Expert: Dianne M. Buxton - 1/24/2011

Question
QUESTION: Diane-

I'm hoping you can help me figure out if the person named Bertram who you previously responded to was able to get a diagnosis on his knee injury.  In reading his description of his knee injury it sounds very similar to mine--- specifically that there is pain only when the knee is weight bearing and at a specific angle/degree of flexion.  I have been to 4 doctors, 5 physical therapists, 2 chiropractors, and an acupunturist with no diagnosis or effective treatment plan.  If there is any way you could help me follow up with Bertram to see if perhaps he has had better luck, I would really appreciate it.  I can't seem to find anyone that has an idea of what is causing this problem or how to treat it. His email was not posted with his original post.

Here is the original post from Bertam: At the begging of this term my right knee started to hurt in ballet. I was at
the barre and I fondu my right leg. As I went deeper in the fondu I felt a pain just under my knee cap then my leg gave way. I didn't think nothing of it and I tried it again and I felt the same pain in the same place. Then later on in the class we where doing some jump work and this made the pain worse. Every time I plie to jump I would feel the pain in my knee and then when I landed from the jump into a plie I would feel the pain again. This would mean that I wouldn't do a deep plie (because I would only feel the pain when my knees are bent just below 90 degrees) which would mean I wouldn't get a high jump but then when I land I wouldn't plie deep enough to absorb the shock from jumping because again the knee would hurt. However  if i don't put any weight on my leg and then bend my knee I don't feel any pain. Also if I do fondu at the barre but take most of the weight by holding onto the bar and fondu past , just below 90 degrees then I dont feel pain but when i straighten up my knee and I straighten through that 90 degree area the I feel the pain.
What I'm trying to say is there is a specific point in my knee bend when i feel the pain. Anything below or above it does not cause me any pain. What could this be as it is really frustrating me. It means I cant do any jump work or single legged fondu work

Answer
Hi Bertram. The sooner you get this diagnosed the better. I recommend seeing an activator chiropractor - go to www.activator.com. If there aren't any in your area, call the local ones and ask each one if they have experience with ballet or sports medicine. Choose one with experience if you can. Ask at your ballet studio too, they may recommend one.

A chiropractor can diagnose with x-rays and examination. They can muscle test the strength of all the muscles related to the use of your knee, and also assess the tension in your quads. Quad muscles can pull on the kneecap. Also, a chiropractor can adjust misalignments that can occur around the knee joint, and of the kneecap, which may be causing your problem.

You need to know right away if there are any tears in the ligaments in your knee. If there is only a sprain, then you can heal it with rest, ice, compression and elevation. A chiropractor will tell you exactly how to do that. Most chiropractors offer various physio therapies as well, to speed the healing.

If you have a tear - that takes you in another direction, medical.

What you can do, today, is start icing your knee every hour or at least three times a day. This will help with inflammation, increase the circulation and healing ability of the area.

It is your job as a dancer to know how this happened - for example, turning out from the feet, the usual suspect in knee problems....but not the only one. I have written many articles at http://www.balletshoesandpointeshoes.blogspot.com, that might give you a review of your strengths and weaknesses, if you like to read.

If you do not see someone about this, it will likely get worse. All the best, Dianne

ANSWER: Hi Renee. No, I did not hear from Bertram again.

http://www.sportsinjuryclinic.net/cybertherapist/knee_injuries.htm

That link goes to a page describing knee injuries - has there been no discussion of any of them with the practitioners you have consulted? Were x-rays taken and nothing showed?

By chance is the knee injury on your less turned out leg? This is often the source of irritation, or the tearing of a tendon or ligament.

If there is no visible tear, no fracture, and no subluxation, that pretty well leaves tendonitis or bursitis, which usually resolves with ultrasound therapy, daily, and ice and rest.

But I'm sure you've heard all of that by now. I'm sorry that I do not have any further clues for you.

Have you taken time off dancing, with no results? I do hope you resolve this, and would love to hear about your further developments.

Regards, Dianne

---------- FOLLOW-UP ----------

QUESTION: Thanks, Diane.  I was wondering if perhaps you had Bertram's email address and could ping him to see if he had resolved the issue.  I have had 3 MRIs with no significant findings.  The physical therapy I have had either has no impact or in one case actually made the problem worse.  None of the practictioners has ever seen anyone with this type of issue.  That is why I was so excited when I saw Bertram's post.  It sounds so similar to what I am experiencing, so I am hoping that perhaps he has had better luck in finding someone who could actually help him with this problem.  If you wouldn't mind pinging him to see if/how he was able to resolve the injury, I would greatly appreciate it.  This injury has severely hampered my life and I'm not having great luck in finding out what is causing it or how to fix it.  I'm really just hoping Bertram's luck has been better and that I can benefit from it.

Answer
HI Renee. I have no access to email addresses through this site - no personal data at all, except the name as given by the questioner.

I asked a chiropractor today about this. He says the degeneration of the bursa could be missed on an MRI. This means the patella could be grinding, bone on bone. The bursa is a fatty pad, it also contains fluids; it is a cushion.

He suggests trying MSM (easy to get at a health food store, organic is better, cheapest on line). You would take it twice a day, probably a teaspoon or two each time. You can do a search about MSM and see what you think about it. It is good for all body tissues and might help your knee pain.

Let me know if it does help. Regards, Dianne