Clarification of Answer by
15 Aug 2002 18:09 PDT
Thank you for your patience. : ) I have yet to hear from my email
queries but there was a severe thunderstorm in the area for about four
hours which prevented me from getting online to do further web
research for your question. I appreciate you understanding in this
The emails I sent had to do with an interesting placebo surgery that
had to do with knee pain and swelling. It was presented (most
probably) by the television show 60 Minutes and dealt with one group
of knee pain sufferers being given a knee surgery and another group
being given only the incisions of a knee surgery. The test was to see
if knee pain could, in any way, be psychological in some instances.
One gentleman who had had knee pain (for over ten years) was "cured"
of the pain even though he had no surgery, only the incisions to look
like surgery. I am still searching for this case and hope that one or
more of the emails will provide this information.
The reason I am curious about the psychological study is because I
wondered if there could be any psychological reason for her knee pain.
The mind is a complex organ and I wonder if there was anything about
her hike/camping that she might have viewed as negative. Perhaps
having to carry the heavy pack, whatever - I am simply searching for
psychological information that might assist her problem. I am not
suggesting that the young lady in question has any psychological
problems so please do not infer that from my mention. It is
interesting, however, the results of the knee surgery placebo study.
In other areas, I discovered a condition known as "patellar
tendonitis" in which a woman had a sudden onset of knee pain and
swelling after dancing. Here is a part of her testimonial:
"I am 29 and in good health, but developed chronic pain and swelling
in my left knee in June 2001. The initial onset occurred during dance
practice one evening. I was a competitive ballroom dancer, practicing
10-15 hours a week, but there was no injury, impact or trauma at the
time to cause the pain. I went though 2 rounds of physical therapy,
including the Protonics device, between June and December with no
lasting results. In December the right knee developed pain and
swelling too, and I started a 3rd round of PT. By March I had so much
swelling and pain in both knees that I ended up in a wheelchair
(couldn't manage crutches until one knee calmed down enough). Blood
test and x rays for arthritis were negative, and MRIs and physical
exams showed no meniscus or ligament damage. After seeing 4 OS and 3
PTs in the state where I live, I flew downt to the Cincinnati Sports
Medicine Clinic. Dr. Noyes was brilliant, pointing out that I had
patellar tendonitis from "kissing knees" resulting from too much
internal rotation in my femurs (congenital)."
As you see, her problem was congenital and apparently not brought on
until she stressed her knee with dancing. She did experience swelling
but also pain and it may be the pain is the only symptom present with
the problem your young lady is having. I found this information of
interest and wondered if that had been explored. Below her story were
links to many other knee-related problems, including a link for "knee
pain" At that link are various stories. Perusing those might lend a
clue for you as well.
You mentioned a specialist: have you seen a Sports Medicine
specialist? If not, I would suggest that avenue as well because much
is being found about stree-related injuries in sports medicine. In an
article I found "The knee, a complex, vulnerable joint, is a common
site of sports injury in children and adolescents (figure 1) (1). The
immature skeletal system is susceptible to a spectrum of injuries
distinct from those in adults. When the growth plates (physes) are
damaged, there is a risk of growth arrest and subsequent development
of deformity, particularly for preadolescent patients who have
significant years of growth remaining."
You mention the girl is 14 so this might also be a possibility. It
may be she injured her knee at an earlier age as well and this new
stress injury is a result of the physes being damaged then. Again,
who knows but I looking for anything that might be of assistance to
the diagnosis of her knee pain.
Also, I found an interesting report about training soldiers in the
military and how injuries can happen during training. The report
"Overuse injuries occur because body tissues were not ready for the
amount of stress placed upon them. Here is where smart PT trainers can
really help their unit to cut back on PT related profiles. Listed
below are examples of some of the most common overuse injuries among
Anterior Knee Pain - The knee pain we refer to here is not where a
soldier blows out a ligament playing basketball, just the the
run-of-the-mill "it hurts when I run," front of the knee pain. There
are a host of contributing factors, but we could practically take this
off this list with an effective flexibility program, proper shoe
selection, and, most importantly, smart use of PROVRBS and FITT (see
"Applying PROVRBS & FITT Factors to Injury Prevention" below). "
I would suggest you read this entire report because, to me, hiking a
long distance with a heavy pack is akin to a military basic-training
exercise. The report was very enlightening to me and also stated
"Gender is also a risk factor for injury since women's injury rates
have traditionally been higher than men's for initial entry training.
The current ratio is about two to one. A large basic training study in
'96 showed that women and men of similar fitness levels had similar
I hope this additional information proves valuable to you and I will
post further info if the emails I sent are answered with the
information I seek.
SEARCH TERMS and LINKS:
knee swelling pain stress "no injury" [Google search]
Knee1--Complete Source for Knee Information (COMMUNITY: Patient
COMMUNITY: Patient Stories - knee pain
knee pain stress "no injury" [Google search]
Training Injury Prevention (Fort Benning report)
The Physician and Sports Medicine "How I Manage Physeal Fractures
About the Knee"