Knee Pain Questions for the Doc

[Weekend_Climberz]

So, I've got an appointment with a knee specialist tomorrow and I'm not sure what to expect. Last fall I somehow hurt my knee hiking up a steep hill with a moderate sized pack on (~30lbs). Then I was told "give it six weeks and it should be okay". After more than six weeks of rest (I played some golf, yeah golf I know, during that time), I did some snowshoeing and the pain seemed to gradually come back during the day. In the days afterwards it subsided significantly and I thought all was well, but after doing some more steep hill hiking with a pack on recently (4+ months later), it's back with a vengence. I've been running on the eliptical and doing heavy leg workouts the last six weeks (squats, extensions, etc) and didn't have any problems. What I'd like to know are some good questions about what may be going on. My current doc told me that PT was pretty much useless since I'm already in pretty good shape. Some questions I was thinking of:

 

Could it be ....... problem with my knee, doc?

If I get a cortizone shot, what else does that affect?

If we're talking about surgery, how many horse tranquilizers will it take to put me out until I'm fully healed so I don't remember anything at all?

 

I hate doctors, hospitals make me nervous, I break out in a cold sweat when a needle appears, and I've never had stitches or a broken bone in my life. Thnx :tup:

[rob]

What kind of pain? I had an ITB problem that was furiously hard to get under control (and switched legs once I started PT), but I haven't had any trouble with it recently. knock on wood

 

As to PT being useless because you're in good shape, I think that's a load of crap. I was in great shape, and PT was instrumental to helping me over my trouble.

[billcoe]

I'd like to hear the results W.C when you get them. Last month I blew out of and then my right knee landed on my brand new skis. (I had made the mistake of accepting the REI mount as is, skiing fast, first run, blew out of them from just normal sking). It was swollen under the kneecap. So I took off some time and iced it.

 

It was feeling close to normal, had cranked the bindings down tighter and was out skiing a few times and all was fine till I went on a death march last weekend. Not too heavy at all as all I had was a rope, water a few other knick knacks for weight. By the end of the day I couldn't weight it going down hill without big pain.

 

periodic icing is all I've done.

 

 

[Weekend_Climberz]

As to PT being useless because you're in good shape, I think that's a load of crap. I was in great shape, and PT was instrumental to helping me over my trouble.

 

This was my first reaction. I'll definately be going over that again with the specialist.

[selkirk]

Is your current doc an athlete/sports med specialist or a general doc? If not I wouldn't but much stock in his opinion on this. Most family practice/general med docs aren't used to dealing with athletes and people who are dedicated to staying in, or getting back into good condition. They also don't see that many joint injuries and/or people who actually want to use the joint hard and soon. Remember, the majority of people they see are "average" and in this country that is not particularly active.

 

Just because your in good shape or strong doesn't mean PT won't help. I've got a buddy who leg press 600+ lbs, but has horrendous knee instability due to lack of a balanced musculature.

 

I used to get sever pain going down hill at the end of the, and finally talked to a sports med guy. His diagnosis was a muscle imbalance in my knee, with the outer quad much stronger than the VMO (inner leg above the knee), so when I fatigued, my VMO fatigued first, then my outer quad would pull my knee cap out of alignment and result in joint pain.

 

Treatment was lots of time on the exercise bike and some additional stuff to build up the VMO, but it got better relatively quickly. Definitely go talk to a specialist!!

And don't talk cortisone or surgery until after you've given PT a serious go. Cortisone seems like it should be reserved as a last ditch thing, and eventually causes long term problems, and surgery is good for tears, but won't fix imbalances.

[rob]

I would avoid cortisone injections as well. I was tempted to use it when my knee pain seemed incurable, but my doctor talked me out of it, and everything worked out in the end.

[Weekend_Climberz]

I'd like to hear the results W.C when you get them. Last month I blew out of and then my right knee landed on my brand new skis. (I had made the mistake of accepting the REI mount as is, skiing fast, first run, blew out of them from just normal sking). It was swollen under the kneecap. So I took off some time and iced it.

 

It was feeling close to normal, had cranked the bindings down tighter and was out skiing a few times and all was fine till I went on a death march last weekend. Not too heavy at all as all I had was a rope, water a few other knick knacks for weight. By the end of the day I couldn't weight it going down hill without big pain.

 

periodic icing is all I've done.

 

 

I'll let you know. It sounds similar to what I've been experiencing, though I don't really know what caused it in the first place. It seems to be relatively minor during exercise (painful, but not debilitating) then gets worse after I cool down and tenses up. There's some minor swelling, but not visually noticable. I feel like a 30 year old buick that needs a new transmission.

