I had Osgood Schlatter's Disease myself in both knees as a kid. Mum entered some fun-runs in the 80's and we used to go running together. I was training more than I should have for cross-country in years 5, 6, and 7, and suffered terribly. Terrible night pain. I used to cry. Mum took me to a GP who confirmed the diagnosis with an x-ray and told me to stop running. Crazy sounding diagnosis. I ran less, and it eventually stopped hurting. I've still got decent bumps on my tibial tubercles to show for it. Osgood-Schlatter's is an overuse injury of the spot where the quadriceps muscle attaches on the front of the knee (tibial tubercle). It’s the tendon where the quad anchors onto the tibia. It gets sore with too much running, jumping, and kicking. Usually 9-12 year olds. Quite often if they’re having a bit of a growth spurt while they’re doing a lot of training. The body is busy spending resources on the growing, and so the recovery between training sessions doesn’t keep up.
It’s usually sore after training when you cool down. It can ache in bed at night. We say that it is self-limiting, which means it eventually gets better when you stop growing, but who wants to wait that long? There’s no long-term problems from it. Once it stops hurting it’s all OK. It doesn’t need an x-ray or a scan, or any injections or surgery. It's an easy clinical diagnosis and simple conservative management. DO:
DON’T:
It’s really a matter of adjusting the running load day-to-day depending on how sore it is. If it’s sore - do less. It's an injury that needs managing through the season. I try and get kids to do a bit less running at training and save it for game day. If it's sore on game day and you need to keep playing, it's safe, in that, it's not going to snap or pop. But it will hurt more for longer if you push through, which is what just has to be done some times. Funny sounding name. Not funny at all when it's sore.
Load Management For Injury PreventionManaging training load is crucial in injury prevention and treatment. A graphic in Tom Goon’s blog visualises how training load outweighs all other factors. Historically we have advised that training loads shouldn’t increase by more than 10% a week. I’m not sure where this number comes from; I’ve got no problem with it; it seems reasonable, and I’ve quoted it hundreds of times. There’s a 2015 BJSM podcast interview with Tim Gabbett on load management for injury prevention. Specifically Tim talks about this paper:
Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers
- Billy T Hulin, Tim J Gabbett, Peter Blanch, Paul Chapman, David Bailey, John W Orchard, 2013. It is research into fast bowlers, but the principles apply just as well to any athlete. The authors measured the acute workload of the last 7 days (and call it “fatigue”) and compare that to the chronic workload of the previous 4 weeks (which they call “fitness”). Measuring Training Load
For runners, if the training is reasonably homogenous, we could most simply measure the workload as the total kms/week.
Or we could be more accurate and account for a mixed training program that may include a variety of hills / sprints / cross training etc, by giving each session a rate of perceived exertion (RPE) out of 10, and multiply that score by the number of training minutes:
Training load = session RPE x duration (minutes)
This is called a Foster’s Score, and provides a simple method for quantifying training loads from a variety of different training modalities.
The research subtracted the current one-week average from the previous 4-week average and called this number the “training-stress balance”. A negative training-stress balance increases the risk of injury by 4 times. So:
[Last 7 days’ session RPE x duration (minutes)] - ([Last 4 weeks’ session RPE x duration (minutes)] / 4) = TRAINING-STRESS BALANCE
Negative balance = 4 times risk of injury
Essentially this formula means you shouldn’t increase your training load by more than 25% a week.
For people that may be more vulnerable to injury I would change the 4-week average to a 6-week average, therefore, bringing the increase in load each week down from 25% to 16%. This more cautious group could include:
A recently published article by Haroy et al, in the British Journal of Sports Medicine, described a simple exercise routine that decreased the number of groin injuries in male footballers by 41%. Groin injuries are very common in football. Research shows that weaker groin muscles are associated with an increased risk of groin muscle injury. So strengthening groin muscles can potentially prevent injury. The paper studied the Copenhagen Adduction exercise, which has previously been shown to strongly recruit adductor longus. Haroy et al, offered the Copenhagen at three levels of resistance, based on the players’ pain. Players started with Level 3. If the exercise gave them more than 3/10 pain, they were instructed to do the exercise level below instead: 3 > 2 > 1.
