Repeated knee injuries in a teenager snowboarder

Patient

Q: In December 2009, I was snowboardingg for the first time. I kept falling and hitting my knees, because I was new at it. Whenever I fell, I managed to always hit a hard piece of ice. Later that night, my right knee swelled up about three times its normal size. After a couple days it was a bit better. Ever since then, however, whenever it gets really cold, or I sit for to long (keeping it cramped up), or put a lot of pressure on my knees my left one gets really sore. I would have excpected that to go away by now seeing as it's almost a year later. What do you think is wrong with my knee?

Doctor

A:   You have a past medical history of Repeated injuries on your knee , that resulted in pain and swelling, muscle strain, or tissue damage, due to your snowboarding. On the other hand, Knee pain is the most common presentation of patellofemoral syndrome. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (during squats, bicycle, ascending/descending stairs, jogging 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. The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory medication (i.e.: “Aleve”, “Advil”), education  so  you understand which activities avoid because those can aggravate patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. The physical therapist should educate you about a home exercise program. Allow time for these conservative measures (exercise program) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms.

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