injury query

[skatingmum2]

Daughter unexpectedly fell on knee over 2 weeks ago. Unbelievable swelling and delayed bruising. Seen physio twic e- initially all muscles in spasm and "lateral collataral" ligament/IT band quite swollen/inflamed although this has now "gone down". Amazingly knee still all colours of the rainbow.

Physio has said this week to return to running and cycling and to start skating next week but to avoid jumps until re-assessed.

She has tried running and quite a lots of pain in knee. Muscles  seem flexible enough and myo-fascial release isn't sore. Child has a ridiculously high pain threshold. She is not always to be trusted.

Coaches are saying if there isn't a problem identified by physio then she should return and that as a parent I'm being over-reactive by continuing to keep her off.  Child herself driving me crazy and wants to return although past experience of quite serious injuries makes me hesitant.
 (She has been known to do double jumps with a stress fracture.....)

How much pain seems acceptable? Does it always follow that exercising through pain causes damage?

[fsk8r]

Bruises to take a long time to fully heal. Is her knee still swollen? It's hard to get enough knee bend through a swollen knee.
I can't advise on whether she should skate or not, only you, she and her medical professionals can make that judgement; but if you're looking for an excuse to get her to eat her greens, this could be it. Most leafy green vegetables are high in Vitamin K which is needed by the body for clotting (and therefore healing bruises).

[rachelplotkin]

Not sure why running would be permitted but not skating.  That just feels inconsistent.  Seems like simple stroking and turns would be far easier on her joints than the foot strikes one gets with running.

[sarahspins]

How much pain seems acceptable? Does it always follow that exercising through pain causes damage?

This is really hard to say... it's probably more accurate to say that compensating for pain leads to injury, but not necessarily the pain itself.

If you haven't had any imaging done of the joint I'd suggest requesting that though, the knee is a complex joint and some injuries can easily go undiagnosed.  Without knowing for sure you could be risking further injury, but an MRI would be able to tell you what's wrong for sure.

I am also with Rachel - skating without jumping is less impact than running.  Personally I think it would be okay to get back on the ice if she wants to, but without jumping, until it can be confirmed that nothing is wrong with the knee.

[aussieskater]

Seems basic I know but has she had an xray to eliminate a cracked patella?  Bruising does take a looong time to go down especially if it's the result of a good whack onto solid bone, but the pain should be disappearing even if the bruising is still rainbow?

ETA agree with sarahspins - knees are very complex and damage can go undiagnosed and come absolutely back to bite you later; and "later" often isn't very much later at all!  I don't think you're being overreactive - while they are highly skilled professionals in their field, coaches are not medicos.  There have been too many permanent injurries caused to young bodies from "pushing through the pain".

[CaraSkates]

Seems basic I know but has she had an xray to eliminate a cracked patella?  Bruising does take a looong time to go down especially if it's the result of a good whack onto solid bone, but the pain should be disappearing even if the bruising is still rainbow?

This. I took three hard falls on my knee over three months - black and blue for days, hurt to kneel on a memory foam bed, etc. I had a bone bruise and rearranged a piece of my patella as a result. It took over a year for me to be able to kneel without pain and two plus years for me to be able to kneel without padding. It's been three years and still occasionally bothers me. I have a bipartite patella, something that is very common but causes no issues until you injure it. On x-rays, you can see the two pieces of my patella and it looks "broken". From the fall, part of my patella moved slightly and changed the way I walk, jump, etc.

 Arnica cream is great for helping speed up healing of bruises.

[AgnesNitt]

Have any of your medical types considered a Bone Bruise.

I've had these after falling / being thrown off a horse. They can take months to stop hurting. I could barely walk for several weeks. These are excruciating.

(wow, I need to type faster than caraskates, she beat me to bone bruise by 40 sec)

[Willowway]

Having just gotten back on the ice after 6 months off for knee surgery (and of course I injured it while taking out the garbage in the dark, not trying something daring on ice - torn meniscus) I would suggest that your daughter has an MRI on her knee. Get a definitive diagnosis before fooling around with an approach to returning to any athletics. At this point you don't really know what has happened and therefore, any road could be the wrong (or right) one but it's a guess.

