132. Sever's and Osgood-Schlatter's w/ Angie Jackson
Jan 23, 2024
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Chris interviews Angie Jackson, an expert in apophyseal injuries in youth athletes. They discuss Sever's and Osgood-Schlatter's diseases, return to activity guidelines, the connection between these conditions, common causes of knee pain in children, treatment options, and Angie's online courses and resources for pediatric pathologies.
Severs and Osgood-Schlatter's are apophositis-based injuries that affect different tendon insertions in youth athletes.
Diagnosing and managing Severs and Osgood-Schlatter's involves careful examination, individual maturation considerations, and conservative treatment methods.
Apophyseal injuries can masquerade as knee pain, highlighting the importance of assessing the hip and evaluating flexibility during diagnosis and treatment.
Deep dives
Severs and Osgood-Schlatter's defined
Severs and Osgood-Schlatter's are both apophositis-based injuries, characterized by inflammation at the point where tendons attach to bones during periods of growth. Severs specifically affects the insertion of the Achilles tendon on the growth plate of the calcaneus, while Osgood-Schlatter's affects the insertion of the quadriceps tendon on the tibial tuberosity. It is important to differentiate between the two conditions and rule out other potential diagnoses, such as patella sleeve fractures or fat pad irritation.
Presentation and Diagnosis
Severs and Osgood-Schlatter's typically present with localized pain at the site of tendon insertion, worsened by activity and relieved with rest. In Severs, there may be intermittent heel pain, while Osgood-Schlatter's is characterized by knee pain. Objective examination involves palpation to assess tenderness and focal points of pain. Imaging, such as x-rays, is not typically warranted, while ultrasound may be useful for grading the severity of Osgood-Schlatter's. It's important to consider the individual maturation process, as well as growth rates, to guide diagnosis and management.
Management and Treatment
Treatment for Severs and Osgood-Schlatter's involves activity modification, rest, and exercise to strengthen supporting muscles. Gel heel pads can provide cushioning and offer symptom relief. Orthotics may be beneficial for some patients, particularly those with excessive pronation or hyperextension. Conservative management with exercises targeting foot intrinsic muscles, hamstring mobility, and trunk stability is recommended. Careful monitoring is necessary, and a gradual return to activity is based on symptom tolerance and pain levels, with a focus on keeping pain below a two or three out of ten. Ensuring proper nutrition, sleep, and managing growth-related factors can also contribute to healing.
Considerations and Differentiation
While Severs and Osgood-Schlatter's are commonly unilateral, they may also present bilaterally. It's essential to differentiate between these conditions and other potential pathologies, such as stress fractures or fat pad irritation. Understanding the individual maturation process and identifying sports-related demands can help guide diagnosis and treatment. Ultrasound imaging may be useful for assessing the severity of Osgood-Schlatter's, while MRI scans are typically reserved for cases where conservative management fails.
Diagnosing Apophyseal Injuries
Many apophyseal injuries, such as hip pathology, can present as knee pain. It is essential to assess the hip for slipped capital femoral epiphysis (SCFE) and other related conditions. Additionally, evaluating flexibility, particularly of the quadriceps and hamstrings, is crucial. Physical examinations, including knee examinations and ankle dorsiflexion assessments, also play a role in diagnosis.
Management of Apophyseal Injuries
Treatment for apophyseal injuries involves a combination of education, strength training, and potentially isometric exercises. Educating patients and parents about the condition, its causes, and the need for patience and adherence to a structured rehabilitation plan is crucial. Isometric exercises, load management, and neurocognitive challenges are effective strategies. In severe cases, temporary orthotics or taping techniques may be considered. Nutrition, sleep, and bone health also play significant roles in recovery and prevention of future injuries. Clinicians must acknowledge parental expectations and emphasize the importance of long-term development and well-rounded athletic capabilities over immediate success at a young age.
Chris sat down with Angie Jackson to discuss all things apophyseal injuries in youth athletes. We dive into the diagnosis, management, and education surrounding Sever’s, Osgood-Schlatter’s, and Sinding-Larsen-Johansson syndrome.
