17-year-old boy experiences knee pain during basketball practice

About two months ago, he started feeling discomfort in his knee while playing basketball in his club activities. Recently, the pain has worsened to the point where he feels it even when walking, so he decided to visit Spine Chiropractic.

At the orthopedic clinic, an X-ray was taken, but he was told that there were no abnormalities in the bones. He was only prescribed a pain relief patch. Since then, he has been going to a bone-setting clinic with his parents, where he received electric therapy twice a week. The treatment included electric stimulation and thigh massages, which temporarily eased the pain for a day or two, but the pain would always return.

Recently, the pain has become stronger and more frequent, so his parents started looking for alternative treatments. While searching for nearby chiropractic or osteopathic clinics, they found this clinic on Google Maps. After seeing that knee pain was listed as one of the treatable conditions, they decided to visit.

[Initial Symptoms]

Interview: Two months ago, he felt discomfort in his knee at the moment of taking a shot during a basketball game, and since then, the discomfort has turned into persistent pain.

He has received treatment at hospitals and Japanese style Osteopathic clinics and has also tried massaging his knee and applying pain relief patches himself, but there has been no improvement. As a result, he has only been able to play for short periods as a substitute in games. He is eager to recover quickly so he can return to full participation in matches.

Visual Inspection: No visible abnormalities were observed upon visual assessment.

Static Palpation: The tension in the right quadriceps was elevated, particularly in the vastus medialis, causing the patella (kneecap) to shift inward.

Additionally, the right adductor muscle group also exhibited increased tension.

Motion Palpation: There was a restriction in external rotation of the right hip (outward rotation).

While there was no significant limitation or pain, the right knee did not bend as much as the left when flexed.

Orthopedic Tests:

Knee adduction: (-)
Knee abduction: (-)

Muscle Strength Examination: No muscle weakness related to the hip or knee joints was observed. However, the patient reported discomfort during the quadriceps muscle test, particularly in the vastus medialis and rectus femoris.

[Initial Treatment Plan]

I hypothesized that the patient’s right quadriceps contracted more strongly than the left. Given that the pain was more pronounced at the moment of jumping rather than when absorbing the impact of landing, I focused on addressing not only the quadriceps but also the core muscles, iliopsoas, and gluteal muscles involved in hip movement.

In addition to improving the flexibility of these muscle groups, I aimed to modify the movement patterns of the pelvis, hip joint, and knee joint. To achieve this, I worked on improving the condition of the lumbar spine, pelvis, and sacrum, applying joint adjustments to enhance the body’s overall kinetic chain from a structural perspective.

The patient was instructed to return for a follow-up visit in three days, after two practice sessions.

[Prognosis]

Second Visit:
After two days of practice, the patient still experienced pain, but he noticed a decrease in both its intensity and duration. In addition to continuing the same treatment as in the first session, ultrasound therapy was introduced to reduce the direct strain on the tendon.

Ultrasound therapy was applied not only to the patellar tendon but also to the vastus medialis, as the pain was concentrated more on the inner side of the knee. After the treatment, the patient reported that knee flexion, extension, and jumping felt significantly lighter. Based on his response, the next session was scheduled one week later.

Third Visit:
During the interval before this visit, the patient had about four practice sessions. While the pain occasionally returned with repeated activity, he followed the instructions given: “If you feel pain, apply ice, then massage the kneecap in a circular motion.” As a result, any pain he experienced would subside overnight, allowing him to return to full play.

Since the alignment of the pelvis and hip joint continued to shift, adjustments were carefully performed in each session.

A new instruction was added this time—performing resistance band leg presses and squats before practice. I advised to avoid squats if they caused pain, as they involve weight-bearing.

Since the pain was becoming less intense and recovery was improving even when discomfort occurred, the treatment was judged to be effective. The same approach was continued, and the follow-up interval was extended to two weeks.

Fourth Visit:
Over the two-week period, the patient had also been diligent with strength training. He reported, “Just as you said, doing strength training before practice prevents the pain.”

Since the pain had decreased to a level where it no longer bothered him and he was recovering quickly when discomfort did occur, the treatment phase was concluded. The patient was reassured, “If the pain returns, feel free to come back anytime!” and the case was closed.

[Practitioner’s Opinion]

Since the boy’s symptoms involved anterior knee pain, it was necessary to differentiate between Osgood-Schlatter disease and jumper’s knee, both of which can cause pain in the same region.

Although no specific diagnosis was given at the orthopedic clinic, the doctor’s assessment that “there were no abnormalities in the bone” suggested that Osgood-Schlatter disease was unlikely. This condition typically presents with pain at the tibial tuberosity and can sometimes lead to an avulsion fracture. However, in cases where there is no obvious separation, it cannot be entirely ruled out based on X-ray imaging alone. That said, there was no pain elicited upon palpation or percussion at the tibial tuberosity, further ruling out Osgood-Schlatter disease.

Based on this assessment, I suspected patellar tendon pain—commonly known as jumper’s knee.

Both Osgood-Schlatter disease and jumper’s knee frequently occur in sports that involve running and jumping. They are often caused by accumulated stress on the tendons due to inadequate post-exercise care of the quadriceps.

Pain can arise either from the strain on the quadriceps during contraction at the moment of jumping or from the impact absorption during landing. At Spine Chiropractic, my approach varies depending on which type of pain is more prominent.

In this patient’s case, the pain was strongest at the moment of jumping and lingered afterward. Massage of the quadriceps at home provided relief, but stretching caused discomfort, indicating that increased stress on the tendon exacerbated the pain. (Stretching the quadriceps is necessary, but there is a proper technique to avoid aggravation.)

Additionally, muscle strengthening was a key factor. Since the pain occurred during jumping, increasing muscle tension before practice was also necessary—to reduce strain on the patellar tendon.

I guided him through a strength training regimen to gradually increase overall muscle mass while ensuring that stress on the patellar tendon was first minimized.

While the specific treatments were outlined earlier, addressing the overall skeletal balance was essential in this case. Without improving the body’s structural alignment, the underlying cause of why the right knee developed jumper’s knee would remain unresolved.

This principle applies to all cases: ultimately, achieving a well-balanced skeletal structure is crucial for long-term recovery and injury prevention.

Currently, his father is visiting for treatment and shared some wonderful news: “Our son is now playing basketball pain-free and recently competed in a tournament, where his team finished as runners-up!” I couldn’t be happier to hear such a great outcome.

At Spine Chiropractic, I address a wide range of musculoskeletal conditions directly impacting daily life, not merely as a form of relaxation therapy. Conveniently located within a one-minute walk from Bashamichi Station, an eight-minute walk from Nihon-Odori Station, a seven-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station, my clinic is well-suited for residents and workers in the Yokohama area.

If you are experiencing similar symptoms, please feel free to visit Spine Chiropractic. I am committed to providing care with sincerity and professionalism.