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Osgood-Schlatter Disease (OSD) is a common overuse injury in adolescent athletes, causing pain at the tibial tuberosity — where the patellar tendon attaches below the knee. While conservative treatments (rest, exercises, hands-on physiotherapy) remain first-line, Extracorporeal Shockwave Therapy (ESWT) is emerging as a promising non-surgical option for persistent or recalcitrant cases.
In this article, we explore how shockwave therapy can help treat OSD, review the evidence base, discuss mechanisms, and explain how it fits into the broader therapeutic protocols used at Mr Salus Sporting Lab.
Osgood-Schlatter Disease is an apophysitis (inflammation of the growth plate) at the tibial tubercle in adolescents.
It typically affects growing athletes (ages ~10–15), especially those participating in running, jumping, or sports with high quadriceps demand.
Symptoms include:
Pain just below the kneecap.
Swelling or tenderness over the tibial tuberosity.
Pain during activities (e.g., jumping, climbing stairs).
Conservative management — rest, activity modification, stretching — works for many.
But for some, pain persists, limiting sports participation.
Extracorporeal Shockwave Therapy (ESWT) uses acoustic (sound) waves to stimulate healing in bone and soft tissue.
The International Society for Medical Shockwave Treatment (ISMST) recognises Osgood-Schlatter as one of the bone pathologies where ESWT is empirically tested.
Shockwaves can produce the following physiological effects:
Induce controlled “microtrauma,” stimulating tissue repair.
Promote neovascularisation (increased blood flow).
Modulate inflammation and reduce pain.
At our sports injury clinic in London, radial shockwave therapy (RSWT) is one of the advanced physiotherapy modalities we use in our injury rehabilitation protocols.
As mentioned in our own blog on how to cure long-term injuries, shockwave therapy helps break down micro-calcifications and support tissue remodelling rather than only masking symptoms.
Lohrer et al. (2012) – In a pilot study of 14 adolescents (16 knees) with recalcitrant OSD, treated with radial ESWT, the long-term follow-up (median 5.6 years) found a median VISA-P-G score of 100/100, meaning most patients recovered fully. No significant side effects or long-term complications were reported. PubMed+2RUG Research+2
Focused ESWT in Youth Apophyseal Injuries (2023) – A case series involving 22 young athletes (15 with OSD) used low-energy, focused ESWT (0.1 mJ/mm²). Recovery occurred in as little as 1–3 sessions, with most returning to full activity by 2–4 weeks. No adverse events reported. PubMed
Shockwave therapy will benefit the rehabilitation from OSD with the following mechanism of action:
Microtrauma & Regeneration: Shockwave delivers controlled micro-injury, which triggers the body’s repair response, including stimulation of bone matrix and growth factors. PubMed+1
Neovascularisation: The therapy promotes blood vessel growth, improving nutrient delivery to the affected apophysis.
Inflammation Modulation: ESWT can downregulate chronic inflammation and reduce pain without relying solely on anti-inflammatory drugs.
Desensitisation of Nerves: Peripheral nerve endings may become desensitized, contributing to pain relief.
Tissue Remodelling: Over multiple sessions, shockwaves help remodel the tendon–bone interface and improve structural integrity.
Shockwave therapy is especially worth considering when:
Conservative treatment has failed — For example, after at least 6 months of rest, physiotherapy, rehab exercises, and activity modification, pain persists.
Recalcitrant or chronic OSD — Patients with persistent symptoms resisting other therapies.
No surgical indication — For skeletally immature patients (i.e., growth plates still open), surgery is not preferred; shockwave offers a less invasive option.
Part of a multimodal rehab plan — ESWT works best when combined with hands-on physio, muscle relaxation, and soft tissue therapy.
Safety: Studies to date (e.g., Lohrer et al.) report no major side effects in adolescents. PubMed+1
Energy Levels: Low to medium energy typically used for OSD; focused or radial depending on clinic protocols. PubMed
Number of Sessions: Often 1–3 sessions for focused ESWT; radial protocols may use more. PubMed+1
Follow-up: Clinical follow-up and functional assessments (e.g., VISA-P) are vital to monitor recovery.
Combined Approach: Shockwave should not replace strength, mobility, and load management strategies.
At Mr Salus Sporting Lab, our approach to Osgood-Schlatter Disease is holistic:
We integrate radial shockwave therapy into our injury rehabilitation protocols alongside hands-on physiotherapy (e.g. sports massage, diacutaneous fibrolysis) and exercise-based rehab if needed.
We also consider High Power Laser Therapy as a complementary or alternative modality, particularly if patients are sensitive or need additional anti-inflammatory support.
For patients with soft-tissue bony changes (e.g. micro-calcifications), our clinic’s calcification and adhesion treatment protocols leverage shockwave to break down calcium deposits and promote healthy tissue remodelling.
Mr Salus Sporting Lab is the unique clinic in London to offer High Power Laser Therapy to treat Osgood-Schlatter Disease, together with Shockwave Therapy.
This dual physiotherapy modality is used to treat OSD, particularly if patients are sensitive or need additional anti-inflammatory support.
At Mr Salus Sporting Lab, we also consider High-Power Laser Therapy for OSD as an alternative to Shockwave Therapy when the young patient is particularly sensitive to tolerate it.
High-Power Laser Therapy has a very strong anti-inflammatory and analgesic action, which is able to reduce the knee pain from OSD in just one 30-minute session.
Not every patient is a candidate – skeletal maturity, co-morbidities, or other knee pathologies may influence treatment decisions.
Shockwave is not a “quick fix”: meaningful improvement often requires compliance with rehab exercises and load management.
There is still limited high-level (e.g., RCT) evidence for ESWT in pediatric OSD; much of the literature is case series or pilot studies.
Shockwave therapy (ESWT) offers a safe, effective, and non-surgical treatment option for adolescents with persistent Osgood-Schlatter Disease, particularly when conservative methods have failed. Current research, including pilot studies and recent case series, supports its use — showing pain reduction, functional recovery, and no significant long-term adverse effects.
At Mr Salus Sporting Lab, we view ESWT as part of a multimodal rehabilitation protocol, combining advanced physiotherapy technologies, manual therapy, and tailored exercise. If you or your teenage athlete is struggling with OSD, we encourage you to book a consultation to explore whether shockwave therapy could be part of your recovery plan.
Lohrer H, Nauck T, Scholl J, Zwerver J, Malliaropoulos N. Extracorporeal Shock Wave Therapy for Patients Suffering from Recalcitrant Osgood-Schlatter Disease. Sportverletzung-Sportschaden. (pilot study) RUG Research+1
Focused ESWT in youth apophyseal injuries (2023) – low energy, safety, return to sport. PubMed
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