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Osgood Schlatter’s Disease

What it is

Osgood Schlatter’s Disease, or “tibial tuberosity apophysitis”, is a common condition affecting children and teenagers where the bone at the site of the tibial tuberosity growth plate is inflamed. It is characterised by a gradual, non-traumatic onset of knee pain that worsens rapidly. It most commonly affects physically active children, particularly boys, but any child can develop the condition.

It is a fairly common condition, with estimates that 15-20% of athletic children will experience it at some point, and up to 5% of non-athletic children. Despite this, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the nature of the condition and management strategies used by physiotherapists.

 

What causes it

Osgood Schlatter’s Disease is an inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the tibial tuberosity, which is a bony prominence at the front of the shinbone. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow and usually occurs in “spurts” over a two-year period.

When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of Osgood Schlatter’s disease the quadriceps muscles and patellar tendon are pulled tight, resulting in pain and inflammation where it attaches to the weakened tibial tuberosity.

Signs and Symptoms:

The most common symptom is intense pain just below the front part of the knee, which presents on activities such as jumping, squatting, running, kicking, climbing stairs and kneeling. The pain tends to start off relatively mild and then increase in intensity until the patient is unable to effectively complete the task due to pain. In addition to pain on activity, the tibial tuberosity may be swollen and tender, even at rest.

In 20-30% of cases, children will experience these symptoms in both knees. In later stages, the growth plate itself may enlarge which tends to look like a bump on the tibial tuberosity. This will often stay even after the condition resolves.

Risk factors

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Factors that can contribute to it

  • Active boys from 11-15 years old are the most likely to experience Osgood Schlatter’s Disease, but girls aged 8-13 years can also be affected. If a child plays multiple sports, they are more likely to experience OSD.
  • Having chronically tight thigh muscles can also make you more likely to experience Osgood-Schlatter’s Disease.
  • Activities involving repetitive, strong quadriceps contractions produce the highest risk. Children who participate in jumping, running, and kicking sports such as football, netball, basketball, soccer etc. are most at risk.

Diagnosis

An accurate diagnosis can usually be made based on the symptoms by a physiotherapist, imaging often won’t be required. An X-ray may or may not show bony fragments at the site of attachment from the patellar tendon to the tibial tuberosity. It is important to see a qualified practitioner for diagnosis, however, as there are several alternative diagnoses that you may be experiencing, including:

  • Sinding-Larson-Johansson syndrome (a similar condition affecting the bottom of the kneecap as opposed to the tibial tuberosity)
  • Patellar tendinopathy
  • Patellofemoral pain
  • Infrapatellar bursitis
  • Fat pad injury
  • Fracture of tibial tuberosity
  • Slipped capital femoral epiphysis

Treatment

The treatment will depend on the findings of the physical assessment, but will likely include pain relief, activity modification, supervised exercise and stretching.

Perhaps the most important treatment we can provide is activity modification. Osgood Schlatter’s is a self-limiting condition, which usually means that the pain experienced during activity is directly related to the amount of inflammation at the tibial tuberosity, rather than a sign of ongoing damage being caused. Activity modification involves modifying the duration, intensity, frequency or type of activity the patient undergoes in order to “manage” symptoms. If the pain is quite severe then rest from strenuous activity may be recommended for a short period of time.

Other treatments may involve strengthening of the muscles surrounding the knee, icing, low intensity activity such as walking and swimming. Stretching, massaging and foam rollers may be used to help to lengthen the tight quadriceps muscles.

Prognosis

As previously mentioned, Osgood Schlatter’s, while painful, is a mostly self-limiting condition. The typical lifespan of the condition lasts for a few weeks to a few months, however in some scenarios people experience symptoms for up to two years.

Once the condition has resolved, most people will not have any ongoing effects, however a small portion of patients will experience an enlargement of the tibial tuberosity, and some will have ongoing discomfort while kneeling on the affected leg.

 

 

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Patella Tendinopathy – Blog by Christian Bonello

The patella tendon is a continuation of the quadriceps tendon and has a role in connecting the quadriceps femoris (4 quadriceps muscles at the front of the thigh) to the tibial tuberosity of the shin. The patella tendon has a principle role in transmitting force through the lower limb, particularly in powerful jumping movements.

Patella tendinopathy is defined as a pathology or injury of the patella tendon, commonly due to overuse mechanisms. For further information please refer to the “What is a tendon and tendinopathy” blog.

Symptoms:

The main symptoms of a patella tendinopathy is pain and tenderness localised to the inferior pole of the patella (ie bottom of knee cap). Patients often report load-related pain that increases with the demand on the knee extensors. Notably this includes activities that store and release energy in the patellar tendon such as jumping and change of direction activities.

Prevalence:

Patella tendinopathy is highly common in jumping athletes with a 45% prevalence reported in basketball players, 32% reported in volleyball players and is common in AFL ruckman. Conversely patella tendinopathy only has a 2.4% prevalence in “in-season” soccer players due to the altered demands of the sport.

Risk factors:

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Diagnosis:

Patella Tendinopathy is medically diagnosed by a physiotherapist.

A physiotherapist will conduct a strength and lower limb power assessment to highlight any differences between the symptomatic and unaffected side, and as a comparison to dominate limb function. Palpation may reveal localised pain and tenderness over patella tendon.

In rare cases, ultrasound may be utilised in the diagnosis of the condition, however is not often required as there is a poor correlation between imaging findings and patient reported symptoms and level of function.

