Through the Eyes of a Doctor – The Young Athlete

A 13 year old female presented to our office accompanied by her mother with a chief complaint of chronic left knee pain and swelling on and off since the age of five. She denies any particular mechanism of injury and reports the pain increases with prolonged walking, running, dance, and lacrosse and improves with ice, wearing a soft knee brace, and swimming. She describes the pain as severe, sore, ache, sharp at times, only experienced with activity, and localized just below the knee cap. She mentions that at times the pain can travel to the outside of the lower left leg and ankle. Upon review, her past medical history was unremarkable; however, her mother does mention that she had been dancing regularly since the age of three and just recently began lacrosse. Her mother goes on to described that she had been evaluated by an Orthopedist numerous times throughout her childhood, most recently resulting in an x-ray followed-up eventually by an MRI which were both negative for fracture or structural deformity, ultimately arriving at the diagnosis of “Patellar Tendonitis” subsequent to “Osgood-Schlatter Disease”.

Upon examination, postural observation revealed hyperextension of both knees, elevation of the left hip, and inward (valgus) stress on the left knee. Lumbar and left knee ranges of motion where within normal limits; however, flexion and extension of the left knee revealed tightness as well as soreness through the left thigh (quadriceps) and patellar tendon region. Orthopedic testing of the left knee was negative as well for ligamentous and/or meniscus involvement in addition to lumbar orthopedic tests. Palpation of the lumbar musculature revealed severe spasm, extending into the gluteal region on both sides. Assessment of joint motion revealed severe pelvic misalignment and restrictions through the right and left sacroiliac joints. With the above findings the diagnosis of pelvic region segmental dysfunction was made, in addition to patellar tendinitis.  

The patient was placed on an initial treatment plan of 3x/week for 4 weeks which consisted of Graston Technique applied to the quadriceps and patellar tendon of the left knee in order to increase blood flow in the area and stimulate efficient healing, Low Level Cold Laser Therapy applied to the left patellar tendon to decrease inflammation and accelerate the healing process, Manual Soft Tissue Therapy applied to the lumbar paraspinal musculature and gluteal musculature, as well as Chiropractic Manipulative Therapy applied to the sacroiliac joints of the pelvis. In addition the patient was given home care recommendations which included stretching and strengthening exercises of the thigh, gluteal musculature and low back. Within the first week off treatment the patient began to experience significant signs of improvement. By the end of the second week she began to re-introduce certain physical activities. As progress sustained, the patient’s treatment plan was tapered down (2x/week for 4 weeks, 1x/ week for 4 weeks, etc.) until she reached a point of being completely pain free despite activities. The patient continues to treat at our office one time a month as part of her wellness routine in order to maintain the progress of her condition. She is currently dancing and playing lacrosse multiple days, weekly, without experience any pain or limitation and feeling stronger than ever.

In this case, the patients’ ongoing knee pain was directly linked to the misalignment and dysfunctional motion of her pelvis. It is important to remember that we are one closed kinetic change of biomechanical movement. In that sense, when there is a change in one region of the body, likely it will impact another in some way, shape, or form. Keep this in mind if you ever begin to experience discomfort and reach out to Complete Care Chiropractic for further investigation. The earlier the treatment process begins, the better the chances for a full recovery.