patellofemoral pain syndrome/tendonopathy and other pains that won't go away

by Maria
(Orange County, CA USA)

My 12 year-old daughter sprained her finger playing basketball 4 years ago. She had to quit playing because in never completely healed. Radiographs were negative. She began to swim competitively 2 years ago and had to quit in October because of nerve impingement in her right shoulder, bicep and supraspinatus tendonitis. She had increased her workload.

She had also been taking ballet over the last year and when she quit swimming, she increased her workload in dance. 2 months ago she began having pain bilateraly in her knees with the severity alternating between the right and left.

One week one knee will hurt more, the next week it is the other. She does not want to now have to give up dance. Her knees usually only hurt her when she jumps and lands on a single leg. Last night her knee began hurting going up an incline. She is in PT and was dxd (diagnosed) with patellar femoral pain.

Her physical therapist said yesterday that she had patellar tendon pain. Both are descriptions of symptoms and not really a diagnosis. Other girls on her swim team and at her dance class have increased their workload and don't seem to break-down like she has. She also began Accutane therapy 3 months ago which complicates this as it can cause joint and muscle pain.

She has been seeing a sports medicine specialist and is to go back for a recheck in 3 weeks. She has not had any studies such as radiographs nor MRIs. PT doesn't seem to be helping. She has cut back from 9 hours of dance per week to 5. She is also slightly knock-kneed and has been taking private ballet classes to teach her not to overly tighten her knees when doing the exercises.

I am wondering what our next step should be? Her sports med dr said he would be willing to order an MRI. I am wondering if I should get a second opinion from an orthopedic surgeon. Her doc is board certified in family medicine and sports medicine. She doesn't seem to heal well.

It has been 4 months since she quit swimming and she still has shoulder pain, 4 years since her finger sprain and it still bothers her. Now I am concerned the kness are going to become chronic as well. Should she stop all exercise completely?

Please help. I live in Orange County, Ca but would be will to travel if anyone knows a really good knee specialist. Any advice is appreciated.



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Joshua Answers:

Hello Maria.

How's your daughter doing now? Give me an update.

You say 'she doesn't heal well'. But that assumes that she's injured. Just because she has pain doesn't mean she has any actual damage.

Maybe you said that as a broader general observation. If she's a slow healer of injury, there's a reason for that. If she has pain but no injury, and the pain doesn't go away fast, that's an ENTIRELY different converstation. Which may or may not be related.

I'm VERY glad that you caught this: "Both are descriptions of symptoms and not really a diagnosis."

Symptoms are NOT a diagnosis, but that's usually as deep as (pretty much all) doctors and (most) PT's go into it, somehow collapsing a symptom as the cause of a symptom.

From what you've said, I'm more interested in her nutritional status. There's likely plenty of good reason that Physical Therapy hasn't helped.

Tendonitis pain can come from a lot of different directions, and may or may not include actual injury.

See: What Is Tendonitis


1. First off, stop the Accutane. Yikes.


2. What's your daughter's Vitamin D level? If you don't know, find out. Tomorrow.


3. Learn about Magnesium for Tendonitis. And get her on as much Magnesium as she can get into her and onto her per day. Follow the link for 'Magnesium Dosage' at the bottom of the above linked page.


4. For Patellar-Femoral pain, and wanting her to have an athletic career, I highly recommend this ebook about hip tightness and muscle balance and how it relates with patellar tendonitis.

Barton has a lot of information on his website that I haven't gotten to adding yet, and it's good information. He's a great athletic trainer, and I like and trust his info.


5. How's her energy levels?


6. How's her digestion?


7. Say more about 'her finger never really healed'. Details, details, details.









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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com