Knee injury with a year

slimergan

Looking for some advice/recommendations on a year long injury I can't get rid of.
December 2019 I developed lateral knee pain during a soccer match and needed to come off. I went to physio and was told it was IT band syndrome which I was given strengthening exercises of glute/hip while he also worked on glute/TFL and ITB releasing from tightness. At this stage I could run for about 20mins until I got the lateral knee pain and had to stop.

As the above didn't work I was referred to a sports doctor who confirmed it was ITBS and gave me a steroid injection into my knee to relieve the pain. This however didn't work and I returned to him. At this point I can now only run for 2mins until getting the pain and having to stop. In an MRI it showed that I had a bone fragment in behind my patella and I was referred to an orthopaedic surgeon to perform keyhole surgery to remove it. I'm now 7 weeks after surgery and successful removal of the fragment but I still have the exact same pain when I run for 2mins.
I'm at a loss at this point and unsure what my actual issue is thus unsure what I need to do to fix it.
Any recommendations of who could help me or suggestions are appreciated?

Thanks in advance

Ceepo

slimergan wrote: »

Looking for some advice/recommendations on a year long injury I can't get rid of.
December 2019 I developed lateral knee pain during a soccer match and needed to come off. I went to physio and was told it was IT band syndrome which I was given strengthening exercises of glute/hip while he also worked on glute/TFL and ITB releasing from tightness. At this stage I could run for about 20mins until I got the lateral knee pain and had to stop.

As the above didn't work I was referred to a sports doctor who confirmed it was ITBS and gave me a steroid injection into my knee to relieve the pain. This however didn't work and I returned to him. At this point I can now only run for 2mins until getting the pain and having to stop. In an MRI it showed that I had a bone fragment in behind my patella and I was referred to an orthopaedic surgeon to perform keyhole surgery to remove it. I'm now 7 weeks after surgery and successful removal of the fragment but I still have the exact same pain when I run for 2mins.
I'm at a loss at this point and unsure what my actual issue is thus unsure what I need to do to fix it.
Any recommendations of who could help me or suggestions are appreciated?

Thanks in advance

Where are you based.?
What if any biomechanical assessment did you have done?
What is your running gait like? Where do your feet land in relation to your hips, under, outside, inside,?
Do you have an anteriorly tilted hip?
Do you have a externally rotated tibial?

Knownig the answers to some of these questions might give an indication as to where you issues stems from.

slimergan

Ceepo wrote: »

Where are you based.?
What if any biomechanical assessment did you have done?
What is your running gait like? Where do your feet land in relation to your hips, under, outside, inside,?
Do you have an anteriorly tilted hip?
Do you have a externally rotated tibial?

Knownig the answers to some of these questions might give an indication as to where you issues stems from.

Thanks for your response Ceepo.
I'm based in Kerry but willing to travel to anywhere to get this looked at.
I haven't got any of those assessments done in order to answer those questions.
I do know that I do have an anterior pelvic tilt which a Pilates instructor told me over a year ago. I did work on it but would need to re-assess.

Is there someone/somewhere in particular that you would recommend to do a biomechanical asessment and gait analysis?

How do you check if you have an externally rotated tibial?

Seannew1

slimergan wrote: »

Thanks for your response Ceepo.
I'm based in Kerry but willing to travel to anywhere to get this looked at.
I haven't got any of those assessments done in order to answer those questions.
I do know that I do have an anterior pelvic tilt which a Pilates instructor told me over a year ago. I did work on it but would need to re-assess.

Is there someone/somewhere in particular that you would recommend to do a biomechanical asessment and gait analysis?

How do you check if you have an externally rotated tibial?

You could try Gerard Hartmann in Limerick. He's one of the best around. A lot of elite runners have gone to him. Best of luck.

Ceepo

slimergan wrote: »

Thanks for your response Ceepo.
I'm based in Kerry but willing to travel to anywhere to get this looked at.
I haven't got any of those assessments done in order to answer those questions.
I do know that I do have an anterior pelvic tilt which a Pilates instructor told me over a year ago. I did work on it but would need to re-assess.

Is there someone/somewhere in particular that you would recommend to do a biomechanical asessment and gait analysis?

How do you check if you have an externally rotated tibial?

Most physios will bring you through passive and active range of motion tests, and look for strength/weakness as part of their assessment.
They often look for things like pelvic tilt etc but most that I know of don't try address it. Similar with external tibial rotation, but in most cases they will not even look for it, let alone try address it.
What work did you do to try and correct your APT?.

Unfortunately their is not to many therapist around the do "proper" gait analysis or biomechanical assessments. Running on a treadmill and only looking at what happens below the knee is not gait analysis.

