Background Osgood Schlatter disease (OSD) is a commonly seen musculoskeletal pain condition in active adolescents. OSD is an overuse injury, where the underlying mechanism is considered to be nociceptive, but other mechanisms have not yet been considered. Therefore, this study investigates pain sensitivity and inhibition through the paradigm of exercise-induced hypoalgesia (EIH) in adolescents with OSD compared to controls.

Methods All adolescents went through a baseline assessment including clinical history, demographics and sport participation. Pain severity was rated (0–10) during a 45-second anterior knee pain provocation (AKPP) test. Pressure pain thresholds (PPTs) were assessed bilaterally at the quadriceps, tibialis anterior muscle, and the patella tendon before and after the EIH paradigm (a three-minute isometric wall squat exercise).

Results Forty-nine adolescents (27 OSD, 22 controls) were included. No differences in the EIH effect between OSD and controls were observed. EIH was detected in both groups, but only at the tendon with a 48 kPa (95%CI 14–82) increase in PPTs from before to after exercise. Controls had higher PPTs at the patellar tendon (mean difference 184kPa 95%CI 55–313), tibialis anterior (mean difference 139kPa 95%CI 24–254), and rectus femoris (mean difference 149 kPa 95%CI 33–265). Higher AKPP pain severity was associated with lower EIH at the tendon (Pearson correlation = 0.48; p =0.011) in participants with OSD.

Conclusion Adolescents with OSD display increased pain sensitivity locally, proximally, and distally but similar endogenous pain modulation compared to healthy controls. Greater severity appears to be associated with less efficient pain inhibition during the EIH paradigm.