The training protocol is shown in the following table: Being only one, quick exercise, compliance was high. They found performing the Copenhagens decreased the risk of groin injury by 41%.
The full article is HERE. Copenhagens are definitely worth adding to your training. The concept is similar to strengthening hamstrings with the Nordic Hamstring Curl which has been shown to prevent 70%-85% of hamstring strain injuries.
Summary of:
FOOTBALL RECOVERY STRATEGIES (Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015) Does Fatigue Cause injury?
|
Often when I’m talking to my patient about their injury and why it has happened, they guiltily report that they don’t stretch enough. We’ve all grown up being told how important is it to stretch:
|
Interestingly, health professionals have changed our tune about the importance of stretching. Research over the last 15 years has suggested static stretching is not as beneficial as was once thought. I’ve been having conversations about the reasons to stretch (or not) for at least the last 15 years, but the current science on stretching just isn’t catching on with the general public.
So, what do we know?…
DOES STRETCHING PREVENT INJURIES?
There is a lot of evidence that stretching does not reduce the risk of injury. This systematic review and meta-analysis of randomised controlled trials found stretching does not prevent injuries, whether done before or after training. This randomised controlled trial, and this systematic review concluded stretching before exercising only reduces the risk of injury by less than 1%.
Therefore, in practical terms the average athlete would need to continuously stretch for 23 years to prevent one injury. Definitely not worth it.
DOES STRETCHING HELP MUSCLE SORENESS?
A systematic review concluded that stretching before or after exercising does not confer protection from muscle soreness (ref). Stretching was found to reduce muscle soreness by a trivially small amount - less than 2%.
DOES STRETCHING INCREASE RANGE OF MOVEMENT?
DOES STRETCHING HELP PERFORMANCE?
A substantial body of research has shown that sustained static stretching acutely decreases muscle strength and power (ref). Stretching before an endurance event lowers endurance performance and increases the energy cost of running (ref). Cycling efficiency and time to exhaustion are reduced after static stretching (ref).
Pretty much any measure of performance is made worse by stretching. Static stretching impairs:
- strength
- maximal voluntary contraction
- isometric force
- isokinetic torque
- one repetition maximum lifts
- power
- vertical jump
- sprint times
- running economy
- agility
- balance
A comprehensive review (ref) from 2011 concludes:
WHAT ABOUT DYNAMIC STRETCHING?
SO WHY STRETCH?
SO SHOULD WE STOP STRETCHING?
- 10 essentials for your first aid kit -
- How can I keep up a fitness routine through the holidays? -
- Relative energy deficiency in sport (REDS) -
- Women are closing in on men when it comes to ultra endurance events -
- Why your spin bike has become a clothes rack -
- Most adults will gain half a kilo every year -
- Should I get a weighted vest to boost my fitness? -
Osteoarthritis is a structural change to the cartilage and boney surfaces in a synovial joint. Most of the joints in our skeletal system are synovial joints, which is where two opposing bones articulate in a joint capsule filled with synovial fluid. The synovial fluid is a lubricant to help the joint move, as well as a source of nutrition for the cartilage that lines the joint surfaces. The articulating surfaces in synovial joints are lined with articular cartilage, which is a smooth, glossy surface to decrease the friction in the joint (as opposed to fibrous cartilage, which is the rubbery type cartilage that plays a more structural role, found in the meniscus in knees and the rubbery part of your ribs, nose, and ears).
The fleshy parts of muscles and organs is pink because it is full of blood, which brings oxygen and nutrition, and is important for healing damage. Cartilage looks white because it doesn’t have a blood supply, so articular cartilage relies of the synovial fluid for its nutrition. This isn’t as effective as having a blood supply, so when cartilage is damaged it doesn’t heal well. Nanna damages the cartilage in her knees and it never really repairs.
