I have a medical question, which is for an assignment. We are given some details and need to work out what is wrong. It is very difficult and I have no idea where to start! I was wondering if anybody out there knew anything that would help me!
Here's the problem:
"Amanda is a 19yo tennis player that you have been contracted to do some fitness training with. She is on a long comeback from a major ACL, MCL and meniscus injury to the left knee whilst playing tennis 11 months ago. She is very committed to the sport and has done heaps of closed kinetic chain rehab on the injured leg and worked closely with her physio to regain full strength in her extensors and flexors compared to baseline measures. The physio and doctors gave her the all clear to begin full competition 3 months ago. Competing again, she is struggling with back pain and has noted a breakdown in technique with fatigue. Amanda says the knee feels fine, her back is annoying her however and she doesn't seem to be able to generate the same punch in her shots as she did before the knee op."
Any help would be greatly appreciated!
it could possibly be a SI joint problem, a few years after i had my first reco i developed a si problem because of the imbalance in muscles............im no expert though, just throwing it out there
Sometimes after a major injury to the knee, there is a loss of normal gait pattern in the knee. in other words, the patients movement patterns subtly change as the knee is not as good at telling where it should be.This is because the original injury caused damage to tiny nerves involved in joint awareness/positioning(proprioception) the bad movement pattern will then be transfered up to the back, causing pain.
Perhaps the rehab programme didn't include enough proprioception(joint awareness) training and gait re-education.
also there may have been little or no attention paid to core strengthening.
Thanks heaps, guys!
I'm looking into the possibilities of the SI joint problems and changes in gait. The information about proprioception may be very useful, too!
I'll keep you posted and tell you if I find the answer!
You may want to look at weak glutes, hip muscles and lower back muscles. These can be issues too.
Compensatory gait patterns to protect the operated knee or time in a crappy hospital bed can do it.
I cannot beleive i have found this forum..
I am doing this exact same assignment and i have the exact same question as this. (pretty lazy from the teachers)
For 2 weeks I have tried to come up with possible solutions about what the problem may be.. and I am also having trouble coing up with any questions to ask the lectuer..
If you can help me in ANY way possible it would be a great help..
Even if you can tell me what the problem it... has it got anythin to do with hamstrings..
please please please get back to me!!!!
Something else to consider is the increased stress on the lumbar spine due to compensation for lack of knee movement during the rehabilitation period. E.g. patients often bend their back to pick things from the floor etc rather than squat or lunge. In addition, sitting time also often increases to take load off the knee resulting in further increases in flexion forces on the lower back. The combination of increased general lumbar flexion and sitting often can be sufficent to cause intervertebral joint damage with an annular tear to the disc or disc bulge often being the final result. Furthermore any loss of flexibility in the hip or hamstrings that has not been restored during rehab will further increase stress on the lumbar spine and result in lumbar spine compensation during serving, lunging forwards movements etc.
For detailed information on a disc bulge check out the following link:
Lumbar Disc Bulge
Hope that helps,