A quick thought on complacency
“Don’t be afraid to give up the good to go for the great.” – John D. Rockefeller
Sometimes you actually do have to fix something that isn’t broke. Is good really good enough?
Maybe it is, maybe it isn’t.
A deep dive on Osgood-Schlatter Disease
I formally nominate Osgood-Schlatter disease (OSD) as the most annoying injury of the century.
It’s been a problem for a long time and for a lot of people. Developing kids and OSD go together like peanut butter and jelly.
The craziest part is- there’s been so little research on it.
When I was in my first clinical rotation in PT school, I had an athlete come in with OSD. I was excited, because the rest of my patients were sedentary elderly folk who just wanted to come in and talk about the weather.
I was dead set on crushing this kid’s rehab. I was going to be the most educated physical therapy student in the world on OSD.
I went home to research that night, logged into PubMed, and found absolutely nothing.
I couldn’t find a single decent study that looked at therapy interventions for OSD.
It’s been around for as long as humans have had knees, but research actually knew nothing about what to do with it.
That didn’t stop people from giving out advice, though. “Stretch the quads. Rest. Ice. Ibuprofen. Stop playing sports for a few months.”
Physicians and PTs would say it so confidently and nonchalantly. “Oh yeah, that stinks. You love sports? You’re a developing kid whose nervous system is trying like heck to keep up with your growing body and figure out how to move effectively? You have an injury that causes some pain, but really won’t do structural damage in the long run? Well, better sit around and do nothing for a month or two, then go right back at it.”
Remember, with ZERO good research to back it up.
There’s good news, though. That tide is shifting. The studies are starting to come out.
Here are 4 things to know about Osgood-Schlatter Disease.
- It’s annoying and painful, but it’s not a death sentence.
We’re already into the meat and potatoes of the article and I haven’t even talked about what exactly OSD even is yet… is that bad writing?
OSD is a traction apophysitis of the tibial tubercle. Let’s break that down, starting from the back.
- The tibial tubercle is a bump on the tibia, it’s where your patellar tendon inserts.
- Apophysitis means inflammation of the growth plate (apophysis = growth plate, itis = inflammation).
- Traction means pulling.
So, OSD is an inflamed/injured growth plate on the front of your leg caused by a lot of stress through the patellar tendon/knees.
It’s commonly thought to be growth related. It’s almost a rite-of-passage for tall kids who grow quickly.
When kids are developing, the growth plate is the weakest link in the chain. That’s why kids don’t have Tommy John injuries (UCL tears), their growth plate is the weaker link and they get Little League Elbow.
OSD is often referred to as self-limiting, with the pain resolving when the growth plate closes (usually between 14-18 years old).
The self-limiting aspect means you’re not really doing any more damage to the area, the pain is the limiting factor.
It’s not fun, but it will go away.
2. It’s all about load management.
OSD is a load-tolerance issue. Meaning, the pain arises when the growth plate undergoes more stress than it can handle.
Managing it, then, becomes a balancing act. We want them to stay active and moving (because kids desperately need to stay active), but we want to do it without making the growth plate mad.
3. Rest, ice, and ibuprofen is a terrible game-plan for recovery.
The advice I hear our athletes get all the time from their pediatricians is rest, ice, and ibuprofen.
Ice and ibuprofen are just pain masking agents. They’re not going to actually heal the underlying issue.
Rest just feeds into a poor load management cycle.
When you rest for a prolonged period of time, your work capacity decreases. This means the amount of stress your growth plate can handle decreases.
OSD is a load-tolerance issue. Rest decreases the amount of stress it can tolerate. So, when an athlete goes back to play after a period of rest, the issue just rears its head again.
We need to build-up or at least maintain work capacity while allowing the inflamed growth plate to calm down.
A brief rest period can be good, but it should be short and strategic.
4. You can train with the issue.
The key is to find what movements you can tolerate and do those.
Changing from a hard surface (like a court) to a soft surface (like turf) can ease the stress that goes through the injured area and be more tolerable.
Squats can be bothersome, so find out how far you can bend your knee before the pain kicks in, and don’t go lower than that.
There are a million modifiable variables to experiment with, just think critically and get some professional help.
An extra note on stretching
Remember how clinicians were tossing out answers with no evidence?
One of the most common prescriptions was to stretch more.
Research is now showing that tightness isn’t a risk factor for OSD.
Anecdotally, OSD is more common in our hypermobile athletes than the rest of our athletes.
Why is our society so obsessed with getting more flexible?
More from me…
- Check out the most recent podcast episode where I give you a 4-step process to start actually gaining weight. Just click here!
- If you think this newsletter doesn’t suck (or maybe you even enjoy reading it), I would really appreciate you sharing it with some other parents that might benefit from reading it. You can just send them to gtperformance.co/free and they can subscribe there!
Thanks so much for your help in spreading the word about long-term athlete development!
Best,
Zach
Dr. Zach Guiser, PT, DPT, CSCS
The information in these newsletters are meant for educational purposes only and not intended to be medical advice. Don’t self-treat, go seek help from a qualified professional.