Week 1: Pain, Foam Rolling & Isometrics

Pain scoring, foam rolling & knee isometrics

Important: If you haven’t, make sure you go back and follow the instructions on the Getting Started page.

Welcome to Week One!

Now it’s time to get into the basics, this week will include three components:

1. Understanding pain and how to score it
2. Learn your full body foam rolling routine
3. Learn how to complete knee isometric holds

You will do the rolling and isometrics daily for this first week.

Helpful links/downloads

Download the program workbook here →

Join the Facebook support group →

Check out the Support Wiki →

Foam rolling and stretching quick guide PDF →

The Science of Pain and Knee Rehabilitation

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.

Understanding 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.

The Reality of Recovery

Recovery from knee pain rarely follows a straight line. You will have bad and good days, there will be setbacks (hopefully only small ones) in your rehab journey.

Think of it more like a rocky path up a mountain - some days you'll feel great and notice significant improvements, while other days might feel like steps backward. You may experience temporary setbacks, especially after more active days, but what matters most is the overall trend over weeks, not day-to-day changes. Throughout your recovery and this program what's important is:

• Staying patient with the process
• Being willing to adapt activities as needed
• Maintaining consistent effort with the rehab program
• Celebrating small improvements in both pain and movement quality

Managing Activity Levels

One of the most common causes of setbacks is sudden spikes in activity. Your body needs time to adapt to increased loads, so it's important to make gradual changes. When you start feeling better, resist the temptation to jump straight back into full training. Instead, plan your progression carefully and include regular rest days, especially after more demanding activities. Learning to listen to your body's signals and adjust accordingly will help you maintain steady progress.

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, where ten represents the worst pain you have ever experienced, and zero means you 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.

Accurate Pain Reporting

The most reliable pain scores come from consistent measurement. Try to score your pain at the same time each day, using the same test movement (squats to chair height). It can be helpful to make note of any activities that might have influenced your pain level that day. Don't be discouraged by daily fluctuations - remember that improvement isn't always reflected in pain scores immediately, and the trend over weeks is more important than any single day's score.

Remember, recovery is a journey, not a race. Focus on consistent effort with your rehabilitation program and celebrate the small victories along the way.

Beyond pain: Movement Quality and Activity Guidelines

While tracking pain levels is important, it's not the only way to measure progress with Osgood-Schlatter's.

Pain reporting can be challenging, especially for younger athletes who might find it difficult to notice small improvements from day to day. This is why we encourage parents to also observe how your children are moving as a complementary way to track progress.

What Parents Should Watch For

Keep an eye on your child's everyday movements in life, sport and in-between. Look for these signs of improvement:

• Reduced limping during regular activities
• More natural walking patterns
• Return of "spring" in their step
• Improved confidence in movement
• Better stability when standing or changing direction

Sometimes these movement improvements appear before pain numbers start to decrease, making them valuable early indicators of progress.

The Importance of Staying Active

A common misconception is that complete rest is the best approach for Osgood-Schlatter's. However, current evidence shows that maintaining appropriate activity levels is crucial for several reasons:

1. Osgood-Schlatter's is primarily a strength and loading issue, not an inflammation problem
2. Complete rest can lead to weakness and deconditioning
3. Maintaining some activity helps preserve fitness and confidence
4. Regular movement helps prevent the stiffness that can come from too much sitting

Finding the Right Balance

The key is finding activities that your child can handle without causing significant flare-ups. Some guidelines:

• Daily walking is beneficial and should be encouraged
• Light activity on rest days can actually help reduce stiffness
• Participate in modified versions of regular activities when possible
• Listen to your body and adjust activity levels as needed

Weekly Exercises: 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.

Don't have a roller yet? We recommend the Trigger Point 1.0 13", it is the perfect density and they are built to last.

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.

Download our foam rolling and stretching quick guide PDF →

Exercise: Knee isometrics

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.

1. 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.
2. They activate and strengthen the quads (in particular your VMO) to support, protect and deload the knee.
3. 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.‍
   

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 for isometrics

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.

*A note on the amount of weight used: More weight is not better, you should be able to comfortably hold the entire 30-seconds without shaking or fatiguing, you may even start with 0kg of additional weight and use just your leg as resistance, then build up the weights used very slowly over time!

1. First get your weights. Sand filled ankle weights can be purchased from most sports stores and online (see the Osgood shop for a great adjustable option), you will need five pounds (2-3kg) per leg to get started. Alternatively, reusable fabric grocery bags with 2-3 cans of baked beans (or bottled water, etc) adding up to the same weight 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.
2. 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.
3. 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.
4. Start your timer or stopwatch and hold for 30 seconds
5. At the 30-second mark swap sides bringing your loaded right leg up and lowering the left leg.
6. Repeat for eight total holds (four each side) for a total of four minutes
   

Gym instructions for Isometrics

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.

1. 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.
2. 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 2.5-5kg or 5-10lb).
3. Lift the weight up with both knees reaching full extension before dropping the right leg away.
4. 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.
5. Start your timer/stopwatch and hold for 30 seconds.
6. 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).
7. Repeat for eight total holds (four each side) for a total of four minutes.

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.