Eliminating Your Pain: Finding Your CONTROL – ALT – DELETE

control alt delete 28When your computer locks up, what do you do?  The CONTROL – ALT – DELETE key combo is probably your go-to plan to put your computer back in business.  How cool would it be if you could quickly fix your body when unexpectedly pain locks you up?

I’m here to tell you that you can do just that!

Unwelcome Guests

We all get them so it shouldn’t come as a surprise to any of us.  Their disguises may vary while their locations tend to be a bit more consistent.  Meanwhile, they are rarely welcome and we never quite know when they plan on leaving.

Who are these mystery intruders?  They have many name such as aches, stiffness, joint catching, shooting pain, throbbing, spasms, stabbing tendon pain and/or deep-bone pain.  Do any of those different forms of pain sound all too familiar?

Onset of Pain

Some of these mild to moderate pains, although not enjoyable by any means, can be justified based on your history.  An old injury or surgery can add merit to why a joint is stiff or why a muscle is not as strong as its counterpart on the  other side of your body.

But what about the sudden stabbing pain in the front of the shoulder when you reach into the frig to grab the milk or when your kneecap catches as you bend down to pick up your shoes?  An injury is almost understandable when it occurs while you lift a heavy weight or run hard up a hill but “…how can I hurt my damn back just sitting at my desk?!”  Those are the pains that frustrate us; athletes and non-athletes alike.

Injury vs Pain

If you have a legitimate injury, get it checked out by a sports doctor, physical therapist or certified athletic trainer.  These quick fixes I’m about to tell you about don’t pertain to serious injuries.  If you’re dealing with a mild to moderate pain, as noted above, you may be able to eliminated it quickly and effectively.

Delving into a deep sports medicine diagnosing injury lesson is well beyond the scope of this article.  Keeping it simple: If your pain started without involving an accident of any sort, a significant change in your activity level and/or is not accompanied by swelling/redness and/or an increased warmth in the area of pain, you might be able to promptly improve your symptoms.

If you have any questions or concerns about your symptoms, see your doctor ASAP and get a firm handle on your injury.

Finding Your CONTROL – ALT – DELETE

When my shoulders hurt, somewhat common after many bike crashes, falls and a shoulder surgery, my Go To Fix-It move is: Pushups.  90% of my shoulder throbbing, stabbing and impingement pain will disappear after a quick set of 25 pushups.  I’m literally smiling as I type this because I love pushups!  They are my shoulder CONTROL – ALT – DELETE solution.

I personally have six (6) of these body pain eliminating routines in my personal toolbox which are awesome quick-fixes for my many orthopedic ailments.  They take no more than 5 minutes to complete and they keep me very active, almost pain-free and, as my wife will agree with, much easier to live with.

My question to you: What are your CONTROL – ALT – DELETE’s?

Tips to Finding Your CONTROL – ALT – DELETE’s

Go With What Works – what have you done in the past that helped you with this type of pain with this joint/body part?  Start with what has worked in the past and work on modifying your technique to improve it’s effectiveness and prolong its benefits.

Stop Looking for the Why – When in pain, the WHY is far less important than the HOW.  Eliminate your pain now and worry about your selfie-in-pain FB picture later.

Bilateral Movements – Your body likes balance.  Doing bilateral (both sides of your body) movements like twists, double arm stretches, bike riding, arm circles and crunches are typically the best moves to start with.

Slow Movements & Deep Breaths – Unless you’re a chiropractor, keep all you movements slow and methodical.  Slow and deep breathing relaxes your body and allows you to listen to the message your body is sending to you, be them good or bad.  Remember, you’re trying to “reset” your body to be balanced and pain-free so allowing for ample time in these new positions is crucial.

Posture, Posture, Posture – Poor posture is a very common source of pain in adults.  Viewing front, side and back photos of you standing and sitting will quickly show visual cues to problem areas in your body.  Focus on stretching stronger/short muscles and strengthening weaker/longer muscles.  Head and neck posture is a common problem in our sit-friendly society.

