Knee Pain

[lol76]

HI everyone,

Im after a course of treatment for what my physio has defined as Patellofemoral pain. I have a tight ITB as well.

This pain came about with excessive squatting exercises with a wide stance. I have cut the squatting down to maybe once a fortnight and have started doing leg extensions instead as i find that rom to have no pain for my left knee.

Initially i was treated by 2 physio's at the same practice...one who i shall deem to be in dire need of upgrading her skills and knowledge whilst the other(owner) treated me fairly well.

He gave me 2 exercises to do. One was to contract my vmo as much as possible several times a day, 10 or so seconds at a time. The second exercise was to wall sit with a towel inbetween my legs for a min at a time.

Now progress seems to be quite slow and it is now about a month later. I am unable to play basketball as the jumping motion seems to bring up the pain quite quickly. I would like to get a few opinions on what else i can do to speed up recovery as basketball season starts up quite soon.

And i have not been back to the physio has present finances dont allow it. Holiday overseas has blown out the credit card. Ahh that reminds me....sitting on the plane made the knee quite sore as well.

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[Dr.Mansi]

hi lol76,

wel give me more information abt ur knee pain.

-like what sort of pain? ( continuous-on action, stabbing-dull aching-throbbing etc..)
-aggrevating factor of pain
-relieving factor of pain
-exact site of pain?
-even grade ur pain from 0-10 scale.( VAS score) (O is no pain and 10 is max pain)
-how much reduction in pain till now?
-what is on going therapy?
-what type of work u daily do?

I'll give my best advice...till thn.. take care..n get wel soon.

Dr. MANSI

[lol76]

Hi Dr Mansi,

In reply to your questions:

-like what sort of pain? ( continuous-on action, stabbing-dull aching-throbbing etc..) It is like a dull ache but becomes worse if movement is continued. The soreness is especially evident a day later after physical activity. During movement the pain increases with the amount of force put through the knee when the leg is straightened.

-aggrevating factor of pain
The pain only occurs when ever there is bending of the knee and subsequent straightening of it with any amount of force. eg getting up quickly from a sitting position....squating with weights....jumping...pushing off it for lateral movement.

-relieving factor of pain
I dont really understand the context of this question but i guess your asking when the pain isnt there? Bascially i can walk around and even surprisingly jog without any pain. Basically as long as the knee doesnt bend the leg more then 45 degrees there does not seem to be any pain.

-exact site of pain?

The pain seems to be located behind the knee cap, slightly to the right.

-even grade ur pain from 0-10 scale.( VAS score) (O is no pain and 10 is max pain)

The pain is about 1-2 during normal day to day activities. Becomes 4-5 during exercise with the leg and about 7 a day after exercise.
-how much reduction in pain till now?

Pain has reduced due to my cutting back on my leg exercises, namely deep squats. I still do deadlifts. From the initial pain which was about 8 it has dropped off considerably but i think thats more due to reduced exercise then any significant improvement in the condition.

-what is on going therapy?
I do static leg contractions with my left leg for 10 secs at a time. Several times morning and night. In the evening i do the wall sit exercise for 45-60secs where the force is directed towards the quadraceps rather then the entire thigh.

-what type of work u daily do?

Im a postie so basically i use my legs quite a bit when im stopping the bike. Luckily since its my left leg, all i use it is for stabilty when stopping.


Hopefully that clarifies it a bit more.

[Dr.Mansi]

hello lol76,

wel its really gud that u hav given all the details...in depth.
but dear friend, I still like to knw abt ur age n ur weight.

from the information ...I can suspect its wear n tear of patello femoral jt.
These might b early symptoms.

DO ONE THING, TILL UR PAIN GET SUBSIDE , REDUCE THE EXCESSIVE STRESS ON THE JT.
this u can do by,
1)reducing ur jog activity.( I knw it really not harms u)
2)secondly, stop jumping or fast running.
3) avoid floor sitting.

tips for relieveing ur pain..
1) continue both the exercises which ur r doing nowdays.

2) do hot pack application when ever u feel the pain of grade 5-6 or more on VAS score. ( can b done by heat packs or by warm water soacked towel application)
at least keep hot pack for 12 mins.. If pain is more... apply twice a day.

3) sit on the high table or chair n relax. try to bend n extend ur knee within the pain free range. do this exercise with the minimum effort from ur side. Do it for 3-4 mins. this will improve ur internal blood circulation n will reduce pain produced muscle spasms. ( Its similar what u usually do by sitting at the egde of swimming pool with legs in water).

at least follow the tips which I have given, for 2 days and reply me as soon as possible.

take care.

Dr. Mansi

[lol76]

Sorry im 31 years old and 5'7. Weight is around 83-84kg Im a bit overweight at the moment so that doesnt help my knees as well. Am trying at the present moment to get back down to 79-80kg.

[Dr.Mansi]

hi,
wel acc. ur age... i can not really suspect wear n tear of patello femoral jt.
other thing which could b is tendinitis of VMO.

I appreciate if u follow the treatment which I mentioned earlier.

Dr. Mansi

[lol76]

Dr Mansi,

What time frame am i looking at here for a full recovery with no pain in the knee?

[Yarok]

hi
could tell what is your range of motion when bend knee?

i'd advice to stretch ITB and quadriceps,

and check your lumbar, pelvise and hip joints those structures can influnce knees.


you can try to assess -palpating thigh and knee area if are any tender point just do some massaging or pressing ( find point, use thumb, press moderetaly 8sec, break 8s x 8, when you finish few points put hot compress)

can be helpful
wish all the best,get well

[lol76]

I have full range of motion in the knee with no weight on it.


