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Sports Medicine

Bone bruising and Baker`s cyst

02/26/2008

Question:

my 12 year old had mri which showed bone bruising and a bakers cyst. he has been told not to play football by phsio although not painful now 4 months later. cyst tender only to touch. how much activity should i allow him. very hard on him not to be allowed play for this length of time.

Answer:

The extent to which your son's activities may or may not still need to be restricted would depend partly on the location and size of the bone bruise, although since it's been 4 mos. and he no longer has pain, you should find out why he was told to not yet resume playing football.

The Baker's cyst may have formed as a result of the bone bruise... that is, if the bone bruise was within his knee joint capsule, bleeding and/or fluid build up from this bruise could have distended (or "inflated") the knee joint and then leaked out the weakest spot in the capsule - which is in the back part of the knee - resulting in a "Baker's cyst." This type of cyst will usually shrink as the fluid gets reabsorbed. If the cyst is still visible or palpable and tender, excess fluid and associated inflammation may still be present, in which case his knee would not have fully recovered as yet.

Pain should serve as a guide. If he has no pain standing, walking, or squatting, jogging may be tried, and if jogging is pain-free, straight-line running can be attempted, and would need to be tolerated before running figure-of-8's, zig-zags, cutting maneuvers, quick stops-and-starts, jumping, etc. This progression should only be attempted if he has full, pain-free knee range of motion, and normal (or near-normal) strength in his thigh and hip muscles, as can be determined by a physical exam by his physician, as well as by a Physical Therapist or Athletic Trainer who may use exercise equipment and perform other functional testing.

In addition to the possible/probable need for specific stretching and strengthening exercises, he'll also need to be reconditioned by engaging in a regular and progressive cross-training regimen which doesn't aggravate his knee, to regain his stamina/endurance.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University