Questions and Answers about Treating Osgood Schlatters and Severs Disease.

Answers to Osgood and Severs questions

We have been treating Osgood Schlatter and Severs Disease for a very long time.

Since 2005 we have helped thousands of rapidly growing, young athletes beat their Osgood and return to the sport they love safely and pain-free. Our online programs began as an in-person training program that we delivered in our High Performance centre in Melbourne, Australia, and since launching this online in 2016 it's success has gone global.

With this experience we have come across a lot of questions about Osgood Schlatters, Severs disease and how our training program works.

You will find answers to the most common questions, myths and plenty more below.

General questions

How effective is this program at treating Osgood?

Incredibly. The success rate for this program, when done in full is close to 100%.

We rarely meet a case of Osgood Schlatters or Severs that isn’t drastically improved or eliminated within 7 weeks of starting this program.

Most commonly athletes will see a 50% or greater reduction in their pain levels in the first 2-4 weeks with a steady drop to 0/10 pain by the end of the seven weeks.

It’s important to state that these programs are designed specifically for Osgood Schlatter Disease and Severs Disease. Other diagnoses and pathologies may not respond as well to this program as Osgood does. Be sure to have your knee pain diagnosed by a medical professional before beginning this program.

It's also important to note that while the program is not hard, it does require consistency, this isn't a magical pill, but a specific exercise routine requiring a few minutes most days of the week to see these great results.

What is the typical result?

Athletes with growing pains in their knees and heels come in all shapes and sizes, however the most common presentation is rapidly growing girls or boys, between 10-16 years of age, playing a high volume of sport with great intensity. They develop pain in their knee and it is diagnosed as being Osgood Schlatter Disease*.

These young athletes often present with pain levels of around seven out of ten when they start this program. Within the first week their pain is reduced by 50% (3/10).

By day 21 most athletes are at a one or zero out of ten (1/10).

By the end of the seven weeks the vast majority of athletes do not get any Osgood pain again.

*The same is true for Severs, with the pain being experienced in the heels or ankles.

Can I continue playing sport on this program?

As long as your case isn’t extreme you should be fine to keep playing and training, however it often helps to cut back by around 20-30% at the start of the program to let the knee calm down enough that you can actually start strengthening the quadriceps.

Instructions and guidance for getting this balance right are included in the program.

Is this program safe for children?

Yes.

Ages 9-16 is the peak range for Osgood so we have built the program specifically to suit children and teenagers at all stages of their development.

Does this program work for adult Osgood Schlatters?

Our online training program was written with children in mind, but there is no reason it wouldn’t still work for an adult case of Osgood Schlatters.

The adult osgood program is a modified version targeted specifically at adults still struggling with knee pain related to Osgood Schlatters.

We have had quite a few adults try the program and get great results, relieving their pain and increasing their function in daily life and sport.

Note: Before starting the program we strongly recommend you get a medical/physical therapist opinion to confirm it is in fact Osgood Schlatters that is causing your knee pain and not some other injury.

This program is incredibly effective for Osgood Schlatters but can be less effective for other injuries or diagnoses.

What's is the difference between the Adult and junior programs?

To be honest, not a lot.

The programs follow a very similar progression plan, the biggest difference is that the adult plan may take a little longer as they tend to take longer to respond to treatment than children. So while both plans contain 7-weeks, expect it to take 8-12 weeks to follow the full progression as an adult with Osgood pain.

The programs are the same price, and contain very similar exercises so you can safely follow either program as an adult and expect to see a quick drop in pain levels followed by a lasting improvement in knee function.

Children and teenagers should always follow the original junior program.

How did Core Advantage come up with this program?

Our athletes-only gym is based in Melbourne, Australia. In our area there are an incredibly high number of registered junior Basketball players, it's one of the world's most densely populated places for junior basketball players!

This popularity of Basketball plus other tall athlete sports played on hard surfaces such as Netball, Australian Rules Football, and Cricket, means that Osgood Schlatter Disease is incredibly prevalent here.

With so many of our young clients suffering from Osgood and Severs, we needed to find something that would alleviate their pain so we could continue helping them to improve their athleticism.

Luckily our city is also home to some of the best physical therapy researchers in the field. We began connecting this research in sports science and rehabilitation to the latest strength and conditioning practices in order to come up with our world-leading 7-week program.

