Osgood Schlatter’s Syndrome

The Patella Tendon pulls so hard on the attachment point, called the “Tibial Tubercle” that it, in essence, pulls the bone away from the tibia.

I hate the term “disease” for Osgood Schlatter’s. Notice how I used “syndrome” up there?

Back in the days of naming conditions, doctors loved to label new conditions after themselves and preserve their research and ideas into fame and glory. I’m OK with that. They classified it, by all means, name it after yourself.

But disease? It just doesn’t fit. Disease in the modern sense is more of an internal issue. It offers less hope. Less Recovery. Plus, you can’t really beat a “disease” like this. As you age and the bone heals you’ll always have that bump there.

My own son is going through this. Do you think I’ll let him grow u with the idea that he has a disease? Quite the opposite. I took him to an NBA game where we sat down in front, real close. Why? Because NBA GAMES are AWESOME!!!

And so he could see that nearly every one of these superstars shared the same “disease” he had. I wanted him to KNOW down into his soul that he will recover, will continue to excel, and will not be hindered by a setback.

I’m not trying to downplay the pain and seriousness of some of these complexes, they can and do get incredibly debilitating and painful. I want you, the reader, to understand the mechanism and what seems to work to get your kid or yourself out of pain faster, to rehab better, to recover MORE, and to stop being terrified of the BUMP.

That’s my issue. The bump. It’s developmental for a lot of kids. A Normal, although painful variant, Not your burden to carry the rest of your life. If so, let me unburden you. In fact, that’s a huge reason I do this web page. So many of my clients tell me that because I took a few minutes to explain a condition, it isn’t scary anymore. They understand it and now they don’t have fear of this “disease” that will plague them their entire sports career and life.

That’s my issue. The bump. It’s developmental for a lot of kids. A Normal, although painful variant, Not your burden to carry the rest of your life. If so, let me unburden you. In fact, that’s a huge reason I do this web page. So many of my clients tell me that because I took a few minutes to explain a condition, it isn’t scary anymore. They understand it and now they don’t have fear of this “disease” that will plague them their entire sports career and life.

Let me explain the process AND my treatment ideas. If, at the end of all of this, you still prefer “disease” then use whatever term you like. I just don’t like it. prefer “OS reaction/OS syndrome/OS (as a stand-alone), etc.

Sports in growing kids add a lot of stress to their growing body. Fast growth like my son went through (where he grew 10 inches in one year!) and the demands of sports, muscle growth, overactivity, overuse, the thrill of jumping high and trying to dunk plus the fact that there are growth centers in developing kids. It can all add up to a mixture that causes a problem.

Just like the picture above, in OS, the patellar tendon pulls so hard it basically “stress fracture” pulls the attachment point away from the bone.

But in order to treat this, you really need to understand it better.

The Tibial Tuberosity is the area of attachment for the bottom portion of the PATELLAR TENDON. The upper portion is the quad muscles. These are the large muscles on the front of the leg. The quads, you can see them right now. If you’re sitting, straighten out one leg. The QUADS activate and using a pulley system pull the tibia straight. This is important to understand.

Here’s why.

If you want to fix this issue, you need to stop the extra pulling force of the quad. Basically, relax the quad muscles so it doesn’t pull so hard.

Muscle takes minutes to a few days to really affect. It’s simple to relax.

Tendons take weeks and up to months to really change in structure and rest. So the biggest bang for your buck is to focus on the muscles. The tendon needs work no doubt but getting the kid out of pain happens quicker when the muscle work is done.

Bones take years. Faster in kids, but not quick, and nothing that is easy to measure, it’s simply a time issue. So…If you want to make the bone stop hurting, work on the area that will give you the most immediate response.

Loosen the quad.

I think that’s pretty easy to understand, and that my friends, is typical rehab for this issue. It’s just not good enough though! It doesn’t work by itself.

Why?