I tried to work and skate through my pain for far too long when I tore the meniscus - I only made it worse. I don't know what I was thinking. I too have a very high tolerance for pain so my coach thought I was really okay and I stalled and stalled and tried and toughed it out - it didn't get any better. When I finally got my butt to the doctor things started to improve.  My right knee will probably never be entirely pain-free again as a result of what I did but it is now moderately comfortable, very functional and I'm not causing myself further damage (until I trip taking out the garbage again!). At my age (66) that probably doesn't matter much but she's young and her knee has a lot of work left to do!

ETA - hope I'm not sounding too strident but after being through surgery and 6 months (3x per week) of PT (what a drag), I just think these things need expert diagnosis from the get-go. You've posted because you want the very best result for your DD and we are all with you on that.

[sarahspins]

Have any of your medical types considered a Bone Bruise.

That was my first thought... and an MRI would show it if there is one (as well as other soft tissue injuries)... an x-ray will not.

I had a bone bruise 18 months ago and it was extraordinarily painful... it was ultimately diagnosed by MRI after a battery of other tests (x-rays, joint manipulation) didn't really give a good idea of what might be wrong, it was probably hurting as much as if I had broken it, but x-rays didn't show anything.  I also had an issue in my "good" knee that was diagnosed after an MRI as well. it hurt a lot after what I felt like was a "pop" but it turns out that I had a cyst that had likely ruptured and has since resolved (without any treatment), but having a cause for the pain I was experiencing helped me a lot - I knew I wasn't hurting anything with the knee by continuing to skate.   I did take some time off for the ankle to heal.

[CaraSkates]

Have any of your medical types considered a Bone Bruise.

I've had these after falling / being thrown off a horse. They can take months to stop hurting. I could barely walk for several weeks. These are excruciating.

(wow, I need to type faster than caraskates, she beat me to bone bruise by 40 sec)

Must have been all the instant messaging I did as a teen.

In all seriousness, bone bruises HURT and should be taken seriously - I needed a knee immobilizer among other things.

[dlbritton]

She has tried running and quite a lots of pain in knee. Muscles  seem flexible enough and myo-fascial release isn't sore. Child has a ridiculously high pain threshold. She is not always to be trusted.

How much pain seems acceptable? Does it always follow that exercising through pain causes damage?

First, I agree with the other statements that you should get an MRI to determine if there is any soft tissue damage.

I tore my MCL skiing last December but fortunately the MRI showed no ACL or meniscus damage. During PT my knee would get very sore from leg curls, elliptical machines or bike riding but the orthopedist said that was not directly from the torn MCL. As he put it I had "stirred things up" in my knee with the tear and the pain would go away with time, but that I was not causing any further damage. In July I took up skating after graduation from PT to regain muscle strength in my legs. For a while I was taking Aleve morning and night for pain from gym workouts or skating but all of the pain has subsided now.

As long as you confirm there isn't any underlying damage, the pain she has may be similar to what I experienced and it will fade with time.

[amy1984]

The instructions from the physio sound a-okay to me - I just got through a round of physio for a hip injury and actually, running mymics a hopping movement that they want you to do or something.  I might be slightly off in the wording but it's not about the foot strike.  Don't ever let a coach guilt you.  As long as you've got a good physio that deals with athletes, they know what they're talking about.

Also, I don't know where the OP is, but I was thinking it might be Canada for some reason?  Please correct me if I'm wrong.  If so, it's not so easy to just 'go get an MRI'.  But as I said, please correct me if I'm wrong on the location of the OP.  This is one thing I'm slightly jealous of the Americans on in terms of health care.  Other than wait lists, I'll take my free heath care any day!

[skatingmum2]

Unfortunately yes - not in US and last time she needed one it took a couple of months to sort. I must admit I did think it would be better by now so didn't push for one. Just read up on bone bruising - doesn't sound great!

Physio thought her knee was fairly intact after pushing and prodding it but maybe we need to get it looked act by a medic.

[Query]

I bet the next time she hurts herself, she covers it up and pretends nothing is wrong, so you won't keep her off the ice.