Refining the protocols over the past 5-10 years with real athlete feedback in our gym and online we are now incredibly proud of our practical, safe, straight-forward, and effective online Osgood and Severs programs.

Hopefully this plan is able to help you too!

Does the program work for all ages?

Yes.

Ages 9-16 is the peak range for Osgood so we have built the program specifically to suit children and teenagers at all stages of their development.

Our online training program was written with children/teens in mind, but it is also highly effective for adults still struggling with Osgood.

To clarify, Osgood is highly unlikely to start during adulthood, but if you had Osgood as a child/teen it can persist - our program is incredibly effective in these cases.

For adults (20 and older) before starting the adult program we recommend you get a medical opinion to confirm it is in fact Osgood Schlatters that is causing your knee pain as this program is less effective for other injuries or diagnoses.

I’ve had my Osgood for years, will this still work?

Absolutely.

The sooner you start this program after being diagnosed the quicker your knees will respond. In longer-term cases of Osgood (1+ year of continual symptoms), it can take a little longer to fully cure Osgood Schlatters but this program will still work, however a little more patience and a slower progression rate through the stages may be required.

The same is true for adult Osgood Schlatters, our program will help, but you will need to be patient.

What if this doesn’t work for me?

We have never seen this program fail when done in its entirety with 100% adherence.

If you have Osgood, you do the work and follow the plan, this program will provide relief for your knee pain.

Some knees are slower to respond and may have to repeat certain stages before progressing (adult Osgood in particular can be slow). You maintain lifetime access to the program so there is no need to rush through the seven-week plan.

We are so confident you will see a positive result that we offer a 100% money back guarantee, that if by the end of the seven weeks you do not see any improvement in your knee pain we will happily refund the cost of the program.

What do I do if my clinician doesn’t think I should do this program?

You should listen to a trusted clinician.

If having assessed you in person and investigated and they read this program they still don’t think it is for you it may be best to listen to their advice.

If they seem stubbornly insistent that it is indeed Osgood and you have no option but to rest and wait, then getting a second opinion may be a good option in this circumstance.

We generally find that physiotherapists (physical therapists) and osteopaths are better at diagnosing and handling Osgood than general practitioners (GPs).

What do I do if my condition is not Osgood Schlatters?

Working online, we are not in a position to diagnose the cause of your pain.

We recommend you seek a medical opinion (physiotherapist, physical therapist, sports doctor, or Osteopath) as to the cause of your pain and confirm that it is indeed Osgood Schlatter Disease.

If your pain is diagnosed as something other than Osgood/Severs then we do not recommend trying this program.

Other knee conditions may respond negatively to this program so a correct diagnosis is crucial. If you are still unsure a second medical opinion can be quite beneficial.

Understanding and managing pain

I still have bad knee pain, should I start this program?

Yes.

The program is designed to help young, rapidly growing athletes cure their Osgood Schlatters by mobilise and strengthen their way out of that pain so they can get back to playing the sport they love.

Please note however: This program is designed specifically for Osgood Schlatter Disease. You should not begin this program without a medical diagnosis of Osgood Schlatters. While this program is 100% effective at curing Osgood, it may not be as effective for other knee conditions.

I am still getting pain, has the program failed?

First of all it’s important to adjust and set appropriate expectations.

In the first 2-5 weeks of the program, your results can vary wildly, some people with Osgood can become completely pain free and return to full functioning. For others the first 5 weeks feels like nothing is happening, they can take 10+ weeks to see a full recovery.

This is why we allow you to maintain lifetime access to the program - to allow you to be patient and go at your own pace through the exercises.

It is not uncommon for your pain levels to fluctuate from day to day or week to week, both during the program and afterwards. What is important is that the general trend is heading downwards. If your pain is going up, then it might be that you need to adjust/reduce your sports and activity levels further, or review the videos for your program exercises to ensure your technique is on point.

I am up to week X and still getting pain, what do I do?‍

First of all, putting your pain numbers in perspective is really important, which is why we use the daily workbook to log the pain numbers each and every day.

Take a moment to look back at these numbers and reflect; are they going in a generally downward direction? Are they flat? or are they going up?

If you started the program with 7/10 pain during week 1 and are now at a 6/10 or lower then this is success, congratulations! You might not be all the way fixed, but we have made a start.

