Teenager with knee pain?

I have a teenager client. He is currently complaining of knee pain on the inside of the knee and under the knee cap. On assessment, I found that his pelvis, knees and feet all turn in which make him walk pigeon toed. He has had orthotics since January 2009 and he has asked his podiatrist to review him however the podiatrist believes that nothing is wrong.

I have tried strengthing exercises as well as manual therapy to release tension in his hips.

What else can be done?

dear Miss Melanie,

Please tell us a little more.
How old is your teenager?
Is the rotation in the bony structures (tibia and femur) or because of hypermobile joints?
How is his strength, not only locally but in the whole chain?
How is his coordination and balance?
How strong are his trunk muscles?

When we know a little more we can give you a better answer.

Esther


Will need some more information before I can give a proper answer.

Ok.

He is 16 years old, 17 in a couple of months. The rotation is in his bony structures. He is quite alot of strength and has great cooridnation and balance. His trunk muscules are quite strong.

Hope that helps

Thanks for your post. Perhaps his vocation history may lead to more ideas here. As a 16-17 year old aussie I assume there is some sport involved here? How rotated is this young man, i.e. to the level of deformity or is this a slight internally rotated leg. With that in mind is the rotation functional or is it structural (in the bones themselves)?

Patellofemoral pain is an indication of excessive load on the joint OR that normal load is not being deal with by the joint (disease/diet inadequacies etc). We need to work out why that is and what factors are present here.

He does play futsal (indoor soccer) once a week and trains for that once a week. You can tell that the leg is internally rotated but not to the state of deformity. The rotation is structural. He does not put excessive weight of his knees and he has no known cause for this.

He does have a healthy diet and is the correct weight for his age/height.

OK, now we have our answers. Futsal is a very demanding sport on the legs. As the ball doesn't bounce as much as a normal football the players technique is called into action here. It would be common to see players with medial ligament and PF joint line tenderness playing this game. He may have some medial laxity making it worse? You could strap him prior to playing one practice session to see if that helps. Otherwise you'll need to look at the patient in the game to see what they do. Consider options in the footwear also as it is played on a hard surface as well.