Examples of Simple Pain Eliminating Solutions

Shoulder Pain – Pushups, door stretches, resisted external rotations, ice massage, thumb-up dumbbell side raises, pool water movements, and seated rows.

Low Back Pain – Crunches, hamstring stretches, laying on hard floor with pillows under knees, hip flexor stretches, bike riding, groin stretches, rolling tennis ball into front/side of hip, Yoga downdog stretches and double arm pull-up bar hangs.

Knee Pain – Roller on front/side of quads, quad stretches, controlled quad strengthening, ice massage, hamstring stretches, massaging and mobilizing kneecap, hip flexor stretches, wall sits, Yoga downdog stretches and bike riding.

Ankle Pain/Heel Pain – Yoga down dog stretches, barefoot walking on soft surfaces, arch & calf massage, ice massage, duck walks on grass on heels only, resisted ankle motion: outward and upward, eliminate shoes with moderate to high heels, picking up marbles/rocks with toes and a heel lift if legs are not equal length.

Key Point to Remember

Your body does not want to be in pain.  Your objective for this endeavor is to put your symptomatic body part(s) in a position which is pain-free and strong to allow your body and mind to reprogram all your associated muscles, tendons, joint capsules and fascia to maintain this “happy place” allowing you to move with less resistance and less pain. Period.

I know this concept sounds very different from the all too common; “medicate to reduce pain” philosophy.  Personally, my physical therapy motto is simple:  Trust your body to know what it needs to do its job!

Being active and healthy is NOT a passive process.   There’s no better time than now to get busy eliminating your pain so you can get busy living.

Tackling a Lateral Meniscus Tear of the Knee


Understanding a Lateral Meniscus Tear

“I tore my cartilage” is the term most athletes use to describe the possible source of their knee joint line pain.  About 40% of the time, they’re correct.  Now ask them to identify culprit, aka “the cartilage”, in a police lineup and they’ll probably have the look of a cow staring at a fence.

The medial (inner) and lateral (outer) menisci are made up of very resilient cartilage.  Their design and cellular structure allows them to assist in the stability of the distal femur (thigh bone), distribute body weight forces across the joint surfaces and absorb compressive forces as we move.

Injuries to the menisci can significantly impair knee functions. Because of their relationship with other structures in the knee joint, the lateral meniscus is less prone to injury when compared with the medial meniscus. The lateral meniscus has less direct attachments to other structures in the knee. However, the long-term impact of a lateral meniscal injury is more concerning due to the high weight-bearing forces in the lateral compartment of the knee.  In other words, if you have a lateral meniscal injury, your likelihood of needing to have it addressed surgically increases and the presence of accelerated arthritic damage rises with time when compared to the medial meniscus.
The types of injuries to the lateral meniscus vary in location and severity, ranging from splitting into two segments to tearing around its more “C” shaped borders. Over time, meniscal micro trauma can result.

The lateral meniscus has minimal blood supply around its periphery.  With no direct blood supply to its central region, one can typically expect minimal healing with injuries involving this region of the lateral meniscus.

The two most common causes for meniscus tears are direct trauma and degenerative conditions. More often, the traumatic injuries involve twisting of the knee with the knee in a bent position.  This is commonly seen in contact sports. With this mechanism of injury, the foot is fixed to the ground resulting in a stretching of the meniscus. A direct blow to the inner part of the knee joint can also injure the lateral meniscus.

The degenerative damage is more commonly seen in the older population and is often associated with underlying arthritic changes. As the meniscus lose significant blood supply and weakens, it becomes more prone to injury. In this population, simpler twists and forces associated with daily activities may prove to be the cause of a meniscal injury.

