Chronic pain at age 12

Understandably, Genna Pingatore has no recollection of her first experience on water skis—she was 2 years old—but clearly remembers the 2006 injury that prevented her from defending her national water-skiing title and the recurring pain that sidelined her for years.

The bubbly 18-year-old Butte College student plays lacrosse competitively, has a love for hiking and distance running, and is “just getting into rock climbing,” she said during a recent interview in downtown Chico. Last year, she gave up competitive water skiing for good, though she’s still open to doing it recreationally.

“It takes away your summer. I would fly back to Florida and Louisiana for professional coaching, which is very expensive,” Pingatore said, also describing the unforgiving nature of the competitions themselves: “You only get one shot—if you fall, you’re done.”

At 10 years old, she was ranked the top water skier in the nation for her age group by the USA Water Ski association, setting a regional record during an out-of-state tournament. “I was very good,” she admitted bashfully.

The following year, when she was 11—only a day before she was scheduled to leave for a regional water-skiing competition in Washington—Pingatore was horseback riding with a friend. Her horse came into contact with an electric fence and began to buck.

“I got ejected off the horse and hit my back on a telephone pole,” she recalled. “It was incredibly painful. My mother picked me up and set me down on this counter, and I just started screaming; I could feel these shots [of pain] going down my back.”

An emergency room visit revealed that the impact had fractured parts of her sacrum (the large, triangular bone at the base of the spine that connects to the tailbone) and her ischial tuberosity (part of the hip bone). For the following six months, she used crutches to walk, and sitting upright was excruciating.

Though it was a “miserable” setback, as she described it, Pingatore was able to resume training the year after her accident and reclaim her top spot in the nation, but the injury became a source of long-term discomfort.

“Any time I would run or do any sort of endurance activity, my back would flare up,” she said. “In lacrosse [at Chico High School], I could only play half the game—in the second half, I would be in too much pain and would have to ice.”

And so Pingatore lived with chronic lower-back pain for four years, starting at age 12.

Enter Dr. Holly Kelly of Marin Orthopedics and Sports Medicine in Novato. During a recent phone interview, Kelly said she first met Pingatore in 2011, when she was 16.

“Her mom and brother were patients of another doctor in our office,” she recalled. “Her mother had mentioned to the physician a little bit about Genna’s story. She ended up coming into the office and I diagnosed her with sacroiliac joint invariant dysfunction.”

Kelly’s original suspicions about Pingatore’s condition were confirmed after injecting the problem area with cortisone, after which Pingatore was provided only a couple weeks of pain relief. “We needed a longer-term solution,” Kelly said.

The sacroiliac joint isn’t designed to move like an elbow or a knee joint, Kelly explained. It’s held in place by ligaments on either side of the joint, and serves to stabilize the pelvic area.

“When you have a trauma to the pelvis, what you can end up doing is stretching those ligaments that hold the joint in place and the joint becomes more mobile,” Kelly said. “Then, any time you walk or bend or twist, that joint will shift a little bit, and that becomes very painful. You have bones moving that aren’t really meant to move that way.”

The procedure subsequently performed on Pingatore—called “cooled radiofrequency denervation”—uses a long needle heated with an electric current to cauterize the nerves that provide the pain signals to the sacroiliac joint.

While radiofrequency treatment has been used since the 1990s, Kelly said it was deficient in that it was unable to reach the full “spiderweb” of nerve endings running in and out of the sacroiliac joint. The water-cooling system, introduced about four years ago, “keeps the tip of the needle cooler so you can add more power, and spread that area of heat so it doesn’t just stay in one position. You’re able to make a more three-dimensional lesion.”

While Pingatore admitted the needle involved was frightening, and the procedure itself was painful, she said it was ultimately worth it. Within two weeks of the procedure, she was fully back into her athletic routine and found she was “able to run longer and farther without any of the pain.”

Given the intense individual competition of her childhood, it’s perhaps unsurprising Pingatore would be drawn to a team sport like lacrosse as an adult. She said the team aspect is what she likes most, though the travel has also been a perk.

Last year, Pingatore traveled to Japan with a women’s lacrosse team assembled by a coach at UC Santa Barbara. Her squad played six games against teams from colleges in the Tokyo area, winning three of them. It was a “fantastic experience,” she said, recognizing that such an adventure wouldn’t have been possible if she hadn’t undergone the procedure with Kelly.

Since Pingatore is young, the nerves in her sacroiliac joint regenerated within two years of the initial procedure. This past February, she went back to Marin Orthopedics and Sports Medicine for a second round of treatment. She has been completely pain-free since, and this past summer (with competitive water-skiing out of the picture) she was able to visit Zion National Park in Utah with her family, where she tried her hand at rock climbing.

Knowing Pingatore has been able to fully pursue her interests has been tremendously rewarding for Kelly.

“Having chronic pain starting at age 12 is unacceptable,” Kelly said. “It’s been a joy to watch her after she’s been treated. That’s the best thing about being a doctor—watching your patients get back to the sports and hobbies they enjoy.”