Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "

Case study ( 7424 views as of April 19, 2024 )

Brooke is a 15-year-old female high school volleyball player visits a sports medicine physician complaining of a 2-year history of bilateral knee pains. She has no swelling, locking, or giving way of the knees, and there have been no serious injuries, but she hears “crunching” as she bends her knees or when she lands from jumping. Although she hasn’t missed any games, Brooke has to ice her knees afterwards, and has been taking 2 tablets of ibuprofen before and after games. Her main concern is an upcoming tournament, where she’ll be playing up to 4 matches each day for 3 days.

On examination, she has crepitations (crackling sounds) on active range of motion, and passive full flexion is painful. She has flat feet, and internally rotated patellae (kneecaps). Her IT bands are tight, and her glutes are weak. She is unable to squat on one leg alone due to pain.

Brooke could benefit from physiotherapy to work on her strength and flexibility, an orthotics provider to fit her for orthotics, and a bracing specialist to consider patellar stabilizing braces. Her sports medicine physician may also order any imaging tests in order to help determine the full extent of her condition.

Author: Dr. Grant Lum

Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "

Case Introduction

Understanding Patellofemoral Syndrome

Presented by

Dr. Grant Lum

MD, CCFP, Dip Sport Med

Sports Medicine Physician

Treatments

Foot Orthotics To Help With Patellofemoral Syndrome

Practitioner help from:

Dr. Howard Green

B.Sc, D.P.M.

Podiatrist
Hamstring Strengthening To Help Treat Patellofemoral Syndrome

Practitioner help from:

Jeff Dallin

Kinesiologist
CT Scans To Assess Knee Pain and Patellofemoral Syndrome

Practitioner help from:

Dr. Greg Louie

Radiologist

Treatments

Use Of Knee Braces In Treating Knee Pain and Patellofemoral Syndrome

Practitioner help from:

Mr. Dale Harris

Bracing & Equipment Specialist
Role Of Physiotherapy In Treating Patellofemoral Syndrome

Practitioner help from:

Mark Pierce

Physiotherapist
Symptoms and Treatment of Runner's Knee Pain and Patellofemoral Syndrome

Practitioner help from:

Dr. Marina Uzelac

Chiropractor

Conversation based on: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "

Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "

Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 31 December 2023

The concentrated platelets obtained from the patient's blood sample are then injected back into the injured area, such as tendons, ligaments, muscles, or joints, where they release growth factors and other bioactive substances. These growth factors help promote tissue repair, stimulate cell growth, and enhance the body's healing response. The idea behind PRP therapy is to harness and amplify the healing potential already present in a patient's own blood. By delivering a higher concentration of platelets to the injured site, the therapy aims to accelerate the healing process and improve musculoskeletal problems such as chronic tendon injuries, osteoarthritis, sprains, and strains. PRP therapy has gained popularity in recent years as a potential treatment option for various musculoskeletal conditions. However, it's important to note that the effectiveness of PRP therapy is still an active area of research, and its use and outcomes may vary depending on the specific condition being treated and individual patient factors. It's always recommended to consult with a healthcare professional who can provide personalized advice based on your specific situation.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
Dr. Bertrand Perey MD, FSRC Orthopaedic Surgeon, New Westminster, BC 15 July 2023 Specialist Referral Clinic, Vancouver, BC

