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The Correlation between Knee Flexion Lower Range of Motion and Osgood-Schlatter's Syndrome among Adolescent Soccer Players

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*Corresponding author: Email: amit.tzal@gmail.com;
British Journal of Medicine & Medical Research
11(2): 1-10, 2016, Article no.BJMMR.20753
ISSN: 2231-0614
SCIENCEDOMAIN international
www.sciencedomain.org
The Correlation between Knee Flexion Lower Range
of Motion and Osgood-Schlatter's Syndrome among
Adolescent Soccer Players
Amit Tzalach
1*
, Liran Lifshitz
2
, Moshe Yaniv
3
, Ilan Kurz
4
and Leonid Kalichman
5
1
Physio Pro Clinic, Petah Tikva, Israel.
2
Physio and More Clinic, Tel Aviv, Israel.
3
Department of Pediatric Orthopedic, Sport's Injuries and Arthroscopic Surgery Service,
Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Israel.
4
Sportopedia Clinic, Ramat Hasharon, Israel.
5
Department of Physical Therapy, Recanati School for Community Health Professions,
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Authors’ contributions
This work was carried out in collaboration between all authors. Authors AT, LL, MY and IK designed
the study and wrote the protocol. Author AT wrote the first draft of the manuscript and managed the
literature searches. The study analyses performed by author LK. All authors read and approved the
final manuscript.
Article Information
DOI: 10.9734/BJMMR/2016/20753
Editor(s):
(1) Panagiotis Korovessis, Chief Orthopaedic Surgeon, Orthopaedic Department, General Hospital “Agios Andreas” Patras,
Greece.
Reviewers:
(1) Anonymous, National Medical University, Ukraine.
(2)
Anonymous, Uniort RPG, Brazil.
(3)
Taranjit Singh Tung, University of Manitoba, Canada.
Complete Peer review History:
http://sciencedomain.org/review-history/11493
Received 6
th
August 2015
Accepted 1
st
September 2015
Published 21
st
September 2015
ABSTRACT
Aims:
To evaluate the association between knee flexion range of motion (ROM) and Osgood-
Schlatter syndrome among adolescent soccer players.
Study Design: Observational case-control study.
Methodology: A study group of 20 male soccer players, mean age 13.4 years (13.4±0.7)
diagnosed with Osgood-Schlatter syndrome and a control group of 21 healthy soccer players,
mean age 13.5 years (13.5±0.9) were enrolled. The knee flexion ROM was bilaterally measured in
a prone position by the Ely's test and using a digital inclinometer for angle measurement.
Original Research Article
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
2
Results:
No significant difference between groups was found as to age, height, weight and
dominant leg. Body mass index (BMI) was significantly higher (t = 2.249; P = .03) in the study
group (18.97±1.61 kg/m
2
) compared to the controls (17.79±1.71 kg/m
2
). A statistically significant (t
= -2.701; P =.01) difference was found in knee flexion ROM between the symptomatic leg in the
study group and the dominant leg in the controls, with a lower ROM in the study group
(132.52±12.40) and (141.40±8.35) in the controls. In a logistic regression analysis, BMI and knee
flexion ROM both showed a significant association with the presence of symptoms (BMI: P = .014;
ROM: P = .013).
Conclusions: Proper training including stretching regime to the quadriceps muscles, with focus on
the rectus femoris muscle, during the growth phase of adolescent soccer players should be
considered in order to reduce OSS symptoms or even trying to prevent them.
Keywords: Osgood-schlatter syndrome; range of motion; rectus femoris; soccer players.
1. INTRODUCTION
In recent years there has been a constant
increase in children participating in sports and
recreational activities. In the U.S. for example,
the estimated number of children participating in
organized sports programs is between 30-40
million [1-3]. These sports activities usually take
place during the age of sexual development, in
which the adolescents are still skeletally
immatureand may be more prone to growth-plate
injuries when the epiphyseal physes are still
open [4]. These athletes may also be at
increased risk of injury due to imbalances among
strength, flexibility and neuromuscular control [5-
7]. In many cases, these sports are not coached
in an appropriate way or are insufficiently
supervised, which contributes to problems in the
musculoskeletal system [8-10]. Non-traumatic
knee pain is one of the most common complaints
among young athletes [1].
One example of such a complaint is due to
Osgood-Schlatter's Syndrome.
