My daughter is a teenage athlete. Mainly travel softball, but earlier this year she was also playing volleyball at school.

Back at the end of February she was playing softball and chasing down a ball hit in the gap in the outfield. When she got to the ball she planted her feet, only the outfield was super wet and one of her feet planted and the other slid until she did a contorted split. It took her moment to regain her composure, but she stayed on the field, finished that game and played two more games that day. We did not give it a second thought until the next morning when she woke up and said her knee kind of hurt.

We gave it a few days, then went to her pediatrician, who referred us to a pediatric orthopedist. Our appointment with her was about 2.5 weeks post injury. She did a very extensive exam, got an x-ray and diagnosed patellar tendonitis. Treatment prescribed was rest, ice, ibuprofen as needed and when pain lessens, start PT.

Throw in a spring break vacation, then Mom and Dad both dealing with COVID and PT started mid April. She did 3 weeks of PT, no improvement, return to Doc. Doc recommends PT stop, no activity outside of walking as required by life for two weeks, then resume PT, but no other activity for 2 more weeks. Changed from Ibuprofen to 500mg of Naproxen twice per day. She also said she has not ordered an MRI because it will cost me a lot of money and every single test she has done on my daughter indicates tendonitis and nothing regarding ACL / MCL or meniscus issues.

Two weeks after this, tried acupuncture. Pain level went from about a 6 to about 3 within 24-48 hours of this appointment.

A week later, follow up with Doc. She was happy with the progress and told us to stay the course.

We are now three weeks past that last Doc appointment, three weeks into PT and three appointments into accupuncture and her pain level is still at about a 3, maybe increasing to a 4.

Since this happened on 2/20, and I write this on 6/9, where do I go from here? I have made some calls today looking for a second opinion. Maybe the Doc missed something, but maybe tendonitis is just this damn hard to beat?

Edited to add - This isn't just about getting her back on the field and playing, this is about quality of life. I was thinking about a trip to The Grand Canyon and Moab this summer. We cannot go because of this knee issue, she would not be able to hike. And even simple things like a family bike ride around the neighborhood after dinner, we cannot do.

Just listen to your doctors, it can take time.

Yes, it can be hard to beat, and can take a long time and a lot of PT. Took me almost 2 years to get rid of it in my elbows from golf, and to this day, I have to exercise and do stretches to keep it at bay. My brother, a radiologist, knows how long it can take via conservative treatments (rest, rehab, anti-inflamatories)and chose surgery to get it over with. He got it from the repetitive motion of keying the mic for transcription into patient files.

Legs are tougher to rehab in my opinion, because in some cases you need complete inactivity to allow healing and inflammation to go away. Few people are willing to stay completely off their feet long enough to allow that to happen.

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Give it time. I would not suggest second opinion at this point. Athletes have injuries and they take time to heal. She is moving in the right direction.

Does the current doc believe this is still just tendonitis (i.e. is this on her expected timeline for recovery) or is it time to reconsider the MRI?

The doc should be able to outline the expected recovery timeline to set progress expectations, based on the assumption of tendonitis-only. If it goes too far outside that expected path, it may be time to think about other potential issues.

quote:

Originally posted by joel9507:
Does the current doc believe this is still just tendonitis (i.e. is this on her expected timeline for recovery) or is it time to reconsider the MRI?

Yes, she told us every diagnostic she performed (my layperson words: twisting my daughters leg in multiple directions, pushing on and around the kneecap, etc) indicates tendonitis and nothing indicts ACL / MCL or meniscus issues.

There was not really a timeline given, other than PT is for 6 weeks / 12 sessions.

Maybe check with the doc and see if diclofenac / voltaren would be a option. I've got x3 spots of arthritis in right elbow plus tendonitis. If I have a flare up this totally kills the inflammation and allows me to treat it with PT.

But yea. Tendonitis sucks. When mine is at my worse it's flinching pain brushing my teeth or using a kitchen knife.

Main thing is to be sure to treat it now. So she's not dealing with it 30+ years from now still.

I once got "tennis elbow" from carrying a heavy briefcase (or maybe it was a laptop?) day-after-day, using the same arm. Took a couple months of not doing that for it to go away. More recently--a few years ago, had tendinitis in my right heel area. Hung around forever--until I took an involuntary three-month or so hiatus from working out. When I went back to the gym I noticed one day it had disappeared.

Perhaps consider consult a sports orthopedic doctor for a second opinion?

Tendon injuries are slow to heal.

Took me a full year to completely get over a nasty case in my elbow. I've still got issues that occasionally flare up in my right knee from an injury nearly 20 years ago. In fairness, I really should have had that one surgically repaired but opted for the more conservative route with the understanding that I'd likely have long term issues.

Just stay the course. You need to pay attention to the psychological aspect of this. You do not want her to become a professional patient.

Rest the pain site, find a good topical

I'm not a dr., but I have had both tendonitis and tendon injury. Tendons have very low blood supply, and therefore very little circulation, oxygenation and nutrition to promote healing. Rest and patience are the best cures. While anti-inflammatories (naproxin is best for me) will reduce pain, they may reduce pain to the point where you use the damned thing too much and make the damage much worse. Time and rest is key.

It takes at least a year to heal.

I had terrible tendonitis in my knee a few years ago (at least I think that's what it was). I could not sit where my leg was at 90 degrees for more than 15 minutes before it became unbearable and I had to stand up (made flying and long car rides miserable). As soon as I could stand up and straighten out my leg again, the pain would go away almost instantly. Anyway, it took six months to a year for it to heal.

Follow the physicians instructions.

And:

Vasodilation (hot shower and then transition to ice cold)

Ice massage on effected area(s)

Strengthen sorrounding muscle groups

Isolate trigger movements that cause inflammation

Supplements that enhance joint lubricity

I have had tendonitis and tendonosis in both elbows and worked through it with basic therapies.

Good luck to your daughter.

Yeah, get the MRI…I will bet there is a tear or something else going on.

Tendonitis comes from overuse…and normally from over a certain period of time…not from one event.

I'm not a doctor, just a guy who's hurt himself a lot over the years with basketball and martial arts, including an ACL reconstruction and meniscus tear. I've had tendonitis in my patellar tendon and now in my Achilles. Yes, it definitely takes a long time to recover, especially the Achilles one (over a year now).

However, a sudden event like this may indicate a different injury like a meniscus tear. Tendonitis (at least for me) has been a repetitive use injury and was not caused by a sudden event. An achy knee with pain that won't go away sounds like a possible meniscus tear, and sometimes it doesn't take much to tear it. Where is the pain coming from?

What you've described does sound like the course of action that my doctor recommended to me for patellar tendonitis. You said you're seeing an orthopedist, maybe you can try a sports medicine doctor or get a second opinion with further imaging.

Best of luck, injuries suck.

I went through a bout of it about 18 months ago. Wore an elbow compression pad for about 6 months. Every day. And it disappeared as quickly as it appeared.

If it ever comes back I am seriously considering acupuncture.

I had it in an elbow when I played baseball. It takes some time. It does not go away overnight.