Back to School, Sports Injuries and Dr’s Names……
This month Physiotherapist Paul Carnell discusses injuries commonly seen in children when returning to school.
What condition do we see in Clinic that links the following statements : back to school, sports injuries and Dr’s Names. The condition is Osteochondritis.
Osteochondritis is a condition that occurs in children and adolescents due to the difference in their bone structure compared to adults. In adults the bone is fully matured and hardened, so any excessive strains placed around or in our joints when playing sports or dancing are absorbed by the tendons and ligaments, hence adults more commonly develop tendonitis when excessive strain is placed on the body. Children’s bones are still undergoing growing processes which makes them relatively softer than adult bone. If a child undergoes repetitive sporting activity that exceeds the levels the body can stand the stress will be placed on the relatively softer bone, compared to the tendon, hence inflammation occurs in the bone itself and is called Osteochondritis. This can occur on the outside of joints where muscles attach, but can occur around the areas affecting the bones growth plates.
In Clinic by far the most common forms of Osteochondritis we see are the types where the muscles attach outside the joint, particularly in 11-14 year olds. Many children in this age group experience rapid growth spurts. During these growth spurts the bodies long bones such as the femur and tibia in the leg lengthen at a rate faster than the muscles can adapt to. This leads to the muscles in the legs becoming relatively shorter than usual.
Also in this age group children move from primary to secondary school. At secondary school they may experience more sporting/dance activities than they were used to at primary level. This, plus already active lifestyles with activities undertaken outside school, leads to more stress on their bones and tissues.
This increase in activity level coupled with relatively shortened muscles due to growing bones creates a perfect environment for Osteochondritis to develop. More and more strain is developed through shortened muscle, pulling on the softer bone via the tendon attachments.
Osteochondritis can occur throughout the body, but the 3 main areas we see in Clinic are around the knee and heel bones.
Traditionally, Osteochondritis occurring at a particular site in the body was named after the Doctor that discovered the condition, with the word “disease” after their name. Osteochondritis is a bone inflammation, so calling it a disease sometimes makes it seem more serious than it is.
Osteochondritis where the soft tissue of the Achilles tendon wraps around the heel bone is called Severs disease, named after Dr Sever, who described it in 1912.
Where the patella ligament attaches to the shin bone its named Osgood- Schlatter disease, and where the patella ligament attaches to the knee cap it is called Sinding-Larsen-Johansson disease, after the respective Doctors.
Children developing these conditions will develop pain on activity and localised tenderness where the tendon attaches to the bone. In the case of Osgood- Schlatters disease a bony lump may develop at the top of the shin bone just below the knee.
Diagnosis is usually made on clinical examination alone, with x rays rarely being necessary.
As Osteochondritis in the above cases involves inflammation of the bone due to overuse and muscle tightness treatment and management must involve some modification of activity levels. Complete rest is usually not advocated, however if a child is doing 4-5 activities of sports/dance, reducing the amount of sessions per week will be necessary. Also ice and non-steroid medication can also be utilised.
The other key driver to Osteochondritis is muscle tightness secondary to bone lengthening. Your Physiotherapist can assess for muscle shortness in key muscles and show the associated muscle stretches, plus perform hands on muscle release.
Correcting faulty movement patterns in the body and checking foot and lower body biomechanics is very important in managing these conditions, any may involve basic orthotic prescription.
Once the initial pain and inflammation is under control your Physiotherapist can start to introduce exercises that place low level strain to the points where the bone has become affected by Osteochondritis. Then by slowly increasing the difficulty and pressure exerted by these exercises the bone can become even more tolerant of strain being applied to it, this will facilitate a return to full sporting activities.
The degree of Osteochondritis and therefore amount of bone inflammation can vary from case to case so management of the condition can take weeks and in some cases months.
The most commonly seen forms of Osteochondritis have been discussed, but as previously mentioned this condition can occur in the feet, hands, hips and elbow, sometimes affecting children as young as 8. In all cases accurate assessment of the condition and all of the contributing factors should be carried out by a skilled Physiotherapist to ensure correct management and resolution.