Osgood-Schlatter Disease

Osgood-Schlatter disease is an overuse injury, medically known as a traction apophysitis.

It is a disease seen commonly in adolescent boys and is more common in athletes as compared to non-athletes.

The increased activity combined with rapid growth during the adolescent period predisposes athletes to develop this condition.  High intensity sport activity causes repetitive tensile stress over the tendon-tibial tuberosity and results in minor avulsions with an underlying inflammatory reaction.

Clinical presentation

Most commonly seen between 11-year and 13-year-old girls and between 12-year to 15-year old boys.

They generally present with pain over the tibial tubercle just below the knee. The pain is bilateral in only 20%-30% of patients. The pain is usually aggravated by sports involving jumping, squatting, kneeling and is relieved by a period of rest.


Treatment is conservative.

  • Activity modification
  • Rest, Ice
  • Short course of NSAIDs are usually used to reduce pain and inflammation
  • Massage
  • Stretching

Self limiting and will resolve when full skeletal maturity has been achieved.

Overuse injuries of the knee in young athletes

Knee pain is a common concern for which young athletes present to general practitioners, sports physicians and orthopedic surgeons.

Acute macro trauma to the knee, especially in contact or collision occurs less frequently and management is often in consultation with an orthopedic surgeon.

Overuse injuries affecting the knee account for the vast majority of adolescent related knee pain.

Causes of overuse injuries in the young athlete

The underlying pathophysiology of these injuries are related to repetitive and excessive strain on the musculoskeletal structures. This is often associated with a sudden increase in the intensity, duration and volume of physical activity, poor sport specific conditioning, insufficient sport-specific training, poor training techniques and inappropriate equipment for the sport.

Knee pain can either originate intrinsically from within the knee (see below) or referred from hip conditions and spine conditions.

Common causes of knee pain

  • Idiopathic anterior knee pain
  • Osgood Schlatter’s disease
  • Sinding-Larsen Johansson syndrome
  • Bipartite or multi-partite patella
  • Plica Syndrome
  • Iliotibial band (ITB) friction syndrome
  • Quadricep tendonitis
  • Popliteus tendonitis

Infections in athletes

Dr Janesh P Ganda

Infection in athletes


Endurance training can predispose an athlete to several infections because of numerous factors:

  • Increased training loads
  • Stress – physical & mental
  • Travel
  • Dry air in the plane
  • Other passengers
  • Poor sleep
  • Increased contact with sick individuals
  • Work environment
  • Race expo
  • Training partners

The immune system is essentially comprised of 2 inter-dependant systems

1. the non-specific Innate immune system,
2. the more specific Acquired immune system.

  1. Innate “Non-specific” immune system
  • Essentially the body’s first line of defense which includes the skin and mucus membranes
  • Exercise affects this system and can lead to higher risk of infection: such dysfunction occurs at a structural level, as well as at a cellular level. Acute bouts of exercise have been shown to lead to increased immune-cellular modulators. However, chronic intense training leads to a decrease = higher risk of infection
  • The effects of this include the increased risk of various infections because of possible immune-suppression

2. Acquired “Specific” immune system

  • The body’s Acquired immune system forms a memory and attacks infectious agents which were previously recognized by the body’s immune system
  • Cellular component and antibody component – antibodies recognize antigens which then kickstarts the inflammatory process to attack the offending agent
  • Changes in the antibody status and the cellular component of this system also result in a diminished immune system

Does exercise always result in an increased risk of infection?

The simple answer is NO, in fact it has been shown that regular, moderate exercise actually decreases the risk of infection. However, the risk of infection has been shown to increase in athletes who engage in regular bouts of high intensity exercise, or in athletes who undergo high training loads. This is demonstrated by the J-curve below.

TIPS to reduce the risk of infections, focusing on Upper Respiratory Tract Infections (URTI’s)

  • Space high intensity sessions and race events far enough apart to allow for adequate recovery
  • Ensure adequate quality sleep
  • Maintain a well-balanced diet
  • Vitamin C (500mg/day) during periods of heavy training
  • Avoid over training and chronic fatigue
  • Thorough hand washing
  • Remain well-hydrated

To exercise or not to exercise, that’s the question

It’s very common for athletes to visit a Sports Medicine Practice before major events and during single/multi-stage endurance events (OMTOM, Comrades Marathon, Ironman, Cape Epic, Wines2Whales etc.) or in a team (rugby, soccer, hockey etc.) to ask for advice on whether an illness should stop them from training. Training with an illness can have severe side effects – the development of a condition called a viral myocarditis can occur. This condition could lead to severe cardiac damage, and even death.

WHEN NOT TO EXERCISE – if you have any of the following symptoms:

  • Fever
  • Muscle Pains
  • Chest pains
  • Tachycardia (elevated resting heart rate)
  • Excessive fatigue
  • Excessive shortness of breath
  • Swollen painful lymph nodes.

Disclaimer – Information supplied in articles is generalised and does not constitute individualised medical advice. Patients are always advised to seek proper medical advice from a qualified medical professional.