[Permission graciously granted without monetary benefit to Stretch to Win by the people in this story to post this blog entry & these videos about a personal medical condition].

A 12 year old female pre-professional ballet dancer by the name of Allie came in to see me last week. She was referred to me by the director Lisa of the Plum Performing Arts Center in Scottsdale because her student hasn’t danced for 3 months due to severe left knee pain.

Allie came in with complaints of pain on the front-inside (it’s called ‘antero-medial’) part of her left knee but her diagnosis was a Baker’s cyst which occurs in the back of the knee.

In adults, Baker’s cysts usually arise from almost any form of knee arthritis and cartilage (particularly the meniscus) tear. Baker’s cysts in children do not point to underlying joint disease. Baker’s cysts arise on the inside calf (between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles & posterior to the medial femoral condyle).

Allie told me that about 8 months ago she had lost her balance while in her pointe shoes & fell onto the front of her left knee. She kept dancing that day (typical dancer) but the knee got increasingly worse over time until 3 months ago she had to stop dancing. X-rays & MRI revealed only a small popliteal (Baker’s) cyst.

Allie’s mom told me that they have been to 2 medical doctors & 2 physical therapists over the last 3 months & there was no change in her pain (7/10 at rest—8/10 walking—9/10 squatting—10/10 pain dancing). She had been on anti-inflammatories with no effect. They were both very frustrated & the mom felt that the medical system left them without any hope that her daughter would be able to return to dance anytime soon, if at all.

After taking her history & physical exam, it became clear to me that she probably had a biomechanical dysfunction in the joint beneath her kneecap. When I asked the mom if any of the previous medical specialists or therapists mentioned the words “patellofemoral joint syndrome” she said no, which encouraged me to pursue this line of reasoning (& differential diagnosis) even further.

When I tested the strength of her quads manually, she had 8/10 reproduced pain with quad weakness (tested at 3/5), so I shifted her kneecap with my hand & firmly held it in place while again testing her quad strength. This time it was pain-free & strong (tested at 5/5). Next I used the Kinesiotaping method to shift her kneecap into a better position & taped it into place.

When she stood up & walked her pain was 1/10 & a squat tested at 1.5/10. I added another strip of tape on a specific angle – she then tested at zero pain in walking & .5/10 pain squatting. Allie had a big smile on her face & her mom said “Is that all it took? I can’t believe it! Why couldn’t the others figure this out??” I replied “I don’t know but I consider this a basic & fundamental part of evaluating a knee”.

It annoys & angers me that this simple diagnosis & treatment was missed by 2 medical doctors & 2 physical therapists & caused so much wasted time & unnecessary pain on the part of the patient who is supposed to matter the most. I think a big part of the problem is that with “managed care” doctors & therapists are way overbooked & don’t spend the necessary time to ask the right questions & take the time to look at the whole patient.

Next week she starts a dance specific Pilates rehab program to progress her to dance class in another 2 weeks.

Here is her home program:
- self myofascial release (self-massage) of trigger points on the outside hip & leg connective tissue (for anatomy geeks: glute min/med, IT band, lateral hamstring/quad).
- stretch above mentioned muscles
- inner quad (vastus medialis obliqus) strengthening
- self tape kneecap