Osgood-Schlatter Syndrome (OSS), first
described in 1903, is one of the most prevalent
causes of knee pain in physically active young
athletes and the most common syndrome of
traction apophysitis [11,12]. OSS is an
inflammatory response generated by micro
avulsion injuries of the tibial tuberosity due to
traction forces generated by the knee extension
mechanism, mainly by the quadriceps muscle.
OSS is characterized by pain over the tibial
tuberosity, painful active knee extension,
swelling, sensitivity and an osseous bump over
the tibial tuberosity at late or advanced stages.
Bilateral involvement has been described in 20-
30% of patients [10,13,14].
OSS is very common among adolescents
involved in sports which entail jumping, such as
soccer, basketball and volleyball. The incidence
of the syndrome among adolescents involved in
sports is around 13% compared to 6.7% in the
general population [15-19]. OSS usually presents
between the ages of 8-13 among females and
ages 10-15 among males [20-22]. Incidence of
the syndrome among male adolescent elite
skaters was found higher (14.2%) compared to
female peers (8.9%) [16]. In another study, OSS
incidence was almost 4 times higher (P = .014) in
males than female adolescents [23].
The tendency to develop OSS at a young age
may be attributed to the rapid growth and
excessive pulling of the quadriceps muscle at the
tibial tuberosity, leading to an overload at the
tenoperiosteal junction and to decreased lower
extremity control [5,10,24-29]. Periods of
accelerated bony growth and loss of flexibility are
also risk factors in for developing OSS [30-32].
Other intrinsic and extrinsic factors such as
muscle strength, tightness, anatomical variants
of the patella and its tendon, angular and
rotational alternation of the knee, vascular
insufficiency, improperly supervised sports
activity, inadequate sports facilities, footwear and
diverse playing surfaces have been mentioned
as potential risk factors for developing OSS
[15,16,21,23,32-36].
OSS is mainly diagnosed clinically. Symptoms
may appear when direct contact is rendered on
the tibial tuberosity, i.e. during jumping, landing,
passive knee flexion and isometric contraction
[10]. Plain radiographs of the knee are
recommended in unilateral cases of OSS to rule
out other conditions such as acute tibial
apophyseal fractures, infection or tumor [4].
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
3
It was found [14,21,22,37-40] that the symptoms
tend to favorably respond to conservative
treatment and are likely to clinically improve
within two years from initial onset with excellent
prognosis in most cases. Sonographic signs of
active disease were found two years after
diagnosis in 50% of patients [41]. Discomfort
while kneeling and limitation in sports due to pain
over the tibial tuberosity was found in 60% and
18% of cases, respectively [39].
With the rising number of adolescents involved in
sports and a higher incidence of OSS amongst
them, it is important to identify potential risk
factors. Two studies reported a significant
association between decreased quadriceps
length and OSS [15,20]. Additional studies are
needed to confirm this association.
The aim of the present study was to evaluate the
correlation between the knee flexion ROM and
OSS. We hypothesized that the knee flexion
ROM is lower in adolescent soccer players with
OSS compared with their healthy peers.
2. METHODS
2.1 Design
Observational case-control study.
2.2 Subjects
The study group consisted of 20 male soccer
players aged 12-15 (13.4±0.7) years clinically
diagnosed with OSS by an experienced board
certified orthopedic surgeon. All subjects had
symptoms for at least 6 weeks and were
recruited by the author’s request from the youth
chief managers of their clubs for contact
information of players suffering knee pain. The
author contacted the player’s legal guardians and
asked for their interest. The diagnostic criteria
were: pain on the tibial tuberosity upon applied
pressure, pain during jumping, landing and
resistance to knee extension. Exclusion criteria
included a history of knee trauma, neurological
abnormalities and musculoskeletal pain at the
time of testing. The control group consisted of 21
soccer players, recruited in the same manner as
the study group, aged 12-15 (13.5±0.9) years
who had experienced no pain in the knee area.
An explanation as to the study aims and
procedures was given to all subjects and legal
guardians who signed an informed consent form.
The study was approved by the Ethical
Committee, Recanati School for Community
Health Professions, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Beer Sheva,
Israel.
2.3 Outcome Measures
Demographic data (age, height, weight, dominant
leg (leg that kicks the ball), number of workouts
per week and duration of each workout) were
collected using a self-reported questionnaire.
Body mass index (BMI) was calculated as weight
(in kilograms) divided by height (in meters)
squared.
