I have just reviewed the posts on Osgood Schlatters. I think everyone makes an important point, and put it all together you have a reasonable treatment.
I never claim to "cure" OS, just make my patients comfortable enough to enable them to continue with sport. However, it is important to take each individual case on its merits. Just last week a 13yo soccer player consulted me with what looked like a very severe case of OS (ie. limping, pain on quads contraction and knee flexion). I sent her for an x-ray which revealed fragmentation of the tibial tuberosity. I have sent her to a specialist for another opinion, but by my wreckonings there is a chance of avulsing the patella ligament if it is severe enough.
In summary, I take a biomechanical approach. Start at the feet because they will tell you what muscles will be tight higher up the chain. eg. if pronating then adductors, piriformis, ITB and hip flexors will be tight, as will hamstrings. Then I set about deep tissue massaging, stretching etc. I advise ice every night, and after sport. I either suggest a change of footwear, make rearfoot wedges or formthotics, or refer to a podiatrist for more permanent orthotics if warranted. Along these lines a loss of T/C dorsiflexion can increase pronation, and this is often caused by multiple ankle sprains. Tight calves may be a problem also. Weak glut max I feel is an important factor. This may be because they are often in anterior pelvic tilt which may put glut max at a physiological disadvantage. The glut max acts as a knee extensor over a fixed foot (try it yourself), and if weak the quads work overtime.
Occasionally strapping the tibial tuberosity may give symptomatic relief, and you can purchase similar braces.
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Scott Epsley
PHYSIOTHERAPIST
Northside Sports Injury Centre
Brisbane, Australia.
e-mail: [log in to unmask]
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