Osgood Schlatter Disease

Has your child been diagnosed with Osgood Schlatter Disease? Well, fear not - it’s not as scary as it sounds!

What You Need to Know

Osgood Schlatter Disease (OSD) is not a true disease, but an overuse injury of the knee. It is a common, temporary musculoskeletal condition that causes knee pain in older children and teenagers. It most often occurs during times when the bone is growing quickly, for example during the teenage growth spurt. OSD is more common in boys. In boys, it is usually reported between 12-16 years. In girls, this growth spurt occurs a little earlier between 11-15 years. Children who participate in running and jumping sports are at an increased risk of OSD (effecting 21%). Less active children are at a lower risk (effecting 4%) but can also experience this problem. Pain is located very precisely so diagnosis is rarely a problem. Patients can point exactly to it - a tender bony bump at the top of their shinbone, below their knee. An x-ray is usually unnecessary.

Anatomy Explained

OSD is caused by irritation of the bone growth plate. While a child is still growing, these growth plates are in the form of cartilage rather than bone. The tendon from the kneecap (patella) attaches down to the growth plate in the front of the shin bone (tibia). The thigh muscles (quadriceps) attach to the kneecap, and when they pull on the kneecap, this puts tension on the patellar tendon. The patellar tendon then pulls on the shin bone, at the area of the growth plate. Cartilage is not as strong as bone, so high levels of stress can cause the growth plate to begin to hurt and swell.

While most children will develop OSD in one knee only, some can develop it in both knees. In almost every case, surgery is not needed. This is because the cartilage growth plate eventually stops its growth and fills in with bone when the child stops growing. The knee pain almost always stops once the child is finished growing, but symptoms may come and go during this period for 1-2 years after.

Sports and Movements

Any movements that involve bending and straightening of the knee can lead to tenderness at the point where the patellar tendon attaches to the top of the tibia. Activities that repeatedly place this stress on the knee, especially squatting, kicking, jumping or running, can cause the tissue around the growth plate to hurt and swell.

In some cases, your child may need to stop sporting activities for a short period, to allow pain levels and inflammation to settle down. Patients who do require a rest period usually do not need to avoid sports for a long time, and often relative rest is adequate. Relative rest means decreasing the intensity or frequency of your sporting activities but not stopping them completely. A physiotherapist can advise you regarding which of these would be most appropriate.

Physiotherapy Intervention

If your child is diagnosed with the condition, the first step would be to schedule in a physiotherapy appointment. A physiotherapist would typically begin with a baseline assessment of your child's:

Functional pain levels
Range of motion (ROM)
Lower limb strength
Functional balance

Based on the assessment, the physiotherapist can design a targeted exercise program to effectively manage OSD. This may involve:

Pain management: Massage and ice application can be used to loosen tight muscles, reduce pain and decrease inflammation. This can be particularly beneficial in the early phase when most painful.
Stretching exercises: Many children with OSD have tightness in one or more muscle groups in their legs. This tightness can increase the pull on the patellar tendon and the area of pain. The physiotherapist may include hamstring stretches, quad stretches, and calf stretches to improve flexibility.
Strengthening exercises: The restriction of movement during the recovery period can cause muscles to shorten and become weaker. This again may cause increased stress on the area of pain. The physiotherapist will include exercises aimed at strengthening the effected muscles such as the quadriceps, hamstrings, and hip muscles. Strengthening a knee that is painful can be difficult, so it is important to follow the strict instructions of your physiotherapist regarding increasing or decreasing the load of the exercise.
Balance and coordination exercises: Some children with OSD experience impaired balance and coordination. To overcome this, your physiotherapist would teach balance exercises to improve balance and strength in the affected knee, hip, and ankle.

Passive treatments like heat, ice, or taping may feel good and help a little, but they do little to improve the underlying condition. Ultimately, the best treatment for OSD is an active physiotherapy rehab program. To speed up recovery, it always helps to have an informed exercise plan designed to improve mobility and to strengthen and stabilise the knee. By working with a physiotherapist, your child is highly likely to recover quicker than sitting at home or on the sidelines.

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This post has been written by Physiotherapist Liam Mc Ginley MSc, MCSP

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Is Running Bad for Your Knees?

Have you heard the myth that running is bad for your knees or damages the knee joints? Well this debate has been raging on for years. However long-distance running has continue to rise in popularity with more than 30 million individuals running marathons each year. Is that going to mean that more and more people are going to require knee surgeries and replacements?

As we find ourselves in Phase 2 of Singapore's reopening, many of us are working from home so now more than ever we need to be exercising for both our physical and mental wellbeing. So, is long distance running a suitable option?