Every Osgood is unique so your pain numbers will progress at a pace that is appropriate to you. Be patient, and pay close attention to the details of each weeks instructions on the website.

Here are some guidelines for progressing through the program.

• We encourage you to repeat a week over if your pain levels have not made any progress.
• If a certain exercise or movement causes your knee pain numbers to rise during or after, stop doing it immediately. Review the exercise instructions, reduce the load or intensity of the exercise if possible and if you still can't get it right then take that movement off for another seven days.
• Reassess your training load. Many athletes can continue with their sport during this program but some do have to take a few weeks off. If you are completing the program and still not making progress, it might be that you need more recovery time in your plan - try reducing your sports load and see if that helps.

Sport and activity questions

*** Please note: It’s not advised to start (or restart) new sports or activities while doing this program.

Can I play sport during the program?

Yes!

Depending on the severity of your Osgood Schlatters, most athletes find they can maintain most if not all of their regular training and playing throughout this program.

As a starting place we recommend that where possible athletes reduce their training volume/frequency by 20-30% for the first two weeks to allow the mobilisation and strengthening work to take effect.

From weeks three onwards, a gradual return to pre-injury playing and training loads should cause no new problems for most athletes.

Throughout the program use pain levels during, after and the following morning from any sports activity as your guide for tolerance to that loading. If pain increases noticeably at any of these time points then the session was too intense or too long, reduce for the next session and try again. This may take some trial and error to get right.

If any of the following occurs, we recommend taking a full 36-48 hours rest until the pain settles before a gentle and gradual return to sport again.

• Your parents or coach spot a noticeable limp or favouring of the sore knee when running.
• Pain levels go above 5/10 during a training session or game
• Pain the morning following a training session or game is greater than a 5/10

If unsure, we advise erring on the side of caution and doing slightly less than you think. especially in the first 2-3 weeks.

Qe have a free seminar on our main Core Advantage website that is a great resource that will help you understand load management and how to best return to sport. Click here to watch the free workshop.

Returning to sport

If you have taken time off sport during or before this program, then being patient with your return is important. Rushing back to full activity has a high probability of a flare up in your knee pain.

The return to sport really is tricky, there is no perfect time or formula, but doing a little bit consistently before building up volumes is probably the best option.

We offer advice and guidance for making your return to sport throughout the program.

Can I do other activities during this program? (swim/cycle/ski/mountain bike/skip)

Almost always, the answer is no. At least for a few weeks anyway

This is really important, it is not advised to start new sports or activities while doing this program.

A new sport or activity is defined as anything you weren't or aren't doing regularly during your weekly routine. While these novel activities are often gentler on the knees compared to your normal sporting activities, the very fact that they are novel makes them a dangerous idea.

So if you are a soccer player or a dancer, and very rarely do any cycling, do not start cycling during this program. obviously, if you are cyclist then the rules are different, you wil want to be cycling in accordance with the instructions in this program, but you probably shouldn't take up swimming!

Try your best to avoid these novel activities until either week 5 of the program or your pain levels are consistently 2/10 or lower and you are performing above 90% of your regular activity levels close to pain-free -whichever comes first.

Note: The exception is when it is advised by your medical professional and you find that this activity helps with your knee pain and function.

Novel activities are the major cause of knee pain flare-ups and slowed progress with the program.

Can I still do my normal gym based training?‍

We recommend you avoid performing other lower body strength training exercises (squats, lunges, etc) while completing the Osgood training program as they can interfere with the recovery process during this program. Instead focus on the exercises within the seven week progression laid out on the website.

Feel free to continue with upper body and core training if you have already been doing this regularly.

I found some other exercises for Osgood online, should I do those as well?‍

No.

This program works brilliantly for Osgood as is. There is no need to add extra exercises or components to the routine. In fact, adding other components can actually have a negative effect on this programs results.

How do I stay fit or get fit again?

Do not panic about fitness.

I repeat, do not panic about fitness.

Fitness, conditioning or cardio is actually a really easy element to training and it improves rapidly.

But there is no point being fit, if you can't play because of injury and pain! For the duration of this program, and while your pain is above a 2/10 there is no need to put any energy or attention into your fitness levels.