The Ely's test was used to evaluate the knee
flexion ROM [42] (Fig. 1).
The reliability of this test in assessing rectus
femoris muscle length and knee joint ROM was
previously examined using a goniometer with
moderate intra-rater and inter-rater reliability
(Inter Class Correlation (ICC) = 0.69 and 0.66
correspondingly) [42]. In the present study, we
replaced the goniometer with the Saunders®
Baseline digital inclinometer (Chaska, MN) which
supplies measurements up to 1º (Fig. 2).
The use of the inclinometer was favored for two
reasons: 1) a universal goniometer measurement
requires the use of two hands for measurement;
with the inclinometer, only one hand is needed;
2) the inclinometer has been demonstrated to
have good to excellent inter-rater reliability and
validity in numerous studies and measuring
different joints (ICC: 83-97) [43-47]. To the best
of our knowledge no previous study has
evaluated the reliability and validity of the digital
inclinometer using the Ely's test.
All ROM evaluations were performed by one
examiner. Measurements were taken from both
legs, totaling 82 examined knees. Prior to the
test, subjects were given an explanation as to the
nature of the test. They were also asked to
refrain from athletic activity four hours before the
evaluation. Prior to the test, all subjects
performed a 5 minute walking warm-up. The
subjects wore a shirt and shorts and were asked
to relax their muscles and remain as passive as
possible.The test was performed as previously
described in Magee's Orthopedic Physical
Assessment Textbook [48]. The subjects lay
prone and the examiner passively flexed the
subject's knee with one hand while placing the
other hand under the anterior superior iliac spine
in order to palpate when the spine rose from the
bed. The examiner placed the inclinometer on
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
4
the tibial crest with its edge placed just below the
tibial tuberosity
.
He then measured the angle
without observing it and had an assistant record
the obtained results. The test was repeated 3
times, 20 seconds apart, for each leg. The mean
value of the 3 tests was used in further analyses.
The examiner noted if pain was felt in the tibial
tuberosity during measurement
.
2.4 Statistical Analysis
All statistical computations were performed using
the SPSS 17.0 for Windows (SPSS, Chicago, IL,
USA). A normal distribution of quantitative data
was assessed by the Kolmogorov-Smirnov test P
> .05. Statistical analyses were conducted at a
95% confidence level. A P -value of < .05 was
considered significant. Baseline features
compared groups using independent t-tests for
continuous data and
χ
2
tests for categorical data.
Knee flexion ROM of dominant and non-
dominant legs of controls was compared using
the paired t-test. The comparison between the
symptomatic leg knee ROM in the subjects and
the dominant leg in the controls was performed
using the independent t-test.
To evaluate the association between knee flexion
ROM and basic anthropometrical characteristics,
bivariate Pearson correlation analyses were
used. Because presence of OSS was statistically
significantly associated with BMI and knee
flexion ROM, logistic regression analysis was
performed (enter method, constant was not
included in the model) where group belonging
(presence of OSS) was a dependent variable
and BMI and knee flexion ROM (in the
symptomatic leg, if symptoms were unilateral and
the dominant leg if symptoms were bi-lateral)
were independent predictors.
3. RESULTS
No significant difference between the two groups
was found for age, height, weight and/or
dominant leg (Table 1). BMI was significantly
higher in the study group (18.97±1.61 kg/m
2
)
then in controls (17.79 ± 1.71 kg/m
2
), (t = 2.249;
P = .03).
Six (30%) subjects experienced pain in the right
and 3 (15%) in left leg; 11 (55%) had bilateral
symptoms.
Comparisons of knee flexion ROM are shown in
Table 2. No significant difference was found
between the dominant and secondary legs in the
control group (t = -1.892, P = .073) or in study
group (t = 1.023, P = .319 (not presented in the
table)).
However, the difference between the
symptomatic leg in the study group and the
dominant leg in the controls was statistically
significant, with a lower ROM in the study group
(132.52 ± 12.40) compared to controls (141.40 ±
8.35), (t = -2.701; P = .01).
Utilizing the results of our study, we performed a
power analysis: 20 subjects in OSS group and 21
subjects in control group, type 1 error probability
0.05; the difference between experimental and
control groups 10
°
and standard deviation
approximately 10.0. Obtained probability of
rejecting the null hypothesis (power) was 0.869,
which is considered high.