Re: external tibial rotation. To give you an indication of what it looks like,
I've attached 2 pictures the 1st "before" is a client with external tibial rotation, the 2nd "after" is taken after approximately 20 minutes after doing some specific release work, and some corrective work.

Ceepo

Sorry just seen that the pictures did not attach. Ill try post them again later

slimergan

Seannew1 wrote: »

You could try Gerard Hartmann in Limerick. He's one of the best around. A lot of elite runners have gone to him. Best of luck.

Thanks Seannew1, I'll look him up

slimergan

Ceepo wrote: »

Most physios will bring you through passive and active range of motion tests, and look for strength/weakness as part of their assessment.
They often look for things like pelvic tilt etc but most that I know of don't try address it. Similar with external tibial rotation, but in most cases they will not even look for it, let alone try address it.
What work did you do to try and correct your APT?.

Unfortunately their is not to many therapist around the do "proper" gait analysis or biomechanical assessments. Running on a treadmill and only looking at what happens below the knee is not gait analysis.

Re: external tibial rotation. To give you an indication of what it looks like,
I've attached 2 pictures the 1st "before" is a client with external tibial rotation, the 2nd "after" is taken after approximately 20 minutes after doing some specific release work, and some corrective work.

For APT, I done exercises like bridge, dead bug, butterfly stretch and pigeon stretch whilst also doing pilates class for a couple of weeks.

Do you have any recommendations of therapists that do proper biomechanical assessments? Looking up on Google there seems to be a lot of podiatrists but not sure that would be the right direction to go

Seannew1

slimergan wrote: »

Thanks Seannew1, I'll look him up

No worries. Hopefully he can sort you out. Let us know how you get on!

Ceepo

slimergan wrote: »

For APT, I done exercises like bridge, dead bug, butterfly stretch and pigeon stretch whilst also doing pilates class for a couple of weeks.

Do you have any recommendations of therapists that do proper biomechanical assessments? Looking up on Google there seems to be a lot of podiatrists but not sure that would be the right direction to go

While not wanting to come across as all knowing apart from myself I don't know anyone else who does what I do in the munster area. I do know someone else in Dublin.
Feel free to pm me if you want to know more information.

Ceepo

Here are the pictures I was trying to upload earlier

motley

In a similar situation to yourself. Would be curious to hear how you get on.

mo_bhicycle

Not the same situation as you but thought I’d mention in case it’s beneficial.
I’ve lateral cartilage damage to my left knee due to an injury from another sport 15 years ago. It flared up 2 years ago and I was struggling to run for more than 5 minutes.
What I’ve found hugely helpful is making sure my quads aren’t in any way tight. When my quads are tight my knee gets v sore.
I foam roll and stretch them before every run and have been able to get back running daily and doing up to 21k for a long run.
This is the quad stretch I do as the other ones aggravate my knee: https://myrehabconnection.com/wp-content/uploads/2017/05/Kneeling-Lunge-Stretch-with-Quad-Focus.png

slimergan

mo_bhicycle wrote: »

Not the same situation as you but thought I’d mention in case it’s beneficial.
I’ve lateral cartilage damage to my left knee due to an injury from another sport 15 years ago. It flared up 2 years ago and I was struggling to run for more than 5 minutes.
What I’ve found hugely helpful is making sure my quads aren’t in any way tight. When my quads are tight my knee gets v sore.
I foam roll and stretch them before every run and have been able to get back running daily and doing up to 21k for a long run.
This is the quad stretch I do as the other ones aggravate my knee: https://myrehabconnection.com/wp-content/uploads/2017/05/Kneeling-Lunge-Stretch-with-Quad-Focus.png

Thanks for that stretch and I think that will be useful, my quads are a little tight but not majorly. I will certainly start incorporating it to see how it goes. I've had 2 MRI's of my knee and nothing has showed up except for the tiny bone fragment that was removed in surgery. The surgeon also said my knee itself is in very good shape. That would mean it's coming from somewhere else where there is an issue

Ceepo

mo_bhicycle wrote: »

Not the same situation as you but thought I’d mention in case it’s beneficial.
I’ve lateral cartilage damage to my left knee due to an injury from another sport 15 years ago. It flared up 2 years ago and I was struggling to run for more than 5 minutes.
What I’ve found hugely helpful is making sure my quads aren’t in any way tight. When my quads are tight my knee gets v sore.
I foam roll and stretch them before every run and have been able to get back running daily and doing up to 21k for a long run.
This is the quad stretch I do as the other ones aggravate my knee: https://myrehabconnection.com/wp-content/uploads/2017/05/Kneeling-Lunge-Stretch-with-Quad-Focus.png

You shouldn't have to foam roll your quads before every run.

If you're quads are constantly getting tight, the chances are you're quad dominant when you're running.

You need to get better glute engagement or you will be consistently struggling with quad tightness and knee pain.