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Athletic Training

Knee pain

04/11/2008

Question:

I am 16 yr old female. I have had knee pain for a out 8 years. I am very active. I have played softball for about 9 years and hockey for about 7 years. I started having knee pain at the age of about 8. It was not anything major. I was diagnosed with tendinitis, because of being a catcher in softball, without a thorough exam. About 2 years ago, the pain in my left knee started to become more painful. At times i could barely walk, and could never run since the age of about 15. I went to the doc, a GP, and she took some xrays and told me that i had patella alta. She sent me for an mri, and the radiologists there told me that there was nothing wrong. My knee pain then started to get progressively worse. I was in a brace everyday. I couldnt really do stairs and everyday living became really hard. I went to a different doc, another GP, and he told me that I had ITBFS, Chondromalacia, and Generalized Ligament Laxity. I went to an OS and he told me that I had ITBFS and that I should go to pt. I went into physical therapy. After 5 sessions, my PT said that since there was no improvement, that there is no reason to continue, so she called my OS, and they sent me to pain management. she told me that she thought it might be a pinched nerve in my back so i went for an mri. the mri came back clean. i went on amityptaline for some pain relief, but it provided no relief. I was in pain for a long time, and then I went to another doc. He is a a gp and bone doc person. He told me that i had ITBFS and generalized ligament laxity. I went along with it, but more and even more pain came my way. I spent many nights crying myself to sleep, because the pain was more than i could take. The docs, at one point, were telling me to take 800mg of motrin, then 1 hour later take 600 mg tylenol. Do this every four hours. We tried this for a couple weeks. NO HELP!!! I eventually kinda gave up going to docs. Then, in november 07, i tore my lateral gastrocnemius, while stretching in the pool, before swimming. I went back to the "bone doc person" and he sent me to pt for this. I diligently followed this, and while at pt, i mentioned my ongoing knee problems, and they examined it. (2 liscensed pts examined it) They told me that I didnt have ITBFS, but that my kneecaps moved too much and that it was too high and that it sat on the outside, causing chondromalacia on the backside of the patella. I continued my pt exercises for the torn muscle and it healed nice. They began on my knee and i followed that for about 4 weeks. They then cut me loose to do them on my own. They gave me a sheet of exercises to do every other day. I recently started softball, just 1st base. I cant run(they put a pinch runner in for me). I am just really tired of being like this. I am still in pain, and nothing has brought me relief. I do not expect total relief, just some. I just wanted to know your opinion on where I should go from here?? Any treatment for the problems?? Thank you so much.

Answer:

Unfortunately, it sounds like you have seen many therapists and have been dealing with a very aggravating situation for quite some time. General knee pain, patella femoral pain, and ligament laxity are difficult issues to deal with and can take some time. It sounds as if you did have some success with your last PT Clinic and that you have increased pain since resuming modified athletic activity. If they have not already explained the conditions you have to you, it sounds like you have some degeneration on the underside of your patella from poor tracking and or general instability do to ligament laxity. If these conditions are present, traditional rehabilitation deals with pain management, swelling, quad and hamstring strength, hip strength, and proprioception exercises.

Some additional means of management are knee sleeves designed to help with patella tracking, and, unfortunately, limiting yourself to pain-free activity (I am assuming your discomfort was down prior to resuming softball). It sounds as if you had the best results with your latest PT Clinic. You may want to consider consulting them again or seeing the physician who referred you to them for a repeat referral if he feels it is indicated and letting them know that you experienced some relief with prior treatment.

Best of luck with your return to competition.

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Response by:

Alex K Wong, MS, ATC Alex K Wong, MS, ATC
Assistant Athletic Lecturer & Trainer
College of Medicine
The Ohio State University