Osgood-Schlatter’s Disease

Osgood-Schlatter’s disease usually occurs in teenagers. It causes pain and swelling just below the knee. It is named after the two people who first described it. It is not serious and usually goes away in time.

Who gets Osgood-Schlatter’s disease?

Young teenagers, particularly boys, are the most commonly affected. It is uncommon over the age of 16. It is most common in teenagers who play a lot of sport involving kicking, running, or jumping. These kinds of sports cause repeated and vigorous use of the quadriceps muscles.

What are the symptoms?

The main symptom is pain just below the kneecap (patella). The severity of the pain tends to flare up and down. It is usually worse during, and just after, activity. It tends to ease with rest. Pain typically lasts a few months, but sometimes persists until you have finished growing. The knee joint is not affected, so knee movements are normal.

A small, tender, bony bump may develop a few centimetres below the kneecap. This occurs where the patella ligament attaches to the tibia (’shin bone’). The small bump is permanent, although in time it becomes painless.

No special tests are usually needed as the diagnosis is often clear from the typical symptoms.

What causes Osgood-Schlatter’s disease?

Sometimes it develops for no apparent reason. However, overuse of the front thigh muscles (quadriceps) is thought to be a common cause. The quadriceps muscle is used to straighten the knee. This muscle pulls on the patella, which pulls on the patella ligament, which is attached to the upper part of the tibia.

Overuse of the quadriceps muscle can cause repeated stress and strain on the attachment of the patella ligament to the growing tibia. This can cause inflammation and pain at the site of the ligament attachment. In some cases, a small flake of bone is pulled off the tibia by the pulling ligament. Healing bone (callus) then forms which may cause a hard bony bump to develop.

What is the treatment of Osgood-Schlatter’s disease?

• Pain usually goes within a few months without any treatment. It may help to be reassured that the condition is not serious and is likely to go.
• Paracetamol or similar painkillers may be useful when pain flares up.
• If symptoms persist for 2 years or more, then immobilisation in a plaster to ‘force’ rest may be advised. A specialist may, rarely, advise an operation on the bony lump if symptoms still do not improve. However, they are more likely to advise patience as a natural easing of symptoms over time nearly always occurs.

What about playing sport and other activities?

Sport or physical activity is not likely to cause any permanent damage, but may make the pain worse. However, it is often sporty teenagers who develop Osgood-Schlatter’s disease. Difficult decisions may have to be made about training schedules and sporting commitments. Each case is different, and your doctor will advise. An approach similar to the following may be advised.

• You do not usually need to stop sport. However, easing off strenuous or vigorous sport may be sensible for a while until the pain eases to a tolerable level. Let the pain be your guide. Play sport only to a bearable level of pain. Avoid heavy sport activities if the pain is bad. Consider a complete break from sport for a while if pain remains bad.
• An ice pack applied below the kneecap for about 5 minutes before and after exercise may prevent some inflammation and pain.
• Consider wearing knee pads during sports such as football and rugby to protect the tender area.
• Consider seeing a physiotherapist for advice on exercises to strengthen the quadriceps muscles.

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Groin Strains

What is a groin strain?
A groin strain is an injury to the muscles of the inner thigh. The groin muscles, called the “adductor muscle” group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles pull the legs together, and also help with other movements of the hip joint. The adductor muscles are important to many types of athletes including sprinters, swimmers and football players.

What happens to the muscle with a groin strain?
A groin strain is an injury to the adductor muscles called a muscle strain. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibers, and can even cause a complete tear of the muscle. Most commonly, groin pulls are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.

What are the symptoms of a groin strain?
An acute groin strain can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

• Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
• Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
• Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

When do I need to see a doctor for a groin strain?
If you have symptoms of a severe groin strain, you should be evaluated for proper treatment. Some signs of a severe groin strain include:

• Difficulty walking
• Pain while sitting or at rest
• Pain at night

Severe groin strains should be evaluated because in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III groin strain injuries, as these patients can usually undergo successful non-operative treatment. If you are unsure if you have a groin strain or the symptoms do not quickly resolve, then you should be seen by your doctor.  Once a strain is diagnosed, you can begin treatment for your groin strain.

Strengthening exercises for a groin strain

Below are examples of strengthening exercises that may be used in the rehabilitation of a groin strain.
(Always seek professional advice before starting a rehabilitation programme)

Static contraction

These are exercises where the muscle contracts but there is no actual movement.

* Place a ball or similar between the legs and gently press inwards with the legs.
* Hold for count of 10, relax and repeat 10 times.
* The number may be increased gradually.
* Doing this with the legs bent and ball off the floor inbetween the knees will strengthen the short adductors.
* Performing with the legs straight and ball between the ankles will strengthen the long adductors.
* This exercise may be done daily.

more advanced exercises..

Straight leg raise and out

* Sit upright with feet rotated outwards.
* Lift one leg slightly off the ground, move leg outwards whilst keeping off the ground.
* Return to the middle, then either rest for a couple of seconds, or if strong enough take the leg out again without resting
* Aim for 3 sets of 10 repetitions.
* This exercise may be done daily.

Straight leg raise and across

* Lie on a couch or bed with one leg relaxed down the side of the couch.
* Raise the leg upwards and across the other leg, lower and repeat 10 times
* Build up to 3 sets of 10 then increase the resistance by adding a weight to the ankle.

Resistance band adduction

* Tie one end of a section of resistance band around your ankle.
* Tie the other end around something sturdy, close to ground level.
* Stand away from the attachment point, standing on the uninvoled leg and hold on to something for balance if necessary.
* Take the involved leg out to the side as far as possible and make sure the band is taught in this position.
* Keep the knee straight as you bring your leg in to the centre and across the standing leg, against the resistance of the band.
* Slowly return to the starting position and repeat 10 times initially.
* Gradually increase the number of reps you perform.

Athletes who sustain a groin strain will want to incorporate a stretching program as part of their rehabilitation. Some simple stretches can help ease the symptoms of a groin strain. Furthermore, stretching can be a useful part of preventing groin injuries from occurring.

As a general rule, the stretches should not hurt. There should be a gentle pulling sensation of the muscle, but this should not be painful.

The first stretch is the squatting adductor stretch:

Squat to the ground with your arms between your legs.
stretch your legs apart by pushing out with your elbows.

The butterfly stretch is done in a sitting position.

Sit with your feet together and knees bent. Grasp your feet with your hands.
Stretch your knees down towards the ground.
Do not bounce. Feel the stretch along your inner thigh.

The adductor stretch is done while standing.

Stretch one leg out to the side, keeping your other leg under your torso.
Bend the knee underneath your torso to stretch the muscles of the inner thigh
of the opposite leg.
Your outstretched leg should have a straight knee,
and you should feelthe stretch on the inner thigh.

The cross-leg stretch is done while sitting.

While sitting in a chair, cross one leg over the other.
Press the knee of the crossed leg down towards the ground.
This stretch will emphasize the muscles of the inner thigh and front of the thigh.