Expert: Dr. J. Shawn Leatherman - 4/24/2009

Question
My Daughter is a highly competitive figure skater, she was on the trampoline practising her triple jumps when she hyperextended her knee. She saw an Orthopedist and had an MRI which did not show any damage. She had physical therapy and was off the ice. She then continued to skate, very little, to complete her season and has now been off the ice for 3 months. We have an H-wave machine @ home that she used for several months on a daily basis. She does not do any therapy for the last 3 months and her knee still swells in the back of the knee at the end of the day. Her injury occured 1 year ago. She wants to do some exercise to strengthen it, but I am concerned about the swelling. Is it normal to have swelling and is it possible to have swelling forever, or can she recouperate from this and possibly get back on the ice?

Answer
Dear Doreen,

Sorry it has taken me a few days to get in touch with you, but my computers are down at the office due to a server issue.

First of all, hyper-extension injuries of the knee can be a a bit difficult to asses because they do not commonly result in tearing of frank injury to the posterior ligamentous structures.  However, when the PCL ligament is torn, the problem is readily identifiable...so this is likely not the case with your daughter...and this continued selling is not normal.

The fact that swelling remains is a sign of continued injury to the tissue.  This could be in the form of an inflamed bursa, torn joint capsule which is allowing some synovial fluid to leak into the tissue, possibility of disrupted lymphatic channels which may leak fluid, or just continued re-injury of the membranes around the knee with activity. Chronic muscle injury to the gastroc complex or the popliteus muscle could result in continued swelling. This is really just speculation without an examination.

If the swelling is present only with activity, then the knee needs to be evaluated after activity by functional orthopedic testing and either diagnostic ultrasound or a repeat MRI (T2 weighted is the best to visualized accumulated fluid).  I would schedule an examination of the knee after your daughter has been active enough to cause the swelling to occur.  

Now...if nothing continues to be pinpointed with further examination, then I would recommend that you follow-up with a chiropractic physician who specializes in sports injury.  The Orthopedist will be at a loss if surgery is not indicated, and will probably offer nothing more than injections or drainage of the knee.  However a sports chiropractor will move in a different direction than the orthopedist or physical therapist.  This last year in Beijing is a case study in how chiropractors can change the health of an athlete...There were approximately 40 athletes who sustained injuries great enough for them to contemplate not competing, a few had already decided to withdrawl from competition, however all were able to compete with chiropractic care...resulting in 25 medals from that group.

Treatment may consist of Kinesiotaping methods, adjustments to the knee joint, ankle and sacroiliac joints, laser, guided stability work, and definite soft tissue work such as Graston Technique, SASTM technique, or Active Release (ART).  These are all proven methods to speed recovery and return the athlete to competition.  I suggest that you research these options, and a sports trained/certified chiropractic physician.  you can find qualified individuals at The American Chiropractic Board of Sports Physicians website: WWW.ACBSP.COM

Good luck Doreen.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net