Baseball/Softball Youth Injury Series: Osgood Schlatter's and Sever's
Osgood Schlatter’s Disease (OS) and Sever’s Disease are common problems affecting young adolescents, especially those who are active in sport. It typically happens from the ages of 8-15 during height of the child’s puberty and growth spurts. OS affects upwards of 17% of young athletes while Sever’s affects up to 16% depending on the studies you read. The fact that these are both referred to “diseases” is a little misleading. When I think of “disease” I don’t think of these injuries at all.
OS and Sever’s affect the knee and heel respectively. Essentially there is an overgrowth of bone in response to muscle tendon pulling repeatedly on the bony surface due to repetitive activity. This often happens during adolescence when the bones are essentially growing faster than the muscles and tendons during growth spurts. The muscles and tendons are “tight” now and the repeated stress of that “tight” tissue during activity leads to the tendon pulling on its bony attachment. Over time, this leads to excessive bone growth in that region with associated pain, inflammation, and sensitivity to touch.
Both ailments are relatively easy to diagnose especially when the bony prominence is apparent to the naked eye. In some instances, radiographs (X-rays) are necessary to see the bony lesion. And even though they’re easy to diagnose, many times parents wait to take their child to seek help. This is because the pain is often associated with sport/activity, but the child’s pain dissipates by the next day following the activity. So, both the parent and child continually write it off as no big deal. If left untreated for a long time, pain will continue to progress, and athletes may miss 4-6 weeks of sport or even upwards of 3 months while rehabbing and recovering. Hence, why understanding what to look out for is so important from a parent’s perspective.
As previously alluded to, OS occurs at the knee when the patellar tendon is excessively pulling on the tibial tuberosity (top of the shin bone just below the kneecap). With Sever’s, the Achilles’ tendon is pulling on the calcaneus (heel bone). Pain and inflammation are localized to these specific areas.
Kids who are affected by these injuries have similar predisposing factors making them more likely for them to experience this pain and sensitivity. Along with tight muscles/tendons, patients typically present with poor stability and control and weakness not only localized about these joints but throughout the trunk and core musculature as well. Childhood obesity is also known to be a contributing factor due to increased load through the musculoskeletal system.
While not completely preventable, these injuries are often reduced with proper sport-specific training programs that are well-rounded including strengthening, mobility work, balance, and core stability to minimize unwanted stress at the knee and heel.