Introduction

Osgood-Schlatter disease, commonly seen in adolescent athletes who complain of “pain below the kneecap,” is frequently observed in middle school students involved in sports. Parents often wonder, “Why does that child develop it while mine doesn’t?”

As a physical therapist working with many growing children, I have realized that Osgood-Schlatter disease is not simply “overuse” or “growing pain” but rather one manifestation of systemic dysfunction throughout the body.

From an osteopathic perspective, based on the fundamental principle that “the body is a unit,” knee symptoms can also be understood as a disruption of whole-body harmony.

Today, I will organize the background of Osgood-Schlatter disease onset based on medical papers published in PubMed and discuss the approaches to enhance natural healing capacity that osteopathy can provide.

1. Growth Speed Gap Between Bones and Muscles

Structural Disharmony During Growth Spurt Period

During the growth period, particularly during the “growth spurt period” when height increases rapidly, bone growth precedes muscle and tendon flexibility, creating an imbalance.

From my anatomical knowledge as a physical therapist, I understand the mechanism by which this imbalance places strong traction stress on the “tibial tuberosity” below the knee, causing inflammation and pain.

Literature Evidence:

“Rapid bone development in growing children causes excessive tension in the lower extremities’ muscles and tendons, leading to reduced flexibility.”

– PMC8920839

Osteopathic Understanding: Relationship with Primary Respiratory Mechanism

In osteopathy, we consider that changes in craniosacral rhythm during the growth period influence growth patterns throughout the body.

Relationship with Growth Hormone Secretion

• Functional changes in the hypothalamic-pituitary axis
• Secretion rhythm of growth hormone releasing hormone (GHRH)
• Relationship between sleep patterns and growth hormone

Effects on Apophyseal Cartilage Furthermore, when the apophyseal nucleus (bone growth center) is immature, repeated stress easily causes micro-avulsion and apophysitis.

“The prevailing theory is that there is repeated traction over the tubercle leading to microvascular tears, fractures, and inflammation.”

– PMID: 31334993

2. Ankle Stiffness and Kinetic Chain Disruption

Effects of Ankle Range of Motion Limitation

“Ankle stiffness” refers to difficulty with dorsiflexion (moving the toes upward). This results in insufficient shock absorption during squatting or jumping, causing compensatory stress to concentrate on the knee joint.

From my kinesiological knowledge as a physical therapist, I understand that this kinetic chain disruption repeatedly applies strong loads specifically to the tibial tuberosity below the knee, increasing the risk of Osgood-Schlatter disease onset.

Literature Evidence:

“Limited ankle dorsiflexion alters tibial kinematics, increasing external rotation and modifying patellar tendon force vectors.”

– PMID: 35287516

Fascial Continuity Perspective

In osteopathy, we understand the effects of ankle restriction on the knee joint through fascial continuity:

Superficial Back Line Effects

• Plantar fascia → Achilles tendon → Gastrocnemius → Popliteal → Hamstrings
• Restriction in this fascial line creates posterior knee tension, leading to compensatory increased load on the anterior (quadriceps)

Deep Front Line Relationship

• Posterior tibialis → Popliteus → Femoral adductor group
• Medial longitudinal arch collapse creates medial knee instability, forming lateral compensatory patterns

Tibial Rotation Patterns Ankle range of motion limitation makes the tibia prone to external rotation, affecting the quadriceps tension axis and amplifying traction stress on the tibial tuberosity attachment site.

3. Individual Differences in Endocrine and Autonomic Nervous Systems

Why Do Individual Differences Occur?

Even with the same growth period and training content, some children develop Osgood-Schlatter disease while others don’t, due to complex factors including endocrine systems, autonomic nervous systems, nutritional status, and genetic elements.

Growth Hormone System Individual Differences

• Individual differences in growth hormone (GH) and IGF-1 secretion amounts and timing
• Genetic polymorphisms in GH receptors and IGF-1 (such as GHR exon3 deletion)
• Effects of sex hormones (estrogen and testosterone)

Literature Evidence:

“Differences in IGF-1 peaks and hormonal profiles during adolescence may explain individual variation in muscle stiffness and susceptibility to Osgood-Schlatter disease.”

