Athlete Profile:16-year-old female track and cross country athlete on the varsity high school team, practicing 4-5 times a week during track season.
The Injury:The athlete had a 3 year history of knee pain with running, where sharp and shooting pain would develop early on in her runs. She was able to continue running with intermittent pain, and experienced pain after running, which continued when walking, climbing stairs, and with squatting and lunging.
The Initial Treatment:The patient was under the care of a pediatric orthopedic specialist and diagnosed with kneecap pain. She had undergone previous physical therapy at another facility which included stretching, strengthening exercises to the knee, and running on an underwater treadmill to address the pain. Rest from running eased pain, but it returned each time she returned to running.
The patient was referred to Pro Motion Physical Therapy and the initial evaluation revealed many factors causing the knee pain, including strength impairments hip and knee, poor muscle control in the trunk, hip and knee, decreased core stability of the lower back, and tightness in the lower back and pelvis. Additionally, a psychological questionnaire to assess patient confidence to return to running was rated 85 on a 0-100 scale, demonstrating she had minimal fear of return to play, but a diminished ability to do so.
The patient was treated by the same physical therapist in the Pro Motion Performance Program for an 8-week period. Her treatment initially included core stabilization exercises to the lower back, stabilization and strengthening exercises to the hip in supported non-weight bearing positions, and specific re-education of the muscles around the knee, controlling the kneecap.
At week 4, a sports specific optimal loading program was introduced, that included upright, and functional based exercises, such as single leg squats off a 12 inch step, while maintaining good trunk, hip and knee control, hip strengthening in weight bearing positions, step ups, and balance exercises, with further progression to more global muscle strengthening to include lunges and running drills.
At 6 weeks patient was running with mild pain of short duration, pain free with walking and stair climbing.
Return to Play:
At 8 weeks, the patient was running in practice and competitions pain free and had won one of her competitions.
The athlete was discharged with a sports specific home exercise program, with exercises to be included in her warm up routines and practices to assist with re-injury prevention.
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