OSGOOD SCHLATTER'S SYNDROME
Bobus is not the only Staffy in the family. My brother Kevin's family has Lucy (Bobus' sister), and my brother-in-law's family has owned a couple of different Staffies (most recently, Vader). But those who have known me long enough, know how everyone's infatuation with Staffies originated. It all started back in 1991 with Drifter.
My friend and classmate Dr. John Wild of Seward Nebraska ('Wild Chiropractic') owned a couple of Staffies while we were in school. I used to "dog watch" for him every once and awhile, and it did not take me long to realize that these fat-headed bundles of energy were the coolest dogs I had ever been around. A couple months before we graduated, John gave me a great deal on the runt of his latest litter (one poor Midwest farm boy to another --- thanks John!). Drifter was a beautiful dog ---- tiger brindle with a white chest. And if there was ever a better dog on God's green earth, I have yet to see it.
Drifter used to go everywhere and do everything with me. When I went to play softball, he went along and entertained the kids at the ballpark by playing "fetch" for hours on end. He did thousands of miles in the passenger seat of my old 1988 Goldwing. And he used to spend hours at the CURRENT RIVER digging up half buried logs and diving for his ring. But quite probably, his favorite past time was "Hanging on the Stick".
You have to understand that Drifter was an athletic dog --- a real leaper. He only weighed about 30 lbs but he could jump straight up into the air about four feet high. To exercise him, I had a small stick of wood hung up in a tree not quite four feet off the ground. Drifter would leap at it until he latched on (any of you who are familiar with the "STAFFIE SMILE" knows how these dog's mouths work). Drifter would clamp down on his stick and begin swinging his hind legs around and around and around. Before long, he would have his body parallel to the ground, whirling in a circle just like a helicopter blade --- sometimes for 10-15 minutes at a time. When he would finally let go and fall to the ground, he would stagger around until he got his bearings and start the process all over again.
My first Thanksgiving in Mountain View, the Prices invited me to come eat Thanksgiving Dinner with them. I was single at the time, so I jumped at the invitation. They ended up eating at one of "Grandad's" friends just a couple blocks down the road from where I lived at the time. After the meal was over, their son Stephen and I walked back to my house to shoot some baskets. Of course Drifter came out to jump at his stick (it may sound crazy, but Drifter loved to show off for people). Michael Smith, who lived right behind me came over as well (he and Stephen were both in grade school at the time), and we shot baskets while Drifter swung around and around and around on his stick. That is; until the cops showed up. Yeah; that's what I thought too.
Ronnie Pruett ("Big" Ronnie as opposed to his son "Little" Ronnie who is currently on the Force) pulled up to my house, got out of the car, looked at all of us with a perplexed 'what-the-heck' frown, and then doubled over laughing so hard that I though he was going to bust a gut. He walked over to look at Drifter who was in the process of swinging, and of course when Drifter realized there was someone new there to show off for, he swung all the harder. Ronnie could not stop laughing.
My first house (since burned down) was at the corner of David Drive and Highway 17 (across from Mountain View's "Little Greenhouse"). Someone had driven by and mistaken what was going on for some novel form of doggie torture. They had stopped by the police station in tearful hysterics, telling Ronnie that there were some men "hanging a dog" out on south 17 ---- and laughing about it.
I told you all that to tell you that the video below, shot on Monday of this week, is of the same Michael Smith as in the story. But Michael's story is not funny. Michael developed Osgood Schlatter's "Disease" (the medical community's word, not mine) as an adolescent and had struggled with severe knee and leg pain clear through school and into adulthood. His case was classic. He had the huge (really huge) Tibial Tubercles on both knees that were so pain sensitive, merely 'bumping' them would make him nearly pass out. It had affected both his ability to play sports as well as his ability to work.
The day before he was to leave for boot camp, he came to see me and I found out about it for the very first time. So, I treated him --- one time ---- seven or eight years ago ----- for a problem he had struggled with for years. Needless to say, the one treatment solved his problem and it never returned. Thanks for the memories Michael (not to mention the testimonial)!
OSGOOD SCHLATTER SYNDROME
WHAT IS OSGOOD SCHLATTER SYNDROME?
"The condition is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit. In more detail, activities such as kneeling may irritate the tendon."
