Growth Related Injury Series: Osgood Schlatter Disease

Hosted by: Tara Christensen PT, MS, DPT

In this episode:

In this second episode of the growth related injury series, we discuss Osgood Schlatter Disease.  Discover causes, symptoms, what it is and how it can be treated.

References:

Corbi, Francisco et al., “Osgood-Schlatter Disease:  Appearance, Diagnosis and Treatment: A Narrative Review”.  Healthcare 2022, 10, 1011.  https://doi.org/10.3390/healthcare10061011

Antich, TJ MS, PT, Brewster, Clive E MS, PT.  “Osgood-Schlatter Disease: Review of Literature and Physical Therapy Management”.  The Journal of Orthopedic and Sports Physical Therapy.  Vol. 7, No1:5-10.

Submit your questions or topic suggestions! This podcast is for you, let us know what you want to hear more about:  doctordancemompodcast@gmail.com

Follow us on social media:

Instagram: @drdancemompodcast

YouTube: @Dr.DanceMomPodcast

TikTok: @doctordancemom

Join our Facebook group: https://www.facebook.com/share/g/1aPGZP9TAo/?mibextid=wwXIfr

If you’re looking for a dance medicine Physical Therapist in northern New Jersey, check out my practice!  Performers Edge Wellness is located in Sparta, NJ and serves artistic athletes such as dancers, cheerleaders and gymnasts as well as active individuals looking to eliminate pain and sustain an active lifestyle. 

Follow:  

Instagram: @performersedgewellness

Facebook: Performers Edge Wellness

TikTok: @performersedgewellness

Subscribe to our newsletter: https://mailchi.mp/performersedgewellness/socials-and-quick-sign-up

To explore other services we provide, check out our website at www.performersedgewellness.com

If you enjoyed this content, please leave us a review and tell your friends!

