This interview is excerpted from Hard2Guard Player Development Newsletters, Volume 6.
Julie Eibensteiner is a physical therapist and owner of Laurus Athletic Rehab and Performance LLC, an independently-owned practice specializing in ACL rehab and prevention in competitive athletes. In addition to being an educational contributor on topics of sport injury and prevention, Eibensteiner is actively involved as a coach in both college and competitive youth soccer settings.
BM: Last season, our doctor’s answer for everything was rest three days, and our physio only worked with professional players. Our 6’7 15 year-old presented symptoms of Osgood Schlatter’s Disease (OSD). In such a situation, with little communication between a medical doctor, physio/PT, and the coach, what should a coach do to help the player? What precautions must a coach take if the coach believes that a player may be suffering from OSD?
JE: The best plan for a coach who suspects a player is experiencing symptoms consistent with Osgood-Schlatter’s Disease (OSD) is to refer them to a physical therapist (PT) specializing in sports injuries and preferably with significant experience with pediatric sport injuries. The PT can evaluate the athlete and develop a solid plan to manage the athlete that SHOULD include open and proactive communication with the coach (and refer to a sports medicine doctor if needed to rule out stress fractures, ligament injury, or other conditions that may be the source of knee pain).
OSD is a condition where the area of the tibia (shin bone) where the patellar tendon attaches becomes inflamed and painful. This often happens during the growth spurts in young athletes where a traction force is applied by tendons doing their best to keep up with bones that are growing very quickly. Sometimes the body will try to grow more bone at that spot and a bump will form. When coupled with busy youth athletes taking part in highly dynamic activities (cutting, jumping, sprinting) that are taxing on the quadriceps muscles, you have the perfect storm for this condition. It most often presents in youth ages 9-16, and in males more often than females.
OSD is typically a self-limiting condition. In my opinion, activity can be modified to allow the athlete to participate in certain aspects of practice/training. Instead of a blanket policy of “three days rest”, I suggest that athletes/coaches use pain as a guide for their activity.
On a 0-10 scale with 0 being no pain and 10 requiring a call to 911:
0-3 is a green light — they can do all activities without restriction.
4-6 is a yellow light— try to modify present activity to bring it back to a green light, discontinue if pain worsens.
7-10 is a red light — discontinue current activity, see PT/MD if persists.
OSD will typically not resolve fully on short notice, but if managed WELL the intensity of symptoms should allow for some participation and resolution sooner than a case that results in repeated higher intensity flare ups. It is better to cut down on the volume of sprinting and jumping and allow some less painful activity than to push through the pain with a “No Pain, No Gain” mentality or going from 0-100-0 MPH repeatedly. I often tell my patients that many tendon conditions are like trying to walk a mule up a hill. If you try force it down the path it will fight back, you will lose ground, and you will both be frustrated (and painful). If you truly GUIDE it – you make progress quicker and no one gets crabby!
It is a great benefit to the player (and coach/team), if the coach develops a strong relationship with a PT who understands your sport and athlete demands so the process can be smooth.
BM: One of your specialties is ACL prevention/rehabilitation, and the dynamic warmup is one thing that you mention in your prevention strategies. You recently released LARP 1.0 Warmup (www.laurusrehab.com/store). Without giving away the product details, can you explain how your program differs from other information online in terms of emphasis, exercises, movements, etc?
JE: The LARP Team Prep 1.0 is a neuromuscular-based warmup I have developed by blending my expertise in sports medicine with my long-term coaching experience at both the competitive youth and collegiate levels. I have taken the science proving these programs are effective and made it practical for the coach through continual refinement using it with my own teams.
The current problem in youth sports is the coach does not implement the program or stay compliant with it. If your coach buy-in is absent, it is very tough to get athlete buy-in. Remember, the mark of an effective program is one that is done and gets done well. The program is presented in a manner to educate the coach both on the “Whys and Hows” behind the “Whats”, and shares some tips on practicality to ensure that it does not take away too much time from the actual sport.
It addresses mobility, strength, and neuromuscular control — all keys to decreasing many lower extremity conditions (not just knee). It includes progressions and variations of many activities and ideas for improving reactive agility/deceleration (key to injury prevention and high-performing athletes) during team training while still being time efficient. It is appropriate for all sports and across many age levels from junior high to college. The feedback I have received across the spectrum — physical therapists using it in the clinic, sports performance coaches at pro clubs in Europe, men’s and women’s collegiate head coaches, youth club directors, parents wanting to implement in school system — has been very positive.
Director of Coaching, Playmakers Basketball Development League
Author, The 21st Century Basketball Practice