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Osgood-Schlatter disease - jumpers knee

Osgood-Schlatter disease is most common in almost every sport involving frequent jumps, runs, and extensions of knee joint with great strain. In e.g. volleyball jumpers knee represents 28% of all injuries, in other words as many as 40% of top notch athletes have issues during their career. It's no better with basketball, handball, high jump, triple jump, weightlifting, cycling, art skating, ice hockey, ski running, and tennis.

A basic characteristic of this condition is pain in the knee area right above or beneath the patella (knee cap). It is a small bone on the front side of the knee, easily noticeable, because it is positioned right under the skin. Its function will be clearer if you're aware of the position of it in the knee joint. Actually, it is „inserted“ in the tendon of the great thigh muscle (quadriceps or four-headed muscle of the upper leg) and it serves as a mobile spot of anchorage, reducing friction of tendon and making movement easier. During great strainage, inflammatory processes happen in places where patella connects with the tendon, and this is called „jumpers knee“.

Other than pain on touch and during squats, pain is typical after long sitting with bent knee, e.g.in the car or during a play or a movie, so this condition is called „cinematographer's sign“. When these symptoms present themselves, it's good to undergo some extra tests in order to objectivize the results, which is best done by ultrasound, because other than affirming clinical diagnosis it's important to confirm the stage of the disease.

Along with strainage as the most important factor, developing jumpers knee can also be caused by „X“ and „O“ legs because of irregular transfer of pressure through tendon and patella, then also weakness of some hip and stomach muscles that have a role in the jump, because this condition additionally enhances the pressure on quadriceps tendon. Risk factors involve not enough stretching or shortened hamstring muscles, which under these circumstances presents additional resistance to knee extension. Hard sports mats, as well as inadequate shoes, can add to development of this painful syndrome.  All this speaks of the necessity of prevention in the training process, through frequent stretching, and strengthening of the proportionally weaker muscles which participate in jumping and running, as well as dosing the strain in training, and ensuring enough time for rest and recovery. But after the injury develops itself, therapy should start immediately, because this syndrome most likely will not pass by itself.

At first the treatment begins with ice (kryotherapy) and rest. With very acute conditions, medication is also advisable. Ice calms the inflammation and reduces pain, which is very important for treatment continuation. After three to five days hot-cold procedures should be continued, along with laser , ultrasound , electro therapy and magnetic therapy, in order to enhance tendon healing. In combination with physical agents you should work on quadriceps strength, especially working out with extended knee, small weight, and great number of repetitions. This approach enables gradual muscle strengthening with better tendon circulation, and without further damage. Stretching is also very important, especially of hamstring and calf muscles, and hip and stomach muscles. Balance board is also great, because it involves interaction of nervous system, joint receptors, muscles, tendons, and ligaments. In later phase of treatment, exercises for strength and endurance are also included.

In the last ten years a great help for jumpers knee has proven to be shock wave therapy (ESWT).

It's important to conduct alternative training during therapy in order to maintain endurance (swimming, strength exercises etc.), and everything must be done with patience, because treatment can last several months. Surgery is rarely applied, and is only the last solution advisable.                
Osgood- Schlatter's disease or syndrome is a type of jumpers knee that usually affects adolescents, and statistics prove it is one of most common syndromes of that age group. Pain is felt on the front side of the knee, but unlike jumpers knee, both pain and swelling are presented a little lower, on the quadriceps (patellar ligament) and lower leg vertex. More precisely, calf bone or tibia. Symptoms are the same as in jumpers knee, sometimes followed by swelling, and enhanced during physical activity.

In the place of tendon and bone vertex there is a bone bump easily palpable under the knee because it's placed very shallow under the skin. In children who are still growing, this bump is not completely connected to the calf bone, but a thin cartilage layer is inserted between them. Its purpose is to enable further bone and bump growth, or in other words, child's growth. When this part of locomotor system is overstrained (in excessive running, jumping, and generally intense sports activity) very strong pulling forces can occur, which the tendon transfers to the bone bump and the cartilage layer. In some children this can result in inflammation of this layer with accompanying pain and impossibility of walking downhill, running or jumping. This condition is also called Osgood- Schlatter's disease.

Recognizing this condition immediately is of grave importance. In young athletes it often goes unnoticed or neglected, and it can also be mistaken with pain from the blow to the knee, especially in sports such as volleyball and handball, where falling is a part of the game. When diagnosed, sports intensity must be reduced, and sometimes stopped. Next follows anti-inflammatory therapy. Most efficient is ice, and some methods of physical therapy can also be applied (like magnetic therapy, electrotherapy, and laser). But perhaps the most important thing is to discover whether something outside the system for knee extension and congenital sensitivity to pulling forces caused this inflammation. All kinds of factors can be involved, such as playing sports on hard surfaces, inadequate shoes, too intense training process, irregular training, all the way to shortened muscles due to speedy growth, flat feet, and bad running and jumping technique. 

After the initial inflammatory process is soothed, further treatment is similar to jumpers knee therapy. Also, a coach should examine the running and jumping technique, and determine maximum strain that injured adolescent can bear without risk of further injury. Returning to sports should be very slow, with frequent check-ups with the doctor and physical therapist. Also, one must be patient in this process, because inflammatory processes reduce very slowly, so entire treatment can last several months. Using compresses and orthosis for the knee should be arranged with the specialist and not self-applied.

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