Signs & Symptoms of Lateral Meniscus Tear

  • Excruciating pain and swelling immediately or up to 3 days after the activity in question.  Lateral joint line pain increases with rotation of the knee and weight-bearing.
  • Difficulty walking, bending or rotating the knee against resistance due to lateral knee pain.
  • The knee joint may become locked or “catch” if the loose piece of the meniscus is in a position of pain within the joint.  This flipping of the flap or unstable section of the cartilage will typically prevent full extension more often than it will limit full flexion.
  • Joint stiffness and tenderness around the outer edge and back ridge of the lateral joint line.
  • A general sense of insecurity with the knee with increased activity contributing to what older athletes tend to refer to as a “trick knee” due to its unpredictability.

Professional Treatment for Lateral Meniscus Tear

The best treatment is often a treatment of the symptoms and not the injury itself due to the limited healing capability of the meniscal tissue.

  • Ice the knee at least 4 times per day and immediately after all athletic activities.
  • Utilize the latest physical therapy modalities and rehabilitation equipments to control the pain, swelling and tenderness in the in and around the joint.
  • Strengthen the muscles directly influencing the knee joint. Strengthening exercise should be mostly pain-free. Muscles of the thigh, quads in front and the hamstrings in back, should be the main focus along with the hip rotators and the calves.
  • Soft tissue massage and stretching of the surrounding muscles and fascia needs to be included. This encourages the muscles to stay pliable which will accelerate the recovery time.
  • Surgery?  Let the doctor and YOU determine the answer to this question.  Closely monitor your symptoms and your activity level before you decide to “go under the knife”.  If unsure, gradually test your knee with functional activities along with the watchful eye a sports medicine specialist.
  • Eat right and drink right.
  • Be cautious of activities that twist the knee to avoid aggravating the injury.
  • Rest as needed.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this injury related to my athletic activities?
  2. What structures in my knee are damaged?
  3. Do I need further diagnostic test like an MRI?
  4. Do I need to have a knee scope and/or a micro fracture surgery?
  5. What kind of exercises do you recommend?
  6. Are there any long-term complications that we should discuss now?

Elite Sports Medicine Tips from Mike Ryan

  • Train With “Training” Specifications: Train smarter.  You can be aggressive and keep your knee pain-free by minimizing the twisting motions during your training.
  • Surgery is Just One Option on the Menu:  Many doctors may tell you otherwise but here is the truth: Just because you have a meniscal tear does not necessarily mean you need to have surgery.  The location of your injury, your pain level, the present knee limitations and your past medical history are the most important factors in determining whether you need to be walking around the surgical center trying to look cool in one of those drafty Johnnies!
  • Grocery Choices: You know when it’s junk or healthy. Help yourself to a healthy diet if you’re serious about getting back to competing like you did 10 years ago.
  • Ride Your Way Up: Don’t play “hero” on day #1 with your agility drills and running.  Bike riding is a great way to get your range of motion back and to start the leg strengthening process the smart way.  It’s time to change your mindset and getting on the bike and in the swimming pool is a great way to start.
  • Employ Proper Techniques: You accidentally did something wrong to incur the meniscal tear so now your focus should be to doing it right. Proper techniques and progression are the keys along with getting in with the right physical therapist.

Playing it Smart with Pes Anserine Bursitis of the Knee

Pes Anserine Bursitis
Pes Anserine Bursitis

What is pes anserine bursitis? This ailment, while not extremely common, can be quite painful. It is the result of inflammation of the pes anserine bursa, which is located just below and to the inner side of the knee. A bursa is a fluid filled sac that acts as a cushion and is located close to most major joints of the human body.

This is a location vulnerable to repeated injury in athletes due to the fact that several ligaments, tendons, and muscles all meet in this same general knee area. This area of ‘high traffic’ can become aggravated with overuse. A typical mechanism of injury is a direct blow to the per anserine area at the upper inner tibia just below the knee. As you know, there is very little protection in this area with no muscle bellies or large fat stories to buffer the trauma.

The MCL, semitendinosus, sartorius muscle, and gracilis muscle all meet at the proximal tibia where this important bursa is located. They each provide support and alignment during body movement. The pes anserine bursa acts as a lubrication device, which minimizes the stress to the underlying tissue during interaction of the knee and all the surrounding tissue. This allows for proper body mechanics and weight distribution with all activities involving the lower extremity.