Fig. 1. Ely's test
evaluation of knee flexion
ROM
Fig. 2. Ely's test, using Saunders
®
Baseline
digital inclinometer
1
2
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
5
The results of the bivariate Pearson correlations
between knee flexion ROM and basic
anthropometrical characteristic are shown in
Table 3.
No correlations between dominant leg knee
flexion ROM and basic anthropometrical
characteristics were found significant in the
control group. In the study group, weight and BMI
were significantly correlated (r = -0.475, P = .034
and r = -0.561, P = .010, correspondingly) to the
symptomatic leg (or dominant leg if symptoms
were bilateral) knee flexion ROM. Analyzing the
Linear regression between ROM and BMI among
the asymptomatic subjects (both dominant and
secondary leg) shows lower results R² = 0.055
and 0.184 correspondingly while among the
symptomatic subjects (symptomatic or dominant
leg in bilateral symptoms) the result was higher
R² =0.351. Fig. 3 shows a clearer and more
visible image of the differences association
between knee flexion ROM and BMI in subjects
with and without OSS.
Table 1. Descriptive statistics of the studied sample
Variables Cases (n=20) Controls (n=21) Comparison
Mean±SD (range) t - test
Age (years) 13.45±0.78
(12-15) 13.55±0.93
(12-15) t = -0.363;
P = .719
Height (cm.) 159.35±8.27
(146-172) 159.14±11.11
(145-180) t = .067;
P = .947
Weight (kg.) 48.43±7.61
(36-68) 45.43±8.74
(34-65) t = 1.168;
P = .25
BMI (kg/m
2
) 18.97±1.61
(16.44-22.99) 17.79±1.71
(15.11-21.34) t = 2.249;
P = .03
N (%) χ
2
Dominant leg (Right) 14 (70.0%) 16 (72.7%) P = .655
Side of
symptoms Right 6 (30%) - -
Left 3 (15%)
Bilateral 11 (55%)
SD – Standard deviation; statistically significant difference P < .05 marked in bold
Table 2. Comparison of knee flexion ROM (degrees) (mean±standard deviation)
Cases* Controls Comparison between
symptomatic leg in cases
and dominant leg in the
controls (t-test)
Dominant
leg Secondary
leg Comparison between
dominant and
secondary leg (paired
t-test)
132.52±12.40
141.40±8.35 142.73±7.91 t = -1.892;
P
= .073
t = -2.701;
P
= .010
*Symptomatic leg or dominant leg if symptoms are bilateral; statistically significant difference
P < .05 marked in bold
Table 3. Bivariate pearson correlations between knee flexion ROM and basic anthropometrical
characteristics
Symptomatic leg or dominant leg if
symptoms are bilateral (cases) Dominant leg
(controls)
Age (years) r = -0.114, P = .633 r = -0.193, P = .403
Height (cm.) r = -0.226, P = .339 r = -0.300, P = .187
Weight (kg.) r = -0.475, P = .034 r = -0.321, P = .156
BMI (kg/m
2
)
r =
-
0.561,
P
= .010
r =
-
0.235,
P
= .305
Statistically significant difference P <.05 marked in bold
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
6
Fig. 3. Scatterplot of the association between knee flexion ROM and BMI in subjects with
(Symptomatic) and without (Dominant and Secondary legs) OSS
In a logistic regression analysis (enter method,
no constant included) where group belonging
(presence of OSS symptoms) was a dependent
variable and BMI and knee flexion ROM (in
symptomatic leg, if symptoms were unilateral and
dominant leg in the rest of subjects) were
independent predictors, both BMI (B = -0.386,
P = .014, odds ratio (OR)=.68 (95% confidence
interval (CI) for OR: .5 .924) and ROM
(B = .052, P = .013, OR=1.053 (95% CI for OR:
1.011 1.097), showed a significant association
with the symptoms. The design of the study is
not allowing establishing of causal relationships
between variables. Our speculation is that
individuals with a higher BMI and lower ROM
have a higher probability of experiencing
symptoms of OSS.
4. DISCUSSION
The common hypothesis related to the etiology of
OSS suggests an asynchronous development of
bone and soft tissues, especially the rectus
femoris muscle during the maturation stage
[3,5,8,43]. These periods of accelerated bony
growth might result in loss of flexibility which
presents additional risk for developing OSS [31].
Accelerated bone growth may lead to an
overload at the tenoperiosteal junction of the
tibial tuberosity and consequently to developing
OSS [10,24].
