seek a professional medical opinion and start a conservative, therapeutic treatment to reduce your pain and find relief.

Home Treatments

At home the first step is always PRICE: protect, rest, ice, compress, and elevate. Reduce the stress and strain to the knee. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs) as recommended by your doctor can help reduce pain and inflammation. Ice helps block the knee pain and reduce inflammation.

Medical Treatments

NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options, as well. Pain management is not usually required unless stronger medications or joint injections are involved in treatment.

MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss.

Conservative Treatments

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

Iliotibial band Syndrome is common in runners who develop the injury because of weakness and poor stabilization of the leg and hip muscles. Specific knee exercises are given to increase strength and endurance. Proprioception exercises help teach the muscles how to work together again to stabilize the knee during walking or running.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

Improve Movements to Eliminate Hip Pain

The back, hip, and lower extremity work as a comprehensive unit allowing for many of the repetitive tasks you complete at home, work, and during recreational activities. Injuries to one area of the musculature often indicates that additional damage has been incurred by adjacent muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise ball, and BOSU balls can be performed on the floor. The more unstable the surface, the more effort and stabilization is required of all the lower extremity muscles.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.

Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.