The Benefits of Pilates in a Young Athlete with. Patello-Femoral Pain Syndrome

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1 The Benefits of Pilates in a Young Athlete with Oshgood Schlatter s Disease & Patello-Femoral Pain Syndrome Heidi Applegate 8/15/2014 Bryn Mawr, PA 1

2 Pilates exercises can change the muscular imbalances that affect Oshgood Schlatters Disease and improve Patello Femoral Pain Syndrome. Oshgood Schlatters is a condition that affects tall, active children, stretching their limbs and joints faster than their muscles and ligaments can support. Patello femoral pain syndrome causes pain, stiffness and a feeling of gliding or grinding in the knee. This paper will focus on Morgan, a 13 year old girl standing at 6 with growth plates that have not fused. Morgan also suffers from Patella femoral pain syndrome in her knee that causes intense pain from overuse. I will discuss how she has benefited from the stretching and strengthening in Pilates exercises to help with both of these painful conditions. Pilates has improved her balance, flexibility, muscle strength and posture. The result of the Pilates repertoire in her weekly routine has created measurable improvement in all areas of her physical development and athletic pursuits. 2

3 Contents Title Page 1 Abstract 2 Anatomical Description 4 Body 5 Introduction 6 Case Study 7 Conditioning Program 8 Conclusions 10 Bibliography 11 3

4 In the above image, these areas of growth are made of cartilage and not bone. The cartilage is never as strong as the bone, so high levels of stress can cause the growth plate to begin to hurt and swell in Oshgood Schlatters. Patellofemoral pain syndrome is a term used to describe pain originating from the region of the patella (kneecap) and femur (thigh bone). Swelling and pain in Oshgood Schlatters can be found on a prominence on the leg bone (tibia) called the tibial tuberosity. 4

5 The focus for this paper is on my daughter, Morgan, age 13, who swims competitively from Sept -July and was one belt away from her black belt in Taekwondo until last year when she began to suffer from Oshgood Schlatter s Disease and knee pain due to Patello Femoral Pain Syndrome. Patello femoral pain syndrome is pain in the front of the knee. It frequently occurs in teenagers and athletes. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap. According to the BASI Study Guide, this condition is characterized by generalized pain in the area of the patella that is classically aggravated by deep or repetitive knee flexion. Patello femoral pain syndrome may be caused by overuse, injury, excess weight, a kneecap that is not properly aligned (patellar tracking disorder), or changes under the kneecap. Oshgood Schlatters is an injury affecting the growth plate below the knee. Growth plates are the site of all bone growth throughout one s lifetime, most prominently in childhood. Oshgood Schlatters happens most commonly between the ages of nine and fifteen. Symptoms are knee pain, tightening of the muscles surrounding the knee and inability to walk, bend or straighten knee completely. The growing pain can last a couple of years only slowing down at the end of the child s growth period (Ed Le Cara). Over use of the breaststroke in Morgan s swim sets and continued abuse in her knees from Taekwondo stances created intense inflammation issues in her joints as she continued to grow. Limitations from the sports that she loves have caused her much anguish and disappointment. She held on to both disciplines as long as she could, modifying swim sets with breaststroke pull and butterfly kick and in Taekwondo, she did not go into the deep stances that caused severe 5

6 knee pain. (However, in order to test for her black belt she was required to do deep, repetitive knee flexions and this is when she had to stop her training.) Prevention and successful treatment for this injury involves restoring muscle balance and proper tracking of the patella. Patello femoral pain syndrome can be relieved by avoiding activities that make symptoms worse such as sitting, squatting or kneeling in the bent-knee position for long periods of time. Taking nonprescription anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen to decrease swelling, stiffness, and pain are other treatments (John Hopkins). In addition there are physical therapy exercises that include stretching to increase flexibility and decrease tightness around the knee and straight-leg raises and other exercises to strengthen the quadriceps muscle may be used. Taping or using a brace to stabilize the kneecap, ice, rest and at as a last resort, surgery are all prescriptions to treat Oshgood Schlatters and Patello femoral knee pain. The patella is dependent on a fine balance between the way the thigh bones are aligned and the how the muscles and ligaments function. When this balance is disrupted compensations are made. These compensations usually affect how the patella tracks over the knee joint; pulling the patella to the outside of the knee joint (American Academy of Orthopedic Surgeons). In the case of Morgan, whose body grew too fast, forcing her body to make compensations that caused hyperlordosis of the spine and excessive hyperextension of her knees; genu recurvatum (BASI Study Guide). She experienced weak dorsiflexors that caused her to land with a flat foot instead of her heel. Her posture was also a result of having weak quads. Normally, as one walks weight is shifted onto the leg, the line of force falls behind the knee requiring quad contraction to 6