In the present study, we confirmed our
hypothesis that the knee flexion ROM is lower in
adolescent soccer players with OSS compared
with their healthy peers. We demonstrated that
there is a significant difference in knee flexion
ROM between the dominant leg in the control
group and the symptomatic leg in the study
group (t = -2.701; P = .01). This is in agreement
with a previous study [15] that found that rectus
femoris muscle shortening is associated with
OSS.
Muscle length in de Lucena et al’s [15] study was
measured dichotomously using the Thomas test.
Despite the fact that this test evaluated the
length of the rectus femoris, it is less precise and
studies that have evaluated its validity and
reliability are scarce and controversial [45,49]. In
our study, on the other hand, we measured knee
flexion in a prone position allowing for better
control in the pelvic position and measuring the
actual degree of knee flexion.
3
Tzalach et al.; BJMMR, 11(2): 1-10, 2016; Article no.BJMMR.20753
7
A pathophysiology explanation as to our findings
can be found in several studies of human growth
and lifestyle, suggesting that accelerated bone
growth during puberty, accompanied by
asymmetrical muscle tissue lengthening, may
create an overload on the tenoperiosteal junction
[50]. The area may become fibrotic, creating a
lack of local osseous connection or a full
osseous connection and an enlargement of the
tibial tuberosity [20]. However, studies conducted
on adolescent tennis players, employing
ultrasound imaging, revealed that ossicles within
hypoechoic cartilage are common and usually
asymptomatic [51,52].
In light of our results and previous studies,
[15,20] stretching of the quadriceps muscle ,with
emphasize on the rectus femoris muscle should
be incorporated into a prevention program for
OSS at a young age (before symptoms occur) in
order to increase knee flexion ROM and
therefore try to reduce the traction forces created
by the quadriceps muscle on the tenoperiosteal
junction. Studies designed to evaluate the
efficacy of rectus femoris stretching in preventing
OSS in adolescent sportsmen, should be
conducted.
We also found that OSS subjects had a higher
BMI than their pain free peers. The cross-
sectional design of the study did not allow direct
estimation of the causal relationship between
BMI and OSS; however, all our participants were
physically active and no one was obese (see BMI
ranges in Table 1). It might be that higher BMI
denotes subjects with a higher muscle mass or
with accelerated body growth. This assumption is
supported by a significant negative correlation
between knee flexion ROM and weight (r = -
0.475; P = .034) and BMI (r = -0.561; P = .01) in
the study group. We can speculate that stronger
muscles, especially if they are shortened
produce more pulling forces on the
tenoperiosteal junction, triggering OSS
development.
Traditionally, decreased muscle length has been
considered an important risk factor for lower
extremity injury in athletes [19,53-60]. However,
literature relating to adolescent soccer players is
scarce and contradictory [53,56,58,61-63].
Therefore, in light of the increasing number of
adolescents playing soccer and the physical
demands characterized by overloading muscles
and tendons, the need for medical care
and preventive measures should be emphasized
[8-10].
Prevention of sports injuries is the most desirable
and most economically effective way to reduce
these injuries. Not all injuries are inevitable and
therefore, it is essential to encourage prevention
of sports injuries as a complementary part of the
process [64].
5. CONCLUSION
The symptoms of OSS differ from adolescent to
adolescent. Therefore, we have to find the right
individual way for each adolescent to cope with
them.
Reduced intensity, impact forces and movement
mechanisms which arouse the pain in addition to
stretching regime, manual therapies and the use
of external devices during the growth phase of
adolescent soccer players should be consider to
handle the symptoms or even trying to prevent
them.
When improvements occur, gradually going back
to full activity should be considered.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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© 2016 Tzalach et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
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... A computer-based scientific literature search was completed from inception to 28 February 2022, using the following information sources: Medline (PubMed), Web of Science (WOS), the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, EMBASE, Scopus and Google Scholar system. It used the keywords: "Osgood-Schlatter", "epidemiology", "etiopathology", "symptomatology", "diagnosis", "treatment" and "sport", with Boolean operators such as: "AND" or "OR". ...
... Although the etiology is not clear and the causes are still unknown, a common hypothesis is that the asynchronous development of bone and soft tissue during the maturation stage (especially of the femoral rectum part of the quadriceps) generates imbalances [28]. Alterations in traction forces are considered a trigger for OSD because the force levels that increase considerably in certain growth phases can generate imbalances. ...
