Looking functionally at Osgood-Schlatters Disease

Recently, a few of my athletes have been coming to training with knee problems which has been neatly diagnosed by their doctors as Osgood-Schlatters Disease. Unfortunately, this effects many adolescent athletes BUT not all of them so it made me start to think, "What in the world is going on here?"  Basing my thought process in Applied Functional Science. , and with guidance from Dr. David Tiberio and Lenny Parracino of the Gray Institute, I wanted to write a short post on this monster known as Osgood-Schlatters that has and is taking out my athletes.

WHAT IS OSGOOD-SCHLATTERS DISEASE?

According to Wikipedia, it is:

Osgood–Schlatter disease or syndrome (also known as tibial tubercle apophyseal traction injury) is a rupture of the growth plate at the tibial tuberosity.[1]



Sinding–Larsen–Johansson syndrome is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia.


The condition occurs in active boys and girls aged 9–16[2] coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls.[citation needed]

The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be extremely painful when hit.


Now this is an interesting analysis of the disease but it never really gets to the WHY of the situation. As we look functionally at OSD, we look at the site of the injury but it would be shortsighted to not look below and above the knee to see if we cannot find out who is zooming who in this situation.

When we look at what elicits symptoms from a person suffering from OSD, we see that it generally mid-range to deep knee flexion. With our knowledge of functional muscle function, we know that the quadriceps decelerates knee flexion, and this makes sense that the tensile stress on the tibial tubercule would cause micro-avulsions in an immature structure if the force exceeded the threshold of the bone/cartilage. Now we also know that many muscles also cross the knee joint that would aid in the deceleration of knee flexion like the powerful gluteal muscles, hamstrings, as well as the gastroc-soleus complex also known as the calf muscles.

The body is not going to allow the knee to not be decelerated. If it did, we would simply fall over with every step we tried to take. When the body sense that the powerful hip and calf muscles are not doing their job, it will OVER-recruit the quadriceps which will do the job but at the expense of the causing microtrauma to the tendon and insertions of the muscle. When we get this OVERUSE, we get....OSGOOD-SCHLATTERS DISEASE.

WHAT CAN YOU DO FOR PREVENTION?

Fortunately, training, conditioning, rehabilitation and prevention of the cause of OSD, are all in the same boat.

If you suspect an athlete is suffering from it, you want to direct he or she to a doctor so that they can receive an accurate diagnosis as well as treatments.

According to Mayoclinic.com, Osgood-Schlatter disease usually gets better without formal treatment. Symptoms typically disappear after your child's bones stop growing. Until that happens, your doctor may recommend mild pain relievers and physical therapy.

However, we can start get a jump on Osgood-Schlatters by getting the powerful gluteals and calves working to help decelerate knee flexion so that the quadriceps do not have to work so hard.

Here's a quick program:

HIP FLEXION WITH SLIGHT KNEE FLEXION TO ACTIVATE GLUTES AND HAMSTRINGS

1. Standing one leg, if possible, slightly bend the knee to about 10-20 degrees or to the point that doesn't cause pain.
2. If there are balance issues use a chair in front of the athlete to help stabilize.
3. Using the nose a driver, start bending from hips with the spine in neutral as much as possible to either chest or hip height.
4. The athlete is concentrating on using the glutes to slow down the anterior pelvic rotation along with the hamstrings.
5) The feeling of a stretching of the glutes and hamstrings. Do this 5-7 times PROPERLY. A trained therapist or strength coach should be able to guide a young athlete in this if necessary.
6) This should be followed up by EASY lunges, to the same nose driver height and knee flexion.

I will post a video of this in a day or so.

If you have any questions or comments, please let me know at will@3doptimalperformance.com