Sports Medicine/Knee injury

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QUESTION: 4 Weeks ago I fell down the stairs to my basement in my home.  I was holding a puppy in my one arm and (luckily for the puppy) did not let go.  My left knee was bend backwards (like a hurdler going over a hurdle)while I slid down the stairs.  Once I landed at the bottom I could not move my leg for a few minutes and had severe pain in it.  No popping sound that I know of.  I could hardly step on it afterwards.  I iced it and took ibuprofen but the next morning it felt worse and stiff.  I could not bend it more than a few inches.  It was not swollen much.  I went to ambulatory care at the medical clinic and they took an x-ray.  Said nothing was broken and gave me a sleeve to wear. My knee has gotten better and I can bend it almost all the way now, but I cannot put any weight on it for the first 5-10 min each morning, and it really hurts.  Also when I sit or lay down for a while.  I am 46 years old and have not had any problems health wise.  How long will it take to heal and is there anything I can do to help it heal?

ANSWER: Hello Louise!

I am so sorry you had this fall, and had you released the puppy, there would be two of you with serious injuries!  From the understanding of your very good analysis of the injury, even though you had an X-ray that showed "no fracture", but they didn't explain any possible soft tissue injury.  Wearing a knee brace, or "sleeve", as they call it, will not heal  a torn meniscus, a posterior ligamentous tissue involvement.  Plus, I'm pretty sure there are other injuries impacted by the slide.  If you are saying the knee was bent at the joint as you glided down the stairs, then we have another set of problems affecting the Anterior Cruciate Ligament (ACL), and attached soft tissue.

It is possible to have movement in the knee, but the symptoms of pain with weight-bearing, laying down with the leg straight, or sitting for a length of time will encourage  almost debilitating pain.  Please realize this is a simplistic analysis on my part, but the next thing we have to think about is making an appointment with a knee orthopedist specialist . Make sure you ask around for the name of the best orthopedist in your area.  This doctor will do a complete exam on your knee, with maybe different radiology images, to visualize the whole picture.  What he finds on his exam will determine what he does to rehabilitate your knee.

Please try to do this as fast as you can, as there is swelling and pain which need to be  taken care of as soon as possible.  I would appreciate it if you could share with me what the physician has found, and how it will be taken care of.  Thank you for your note, and I appreciate your contact with me.

Sincerely,

Dr. Patricia Arthur

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

QUESTION: Thank you very much for your prompt response.  I just contacted my medical insurance company.  Accidental injuries are 100% covered for the first 72 hours.  Although I went the next morning, he only took x-rays.  If I go back now for an MRI it is not considered an accidental injury anymore and the cost will be very high.  If something is torn would it get better with time or is medical intervention required?
Thank you for your time.

Answer
Hello Louise!

Thank you for contacting me relevant to your insurance company.  Because this accident happened 4 weeks prior to seeing your family doctor, and X-rays were taken, the insurance company will no doubt try to eliminate you from benefits due you.  As soon as possible, you find the specialized knee surgeon, and speak with their office about the situation with your insurance company.  Ask them to call the insurance company to insist on payment for this injury.  In the meantime, you call your insurance company, and ask for the Supervisor.  Give them the details, and tell them you need to see a specialist.  Giving them the background on the injury, tell them you valiantly tried to wait it out so you wouldn't have to utilize their service, but due to the pain and swelling, you HAD to see the Urgent Care physician.

Now the time has come when it is getting worse, and you need a Specialist to make an accurate diagnosis, and the insurance company to pay for it!  If they insist there was too much time between the injury, and the selection of a Specialist, your attorney might be interested in your story.  Usually, they become  satisfied you will be taking good care of your knee under their fine insurance program.

Find out what the specialist had to say, and let them tell you what your insurance company had to say.  Make notes as you go along so IF you have to get an attorney involved, you will have the date, time, and event in writing.  It's too bad we have to fight tooth and nail to get the insurance companies to work with their paying clients, but that is what we must do in many cases, so they will be fair and obliging.

The type of injuries you have would normally incur tearing injuries, and many times will not heal properly without surgical care.  If it were my knee, I would not wait another minute before confronting the insurance company, nor making an appointment with the specialist.  One rule of thumb to remember, do not pick names out of the phone book!  Ask around for the names of specialists, and while you are at it, ask for names of attorneys equipped and qualified to take on medical and legal cases.  Additionally, do not go back to the same Urgent Care walk-in clinic  you used before.  Try to get  an Orthopedist in a specialty practice, and tell them it is an emergency that you be seen as soon as possible.

Please let me know the outcome, and don't be shy about speaking up for yourself!  You can't fix it, but the Specialist can, and the insurance company should be grateful you are their client.

Sincerely,

Dr Patricia Arthur  

Sports Medicine

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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