– Endocrine Abstracts (2019) 63 P413

Osteopathic Perspective: Understanding as Whole-Body Harmony

Autonomic Nervous System Effects Strong psychosocial stress leads to sympathetic dominance, potentially increasing muscle stiffness and pain sensitivity.

In osteopathy, we consider that the balance between the sympathetic chain and parasympathetic nervous system directly affects musculoskeletal tension patterns.

Nutritional and Metabolic Effects

• Regulatory effects of nutritional status and body fat percentage
• Relationship between intestinal environment and inflammatory cytokines
• Metabolism of vitamin D, calcium, and magnesium

What Our Clinic Can Offer

1. Structural Adjustment

Pelvic and Sacroiliac Joint Adjustment Pelvic misalignment during growth affects the kinetic chain of the entire lower extremity:

• Sacroiliac joint mobility improvement
• Pelvic tilt angle adjustment
• Normalization of innominate rotation patterns

Spinal Adjustment

• Optimization of lumbar lordosis
• Thoracolumbar junction function improvement
• Recovery of sacral nutation and counternutation

Ankle and Foot Adjustment

• Talocrural joint mobility improvement
• Inter-tarsal joint adjustment
• Plantar arch function recovery

Through these approaches, we aim to achieve kinetic chain normalization and knee joint load reduction.

2. Release of Adhesions

Myofascial Release

• Superficial Back Line adhesion release
• Deep Front Line tension relief
• Lateral Line balance adjustment

Soft Tissue Adjustment

• Quadriceps flexibility improvement
• Gastrocnemius and soleus tension release
• Infrapatellar fat pad mobility recovery

3. Self-Care Instruction

Graduated Exercise Program

Phase 1: Pain Management Phase

• Activity level adjustment guidance
• Range of motion maintenance within pain-free range

Phase 2: Functional Recovery Phase

• Ankle dorsiflexion range of motion improvement exercises
• Graduated quadriceps stretching
• Core stability improvement exercise instruction

Phase 3: Functional Integration Phase

• Graduated return to sport-specific movements
• Jump and landing movement re-education
• Preventive exercise continuation guidance

Lifestyle Guidance

Sleep Quality Improvement

• Sleep environment setup to promote growth hormone secretion
• Circadian rhythm adjustment
• Digital device usage restrictions

Nutritional Guidance

• Intake guidance for nutrients necessary during growth
• Recommendation of anti-inflammatory foods
• Importance of proper hydration

Stress Management

• Breathing techniques to balance autonomic nerves
• Relaxation technique instruction
• Academic and sports balance adjustment

Evidence-Based Comprehensive Approach

Evidence-Based Practice

Our clinic’s approach integrates basic medical knowledge as a physical therapist, research perspective gained as a Master of Health Sciences, and osteopathic philosophy.

Clinical Application of Latest Research

• Knowledge about endocrine dynamics during growth
• Understanding of kinetic chains and fascial systems
• Neuroscientific elucidation of pain mechanisms

Individualized Assessment

• Detailed evaluation of growth stages
• Movement analysis considering competitive characteristics

In Conclusion

Osgood-Schlatter disease onset involves not only “bone and muscle imbalance during growth” but also multi-layered factors including ankle function, endocrine systems, autonomic nervous systems, nutritional status, and psychosocial factors.

In osteopathy, we understand these symptoms not as localized problems but as disruptions of whole-body harmony.

“The healing power lies within you”

Based on this belief, we help maximize the natural healing capacity and growth potential that growing children inherently possess.

Our clinic integrates specialized knowledge as physical therapists with osteopathy’s holistic approach, providing individualized treatment programs according to each child’s growth stage and characteristics.

If you are troubled by your child’s knee pain during growth or have concerns about sports activities, please feel free to consult with us.

Through evidence-based evaluation and comprehensive support with your child’s future in mind, we will help ensure healthy growth.

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Sota Omura,
Qualifications: Licensed Physical Therapist / Master of Health Science

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