... A computer-based scientific literature search was completed from inception to 28 February 2022, using the following information sources: Medline (PubMed), Web of Science (WOS), the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, EMBASE, Scopus and Google Scholar system. It used the keywords: "Osgood-Schlatter", "epidemiology", "etiopathology", "symptomatology", "diagnosis", "treatment" and "sport", with Boolean operators such as: "AND" or "OR". ...
... Although the etiology is not clear and the causes are still unknown, a common hypothesis is that the asynchronous development of bone and soft tissue during the maturation stage (especially of the femoral rectum part of the quadriceps) generates imbalances [28]. Alterations in traction forces are considered a trigger for OSD because the force levels that increase considerably in certain growth phases can generate imbalances. ...
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Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological , functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate-specific exercises or the usual care treatment.
... Measurements of maximal active knee flexion range of motion were taken from the dominant side while the participant was lying prone, and hip and knee joints were in 0 0 flexion and feet were free. Contralateral leg was extended during the measurement [17][18][19]. ...
... While measuring maximal active knee extension range of motion, the participants were lying prone when the joint of hip and knee is 0-degree flexion and feet are ease, and femur was supported by a towel (terminal extension) from dominant side. Contralateral leg is extended during the measurement [18,19,21,22]. Since maximal active range of motion measurement was completed, a certain extent of hyperextension was observed in the measurement of knee extension. ...
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Background and Study Aim. The aim of this study was to analyse reliability and validity of accelerometer-based Iphone® Level application for measuring lower extremity active flexion and extension joint range of motion. Material and Methods. Thirty physically healthy students enrolled in sport sciences (11 males, 19 females, 21.2±1.5 years, Body mass 64.4±10.0 kg, Height 1.68±0.8 m, Fat percentage 21.2±7.8 %, 22.5±2.6 kg/m2) participated in the measurements of hip, knee, and ankle joint range of motion twice through Universal goniometer and Iphone® Level applications. The same experienced measurer carried out blind study of plantarflexion, dorsiflexion and knee flexion/extension, hip flexion/extension joint range of motion three times for each measurement methods and the other researcher recorded the results. For simultaneous validity analysis Pearson coefficient of correlation was used to decide the level of adaptation between the two intraclass correlation coefficient and Cronbach’s alpha values. Bland-Altman graphics were utilized for level of agreement between these two different methods. Results. The results of Pearson coefficient of correlation analysis revealed a positive correlation between the measurement values of joint range of motion performed through Universal goniometer and Level App (r2 = 0.44-0.94, p
... It could be secondary to repetitive microtrauma of the tibial tuberosity or due to a tight quadriceps (de Lucena et al., 2011). A common hypothesis on the aetiology of OSD suggests an asynchronous development of bone and soft tissues, in particular the rectus femoris muscle, during the maturation stage (Tzalach, Lifshitz, Yaniv, Kurz, & Kalichman, 2016). This force results in irritation and, in severe cases, a partial avulsion of the tibial tubercle apophysis. ...
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Objectives Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with locally painful alterations around the tibial tuberosity apophysis. Up to 10% of adolescents are affected by OSD. Treatment is predominantly conservative. The aims of this systematic review are to comprehensively identify conservative treatment options for OSD, compare their effectiveness in selected outcomes, and describe potential research gaps. Methods A systematic literature search was conducted using CENTRAL, CINAHL, EMBASE, MEDLINE, and PEDro databases. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were searched. We also systematically retrieved review articles for extraction of treatment recommendations. Results Of 767 identified studies, thirteen were included, comprising only two randomised controlled trials (RCTs). The included studies were published from 1948 to 2019 and included 747 patients with 937 affected knees. Study quality was poor to moderate. In addition to the studies, 15 review articles were included, among which the most prevalent treatment recommendations were compiled. Conclusion Certain therapeutic approaches, such as stretching, have apparent efficacy, but no RCT comparing specific exercises with sham or usual-care treatment exists. Carefully controlled studies on well-described treatment approaches are needed to establish which conservative treatment options are most effective for patients with OSD.
... It could be secondary to repetitive microtrauma of the tibial tuberosity or due to a tight quadriceps (de Lucena et al., 2011). A common hypothesis on the aetiology of OSD suggests an asynchronous development of bone and soft tissues, in particular the rectus femoris muscle, during the maturation stage (Tzalach, Lifshitz, Yaniv, Kurz, & Kalichman, 2016). This force results in irritation and, in severe cases, a partial avulsion of the tibial tubercle apophysis. ...
