The kneecap fracture in a runner that wasn’t; the problem with a painful knee
This past weekend, I was the medical director for a track and field event at Franklyn Township high school. I was quite busy helping many children and their parents understand some of the running related problems they were experiencing.
One mom stopped by to ask me about her daughter who could not run due to knee pain, which began while running during practice. At the end of practice, her daughter could barely walk and had excruciating knee pain.
I asked her if the daughter was at the event and she way, so she brought her over to me. Her daughter was able to walk (which is generally very difficult to do with a knee cap fracture due to the pain and because of what the kneecap does functionally which is that it acts like a pulley).
Her history did not include an impact on the knee (which is commonly how a kneecap is fractured) and she had been having other running problems such as back pain, leg pain and flexibility issues for a while, but as most runners do, she decided she could run through them.
Her entire left side of her left leg was tight and she had difficulty bending the knee. After performing some myofascial release to the lateral leg, she was able to move the leg, walk and move about quickly without pain. She also had compensatory tightness in her upper back which is likely part of the reason the pain and the myofascial surrounding the knee became so tight.
What was the difference between my evaluation and that of the orthopedist who ordered the x-ray and the MRI?
The orthopedist looked at her knee, I looked at her, her feet, her body style, her upper body and dug more deeply for facts about her running habits and other symptoms she commonly experiences. A young runner is much less likely to understand their body due to past experiences, so it is especially important to explain to them what happened and what training soreness is normal and what they should not try to run through. As described in the book Cheating Mother Nature, what you need to know to beat chronic pain, our body style is set by the age of 6, so if we are stiff or tight all the time, it seems normal to us. Perhaps, this is why symptoms alone is not a good enough basis for ordering an expensive test as an MRI and why doctors need to fully evaluate the entire leg or kinetic chain (series of joints including ankle, foot and knee) rather than just the knee since the knee is just a conduit.
While I am sure the girl was sore the next day, her mother learned why a chiropractic sports physician may have been the best first contact healthcare provider for her daughter.
When evaluating knee pain, it is always important to evaluate the patient first, and the knee second. Also, it is important to dig for facts, since most patients will tell you only what they think you need to hear, rather than what you need to know to help them solve their problem.
What do you think? As always, I value your opinions.
You can purchase Cheating Mother Nature through Amazon.com and other on line book stores.