Knee trouble.. Again

Trotter

Hi all.

After having an arthroscopy this time last year on my right knee, the left one has now decided to officially join the party.

Keeping this post short..
Ive been to the consultant again, he basically said tough.. my "Q Angle" is all over the place and its gonna hurt basically.

Ive no intention of accepting that to be honest, I want it fixed. It hurts somethin awful if Im driving for more than 10 mins.. and I have to get out of the car every half an hour or so to lock my leg straight and flex the thigh muscles. This gives it temporary relief. Even sitting on the couch with my feet on the floor means it'll hurt like crazy around the base of my kneecap and under it.

Any ideas or advice? Im going crazy because I was sure the consultant would have been more helpful. I got the impression he was just moving me on and getting to the next "customer". It took 4 months for the appointment because I agreed to private and handed him 150 quid for the handiest 10 mins of his life.

Transform

Most knee problems can be as a direct result of

1.Poor hip flexibility
2. Weak inner quad muscles

E..g In a normal sitting position place your right foot (the side of the foot) directly on the left knee,

Is the lower partof the right leg (shin etc) parallel to the floor? If its pointing up a great deal your piriformus,glutes etc are tight and you need to stretch them and get them massaged

Everyone should do that little test as its a simple way to check

It could of course be related to a number of issues but this is the most common i have seen when dealing with my clients

Trotter

Thanks transform..

Luckily enough, I bumped into another orthopedic surgeon on saturday! (Dont ask..)

He's convinced its "chondromalacia patella" .. and I need to strengthen up my quads and hamstrings.

Without using a gym, whats the best way to work on those?

Patto

Transform wrote:

Most knee problems can be as a direct result of

1.Poor hip flexibility
2. Weak inner quad muscles

E..g In a normal sitting position place your right foot (the side of the foot) directly on the left knee,

Is the lower partof the right leg (shin etc) parallel to the floor? If its pointing up a great deal your piriformus,glutes etc are tight and you need to stretch them and get them massaged

Everyone should do that little test as its a simple way to check

It could of course be related to a number of issues but this is the most common i have seen when dealing with my clients

What stretches would you recommend?

Rogueish

It sounds as if you may need to get your patella strapped in the proper position before you start a rehabilitation programme. If your biomechanics are so out of whack that you are on the borderline of needing surgery then you in all likelihood do not have the muscular control to control the tracking of the patella as you straighten and bend the knee.

Patellofemoral Pain Syndrome (also known as jumpers knee, runners knee, cinema goers knee) can develop if left untreated into chondromalacia patella. This is where there is an abnormality in the muscular control of the quadriceps on the patella as the knee bends and straightens.

In normal mechanics as you bend and straighten the knee the patella stays between the femoral grooves of the end of your thigh bone (picture it like a valley with two mountains on each side). It is like a little valley at the end of your thigh bone. This is controlled mainly by your quads. In those with patellofemoral Pain Syndrome the muscles(usually the quads esp the VMO) cannot keep the patella in this little grove and the underside of the patella continually scrapes off these 'mountains'. As the underside of the patella wears away it causes +++ pain.

Therefore it is important to correct this tracking before undertaking any quadriceps strengthening programme. Because the patella can tilt, glide or rotate out of its normal track - it usually must be assessed by a professional. Who can then show you how to tape it yourself. A professional can also check as see if your glutes or I.T.B are having an abnornal effect on the kneecap. Fibres of the I.T.B insert into the outside edge of the kneecap and can exert a 'pull' on the kneecap. A professional can check to see if you have abnormal biomechanics such as a rotated tibia, pronated feet and put you on a personally tailored strengthening programme.

Having a programme specifically tailored for you will have far greater and faster effects than a general programme that we can give over the forum. If you are given a general programme that progresses you too soon you may end up in a worse position than you are in already.

If I can explain anything further or if there is anything unclear just ask and I will do my best to help.

[Edit] heres a pretty good article that explains in more detail http://www.aafp.org/afp/991101ap/2012.html

Trotter

Rogueish wrote:

It sounds as if you may need to get your patella strapped in the proper position before you start a rehabilitation programme. If your biomechanics are so out of whack that you are on the borderline of needing surgery then you in all likelihood do not have the muscular control to control the tracking of the patella as you straighten and bend the knee.

Patellofemoral Pain Syndrome (also known as jumpers knee, runners knee, cinema goers knee) can develop if left untreated into chondromalacia patella. This is where there is an abnormality in the muscular control of the quadriceps on the patella as the knee bends and straightens.

In normal mechanics as you bend and straighten the knee the patella stays between the femoral grooves of the end of your thigh bone (picture it like a valley with two mountains on each side). It is like a little valley at the end of your thigh bone. This is controlled mainly by your quads. In those with patellofemoral Pain Syndrome the muscles(usually the quads esp the VMO) cannot keep the patella in this little grove and the underside of the patella continually scrapes off these 'mountains'. As the underside of the patella wears away it causes +++ pain.