Only with weight on it and when straightening it does pain occur.

[morwenna]

I'm assuming this is your right knee.

It could well be a problem with patellar tracking leading to wear/roughening of the posterio-lateral aspect of patellar.

If you strengthen the VMO, stretch the ITB and lateral soft tissues, these things should help. Sometimes taping is helpful, but not a permanent solution, more as a diagnostic tool.

As others suggested it may be worth looking further into the biomechanics of your whole leg (Hip and ankle/foot). A visit to a Kinesiologist or orthotist may help analyse your gait and see if there are any other areas that need to be addressed.

Sometimes surgical release of lateral soft tissues at the knee is indicated, or an arthroscope. It is hard to say, without seeing you, and unreasonable for you to ask for a time-frame to become painfree, in my opinion.

[lol76]

Hi,

Thanks for the post. Actually it is my left knee. My left leg is my strongest leg. I wear orthotics pretty much all the time. According to some recent xrays without the orthotics, my left hip does not sit inline with my right.

Im due for a review of my orthotics so maybe something has changed since the last time i had them made. That and combined with pretty much heavy leg exercises for the last 6 months have brought the problem to surface.

[tuja]

Hello, does your knee hurts when landing from a jump? do you feel pain right under your patelar tendon?
Well by loosing some weight you would release a lot of stress of your left knee.
Best luck

[morwenna]

Hi,

Thanks for the post. Actually it is my left knee. My left leg is my strongest leg. I wear orthotics pretty much all the time. According to some recent xrays without the orthotics, my left hip does not sit inline with my right.

Im due for a review of my orthotics so maybe something has changed since the last time i had them made. That and combined with pretty much heavy leg exercises for the last 6 months have brought the problem to surface.

Sorry, I did not read all the posts properly ... you did say it was your left knee ..... but you are having pain on the right side of the patella? ... the inner (medial) edge?
If the patella was tracking laterally due to tight ITB etc, I'd expect lateral patellar pain.

So the story doesn't quite add up to me. If you have had orthotics for some time then it definitely indicates a muscle imbalance problem and is more complicated that just treating the knee.

I know it's a cost thing, but basically you invest in a proper evaulation and treatment, or you continue to curtail your activities to operate within the pain-free range, or you take pain meds etc and carry on. I guess you have to choose. Certainly get the orthotics checked, but that is addressing the effect as much as the cause of the problem. Weight loss would help as well. Good luck with it anyway.

[lol76]

Ok obviously its a bit hard to diagnose conditions at the best of times let alone on the net but also relying on the patient to come up with the description itself without having first hand knowledge of the afflicted body part.


Reason why i said it was to the right of the knee is due how it feels the pain is originating from. Just as i read the latest post i specifically squatted down on the left leg just to make sure i was describing it right. Specifically the pain is behind the knee car towards the part where the quad muscle links up with the knee cap. So im sorry for saying it was towards the right but that was what it felt like.

On my initial consultation the physio basically described that my vmo had changed its muscular function and was no longer acting as a stabilizer for the knee. And therefore the pain was originating from that.

With regards to the orthotics, i have flat feet as well as uneven leg length. My gait was mesaured as well as my running style. You are saying its a treatment of the effect but when that effect is from birth, how/what is the solution? have my other leg broken and shortened?

Basically i believe the problem with the knee, which i have stated in the first post is from embarking on a heavy exercise schedule involving the legs. This program involved heavy squatting, dead lifting, power cleans and over head squatting. This was a 5 day program. I was doing these exercises with a wide stance with the feet pointed outwards, with rom all the way to the ground, ala powerlifting style.

[physiobob]

I have a tight ITB as well.

This pain came about with excessive squatting exercises with a wide stance.

Ahh that reminds me....sitting on the plane made the knee quite sore as well.

Sounds like you have developed a chronic injury to the articular surfaces. These take months/years sometimes to develop to a level that becomes painful. So they will take a long time to go.

You comments above and the history suggest that the pain is specific to a range of motion or point in that motion. Leg extension exercises whilst somewhat useful for focusing on the extensor muscles (perhaps work on inhibition of the ITB/Glutes a little if you can whilst doing this - maybe with some EMG retraining) this is not useful for the normal leg movement. You should assess the balance of the leg muscles. Hamstrings need to work as strong hip extensors. Glute medius as a useful hip stabiliser etc. If the ITB is tight then the glute max is overactive and you need to correct that.

Basically the treatment approach should be two fold:

1. Assess the actual problem tissue and treat in a supportive manner to reduce pain and facilitate healing of the injured structures

2. Assess the biomechanics and muscle balance of what you have been doing in order to correct it. This will mean reducing weight considerably and retraining your existing movements as well as learning new ones so that this becomes a preventative strategy and not just a reactive one.

[morwenna]

You are saying its a treatment of the effect but when that effect is from birth, how/what is the solution? have my other leg broken and shortened?

Sorry, my comment was more a general statement on the provision of orthotics without regard to trying to alter body mechanics to fix a problem. Obviously leg length discrepancy is not something that can be fixed, but you had not mentioned that as a factor previously.

You have been given sound advice by Physiobob and others, and I do not feel I have anything else to contribute to the discussion, personally.

Hope it improves. Good luck.

[lol76]

Thank you everyone who has posted.

I will have to bite the bullet and go back to the physio, preferably someone else rather then the initial one i went to.

My question then goes to.....what can i reasonably expect for the physio to do when i see one? I was told by another physio that if when you see a physio and all they do is break out the ultrasound machine and electric stimulation machine then they really are not doing their job. Is that a valid point?

I just really do not want to pay good money for half way solutions.