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Background: Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with painful osteochondrosis around the tibial tuberosity. Up to 10% of adolescents are affected by OSD. Treatment is primarily conservative or non-operative and includes injections, ice, braces, casts, tape and/or physiotherapy. However, treatment outcomes are often insufficiently described and there is lack of evidence for current best practice.Objective: The aims of this systematic review are to comprehensively identify conservative or non-operative treatment options for OSD, to compare their effectiveness in selected outcomes, and to describe potential research gaps. and to describe potential research gaps.Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. CENTRAL, CINAHL, EMBASE and MEDLINE via Ovid, and PEDro were searched through to January 6, 2020. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were retrieved. We included prospective, retrospective, case control, randomised, and non-randomised studies reporting on the effectiveness of any conservative or non-operative treatment of 6- to 28-year-old OSD patients. Studies written in English, German, or French were included. The quality of the included studies was assessed using the PEDro scale and extracted outcome data were narratively synthesized. In addition, we also systematically retrieved review articles for extraction of treatment recommendations.Results: Of 767 identified studies, thirteen were included: two randomised controlled trials (RCTs), two prospective and eight retrospective observational studies, and one case series. Eight studies had no control group. The included studies were published from 1948 to 2019 and included 747 patients (563 male, 119 female, 65 sex not reported) with 937 affected knees. The study quality was poor to moderate. The two included RCTs examined the effectiveness of surplus dextrose-injection in OSD patients treated with local anaesthetics injection and came to opposite conclusions. Other than that, inter-study heterogeneity prohibited any descriptive cumulative analyses. Among the 15 review articles, the most prevalent treatment recommendations were activity modification (15/15), quadriceps and hamstring stretching (13/15), medication (11/15), ice (11/15), strengthening of the quadriceps (9/15), and knee straps or brace (8/15).Conclusion: Conflicting evidence exists to support the use of dextrose injections. Certain therapeutic approaches, such as stretching, seem to work, but no RCT comparing specific exercises with sham or usual care treatment exists. Carefully controlled studies on well- described treatment approaches are needed to establish which conservative or non-operative treatment options are most effective for patients with OSD.
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Objectives: Pre-season or pre-participation screening is commonly used to identify intrinsic risk factors for sports injury. Tests chosen are generally based on clinical experience due to the paucity of quality injury risk factor studies for sport and, often, the reliability of these clinical tests has not been established. The purpose of this study was to establish the reliability of eight, musculoskeletal screening tests, commonly used in the screening protocols of elite-level Australian football clubs.Methods: Fifteen participants (n=9 female, n=6 male) were tested by two raters on two occasions, 1 week apart to establish the inter-rater and test–retest reliability of the chosen measurement tools. The tests of interest were Sit and Reach, Active Knee Extension, Passive Straight Leg Raise, slump, active hip internal rotation range of movement (ROM), active hip external rotation ROM, lumbar spine extension ROM and the Modified Thomas Test.Results: All tests demonstrated very good to excellent (Intraclass correlation coefficient, ICC 0.88–0.97) inter-rater reliability. Test–retest reliability was also shown to be good for these tests (ICC 0.63–0.99).Conclusion: The findings suggest that these simple, clinical measures of flexibility and ROM are reliable and support their use as pre-participation screening tools for sports participants.
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Sports participation is common among children and adolescents throughout the United States; along with that participation comes risk of injury, sometimes serious. Over 4 million sports or recreational injuries are sustained by school-age children per year in the USA. This injury prevalence has led to significant interest in prevention strategies. In this review, we examine the last year of publications related to sports injury prevention in the pediatric population. Pediatric and adolescent athletes differ from adults in significant ways that often render them more susceptible to injury. Concussion is a particular problem, as are injuries to the thrower's elbow and injury to the female athlete's knee. Recognition, proper rest, and attention to mechanics may assist in decreasing the incidence and severity of these issues. Further inquiry into the nature, prevalence, causes, and, in particular, sequelae of pediatric sports injuries is required. In the interim, attention to proper technique, core and neuromuscular conditioning, and helmet use are important preventive measures; avoidance of overtraining and providing adequate rest for recovery are essential for pediatric and adolescent athletes.