Today I'm going to lift the lid how to cure Osgood Schlatter disease in a matter of weeks.
We have been quickly and quietly fixing this serious and painful problem for well 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 easiest injuries we rehabilitate 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 and advice just aren't working. By writing this article I hope we can help more athletes who don't have the proximity to come and see us in person.
Update (May 2018):
Since I wrote this article in 2014 we have been overwhelmed by the sheer volume of requests for more information about our Osgood Schlatter’s program. This year we decided to deliver what people were asking for and built a complete online program for all those young athletes suffering from Osgood Schlatters who aren’t lucky enough to live in Melbourne, Australia!
The program features a seven-week plan that includes everything you need to rapidly beat Osgood-schlatters. We have created detailed written and video instructions on every facet of our approach including our techniques for foam rolling, isometric holds, movement skill training and a bunch more. It really is a great resource and I can’t wait to see the impact it has.
To find out more you can either click the learn more button below or keep reading the article all the way through and then check out the information at the bottom of the article.
Either way, good luck and thanks for reading.
All the best, Durham
Osgood Schlatters Treatment Program
The catalyst for this was basketball athlete Sarah and her sore knees. Sarah was referred to us eight weeks ago having carried serious Osgood Schlatters pain for 18 months.
Two weeks after starting with us her Osgood was almost completely 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 frosting and no cake. Lots of fiddling around in the margins but nothing striking at the true root cause 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 with every step the athlete takes the muscle is pulling at its attachment site below the knee cap (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, tennis and netball.
So that's it: Bones growing too fast for tight muscles to keep up resulting in soft developing attachment points getting angry.
How can we fix Osgood Schlatters rapidly?
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.
Once the rolling starts doing its job and the knee is less angry, you should be able to start some gentle stretching. 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.
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 with 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 Isometrics
Isometric holds (or 'Iso holds') are incredibly effective 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 process in which sustained non-impact loads actually change the physical properties of the tendon and help it to heal and become stronger.
So there you have it.
The first half of the solution to curing Osgood Schlatter Disease. Foam roll to loosen off the quads, use the magic of isometrics calm down the knee and start strengthening your way out of the problem.
The second half of the program involves re-patterning exercises to change from a knee dominant movement pattern to a glute dominant pattern as well as training strategies to reduce the cumulative load of ground reaction forces just enough to enable young tendons to adapt. The last piece of the puzzle is movement skill retraining where we teach athletes to run, jump and cut in a way that reduces the amount of load going to the Osgood site and make safer, faster and more efficient athletes.
All of these components are laid out in our seven week Osgood Treatment program that you can purchase by clicking the link below. You will receive training logs, bonus articles, instructional videos and our ongoing support to help you or your child beat their knee pain and return to the sport they love pain-free.
Osgood Schlatters Treatment Program
Alternatively, 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 (please bear in mind we usually have a 2 to 3-week waiting list.)