Comparison of Three Treatments for Lower Extremity Apophysitis

Osgood-Schlatter syndrome (OSS), Sinding-Larsen and Johansson syndrome (SLJ), or Sever's
disease are three types of apophysitis, or secondary growth center irritation, that
frequently affect children and teens. Although these conditions are common, there is very
little data from high quality studies to support a particular treatment method in affected
patients. The purpose of this study is to compare three different treatments for these types
of apophysitis. The investigators plan to compare two types of home exercise program (HEP),
one involving active elongation exercises and one utilizing static stretching, with
symptomatic treatment consisting of icing, over-the-counter medications and relative rest.
The investigators hypothesize that the active elongation HEP will result in improvement in
pain and earlier return to athletic activities when compared to the static stretching HEP
and symptomatic care. This pilot study will recruit subjects at the Ann & Robert H. Lurie
Children's Hospital outpatient sports medicine and orthopaedic clinics with any of the
following types of lower extremity apophysitis: OSS, SLJ or Sever's disease. Subjects will
complete a baseline evaluation and questionnaire and will be randomized into one of the
three treatment groups. At 2, 4, 6, and 8 weeks, subjects from all groups will use a secure
website to complete an online survey to complete questions regarding current pain level,
compliance with their home exercise program, if applicable, use of other forms of treatment
or pain management (e.g. splinting, icing, rest from activities) and current activity level.
The investigators will compare results from each group to determine which treatment(s)
resulted in the largest improvements in pain scores and the highest rates of participation
in sports and recreational activities.

Inclusion Criteria:

- diagnosis of OSS, SLJ, or Sever's disease

- must have regular access to the Internet

Exclusion Criteria:

- history of prior treatment for OSS, SLJ, or Sever's disease

- history of previous injury to the affected joint requiring more than 1 week off of
sports or activities