[layton]

it's usually not the knee that's the problem, but an imbalance in your hips or feet. sounds like your quads are injured or weak and aren't pulling the kneecap up when you're walking. just a guess. could be other muscle or skeletal structural imbalances. so before you go cutting or opening shit up, find out why before you fix it. replacing the tires on your car doesn't make sense if the wheels aren't straight. problem usually isn't bad tires ... or bad knees.

the doc you saw was a fucking retard

[Weekend_Climberz]

That's what I like. Give it to me dirty. I'll see what these guys say tomorrow before I start fantasizing about become the meat in a swedish hospital sandwich.

[Matt Kidd]

Where on the knee is the pain? Have had problems with different knee pains. The IT Band was mentioned - pain on the outside of the knee. Difficult to stretch but cured it for me. I also had problems with patella-femoral syndrome (irritation on the back of the kneecap). Saw a GP, sports med doc, physio, podiatrist etc. All diagnosed the problem, noone offered a solution. Found out sort of by accident that a latent strained calf was behind it - two weeks of good stretching = no more pain. Do you stretch?

[Kat_Roslyn]

You should ask your doctor for a refferal to a physical therapist, and don't leave until you get one. Doctors are good with fixing stuff that is broken, but the pt's really know the mechanics of how stuff works and can show you how to have your body heal itself.

[Maine-iac]

IT Bands also tend to hurt on the inferior end of the knee cap as well as the lateral side. They (from what iv heard/seen/felt) can be very painfull and will stop you right where you are. It just started all of a sudden for me one day, and ended almost as fast as it started, although there was close to a 5 week period where i couldnt do anything. Muscle imbalance/strain is also possible. I managed to blow out my hip flexor with a few hours of snowshoeing and that was last march, i have only now just started training again. Let us know what the doc says. and make sure whenever you are in-doubt about something to put ice on it. If it is IT problems the good thing is you can "push" through the pain, although it takes quite the pair of balls to do that.... Good luck man

[iluka]

Without knowing what the pain feels like, where it is located, what aggravates it or makes it feel better, it's hard to comment on the precise cause of the pain and, therefore, hard to comment on what is best for dealing with it. Some thoughts:

 

- PT should not be written off because you are in good shape. Good PT work can be of benefit to very fit people for the purpose of rehabbing specific injuries or training up other muscle groups whose weakness or instability may be contributing to a particular problem. It helps, though, if the PT has a specific diagnosis to work with in developing a rehab program.

 

- The source of the problem could be in the knee but Layton is correct in pointing out that in some situations it is a problem elsewhere that manifests as pain in the knee. For example, sometimes people develop knee pain due to hip problems. This is only something that can be sorted out with a thorough history and musculoskeletal exam.

 

- I would not look at a cortisone injection until you know have a reasonably firm diagnosis as the utility of such a shot will depend on what the problem is. Similarly, whether or not you need surgery depends on what this is.

 

If you don't like the opinion you get from the knee specialist, you could consider going to a dedicated sports medicine clinic. There is a good one at the UW ((206) 543-1552). They have some quality docs over there.

[Weekend_Climberz]

Found out sort of by accident that a latent strained calf was behind it - two weeks of good stretching = no more pain. Do you stretch?

 

Ah Ha!!! This is great stuff guys. I'll be sure to get a PT and ask about the pulled calf. I just pulled my calf on the same leg about two weeks ago and before then the knee hadn't bothered me. Right now the pain is right on the knob below my knee cap (where my Oshgood-Schlatter is at). I do stretch pretty extensively for 10-15 minutes before and after working out, but I could be missing something in that area. I'm hoping that it is something that will only take a week or two of recovery and won't affect this summer. Physical therapy is just a fancy word for training, right?

[jclark]

If it hurts worse when climbing stairs or uphill and you can't remember any trauma that would cause it, look into

 

orthopedics.about.com/cs/patelladisorders/a/chondromalacia.htm

 

Very common in active folks like us. I had it and it was painful. I had disproportionately developed leg muscles from years of cycling and running lifting weight the wrong way...long story short my quads were much stronger than my hamstrings and the imbalance caused the condition. I recommend 4-6 months of crossfit and some ibuprofen.

[Weekend_Climberz]

Bingo!!!

 

Patellofemoral Chondromalacia

 

PT here I come

[i_like_sun]

Good luck with this Weekend Climberz!