Once you are pain-free and moving well on the court/field then usually fitness will take care of itself, if not then there are some suggested fitness workouts in week 7 and we also have an online conditioning program that is available via the Shop.

Pain relief (ice, heat, pills, straps, braces)

Should I be using ice for my Osgood or Severs pain?

Avoid if possible.

Ice is actually no longer a recommended method for treating injuries. In fact, the inventor of the RICE method has released a statement saying he was wrong to suggest this as an injury protocol. This paper explains why.

Most people find they do not need to ice during this program.

Ice can help by reducing pain but has little effect on curing Osgood.

Should I be using heat for my Osgood or Severs pain?

Definitely not.

Heat is inflammatory and while it feels nice in the short term it can introduce more inflammation to the tissues we are trying to make less inflamed!

Should I be using anti-inflammatories (NSAIDs) for my Osgood or Severs pain?

Probably not.

Like ice, they will not benefit the healing process. Only take NSAIDs if prescribed by a medical practitioner.

Should I take painkillers for my Osgood or Severs pain?

Definitely not.

Like ice they will not benefit the healing process. Painkillers also mask your pain levels making it impossible to accurately gauge how effective the training program is.

Do knee straps help for Osgood Schlatter Disease?

In our experience knee straps (the kind that apply pressure onto the tendon under the kneecap) can provide some level of pain relief (whether this is due to placebo or not we aren’t sure).

If you already use them and feel they help, continue using them, if you don’t, we recommend this product on Amazon if you want to try them, but they are very much optional.

Knee straps can also provide protection from knocks and bangs which some people find very helpful. Alternatively, some people like padded knee sleeves instead, especially for court sports.

Should I start/stop wearing orthotics or change my shoes?

For Osgood Schlatter Disease, probably not. For Severs Disease, probably yes

In our experience the role of footwear and orthotics in Osgood Schlatter treatment is overplayed. We don't see much of a change when making adjustments to footwear or inserts/orthotics.

Every person is unique so they may work for you, but it definitely isn’t a big rock for this program to be successful.

If you also struggle with Severs however, then a heel wedge or orthotic can be incredibly beneficial in the short term. Check out our Severs training plan here →

Equipment and supplies

Do I have to join a gym?

Not necessarily.

While having a leg extension machine certainly helps, similar results can be achieved with grocery bags or ankle weights at home. We will show and detail options for both gym access and home training throughout the program.

What is the best foam roller for Osgood?

Softer is better to start with.

Foam rollers can be bought from all sports and in some department stores. Our favourite is the Trigger Point 13″ original roller which you can get online from Amazon and most sporting good stores.

When in doubt aim for a roller that is at least 30cm long (12″), 12-18cm in diameter (5-7″) and softer is better for young tight athletes starting out.

The key factor when buying a roller is it should not have spikes as these create unnecessary pain with no added benefit (in fact, spikey rollers are mostly worse because they do not provide the even pressure needed to release out an entire muscle).

If you have not rolled before it is going to be painful to begin with but it’s important that you persist as this pain is directly linked to the same tightness that may be contributing to your knee pain.

Over time the rolling pain will decrease with regular rolling and should be gone within the first week or so. If your pain levels persist, don’t stress, your legs might be extra tight, or your roller is too firm. Try a softer roller and pay close attention to the details of the rolling routine.

The interval app

The Core Advantage Interval timing app is an optional extra to help you accurately time your stretching and knee isometric exercises during the program.

To download the app search “Core Advantage Interval” on either the iOS App store or the Google Play store, we should be the first option that pops up

You do not need to login to the interval timer to use it.

The log in section of the interval timing app is used as a booking system for our in-gym members here in Melbourne, Australia. You will just use the interval timers on the first page of the app for your exercises during the program.

Questions about exercises

Foam rolling for Osgood Schlatter Disease

Foam rolling is boring, Do we still have to do it?

Yes.

The first two weeks of the program with the foam rolling and the knee isometrics are crucial to both the short term pain reduction and long term success of the program. I do assure you that pain and awkwardness on the foam rolling improves rapidly and even become enjoyable for most athletes! But the first few sessions can be uncomfortable as your tight and weak muscles become accustomed to the rolling. Starting with a soft, smooth roller is the best way of getting around this hurdle.

Can I massage the legs or use a massage stick instead of a foam roller?

No.

