More than Clumsy: Why Every Fall Deserves a Second Look

One moment everything would be fine, and I’d be upright. The next, I’d be on the floor, a strong wave of nausea sweeping over me, something in the region of my knee moving back into place followed by immense pain. I’d immediately clutch whichever knee had given out from under me to my chest. I’d then proceed to groan in pain, cry, and rock back and forth on the floor. I don’t remember how many times this happened as a child. Sometimes it happened on the landing as the stairs changed direction. Most often, it happened in the kitchen, my bedroom, or wherever I’d be, being a kid. I was a clumsy child, and my parents would always come over to see if I was okay. The first question they would ask is, “Can you get up?” After the nausea lifted, I would be able to get up and limp ot a place to sit. My dad would bring me ice, and I’d be terrified of it happening again, until I would eventually convince myself it was a one-off. It was not a one-off. I was always terrified of it happening as a child, and I never knew why it did.

As an adult in my mid-twenties, I went to see an orthopedist for knee pain due to my low arches. Part of the exam included X-rays. I didn’t expect to get an answer to the terrifying childhood episodes, but I was relieved. I was diagnosed with patella alta. I now know what was most likely occurring in those moments was partial patella dislocations. Because the motions I was doing in those moments involved torsion, the kneecap, which was already unstable, I believe, was popping out of place. The immense wave of nausea was caused by the kneecap popping back into place and the nerves sending the pain signals to my brain. From what I’ve read, these partial dislocations are more likely to happen in childhood because of the laxity in the joints and the muscles still developing. These episodes did decrease in frequency significantly as I got older. In adulthood, they only recurred when I wasn’t regularly exercising. The doctor recommended physical therapy. He mentioned that surgery was an option but that trying physical therapy first would be best.

Being stubborn and not having very good insurance, I decided to try an at-home remedy first. I was lucky at the time in that I had an acquaintance who was a physical therapist and recommended some exercises I could do. I started attending a Pilates class regularly, doing bodyweight strengthening and stretches. I continue with these exercises, and I’ve added more. I now include myofascial release. I focus on stretching muscles that I now know are tighter than others. I’ve also decided to pursue physical therapy for a variety of issues. I’ve found a clinic with hours that align with my work schedule, and once I’ve finished addressing the first issue, my next stop will be focusing on my knees.

I wish I could say that as soon as I got better insurance, I decided to make an appointment. This was not the case. I attended my first 5k as a volunteer last month. The environment at the starting line was electric. I realized I wanted to be part of the crowd participating in the race. I completed my first 5k a few weeks later, but it was not without immense pain. I also knew after completing the first one that I wanted to be able to complete many more without being in the same amount of pain again. After this, I made the appointment with the physical therapist. It’s been painful going to physical therapy because I’ve been thinking about the origins of my physical pain. As a child, I knew that I was not tripping when my knee was giving way and I was collapsing, but I didn’t have the words to explain what I was feeling in my body. I wanted someone to do something to make it stop. My parents always showed concern but expected me to get up and walk it off. Because of that expectation, I didn’t tell them every time it happened.

I remember it happening in my bedroom when I was a teenager. I ended up next to my new furniture, groaning in pain, clutching the offending knee to my chest. After I could stop worrying I was going to throw up, I went back to whatever I was doing. The episodes had been happening for years, and at that point no one had ever treated them like a big deal. As an adult, I’m left not knowing if I have long-term damage because of these likely partial dislocations. Soft tissue damage would only show up on an MRI, and I can only wait to see if I need more invasive treatment over time. I don’t have a lot of anger towards my parents, and at the same time I feel immense grief for the suffering I endured. It feels so unnecessary.

My mom had been a nurse at one of the region’s best children’s hospitals, and for years we regularly went to see a pediatric orthopedic specialist for one of my siblings. My family was aware of the resources available. The pieces just didn’t come together for me to avail myself of them. From what I’ve read, patella alta doesn’t appear when legs are straightened, which does raise the question in my mind: why didn’t my pediatrician catch this, as I was a patient until I was 21? I remember often sitting on the examination table, legs bent at a ninety-degree angle, waiting for the provider, a shot, and all of these were opportunities for a diagnosis.

I have these same questions not just about my knees but about my autism and OCD. My memories of my internal life from childhood feel so clear. My memories about the falls with the partial dislocations are also very clear. I always knew what was going on. I wish questions had been asked in a way that I could have understood. If a provider had asked if I had a hard time turning my thoughts off at night, I would have understood that. If someone had asked me if I ever fell over while I was turning from the waist and my knees were in a different place, I could have said yes. Asking open-ended questions of “do you feel anxious?” or “do you fall a lot?” seems very abstract.  

I want to encourage parents not to write off a child’s falls as clumsy. My “falls” ended up being my undiagnosed autism or partial patella dislocations. Your child doesn’t have the vocabulary to express what they are feeling. Take notes on what happens so you can bring them up at pediatrician visits. My parents had three kids, and it would have been helpful to have had one notebook or notepad per child. If your child does fall, ask them what they were doing before the fall in a non-judgmental way. Try to ask them if they were twisting their bodies in any way. It’s a good idea to ask them to take you back to where they were. Playing detective is essential. You are the voice of your child.