The really great news is that Ally's knees are fine. Totally fine - there is no inflammation visible, there is nothing wrong with her knee cap, the joint, the bones, the tendons - everything looks really good.
The bad news is that Ally is still experiencing pain. She says that with walking or doing stairs at school her knees hurt a little - on a scale of 1-10 (10 being I need to go to the hospital this hurts so bad its an emergency) her pain now is a 2 to 3. That is her pain level whenever she is doing any weight bearing activity like walking.
Yes. 2 years since the last pain incident and Ally is dealing with pain again.
The ultrasound doctor said it best "sometimes when we don't do our regular activities our brain gets confused and thinks there is something wrong when there really is not anything wrong" Ally's medical history with chronic pain, and the fact that she is a high performance athlete all compound what is probably her body's natural inclination towards mixed pain messages. That means that since Ally's body is so used to lots of activity that when she stops the activity due to injury it is even harder for her nerves to cease sending pain messages after the injury has healed.
Basically Ally had some kind of injury to her knees, whether it was "jumpers knee" or tendinitis or just pain old patella femoral pain no one really knows which one for sure and it doesn't actually matter, they are all treated the same way with rest and lots of PT to strengthen the surrounding muscles. We did all that and Ally's pain which was a 6,7 or 8 when walking or doing activity has decreased significantly - she says the most pain she has experienced in the past 2 weeks is at ballet - it was a 4 at some times during class but not even all of class. That is much better than an 8; its a 50% reduction in her pain! And it was an 8 - back in January and February she would come home from ballet almost in tears and would limp over to the couch and ask for ice. It took a long time for the pain to go away. Then she would go to practice 4 days a week and experience the same pain and we would repeat the same ice and ibuprofen routine. Tears some nights it hurt so bad. So honestly the 50% reduction in pain is really great.
The way forward is for Ally to start getting back to running and jumping and tumbling. Gradually, so that as Ally increases her activity her confidence in her body also increases. She has been out of these tasks completely since early March and on limited activity since early February. On the plus side Ally hasn't stopped going to practice or ballet, and she has been doing twice weekly physical therapy the entire time. She is so strong right now - stronger than she has ever been. When her team mates are practicing floor and vault Ally is working on her conditioning so she is in top physical shape to start running and jumping again.
She just has to battle the pain. The doctor said pain below a 5 is OK and to be expected and that Ally has to work thru that as she feels comfortable. And Ally needs to recognize the difference between soreness and achey-ness from doing things she's not used to doing from the pain sensations. But that if the pain sensations are really bad - like a 6, 7, 8 or higher then Ally should definitely stop the activity and rest and if the pain continues then we will need to go back to Children's and visit with the Pain Treatment Services like we did two years ago. No one right now thinks this is Pain Clinic worthy, but it is the same type of condition as before. I learned yesterday that "its not uncommon" for repeat of the nerve mis-firing.
I asked the big question about how to prevent this from happening again. This being the pain condition. There isn't really an answer. They just don't know that much about this kind of condition. But the short answer was:
1) Stretch - stretch a lot - keep muscles and ligaments as loose and in good shape as possible. Stay in top shape - the better shape then the less likely for injury. They did tell us at the Pain Clinic when we were discharged 2 years ago to keep up the stretching - we just figured with all the ballet and gymnastics that was enough. Now we know that for Ally she should do more. She should stretch every day in addition to what she does in her activities. She should also keep doing a home exercise program so that her body is better equipped for her activities.
3) Contrast therapy with any injury, no matter how small. Since we now know that Ally's nerves have a tendency to get confused we should help them stay focused and one way to do that is with contrast therapy: alternating hot and cold packs on the injury site so that her nerves feel hot for 1-3 minutes then immediately change to a cold pack for 1-3 minutes. There is some medical evidence that shows that contrast therapy helps nerves to stay on track.
2) Quick injury recovery - That when Ally does have an injury (and we all agree that she will get hurt again, and the doctor was very quick to point out that injuries are inevitable in all people, not just athletes so its not just because of ballet and gymnastics, its that as humans we injure ourselves with a fall or a trip or just doing regular and recreational activities, its not just performance and competitive sports). The take-away here for me was that if Becky and I had been more aggressive with getting Ally to the orthopedist sooner, we would have had a diagnosis of her knee pain earlier and then the actual injury recovery would have been sooner. (The nerves would have felt the pain for less time, beacuse as the injury healed faster the nerves would have had less time over all to keep sending the pain messages, and maybe wouldn't be confused because the pain would have been for less time, and the longer the pain is there the easier it is for the nerves to get confused and then the longer Ally stays away from activities that cause the pain the longer the nerves continue to be confused.)
This is a hard one to swallow; the realization that maybe if we had listened more or acted sooner this could have been prevented. But we didn't know. And Ally has to learn how to advocate and communicate to us and to her coach about how bad her pain is. If we had all known how much she was suffering sooner then maybe we would have taken action sooner. Its also important to note that there is no way to know. Its not like any doctor knew this would happen. It might not have happened.
But it did and here we are.
Th orthopedist asked that Ally take the next 2 weeks and increase her participation at gymnastics and see how the pain is. She asked that we call to check in in 2 weeks. Hopefully, and I do have a lot of hope in 2 weeks of working thru the pain the pain will be less, and then we can give it another couple of weeks and gradually the pain will go away. It is was happened last time. I recall clearly leaving the Pain Clinic and being told that now it was up to Ally - she had to do things and work thru the pain and that after a while the pain would go away. It did eventually go away.
Its up to her again.
And she is feeling conflicted. Relieved there isn't anything structurally wrong with her knee. Scared about how much her knees will hurt when she starts running and tumbling again. Bummed that this is a pain condition again. She herself said the fear of the pain is real and big. She wants to get back into tumbling and running with "baby steps" as she calls them. A gradual increase in the pain-inducing activities so that she can better manage pain.
Yesterday after we got home from the hospital Ally spent hours in her room - its her favorite thing to do now a days. She sorted and purged and straightened things up. It occurred to me this morning as she told me how glad she was that she worked on her room last night that she took control. She doesn't have control over the nerves sending bad messages but she has control over her room and how that looks. So she exercised her control where she could. And she felt better because of that. Good for her.
I try to be honest in this blog. Part of why I blog is to share with family and friends far away but also part of why I blog is for Ally - so she has a record of her life. And so she always know how very much Becky and I love her. We are so grateful and honored and proud to be her parents.
But this is hard. Its hard to know Ally has to deal with pain again, and to realize that she will probably have to deal with this again and again in her life. I'm trying to focus on the positive - this time its not as bad as last time. We know more now, and we will know more the next time. But honestly its a bit heartbreaking to know Ally has to experience pain at a level 3 or 4 and maybe 5 and work thru the gymnastics she loves with that level of pain for a while until it goes away.
On another positive note Ally is cleared for tumbling and running and jumping - things she loves to do! That is good news.
Some pictures of Ally I took last week before school.
She is so beautiful and looking so very grown up.
PS - This says this post was by Becky. It is not - Julie wrote this. I'm still having some technical issues.
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