The unhappy triad is a significant knee injury that often occurs in contact sports or motor vehicle accidents. It involves a force applied to the knee, resulting in simultaneous damage to three key structures: the medial collateral ligament (MCL), the medial and lateral meniscus, and the anterior cruciate ligament (ACL). To illustrate the injury, imagine this knee model. The front of the kneecap is here, the outside of the knee is on this side, and the inside of the knee is here. Symptoms of the unhappy triad may include hearing a popping sound at the time of the injury, intense pain, and swelling. There might be difficulty straightening or bending the leg, and the knee may feel unstable. A torn meniscus can cause sensations of catching or locking in the knee while walking, and putting weight on the knee can be challenging, especially when standing up from a seated position. Treatment for the unhappy triad often involves surgical intervention, particularly for the ACL and the meniscus. The MCL may be managed with non-operative treatment in some cases. Regardless of the treatment approach, a comprehensive rehabilitation process with physical therapy is crucial. Physical therapy focuses on controlling pain and swelling immediately after the injury, as well as regaining range of motion and facilitating proper tissue healing. Knee braces may be prescribed to aid in daily activities and support the rehabilitation process, helping to increase strength, range of motion, and overall function for a quicker return to normal activities. If you suspect that you have a knee injury resembling the unhappy triad, it is essential to consult with your physician or physiotherapist for a proper diagnosis and appropriate treatment plan. Early intervention and proper rehabilitation are vital to optimize recovery and get you back to work or sports activities as soon as possible.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
Dr. John Wade MD, FRCPC Rheumatologist, Vancouver, BC 14 May 2019 Artus Health Centre

Ankylosing spondylitis (AS) is a chronic type of arthritis that affects the lower back. While the cause of AS isn’t known, it occurs when the immune system attacks the back, causing inflammation and resulting in pain and stiffness. Similarly to osteoarthritis, the body attempts to repair your lower back by growing new bone, which often grows across the joint and may even become fused.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 22 April 2022
  
  During hip replacement surgery, the surgeon removes the painful joint and replaces it with an artificial hip joint made from plastic, ceramic and/or metal.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
  
  Once a patient undergoes knee replacement surgery they are guaranteed to be pain free.
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 10 August 2018

It is a degenerative process that results in relatively rapid deterioration of a joint. It generally affects people in their 60s and 70s, but can also occur among those in their 50s and younger. In most cases, a regular exercise program designed to maintain flexibility, muscle strength and endurance, will help people maintain their normal activity level.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 03 May 2022
  
  Ankle surgery on patients with severe injury may have to have the ankle bone fused together and straightened in order to relieve pain and correct deformity.
Chantal Sayers Vancouver, BC 22 August 2017

How long would physiotherapy take to correct this issue?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 22 April 2022
  
  A very common question patients ask is when should I have a hip replacement? Your healthcare provider will likely recommend that you wait as long as possible to have the surgery.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
  
  Some of the risks of knee replacement surgery include blood clots, deep infection in the knee and stiffness.
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 07 October 2015

A brace is always a good option if you have had surgery on the knee or you think you are doing long-term damage. Repetitive injuries like hers might benefit as long as it does not make her favors her knee.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 22 April 2022
  
  Following your surgery, you may wear compression stockings or take blood thinners to prevent blood clots. You will begin physical therapy in the hospital, and should continue with a physiotherapist once you leave.
- K. Michael 10 December 2015
  
  Wouldn't an injury cause you to favor the knee that is causing you pain anyway ?
K. Michael 06 October 2015

Would Brooke have to get a special brace to wear while playing volleyball ?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
  
  Another risk of knee replacement surgery is long term failure of the knee replacement after 15 years.
K. Michael 12 August 2015

If she is going to be playing in a volleyball tournament she could benefit from taking a longer lasting pain reliever instead of multiple doses of ibuprofen to help with her knee pain

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 21 September 2017
  
  She could ice after each event as well to help swelling.
ShirleyG 08 February 2015

What is the benefit of wearing orthopedics when you have Patellofemoral Syndrome ? Will wearing them reduce swelling and assist with pain management ?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- K. Michael 12 February 2015
  
  I have flat feet and, while I don't have knee issues, I do experience knee pain if I am wearing certain types of shoes for a long time. I have to be sure to switch out my supportive shoes with orthotics for things like cute ballet flats and sandals to avoid knee pain.
- Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 08 February 2015 Vitality Clinic, Downtown, Vancouver, BC
  
