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Tuesday, March 11, 2014
Gymnast Knee Pain
My daughter has been doing gymnastics for 7 years. She trains in the gym approximately 17 hours a week. Her knee started hurting about 7 months ago at the end of field hockey season and continued thru the gymnastics competitive season. She saw a sports medicine doctor and he said that it was her knee cap not being in the correct position and that was causing the pain. He also said that she could continue doing gymnastics and no damage would be done to the knee as long as she could deal with the pain. After the competitive season, she had severely limited any pounding events during practice and does a lot of conditioning. She has done this for 6 weeks and she still has pain in her knee. We went and got a second opinion. This doctor said the same thing. He also said that the x-rays showed her knee cap was out of alignment and that she should do certain exercises to strenthen the muscles that will keep her kneecap aligned. He also did an MRI which we are waiting the results for. He said that she could pretty much do anything in gymnastics, including the pounding, and that if she did the exercises the pain would be gone in about 6 weeks. She has done these exercises along with others from physical therapy and had no luck in the past. She has tried knee braces, though the second doctor gave her a much better one, one that will actually move the kneecap over and hold it in place. I still feel that this problem won`t go away. Should she take time off of gymnastics completely and wait for it to heal or is this something that should go away on its own with the exercises? My daughter is 13 and very active and forced inactivity would drive her nuts. Any help would be greatly appreciated.
It sounds like what both physicians are describing is Patella Femoral Pain Syndrome (PFPS). It has possibly been discussed with you; this is the malalignment of the patella as it sits in the femoral groove. Traditionally the pain comes when the knee reaches 60-90 degrees of flexion. The imaging may show if the malalignment is causing any degeneration on the undersurface of the patella (chondromalacia).
For strengthening, yes, it is a series of exercises often involving the VMO (quad muscle) in conjunction with making sure her mechanics are correct. Although she may be modifying some activity, she is still active. Potential conditioning activities that involve deep flexion (biking) and running will aggravate the condition.
Pain tends to be the best indicator that you are aggravating the condition. If she is able to do any pain free (or minimal pain) activity with rehabilitation she may see additional benefits. Mechanically, her preferred sports do place a very high demand on her knees. Squatting, the bent over posture in field hockey and the tremendous strain that gymnastics places on your entire body all place a high demand on her knees. The inflammation in her knee may need a period of inactivity (sport) with rehab to hopefully resolve this condition. Best of luck.
Alex K Wong, MS, ATC
Assistant Athletic Lecturer & Trainer
College of Medicine
The Ohio State University