Grant Frost is our Senior Physiotherapist whose passionate about uncovering the reasons why we suffer the issues we do. He doesn’t believe in bad luck or apologetics – and for good reason. This one is close to his heart.
Osgood Schlatter’s Disease (OSD) is a very common knee issue amongst young athletes.
More specifically, the bump at the top of the shin gets overloaded and irritated where the Patella tendon attaches from the knee cap.
Traditionally it’s thought of as “Growing Pains”. If you speak to almost any health professional you will hear that OSD is the result of rapidly growing tissue that’s unable to cope with the dynamic demands of exercise and activity.
This. Is. Bullshit.
To be fair – on one level it makes perfect sense. Growing legs meet rigorous activity in a messy head on collision to create potentially persistent pain.
Frustratingly, this explanation can also be followed by something along the lines of “it will settle once you stop growing”.
Why all the bullshit?
Growing should not be used as a valid excuse for a few reasons.
- Growing is by definition – normal.
- Logically we should expect growing to be a symmetrical thing. Most with OSD have a single sore side or at least one more symptomatic.
- Exercise and activity are also normal. Why should two normal things conspire to make us sore?
It’s important to remember that something must be going wrong to create the issue but the above factors don’t seem as relevant once we delve a little deeper.
As a junior AFL footballer I had the (dis)pleasure of OSD for almost 3 years.
It impacted my ability to run, jump, kick a ball, shoot a basketball, surf, ride a bike and generally be active.
As a Physio, I now know that my suffering should have lasted for all of 2-3 weeks, NOT most of my mid-late teens.
I was also told to wait it out and it’d get better once I’d finished growing…
I was given some quads strength exercises, various leg stretches, shown how to tape it and off I went.
Like most with OSD I just did my best.
The toughest thing about OSD is that the majority of information on the issue does make some sense as mentioned above. Google the issue and you’ll be see a multitude of sites with the same explanations and treatments – all provided with the best intentions.
But the problem is is that we’ve completely missed the point – as I had when younger and also when starting out as a Physio.
We haven’t taken enough of a step back to be able to see OSD for what it actually is.
Yes it’s still an overload and irritation of the bump where the tendon attaches. Yes, kids who grow are susceptible as that bump is more likely softer and less likely to have become rock-solid, permanent adult bone. But the reason why we are even having this conversation is because of one simple thing…
It’s NOT activity.
It’s NOT growing.
It’s a small section of the lower back.
Clinically I’m now finding that stiffness in the area at the base of the ribcage/top of the lumbar spine (T10-L2’ish for the nerds out there) sets the knee up to fail in the way that it does.
This area houses nerves and neural connections that supply and control the quads and knee. By stiffening up this area we find stiffer and tighter quads and a greater resting load through the patella tendon and Tibial Tuberosity (shin bump).
This causes us to load a vulnerable area POORLY.
The more dynamic activity we do, the more we challenge an already overloaded area.
This is often really well highlighted in athletes with dual-sided pain with one side worse than the other.
Pushing through the spinal joints around the base of the ribcage usually reveals greater joint stiffness on the symptomatic side.
Depending on how irritated the knee is, we can often see a decrease in pain with something like a squat immediately after loosening up those stiff segments.
The best thing about testing and re-testing with a squat is that we can see repeatable results between treatments and between different patients.
Like my OSD patients, my back was also stiff in those areas.
So if you are reading this, please please please do yourself a favour and check out your lower back. If you or anyone you know suffers from OSD grab a foam roller or ball and go hunting for stiffness at the base of that ribcage.
De-irritate the knee, free up your quads and make sure you attend to any likely slouchy sitting postures.
This issue will most likely respond once things balance out again.
Don’t wait until you finish growing to hopefully overcome the issue.
Consult your local Physio, see what they have to say. Get them to mobilise your back as mentioned above if they don’t end up there on their own. Feel free to tell us what you need.
But make no mistake – sort out that lower back.
You could potentially save yourself years of unncessary pain and frustration.
Best of luck,
Note: these views aren’t yet backed by rigid, unbiased empirical research. But they are backed by years of robust clinical results. When face to face with patients in the trenches we keep finding the same things, and getting the same positive results. My hope is that in time the research will eventually catch up.
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