Growth Spurt Injuries, Part1 with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. Multiple time winners of best physiotherapists in Vancouver. And we're talking about growth spurt injuries today. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. 

Mark: So you had given me some fancy names, Osgood-Schlatter syndrome. What the heck is this? 

Wil: Yeah, so, basically it happens in mostly the athletic population, in younger people. So these are the younger people who are basically going through growth spurts. And that's usually the important factor there, is that there's a larger amount of load. So with training, so in sports and being more repetitive and increasing that load, and then the growth spurt. 

So Osgood's what that is, is basically the attachment point of where your quadriceps muscle, the tendon, attaches down, like just below the kneecap. And so it's basically a pulling away of that attachment point because that bone and all that area is still immature.

And so the big, fancy name is Apophysitis. So basically it's the pulling away at that attachment point of the tendon on the bone.

Mark: So what kind of symptoms would someone, how would this show up for a kid? 

Wil: Yeah, so they would start to get some knee pain there right in that attachment point. And then the classic thing, especially if it's been going on for a little bit where they're still playing, they might start to get a little bit of a bony bump. And then essentially that's there for life because, you know, it's the protuberance or the attachment point of that tendon pulls away. And it essentially is a permanent bump. But in terms of long-term effects, if you manage this correctly and that's the key, is managing it correctly, and knowing what to do and knowing what not to do. And in terms of sport, gradual return to sport is really huge. 

Mark: So, how do you go about diagnosing this?

Wil: Yeah, so like I was saying that the biggest factor is you know, the load and also looking at the growth spurt because it happens in younger kids or kids between the ages of like, it could be as young as 8 to even like 14 or 15. And basically they get tenderness on palpation maybe swelling, you know, if it's really, really bad, just on that attachment point of that tendon, where the quads attaches just below the kneecap.

And so basically in really worst case scenarios, which I'm thinking about a kid that we saw, you know not too long ago in the clinic, one of our therapists, basically the kid had trouble walking. Woke up the next day, like had a hard training session, and it's obviously been developing for a while and he was pushing through the pain. But then it was just the last straw, that last training session.

And he was a competitive soccer player. And then woke up the next day and then just was limping. And normally in terms of the referral and the medical system, they would go see the family doctor, you know, like, oh, what's going on. And then they would probably refer over to what's called a pediatric specialist, which is basically a doctor that specializes in seeing kids.

And they may do some tests and scans, but usually when you look at it, you can see it. And a lot of it is proper physiotherapy management, and there's a lot of research that's showing, it's very dependent on where they are and their growth spurt. So if they're having a huge growth spurt in addition to that training load, then there's a certain amount of graduated return to sport that you want to take them in terms of intensity.

Mark: And what's the typical course of treatment? 

Wil: Yeah. So you really got to give them a chance to settle down and you really want to just take off the load. So if this was a mature, like adult, where the bones are all developed and the tendons are all developed now, then it present more as a tendonopathy or tendonitis. So then protocol would be much different. When you have something like this with an immature adult, with this kind of condition, you really got to take the load off.

And that's huge. It's not about, okay. Yeah, we've got to strengthen this and we got to stretch this. I mean, that's not the case. You don't really want to be doing too much of that. There are some things that you don't want to do because when they start to develop this and what we want to also look for is all the compensation patterns they might develop. Because then you don't want them to start that, because they're growing, not just in that, obviously in that area of their body, their whole body is growing. 

And you know, you look at some athletes that may have, you know, maybe oh, two inches in the year, or maybe a whole 12 inches in the last year. So depending on how big that growth spurt is, then you've got to look at, okay, let's see what's happening in the back. Let's see what's happening in the hip, you know, and in the compensation patterns that are going on there, because then they can start to have issues that can come back to haunt them.

Mark: So there you go. If your kid is having some issues with pains that are getting worse as the training load in their sport is going up, the guys to see are Insync Physio. You can reach them in Vancouver at 604-566-9716 or in Burnaby 604-298-4878. Or of course you can book online at insyncphysio.com. Get them in there, get this treated right so they don't have long-term injuries. Thanks. Wil. 

Wil: Thanks Mark.