Robert
My treatment was in S.Africa a few years back when I hadn't even heard
of EBM.
I have no evidence base (anecdotal only unfortunately). However based on
the previous regime/variants of that regime + biomechanical assessment
(subtalar pronation being a predisposing factor - which I forgot
earlier), I seem to remember that approx 70 - 80% (on a sample of about
10 patients) were able to return to their original/or higher levels of
activity within 3-6/12 of the onset of the condition (it is usually self
limiting within 24/12).
I believe the key to this is the concept of 'relative rest' (i.e.
activity modification NOT rest).-> 'Treatment' as per my previous post +
Non aggravating graduated rehabilitation e.g quads control, eccentric
strengthening etc (PAINFREE)
NB: activity modification does not only apply to the activity perceived
to be aggravating the condition - for example if an adolescent is
playing a large number of different sports as they are wont in SA, then
it is worth eliminating some of those sports from their repertoire until
they have 'recovered'.
cheers
dave riddell (Chartered Physio).
> I am interested to see interventions suggested for Osgood-Schlatter's
> from
> various sources but I wonder if there is any evidence base for these
> suggestions, or are they purely there as a need to 'do something'. As
> a GP
> with an interest in sports medicine it has been my experience over the
> years
> that the only thing which works is rest, and this is certainly what I
> have
> seen in countless patients with this condition. Perhaps the
> physiotherapists
> in my area have been unsuccessful for different reasons, but no
> intervention
> that I have seen has done anything special. Unfortunately, advising
> rest,
> rest and more rest generally proves unpopular, not only with the
> (relatively
> young) patient, but also with the parents, especially if Junior is any
> good
> at the sport which appears to have provoked the problem. Often they
> request
> 'a specialist opinion' only to have the rest advice emphasised once
> again. I
> have known orthopaedic surgeons put patients in a plaster of Paris
> cylinder
> to enforce this rest where the patient has been unable/unwilling to
> comply.
>
>
> > I have only treated a few cases od Osgood -Schlatter so can hardly
> claim
> to
> > be an expert. My tuppence worth.
> > i. Stretching of all quads (ALL i.e. one and two joint muscles),
> hams
> > other as indicated.
> > ii. Regular ice brushing - >5 per day for approx 5 minutes at a
> time
> > (with a cryocup or ice in a polystyrene cup).
> > iii. 'Relative rest' from the aggravating activity with a
> graduated
> > rehab programme including eccentric quads control
> >
> > The above seemed to be successful in most patients however the
> degree of
> > relative rest was probably the area requiring the most
> judgement/most
> > difficult?!?
> > Have not seen the condition for a while so I may have forgotten
> something -
> > will post if I remember
> >
> > cheers
> >
> > Dave Riddell
> > Physio
> >
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