What the Heck is that Bump Below my Knee?

Maybe you have a condition called Osgood–Schlatter disease (OSD), which is essentially an inflammation of the patellar tendon where it inserts into the tibia just below your knee cap.  The easiest way to recognize this is that there is a painful bump just below the knee that gets aggravated by activity and eases with rest.  Often it is seen on one side, but both knees may be affected as well. More commonly we see this in adolescent boys between the ages 12-15 but girls can be affected as well. The onset of this condition coincides with growth spurts of adolescents especially in kids who are active in sports or activities that involve running, squatting, kneeling and jumping. Osgood Schlatter disease is really an overuse injury that occurs over time due to repetitive strain from the force applied by the strong patellar tendon at its insertion into the tibial tuberosity.  In growing adolescents, this area where it inserts is weak because it has not fully developed yet and therefore is susceptible to injury.  The result of this repeated strain causes an irritation and inflammation of the bone which leads to that unusual “bump” that is the characterizing symptom of OSD. The good thing is that the pain with this condition won’t last forever! Usually, kids experience symptoms up to 2 years until the bone structure of the tibia as matured and they are experiencing fewer growth spurts. Once the symptoms have subsided however, you are usually stuck with that distinguishing bump, which is just a nice reminder of that old knee pain that you USED to have. Ok, so I think I have OSD.  What do I do about it? There are some specific things that you can do to help limit your symptoms.  Ice, rest and modification of activity are some of the things that can help in the short term but it is necessary to get a physical assessment.  If you don’t learn what’s causing OSD it’s kinda hard to get rid of it! So we want to assess and see if there are any predisposing factors that may be causing this, such as tight or weak quads, gluts or hamstrings.  The next thing that is important to discover is if there are any biomechanical alignment problems in the hip, knee or foot that may be setting the knee up for an abnormal line of pull of the patellar tendon on the tibia, such as excessive pronation, patellar tracking issues or congenital hip alignment conditions. Once we have learned what the culprit is, a specific exercise program to address weak or tight areas, correct the biomechanics and alignment issues, needs to be followed.  Then, a progressive, modified return to activity plan needs to be developed to ensure that, one, you get back playing your favorite sport and two, that nasty knee pain doesn’t come back!