7 prevent buckling of the knee (Osteopilates). With quad weakness, Morgan has a tendency to lean forward at the hip causing her center of gravity to be shifted forward and forces her knee into hyperextension. Normally as the knee bends, the patella slides smoothly along a groove in the femur. But with Morgan, her condition in her knee was initiated from Oshgood Schlatter s Disease but the pain persisted due to her patella pushing against the sides of the groove. Once she began to focus on stretching and strengthening her quadriceps, hamstrings and abdominals she found a greater range of motion and flexibility. Morgan s goals are to return to her previous activities and sports pain free with increased strength and flexibility in her knees, quads, hamstrings and hip flexors. She will focus on prevention of future pain through correct posture and a continuation of strength and condition. 7

8 CONDITIONING PROGRAM BLOCK EXERCISE APPARATUS RESULTS & REASON WARM UP FOOT WORK Roll down 3x Spine Twist Supine 5x Double Leg Stretch 10x Single Leg Stretch 10x Criss Cross 10x Parallel Heels Parallel Toes V Position Toes Open V Position Heels Open V Position Toes Calf Raises Prances MAT REFORMER Morgan used a block between her knees to assist her inner thighs and maintain proper alignment To increase abdominal and oblique strength, spinal rotation, pelvic lumbar and trunk stabilization. This can be done at home to help with core strength on apparatus To increase strength in hamstrings, quads and ankle plantar flexion. Open V with emphasis on external rotation of hip. Focus on hip extensor, knee extensor and ankle plantar strength ABDOMINAL WORK HIP WORK 100 prep 100s Coordination Short Box Series: Round Back, Flat Back, Tilt, Twist Double Leg Double Leg with Rotation Singe Leg Supine Frog Circles Down Circles Up Walking Bicycle Cadillac Abdominals with oblique emphasis, back extensors, pelvic lumbar stabilization, hip flexor strength and trunk stabilization Single leg work to isolate hamstrings and adductors, utilize hamstring and hip extensor control and maintain a stable lumbar pelvis to help maximize hip disassociation and increase hip strength and alignment SPINAL ARTICULATION Bottom Lift Bottom Lift w/ Extensions Strengthens Abdominals, hamstrings and hip extensors. Spinal articulations and hip extensor control STRETCHES Standing Lunge Gluteals Ladder Barrel Improve hip flexors and hamstring flexibility. Emphasis on quad stretch, 8

9 Hamstrings strength and ankle stability FULL BODY INTEGRATION ARM WORK Reverse Knee Stretch Scooter Up Stretch 1 Elephant Arms Supine Series Extension Adduction Circles Up Circles Down Triceps To increase flexibility in glutes and hamstrings Helps to strengthen abdominals and hip flexors To help improve weakness in quads, hip and ankle Abdominals and Back Extensors This series will help trunk stabilization, shoulder mobility, shoulder extensor and adductor strength. Focus is on the Latissimus Dorsi and triceps. LEG WORK Gluteals Side Lying Series Side Leg Lift Forward and Lift Forward with Drops Adductor Squeeze Comprehensive BASI Block System Working the gluteus medius, strengthening the hip abductors and maintaining pelvic lumbar stabilization Hip adductors strength LATERAL FLEXION/ ROTATION Side Overs 10x short arms 10x long arms / Short box Abdominals with oblique emphasis, Ab strength and trunk stabilization. Co- contraction of abs and back extensors to help build strength BACK EXTENSION Post- cool Down Breaststroke Prep- long box series Breaststroke long box series Back extensors, upper back extension to help strengthen and support overall posture Roll Down Mat Important to do a body scan at the beginning and at the end of the session to assess alignment. 9

10 Morgan has spent the last year achieving a more balanced body by incorporating Pilates as a tool to strengthen, stretch and correct her imbalances. Morgan presented with tight Iliotibial bands, quadriceps, hamstrings and calf muscles. Her goals were to improve flexibility and strength, decrease pain, improve function and to return to a level of fitness prior to the onset of symptoms. Morgan learned how to find neutral pelvis and neutral spine to encourage balance and functional alignment with the use of breath in an exercise as well as how stabilizers and movers differ in a movement. Tightness of the quadriceps muscles, hamstrings and iliotibial band and relative weakness of these muscles contributed to her inflammation. Other factors that contributed to her problems included femoral anteversion (excessive rotation of the hips), genu recurvatum (hyperextended knee) and excessive pronation (flat feet). These factors were addressed in the above conditioning program and Morgan did return to swimming. However, her black belt is still waiting for her as she continues to strengthen and condition her lower extremities. 10

11 Bibliography 1. Study Guide, Rael Isacowitz, Body Arts and Science International, BASI Movement Analysis Workbook;, Rael Isacowitz, Body Arts and Science International, Movement Analysis Workbook; Cadillac, Rael Isacowitz, Body Arts and Science International, Patella Femoral Pain in Teen Athlete, 5. Patient John Hopkins Sports Medicine Guide to Oshgood Schlatter Disease: What are Knee Problems? Growing is a pain with Oshgood Schlatter s Disease: July 31, 2013, Ed Le Cara 10. American Academy of Orthopedic Surgeons, Oshgood Schlatter s Disease 11

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