Because in order to really get a change we have to figure out WHY the quad is so tight in the first place. All the above-named reasons and the fact that the quad tends to stay over tight is typically because the back of the leg, the hamstrings, and glutes, aren’t doing what they are supposed to. Despite all the stretching, couch stretch, foam roll, tools, massage, and therapy, kids with OS seem to always revert back to over-tight quads.

there is a serious imbalance with the quads tight and the hamstrings and butt basically too stretched or even, basically, off-line.

 When this becomes imbalanced, typically I will see a low-grade to very high-grade patellar tendon hypertonicity or tendonitis. Pain to the lower area of the knee cap especially when the athlete has the knees bent (as is common at work, a school desk, or in the car.) This becomes increasingly annoying and occasionally debilitating.

HOW CAN I FIX IT?

Well, first, understanding is key to treatment. I think you understand it better now.

Second, You can’t just do one thing. This condition is not simply knee pain at the area of bone attachment.

Ice and rest are just not enough. It’s a part of it. The inflammation MUST be taken care of before anything else will work. But that is only the first step. Stop the mechanism.

Stretching hasn’t been very effective, nor has foam rolling. Not by themselves. There are multiple issues involved, it takes a multifaceted approach to get back on track.

This protocol has been working great for fixing OS.        

  1. Ice the tibial tubercle if it is actively irritated, nothing works well for rehab when it’s inflamed!
  2. When the initial pain is gone (often a week or more) Then rehab. This order seems most effective.
  • Glute activation – grab your butt and make it contract -10 each leg & 10 both together
  • Glute contraction – mini squat with a squeeze (weighted if available)
  • Hamstring contraction – Chair hamstring contraction – (see below)
  • Quad (front leg) stretch – Couch Stretch and/or foam roller, TAK ball roll
  • Voodoo Band if available – Helix style Voodoo/Floss (link) seems to work best!

This is a very reversible and easy condition to fix and should also show an increase in performance as the body gets back into the preferred ratio. To fix this issue, add some easy quad stretches and hamstring strengthening exercises. To add to that advice, don’t waste time strengthening the hams with traditional machinery, bending the knee with weights attached low will most likely just irritate the tendonitis anyway and the beef of the hamstring is at the proximal end near the glutes. I prefer lying prone with your knees bent and the heels digging into a chair. Get situated so the knees are at 90 degrees and use the hamstrings and lower glutes to do a hip thruster. Go slow, activate the big part of the hamstring and glutes. Put your hands right there to make sure you are making the hams fire. (Basically a hip thruster, only don’t make it the hip, use the hamstring.)

Voodoo Band exercises if that works for you!

Helix wrap has been the most effective way and really helped my son using 100 reps of walking and sports specific movement followed by 10 slow squats.

 These are easy and in a few short days, you’ve stretched the quads and re-activated the hamstrings as well as got the glutes on board so that the balance and ratio are getting back to the right state. This routine is all you need to undo the problems. It seems that classic training seems to only address one aspect: rest, stretch or strengthen. I’m saying, “Do all, better, to get the fastest, most efficient results.”

 As I stated before, there is no one single reason why the quads are growing faster and at a quicker rate than the hamstring. More than likely it is any one or a mix of the following: technique, form, jumping, growth, hormone response, genetics (muscle composition), or just that High-Intensity workouts wake up the lower body better than most programs and there is a focus on squatting in a lot of exercises. This will elicit a greater quad response. Most likely it is a combination of all these factors.

Note: Often when these issues are resolved the bump on the knee will not go away. These stay with you and is evidence of what was called in the past, “the disease.”

I’ve noticed a huge percentage of top-tier athletes, especially basketball and taller sports athletes with evidence of these “growth type issues.” My take? If handled correctly, these issues are self-limiting, strong, and most likely as the athlete matures, offer a large bony attachment. I don’t see these when treated and recovered properly as crippling or performance inhibiting in any fashion.

Get these issues fixed and treated so the athlete can continue to play.

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