Osgood-Schalatters/inner leg strength?

[coachinkal]

I took my son to physiotherapist yesterday after about six weeks of increasing knee pain (which started after a basketball game).

She has advised that his outside leg muscle is stronger than his inside leg muscle and to rest. Appears his kneecap is not sitting central on his knee because of this. Luckily we have just finished the year for gymnastics and do not start again until school goes back in late January/early February. Lots of rest and physiotherapy in the meantime.

He has had a big growth spurt in the last couple of months of about an inch or more and has started to fill out in his upper body. It does sound a bit like Osgood-Schlatters given the growth spurt and Physio also suggested growth spurt may be involved. He is very tender under the kneecap where patellar tendon joins the Tibial bone. I was wondering if other coaches have had exeriences of Osgood-Schlatters in their gymnasts or in their own children? How has this effected training?

I am however concerned that as a coach I may need to incorporate more inner leg strength training for our team. We usually do extensive strength training for the first term back at the beginning of the season. Any ideas on strength drills to improve strength of inner leg?

[bogwoppit]

You may want to consider some stretching for the outside of his thigh if that muscle is very tight. Check out these links

Iliotibial Band Syndrome - Exercises and Treatment

Knee Pain, Knee Injuries and Iliotibial Band Syndrome (ITB)

We saw a sport therapist for this issue, she gave gymmie execises and stretching and it really helped. Gymmie uses one of these on her outer thight muscle and it really helps.

The Stick massage sticks - exercise recovery tools - marathon stick, original body, flex, sprinter, big stick, foot and trigger wheel by Intracell

Good luck with this.

[CoachTodd]

Knee extensions. I've seen this same thing with runners, bikers, basically anyone that uses the leg to push on anything for power. What happens is the outer quad becomes stronger than the inner one (the teardrop shaped one right above the knee). I've found that knee extensions work this muscle quite well and seems to pull the knee back where it belongs. This has helped some of my gymnasts going through the growth thing as well as me with some knee issues I developed when I ran track.

I'd keep the weight reasonably light until they get used to doing the exercise correctly. You can even use one leg as resistance by sitting with one leg crossed over the other and pushing against the one that is extending.

Good luck

[Valentin]

Hi

Without your physios exact diagnosis it is very hard to prescribe exercises, or suggestions. Definitely however based on what you have described, i would star the athletes on stretching the vastus lateralis and the ITB (the outer quad muscle and Iliotibial band), and start strengthening the vastus medialis (VM). A good exercises that doesn't place stress the knee joint and still can help strengthen the VM is Straight leg lifts. They should be done in sets of 10 times on each side. Start with 5 sets of 10 and work your way up to 10 sets of 10.

To perform straight leg lifts:
1. Lie down on your back with one leg bent and one leg straight.
2. Next, perform a posterior pelvic tilt to protect your back from injury. To do this, draw your umbilicus (belly button)
toward the floor. If you are doing this correctly, your back should be flat against the floor/mat. You can also check your
technique by putting your hand under the small of your back, on the floor, and flatten your back so that your back is
"crushing" your hand.
3. With your toes pointed to the ceiling, keep your knee straight and lift your leg up to about 45 degrees.
a. It shouldn’t be raised higher than the bent knee.
4. Slowly lower your leg back to the floor.
(es.oncolink.org/coping/pdf/OncoLink_Exercises.pdf)
(beats me having to explain)
Also if you have access to leg extension machine you can have your son do leg raises with a light weight (with Full ROM, as research is mixed on best ROM to activate the VM) and the feet turned in. This burns, and will help strengthen the VM.

I would be careful with diagnosing OSD without the the presence of the standard symptoms, like redness around the tibial tuberosity, pain with palpation of the tibial tuberosity, sweeling around that area, pain experienced with walking up stairs, and if you can get it for free a MRI (from side)) but given that he has had a growth spurt it could be as this is a prime time for kids to get it.

I have coached a gymnast with OSD and it can be quite restrictive at times. Best thing is rest at first (and given that you have the holiday that is great), with lots of hamstring and calf strengthing. Minimal knee bending exercises and stretches of the quad.... for more information on OSD check out an article i wrote on the topic
"A look at the pathophysiology and rehabilitation of Osgood-Schlatter Syndrome"
It will give a good idea of what to do if he has OSD.

[coachinkal]

Thanks for suggestions. Until the inflamation has reduced and knees are rested we cannot do a lot of therapy. It is not easy for boys to rest!

I was surprised however that he lacked inner leg strength and I thought maybe we were lacking something in training for this to happen.

In planning next years strength program I was thinking of introducing things like holding a ball between ankles and squeezing, or some other sort of resisitance training to strengthen the inner leg. There might even be exercises with a fit ball that would work. Any other ideas?

[Valentin]

Hi

I think you should be careful with what you are planning, because your son doesn't have weakness with adductors, but rather with the VM which is crucial for proper knee cap positioning. Doing stuff leg squeezing legs together works the adductors and not the VM. The adductors don't have a role in the kneecap position, but if you imbalance them then you could cause other issues.

I would steer on the side of conservative in the begining. I really just educate yourself.

[coachinkal]

Physio has given a number of exercises/things to start on:
. Deep massage to relax muscles (he hated this!).
. leg extensions while squeezing towel/ball between knees.
. standing on one leg balances with closed eyes.
. one leg small squat (bit technical to explain how to do properly)
. a range of stretching exercises that look like origami!

You are right Valentin I need to make sure I follow the physio advice so that it heals properly. Otherwise might make things worse.

[bogwoppit]

Oldest had one stretch that we called the pretzel, as that's what she looked like when she was doing it, works great though.

[coachinkal]

Yes. Definately looks like a pretzel!

[kiwiflyer]

Have you thought about asking the physio about exercises for strengthening the inner leg (particularly vastis medialis as Valentin mentioned), and stretching the outer structures of the leg? The exercises given by the physio are great, and the physio may have some progressions in mind which could be appropriate for the other gymnasts with uninjured knees. Single leg squats (done with proper technique) are useful because they are a functional movement.