Chronic inside upper knee/thigh pain

[Roberts]

Hi Iceman, I have seen a physio who specialised in pelvis biomechanics and he said my right side of the pelvis was rotated forward a bit and that was putting a strain on my SI joint and giving me pain in the ligament on the rhs of the SI joint.
He gave me a muscle energy technique stretch to help this where you lie on your back and bring your knee up to your chest.
I think it was just my SI joint he talked about when he examined my lower back.

I stopped seeing him when I started getting knee pain because he said it was to be expected as I was re-strengthening my muscles, but I was struggling to walk and it was getting worse. And it turns out I was developing tendonitis above my knee cap and I should have been resting.

Another physio I saw a few years ago was unsure about my lower back and used to push into it with her fingers and say it was tight and a bit higher up it was too flexible when she pushed in. But she wasn't sure why this was but did wonder if it was linked to the nerve pain I was experiencing in my calf. She gave me neural stretches which helped my calf improve.

[Roberts]

Hi Yarok
To balance the quads I now do straight leg raises and quad muscle contractions where I just push my knee into the ground to contract the vmo.
But I'm not making any progress with these as I can't manage to do 10 reps without aggravating the tendon, which then aggravates the knee and it goes purple and swells slightly.

I have been told to start ems for the vmo but the nhs physio doesn't have a machine, so I have borrowed one from a friend and am about to try it.


I don't do any exercises to stabilise the SI joint as my knee is so irritable I can't do things like bridging. I have found that I can do clam shells now since I had a cortisone injection into the tendon, so I guess I should be working on my glut med a bit more now as it is still very weak.
I have tried glut max exercises but it hurts my knee again.

Actually I'm not sure if I have been given many SI exercises, maybe I should be heading to a physio who knows more about the back or be doing some pilates?
I keep meaning to do pilates but always get scared that it will hurt my knee more.

I have been told I have a very weak core.

[IceMan]

Hi Iceman, I have seen a physio who specialised in pelvis biomechanics and he said my right side of the pelvis was rotated forward a bit and that was putting a strain on my SI joint and giving me pain in the ligament on the rhs of the SI joint.
He gave me a muscle energy technique stretch to help this where you lie on your back and bring your knee up to your chest.
I think it was just my SI joint he talked about when he examined my lower back.

Yes but did he actually evaluate (and treat) your Lumbar spine? Problems in the SI joint and torsions of the sacrum are often accompanied by Lumbar problems (particularly L5/S1 issues if the sacrum is not moving as it should).

I stopped seeing him when I started getting knee pain because he said it was to be expected as I was re-strengthening my muscles, but I was struggling to walk and it was getting worse. And it turns out I was developing tendonitis above my knee cap and I should have been resting.

I would have stopped seeing him as well.

Another physio I saw a few years ago was unsure about my lower back and used to push into it with her fingers and say it was tight and a bit higher up it was too flexible when she pushed in. But she wasn't sure why this was but did wonder if it was linked to the nerve pain I was experiencing in my calf. She gave me neural stretches which helped my calf improve.

Just pushing into the lower back does not a lumbar eval make. A full evaluation might include range of motion testing in multiple planes, repetitive motion testing, segmental joint mobility testing, an assessment of alignment (along with sacral and pelvic alignment and dynamic tests), soft tissue assessment, muscle strength, reflex and sensation testing etc. The fact that neural tension stretches helped to reduce your calf pain is further suggestive of a possible nerve impingement in the lumbar spine. From all that you've said in previous posts it just doesn't sound like your lumbar spine has been adequately addressed.

[Roberts]

Hi Iceman,
how do I find a physio who will give me a thorough lumbar evaluation. Do I need a physio who specialises in this to get the best treatment?

All the nhs people I have seen say that my back isn't involved, I have had it mri'd and that is clear so they say its not causing any of my problems including my initial calf problem.
No one has said anything about my back being linked to my knee yet.

I think the feeling I used to get in my buttock, (which was finally sorted by the met stretch to release the spasm in the piriformis) is similar to the feeling I get in my vmo. When I walk the muscle slowly gets more tired and then eventually its too achey/tired to walk on anymore, it kinda gives up. This always leaves me wondering if it is linked to the buttock problem I had, and if it could be as easily sorted as that was.

[IceMan]

Hi Iceman,
how do I find a physio who will give me a thorough lumbar evaluation. Do I need a physio who specialises in this to get the best treatment?

I would look up all the clinics in the phonebook and call and speak to physios to see what kind of experience they have in treating these kind of symptoms. Maybe an internet search would yield some results. What many people don't realize is that within the profession of physio there are many different philosophies of treatment. For example for your symptoms a physio who follows the McKenzie approach may choose an entirely different plan of care than someone who is Maitland trained. That's not to say that one approach is necessarily better than the other. I believe that there may be a number of different ways to treat a particular condition but it is important that the patient is diagnosed correctly.

When calling ask what percentage of the patients they see are lumbar spine patients and the number of years experience the physio has had in treating these conditions.

All the nhs people I have seen say that my back isn't involved, I have had it mri'd and that is clear so they say its not causing any of my problems including my initial calf problem.
No one has said anything about my back being linked to my knee yet.

Forgive my ignorance but is the nhs some sort of government setup in the UK? Anyway a negative MRI does not mean you don't have a lumbar spine problem. An MRI is just one piece of the puzzle. A solid clinical evaluation(ie interview followed by hands on testing) should always be the primary driver in determining the plan of care from a physio perspective.

