Knee pain and Back pain in a young discharged Marine


Q: My son served 4 years in the Marines and was honorably discharged before returning to military service in the U.S. Army. He can no longer parachute because of the toll that "jumping" and the rigorous manuevering of the "badlands" of Afghanistan with heavy packs have had on his knees. He is very slender and has always been very active and a superior runner... until now. NOW, ascending stairs causes severe knee pain; simply carrying a bag of groceries up the few steps of his home is painful unless (as he says) he gets a "running start" so that he reaches the porch surface before the pain can register. Sadly, a relentless back pain is beginning to eclipse the knee problem. He's pretty cynical about the kind of medical attention he's able to access, shrugs off questions about his condition because he doesn't think there's anything that can be done, and basically "sucks it up". Right now he's concerned because he's discovered that he's lost 3/4 inches of height: 71 1/4 inches versus his former 72 inches. What should he do? I worry about him and feel bad that I am not medically "savvy" and have no good recommendations as to how he should proceed.


A:   Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (ei, during squats, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. On the other hand, the parachute jumping is a high impact activity with consequences on the lumbar spine and the weight bearing joints. Mechanical or activity-related spinal pain is most often aggravated by static loading of the spine (prolonged sitting or standing), long-lever activities (vacuuming or working with the arms elevated and away from the body), and levered postures (forward bending of the lumbar spine). Pain is reduced when walking or constantly changing positions, and when the spine is unloaded (reclining). However, a persistent, relenting pain requires further investigation, and also the loss of height, as follows: evaluation by a physician, imaging studies (MRI, CT scan) and sometimes even functional studies as electromyography.
The suggested strategy to treat a back pain that has persisted for more than 1 month is as follows: evaluation by a physician to rule out other possible causes than just mechanic or postural and start a physical therapy program aimed to control pain, stretching and strengthening exercises, correct posture, and learn an exercise routine that can be follow at home, also the use of anti-inflammatory drugs (i.e: “motrin”, “advil”, “aleve”) can be beneficial to manage the pain. Nearly everyone improves within a month following this conservative measures if it is indeed a mechanical back pain.

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