have been offering advice on dance health care
since 1970. My own kids have suffered with it so I have a hands n
empathy as well. This recent posting concerning Osgood-Schlatters
-Growing Pains- needed to be looked into by a number of dancers ,
teachers and of course concerned parents. This is extracted from my
Osgood-Schlatters Disease or 'Growing Pains'
The most common knee pain for ...adolescents
between 11 and 14.
In response to the excellent observation regarding tendon damage in
young people this can be a number of things. Growing Pains, Osgood's
Schlatters Disease or Shin Splints. I have extracted some helpful
articles from the Internet that will be of interest. They are
essentially American articles .
Osgood-Schlatter Disease Kevan E. Ketterling, M.D.
Osgood-Schlatter disease is indeed an impressive sounding ailment. The
name brings to mind exotic illness and many patients tend to confuse it
with Hodgkin's disease, a form of cancer. In reality, Osgood-Schlatter
disease is a very common and benign variety of overuse injury that
occurs in knees of adolescents. It is related to growth of the bones and
thus occurs only in athletes who have not yet finished growing.
Osgood-Schlatter disease refers to pain, swelling and inflammation about
the tibial tubercle. This is the bump on the front of the shin bone (or
tibia) where the kneecap tendon (or patellar tendon) attaches. Force
from the strong muscles in the front of the thigh is transmitted through
this attachment to straighten the knee. The tibial tubercle is also the
site of a growth plate. This is an area of cartilage where bone growth
occurs. The growth plate cartilage is weaker than the underlying bone
and the tendon attached to it.
When the forces across the knee are greater eater than the muscles can
accommodate, the growth plate is pulled away from the underlying bone.
This results in the pain, swelling and inflammation which characterize
the disease. Activity exacerbates the pain, particularly running,
kneeling, squatting and jumping. Often pain occurs in both knees. As
with other overuse type injuries, symptoms are more common at the
beginning of a new season, or after a sudden increase in training
Osgood-Schlatter disease most commonly occurs between the ages of 11 and
15, and is more common in boys. This is a time of rapid bone growth,
which may contribute to the problem. The bones grow so fast that the
muscles and tendons are unable to keep up. This leads to a lack of
flexibility and strength, which increases stress on the tibial tubercle.
When an athlete presents with Osgood-Schlatter disease, x-rays are
usually necessary to rule out more serious problems such as tumors or
infection. Additionally, x-rays may show small extra pieces of bone
forming in the patellar tendon where the growth plate cartilage has been
pulled away from the underlying bone.
Treatment begins with a short period of rest and methods to reduce the
inflammation, such as ice and inflammatory medications. A rehab exercise
program is then beg un, emphasizing flexibility and strength,
particularly in the quadriceps muscles. A brace which decreases the
force on the tibial tubercle is often useful to keep the athlete
competing. The goal of treatment is control of the symptoms until growth
is finished since once the growth plate has fused to the underlying
bone, the problem resolves.
Emphasizing pre-season conditioning can help to prevent development of
Osgood-Schlatter disease. Incorporating stretching to increase
flexibility into the work-out routine is also important. Lastly, it is
important to recognize that in adolescent athletes organized team sports
may be only a portion of their overall activity. Gym class, sandlot
sports, and even play activities may contribute to overuse injury.
1997-99 Fox Valley Orthopaedic, all rights reserved.
Shin-splints isn't a specific diagnosis,"
reports Dr. Robert Gambrell of the Medical College of Georgia Center for
Sports Medicine "It really means that your shins hurt and you don't want
to move them. " Shin-splints generally involve pain in the front or
inside part of the lower leg. This pain frequently results from
tendonitis, the inflammation of the muscles where they attach to the
bone," said Dr. Gambrell.
Growing Pains are Real and Common Among Children
By Dr. David Zuckerman
Growing pains. An old wife's tale? Well, yes and no.
Adolescents do experience accelerated growth spurts. And the foot,
ankle, and leg pains that young boys - and increasingly girls - report
are associated with growth plate centres. Thin, flat, crescent - shaped
growth centres separate bone and cartilage in younger children. As a
child nears puberty, these growth centres close and ossify, the process
by which cartilage becomes bone.
Between the ages of 8 and 12, when boys and girls become more active in
sports, or dance, a child may complain of pain or parents may notice
limping. While these complaints are historically more common among boys,
as more and more girls join in hockey, soccer and other team sports,
they, too, suffer growth centre pain. The most common growth centre
complaint I treat is severe pain behind the heel, which stems from
overusing the foot and ankle in hard training. The fibres of the
Achilles tendon pull on the heel's growth plate and create inflammation
within the heel bone.
Growth centre pain is even more common among children who have flat
feet, toe-in or have other foot problems. For these youngsters, an
orthotic, a splint or soft cast is usually enough to properly position
and strengthen feet an d ankles, and prevent future pain and injury.
With prompt treatment, growth centre pain persists only a few days or
weeks and surgery is rarely needed. Untreated, growth centre injury can
require long term treatment.
Such an injury can even result in fracture or dislocation of the growth
plate, chronic pain, muscle imbalance, reduced range of motion,
shortened limbs or permanent joint deformity. In extreme cases, a total
joint replacement may be necessary.
When I suspect a youngster's pain is growth plate related, I x-ray the
area to rule out fractures or dislocation of the growth plate, which is
held together only by cartilage. I examine the child's practice and game
schedules, and I often find the youngster is playing sports year-round,
practicing daily, warming up with wind sprints and skipping proper
cool-down exercise. Kids will resist interrupting their game and
practice schedule, even for a short time. But sometimes the podiatrist
must immobilize the injured growth centre in a soft removable cast o r
splint for a brief period. Then, more often than not, he or she, can
prescribe an orthotic for the shoes that allows the child to play,
Usually, when growth centre pain occurs, modifying activity is enough to
remedy the problem. Above all, parents and coaches must never allow a
youngster to play through injury or pain. The writer is a surgeon
podiatrist who practices in Woodbury, NJ.
This is a reprint from the Pulse Section of the Courier Post.
Growing Pains In Children by Bruce A. Epstein, M.D. - 6/8/92
Growing pains are a family common occurrence in a paediatric population.
These discomforts are all too familiar to the concerned mother or father
who has awoke in the middle of the night to the sound of a crying child.
Rushing to the bedside, the parent finds the child holding their leg in
Remarkably, a gentle massage, some hugs, and a few words of reassurance
are all that is needed to soothe the pain. The recovery is usually
complete by dawn, and the parents are frequently astounded by the sight
of their healthy child bouncing out the door at full speed, pain free .