Osgood Schlatter Protocol

Osgood Schlatter Disease Rehabilitation Protocol

Disclaimer: This protocol is a guideline and should be adjusted based on individual patient presentation, pain levels, and response to treatment. A qualified physical therapist must supervise the rehabilitation process. This protocol is not a substitute for clinical judgment.

I. Clinical Presentation

Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle, commonly affecting adolescents during periods of rapid growth. Symptoms typically include:

Pain and tenderness over the tibial tubercle.
Prominent tibial tubercle.
Pain exacerbated by activities involving quadriceps contraction (running, jumping, kneeling, squatting).
Pain relieved with rest.
Possible swelling and inflammation around the tibial tubercle.
Limited knee range of motion (ROM) due to pain.

II. Rehabilitation Phases

The rehabilitation program progresses through phases based on pain levels and functional abilities. Pain should be the primary guide for progression.

Phase 1: Acute Phase (Pain Management & Inflammation Reduction)

Goals: Decrease pain, inflammation, and protect the healing tissues.

Activity Modification: Limit or avoid activities that aggravate symptoms. This may involve reduced training volume or a temporary cessation of sport participation.
RICE Protocol: Rest, Ice (15-20 minutes every 2-3 hours), Compression, Elevation.
Pain Management: Over-the-counter pain relievers (NSAIDs) as prescribed by a physician.
Gentle Range of Motion (ROM): Focus on pain-free ROM.
Exercises:
- Ankle Pumps: 3 sets of 15-20 repetitions.
- Quad Sets: Isometric quadriceps contractions, hold for 5 seconds, 3 sets of 10-15 repetitions.
- Hamstring Sets: Isometric hamstring contractions, hold for 5 seconds, 3 sets of 10-15 repetitions.
- Patellar Mobilization: Gentle mobilization of the patella in all directions.

Progression Criteria: Minimal pain at rest, decreased swelling, and ability to perform pain-free isometric quadriceps contractions.

Phase 2: Subacute Phase (Strengthening & Flexibility)

Goals: Improve quadriceps strength, hamstring flexibility, and overall lower extremity strength and endurance.

Continue Activity Modification: Gradually reintroduce activities as tolerated, monitoring for pain.
Flexibility Exercises:
- Hamstring Stretch: Hold for 30 seconds, 3 repetitions.
- Quadriceps Stretch: Hold for 30 seconds, 3 repetitions.
- Gastrocnemius/Soleus Stretch: Hold for 30 seconds, 3 repetitions.
Strengthening Exercises:
- Straight Leg Raises (SLR): 3 sets of 10-15 repetitions. Progress to adding ankle weights.
- Mini Squats: (0-45 degrees) 3 sets of 10-15 repetitions. Focus on proper form and pain-free range.
- Hamstring Curls (Theraband or Machine): 3 sets of 10-15 repetitions.
- Calf Raises: 3 sets of 15-20 repetitions.
- Glute Bridges: 3 sets of 15-20 repetitions.

Progression Criteria: Ability to perform strengthening exercises with minimal pain, improved hamstring flexibility, and good quadriceps control.

Phase 3: Return to Activity Phase (Functional Training)

Goals: Restore full functional capacity and prepare for return to sport or activity.

Sport-Specific Training: Gradually reintroduce sport-specific activities, starting with low-impact drills.
Agility Drills:
- Cone Drills: Lateral shuffling, figure-eight running.
- Ladder Drills: Various footwork patterns.
- Shuttle Runs: Gradually increase distance and speed.
Plyometrics: (Initiate with caution and proper technique)
- Double Leg Hops: Forward and lateral.
- Single Leg Hops: Forward and lateral (only when pain-free with double leg hops).
- Box Jumps: Start with low box height.
Eccentric Strengthening: Emphasize eccentric control during exercises like squats and hamstring curls.

Progression Criteria: Pain-free performance of all sport-specific activities, full ROM, and adequate strength and endurance.

III. Return to Function Criteria (Evidence-Based)

The following criteria must be met before returning to full activity:

Pain Level: Pain-free with all activities, including sport-specific drills. A visual analog scale (VAS) score of 0/10 during and after activity.
Range of Motion: Full and pain-free knee ROM, comparable to the uninjured limb.
Strength: Quadriceps and hamstring strength at least 80% of the uninjured limb, assessed via dynamometry or functional hop testing.
Functional Testing: Successful completion of functional tests, including:
- Single Leg Hop Test: Distance within 90% of the uninjured limb.
- Triple Hop Test: Distance within 90% of the uninjured limb.
- Crossover Hop Test: Distance within 90% of the uninjured limb.
No Palpable Tenderness: Minimal to no tenderness upon palpation of the tibial tubercle.
Physician Clearance: Final clearance from the treating physician or orthopedist.

Note: It is crucial to gradually increase activity levels and closely monitor for any recurrence of symptoms. A brace may be used for added support during the initial return to activity.