PAIN IN ATHLETES
painful knee is a very troublesome problem to a keen athlete. The majority
of athletic endeavour places tremendous demand on the largest most complicated
joint in the body.
pain is most resistant to treatment. Patella tendonitis is extremely
common in many sports, specially basketball, tennis and weight lifting.
The frustration with this condition is that although it is a catastrophe
to the athlete, the physical signs are minimal. Management of such a
condition is the essence of Sports Medicine. The understanding of a
personís desire to choose continued participation over rest or retirement
is essential to the practitioner dealing with sportsmen.
commonest causes of chronic knee pain in athletes are patella tendonitis,
chondromalacia patella and iliotibial band friction syndrome.
lesions in athletes do not usually present with pain. Chronic ligament
lesions almost never present with pain as a chief symptom.
knee pain is most often due to haematoma from direct contusion. Sever
twisting injuries, although they cause immediate pain, may be completely
painless, especially if the capsule of the joint is totally ruptured.
is the most sever pain outside of pyarthrosis (infected knee), the athlete
can experience. Tension in the joint is unrelenting but is immediately
relieved by aseptic drainage.
provisional diagnosis of ruptured anterior cruciate ligament should
be made in all cases of haemarthrosis. Test have been described which
measure anterior transition of tibia on femur. These tests are the Lachman,
dynamic extension, Jerk and pivot shift tests. If positive, they will
confirm the diagnosis.
acute pain should alert one to the possibility of fracture. I have seen
three undisputed fractures of the tibial plateau in patients originally
treated for meniscal injuries. Of course undisplaced epiphyseal injuries
are notoriously missed in the skeletally immature athlete.
into a prepatella bursa may be a difficult diagnosis. I have seen even
experienced practitioners mistake it for haemarthrosis. Of course the
patella can not be palpated by CAREFUL PHYSICAL EXAMINATION in cases
of prepatella bursae.
OF ACUTE KNEE PAIN
important to x-ray all causes in order to rule out fracture even through
this is the least common cause of pain.
SITES OF KNEE PAIN
is the most common perplexing problem with the knee. It is most resistant
to treatment as its causes are multi-factorial. Difficulty arises
also as the pathological state of the patella does not parallel the
degree of symptoms.
is primarily based on physical therapy with extensive vastus medialis
obliquus rehabilitation. Rarely is surgery of benefit. Chondroplasty
of the patella is of questionable value. Patella realignment is indicated
only in gross malalignment situations.
release was fashionable for lateral pressure symptoms for a time,
but the long term benefits are not yet available.
of synovial plicae was fashionable also for some time but is only
rarely indicated today.
condition is commonly resistant to treatment. In many cases physical
therapy with ice, quadriceps stretching and rehabilitation effect
a cure. In the chronic cases peritendinosus cortisone injection may
be beneficial. Patella tendon strapping and bracing is very beneficial.
I have found alteration of training or performance technique to be
beneficial, especially in tennis players. This condition is also known
as Jumperís Knee and if proper landing techniques are practised, symptoms
can be alleviated. Surgery is sometimes necessary and exploration
under local anaesthesia helps to isolate the specific torn tendinous
area. Exploration sometimes does not relieve the classic swollen haemorrhagic
tendon tear. Some authors even recommend distal patella pole excision.
It is interesting that some patients who go on to rupture and eventual
repair that the condition is then cured.
BAND FRICTION SYNDROME
condition is the bane of long distance runners. They are usually slightly
varus and their symptoms are easily reproducable. Many times this
condition is confused with lateral meniscal tears.
tests will give the diagnosis and ilio-tibial band stretching combined
with orthotics will alleviate the patientís symptoms.
beak tears of the lateral meniscus are a common cause of chronic knee
pain. They cause pain on running up inclines and ascending stairs.
Their pain is commonly associated with radiation into the calf and
thigh. In 30% of cases, a small lump is visible and palpable on the
lateral joint line when the knee is examined at 40° short of
full extension. These tears may progress to form a cyst of the lateral
meniscus and the cyst becomes painful after activities of running
and after excessive use.
meniscal lesions causing chronic pain are posterior cleavage tears
and are most common over the age of 30 years. They are rare in younger
athletes but should be considered in the differential diagnoses.
of the semimembranosus sometimes causes difficulty in distinguishing
between these lesions.
pain from the hip and lumbar spine should always be considered in
the differential diagnosis. Hip pain usually presents on the medial
side of the knee as the obturator nerve is involved and interestingly
it is more common when the acetabulum is primarily involved in the
is only by taking a careful history as to the site, nature and other
characteristics of the pain, by understanding the nature of the athleteís
sport and training conditions, added with a thorough physical examination,
will one be able to solve the problem of knee pain in athletes.
KNEE PAIN IN ATHLETES