Can go upstairs but can't walk?!

[Wobblyknee]

I recently went to see my Physio for pain in various parts of my right leg, namely small of back, upper buttock, hip, thigh, knee and calf (all on the right leg)
He diagnosed a tight hip capsule and prescribed exercises to stretch it, namely squats and straight leg bends using an elastic ring round thighs/ankles.
Hip and groin are responding well but my knee has got WORSE!
I can squat and go upstairs ok but it's very painful and difficult to walk.
I Googled "can go upstairs but can't walk" and there was NOTHING!
I will of course go back to my own Physio but I'm here for a second opinion.
The pain is focused on my outside right knee which feels wobbly.
I am not in pain when sat or standing still.
All insight welcome!

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[physiobob]

Hi Wobblyknee, thanks for your post. Essentially the main difference between climbing stairs and walking on the flat ground is the angle/range of movement that the joints are working in differs between the two. The knee joint is operating more flexed/bent state when climbing stairs and less so when walking on the flat. Also the load on the knee is being taken in a flexed state with the knee cap more secured in place on stairs and it is located in a different position when walking. The nerves running from the low back down the back of the leg at also on more stretch walking that on climbing stairs so if the pain is referred in origin, then this would also be taken into consideration.

All these factors would be useful to take to a followup examination and treatment plan with your therapist. Ahead of that you could try to refine the specific mechanics of the pain even more.e.g try to find out where in the motion of walking the pain becomes evident. Such as: As the leg is swinging, when the heal hits the ground, as you transfer the weight, when the leg is fully loaded...... Armed with that information your therapist should be able to do a few more tests to pin point the origin and provide you with the next steps in the progression of treatment.

What you are reporting is not uncommon although often people might be fine climbing stairs but have pain descending stairs.

Let us know what you find and how you get on.

[Wobblyknee]

I am now getting seriously concerned as my knee is getting worse quite rapidly. It is getting increasingly harder to walk on. The pain is central just below the knee cap and also on the exterior side of the knee, shooting down my shin as I bear weight on it.
It now also hurts in these places when I raise the knee from the bed. And yet I can still walk up stairs, do standing upright squats and the straight leg stretches prescribed by therapist.
What I don't understand is my groin and thigh getting better while my ability to walk is rapidly going south. What's going on?? I buy the tight hip capsule theory, but I worry that my therapist got fixated on the most obvious problem and overlooked a second issue which is crippling me! I could really use some answers as I am beginning to get distressed.

[physiobob]

Hi Wobblyknee. This continues to point to the position of the knee when the issue is provoked, either the patella position or the compression of the fat pad and meniscal structures in the front of the knee under load. The causes of knee issues, in the absence of direct trauma, are often the result of overuse or overloading. This is why your therapist has looked at the mechanics of your hip and perhaps lower back. Once that is addressed it might be that there is a focal issue of discomfort which might in a way have been the precursor to moving in a certain way. It is positive to highlight this focal point and so the advice right now is to return to your therapist for a review and progress of your treatment plan. They might also assess your ankle and your superior tib/fib joint (side of the knee) as I have found superior tib/fib joint issues have lead to persistent knee pain and treating that joint, which is very simple, has lead to the resolution of the discomfort.

[Wobblyknee]

Hey thank you Physiobob! Following your suggestion I looked up tib/fib joint mobilisation exercises. I found that doing them eased my knee pain considerably and it had been masking the pain coming from my hip.
I found that I have to do them fairly frequently, probably because my tight hip capsule keeps pulling the nerve out of line.
It looks like it's now a case of time and perseverance gradually stretching the hip capsule.
I'm still coming to terms with the fact that my body no longer looks after itself and I have to DO stuff to keep it working. I am having to learn about body parts I never knew existed and stretch them! I kinda resent all this.
I think many middle aged people feel the same and Physios need to understand that we struggle to accept being dragged into this new reality.

[physiobob]

That is great news! I hope you continue on the steady path to full function ;-)