Knee/leg injury advice needed please

[Deano82]

Hello everyone,

My injury happened almost 3 weeks ago. I overdone it on the rowing machine (without warming up, yes stupid idea!) and the day after i noticed both knees were a little stiff so i had a few days off from the rower. In the meantime i was doing oblique twists for a few days and i woke up one morning and my left knee was quite painful (by this time my right knee had gone back to normal). I did knock my left knee on the door frame around 6 months ago so i expected it to take a little longer to get over the stress from the rower. I think the twisting action may have worsened the injury to my left knee. Anyway i rested a few days and kept my weight off my left leg as much as i could but the more i rested the stiffer my knee became. Also at this time i noticed soreness in my thigh and calf muscles and they kept pulling all the time. I could put weight on the leg no problem but it always felt unstable.

After a week of no improvement i went to my local injury clinic to get it checked out. The Nurse there examined my knee and leg and she concluded that i had not broken any bones or torn any ligaments. She said she thinks the problem is more to do with my overused muscles rather than the knee itself. She gave me a sheet of exercises to do and told me that it may take another 4 weeks until my knee/leg is back to normal.

Ok so now it has been over a week since my visit to the clinic and almost 3 weeks from when i first noticed the problem with my knee/leg. I have been doing the exercises daily and have been using a single crutch to help me get along. My leg does feel a bit stronger but it is still giving me problems and i was expecting recovery to be a bit faster than what it has been. The main issue i am still having is the stiffness of my leg especially behind my knee as i struggle to straighten my leg fully and also my calf muscle and thigh muscle keep pulling. They will be ok for a few days but sometimes all of a sudden when i am walking or doing the exercises i was given the muscles will pull and i have to stop. I have noticed that after walking around for a bit the leg loosens up but after sitting down for a while it goes stiff again.

Along with the muscles pulling i have experienced a strange sharp pain over and around the knee cap. It feels like the pain is on the surface of the skin, almost like there is something sharp caught in my trousers and it rubs on the knee. This pain only lasts for a second. I also get the odd shooting pain going from the back of my thigh down the inside of my leg and down towards my foot, this is only felt sometimes when i fully stretch my leg. I am finding it quite uncomfortable to sleep as well. If i lay on my back with my leg straight i can feel the muscles pulling from the back of my thigh past the back of my knee. Sometimes when i sit down for a while my leg below my knee gets quite cold and there is a numbness felt in my foot

Can anyone give me any advice in addition to what my nurse has told me? Is it just a case of keeping my leg active and just wait it out and hopefully it will get better soon? Are there any other exercises i should be doing? Or do you think there is something else wrong other than overused muscles?

thanks in advance

oh and incase it helps i am 30 years of age

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[nmarman]

Firstly it is unlikely to be over use. It sounds like there is Denis in the knee, either meniscus or even a chip of bone. This would limit the extension and cause the sudden giving way feeling. This can be caused be Truma (direct bang) or a twisting of knee. It is also possible there is ligamentous damage. Have it checked again by a sport physio or sport chiropractor. Preffably see if they do MRI referral.

Saying that it might just be soft tissue, although sounds unlikely. To rule this out try ice and heat twice daily for another week and buy some tube grip for knee at boots. If your still getting locking and giving way after this time- you need a second opinion.

Good luck

[Deano82]

Hi,

Thanks for your reply.

I am not getting any locking of the knee at all it just feels stiff after i have been sitting down a while. I have had a look at some websites and my symptoms are very similar to that of runners knee.

I will take your advice and keep icing twice a day and i will also continue the exercises i have been given.

Anyone have any other views?

[nmarman]

The locking was in relation to the statment: "The main issue i am still having is the stiffness of my leg especially behind my knee as i struggle to straighten my leg fully" this is a sign of joint irritation. Runners knee tends to be from reparative flexion of knee under load and causes pain in the upper outside of knee during bending not straightening.
Please clarify what movements cause you pain?
Also can you explain what oblique twist are ?? Standing trunk twists or sit ups with a trunk twist or something else??

[Deano82]

Sorry yes by oblique twists i mean standing trunk twists

The only actual 'pain' i get is on or around the kneecap. This is usually when i am bending my leg but it isnt always there. It almost feels like someone is pricking the surface of the skin with a pin and sometimes its a dull ache coming from under the kneecap. I find its worse if i sit down for a while. My main complaint is really the feeling of the muscles pulling and the stiffness of the knee (especially the back of the knee). After walking for a bit the stiffness goes away but comes back after sitting or resting. I find that if i stand up straight and put weight on the leg i can feel what feels like a muscle getting tight at the back of the knee and thigh. I havent had any swelling of any sort that i have noticed but sometime the back of the knee feels a little swollen but its not noticeable to look at

Yesterday while at work i did a lot of leg extensions while at my desk and straight leg raises. After resting at home i could then feel my thigh muscles were quite sore and they were pulling as i tried to walk. Maybe i should give the leg extensions a rest today for my muscles to recover properly. I am finding that even though the exercises that i have been given are making my leg stronger albeit very slowly, my leg muscles seem to 'pull' very easily

[nmarman]

Pain location is the most important diagnostic tool.