 

I've dislocated BOTH patellas at this point (both separate orthopedic tramas) and I've had to become aware of how I move my lower extremity. Your pain sounds a lot worse than mine, but when I do any kind of deep squats with sloppy form then they start to kill.

 

Layton is right on, if it is chondromalacia, fixing the problem by improving the biomehanics of your hips and feet is the way to go. All the successful research says so.

 

[Weekend_Climberz]

Well it's been two months of PT, and I went out this past weekend to do some hiking and climbing. It was sore before I went out and it got worse, and so now my therapist wants me to talk to my ortho doc about a cortizone shot. It's never been 100% in the last 2 months or much above 80% for that matter. I'm wondering if I should get a different therapist, or something. She gives me the hardest exercises she can (or maybe knows of?), and I've been doing them pretty easily for the last two months. I had a slight internal deviation when I pressed up with my right leg that I've corrected, but still having tons of pain. Even while sitting down in a chair. Maybe my original doc was right by saying PT wasn't going to work, since I'm in such good shape. Maybe a wrong diagnosis?? Fucking lame!!!!

[Reid]

Do you still use the elliptical trainer?

 

I think I had a bit of chondromalacia recently. It never prevented me from doing much except squats and basketball. The strange thing is it would feel better for a couple days after activity then get worse the lazier I was. So I used the eliptical. When I graduated from UW I no longer had access to the gym and I kept in shape by mostly running and biking. I figured these activities are harder on the knee and so I expected my pain to worsen. Not so, and actually I rarely have knee pain. I'm not saying the ellipticals are bad, but cross-train and stretch a lot.

 

Also you mention sitting in a chair causes pain. Keeping my leg extended when sleeping or sitting helped, probably because it relieves pressure on the cartilage. I also tried to strengthen my quads by doing leg extensions, but only the last 20 deg of extention to keep the stress off the kneecap.

Edited May 7, 2008 by Reid

[pdk]

If you're in the portland area, I've worked with an excellent PT who has helped me rehab back from shoulder surgery, hip surgery and patellar femoral pain (pain behind my kneecap from it not tracking properly - similar to what some of you have descibed on here). He runs his own clinic and deals primarily with althletes. His name is Erik Meira, here's his website:

 

http://eliteptsportsmed.stcnetsite.com/

 

 

 

[ericb]

Well it's been two months of PT, and I went out this past weekend to do some hiking and climbing. It was sore before I went out and it got worse, and so now my therapist wants me to talk to my ortho doc about a cortizone shot. It's never been 100% in the last 2 months or much above 80% for that matter. I'm wondering if I should get a different therapist, or something. She gives me the hardest exercises she can (or maybe knows of?), and I've been doing them pretty easily for the last two months. I had a slight internal deviation when I pressed up with my right leg that I've corrected, but still having tons of pain. Even while sitting down in a chair. Maybe my original doc was right by saying PT wasn't going to work, since I'm in such good shape. Maybe a wrong diagnosis?? Fucking lame!!!!

 

WC - have you gotten an MRI?....if you haven't and your insurance will cover it, it might be worthwhile.

[archenemy]

Do you still use the elliptical trainer?

 

I think I had a bit of chondromalacia recently. It never prevented me from doing much except squats and basketball. The strange thing is it would feel better for a couple days after activity then get worse the lazier I was. So I used the eliptical. When I graduated from UW I no longer had access to the gym and I kept in shape by mostly running and biking. I figured these activities are harder on the knee and so I expected my pain to worsen. Not so, and actually I rarely have knee pain. I'm not saying the ellipticals are bad, but cross-train and stretch a lot.

 

Remember that exersize, especially something like running, actually lubricates the joints and keeps the synovial (sorry about my poor spelling) fluid moving through the joints. That may be why your higher impact sports are lessening your knee discomfort.

 

[Stefan]

I take cortisone shots one a year in my ankle....the shots do help.

[sampdx]

If you're in the Portland area, I suggest calling Dr. Jeff Robinson. He's a chiropractor (and much, much more!) who works with athletes, including pro-football and basketball players who deal with injuries of this nature. He knows about getting people back out there. I've been a patient of his for a few years and he's helped me with numerous injuries. His number is 503-517-8700.

[Weekend_Climberz]

I'm in downtown Seatown, so PDX is a bit of a drive. Though I do owe Ivan a visit.

 

Anyway, made an appointment with the orthopedic doc again, and will see what my options are.

 

As a side note, I did stop doing the elliptical one month into the PT, but kept up on the other exercises and stretches she gave me. It seemed to just aggravate it more. Pretty soon, I'm going to look like one of those muscle bound freaks with the big chest and toothpick legs.