Transcript

SPEAKER_00 0:01

Welcome to the Dr. Dance Mom Podcast, your guide to strong dancers with a bright future. I'm your host, Dr. Tara Christensen, Doctor of Physical Therapy, Dance Medicine Specialist, and Proud Dance Mom. Let's dive into today's episode. The information presented in this podcast is for educational purposes only and does not constitute medical advice. Listening to this podcast does not create a healthcare provider patient relationship. Always seek the advice of a qualified healthcare professional regarding any medical conditions or treatment. Hi everyone, and welcome back to the Dr. Dance Mom podcast. This week we're going to talk a bit about Osgood Schlauter's disease. And uh last week I talked a little bit about Sever's disease. Um and in that podcast, I mentioned that Osgood Schlaughter was sort of a factor that can be associated with Sever's disease, not in the sense that it was causal in nature, like one would cause the other per per se, but that there seems to be an association where if you have one, you may be at increased risk for developing the other. And so as I continue with this series on growth-related injuries, this week I would like to talk to you about Oshgl Slaughter. When I think about this diagnosis, I'll never forget a patient I saw a couple of years ago. I was doing some preseason screenings, or they may have just been open injury screens at an open house. And a mom came to me with her son and asked if I could screen him. And he was having some knee pain. So I said sure. And when I examined him, he was so, so, so tender to the touch throughout his entire quad, IT band, um, patella, patellar tendon, everything around his knee was just screaming to the point where I could barely touch him. He was probably, I want to say about 12 at the time, and he was a very competitive soccer player. I think he may have been on multiple soccer teams, and he had been diagnosed with Odgridge slaughter by an orthopedic doctor, and his mom said that he they were told that it was just a growth-related issue and that he would eventually grow out of it. So in the meantime, he had been playing soccer, still struggling through his practices and games, and they were just kind of waiting it out. Now, I think it had been well over a year that this poor child had been struggling through all of his soccer practices and games with significant knee pain to the point where you know it almost made him not want to play sometimes. There were no other recommendations by the orthopedic doctor. They basically just said you'll grow out of it. Um, no recommendations for pain relief, um, no recommendation for physical therapy or for activity modification. Um, you know, a lot of the pain that I was seeing looked like it may have been due to muscle guarding, compensation patterns, pushing through pain. Um, and so there were a whole host of secondary problems, including, you know, significant loss of flexibility at this point. Um, and you know, like I said, this child was just in a ton of pain. So, long story short, I saw this patient for nine sessions. After session two, his pain was cut in almost half. After session five, it was barely noticeable. Um, still was having pain with some activities, but it would come and go. It wasn't constant anymore. And by session seven, he had no pain, and we were doing high-level pliometrics, jumping, cutting and landing drills without any symptom provocation on either side. This was bilateral, by the way, so he had it in both knees. Um, he was also playing during this entire time, so he didn't take any time off of his sport. Um, and he was able to end his season way, way better than he started. He was given an individualized program to follow, and uh, he hasn't needed to return since. So the moral of the story here is um sometimes orthopedic doctors don't recommend physical therapy for things like growth-related injuries. Um, and many parents are told that they'll grow out of it. But imagine if I'd found this athlete earlier. He may have had a ton more progress in his skills, um, and obviously would have saved him a lot of pain. So it's just kind of an anecdotal story to start out this episode because this is something that I think about um whenever I hear this diagnosis because I just remember such um it was such a significant difference in such a short period of time, and I just felt so deeply for this child that, you know, he had to endure that level of pain to begin with, but also for so long without having any sort of intervention. Um, and it's really too bad that um he wasn't referred to physical therapy. Um, so what is Osgood Schlatter disease? It is a common cause of knee pain in growing athletes. And if you listen to last week's episode on Sever's disease, it is very similar. It occurs when the patellar tendon pulls repeatedly on the growth plate at the top of the shin bone or the tibia where it attaches. Um, because this growth plate is still developing, still open, it makes it much more sensitive to stress, um, especially during rapid growth patterns. So growth plates are definitely more sensitive than typically any of the surrounding bone structures, ligaments, tendons, um, muscle tissue is typically stronger than the growth plate tissue. And so it does tend to get really, really irritated very quickly when there are repetitive forces on that growth plate. Since the growth plate is still developing and hasn't yet closed, it is much more sensitive to load, especially repetitive loads, poor shock absorption. So if your athlete doesn't have the best landing mechanics, that can definitely influence it. But um, it this often appears as a painful bump just below the kneecap. Um, so as I mentioned, this is the growth plate at the top of the tibia bone or the shin bone. Um, so it does appear below just below um the knee, so right where that patellar tendon inserts. It was first described by Osgood and Schlauter in 1903 and is one of the most common overuse lower extremity injuries reported among children and adolescents. It is generally more common in males than females. It is most common in ages 9 to 14, especially during gross spurts, so kind of the same age range as Sever's disease. Again, these are all growth-related injuries, so the time frame that these typically occur in is going to be very similar. Um, it occurs more frequently in athletes who do running, jumping, and quick direction changes, such as soccer, basketball, dance, cheerleading, gymnastics, volleyball, etc. It often shows up when training intensity increases. So maybe at the beginning of a new season where there's been some rest, um, if there's more practices added to a schedule during training camps and of course during growth spurts. There may or may not be trauma associated with the onset. So meaning like maybe they fall on their knee, um, that could initially start some of the inflammation or the inflammatory process, um, and then it can get kind of irritated from there. One study showed that a higher incidence was found in the athlete's supporting or stance leg due to traction forces on the patellar tendon that occur when the quadriceps is contracting eccentrically or to stabilize the limb. So muscles contract um a couple different ways. So concentrically is what you think of as like a bicep curl. So if you are lifting, let's say, a grocery bag and you're bending your elbow to kind of lift up that grocery bag, that would be a concentric contraction of your bicep. Now, if you have that same bag of groceries and you're going to lower it down to the floor using just your elbow motion, then your bicep is eccentrically contraction or lengthening as it's contracting to control the load. And then, of course, if you're just holding that bag and your elbows may be in a bent position and you're not moving, that's called an isometric contraction. And so um eccentric contraction is actually the most forceful type of muscle contraction. And so that's what it was just saying here is that um when the athlete is supporting themselves on their stance leg or landing from, let's say, like a jump or even loading when they're running. So each time their foot hits the ground, that quadriceps muscle is going to eccentrically contract as uh it helps to stabilize the limb underneath the athlete. Some of the other risk factors might include things like height, weight, BMI, loss or lack of flexibility in the legs, um, really tall arches in the supporting foot. Um, so that's something that can also be a factor on the supporting leg side if that's the side that's affected. Previous diagnosis of sever's disease, so we had talked about that before. Um, decreased ankle range of motion and flat arches. Parents might