Massage sticks do not apply enough pressure to have the same effect, and while massage is a useful addition to your rolling routine, it should never be used to REPLACE foam rolling. It takes extra hands to administer and is not a good practical long term solution.

Learning to roll yourself is a valuable life-skill for young athletes and doing this regularly has huge benefits for both helping with your Osgood and improving your long term performance and resilience (rolling can contribute to faster running and higher jumping too!)

Is foam rolling bad for Osgood Schlatter Disease / Severs Disease?

There are clinicians online who suggest that rolling is a waste of time and ineffective. Stating that you do not need it and should not use them.

This has simply not been our experience with 1000s of in-person and online cases of Osgood successfully treated, we can very confidently say that foam rolling is an essential element of treating it in both the short and long term!

We have almost three-decades of combined experience working in injury rehabilitation and high performance for youth and professional athletes. Foam rolling is one of the key factors we see in our athletic population that leads to fewer niggles and overuse injuries (inlcuding less Osgood and Severs), less aches and pains, faster recovery time, better warm-up, and greater overall improvements in physical performance over time.

Rolling is so cheap, so easy to do, and has such a high return that for just a few minutes per day that we think it should be the first part of every athlete’s (and human’s!) warm up and cool down regardless of sport and experience level. The long-term benefits are astounding.

For those of you struggling with Osgood in the short term, when combined with the rest of the activities in this Osgood training program it has tremendous ability to help alleviate your pain and get you back to playing sport rapidly - a small price to pay for being pain-free and back to full participation in the sport you love!

What is the best foam roller?

Foam rollers can be bought from all sports and in some department stores. Our favourite is the Trigger Point 13″ original roller which you can get online from Amazon and most sporting good stores.

When in doubt aim for a roller that is at least 30cm long (12″), 12-18cm in diameter (5-7″) and softer is better for young tight athletes starting out.

The key factor when buying a roller is it should not have spikes as these create unnecessary pain with no added benefit (in fact, spikey rollers are mostly worse because they do not provide the even pressure needed to release out an entire muscle).

If you have not rolled before it is going to be painful to begin with but it’s important that you persist as this pain is due to the same tightness that is contributing to your knee pain. Over time the rolling pain will gradually decrease with regular rolling and should be gone within the first week or so. If your pain levels persist, don’t stress, your legs might be extra tight, or your roller is too firm. Try a softer roller and pay close attention to the details of the rolling routine.

I've heard of risks to foam rolling, specifically, rolling away from the heart and against the valves in veins. Are these concerns about damaging valves valid? Should we be careful applying pressure away from the heart?

Physiology and biomechanics are very nuanced areas of research and study so it’s tricky to get into the specifics, but these concerns are grossly over-stated, and some of the science in these arguments is a bit off.

With more than 21 years experience coaching athletes, teaching and utilising foam rolling for 15 of those and more than 5,000 athletes coached in person, plus the 3000 + who have completed our online program, not once has this issue of veins and valves presented for our team at Core Advantage!

It seems logical, but if rolling were intense enough to cause these issues, then skinny jeans, massage, compression garments and leggings would all also need to carry these warnings also! (Which they do not - because they are not risky items).

As long as you use a soft roller (and one that does not have spikes), roll slowly and avoid rolling directly on the joints then rolling carries significant benefit with very little downside or risk.

Isometrics and Osgood

The knee isometrics are too easy with only 5lbs (2.5kg). Can you clarify whether we should look for heavier weights?

Harder is not always better and in the case of isometrics there is a good chance heavier loads will actually make them less effective

I suggest being twice as patient on the iso loading and stay with the 5lb (2.5kg) for another week, if pain levels continue to go down increase to 7lbs (3.5kg) and then 10lbs (4.5kg) the week after.

Our coaching experience suggests that young athletes who freestyle on the load selection for their isos will try to do the same on other elements of the program and are often too aggressive on the re-load back into sport.

This is your notice to be on the look out for a aset back later when this aggressive impatient approach comes back to bike!

How often per day should I do the knee isometrics

Once per day is appropriate in the first two weeks, later in the program you will phase down to only doing them 3x per week.

Instructions for this are laid out in the weekly instructions and in the workbook.

Can I do more 30 second holds on the knee isometrics?

No.

