Osgood Schlatters (OS), Larsen-Johansson (LJ) and Severs disease are common adolescent conditions that affect young rapidly growing athletes. These injuries occur where the muscle tendons attach to the bone. During a growth spurt the bones, muscles and tendons are all growing at different rates. If the muscles are tight they put extra stress on the bone resulting in inflammation and pain. In the case of OS and LJ the pain is felt at the knee, where Severs affects the heel. Many athletes are specializing in sport earlier and are engaging in year round training, how can you make sure your young athletes can continue to train during this stage of development without suffering from growing pains?
Risk Factor #1
The bones are growing faster than the muscles can adapt in terms of flexibility. Which puts a lot of stress on the muscle-tendon junctions, bone-tendon junctions, ligaments and growth cartilage.
Prevention strategy: Implement a regular stretching program focusing on the hamstrings, quadriceps, and calves, which have all been shown to be excessively tight during the adolescent growth spurt. Stretching should take place when the body is warm, i.e., at the end of your workout. Stretches need to be held for at least 30 seconds to be effective x 3 sets.
Hamstrings: Raise one foot onto a bench, lean forward bending from the hips and keeping your back straight. You should feel a stretch at the back of your leg.
Quadriceps: Stand on one leg (holding onto to something for support if needed). Bend your opposite knee and bring your heel towards your buttock as you hold your foot with your hand. You should feel a stretch in the front of the leg.
1. Gastrocs: Stand in front of a wall/bench and bring one leg back ensuring your toes are facing forward. Keep your heels on the ground and lean forward keeping the back leg straight. You should feel a stretch in the back leg.
2. Soleus: From the same position as above bring your back foot forward. Make sure both heels stay on the ground and bend through your knees. You should feel a stretch in the back leg.
Risk Factor #2
“Adolescent Awkardness:” the athlete is growing at different rates and there is now an imbalance in strength and coordination.
Prevention strategy: Exercises focusing on glute strengthening, core stability and neuromuscular control. Stability and strength of the pelvis and spine help with proper mechanics and loading of the lower extremity in running, kicking, and changing directions. Perform the exercises below 2x/week for 10 repetitions and 3 sets.
Start position for exercises below. Start in an athletic stance, both knees/hips slightly bent with your chest and head up. A band is wrapped around your knees or ankles. Your knees should be in line with your 2nd toe. Make sure your knees are not caving in (see bad/good form below).
1. Mini walks with a band: Start in an athletic stance. From this position take a step outwards and then feet back together again. Repeat 5-8 steps in one direction and then back in the other direction.
Single leg balance (with or without a band): Start in an athletic stance with a band around your knees for added difficulty. Keep one leg bent and raise the other leg out in a 45 degree angle. Hold for 5 seconds and return to start position and repeat on the other side.
Plank (with/without a ball pass): Start in a plank position from your elbows or hands, making sure your back stays flat and core stays tight. Hold for 30 seconds. For added difficulty hold the position while rolling the ball to a partner or wall.
Side plank: Place one hand on the ground, extend your legs out so you are in one straight line. The only thing touching the ground is your hand and the outside of one foot. Make sure your hips don’t sag towards the ground. Lift the top leg up for added difficulty. Hold for 20-30 sec and switch to the other side.
Y balance exercise: You can use tape to draw a Y on the floor (or imagine a Y on the floor) while you are doing this exercise. Stand on 1 leg with the support knee slightly bent, while reaching out in three different directions with the opposite leg. Position 1 is in front, position 2 is out to the side and back, and position 3 is back and across to the opposite side. Perform each position once and repeat the cycle for 3-5 sets. Ensure your form is good, and your stance knee is staying in line with your 2nd toe (not caving in).
Risk Factor #3
Congested training schedule with very little rest
Prevention strategy: Modify your exercises and training if you are suffering from an injury. I.e., Single leg landing, jumping and sharp cutting drills puts a lot of stress on the knee and heel and will aggravate these injuries. Modify or eliminate these exercises as needed.
If you are the parent, coach, or trainer of a young growing athlete be proactive and chat with one of the therapists at Sheddon on injury prevention strategies.
For more info, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.