Treatment:

Multiple interventions can be utilised in the treatment of a patella tendinopathy but should primarily be gym based. As the condition can become chronic and often debilitating, treatment is most successful when commenced early.

Your physiotherapist will guide the appropriate management based on your assessment findings and the severity of symptoms which may include:

– Rest from aggravating exercises

– Graduated strengthening exercises (starting with static contractions and building through range with resistance to power based activities)

– Taping

– Load  management strategies or advice

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Christian Bonello (Physiotherapist)

Stress Fractures

What are stress fractures? – Blog By Rhian Davies

A stress fracture is an overuse injury where there is an overload of stress to the bone resulting in a tiny crack.  This occurs when the stress of repetitive loads overwhelms the ability of the bone to repair itself and these cracks begin to occur within the bone structure.

Causes

Stress fractures are often the result of increasing the amount or intensity of an activity too rapidly. Can also be due to an impact of an unfamiliar surface, improper equipment or increased physical stress.

Where do stress fractures occur?

Weight bearing bones of the body such as:

  • Metatarsal bones of the foot
  • Navicular bone in the foot
  • Calcaneus (heel bone)
  • Tibia (shin bone)
  • Femur (thigh bone)
  • Pelvis
stress-fracture
Common bones where stress fractures occur

 

Most common in the weight-bearing bones of the lower leg and foot with more than 50% of all stress fractures occurring in the lower leg.

Risk Factors:

  • Repetitive sporting activities ie. Running, Basketball, Tennis, Dancing
  • Sudden increase in activity ie. Intensity, duration or frequency of training sessions
  • Poor foot posture ie. Flat feet or high arches
  • Females more likely than males
  • Osteoporosis or weakened bones
  • Previous stress fractures
  • Lack of nutrients ie. Lack of Vitamin D and calcium

running

Symptoms:

  • Symptoms can vary widely but a common complaint is pain with activity which subsides with rest.
  • Pain that gradually worsens over time when continuing the aggravating activity.
  • Swelling and tenderness may also be present around the area of pain.

sports

Diagnosis:

A stress fracture can sometimes be diagnosed through a subjective and physical examination but often imaging is needed to confirm the diagnosis.

  • MRI: Can visualize stress fractures within the first week of injury
  • Bone Scan: Can detect problems in bones but not specific to stress fractures
  • X-ray: Not seen on regular x-rays for at least several weeks up to over a month from the initial onset of pain.

x-ray-of-foot

Management

If diagnosed with a stress fracture, your physiotherapist will be able to prescribe the correct management specific to you and your needs. In most cases, the initial management will include a period of rest to allow the stress fracture to heal, this may involve the use of crutches or wearing a weight bearing boot in moderate to severe cases, to reduce the bone’s weight bearing loads.

Rehabilitation and strengthening as well as a gradual return to activity are extremely important to prevent or reduce the likelihood of re-injury. Your physiotherapist will be able to develop a specific program to enable you to safely and efficiently return to your activity or sport.

stretching

Tips to help prevent stress fractures:

  • Proper footwear for specific type of exercise
  • Gradual build up when starting a new exercise program
  • Walk/warm up prior to running
  • Stretch + strengthen calf muscles
  • Cool down properly after exercise

At Total Physiocare we specialise in the accurate diagnosis, management and return to activity or sport for clients presenting with stress fractures.

Book an appointment today for your assessment!

Blog By Rhian Davies (Physiotherapist) 

Concussion

Louise represented in the hurling team in the world championship in Dublin this year gives us her insight about concussion.

concussion

A hot topic at present in the media/ world front as more and more concussions especially in playing sport are coming to the fore and evidence & management/ views are changing to not take this matter lightly. As a sufferer of a few concussions in the past I know exactly how it can affect you in the long run if not treated effectively and respectfully when first occurs. After all your brain is the most important part of your body, it is the control centre for everything else. Treat it with respect.

So what is a Concussion or Acquired Brain Injury (ABI), it is a temporary unconsciousness or confusion & other symptoms caused by a blow to the head.

Another definition is a brain injury and is defined as a complex physiological process affecting the brain, induced by biomechanical forces.

Maybe caused by direct or indirect blow to the head/ face/ neck or body causing an impulsive force transmitted through to the head.

Symptoms including

  • Short period of unconsciousness
  • Confusion
  • Dizziness
  • Amnesia/ Loss of memory
  • Persistent headaches
  • Nausea/ vomiting
  • Blurred vision
  • Sensitivity to light and noise
  • Feeling foggy/heaviness in the head
  • Neck pain
  • Fatigue/ low energy

concussion2

Anyone with a suspected Concussion should immediately be removed from play in sport, and should not return to activity until assessed fully by a medical professional. They should not be left alone and should not drive/operate any machinery. A SCAT2 or 3 (Sports Concussion Assessment Tool) form should be carried out immediately post-concussion and furthermore to assess recovery to return to sport adequately.

 

concussion3

Managed return to work/ school and or sport should be approached with a professional practitioner and not to be rushed back into a hectic daily lifestyle. Take rests periods regularly and limit your exertion. Cognitive function as well as the physical function should be assessed during return to activities. Studies are now coming to the forefront that individuals who continue to play on after receiving a concussion, DOUBLE the recovery time.

concussion4

Personally a sufferer of post-concussion syndrome/ injury I know firsthand how individuals can feel and the affects it can have on a person’s whole life. Protect your head wear a helmet in sport such as cycling, snow sports etc. For any further assistance with concussions please contact the Total Physiocare for an appointment!

Blog by Louise Holland (Physiotherapist)