Do exactly the amount prescribed in each weeks instructions and in the workbook. The program has been compiled with high precision through years of experience and refinement. Deviating from the prescription laid out in the seven-week plan is not recommended.

Squatting

Are squats bad for Osgood Schlatter Disease?

No. Squats are an incredibly beneficial part of treating Osgood Schlatter. We include them in our program in the mid to late stages of the seven weeks, after your pain has already started to reduce.

There are a few reasons why the squats might be causing you pain, let’s go through them.

• Squatting too deep. Really the shallower the better to start, range can be added and progressed later
• Squatting forwards. Too much of your weight is moving forwards into the knees not back into the hips. Try for an even distribution between hips and knees (using the glutes)
• Progressing too fast. You might not be ready for squats yet. Refer to your pain numbers in the previous week and possibly go back and repeat the last week, before trying squats again.

We provide detailed instructions to squat with good technique along with modifications for handling them well inside the seven-week training program.

Rate of Progression

I am up to week X and still getting pain, what do I do?‍

First of all, putting your pain numbers in perspective is really important, which is why we use the daily workbook to log the pain numbers each and every day.

Take a moment to look back at these numbers and reflect; are they going in a generally downward direction? Are they flat? or are they going up?

If you started the program with 7/10 pain during week 1 and are now at a 6/10 or lower then this is success, congratulations! You might not be all the way fixed, but we have made a start.

Every Osgood is unique so your pain numbers will progress at a pace that is appropriate to you. Be patient, and pay close attention to the details of each weeks instructions on the website.

Here are some guidelines for progressing through the program.

• We encourage you to repeat a week over if your pain levels have not made any progress.
• If a certain exercise or movement causes your knee pain numbers to rise during or after, stop doing it immediately. Review the exercise instructions, reduce the load or intensity of the exercise if possible and if you still can't get it right then take that movement off for another seven days.
• Reassess your training load. Many athletes can continue with their sport during this program but some do have to take a few weeks off. If you are completing the program and still not making progress, it might be that you need more recovery time in your plan - try reducing your sports load and see if that helps.

I just finished week seven and my knees still hurt, what do I do know?‍

The first thing to clarify is how much they hurt.

Go back through your workbook and look at all the pain numbers, have they been trending down? staying flat? or up and down?

If they have been trending down but are not yet at a zero, this is completely normal, your knees might just need a little more time to fully recover.

Continue to follow the week seven plan and continue logging your pain levels. Everyone adapts at a different rate, so be thorough and consistent with the training.

If your pain has not gotten better at all then there are two potential solutions:

• You might have another underlying condition that is effecting your knees, consider consulting a physical therapist/sports doctor to have your knees reassessed.
• If it is indeed Osgood, the other option is you might have rushed through the program. Go back to week one and start the program again, this time paying close attention to the details. This program has never failed to eliminate Osgood pain when done in its entirety. It might also pay to do a further deload in your sporting loads for the second time through the program, giving your knees more time to rest and recover.

Remember, we offer a money back guarantee, so if you find out after a medical reassessment that your knee pain is not Osgood Schlatters, does not get better with our program and is indeed something else, get in touch and we will refund the cost of the program in full.

The program isn't working!

What if this doesn’t work for me?

We have never seen this program fail when done in its entirety with full adherence.

If you have Osgood os Severs, and you follow the appropriate plan, this program will provide relief for your knee pain.

Some knees are slower to respond (especially if you have had Osgood for a long time or are anadult sufferer of Osgood) and may have to repeat certain weeks before progressing.

You maintain lifetime access to the program so there is no need to rush through the seven-week plan.

Our #1 focus is helping you get out of pain and achieve a positive result with our program. To achieve this, our coaches are are accessible through our online support community, we are regularly logging on to answer questions, provide encouragement or suggest modifications, so you know our experienced coaches are here to help you get out of pain quickly and safely!

We are so confident you will see a positive result that we offer a 100% money back guarantee, that if by the end of the seven weeks you do not see any improvement in your knee pain we will happily refund the cost of the program.

My question wasn't answered?

When you purchase a training program from the Osgoodschlatters.net website, you get access to the full seven week program, an even more extensive knowledge base full of answers plus access to our coaching team via the Osgood online support community for ongoing help and assistance during your program.

There are also a number of past parents and athletes who have successfully completed the program they are there to help too!