It is likely that the muscle pull is due to knee stability but have a look at map and tell me which numbers correlated to pain location.

Regards,

Dr Niall Marshall-Manifoldknee pain map.jpg

[Deano82]

The sharp pain is usually over the top of the knee cap (4) and (6) the dull ache is also here but sometimes radiates down to (7) and (9)

I havent had any sharp pains at all today just the dull ache for around 10mins and then it went away

I get a pulling sensation around the inside knee (8) and it goes down to (10) and further towards the foot. Sometimes i get a feeling at the top of the kneecap almost like someone has a thin elastic band and its pushing on the kneecap just at the top

[nmarman]

Right sounds more like variation of patella tendonitis (jumpers knee) it comes from over tight quads. It may have even have started to involve the pre patella bursa.
Do you stretch the quads? If so how exactly.
Either way ice the knee, foam roll the upper quads to loosen pressure on tendon. Dont stretch quads directly. You could even get a marathon stick to help with self massage.
If after two weeks it still feel unstable it probably is.

Best thing to do next: Get some imaging on it and buy a strap if is shows ligament or meniscus tears. Get a good practitioner who can refer quickly if this is the case.

just to help: what is the most aggravating movement for the knee and which point on knee map hurts the most when it's in this position?

[Deano82]

To be honest the dull ache is the wost pain and this gets worse when i am resting the leg. This is coming from under the kneecap and just below it. When moving the leg sometimes i can also feel a grinding sensation coming from under the kneecap.

I dont do any stretching of the quads no, how do i foam roll them?

Also do you think i should carry on walking on the leg (i am currently using one crutch to help me) or should i keep all weight off it? Or should i try to walk without the crutch?

[nmarman]

In that cases you will also have condtomalaciapatella you need a good knee strap to control patella tracking. On top of what I said before - get someone who knows what they are doing.
Check you tube for foam roller and marathon stick exercises.
Don't forget ice x2 daily - 10mins

Good luck

[Deano82]

Thank you so much for your info and advice - much appreciated.

I have got a knee support which i cut a hole out for the kneecap but after one day i removed it as it was too tight and causing pain. I have found that when i walk longer distances my leg/knee feels better as everything seems to loosen up, while at home when i only do very short walks back and forth from the kitchen etc the whole leg seems to be worse as everything seems to stiffen up.

Can you adivise - should i continue to walk on the leg with the crutch? Or so you think i should try to walk without it?

[Deano82]

I am planning on going to see a Physio this week for more info...

Do you think i should still use the leg with the crutch or without to help gain strength?

[Deano82]

Seen a Physio this morning..
He said its my hamstring that i have sprained. This is causing me not to straighten my leg fully when walking and standing which is causing the other muscles to overcompensate and pull. This in turn is causing my knee instability
He has given me stretching and strength building exercises to do and told me not to use a crutch to walk as it will make things worse.

I have to do the exercises for a month to see if it improves
Hopfully it will get better

[Deano82]

UPDATE:

Well its been a week since i started my rehab exercises and so far my hamstring and quads are gaining strength. I can now walk up and down stairs with minimal pain. My hamstring is still quite tight so i still walk without straightening my leg fully but it is improving.

I have a problem now where my calf muscle keeps pulling/cramping. This usually happens first thing in the morning after waking. As soon as i get out of bed and take a few steps i get a cramping pain right at the top of my calf where the knee bends. If i take weight off it the pain resides after a few minutes. As the day progresses and i walk further it dissapears but its still sore.

Any tips on what i can do to releive this?

[Deano82]

UPDATE:

Since my last post i have seen a different physio. He thinks the cramps/stiffness is being caused by a trapped nerve in my back (he said a form of Sciatica). Was given back stretches to do which did not help much. The original weakness/stiffness in the knee seems to have gone away and the stiffness seems to have moved down to the calf/ankle area

Since then i have had stiffness in my other leg but not as bad. Also i have been having muscle twitching in various locations on both legs. I now struggle to walk very far as the cramps stop me in my path and i have to sit down. Also getting a tingling/numbness in my left heel which also seems to point to a trapped nerve somewhere. I am not getting any shooting pains in my legs but do get lower back ache after sitting for a while. The Physio also noticed slight atrophy in my calf muscle. He checked my reflexes which were fine but quite strong

Still unable to stand with my left leg straight as the calf muscle starts to pull. Have been stretching the calf which has helped a bit. Walking on the ball of my foot is more comfortable at the moment. Also experiencing weakness in both legs when climbing stairs although the Physio tested my strength and he said i didn't have any weakness there

As its now been 9 weeks and I'm still limping i went back to my GP who prescribed me Gabapentin which he said will help with the muscle tightness which is leading to the cramps.

At the moment i am having regular physio sessions and have an appointment to see a Muscloskeletal doctor in 4 weeks

Any other advice on how to help with this stiffness is much appreciated

[Deano82]

UPDATE:

The Gabapentin seems to be working well. I have not had any cramps now for over 2 weeks and my limping has improved.

One thing i have noticed recently is that my lower hamstring just above the back of the knee seems swollen when i straighten my leg. It seems to start at the crease behind my knee and then go upwards in the shape of the hamstring (if that makes sense). Any ideas what this could be?