Today I'm going to lift the lid how to cure Osgood-Schlatter disease in a matter of days.
We have been quickly and quietly fixing this serious and painful problem for over a decade. Time and time again we have defied conventional wisdom, and rapidly put young athletes back on the court or field pain free while they are still in the middle of a growth spurt. It is one of the simplest and best things we do at Core Advantage.
We think this is a really big deal, but until recently we didn't realise HOW big a deal. More and more promising young athlete's dreams are being shattered because the standard treatment is just not working. By writing this article I hope we can help more than just the athletes who have the time, money and proximity to come and see us.
The catalyst for this was basketball athlete Sarah and her sore knees. Sarah was referred to us eight weeks ago having carried serious Osgood-Schlatter pain for 18 months.
Two weeks later she was almost pain free.
This week she was a 0 out of 10 for pain, and moving around the court like the true athlete she is.
Sarah is a 12 year old kid of normal height hobbled by severe pain in her knees. Despite having excellent genetics and a strong athletic frame she did not move well. In fact when I saw her on court, I thought she looked more like an over-60s player than an under-14s!
Throughout her prolonged injury, Sarah had been under the caring and focused treatment of a diligent and excellent health practitioner. They were kind enough to send me a 2-page letter detailing all the adjustments, mobilisations, activations and rehab activities prescribed to Sarah in an effort to alleviate her pain, all to no avail. After training her and getting immediate improvement in Sarah's pain levels, I went back to the letter and was struck by the fact that despite being a textbook application of all the traditional modalities for treating Osgood-Schlatter disease, Sarah's treatment list didn't include ANY of our top treatments. Not one.
To me her previous program was all icing and no cake. Lots of fiddling around in the margins but nothing striking at the heart of the problem.
What is Osgood-Schlatter disease?
To understand our solution to Osgood-Schlatter Disease (OSD) you first need to understand the problem. Put simply, OSD occurs when the thigh bone (femur) grows too fast for the longest quad muscle (rectus femoris) to keep up. This means every step the athlete takes the muscle is pulling at its attachment site (the tibial tuberosity).
Below is an isolated picture of the femur and the rec fem as well as a closer view of the knee. The shiny thing in the middle is the prepatellar bursa which sits in front of the kneecap itself (the patellar). As you can see the tendon goes from the quad above and then down to its attachment site at the top of the shin bone (tibia).
Looking at this it is pretty easy to understand that a tight quad that can't keep up with a rapidly growing femur is going to cause drama at the tibial tuberosity. It's as though the bones are literally tearing the tendon off its attachment site at the top of the shin.
As if that isn't bad enough, this is also compounded by the fact that the attachment sights are not fully bonded, as they need to stay like semi-set glue to allow for further growth and skeletal maturation. Add in tall kids with no glutes, terrible running styles and a 48-week season on a hard surface and it's easy to see plenty of Osgood drama in basketball.
So that's it: Bones growing too fast for tight muscles to keep up resulting in soft attachment points getting angry.
How can we fix it?
First, create some length in the quad.
The first and most important thing to do is to create some length in the quad to accommodate the rapid bone growth and take some pressure off the attachment site. That's the obvious bit.
But the problem is that in stretching the quad you are actually pulling on the sore bit. Not cool. Especially if you are sore and flared up. This vicious cycle is what trips up most people.
This is where rolling for self myofascial release comes in handy. The beauty of rolling for Osgood is that it allows us to create some length at the quad and help it catch up to the femur without pulling at the sore bit. Although all the rolling is important, kids with Osgood's need to pay particular attention to rolling out the quads properly as Sarah is doing below.
Assuming the rolling has done its job and the knee is less angry, you should be able to start some gentle stretching at around days 7 to 14 of rolling. The stretch below is my favourite quad stretch, as it locks down the rec fem from both ends so it has nowhere to hide. It is a pretty strong stretch so:
- Be gentle and start slow
- Make sure to engage your core and maintain a neutral spine and a "tucked under pelvis"
- Always do it on something super soft
As you can see from the pic, Sarah's quad flexibility is still a work in progress. The cool thing is you only need to create a millimetre or two of length to dramatically reduce the traction on the tuberosity and get the knee out of the angry phase. This stretch is vastly superior to the standing quad stretch which is never done properly and the sitting hurdle one which I just flat out hate! So do it, but gently. Read all about why stretching is amazing for durability and performance.
Second, create some strength in the quad.
I like to think of athletic qualities like vitamins. Some we have too much of, some we have too little and some are up for debate.
In these terms strength deficiencies rank a very close second to flexibility problems but often remain hidden as it is sometimes hard to see weakness, especially in strong-looking bodies. Part of this weakness often stems from muscles becoming reflexively inhibited in the presence of pain. Although these kinds of reflexes are handy at preventing us from lifting loads so heavy we snap our tendons off, they are very problematic for athletes and knee injuries, as they generally mean that the muscle that should be soaking up the kinetic energy of movements are switched off, leaving the tendons and attachment sites to take the brunt of the force. For our purposes, these are bad reflexes. The great news is we can activate these muscles almost instantly and start to get the quads to do their job from day one.
The wonder of Iso's
Isometric holds (or 'Iso holds') just short of terminal knee extension (we call it the shake point) are a cure-all for tendons and tendon-related problems. I have seen them take someone from 7/10 soreness to 0/10 in less than 5 minutes. At Core Advantage we have found that near to end-range work is so beneficial that we just start and finish with the leg out almost straight as pictured below. (We get our range work from squats.)
Iso holds at close to end-range extension do a couple of things. First they wake up the quads. Sarah pictured here easily doing her holds was so weak when she started she couldn't even do it on the lightest weight for 5 seconds. I've trained nannas who were considerably stronger!
The other thing iso-holds do, is take advantage of an amazing phenomenon called mechano-transduction which, in this instance, is the the process in which sustained non-impact loads actually change the physical properties of the tendon and help it to heal and become stronger.
For Iso holds the recipe is pretty simple:
- Place a light external load on the ankle with the knee extended (you could try a can of baked beans in a plastic bag while on a seat if you can't get to a gym)
- Externally rotate the leg a tiny bit so that the inside of the quad is pointing up a bit
- Make sure the leg is just short of locked out and quads squeezed
- Hold for 4 sets of 20 seconds on with 20 off, 3 times per week
Follow the steps carefully to be pain free
It really can be this simple to cure Osgood-Schlatters:
- Start rolling on a foam roller, paying particular attention to the quad
- After 7-14 days commence gently stretching the quad using the method above
- When you have achieved some length in the quad you can now 'wake it up' with some isometric holds 3 times per week
Warnings and Advice
- Carefully read ALL the stuff above TWICE.
- ONLY AFTER you have consulted with your Physio, Osteo, Chiro or Doctor and shown them our plan and verified that this safe and appropriate for your individual case can you get going.
- There are lots of small things you could be getting wrong in terms of the application, so If you are not getting good results make sure you are following the process in the right order. It's amazing how many people do things the wrong way and in the wrong order and then ask me if it matters. Yes it matters!
- If you are in Melbourne you should probably just get in touch and come and see us once your health practitioner has approved it so we can fix it ASAP
- If you aren't in Melbourne and have any questions feel free to comment below!
- Good luck