Once articular cartilage is damaged, the joint tries to reinforce and repair the damaged area by laying down new tissue. It would be great if cartilage repaired itself with new cartilage cells, but the joint wants to make itself even stronger than the obviously insufficient cartilage, so it lays down a stronger building block - bone cells. So when we say that Nanna has “worn away” her knee to the point where it’s “bone on bone”, it’s not just that she’s worn away the cartilage, but actually there’s also a build up of “extra” bone, as the knee tries to make itself stronger than cartilage. Rather than being a nice smooth, glossy surface, the extra bone is now a bit rough, so we might hear and feel some gravely crunching and creaking in an osteoarthritic joint.
Osteoarthritis occurs most frequently in the knees, hips, hands, and spine and is more common the older we get. 59% of people with OA have knee OA. Osteoarthritis is diagnosed with an X-ray that shows the changes to the bony profile in the joint.
When we look at what causes osteoarthritis:
- The biggest contributor is a previous traumatic injury that has physically damaged the cartilage. This can be a landing/twisting injury or sprain, where the trauma of knocking one bone against the other, takes a “divot” or tear in the cartilage, or bruises the cartilage and underlying bone.
- The second biggest cause of osteoarthritis is genetic - the way our joints age, based on our family history. Nanna had a hip replacement and so will I.
- The third biggest contributor to osteoarthritis is BMI. Every 5 kg of weight gain, confers a 36% increase in the risk of OA. Interestingly, it isn’t the extra pressure through the joints of being heavy that causes a problem - fat people have a higher rate of hand osteoarthritis too (which are non weight-bearing joints). The problem with BMI is the systemic inflammatory effect of cytokines produced by fat tissue. Being fat causes inflammation that irritates joints, so fat people get osteoarthritis (and have heart attacks from the scarring/hardening of coronary arteries, also as a reaction to systemic inflammation caused by adipose tissue).
Osteoarthritis isn't painful most of the time. At a certain age, essentially everyone will have arthritic changes in their joints without knowing about it. When we X-ray the joint, it doesn’t look as good as it used to, but it doesn’t hurt. It’s a bit like my grey hair and wrinkles - they don’t look great anymore, and it's a sign that I’m getting older, but I don’t expect them to be painful.
If an arthritic joint is painful, it tends to go through phases of being sore and not being sore at all. It can be sore for a day, a week, a month, or a year, but then will be fine again. Whether or not it is sore is not determined by the severity of the changes we see on the X-ray. We can see nasty looking joints that have never been sore, and we see very sore joints that look fine on the X-ray. There isn’t much of a correlation.
What determines whether or not the osteoarthritis hurts is the body’s perception of "vulnerability" in that joint - essentially whether or not it feels strong or weak. Pain is an alarm system “software”, employed to defend against damage to the "hardware”. We can have different levels of sensitivity of how easily the alarm is triggered. Very commonly, an arthritic joint starts to hurt more after a period of rest, as the body looses some fitness, muscles loose some strength, an arthritic joint gets less support from the external scaffolding of the muscles, it feels more vulnerable, and communicates that by being painful, as a way of saying “be careful”.
So that gives us some treatment options for arthritis:
WEIGHT LOSS (Adipose)
- We know that a 5kg reduction in weight over a 10-year period decreased the likelihood of symptomatic knee OA by 50%.
- Losing 5% of body weight has been shown to provide some pain relief, and 10% provides significant reductions in pain.
EXERCISE
- Stay as active as possible. Rest doesn’t help. Improve muscle mass and strength so the joint is more supported and feels less vulnerable.
- Both aerobic walking and quadriceps' strengthening exercises have been shown to reduce pain and disability in subjects with knee OA.
PAIN RELIEF
- Paracetamol.
- Hot packs.
- Taping.
- Sleeves.
SURGERY
- There’s a lot of research showing that “tidy up” operations, or arthroscopic surgery for osteoarthritis is no better than an exercise program. It’s the exercise you do after the surgery that provides more benefit than the surgery itself.
- For people that never get on top of their arthritis with weight loss and exercise, the pain can get so severe that they end up needing a total joint replacement, where the bones are replaced with a metal and plastic joint.
How do you decide when it’s time to have a joint replacement?
