OSD: Basketball, Knee Pain, and the Desire to “Fly!”

Sports and athletics in general, are some of the most common universal pastimes for young athletes. Each activity embodies its own unique identity and personality, establishing itself as a major part of the upbringing of young individuals around the world. In this article, I would like to share with you the experience of a young man, turned friend and colleague of mine, Joshua Price.  As a young 6th grader, Josh experienced the beginning of a decade-long knee pain issue while playing pick-up ball on a hard, concrete, basketball court. This story reflects the experience of many young athletes who like Josh, are limited by knee pain as they engage in running and jumping activities. Osgood Schlatter Disease is one of the more common sources of this particular form of knee pain.

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Everyone in the world wanted to be like Mike (Michael Jordan), or so it seemed!  Joshua however, was prepared to take it to the next level. The legend of the iconic superstar, hailed by many as being the greatest basketball player to ever play the game, could be summed up in his trademark nickname, “Air Jordan.” Flight was all that Joshua desired! During his 5th and 6th grade years, Josh was introduced to the game of basketball. At the time, he didn’t realize how much his new hobby would grow to become more than just that. Like most kids with “hoop dreams,” basketball and the desire to get better at it fast, would be an instant obsession.

Josh found himself engaging in jumping drills more than anything else to add “flight” to his game. It wasn’t long before his jumping was translated into the games he played. With every jump shot, layup and block attempt, Josh noticed that his hard work was knee_pain_runningpaying off. As a 7th grader, he could already jump high enough to easily dunk a volleyball. The repetitive engagement in jumping activities however, would not come without a price. As a left footed jumper, Josh recalls a dull ache just below his knee-cap (patella), that would come on after a ball game or a set of jumping drills. It was manageable initially, but as he continued to play, the ache became increasingly relentless. Although unsure at the time of the source of his unrelenting knee pain, Josh’s participation in the game he had come to love would eventually be limited whether he liked it or not. Initially, the knee pain did not present drastic limitations to Josh’s on-court activity, so he chose to fight through the pain and play. That would change during his first stint on the high school Varsity team during his sophomore year.

Josh was experiencing the effects of Tibial Apophysitis also known as, Osgood-Schlatter Disease (OSD).  OSD is an overuse syndrome affecting 20% of adolescent athletes A00411F01between the ages of 9 and 15 years old. Common sports associated with OSD are basketball, gymnastics, volleyball and soccer. This syndrome can last anywhere from a few months to years depending on the individual, and whether the adolescent affected takes the appropriate measures to reduce the symptoms of OSD. As Josh experienced, the earliest sign of OSD is a gradually increasing pain felt just below the knee cap. This pain is generated by high levels of repetitive jumping, running and squatting. These activities can put a strain on the tibial tuberosity which is attached to the patellar ligament. When the quadriceps muscles contract, they pull on the ligament, which in turn pulls on the tibial tuberosity, the primary location of pain with OSD.

The repeated strain on the tuberosity caused by continuous jumping and running can lead to issues with young athletes because the bone has not completely ossified (become solid bone). Some have said that OSD occurs through a number of micro stress fractures over a period of time, leading to the pain felt with these activities. Initially, nothing visible is noted in the area, but after some time, these micro fractures will heal in the form of an elevated bump on the tuberosity, and will continue to grow with more stress and strain.

In the 7th grade it was just a little bump on Josh’s left knee, so he didn’t give it much thought. It felt like a small, firm, fluid-filled pouch that was tender to the touch. Josh noticed that the number of explosive jumps and plays he was able to tolerate in basketball games began to diminish. At times he needed a few days off just so the pain lay-upwould subside and the “knot” wouldn’t be as tender. Ice was never placed on it before or after being active, because it was just “growing pains,” at least in the eyes of those closest to him. What was once just the left knee became both knees, each with a swollen, painful bump. As Josh transitioned into high school, the bumps continued to grow. As a sophomore starting on the Varsity basketball team while simultaneously running on the track team, the OSD led to a physical limitation in his jumping ability. He could only perform a handful of dunks before his knees were unable to handle it.  Bumping his knees into anything was excruciating. Even then, a professional was never seen. The sensitivity in both knees lasted until Josh was in his late 20s. It wasn’t until he was in his 30s that the bumps became hard, leading to a major reduction of pain.

As expressed through Josh’s experience there are a few clear signs of OSD that are important to acknowledge. To begin with, there will be a gradual buildup of pain, swelling or tenderness below the knee cap. That pain may reach the point when it becomes aggravated and worse with activities such as jumping and running. These symptoms commonly reduce or go away when the affected individual rests, depending on the severity of the syndrome.  Reducing the pain levels and preventing the progression of OSD can take place in the form of Physical Therapy as well as other conservative methods that can be done at home. Beneficial treatments include ice, pain medications, stretching the hamstrings and quadriceps muscles, and modifying the amount of activity until symptoms go down.

OSD does not affect every athlete. However, if you or someone you know experience a gradual build-up of pain around the tibial tuberosity, joined with high intensity jumping and running, remember to act earlier than later.  It took years for Josh to recognize that he could have limited the pain he experienced for years in his knees, had he taken care of his symptoms early on. His story is also one of hope. If you are a young athlete with OSD, that pain is usually temporary. Josh’s knee pain is nearly all gone now, as he enjoys life alongside his family. Knee pain is never enjoyable, but in understanding why it is there, as well as understanding the steps necessary to alleviate the symptoms, you will be able to gain control of your life once again.

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Thank You For Your Time!

My success and inspiration has come from the guidance of Greg Todd and the Smart Success Physical Therapy course! If you are a Physical Therapist or future Physical Therapist interested in leveling up, I would highly recommend being a part of the Smart Success Season 4! It has changed my life!
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Joses Ngugi, SPT      img_1301

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