  If you have knee pain and have been diagnosed with flat feet that cause your ankle to drop inward (pronation syndrome) when you stand or walk, then yes, orthotics can alleviate pain and swelling around your knee. The main function of the orthotic is to assist the body in regaining proper lower extremity biomechanics, and provide some shock absorption. It is not the only treatment you should undergo as you should implement an exercise regime to strengthen the VMO (vastus medialis oblique) muscle of the quadricep, as well as localized inflammation and pain management of the knee.
ShirleyG 08 February 2015

Is Patellofemoral Syndrome hereditary ?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- K. Michael 27 July 2015
  
  That's interesting. I'll have to talk to my doctor because myself and both of my kids have flat feet and my daughter frequently experiences knee pain
- Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 08 February 2015 Vitality Clinic, Downtown, Vancouver, BC
  
  While patellofemoral syndrome itself is not hereditary, some of the predisposing factors are. These include (but are not limited to) the position of the patella (knee cap) in relation to the thigh bone (femur), or having flat feet that collapse inward (pronation). My suggestion is to seek out a health care professional who is able to diagnose and treat the underlying cause of your knee pain. Chiropractors are one such professional. :)
Michelle Kaarto, BScK, CSEP CEP 05 February 2015

With patellofemoral syndrome, a good drop squat program can be very effective in helping treat the knee pain. I would definitely assume a physiotherapist or exercise specialist this girl would be working with would have her doing some type of squat program as part of her rehabilitation.

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
Bernadette van der Boom-Bebb 04 February 2015

Very interesting Kimberley! So does the cartilage reach a maximum thickness at a certain age and then start to degrade as we get older again?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- K. Michael 12 February 2015
  
  I'm not certain but I would assume so.
Dr. Crysta Serne BSc(Kin), DC Chiropractor, Vancouver, BC 30 January 2015 Vitality Clinic, Downtown, Vancouver, BC

I agree an assessment is in order. Often patellofemoral syndrome is due to an imbalance between the vastus lateralis and vastus medialis oblique quadriceps (leg muscles) which causes a tracking issue. Think of trying to lift a weight over a pulley when it's not perfectly lined up- a lot of friction can occur. :)

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
Carrie Cooke 15 January 2015

Patellofemoral is very common among teenagers is it not (because they are growing.. like growing pains)?

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- K. Michael 26 January 2015
  
  When my daughter hurt her knee at age 16 we were told that girls of that age had less cartilage which is why they are more prone to injury.
K. Michael 08 January 2015

It would be interesting to know if the issues with her knee are due to sports or due to the flat feet. I have flat feet and when I am on my feet a lot without my orthotics I have a lot of knee pain

Reply to: Patellofemoral Syndrome - Knee Pain " Brooke is a 15-year-old female volleyball player "
- Yuan Lew, MSc MBA 27 January 2015
  
  @michelle, good point about getting patellofemoral syndrome and whether it is related to flat feet checked out. Potential bilateral knee pain issues should be addressed when teenagers are growing. Otherwise, it can become worse later in life.
- Yuan Lew, MSc MBA 15 January 2015
  
  Is obesity a risk factor for Patellofemoral syndrome?
- Carrie Cooke 15 January 2015
  
  With the legs - all of the components are tied together more than any other part of your body. They support the body weight, and deal with motion. So the knee needs to be protected by the IT band, and the quads, and the all the muscles, and ligaments of the leg. Even though it is common - it needs to be addressed now, and taken care of. It is sad to see so many young kids with knee pain (which usually lead to lifelong pain and issues).
- Michelle Kaarto, BScK, CSEP CEP 13 January 2015
  
  It's very likely that her anatomical issue of flat feet have caused knee discomfort over time. I would be concerned given her age, and think it's best if her parents encourage her to seek assessment and treatment. She has a lot of years left on those knees! I would also encourage she consult with a sports medicine physician to determine if any scans or images need to be taken to fully investigate the cause of her knee pain.