MORE PICTURES OF OSGOOD SCHLATTER SYNDROME
The picture on the left shows the front right thigh (Quadriceps Muscles). These (4) muscles make up the most powerful group of muscles in the entire body. And although these four muscles have upper attachments that range from the pelvis to the thigh bone itself (femur), the lower attachment is the same for all of them. It is the Quadriceps Tendon. Just below the Quadriceps tendon is the short Patellar Tendon which attaches to the lower leg at a place called the
Wolf's Law says that,"Bone grows due to mechanical stresses placed upon it, whether the stresses are normal (good) or abnormal (bad)". This is valuable information. It is why people who have broken a leg are put in a walking cast as soon as they can tolerate it. It is also why people develop Degenerative Arthritis in joints that have been injured or do not 'move' like they used to move. Abnormal mechanical stresses on muscles, tendons, joints, or bones, are going to cause problems in one way or another.
Let's think about this for a moment. What is one result an overly tight quadriceps muscle is going to produce? It is ultimately going to pull like crazy at the Tibial Tubercle. If you understand Wolf's Law, you realize that this is going to cause the Tibial Tubercle to increase in size as new bone is laid down. As the earlier quote from Wikipedia says, "repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity." When this happens, you will get varying degrees of, "avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump." In the case of Osgood Schlatter Disease, there will always be a degree of TENDINOSIS. However, treatment that is geared at the tendon itself will frequently fail ---- especially in more severe cases. The tendon problem, the repeated avulsion fractures, and the extra-large Tibial Tuberosity all have an underlying cause.
In the case of these "Avulsion Fractures", there is so much mechanical stress at the point where the Patellar Tendon anchors into the Tibial Tuberosity, that it not only causes the Tuberosity itself to grow increasingly larger (Wolf's Law), it actually causes tiny chunks of bone to be pulled away from the tubercle. In the picture to the right as well as the picture below, you can see what these Avulsion Fractures look like on an x-ray. This might be why the 'official' medical terminology for Osgood Schlatter Disease is to refer to it as a Tibial Tubercle Apophyseal Traction Injury. This is actually much more descriptive than naming it after the two guys who 'discovered' it --- and then throwing the word "Disease" on the end. Just like I wrote about a couple of weeks ago when discussing the relatively new terminology DEGENERATIVE JOINT DISEASE, Osgood Schlatter cannot really be considered a disease. It is the result of an underlying mechanical problem.
In 1987's Predator, Arnold famously said, "If it bleeds, we can kill it." Dealing with Osgood Schlatters requires a similar thought process. Many mechanical problems (including OS) can be fixed if you know what to look for and catch them before they degenerate. But then again, you have to really know what to look for. The problem is that the medical community seems to be stuck in the dark ages in dealing with Osgood Schlatters. Again quoting from Wikipedia, "treatment is conservative with RICE (Rest, Ice, Compression, and Elevation), and if required acetaminophen (paracetamol), ibuprofen and/or Co-Codamol or stronger if in 'acute phase' & (the pain is severe and continuous in nature)..... Bracing or use of an orthopedic cast to enforce joint immobilization is rarely required and does not necessarily give quicker resolution. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures. Surgical excision may rarely be required in skeletally mature patients." I think that this quote shows how backwards the thinking is concerning the manner in which our medical community addresses mechanical issues. This protocol simply does not help a large percentage of the people suffering with Osgood Schlatter's!
To the best of my knowledge, I have never seen a case of Osgood Schlatter Syndrome that I was unable to resolve ---- quickly. The thing that I find somewhat odd, however, is that despite the fact that it is dog-common, few people have heard of it and the medical community has no real idea how to address it other than the methods mentioned above. If you or a loved one has Osgood Schlatter's, call Tracy at (417) 934-6337 and schedule an appointment to let me take a look. Dealing with this common mechanical problem now, can potentially save a lot of time, grief, and money in the future. We will never make that ugly over-sized Tibial Tubercle go away ---- no one can. Unfortunately, it will be with you forever. But we can stop the abnormal bio-mechanics that are causing it to grow, as well as helping prevent future knee problems. It is my experience that doing this will stop the pain of Osgood Schlatter Disease dead in its tracks!