Sign and Symptoms of Pes Anserine Bursitis

Pes anserine bursitis is most common in long distance runners. Failing to properly stretch is a main cause but this condition also occurs in athletes who tend to contact the ground with their foot rotated outward. Even the slightest outward rotation of the lower limb during contact with the ground causes poor weight distribution and strains the inner thigh muscles and knee ligaments.

The following are symptoms of pes anserine bursitis:

  • Pain at the inside of the knee with repetitive knee movement (usually while extending the knee or climbing stairs).
  • Palpable swelling, warmth and tenderness on the inside of the knee 2-3 inches below the jointline. Often the pain associated with a bursitis can be minimal and the athlete reports that it “looks a lot worse than it feels”.
  • Redness over and around the area of the per anserine.
  • Pain located just below the inside joint line of the knee, which increases with resisted knee flexion and/or adduction (pulling the legs together).
  • Knee weakness associated with activities.

Professional Treatment for Pes Anserine Bursitis

Do not underestimate this injury. Take the necessary time off to allow for a full recovery prior to returning to your activities. One of the most common mistakes athletes make with this injury is not allowing for ample time to allow for sufficient healing before subjecting the tissue to high level stress. When this happens, the symptoms return much worse than previously experienced as you enter into the world of “chronic bursitis” and let’s just say that is not a fun place to be!

The following are my treatment recommendations for this condition:

  • Rest affected area by minimizing the activity associated with the cause the ailment.
  • Apply ice packs for 10-15 minutes 3-4 times daily.
  • Utilizing the necessary therapy modalities to decrease pain and reduce swelling.
  • Regularly stretch the knee, thigh muscles, and hips to promote relaxation of the area. Remember to breathe!
  • Proper diagnosis from your primary physician may require a referral for an x-ray an/or special test. Pain caused by pes anserine bursitis can mimic that of a stress fracture of the proximal tibia with endurance athletes.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Are you certain of your diagnosis of pes anserine bursitis or are there other injuries the source of these symptoms?
  2. Are all of the surrounding knee structures stable and intact?
  3. What activity do you believe is causing this pain and what can I do to prevent it in the future?
  4. Would you evaluate my lower extremity biomechanics to see if I have a leg length discrepancy, alignment problem or foot pathology that is a contributing factor to my injury?

Elite Sports Medicine Tips from Mike Ryan

  • Take a Timeout – In order to prevent any further aggravation to the knee take time off NOW so you can enjoy your sport next week.
  • Stretch It Out – Stretching works wonders for the body and proper healing of an injury such as this where muscles and tendons are involved.
  • Refill The Ice Tray – By now you may want to purchase additional ice trays after all of the icing that you will be doing! Ice is a great vasoconstrictor and it quickly reduces swelling. Apply the ice to the inside of the knee.
  • Baby Steps – After you feel you are healthy once again do not go out and run a half marathon! Start small and avoid obstacles such as hills and high intensity workouts while your leg strength and flexibility improves.

Knee Therapy: Sports’ Best Kept Secret

One of the most common questions that I’m asked is:  “With a sports-related injury, when do I use ice and when should I apply heat?”

ICE THERAPY the best kept secret in sports medicine, period!

All the fancy machines and cool rehab techniques may get all the hype.  But if you ask the elite athletes with a knee injury what helps them maintain their body and assist their recovery the most, they will tell you that some form of ice therapy is vital.

Personally, my best training partners when it comes to athletic injuries is ice therapy.  I often use ice to help me control soft tissue pain and supercharge my recovery.

Knee Surgery Recovery is Enhanced With Ice

Recovering from any type of knee surgery is not easy.  Unless you have the unique skill of a gymnast, you won’t be able to walk around on your hands all day.  With the painful and lengthy rehab work that needs to be done with most knee injuries, you’re creating additional swelling and pain in the joint on a daily basis.  Knee surgery recovery starts with pain control to allow you to increase your range of motion (ROM), increase your strength and to restore your function.  Ice therapy is the trick to making that happen as soon as you wake up from your surgery.

