Knee shooting nerve pain, knee ache

[SteadyEd]

I’m hoping someone could point me in the right direction, I’m at a bit of a loss with the pain I’m encountering, it’s not a hugely serious issue, but it’s becoming annoying.

So, early thirties.
Overweight, but a long distance walker/cyclist.

How it happened:
Issue happened back in February this year.
I had cycled in the morning, legs were fatigued, quads mainly taking the brunt. Garden working in the afternoon.
I over balanced backwards, began to wobble back, somehow engaged my knees to pull myself forward, no twisting action involved, just pull myself upright with my knees.

Instantly felt something tug/pull/over stretch in the centre front of my knee, assumed it was the patella tendon, right knee.

I carried on, as I needed to finish what I was doing. Pain was mild, present when squatting down etc, but tried not to squat down too much whilst I finished off.
Next day, mild pain going down the stairs. Unfortunately had to distribute leaflets, so I walked at a very slow pace for around 3hrs. Pain similar to above, manageable.

Took a long week off from distributing leaflets.

Pain on going down the stairs subsided around two/three days after.

That night when I got into bed I got in on my knee and twisted over, stupid – instant knee pain, it was sharp but faded instantly, and didn’t seem to trigger the stair pain the next day.
After that though shooting like nerve pains in the knee started, the shooting like pain was focused around the knee and would kick in when my knee was bent, so sitting down. Eventually that stopped, and that has only returned once when I was visiting friends in a caravan, sat awkwardly trying to keep my knee straight but didn’t do a good job and then the next day shooting pains returned during the day, and again disappeared afterwards.

When I returned to distributing leaflets I’d get a pain that was more central to the patella tendon, which eventually went away foam rolling the quads seemed to help get rid of that, but then a pain reappeared along the inside of my knee, the pain has reduced to a low ‘tightness’ feeling when walking for a couple of hours now and isn’t problematic too much.Pain locations are inside, just to the left/below of the patella tendon really, I'd point it out to around here: Untitled-1.jpg

The huge issue is aching. My knee has a central ache type sensation anytime I’m resting, it’s really hard to pin-point exactly where, seems more below the kneecap where the pain has been, rather than the kneecap area, and seems very medial but again, I find it almost impossible to say where. Wearing a knee brace at times seems to instantly take the ache away, other times it doesn’t have much affect.

I can wake up with no ache, and then just lay around in bed and it can begin before I even get out of bed, but the moment I start moving around/walking the ache will disappear.

No locking, no weakness, no swelling, no noticed range of motion changes.

Knee does feel generally tighter when doing quad stretches

Thanks, pretty long post so if you made it this far, I appreciate it!

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[toronto_physio]

Have you had an ultrasound to rule out a Baker's cyst? Sounds like a bursitis.

[Click Physiotherapy]

Hi there!

To me this sounds like it could me a minor meniscal tear. The area of pain doesn't seem to indicate bakers cyst, unless you are getting pain behind the knee as well. The area just inside the patella tendon is usually pain referred from the inside joint line. Do you get any locking or giving way associated?

A couple of quick tests to try is to see if there pain with full knee bend, pain with full knee straighten and then also if there are painful clicks in the knee. If these are all there then its probably a meniscal tear and should heal with physiotherapy and time (you wont need surgery unless there is major locking of the knee which it didn't sound like there was)

One other possible diagnoses is a pes anserin tendinopathy - this is where three tendons join onto the bone at that same area.

[SteadyEd]

Thanks for the answers from both of you.

Admittedly, haven’t sought a doctor/physio yet mostly because it’s always felt like something that’s incredibly minor, but just doesn’t seem to be going away, so unfortunately seems the direction I’m going to have to take at some point.

No pain at the back of the knee at all. It’s all front-area, so I hadn't considered bakers cyst

No locking, no giving way, no (as far as I can tell) reduced flexibility/mobility. When stood leg fully locked, there is a tightness in the knee area, but at the same time this with a resistance band stretching out the leg has always felt good.
I had considered meniscal but thought I’d be in a lot more pain.

Initially I tried a few half-squats recommended for meniscal/pes anserine but these irritated the shooting pain on the right-hand side of the knee (not the left where the initial walking pain was), pain feedback was after doing a few days of doing it, and then it seemed to hurt every time I attempted it so backed off – did nothing, and it went back to the status quo of not mild sensation when walking and persistent ache when resting which is helped by movement/walking.

For example, this morning ache came on, went for half an hour walk, whilst felt odd sensation, no pain present, and the ache disappears, and doesn’t return until at rest.

The typical floor quad stretch is extremely tight/uncomfortable in the knee and irritates the aching sensation afterwards/next day etc so I’ve avoided that, at the moment I’m in an ache flare up because of what I suspect is from quad stretches.

Knee has always been a bit of a cracker/clicker, felt more clicks than normal initially but at the moment seems to be like it was before in terms of clicking/cracking, never with any pain.

At the moment I’m focusing on cross band lateral walks/glutes and do a lot of quad foam rolling.

[Click Physiotherapy]

You're on the right track focusing on gluts. You will need to add in quadriceps, there is a video I made on youtube for this here:
Click Physiotherapy - knee extension exercise - YouTube

There is a great manual technique that could help to relieve some of your symptoms, I'm in the process of editting that video so subsribe to the youtube channel and that should be out very soon.

Other than these the main thing will be load management. Here is an article that should help with this:
What your rehabilitation is missing.. - Click Physiotherapy

I hope these help! All the best with this and let me know if the exercises help. If it does get worse, make sure you see someone!

Kind regards,