COMMON ADOLESCENT CONDITIONS – PART TWO: KNEE

Part two of load related adolescent conditions focuses on the knee.

Osgood-Schlatters Disease

 What?

An irritation of the insertion of the patella tendon into the tibia. This differs from adult patella tendinopathy due to the immaturity of the adolescent skeleton which means it affects the actively remodelling trabecular metaphyseal bone.

How?

It is usually due to the area’s inability to deal with an increase in activity (particularly activity that uses that area eg running or jumping sports). It can also be related to growth spurts which puts increased tension through the muscles and therefore tendons.

 When?

More common in boys and usually between the ages of 10-15 compared with girls which is usually between the ages of 8-13.

How does it resolve?

Usually self resolves with time (6-24 months) however the reason it’s best to seek treatment/advice is due to the pain that accompanies the condition which can affect sports performance and most importantly day to day activities. 

What is the treatment?

The main focus of treatment is to reduce pain levels. This can be done in a few different ways including:

-       Manual therapy (eg muscle massage)

-       Taping to offload the tendon

-       Exercises to strengthen key areas 

-       Implementation of load management strategies (eg RPE scale)

-       Advice regarding recovery (eg icing)

The main takeaways about the condition are:

-       The adolescent will grow out of it

-       It can still be quite painful so there should be a focus on pain relief

-       Load management with guidance from a physiotherapist can allow the continued participation in sport without compromising day to day function 

If you would like your injury reviewed by one of our physiotherapists, then don’t hesitate to book an appointment. All of our physiotherapists specialise in sport and have had extensive experience with adolescent athletes.

Load Management

I started writing this blog about 2 months ago as Winter Sports pre-seasons started to ramp up. What a difference 2 months can make right? Back then, my purpose was to focus on the consequences of increasing physical activity (too much load) too quickly. However, on further reflection, the focus can also be on not enough physical activity (under-loading) which is probably more topical.

 What is Load Management in sport?

Very basically it is the balance of physical activity and rest for an individual athlete.

This has two main purposes:

1.     Reduce injury risk

2.     Allow for Optimal Performance

From a physiotherapists perspective, we focus primarily on the first point whereas the coaching staff, club personnel and athletes are more involved with the second point. However, both groups work together to monitor an athletes load “ceiling” and “floor”.

 What is the ceiling and the floor?

This refers to the max load an athlete can tolerate (the ceiling) and the minimum load an athlete should be maintaining (floor). Very basically, if you don’t continue to load your body, it’s capacity/resilience will drop which means it will tolerate less and less load over time (lower the ceiling). If an athlete then tries to increase their physical activity (eg pre-season) then they are at risk of overload injuries like stress fractures and tendinopathies. The ceiling is important because that informs the coaching staff of an athletes current limitations so they can plan for that in their trainings/gym sessions. Luckily, the ceiling can be increased with pre-planned and monitored loading over time.  The main way this is monitored is through the Acute-Chronic Workload Ratio (ACWR).

What is the Acute-Chronic Workload Ratio?

Acute workload refers to the amount of loading over a week. Chronic workload refers to the average of loading over four weeks. Loading can be a number of factors eg kilometres per week which is applicable for marathon runner.

Optimal ratio is 1-1.25 so anything above or below can mean a large spike in injury risk.

Equation: (Acute workload) / (Chronic workload)

Eg week 1 40km, week 2 40km, week 3 50km, week 4 55km

So Acute workload is 55km (the latest week kms)

Chronic workload is average of four weeks ((40+40+50+55)/4) = 46.25

55/46.25= 1.2 (reduced injury risk)

As mentioned, ACWR can be built up over time. For example, the reason marathon runners can do 180km+ per week is because they have painstakingly built up their distance (and therefore ACWR) over years of training.

 How to monitor relative load:

• RPE Scale: Rate of perceived exertion times minutes per session

• Smart watch that monitors distance, speed etc

• GPS: electronic unit that calculates distance, speed, collisions etc

• Subjective Questionnaires (eg Smartabase)

How is Load Management applicable to Elite Athletes?

You may see that every now and again an AFL player is ruled out of a game with “general soreness”, this is most likely because a players load is too high and they are at a high risk of injury so to reduce the risk, they won’t play the game. The same goes with NBA players (eg Kawhi Leonard in the 2018/2019 season) and high profile soccer players. Usually this is done during the season to make sure the player doesn’t get injured before the important part of the season (finals). It also serves to make sure they are “peaking” performance wise. The focus is on winning and the teams chances infinitely increases if their best players are;

A - able to play (no injuries) 

B - optimally performing

How is it applicable to the everyday athlete?

Pretty much the same as above, just because they don’t get paid to play doesn’t mean they don’t want to perform well, remain injury free and win. However, it can be harder for everyday individuals to be able to monitor their loading as intensely as sporting clubs/elite athletes. So here are my top tips for monitoring loading if you don’t have a GPS etc:

• Record each exercise session in terms of duration and RPE 

• Monitor your ACWR (as explained above) by reviewing and planning your training 4 weeks at a

  time (at a minimum)

• Keep an eye on types of physical activity and alternate if possible (eg running/jumping, weights, swimming, bike)

• Apply the 10% rule: don’t increase distance, speed or weights more than 10% on your last session (especially if you can’t calculate your ACWR)

•  Lastly, listen to your body as it will most likely tell you when you need to “de-load”

Main points from this blog:

• You need to load (even if you’re in isolation) otherwise you lose capacity

•  Load a bit more each week if you want to increase your capacity (not more than 10% is a good start)

• Structure your physical activity to load manage which can reduce injury risk as well as improve performance 

• Listen to your body!

 A big thanks to Glenn Stewart, Tim Gabbett and Lauren Shelley for all their work thus far in understanding load management.

If you would like some help load managing, make an appointment (call us on 9361 3777 or click the Book Now button) and any one of our highly trained physiotherapists will be able to assist you.