It’s not a coincidence most successful knee orthopedic surgeons apply a cold therapy device to their patient’s knees before they even leave the operating room!  What does that tell you?

Injury prevention is an important motivator for me as the founder of this website and I’m sure it is the same for you.  Ice therapy should become a part of your injury prevention plan.

There are many myths and questions in the battle of ice versus heat…so today I am going to shed some light on the truth about ice.  I’ll discuss the benefits of heat therapy in upcoming blog writings.

How to Use Ice in Knee Therapy

Three Benefits of Ice

  1. It’s a lot easier to keep a joint from swelling than it is to reduce the swelling of an inflamed injury.
  2. Icing will quickly relieve knee pain by blocking pain receptors’ feedback to the brain.
  3. Ice will significantly minimize the likelihood that the injury will swell which can actually reduce your recovery time by 50%!

How Does Your Knee Respond to Ice?

  • It decreases inflammation.
  • It moderately reduces circulation to an area which will drastically decrease the rate of tissue swelling. (In contrast, applying heat to an acute injury is like turning on a drippy faucet.  It speeds up blood flow which can quickly INCREASE tissue swelling.)
  • It slows down the metabolism of the injury site which will reduce the body’s normal inflammatory process.
  • It decreases pain.

How Should I Include Ice in my Knee Therapy?

  • Ice the injury and the surrounding tissue, not just at the site of the injury.  For example, if your injury is on the right side of your knee, ice all the way around the knee instead of just on the injured side.
  • Try to ice the knee injury while elevating the body part.
  • Ideally ice with compression.

Methods of icing:

  • Submerge in ice water – the most aggressive and effective way to ice.
  • Ice Bags
  • Ice Massage
  • Frozen Vegetables

How Long Should I Ice My Knee?

  • Ice Massage – 10 minutes
  • Ice Bath, Ice Bag/Veggies – 15 minutes

Ice Massage Made Easy:

Fill a paper cup almost to the top with water and place in the freezer.  Once frozen, peel away most of the cup and massage with the exposed ice.

Common myths about icing

  • “Ice hurts.” Toughen up!  It’s not going to kill you.  Besides, you’ll get used to it.  To minimize your pain when icing the entire leg, keep the distal extremity being iced warm.  One way to do this is to put a rubber glove or bag over the toes when submerging the body part in ice.
  • “I might get frostbite.” The likelihood of frostbite is pretty rare–especially when you are only icing for 15 minutes or less.  However, if you have a circulatory pathology like diabetes or are being medically treated for chronically swollen extremities, consult your doctor before implementing this type of ice therapy.
  • “It’s been more than 72 hours since my injury, so it’s time to switch to heat?” If the injured area feels warm, it needs ice, regardless of the time frame.  So if the injury site feels warm and inflamed, apply ice, even if it’s been more than 72 hours.

The bottom line is simple:  If you want to stay active and continue to challenge yourself as an athlete, ICE THERAPY needs be included in your knee therapy plan.  If you’re pondering the eternal question: “To use ice or heat?”  ICE is always the safe selection.

Chondromalacia of the Patella Tendon

Chondromalacia - Dreaded Runner's Knee

Chondromalacia, known as “Runner’s Knee”, is one of the most common sources of knee pain for athletes over 20 years old.  The patella injury involves the patellofemoral joint, where the patella (kneecap) and the femur (thigh bone) interact.

Chondromalacia is the pathology that takes place when the articular cartilage on the back of the kneecap becomes irregular and damaged.  Because the back of the patella is now not the smooth and firm surface it usually is, it can damage the distal femur articular cartilage surface.  Much like a damaged pulley, the stresses that are placed on the moving surfaces being loaded become a source of patella pain.