Now new evidence from two studies can help shed light on the effects of long distance running. The first study is by Ponzio et al, titled, “Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners.” This study compared Arthritis prevalence in 675 United States marathoners with the National Centre for Health Statistics prevalence estimates for a matched group of the U.S population. Arthritis prevalence was 8.8% for the marathoners, significantly lower than the prevalence in the matched population, 17.9%. These results indicate that there is a link between marathon running and arthritis prevalence, but it does not look into the reasons why.

The second study digs a little deeper into the reasons why the arthritis rates may be lower. A prospective cohort study by Horan et al was titled, "Can Marathon running improve knee damage of middle-aged adults?"

The study had 82 first time marathon runners have MRI scans on their knees 6 months before the marathon and half a month after. The subjects had to complete a 4 month standardised training program before completing the marathon. Pre-marathon and pre-training MRI showed signs of damage, without symptoms, to several knee structures in the majority of the 82 middle-aged volunteers. However, after the marathon, MRI showed a reduction in the radiological score of articular cartilage damage and bone marrow lesions.

To date, this is the most robust evidence to link marathon running with knee joint health and provides important information for those seeking to understand the link between long distance running and osteoarthritis of the main weight-bearing areas of the knee.

Now these studies are not high level evidence to tell us that we all should be going out running marathons but it certainly forms the base of a good argument to say that running does not necessarily damage our knees. In fact, it can ‘heal’ our knees. Coupled with the fact that physical activity reduces our risk of conditions such as cardiovascular disease and diabetes mellitus, it’s safe to say running is good for us.

We must still consider safely beginning or increasing our running. If you’re new to running then you should gradually introduce it to your exercise routine. For example, running 2-3 times a week for 3-5km. If you are a regular runner then follow the 10% rule, only increase your running distance by 10% per week.

Unfortunately, some people will still have discomfort in their lower extremities when they try to run due to other conditions such as; patellofemoral pain syndrome, tendinitis, shin splints or plantar fasciitis. If you’re having symptoms when you try to run then it isn’t recommended to ‘run through the pain.’ Give us a call and get booked in for an online assessment with one of our expert physiotherapists so they can identify the problem and get you running pain free as soon as possible.

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This post has been written by Physiotherapist Louis Platt B.Sc. (Hons).

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Massage VS Physiotherapy: Which Is "Better"?

It has been over two months since Phase 2 of Singapore's reopening commenced. During this time of increased spare time and being cooped up at home, it is no surprise that more than a few of us have taken the old running shoes out or greased up the bike chain in a bid to get some much needed exercise.

On the flipside, many of you now find yourselves doing work at an inappropriate makeshift work station in your kitchen or dining room table as a result of the ”work from home” measures that many have to adhere to at this time. Perhaps, then, it is also no surprise that many of us have had a few old, and some new, injuries cropping up this period too. This can happen for a variety of reasons, chief among which are improper loading, over-zealousness with our exercise volumes and capacity as well as underlying lack of conditioning, and performing certain exercises without the proper form.

Over circuit breaker, when we were hampered by the closure of clinics islandwide, you may not have been able to get the required help at short notice and may have resorted to stretching, foam rolling or even complete rest in order to manage your issues. Now that clinics are fully operational, we are seeing a lot of cases of this type present to us with increasing requests for massage and sports massage to relieve pain or simply just to alleviate soreness and tightness. Essentially, while both massage and physiotherapy can help manage pain, there are still key differences that you should note!

Why Massage?

Massage is one of the most ancient forms of musculoskeletal treatments. It is natural for us to veer towards it, either through a massage therapist or through the use of a foam roller, given its perceived effectiveness at reducing muscle soreness and improving our general wellbeing.

But just how effective is massage at improving our athletic performance and recovery? Well, in a recent systematic review (the highest level of evidence available to researchers), massage was found not to have any benefit on jumping, sprinting, strength, endurance, and fatigue. On the other hand, the same review showed some improvement to flexibility and muscle soreness. The studies analysed for these were however, of poor quality, which makes it is difficult to measure the true effects of massage and to quantify exactly the benefits it provides.

When it comes to pain or stiffness resulting from prolonged sedentary behaviour, there are other factors at play which may include desk ergonomics and a baseline lack of conditioning which predisposes you to pain. What we can likely deduce from these findings is that while there may be some benefits to massage therapy, the perceived benefits may mask a key underlying issue that is hampering your recovery.

What Can Physiotherapy Offer?

