Q: I’d like to start off by saying that I thoroughly enjoy reading your column after I’m done reading the comics. That may see a bit odd, seeing as I am only 16, but you have had good advice for many different health issues that people have had and I thought I would see what you have to say about my knee.
I’m a very active female and have had no serious injuries before. I play multiple sports, including field hockey. I’ve had no injuries before, except for a recurring right quadricep strain and have always had full mobility in both knees. However, I’ve suddenly been unable to bend my right knee into any position resembling “Indian style” without terrible pain. I’m still able to run and move my legs in other ways without pain.
I’ve spent the last few weeks at the beach and have been running a few times on it (about a mile or so) and spent a lot of time surfing. Both of these things are not out of the ordinary for me.
Field hockey begins very soon and I’m afraid that I could have done something to a tendon or ligament somewhere that could get progressively worse. What should I do?
A: Knee pain can occur for a number of reasons to include a torn meniscus, or often as a result of participating in sports or recreational activities and various work projects. The femur (the upper leg bone) and the tibia and fibula (lower leg bones) are connected by ligaments, tendons and muscles. The surface of the bones within the knee joint is covered by cartilage that acts as a shock absorber, which provides a smooth surface for movement of the joint. Were you older, I would lean toward arthritis or even osteoporosis, however in someone your age, the most likely answer is injury – injury from bending or twisting the knee (as in crossing your legs), from a fall or blow to the knee, or from simple overuse. In the case of an injury, pain, swelling and bruising may develop within minutes, alerting you to the damage incurred. In other conditions, damage may not be readily apparent or visible to the naked eye right away. Sprains, strains, tears and more importantly overuse, can cause damage to ligaments and tendons that support the knee cap. Also, tendons have a poor blood supply and do not heal as quickly, making the pain last longer.
Sprains are stretches and tears of ligaments (the strong bands of tissue that connect bones) that support the knee. Sprains can result from stretching in one direction while the ligaments involved are attempting to hold the knee in place. Strains on the other hand are injuries that involve tendons and muscles. Tendons are tissue that connect muscle to bone. A strain may be the result of over-stretching a tendon or muscle. A simple strain can take up to three weeks to heal. Overuse can cause problems with participation in repetitive or prolonged activity. Inflammation, pain and internal damage can result.
A condition known as Osgood-Schlatter disease can present in young people who participate in sports such as soccer, basketball, running and jumping. Symptoms include a bony protrusion just below the kneecap, with pain and swelling in the front of the lower portion of the knee. The condition is common enough to appear in as many as one in five young athletes. You don’t mention anything other than pain so my guess is this condition can be ruled out. Further, it generally presents in girls up to the age of 12 and in boys up to age 14. Osgood-Schlatter resolves on its own once an adolescent stops growing.
Treatment, whether from a strain, sprain, tear, overuse, or another cause or condition will depend on the primary reason for the problem that should be determined by an orthopedic or sports specialist. Resting your knee, elevation, wearing a temporary brace, physical therapy, the application of ice and other options are available. An over-the-counter non-steroidal anti-inflammatory (NSAID) might be appropriate to lessen your symptom of pain. Following that, an MRI might be considered to help rule out or diagnose the torn meniscus.
Above all else, keep reading the comics. They’re why many people buy their local newspaper every day!
