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Harold M. Olson
Nathan Hinkeldey



Objective: To describe the chiropractic management of symptoms typical in patients with juvenile osteochondrosis, either Osgood-Schlatter’s Disease or Sever’s Disease.

Clinical Features: Eleven young (pre-teen and teen-aged) athletes sought care for the management of juvenile osteochondrosis.  Eight of the patients were diagnosed with Sever’s Disease and 4 patients were diagnosed with Osgood-Schlatter’s Disease. Objective measures were evaluated using the Lower Extremity Functional Scale during the duration of care.

Intervention and Outcome: Chiropractic manipulative therapy, manual myofascial release, instrument-assisted soft-tissue technique, therapeutic post-isometric stretching (PIR), and kinesiology taping was provided to help treat the dysfunctions causing the pain associated with either disease. Percent improvement as measured by the Lower Extremity Functional Scale ranged from 10.0-40.0% from the start of care to the day of discharge. Additionally, improvement ranged from 8-32 scale point difference measured using the Lower Extremity Functional Scale.

Conclusion: Patients with Osgood Schlatter’s Disease or Sever’s Disease may benefit from a combination of IASTM, manual therapy and chiropractic extremity manipulation. This case series suggests that treating both disease states as a tendinopathy can provide significant pain relief and functional improvement without withholding the young athlete from athletic participation.


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1. Atanda A, Shah S, Obrien K. Osteochondrosis: common causes of pain in growing bones. Am Fam Physician 2011;83(3):285-291
2. Takahara M, Ogino T, Sasaki I, Kato H, Minami A, Kaneda K. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res 1999;(363):108-115
3. Valovich McLeod TC, Decoster LC, et al. National Athletic Trainer’s Association position statement: prevention of pediatric overuse injuries. J Athl Train 2011;46:206-20
4. James AM, Williams CM, Haines TP. Effectivenes of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review.J Foot Ankle Res 2003;6:16
5. Kose O, Celiktas M, Yigit S, and Kisin B. Can we make a diagnosis with radiographic examination alone in calcaneal apophysitis (Severs Disease). J Pediatric Orthop B 2010;31:396-398
6. Rachel JN, Williams JB, Sawyer JR, Warner WC, Kelly DM. Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (Sever Disease)? J Pediatr Orthop 2011;31(5):548-50.
7. Sita FC, Kingori J. Chronic bilateral heel pain in a child with Sever disease: case report and review of literature. Cases J 2009;21;2:9365
8. Lawrance DA, Rolen MF, Morshed KA, Moukaddam H. MRI of Heel Pain. Am J Radiol 2013;200:845–55
9. De Lucena et al. Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. Am J Sports Med 2010;39:415-420
10. Lee DW, Kim MJ, K JG. Correlation between magnetic resonance imaging characteristics of the patellar tendon and clinical scores in Osgood-Schlatter disease. Knee Surg Relat Res 2016 Mar;28(1):662-667
11. Hirano A, Fukubayashi T, Ishii T, Ochiai N. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol 2002;31:334-342
12. Lion et al. Prevalence of jumper’s knee among athletes of different sports: a cross-sectional study. Am J Sports Med 2005;33:561-567
13. Cook JL, Khan KM, Purdam CR. Conservative treatment of patellar tendinopathy. Phys Ther Sport 2001;35(5):291-294
14. Maffulli N, Wong J, Almekinders LC. Type and epidemiology, Clin Sport Med 2003: 22(4):675-692
15. Gaida JE, Cook J. Treatment options for patellar tendinopathy: critical review. Curr Sports Med Rep 2011;10(5):255-270
16. Saithna A et al. Eccentric exercise protocols vs. no special treatment for patellar tendinopathy: should we really be withdrawing athletes from sport? A systematic review. Open Orthop J 2012;6:(Suppl 3: M10):553-557
17. Rowe V, Hemmings S, Barton C, et al. Conservative management of mid-portion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. Sports Med 2012;42(11):941-967
18. Wilson JK, Sevier TL, Helfst RH, Honing EW, Thomann AL. Comparison of rehabilitation methods in the treatment of patellar tendinitis. J Sports Rehabil 2000;9(4): 304-331
19. Mccrea EC, George SZ. Outcomes following augmented soft tissue mobilization for patients with knee pain: A case series. Orthop Phys Ther Pract 2010;22(2):69-74
20. Phipps RL, Carney SR, Loghmani MT, Baylis AJ. An innovative manual therapy approach for treatment of patients with Achilles tendinopathy: A case series. J Orthop Sports Phys Ther 2011;41:A1-A10
21. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodywork Mov Ther 2008;3:246-256
22. Miner AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. J Can Chiropr Assoc 2011;55(4):269-279
23. Papa JA. Conservative management of Achilles tendinopathy: a case report. J Can Chiropr Assoc 2012;56(3):216-224
24. de Vries A, Zwerver J, Diercks R, et al. Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial. Scand J Med Sci Sports 2015;26:1217-1224
25. Gehlsen GM, Ganion LR et al. Fibroblastic response to variation in soft tissue mobilization pressure. Medicine Sci Sports Exercise 1999;31(4):531-535
26. (Authors) Instrument-assisted cross-friction massage accelerates knee ligament healing. J Orthop Sports Phys Ther 2009;39:506-514
27. Davidson et al. Rat tendon morphology and functional changes resulting from soft tissue mobilization. Med Sci Sports Exercise 1997;29(3);313-319
28. Loghmani T., Warden S. Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. BMC Compl Alternative Med 2013;28:240
29. Launay F Sports-related overuse injuries in children. Orthop Traumatol Surg Res 2015 Feb;101(1 Suppl):S139-147 (was 4)
30. Lefor G. Sport et pathologie apophysaire de I’enfant et de I’adolescent. Cahiers d’enseignement de la SOFCOT. Conferences d’enseignement, 66, Expansion Scientifique, Paris 1998:191-203
31. Frush TJ, Lindenfeld TN. Peri-epiphyseal and overuse injuries in adolescent athletes. Sports Health 2009;1:201-211