KNEE INJURY - GYMNASTICS

Abstract

1536 HISTORY - A 13-year-old female gymnast presented with a history of bilateral anterior knee pain for 10 weeks. The onset of the pain had been gradual. The pain was intermittent and occurred with jumping, bouncing, and with kneeling. There was no history of night pain, swelling or fever. She had not had any previous injuries to her knees. She did 10 hours of gymnastics per week and was icing her knees after gym. For the past 2 or 3 years, she had noted pain in her lower back with doing back walk-overs. PHYSICAL EXAMINATION - Her hips and knees had full passive pain-free range of motion. There were no ligament abnormalities noted. There was tenderness over her tibial tuberosities. She had good concentric strength in her quadriceps and hamstrings.She had pain with doing 1/4 squats on each leg. On examination of her back, there was decreased side flexion left in her upper lumbar spine. There was decreased side flexion left and right in her lower lumbar spine. L2 was in a flexed, rotated right and side-flexed right position. There was decreased mobility at L5/S1. Her left sacroiliac joint had decreased mobility and the left ilium was posteriorly rotated. There was no tenderness on palpation of the spine. Her straight leg raise was 95 degrees bilaterally. DIFFERENTIAL DIAGNOSIS: KNEES Osgood-Schlatter's Disease patellar tendonitis stress fractures bone tumors LOWER BACK spondylolysis somatic dysfunction of lumbo-sacral spine and left sacroiliac joint TESTS: As the tenderness was directly over her tibial tuberosities, I did not do further tests. Regarding her low back pain, there was no pain with one leg standing hyper-extension testing. No further tests were done. WORKING DIAGNOSIS: Osgood-Schlatter's Disease and Somatic Dysfunction (left sacroiliac joint and lumbo-sacral spine) TREATMENT: At the initial appointment, I treated the compression at L5/S1 and the posterior rotation of the ilium. Following the treatment, there was improved movement at L5/S1 and in her side flexion right and left in her lower lumbar spine, and at the left sacroiliac joint. I advised her to continue icing her knees after exercise. The following week I treated the somatic dysfunction at L2. One week later, there was no tenderness on the tibial tuberosities, but she was still having pain with one leg 1/4 squats. Eccentric strengthening for the quads was taught. Nineteen days later, she was experiencing only occaisional pain when she did a lot of tumbling.