I think the feeling I used to get in my buttock, (which was finally sorted by the met stretch to release the spasm in the piriformis) is similar to the feeling I get in my vmo. When I walk the muscle slowly gets more tired and then eventually its too achey/tired to walk on anymore, it kinda gives up. This always leaves me wondering if it is linked to the buttock problem I had, and if it could be as easily sorted as that was.

What you're describing could indicate a lumbar radiculopathy ie impingement of a nerve root in the lumbar spine which is causing muscle weakness. If you find someone who can test for this, along with a comprehensive look at your back, pelvis and legs, and then treat you appropriately you may well find some relief.

[Roberts]

Hi
I have found a person who does structural massage and re-alignment therapy they say they identify and correct postural/structural misalignments by deep focussed massage and soft tissue release techniques. They have qualified as a McTimoney chiropractor so this should mean that they know more about the back. Do you think they would be any good? I'm also still looking into another physio.

Oh now I understand why the clamshells hurt my knee! That makes sense

Yarok please could you give me an example of nonresistive in free of pain range of motion exercises, as I'm unsure what you mean by these.

Iceman the nhs is a government set up allowing us to have free health treatment but unless its urgent you have to wait a long time to get it. In fact when I first tore my calf they told me it would take 6 months till I could see a physio, its a bit of a joke!

What you're describing could indicate a lumbar radiculopathy ie impingement of a nerve root in the lumbar spine which is causing muscle weakness. If you find someone who can test for this, along with a comprehensive look at your back, pelvis and legs, and then treat you appropriately you may well find some relief.

Its definitely worth looking into.

[Rockygrass]

I was relieved to find someone with the same symptoms and going through the same medical mess as me. I have been dealing with this for only a year and a half, so I guess I should consider myself lucky? I am also a female with a particuarly arched back that has the same symptoms (pain and tightness in the same areas, etc.) and tried many of the same things as you. Since you haven't posted in a while, I was hoping to get an update on what has been working for you.

[Roberts]

Hi Rockygrass, I went to see a physio in London where they treat top sports people so I figured they should be able to help me! The lady I saw checked out my knee and a few other things and decided that it seemed pretty healthy and that I shoudn't be experiencing the pain that I was. She then explained how some people when they get chronic pain their central nervous system starts to get oversensitive to pain signals and starts telling you your in pain when you shouldn't be. She thought this could be my problem and so the plan was to trick my brain into thinking that my knee is ok but just very weak, and to also try and ignore the pain, and my "homework" was to think of 3 things that made me happy everyday.

This all seemed a bit crazy to me as I have a background in science and factual stuff and thought mind stuff was all a bit weird. However I had decided that this was the last physio I was going to see so I had to commit to what she wanted me to do. And strangely it seems to be working!!!

She also stopped me from doing all physio exercises as they made my brain focus on my knee to much and the pain it was experiencing and told me to do functional exercises instead like going out on a bike, a gently walk. And arranged to do some hydrotherapy with me in their pool as the water supports the knee so it can do some weight bearing exercises better.

I was doing the exercises in a pool near home but now I have made such progress that I am able to take the dog for a walk and do stuff like shopping all in the same day and be fine the next day too! So I am just focussing on trying to build up my thigh muscles by walking and riding my bike on gentle slopes.

The pain above my knee seems to have gone but I now just have a jarring/jabbing type pain under my knee cap when I put my weight though it when my leg is bent, ie like when going up a hill. But the next day it feels fine, my main symptom is that the knee goes red and hot after a day of activity and then recovers over night.

Also I take green lipped mussel every night and that seems to calm the inflammation over night.

I hope this helps you. Let me know if you have any more questions about my injury tales!

[Roberts]

Hello everyone.
I've decided to post again as I have stopped making progress and I am stuck as to what to do again.

The muscle energy technique that helped my piriformis come out of spasm eanbles me to walk without my butt going dead but the effect seems to be limited and the glute muscle gets sore if I over do it. When it gets sore this makes my knee flare up so I assume it is still my glutes or piriformis that needs sorting. But I don't know what to do now.

The obvioius thing that is need is for my glutes to be strengthened and in turn my quads but I can't seem to make any progress.

Does anyone have any idea what I should be doing now? Are muscle energy techniques, i.e., releasing the muscle from spasm supposed to be combined with other treatment? I feel as if I am half way there to getting better.

Any comments would be highly appreciated.

[marzipan]

This is obviously a very old post so I'm not sure if you are still on here. But I found your post on Google and your problems sound similar to what I've experienced- you also seem very proactive at trying everything the medical community and alternative community can throw at you. So. If you're still on here, has there been any progress?

[roycar]

i'm sorry to hear about your problems over the last couple of years. tough break. i think ice man has a good point with the lumbar spine. you seem to be having so many issues peripherally that i would have to start proximally and work my way out. i personnally would not be doing any strengthening ie clams until i was happy that the range. have you had your hip and pelvis complex assessed in depth? i dont want to complicate an already deep clinical picture but problems with hip range esp rotation, can lead to altered muscle recruitment patterns around the hip, poor firing in glutes, increased activity in tensor fascia lata. if hip is stiff and for eg cant get to 90 degrees of flexion its obviously gonna impact on your sij and lumbar spine and also if there is decreased range and hence decreases stability at the hip its going to have a direct impact further down the kinetic chain at the knee.

just my two cents! people sometimes avoid the hip.