D: What brings you in?

P: Hi, I've I've had um this pain in my left knee that's been going on now for the last uh three or four months um but it's gotten a bit a bit worse, it used to only really bug me while I was doing activity, and now its started to uh hurt even more um afterwards as well, so I'm getting the pain at at rest. and so I wanted to come and get that checked out.

D: OK yeah, for sure. Um and you said it started a few weeks ago?

P: Uh well, I think it first started a few months ago, but in the past couple of weeks it has started to um kinda like last longer and and happen at rest as well.

D: Yeah, and so does anything make it worse or better? I assume doing any sort of physical activity makes it worse and rest makes it better, but how about anything other than that?

P: Uhm not really, yeah, it's mostly just the the activity, if I'm going upstairs or um downstairs or uh during running is really where it hurts the most and that's what's bugged me the um yeah, the most, running.

D: OK, OK, and if you were to describe the quality of this pain, would you say sharp, dull, achy, crampy?

P: Uh it's a sharp pain, uh almost like every time my foot hits the ground I get like a sharp stabbing pain and while I'm at at rest it feels a bit more dull, while, yeah, yeah while I'm at rest. 

D: OK, OK, and 1 to 10, 10 being the worst pain ever, how bad is this pain?

P: A six.

D: OK, alright, and have you ever experienced this type of pain before?

P: Uh I did have something similar like many years ago. I used to be a rower uh in undergrad and I got some similar pains before, and I mean with some stretching and um other I don't know kind of strengthening stuff, it it kind of helped but I didn't go see anybody for it at that time because it it kind of went away after a little while,

D: OK, OK, um and you said you were, are you still rowing?

P: No, no, the only activity that I'm doing now is is running.

D: Running, OK and from when it started to now, in the past couple of weeks has it changed like dramatically, um is it affecting your day to day life?

P: Uh a little bit, yeah, like even now, just walking I can I can feel it. Um the pain's not as severe but like as when I'm running but I can, I'm starting to notice it uh daily.

D: OK, alright, and um are you otherwise healthy? Do you have any um symptoms like fevers or chills? 

P: No, nothing like that.

D: No, any weight loss?

P: Uh no weight loss.

D: No, any rashes?

P: Uh no rashes.

D: No, uh changes to your uh vision, hearing, taste or smell?

P: Uh no changes there. 

D: OK. How about a cough, shortness of breath, or um wheezing? 

P: Nothing like that.

D: OK. How about uh chest pain, heart palpitations?

P: No, I haven't had anything like that.

D: OK. Um any changes to your bowel movements?

P: No, I haven't had any diarrhea, or yeah, everything's been normal there.

D: OK, nausea or vomiting?

P: Nope.

D: No, um how about abdominal pain?

P: No, I haven't had any uh any abdominal pain, nothing like that.

D: OK, any changes to your urine?

P: No, uh no I haven't had any issues with that.

D: OK, how about uh headaches?

P: No, I haven't had any headaches.

D: OK. Um any pain elsewhere on your body?

P: Uh nope, I've, it's just my, yeah just my knee. 

D: OK, any numbness or tingling in the area?

P: No, I haven't had anything like that, it's just the uh sharp pain.

D: OK. How about confusion or memory loss?

P: No, I haven't had that. 

D: OK. Um any um muscle aches around the knee, like so just above your knee where your quads are or just below?

P: Um no, nothing, nothing like that.

D: OK, and are you otherwise healthy? Do you have any longstanding medical conditions?

P: Um yeah, I'm otherwise healthy, I it's nothing that I see the doctor for, I've never been diagnosed with anything.

D: OK. Um how about hospitalizations or surgeries in the past?

P: Um nothing like that. no.

D: No, OK. Um any medications that you're on?

P: Um nope, I I don't take anything just well, no medications, but I do take a like a multivitamin.

D: OK, um are you up to date with all your immunizations?

P: I am yeah, I'll get the flu shot each year.

D: OK, how about allergies? Do you have any? 

P: Um, no, I I don't.

D: No, OK. Um any family history of musculoskeletal issues?

P: Uh nope, I don't think so.

D: How about um heart or lung conditions?

P: Uh I think my dad has like high blood pressure um and high cholesterol, but uh nobody's had a heart attack or, and no cancer.

D: OK, um how about autoimmune conditions?

P: Uh no, I don't think so.

D: No, OK. Um any um, do you do you do any smoking?

P: Uh no, I've tried uh like smoking marijuana in the past, but didn't really like it, so I've stayed away from that.

D: OK, how about um other recreational drugs?

P: Uh no, no, I I I haven't used anything like that before. 

D: OK, um and then where do you live right now? And who do you live with?

P: So um right now I just live on my own, actually I'm um just finishing up my my my Masters um and just live in a small apartment. 

