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Q: I am having increasing pain in the front of my knee. I am a 35 year old female and like to be active in sports. What can cause this and how can I improve it?

A: Anterior knee pain is one of the most common complaints in the knee. This is more common in women then men and may or may not be sports related. It often times starts out slowly with symptoms but increases with activity. There are many possible causes for the pain. These include bursitis, tendonitis, cartilage injuries and even referred pain from the back and hip. The most common reason is due to patellar (knee cap) and surrounding tissue irritation. This can be brought on by a sudden increase in activity, structural abnormalities and muscle imbalances. Treatment: begins with the modification of activities until the pain resolves. This may involve cutting back on activities, cross training or discontinuing the activity. Ice, anti-inflammatory medications, massage and even braces may help get the pain under control. Once the pain is absent a progressive flexibility and strengthening program focusing on the appropriate muscle groups will often times allow pain to be relieved. If pain persists or if swelling, locking, catching or giving way occurs it is best to be evaluated by an Orthopedic Surgeon rather then continue on with activities.

Q: On 11-05-2008 I rolled my right ankle severely. I went to a clinic on Tuesday (11-11-08) and they took 3 x-rays of my ankle. The physician told me I had a broken fibula and to go home and keep it evaluated with ice. He also gave me some mild pain killers. My question is shouldn't he have asked for an MRI or something else to check for soft tissue damage as well? I'm getting sharp pain that is originating near my toes and going around my foot through my calf muscle, nearly up to my knee.

A: All ankle sprains and fractures are different, and the treatment varies depending on the severity of the injury. It is not very common to order an MRI for someone with a recent ankle injury. If you have a fracture, the ligaments are probably OK. If you have a bad spain, then the ligaments are torn. However, in almost every case, if we protect the ligaments in a boot or brace, they will heal perfectly normal on their own. MRI's are typically down when patients are not improving as fast as we would expect. If you are not improving or you are unsure of the care you are receiving, then you should follow up with an orthopedic surgeon, possibly even one who specializes in the treatment of the foot and ankle. I hope this advice is helpful for you.

Q: I keep tearing or pulling a calf muscle when just trying to maintain a walking program. This has been going on for over 2 years now. Rest and stretching only helps temporarily until I
begin walking!

A: Repetitive tearing or pulling of the calf muscle is usually the result of failure of complete healing of the muscle/tendon unit. This ultimately leads to weakness in this area and as a result a re-tear. Treatment of this problem would first involve making sure that no other muscles other then the calf muscles are involved. Following a thorough exam the most benefit would come from a comprehensive therapy program concentrating on stretching and eccentric (muscle lengthening) strengthening exercises. Sometimes a small heal lift also may be of benefit. If following this you continued to have tearing then an MRI might be performed to determine the extent of injury and the possibility that this would be a surgical problem.

Q: I work a regular 9-5 job where I sit in front of a computer all day. I have tried two different kinds of office chairs, but continually have severe lower back pain. Is this something I need to come in for, or do you have an office chair recommendation that would solve the problem? I don't
want to make my company buy me a new chair unless I know it won't hurt my back!

A: Chairs are important. I recommend a high back chair which reaches the upper back or the base of the neck. The chair should provide lumbar support. The arm rest should be adjustable as well as the height. The desk are should sit comfortably in front so the arms are at 90%. The computer monitors should be at eye leave as well. You should also frequent position changes at least every 30 to 45 minutes. If you have attempted this option and have found no relief scheduling an appointment with your orthopaedist will be helpful.

Q: I tore my ACL, MCL and meniscus in a soccer injury on 11-16. The tibial plateau was also fractured, but did not show up on X-ray, only on the MRI which I had 2 weeks after the injury. How
will I know when the fracture has healed since it didn't show up on X-ray? I am private pay and can't afford multiple MRI's knowing that I will have to have surgery in the future.

A: Typically, we ask that you allow 8 weeks for a tibial plateau fracture to completely heal.

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