This brings me neatly onto why physiotherapy would be the right choice for you. For one, a physiotherapy session is always preceded with a comprehensive functional assessment of range of movement, muscle strength and biomechanics with further assessments of functional activities like running gait, hops, jumps, throwing etc. where applicable. Our treatments include, but are not limited to, exercise therapy, manual therapy, ultrasound, shockwave therapy, dry needling, as well as massage therapy, all with the intention of reducing pain, improving function and achieving the goals set out with your therapist. By getting a full assessment from your physiotherapist, you will have a much clearer and better idea of exactly how to manage your condition. With all these tools at our disposal, physiotherapists are in a brilliant position to decide the best course and direction of treatment for you. In certain cases, a condition may need further assessment, in which case we can also refer you to a trusted specialist so that you can get the best care possible. So, the next time that niggling injury crops up again which doesn’t seem to be abating, consider the option of an assessment from a physiotherapist at one of our five clinics.

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This post has been written by Physiotherapist Conor Walsh B.Sc (Hons).

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Call us: 6258 5602

Email us: info@physioactive.sg

PhysioActive is available in Orchard, Raffles, East Coast, Jurong & Novena!

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Ref: Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine (2020); 6:e000614. doi:10.1136/ bmjsem-2019-000614

Women Are 6 Times More Prone to Knee Injuries Than Men

Many women are following the recommended guidelines to be active with adults targeting to achieve at least 150 minutes of moderate-intensity aerobic exercise a week. However, along with exercise, women should also consider adding some preventive measures to reduce their risk of getting injured.

Researchers have found out that Anterior Cruciate Ligament (ACL) injuries occur with a four to six-fold greater incidence in female compared to male athletes playing the same high-risk sports. What is more interesting is that these injuries often occur via a non-contact mechanism!

A combination of factors contributes to this higher incidence of knee injuries among female athletes. Here’s why.

We Are Built This Way

Unfortunately, women tend to have a wider pelvis as we are required to carry and give birth to children. This creates a larger Q-angle at the knee, resulting in a more “knock-kneed” posture.

(image via http://blog.footsmart.com)

However, a greater inward rotation of the thigh bones from the hip to the knee can cause added stress on the joints. This in turn leaves the ACL more vulnerable for injury.

We Activate Our Muscles Differently

It is suggested that women tend to have an imbalance in the strength ratio between their quadricep muscle and their hamstring muscle. Female athletes tend to develop strong quadriceps and relatively weak hamstrings – a dangerous imbalance of power.

As such, a female athlete is more likely to use her quadriceps to decelerate from a sprint, causing instability in the knee. A male athlete on the other hand, is more likely to slow down using his hamstrings to absorb the change in speed. While this may sound like just a slight difference, it does in actual fact, provide an inherent protection to the ligaments of the knee.

Differences in muscle activation may make it more likely that women will suffer tears to the ACL and develop chronic knee pain from certain activities.

Blame It on the Hormones

Both men and women produce the hormone Oestrogen but women produce it in greater quantities to help regulate their reproductive functions. However, higher Oestrogen levels are associated with changes in the formation of fibroblasts, causing water retention in the soft tissues within the knee.

The effects of Oestrogen can weaken the ligaments and make them more prone to stretching or tearing. With that being said, women are more likely to have a knee injury when their Oestrogen levels are at the highest during ovulation. Should we blame the hormones for everything?

You Can Be in Control

A woman cannot do much about her anatomy or hormones, but other factors are within our control.

Both female and male athletes can reduce their risk of ACL injuries by performing training drills that require balance, power and agility. Adding plyometric exercises such as jumping can help to improve neuromuscular conditioning and muscular reactions too. Many sports professionals, especially female athletes, now routinely undergo an ACL conditioning program to prevent injuries.

We have also seen numerous cases where athletes invite trouble by keeping their legs straight when they jump, pivot, or land. This posture requires the knee to absorb a shock equal to four times your body weight. With bent knees, the force drops by 25%! Learning how to bend your knees when landing from a jump can provide tremendous protection.

How PhysioActive Can Help

Each year, millions of women see their doctors for knee pain, often caused by activities that are not related to sports, such as going up a flight of stairs or lifting boxes. This suggests that you don’t have to be a weekend warrior to end up with a serious knee problem.

The good news, however, is that many of these injuries are preventable with proper neuromuscular training. The risk of ACL injury may be reduced through strength and conditioning training programs designed to increase balance and flexibility, and improve muscular strength and endurance.

Our physiotherapists can help you to enjoy the benefits of exercise and minimise your risk of injury with a personalised training program.

This post has been written by Goh Yun Jie.