D: OK alright. And have you been in contact with anyone sick recently?

P: No, I don't believe so.

D: OK. Um how about um travel?

P: Uh no, I've just been yeah finishing up the the thesis and running. 

D: OK, alright, um those were all the questions I had for you, um we'll move on to the physical exam component of this. Um so if you can take a look at both your knees, um do you see any visible redness or swelling in the area?

P: Uh no no swelling or yeah, nothing visible that I can see.

D: OK, so no bruises?

P: Uh no, no no bruises 

D: OK. Do you notice any like muscle atrophy, any deformities or skin changes otherwise?

P: No, everything looks looks normal.

D: OK, and if you can just um place your hand just kinda at the top of your, on top of your kneecap on both sides, do you notice any temperature changes from your, uh between your right knee to your left knee?

P: No, no temperature changes, they they feel the same.

D: OK. Um and then when you palpate your knee cap as well as um yeah, just if you could palpate just at the center of your kneecap, do you feel any pain there?

P: No pain over the kneecap, that feels fine.

D: OK. How about when you palpate kind of like the medial ligaments of your kneecap, do you feel any pain there?

P: No, everything on the medial side feels feels normal and fine.

D: How about when you palpate the lateral ligaments of your kneecap?

P: Yeah, the ligaments feel feel OK, on the lateral side though I I do get some pain along the um like above the joint line.

D: Above the joint line?

P: Yeah.

D: OK, OK, and how about when you palpate uh that big muscle group on your thighs like the quadriceps?

P: That feels OK, no pain in the muscles.

D: OK, how about like the patellar tendon?

P: Uh no pain there.

D: OK. And then when you go lower below your kneecap, um when you palpate like the top part where the proximal parts of your tibia and fibula are, do you feel any pain there?

P: Uh, yeah, no pain there.

D: OK, and now let's do some um movements with your leg. Um are you sitting down?

P: Uh, yeah, I am.

D: OK, I'm gonna get you to stand up from a sitting position, does that, is that painful?

P: It is, yeah it's, I get a sharp pain if, when doing that. 

D: OK yeah, uhm how about when you um sit back down, does that hurt? 

P: Um yeah, that hurts too.

D: That hurts too, OK. Um and then how about when you flex your knee inwards, um so that your heel is touching your bum like does that hurt? 

P: Uh like I, I'll get up, uh no that doesn't hurt, that feels OK.

D: OK, how about when you extend your knee back out, straighten it all the way?

P: Yeah, that feels OK too if I'm just sitting and doing that, I can um, I can do that OK.

D: OK. Um how about when you, so you're standing and then you uh you abduct your hip so you basically, um you flex your hip but laterally and you kind of bring it upwards so that it's almost, so that your your, the action is like you're uh trying to touch the ceiling.

P: OK yeah I um, it, if, it does feel, it feels like it's kind of pulling um like it feels tight when I do that uh like on that side, it's, I don't get the same sharp pain, but it's uncomfortable.

D: OK, uhm, so I'm gonna try a special test, it's called the Ober test. So can I get you to lie on the side um with the injured knee?

P: Yep.

D: OK, and then I'm gonna get you to flex your knee at 90 degrees and um abduct and extend the hip uh while your thighs maintain in line with your trunk. Um so I'm gonna get you to adduct your thigh, so bring it back towards you, the the median, um as far as possible.

P: Oh yeah, I can't really, it's kind of like stuck out there. It feels really tight if I'm trying to like bring it, bring it back down, my leg almost like floats up if I just leave it there.

D: OK, so that is a positive Ober test. Um OK, so what it sounds like is you, it sounds like you have something called um iliotibial um band syndrome, so ITB syndrome, and basically that happens in um athletes, so depending on your like position, like how much you're using those joints um and like repetitive actions um of like knee flexion extension um kind of triggers that. And to treat it, uh we can try some conservative um things first, so the first thing would be um for you um to have some sort of activity modification to prevent aggravating that joint even more, so you're doing a lot of running, so maybe uh switching to things like swimming um for the time being can help with that. And then other things include ice or heating pads, uh taping and stretching, um and then if the pain is, if the pain uh persists, you can try some like ibuprofen for temporary relief. Um we can talk about other treatments as well, like physiotherapy because um it'll be important to kind of strengthen those muscles around that joint as well as um increase your range of motion, so we can do, we can put in a referral for that. Um and if none of those work, we can also discuss um some other things like ultrasound therapy or like muscle stimulation, um shockwave therapy, and then eventually if none of those other things work, we can discuss surgical management but uh it's rare that it ever gets to that point. Does that sound OK?

P: It does, yeah, thank you so much.

D: OK yeah, no worries.