Healthy articulating surfaces in the human body, including the patellofemoral joint, have 3 times less resistance than a wet ice cube on ice!  Think about that for a minute. This simple yet amazingly efficient system of transferring forces over joint surfaces allows 400 pound men to run and jump with minimal damage to the joint…..until that articular cartilage becomes damaged.

The back of the patella has a medial (inner) facet and the lateral (outer) facet that both come into contact with the medial and lateral condyles on the distal femur bone.

What Happens When You Have Chondromalacia

In between the two facets is the intrafacet ridge which glides in the trohclea groove located between the medial and lateral condyles of the femur or thigh bone.  Patella injury can result in damage to any combination of these articular contacts or the patella tendon itself.

With activity, the patella may not glide or track in the proper manner with knee flexion and extension.  With abnormal motion, damage to the surrounding tissues and/or the cartilage on the underside of the patella or distal thigh bone can take place.

The vastus medialis muscle, the most distal and medial of the quad muscles, will usually become weak with any patella injury.  With this inner quad weakness and resulting tightening of the outer knee structures, the patella tends to shift too far laterally or to the outside.

Younger Athletes and Osgood Schlatters

With younger athletes who have not physically matured enough to close their growth plates, they are susceptible to Osgood Schlatter disease.  Osgood Schlatters is a condition where the insertion of the distal patella tendon is elevated.  It significantly changes the tracking and movements of the kneecap.  Because of the alterations with the wear patterns of the backside of the patella, excessive articular cartilage damage occurs and patella tendon quickly becomes symptomatic.

Signs and Symptoms of Patellofemoral Pain Syndrome

  • A visible (atrophy) and functional quadriceps weakness when compared bilateral.
  • May have discomfort/pain in the anywhere around the patella with prolonged sitting and activities involving resistive knee extension such as running and jumping.
  • May have a history of Osgood Schlatters disease or patella injury.
  • Swelling sometimes occurs after activity.
  • A palpable grinding/clicking sensation from behind the kneecap with leg extension that may or may not be accompanied by pain.
  • A Q-angle greater than 20 degrees.

Professional Treatment for Chondromalacia & Osgood Schlatters

  • A product like the Trigger Point Quadballer is a great therapy option to relax the quad and increase the knee range of motion
  • Biomechanical analysis to assess the lower extremities bilaterally to determine if there are specific mechanical issues that are contributing to the Chondromalacia.  Common factors are:
    • Leg length discrepancy
    • Poor flexibility
    • Excessive pronation or supination
    • Quad weakness
    • Weak abdominal musculature
  • Consistent use of rollers and massage to the entire thigh area including the lateral thigh, groin and hamstring muscles.
  • Implementing aggressive quad strengthening exercises that are pain-free with minimal patella crackling or noise present.  To accomplish this, the types of exercises, the specific range of motion and the amount of resistance must be closely monitored to safely improve strength without increasing the symptoms.
  • Full flexibility of the lower extremity and low back.  The hip flexors, the IT band, the calves and, believe it or not, the big toe are the most overlooked areas for athletes who are not successful in overcoming this patella injury.
  • Warming up the knees are often overlooked but it is priceless with this injury.
  • Aggressive manual therapy and modalities to decrease the pain while increasing the mobility of the soft tissue associated with the patella.
  • Ice, ice, ice….immediately after any activity.

Questions a Pro Athlete Would Ask about Chondromalacia

To ensure you are treated like a smart professional athlete with a patella injury or Chondromalacia who wants to safely return to his/her sport, you’ll want to ask your sports medicine specialist the following questions:

  1. Are you certain of the diagnosis?
  2. Do I need any other tests to determine the extent of this injury?
  3. How badly damaged is the cartilage on the back of my kneecap and are there any activities that I need to avoid as I rehab this injury?
  4. What are my options with treating this injury?
  5. What factors do you consider to be the main reasons for my injury and, more importantly, need to be addressed with my rehab?
  6. Quad Weakness
  7. Poor Flexibility
  8. My Sport(s)
    1. Who do you consider to be the expert patella rehab specialist in this area?
    2. Do you have a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips To Help You Heal And Reduce Knee Pain

