Right knee and left calf pain

This 16-year-old cross-country runner for a high school team presents today for an initial evaluation referred by a local urgent care who is accompanied by his mother regarding acute right knee and left calf pain. The patient states that he started experiencing left calf pain some time in July or August and right knee pain which is recent. The patient states that he noticed an aggravation of symptoms with running. He was running approximately 25 miles a week; however, he stopped participating in cross-country due to pain symptomatology. The patient states that he is able to squat and kneel without aggravation of symptoms; however, running increases his levels of pain.

The patient describes his knee and left calf pain as a constant, sharp, throbbing, achy, pressure pain without any numbness, tingling, or weakness. The patient denies cramping, swelling, or changes in temperature of the knee.

ASSESSMENT:
1. Patellar tendinitis versus patellofemoral syndrome.
2. Bursitis of right knee.
3. Gastrocnemius versus soleus strain.
4. IT band syndrome.
5. Possible jumper/runner’s knee.
6. Knee bursitis.

PLAN:
Goals of Treatment:
Short-term goals: (1-8 wks)
1. Decrease pain and inflammation in the right knee and left calf from constant levels of pain to intermittent levels of pain.
2. Decrease muscle tightness, IT band tracts.
3. Return the patient back to running activities.

Long-term goals:
1. Teach Home exercise program and become independent with use.
2. Stabilization and strengthening of the quadriceps and knees in an effort to avoid further injury.

Treatment Plan:
1. Recommend physical medicine and rehabilitation therapy directed at the knees and bilateral calves.
2. Include passive modalities of myofascial release, electrical muscle stimulation, and ultrasound.
3. Include rehabilitation and therapeutic exercises and activities.
4. X-rays of bilateral knees to be performed in an effort to rule out bony pathology and differential diagnosis.
5. Follow up in four weeks or sooner if change or worsening in condition as needed.

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