February 27


Knee Pain – Osgood Schlatters Disease with Iyad Salloum

By Wil Seto

February 27, 2023

knee injuries, knee pain

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. We're gonna talk about an issue that's happens mostly with young gentlemen as they're growing. How you doing Iyad? 

Iyad: Good Mark. How are you? 

Mark: Good. Awesome. Fancy name for this one. 

Iyad: Osgood Schlatters Disease. And then we have a few other types of things that kind of fall in the same category of injuries. So the most common one, most people will know this as Osgood Disease or Osgood Schlatters Disease, and usually affects boys as they're going into the adolescent years, and tends to be from an issue of overactivity, like doing a bit too much, a bit more than they're able to handle.

And it comes in as like pain in the front of the knee and it'll affect you right under where the kneecap is. And we tend to see this a lot with people over a long period of time where they're just persisting through a bit of pain, and they're just kind of patching up and managing, and just kind of going along and playing a lot of soccer and maybe a high impact jumping sports.

So I've recently been seeing a couple of gymnasts who've had this cuz of all the tumbling that they're doing, and the way it kind of presents is just like localized knee pain. Really painful with impact weight bearing and sometimes also resisted exercise because you know, your quads pull right on that spot that hurts in the knee.

So yeah, usually when the bone's sore, you can't really do much with it. And you know, it's one of those things that most people will look online and read that it's self-limiting. And it typically is when, you know, most kids grow out of it. The annoying thing and the unfortunate thing is it can be really, really painful and it can like actually stop kids from being as active as they'd wanna be and maybe participating in the sports that they want to do.

And it's usually really funny cuz sometimes when we advise parents on like, well your kid's probably doing a bit too much and maybe we need to change some of the training routine a bit. And not necessarily just with rest, but also to modify a few activities, maybe do more of something and less of something else.

It's met with a bit of this kind of, oh, well, it's self limiting, so we'll just leave it be, but then, you know, it's not really a fun condition cuz it can really affect people's activity level. Especially a lot of young, active kids. They really love sports. Gives them a bit of identity, gives them something to explode their energy into. So that's one of the most common ones. 

We also have something similar to it that can affect the heel, which is called Sever's Disease. And it's the same idea as where you have pain just in the heel where the achilles tendon inserts and it happens from the same thing usually. Lot of activity, repetitive impact.

This one I see a lot in soccer and I guess also, because if you think about the cleats, they don't really give you lots of cushion support. And here in Vancouver we have a lot of turf fields, which are really nice, ripe for impact. And they don't give you as much cushion as grass does. And that could be one of the factors. 

Obviously it's a little more than that, but it tends to be also one of those volume related things. So if you are doing just a bit too much, not getting enough adequate recovery, maybe there's also some other risk factors that could predispose the kid to getting it sooner than later.

But there's so many factors in there. But it tends to be one of those things where we would see, and you know, then people usually come in when they're kids, like a lot of pain. 

Mark: So what, is there a root cause to this other than just over-training? 

Iyad: That's the most common one. Unless the kid has some form of like, let's say bone abnormality, it tends to be that. The other thing to keep in mind is like as kids are growing their bones, like we, stuff like good open growth plates. So the bones are a little softer than you would expect in let's say immature kid or somebody who's like, let's say in, in their teen years, and the tendon is not, let's say, a weak structure.

So the tendon even tensioning through the bone, puts a bit of a force. And if that happens, like let's say enough, you might ask, well, why does the tendon not get affected? Well, in those age groups, the tendon sometimes could be a little stronger and they're a little better at handling the loads than the bone. And then that's usually could present that way. 

Now with boys, if they develop this as they're into their teenage years, a little further in, they'll develop more likely things like lip patellar tendon problems, which is the pain just immediately under the kneecap, and they'll get a bit less of their bones getting involved.

Like the most common people I see in the clinic with Osgood Disease, and this is not based on any studies, is they tend to be between 9 and 13. Those are the most common ages I'll see them in. And it tends to be kids who are just, are incredibly active, which is a great thing but maybe doing a bit more than their bodies able to handle all at once.

Mark: And so is the diagnosis, is it fairly straightforward?

Iyad: Tends to be. I usually confirm with some form of imaging. Like if we need that, but it tends to be pretty easy to diagnose in the absence of a few things. Obviously if somebody comes in unable to weight bear, we wanna look at that. We wanna look at that pretty seriously, cuz kid not being able to weight bear, I would highly encourage everybody to go check with their physician right away. And this is like, cuz it doesn't tend to happen so much. And then it's one of those things where we just wanna remain vigilant for some of the things that could be a bit more serious than like, let's say just the early stages of Osgoods or Sever's. 

So that weight bearing thing can be really important. Sometimes kids with hip pain can also report knee pain. So they can actually come in with knee pain when it's actually just the hip. Well, that's also something we wanna consider. We wanna kind of keep an eye out for.

But yeah, for the most part most of us working in orthopedics get to identify that pretty well. And then sometimes a need confirmation with an x-ray and sometimes it's really just confirming kind of what you already know.

Mark: So the treatment generally is then a little bit more flexibility in the training program. A little bit lighter training program. What does that look like? 

Iyad: Potentially that, or sometimes we just get 'em training different things. So for example, if you're doing training for like cardiovascular fitness. You're just doing a lot of aerobic exercise. Well, there's some things that you could do that are probably a little less strenuous.

So that's one of the things we would do right away. We've gotta keep the kids active and keep 'em busy. And then if we're out of the very, very acute phases, we start some strengthening program, which can help with their ability to tolerate more impact. We could also change some, again, it depends on extensive it is and how bad it is and how necessary it is. 

Sometimes we could also look at running retraining and could look at strengthening up and down the chain. Because if you get somebody who's really sore, let's say with Osgood Schlatters Disease, and then you try to give them quad exercise, that might be really, really sore early on.

But later on it might be actually appropriate where you're trying to get them to do a bit more of that good load to the system to get them a bit more used to, let's say the good stressors that you would wanna put through their body and gets them a bit more adapted to the stresses.

Mark: If your child is having some issues with knee pain, heel pain, get into Insync Physio in North Burnaby. You can book online at insyncphysio.com. You can book for the Vancouver office there as well. You can call as well, Burnaby office is (604) 298-4878. You have to book ahead. They're always busy. Insync Physio in North Burnaby. Thanks Iyad. 

Iyad: Thank you.

Wil Seto

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