Therefore it is important to correct this tracking before undertaking any quadriceps strengthening programme. Because the patella can tilt, glide or rotate out of its normal track - it usually must be assessed by a professional. Who can then show you how to tape it yourself. A professional can also check as see if your glutes or I.T.B are having an abnornal effect on the kneecap. Fibres of the I.T.B insert into the outside edge of the kneecap and can exert a 'pull' on the kneecap. A professional can check to see if you have abnormal biomechanics such as a rotated tibia, pronated feet and put you on a personally tailored strengthening programme.

Having a programme specifically tailored for you will have far greater and faster effects than a general programme that we can give over the forum. If you are given a general programme that progresses you too soon you may end up in a worse position than you are in already.

If I can explain anything further or if there is anything unclear just ask and I will do my best to help.

[Edit] heres a pretty good article that explains in more detail http://www.aafp.org/afp/991101ap/2012.html

Thanks for all that info! I dont think its gone to the stage where I might need surgery because 3 surgeons have said now that they dont think I need it.
I better go find me a professional so! Ive been to a guy in Dublin before called Adam Bux, and he's excellent. I think I'll go see him again.

Rogueish

Trotter wrote:

I better go find me a professional so! Ive been to a guy in Dublin before called Adam Bux, and he's excellent. I think I'll go see him again.

Sounds like a good plan. Good luck.

Rogueish

mloc

Ugh weak patella... I spent a month in a knee immobiliser after tearing a tendon and dislocating my patella, and it's damn week now, even after nearly 2 months of physio. You'd want to get that looked at and sorted, it's no fun.

TempestSabre

I think I have the same problem. I first got it playing football on astroturf. I started getting a pain in the knee when doing sharp stops. Then the knees would swell and I started getting pain when using stairs etc. Basically once I got it, it wasn't getting better on its own.

When I first got it, I went to a physio and after the swelling had gone down, the Physio measured the knee caps and then taped them up accordingly. The idea being to pull them slowly back into position. After a while I was given exercises to do. Eventually everything returned to normal. Took a while though. Maybe mine is a much less severe than what you have though.

Unfortunately I didn't keep up the exercise and have fallen back into bad habits of not making time for exercise. Recently started cycling again after many years of not doing it. Didn't really having any problem with that. Then in a fit of madness played a light game of footie last weekend. Result, my knees/caps are really not happy this week, and getting worse. I'll needing another physio visit now. My own fault I know.

Its not that its painful, at least mine weren't/aren't. But they are very uncomfortable, its an odd feeling that kinda weirds me out. I do find those elastic support bandages help a bit. But theres no avoiding proper treatment.

I tried swimming with limited success. But that caused problems with an other injury I have. A shoulder problem caused by an old dislocation. But thats another story.

comad

I have patella fermal syndrome at the moment. I've been in agony for two months now. I had a pain in the side of my knee when I squatted but the morning after a game my knee was so stiff. A consultant misdiagnosed it as a torn cartilage and operated so i had to wait 3 weeks before starting physio. The physio spent 2 weeks working on my hip and quads but there was no improvement. 2/3 weeks of strapping my knee and working on my VMO muscle has made absolutely no difference. Overall, my knee is worse than it was two months ago and my bank balance is down about €1,000. I can't stand,walk, sit or drive for more than 15 or 20 minutes due to an injury that is described as "an extremely common running injury". I'm gonna get a second opinion and change physios. Can anyone recommend a physio who has cured this type of injury

Trotter

Eventually I was diagnosed with a genetic Q angle problem. Basically it meant as I grew, the angle between the joints in my leg caused stress on the muscles.

If I play a lot of badminton for example, I'll find it hard to drive because it kicks up when my knee isnt straight and the muscles have been working hard.

I can run for long distances without a problem if I've warmed up my quad muscles well beforehand.

thirtyfoot

Trotter wrote:

He's convinced its "chondromalacia patella" .. and I need to strengthen up my quads and hamstrings.

I had "chondromalacia patella" when I was 16. After a program of overall strenghtening (which included strapping the knee is a certain way when running) it cleared up and I never heard anything from it since.

Ronan|Raven

If it is any consolation to the O.P. I had two arthroscopy's last year on the same knee, the first one in January and the second one in August. Having been assured the issue was sorted properly the second time. I have been doing a lot of cycling to build up the joint and muscles, plenty of walking and have lost a deal of weight which was being blamed for causing a lot of it. I now, 9 months on from the last operation have the exact same pains returning once again. De damned if I am accepting another operation to "sort it" like the last two. Hard to know what to do.

empirix

mloc wrote:

Ugh weak patella... I spent a month in a knee immobiliser after tearing a tendon and dislocating my patella, and it's damn week now, even after nearly 2 months of physio. You'd want to get that looked at and sorted, it's no fun.

