Question
I am 18 years old and have had left knee pain for the last two years and two months. I went from being a very active person to not being able to do the things I use to do because of the pain. The doctors diagnosed it as patella femoral pain. They said that the muscle was wrapped so tightly around the bone that it was pulling my kneecap and causing bone to rub against bone. I was born with cerebral palsy which makes treatment of the knee pain even harder and especially this type of knee pain because of the spasicity that comes with the cerebral palsy. The cerebral palsy mainly affects my lower legs causing severe spasticity and weakeness. As a result of the decreased strength in my hips and legs I have had to use a walker to get around on a daily basis since I was born. About a year and half ago I had femoral osteotomy to fix the deformity in my femur with the hopes that, that would make the knee pain go away, but no such luck. The osteotomy improved the turning in of my left knee a little bit, but it still is not lined up completely straight due to years of it rotating inward when I walk. Five months later I had my knee scoped. They found nothing except for a contusion underneath my kneecap, but nothing that would fix the pain. Then I had a cortisone injection that provided complete relief for just a few hours the following day due to the litocane. After that I had euflexa injections, but got no relief at all. The doctors considered doing a lateral release, but after my visit to the mayo clinic they decided this would probably put me in a wheelchair for the rest of my life due to the lack of strength i have in my hips and legs. I have also done physical therapy, but that was not successfu do to how tight my patella tendon is.The phsical therapists were not successful in manually trying to stretch that out. I have also taken many different medications that included: codeine, celebrex, alieve, advil, and amitriphilin, but had no luck with any of those either. I have never received any type of chiropractic treatments, but decided to give the option a try after all the previous failed options. I read up on acupuncture and went to my local chiropracter to give it a try. I have received about 16 treatments and had no luck yet. He also adjusted the cartilage in my knee. What else can the chiropractor do for the knee pain??? Is it normal for the acupuncture to take this long to be effective??? Also I recently started having si joint pain. My chiropractor confirmed this to be facet joint pain after seeing that my mri of my lower back and pelvis was normal noticing only that I had a few dark spots in the joints do to lack of motion. How is si joint pain related to facet joint pain? What is facet syndrome? What is the difference between si joint pain and facet syndrome? Is the pain going to go away in time with stretching?? Thank you for taking the time to read and or comment on what I wrote. Any comments or answers to questions you can provide would be more than helpful.

Answer
Heidi,

This is a complicated situation and you have asked several questions.

First, this is not a diagnosis or a prognosis of your condition. Generally speaking, if you have not experienced any relief with the current therapy that you are receiving, it is unlikely that you will after 16 treatments. Chiropractic manipulation cannot correct cerebral palsy or the structural effects of that condition. I cannot speak to acupuncture, as I am not an acupuncturist.

Sacro-iliac joint pain may refer pain to the hip or the spine. Generally speaking, chiropractic manipulation may be helpful for this condition. However, the structural problems caused by cerebral palsy may cause your S.I. pain to be chronic. This alteration in normal biomechanics may aggravate or cause facet syndrome in the spine (pain resulting from irritation of the facet joints of the spine). Essentially, S.I. joint pain and facet syndrome pain are more or less the same in that pain is produced in the joint due to structural stress or irritation.

Stretching may be of some help to the supporting muscles of the spine and pelvis, but this may not correct the joint pain. Stretching combined with massage therapy, which will not correct the effects of cerebral palsy, may offer you relief if the problem is primarily one of the muscles pulling your joints in abnormal positions. While I am not familiar with your comprehensive clinical picture, as a general statement, you probably looking at managing a chronic condition than in completely correcting it.

I hope that this helps to answer your questions.