It's time to get into the training. We'll cover the science of pain and knee rehabilitation, a full body foam rolling routine, and knee isometric holds.
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Every week the content in this top section (blue background) will outline your weekly tasks, and highlight changes from he previous week. (Modifications will be in bold).
More detailed instructions and information plus photos or videos explaining new exercises are located in the main page section (white background).
Common questions for this week can be found at the end of the page.
Being in pain is the worst. You can’t play the sport you love, climbing stairs is a struggle and you can feel isolated, alone and frustrated. But pain doesn’t define who we are, it’s simply a hurdle that we have to overcome.
We will be asking you to report your knee pain levels throughout the next seven weeks of this program, so it’s worth taking a little time to understand exactly what pain is and what is happening in our bodies and brains when we are injured.
Understand pain
This short video is a great starting place to better understand what is happening when we are injured and the mindset we should be focusing on as we aim to become pain free and go back to normal movement. We recommend you (and even coaches) watch this video, maybe even refer back to it throughout the program.
Scoring your pain
This short video below explains how to best score your pain.
We recommend doing one or two squats to a moderate depth and then scoring the amount of pain out of ten, with ten being the worst pain you have ever experienced, and 0 being I cannot feel anything. To keep this consistent do the test squats to the same depth every time, using a chair or stool is a great way to control this.
Exercise: Foam rolling
The first and most important thing to do when trying to fix Osgood Schlatter Disease is to create some length and flexibility in the quad to accommodate the rapid bone growth and take the pressure off the attachment site at the knee.
Stretching the quad alone is problematic, because you are actually pulling on the sore bit and potentially making it worse. This is not fun, especially if your knees are sore and flared up.
This is what trips up most people. As their soreness increases, they stretch less which makes it harder and harder for the quads to keep up.
Foam rolling for self-myofascial release provides the perfect solution. Rolling allows you to create some length in the quad without pulling directly on the sore tendon as you would with stretches.
WARNING: Foam rolling can be quite painful on the muscles when you first start. It is important that you persist and continue rolling as this is critical to curing Osgood Schlatters. The good news is the more you roll the less it will hurt until eventually, it will even feel good! You just have to push through the first few days where it really hurts the tight and weak muscles.
Foam rolling instructional video
The video below shows instructions for how to perform the foam rolling routine - pay close attention to the slow controlled motion and the alignment of James’ limbs in each position.
Isometric holds (or ‘Isos’) just short of terminal knee extension (we call it the shake point) are amazing at helping settle down sore knees and strengthen the muscles that support it. They work in three ways.
They promote analgesia (pain relief) at the tendon, which will be incredibly beneficial in the weeks to come when we add the strength component of the program.
They activate and strengthen the quads (in particular your VMO) to support, protect and deload the knee.
They take advantage of a phenomenon called mechanotransduction which in the case of Osgood, is the tendons way of responding to isometric loading to heal the tendon tissue and stop the pain cycle. We have found four sets of 30 seconds (each leg) to be the perfect dosage.
The VMO (highlighted) is a key muscle to strengthen for your Osgood rehabilitation
WARNING: These might cause a slight amount of discomfort in the knees or quads during the hold or while lifting the weight into place. If this happens to you, lighten the weight or swap to double leg holds. Some low level pain during these holds is normal, so do not be alarmed by this.
Knee isometrics instructional video
The video below shows instructions on how to perform the knee isometrics - pay close attention to the placement of the weights on the ankle, the alignment of the foot and the slight bend in the knee when holding the weight.
If doing these at home, we have received feedback that the grocery bag method can be tricky to get set up and comfortable to do. With this in mind we now recommend purchasing a set of adjustable ankle weights as they are more comfortable and can be easily calibrated to get exactly the right weight. These adjustable ankle weights are our favourite for this.
At home option
While the leg extension machine is the easiest way to do knee isometrics, doing them at home with ankle weights (or anything appropriately weighted) can still work great.
First get your weights. Sand filled ankle weights can be purchased from most sports stores and online, you will need ten pounds (5kg) per leg to get started. Alternatively, reusable fabric grocery bags with 3-4 cans of baked beans (or bottled water, etc) will work just fine. Be sure that the weight on each leg is equal and that the straps don’t cut into your shins or ankles.
Find a stable seat or bench high enough that your weights will clear the ground and sit far enough back on the bench that the edge is just behind the knees.
Lift the loaded left leg up until the knee is only slightly bent and point your toes directly up to the roof. This is the holding position.
Start your timer or stopwatch and hold for 30 seconds
At the 30-second mark swap sides bringing your loaded right leg up and lowering the left leg.
Repeat for eight total holds (four each side) for a total of four minutes
A set up like this can work well with a few household items
The leg extension machine is the best way to do your knee isometrics. Every gym will have a different model so best to ask a gym instructor to point it out and show you how to adjust the machine to suit your height.
Take a seat in the machine. Be sure to set the backrest far enough back so the edge of the seat is just behind the knee.
Set the roller pad up so it is resting as low on your shin as possible, but not on your foot. Set the weight to it’s lowest possible setting (on most machines this is 5kg or 10lb).
Lift the weight up with both knees reaching full extension before dropping the right leg away.
Slightly bend your left knee and point your toes directly to the ceiling. This is the holding position. Notice in the picture how Jacob’s knee is not fully locked out but is slightly bent.
Start your timer/stopwatch and hold for 30 seconds.
At the 30 second mark bring your right leg up to take the weight, lower the left leg and start the timer for the right leg (remember to slightly bend knee and point the toes directly up at the ceiling).
Repeat for eight total holds (four each side) for a total of four minutes.
Leg extension machines vary in shape and size
Important notes on doing the knee isometrics:
If the pain is in a different location to your usual Osgood pain, or feels different to the normal pain then stop immediately and review the instructions closely before proceeding.
Ensure the entire thigh is supported on your chart or bench, with the surface you are sitting on going all the way out to the back of the knee. This allows you to relax the leg and focus on the quads directly
Do not hold the knee in a fully locked/extended position. There should always remain at least a small amount of flexion at the knee joint.
Use less weight than you think. The goal is not maximum load but to achieve a high quality duration of time under light load. Starting with literally 1 pound (0.5kg) is often a great entry level.
Closing Week One
Continue foam rolling routine, performing the knee isometric holds every day and filling in your workbook.
Some people like to roll twice, it won’t do any harm if you have the motivation. The foam rolling routine should take ten minutes, and you need to roll each position ten times. Once per day is enough for the knee isometrics
When should I do the knee isometrics?
Perform the knee isometric exercises immediately after your foam rolling. Be sure to pay close attention to the instructions below when performing this exercise. You will do four 30 second holds on each leg, alternating legs. Many people like doing both these activities prior to sport or activity as it can warm the knees up.
I only have knee pain in one side, should I still train the pain-free side?
Even if you only have knee pain on one side, you should still do all the exercises for both legs, this will keep you balanced and prevent future knee pain in that leg.
Can I still play sport? Can I do other activities?
As a general rule, most young athletes completing this program can maintain about 40-60% of their normal activity levels they had been doing prior to starting the plan. They are usually able to build this percentage back to 100% gradually over the seven weeks.
We advise against starting new activities (swimming, cycling etc) during the plan as these can be a source of new knee pain. We offer suggestions to help you return to fitness after completing the full seven week plan. For more information please refer to the Knowledge base document.
