Many children often present in practice complaining about anterior knee pain. One condition that is worth mentioning is Osgood Schlatter disease (OSD). This condition involves an inflammation of the patellar tendon as it inserts on the tibial tuberosity. It is well known to occur in late childhood and often characterised by pain over the bony prominence just below the knee cap (tibial tuberosity). As children are growing, there are growth centers made up of immature bone and cartilage that become mature and ossify into larger bones after skeletal maturity. However, in late childhood, the tibial tuberosity is subject to much stress as activity level increase, and the patellar tendon tugs away from the growth center of the tibial tuberosity leaving inflammation. Pain is usually felt after physical activity, sometimes pain is permanent and steady regardless of the time of the activity. The pain is sometimes followed by a visible inflammation around the patellar attachment of the tibial tuberosity (Figure 1). Activities such as running, climbing up stairs, jumping, bending at the knees can usually exacerbate the symptoms of OSD.

Figure 1 – OSD: Anatomcial signs showing palpable growth on tibial tuberosity (left), and Xray findings showing fragmented growth (right).


The first line of defense is resting from pain generating activities, the use of conservative management that targets reduction of pain and swelling, and the use of ice and protective padding. In practice, I tend to use manual muscle release techniques to help reduce the tension along the bony prominence and a combination of electrotherapy and rehabilitation to strengthen muscle groupings. It is important to examine the child’s lower limb biomechanics as poor biomechanical functioning can lead to added complications and poor recovery time.

In some cases, where either conservative management has failed, or the condition has progressed, an x-ray is needed to examine the affected area for bony fragmentation of the tibial tuberosity. And, sometimes an Ultrasound of the soft tissue swelling is important to rule out differential diagnoses. In more extreme cases, a second line of defense involves surgical removal of a bony fragment if pain persists after conservative management. But research tells us that there is no benefit with surgery versus conservative care.

It is also important to consider that there are many other reasons for anterior knee pain such as tumors, infections, muscle and tendon tears, other bony lesions etc.

Take home point: Don’t delay anterior knee pain on a child, get it checked out by a medical health professional.

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Dr. Nourus Yacoub, DC
Medical Director and Chiropractor
Royal Chiropractic and Sports Injury Clinic

Vaishya R, Azizi A, Agarwal A, et al. (September 13, 2016) Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Cureus 8(9): e780