I suggest it’s time when you really can’t walk anymore because of the pain, and/or the pain is stopping you sleeping at night. Joint replacements last for about 25 years on average, so don’t rush into doing it too early. The rehab after surgery is 3-12 months before the leg completely feels like it’s yours. The joint replacements are good for relieving pain, but unfortunately we don’t see improvements in patients’ activity levels after surgery. Total hip replacements are easier all around than total knee replacements.
- There are 2 main ways to stretch. The one you should choose depends on what you want your body to do -
- The role of a coach in concussion management -
- Four Lions revealed to be part of a group suing authorities over brain injuries -
- Women's Rugby Injuries -
- How long, hard, and often you need to stretch to improve flexibility -
- Cricket balls can concuss and even kill -
- Breaking stigmas around pelvic floor disorders in sport and exercise -
- Many elite women athletes don't eat enough carbs, which can affect their performance and health -
- How clubs assess injury risk at the AFL draft -
- Women are less likely to receive CPR than men -
- NRL star backs call for mandatory concussion training -
Archives
June 2025
May 2025
April 2025
March 2025
February 2025
January 2025
December 2024
November 2024
October 2024
September 2024
August 2024
July 2024
June 2024
May 2024
April 2024
March 2024
February 2024
January 2024
December 2023
November 2023
October 2023
September 2023
August 2023
July 2023
June 2023
May 2023
April 2023
March 2023
February 2023
January 2023
December 2022
November 2022
October 2022
September 2022
August 2022
July 2022
June 2022
May 2022
April 2022
March 2022
February 2022
January 2022
December 2021
November 2021
October 2021
September 2021
August 2021
July 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
May 2016
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
Categories
All
Achilles
ACL
Active Transport
Acupuncture
Ageing
AHPRA
Alcohol
Ankle
Ankylosing Spondylitis
Apps
Arthritis
Arthroscopy
Babies
Backpacks
Back Pain
Blood Pressure
BMI
Body Image
Bunions
Bursitis
Cancer
Chiro
Chiropractic
Cholesterol
Chronic Pain
Concussion
Copenhagen
Costochondritis
Cramp
Crossfit
Cycling
Dance
Dementia
Depression
De Quervains
Diet
Dieting
Elbow
Exercise
Falls
Fat
Feet
Fibromyalgia
Fibula
Finger
Fitness Test
Food
Foot
Fracture
Fractures
Glucosamine
Golfers Elbow
Groin
GTN
Hamstring
Health
Heart-disease
Heart-failure
Heat
HIIT Training
Hip-fracture
Hydration
Hyperalgesia
Ibuprofen
Injections
Injury
Injury Prevention
Isometric Exercise
Knee
Knee Arthroscopy
Knee Replacement
Knees
LARs Ligament Reconstruction
Lisfranc
Load
Low Back Pain
Massage
Meditation
Meniscus
Minimalist Shoes
MRI
MS
Multiple Sclerosis
Netball
Nutrition
OA
Obesity
Orthotics
Osgood-Schlatter
Osteoarthritis
Osteopath
Osteoperosis
Pain
Parkinsons
Patella
Peroneal-tendonitis
Physical-activity
Physio
Physio Mosman
Pigeon-toed
Pilates
Piriformis
Pokemon
Posture
Prehab
Prolotherapy
Pronation
PRP
Radiology
Recovery
Rehab
Rheumatoid
Rheumatoid-arthritis
Rotator Cuff
RTP
Rugby
Running
Running Shoes
Scan
Severs
Shin-pain
Shoes
Shoulder
Shoulder Dislocation
Sitting
Sleep
Soccer
Spinal-fusion
Spondyloarthritis
Spondylolisthesis
Sports Injury
Sports Physio
Standing
Standing-desk
Statins
Stem-cells
Stress Fracture
Stretching
Sugar
Supplements
Surgery
Sweat
Tendinopathy
Tendinosis
Tendonitis
Tmj
Treatment
Vertigo
Walking
Warm-Up
Weight Loss
Wheezing
Whiplash
Wrist
Yoga