  • Be Farsighted – Chondromalacia is often the result of a biomechanical problem that needs to be corrected.  Look above, below, behind and in front of the kneecap to find the source(s) for the pain..
  • Change Now & Stay the Course – Most factors for patella injuries don’t just go away.  Plan on finding the problem, making the necessary changes and then maintain those changes for the long haul.
  • Be Honest With Yourself – Look closely at your workouts for the past 3 months and ask:  “Did I change too much too soon?”  Increasing the workload too fast is a common problem with athletes suffering from acute patella injuries.
  • Ice is Your Friend – Here we go again…….Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate. You’ve heard me say this many times throughout MRF, however I can’t stress the importance enough. You need ICE and lots of it. Also, if you have a child with Osgood Schlatters, make sure he/she is icing properly.
  • Father Time Has a Bum Knee – As we age our flexibility naturally decreases unless we work at it.  Consistently maintaining out flexibility is the key while joining a yoga or Pilates class is the ideal solution.  Start stretching NOW and take a lot of stress off your knees, patellas and low back so you can make this patella pain a thing of the past.

Osgood Schlatters: Managing Youth Patella Pain

Painful Osgood Schlatters Disease

He has this huge bump below his knee, his doctor says he’ll grow out of it but it hurts him all the time.  What should we do?’ his mother said, frustratingly seeking an answer.

Following a fund raising golf tournament recently a good friend of mine came to me looking for a clear answer for a strange injury with a bizarre name.  Her athletic teenager had an overly large bony lump just below his right knee.  He was 16 years old, still growing and she was understandingly concerned about her son’s knee.

Osgood Schlatters Disease is an orthopedic disorder that results in an enlarged tibial tuberosity just below the front of the knee.  The tibial tuberosity is the lower attachment of the patella tendon.  Because of the excessive forces generated by the quadriceps (muscles located in the front of the thigh) muscles, the load is transferred to the patella (kneecap) and directly to the tibial tubercle on the tibia (shin bone).

Patella injuries are usually a mechanical injury.  In a simplistic manner, when these muscles are contracted, the forces are applied to the tibial tuberosity and the knee is extended.  That’s the easy part.

A growth plate is typically a location at the end of most long bones.   At a growth plate, a cartilaginous ring allows for the growth of the bone.

Chondromalacia is commonly associated with many types of patella injuries.

Here comes the interesting part…..a growth plate is located at the tibial tuberosity.  Therefore, when an active teenager creates excessive forces at the knee with activities such as jumping, squatting, running, trauma,…etc., the rate and the direction of the growth at that tibial growth plate can easily be altered.  Hence, the bump gets larger and more painful.

Patella injuries are successful resolved when addressed promptly. With an early onset of Osgood Schlatters, if the young athlete rests the area for 2-4 weeks and avoids the specific sports activities that worsen his pain, his symptoms will resolve themselves.

Osgood Schlatters and chondromalacia are similar in the fact that when these conditions occur, the athlete is typically predisposed to having symptoms in the future.  With Osgood Schlatters, when the athlete stops growing and his growth plates mature or “close”, the athlete has much less problems with the injury other than the cosmetic appearance and mechanical issues of an enlarged tibial tubercle.

Suggestions to Alleviate Osgood Schlatters Pain

  1. See his doctor to clearly diagnose this problem and to “rule out the bad stuff.”
  2. Ice his knee after every workout and competition.
  3. Become a flexibility machine.  My advice on flexibility: start young and stick to it.
  4. Avoid aggressive leg strengthening exercises and agility work whenever possible.
  5. Rest the knees.  A little rest now will help him avoid missing large chunks of time later.

I think this young man will do well if he follows this advice.  The Osgood Schlatters will quiet down in time.  Meanwhile, the enlarged tibial tubercle will probably not return to its normal size.

As with most sports injuries, the earlier you address the problem the quicker they quiet down.  Being smart now will ensure that you will be active and healthy later!