Yeah i would get this sorted and invest money into it if need be, dislocated both my patella's(one after another) playing ball many moons a go now, ripped all my cartillage in one knee, took about a year for me to even ghet back walking correctly. Joined a gym and have never looked back since, although i stay away from doing heavy squats etc because the pain is excruciating and i can feel both kneecaps ready to pop, i can do heavy squats but i'm thinking i might regret it further on down the road when i'm in the wheelchair! Join a gym and get a good routine

Hail 2 Da Chimp

Transform wrote:

Most knee problems can be as a direct result of

1.Poor hip flexibility
2. Weak inner quad muscles

E..g In a normal sitting position place your right foot (the side of the foot) directly on the left knee,

Is the lower partof the right leg (shin etc) parallel to the floor? If its pointing up a great deal your piriformus,glutes etc are tight and you need to stretch them and get them massaged

Everyone should do that little test as its a simple way to check

It could of course be related to a number of issues but this is the most common i have seen when dealing with my clients

This sounds very simular to a problem I am having with my knee / hip. I also find both my knee and hip (right at the front of my hip) are getting very sore. Are there any particular stretches that I can do to counter this, bearing in mind I do train in martial arts and most of the stretches/kicks seem to aggrivate this.

comer_97

I've been laid low with patella tendonitis (alledgely) for about 7 months now. It is so frustrating. I am trying to get a referral to a consultant. I'd like an MRI or some sort of scan to show me once and for all what the problem is.

It started out as patella tendonitis caused by ITB, so after months of physio and stretches and no exercise, it was patella tendonitis caused by weak quad muscles! I didn't have weak quad muscles until i stopped training!

Now i just have a swollen knee!!!

fenris

Transform wrote:

Most knee problems can be as a direct result of

1.Poor hip flexibility
2. Weak inner quad muscles

Suddenly it all makes sense!

I am getting a lot of pain on the inside of my right knee, I had resigned myself to surgery.
I tried your sugested test, with the result that my left shin goes parallel with the floor but my right shin need serious pressure to get below 40 degrees!

I broke my pelvis and made bits of my right hip socket nearly two years ago, recover has been slow but I though I was back to a reasonable level and so have started pushing things in the last three months. The knee pain arrived in earnest about two months ago. While my pelvis was being bolted back together I had a traction bar through my femur just above my knee (site is permanently numb), but would have though that my quads would have recovered by now. So with boxes ticked for poor hip flexibility and potentially ticked for weak inner quads - should I just work on resolving these areas first or continue trying to rebuild a gereral fitness base with additional work on these areas and just deal with the pain as necessary?

BostonB

fenris - thanks for the graphic description. :eek:

I have the same problem with my knees and the physio put it down to weak quads. I just need to get off my butt and get working on them. Keep forgetting the exercises though.

fenris - I think Rogueish kinda answered your question earlier.

Having a programme specifically tailored for you will have far greater and faster effects than a general programme that we can give over the forum. If you are given a general programme that progresses you too soon you may end up in a worse position than you are in already.

fenris

YOu know when you read something and it just doesn't register fully due to lack of sleep and way too much caffeine!

At the moment I am trying to balance out both legs, so I was thinking more about quads and hip flexibility than relating the pain to their effect on the patella.

If taping is necessary, is it something you can do yourself after the physio does it the first time?

DaveN

Hi,

I was very interested to read this thread. I have experienced pain down the inside (not the front) of my knees for well over a year now - it comes on from running or doing things like burpees etc. and if I try to kneel/get on my hunkers with my 2 year old son for more than a few seconds I have to stand up. I am 38 and have exercised moderately most of my life. I have a few questions which would be very grateful if people could look at:

If the pain starts on the inside of the knee at the top and runs all the way down are the likely causes the same as listed above i.e. Poor hip flexibility and Weak inner quad muscles?

What is the specific stretch and/or exercise to remedy this?

I have started taking Omega 3 oil after reading the 'Udo' thread - will this help or is it grasping at straws?

Could anyone recommend a good physio who might be able to get to the bottom of the problem - I have tried a couple over the last couple of years but get conflicting opinions?

Apologies for all the questions - I would really appreciate any help.

thanks
Dave

BostonB

fenris wrote:

...If taping is necessary, is it something you can do yourself after the physio does it the first time?

I was shown how to do it. There was a way of measuring the correct location. I've forgotten now. I'll have to revisit the physio, and get a refresher on the exercises. Once I was taped up and doing the exercises the symptoms definately improved after 1-3 weeks.