notice things like pain or tenderness below the kneecap, swelling or a visible bump on the shin bone, pain that is worse with running, jumping, kneeling, going up and down stairs, or with squatting. Athletes or dancers might say that their knee hurts during activity but improves with rest. Some athletes might develop tight quadriceps and hamstrings along with the pain. So this is a little bit of a tough one with dancers because they usually do have pretty long hamstrings because they're stretching them constantly. But a lot of dancers do have really tight quadriceps. Um proposed treatment. So much of the literature proposes things like ice application for pain, supportive footwear, activity restriction, immobilization, cortisone or lidocaine injections, use of a infrapotellar strap, and stretching. The problem is that none of these treatments address the cause of the condition, which is typically overuse or too much loading on the patellar tendon. It is also important to note that much of the research states that it will resolve in one to two years whether there is treatment intervention or not. But during that time, athletes can develop many other secondary issues due to pain avoidance, including development of faulty movement patterns that do need to be untrained later on. So I wouldn't recommend doing nothing. One study suggests restricting running and stairs for 12 weeks, which could be an athlete's entire season. So again, I don't really see this as a very practical solution. It's also worth noting that the enlargement of the tibial tubercles, so the place where the patellar tendon inserts on the tibia, that gets swollen and that little bump is created, that can be permanent. So letting this sort of just ride it out and not addressing it can kind of create more of like a permanent um bump there. And sometimes even with intervention, it can be permanent. But again, addressing it early on is the best way to avoid that from happening. The good news is that Osgoodge Slatter is not dangerous and can be treated with physical therapy. The condition usually resolves once growth plates close, but load management and proper rehab can help to eliminate symptoms. Managing symptoms early can prevent prolonged pain and misactivities, of course. What helps most is managing activity levels rather than pushing through the pain. Modification of activities for a short period of time can help reduce time out of the activity later. And this goes not just for Oshgood Slaughter. This is something that I tell my dancers all the time. A lot of them don't want to take time off of dance, and I get it, I totally understand, and also depends on the season. So in fall, if they're not competing yet, it's much easier to have a dancer maybe sit for a week or two to get ahead of their symptoms, so to speak. In the middle of competition season, that can be a lot more challenging or leading up to comp competition season, but sometimes it is really necessary to allow the body to properly heal itself so that we can kind of move forward and completely eliminate symptoms instead of just continuously triaging symptoms throughout the entire season, which is not very productive. Strengthening of the hips, the glutes, and core to reduce stress on the knee is super important for Otwood Slaughter. Improving flexibility in the quadriceps, the hamstrings, and the calves is also beneficial. And many times I have found significant tension in these areas for athletes. Gradual progression of their training load cannot be emphasized enough as well. So this isn't something where you can just like sit for two weeks and then just jump back in and dance full out. This is something where you might need someone to guide you through that gradual progression back into class. So this also helps to reduce the amount of time that the athlete is sitting. So I never like anyone to go just from like sitting to jump right into class, you know, and to be performing everything full out. Um, what I usually do is kind of a graded approach where if they do need to rest from class to allow for some healing, we'll do that. Um and then we'll kind of do some testing. Once they're tolerating some loading, we'll go back and maybe restrict certain things, like maybe no turning, no jumping, depending on what the injury is. Um, and then we'll work up to that in in the clinic. And once they can successfully um load in that manner in the clinic, then they can return to doing those things in class. I always like to be a step ahead in the clinic of what they're doing in class because I don't want them doing things in class for the first time that we've not really tested in a more controlled environment. Also remembering that if they're doing it in the clinic environment and it's painful, we're doing many less repetitions than they're going to be doing in a dance class typically. Um, and if you think about most dancers' schedules, the majority of them have multiple classes back to back to back, whereas a typical physical therapy session, I spend an hour with my patients. Um, it depends on what type of physical therapy clinic you're going to. If it's an in-network clinic, you may not be with your therapist that whole time. So I spend a lot of individualized time with my patients, kind of sorting out what's provocative and what's not provocative. Um, so we really do have the time to sort those things out. But in some cases, um, there's just, you know, not enough time with the therapist to really go through all of that. So I do really recommend trying to sort that out, make sure that you're doing more in the clinic than what you're doing in class, um, just so that we're not re um aggravating those symptoms. When should parents seek help? Um, so typically when a dancer's pain has is persistent despite rest. So if they say, hey, my knee is really bothering me today, um, I'm not gonna dance today, and um, it's still hurting, like two days later, then that's something that typically will need some sort of um intervention. Uh pain that changes an athlete's moving patterns or movement patterns. So if they are just not, if they're not jumping the way that they normally would, if they're changing their technique to avoid pain, that's a problem. If they're having trouble, obviously jumping, squatting, or running, or any pain that interferes with participation in sports or dance. So if they're telling you that they can't dance or they need to sit out, usually that's a good sign that they need to see somebody. Physical therapists can help by identifying movement patterns that contribute to the stress on that growth plate. Create a strength and mobility program specifically for that individual dancer or athlete. Everyone's body is different, so I do think this is super, super important. I wouldn't just go online and Google, you know, exercises for Ajkutshlada or something like that. Um, all of the information on the internet is not credible information, so you do have to consider the source, but also consider that your individual child has their own individual needs based on their own body, their how their body's put together, the amount of mobility that they have in their joints, etc. There's so many different considerations that go into putting a program together. It really needs to be individualized, especially if they're having pain. Um, and then a physical therapist can also help athletes stay active safely while symptoms calm down. So even if it's something where they do need to totally rest something for a while, um, PT can be started early and to work on some other things maybe around that. So, okay, so maybe we can't do anything around the knee joint itself initially because it's super, super fired up. So let's work on hip strengthening or core strengthening in the meantime. All of that is gonna help to get the dancer back sooner and help to support healthy recovery and integration back into class. I hope this information is helpful to some of you who may not know too much about some of these growth-related injuries. Um, feel free to ask questions in the comments. Send me an email, find me on Instagram or TikTok, and let me know if there's other topics or diagnoses that you would like to see covered in the future, because I'm happy to explore those for you. Thanks for listening. I hope you enjoyed today's episode and learned something. Please be sure to follow or subscribe so you don't miss a thing. Also make sure you head over to Instagram and YouTube and follow us there. Send us your listener questions, topic suggestions, and feedback at Dr DanceMontpodcast at gmail.com. That's Dr. Fully Written Out at DanceMont Podcast also fully written out at gmail.com. Thanks so much for listening to