Chronic inside upper knee/thigh pain

[Roberts]

Hello, I am hoping that someone can help me as I am thoroughly fed up with being injured and think I might go crazy!!

I have been suffering with injuries since september 05 now and as one seems to heal another part of my body flares up. I originally tore my right calf muscle which took ages to heal and caused me to limp for months resulting in pain in my left buttock which became chronic. I eventually managed to get rid of this buttock pain last year by doing a muscle energy technique stretch every day which apparently released my piriformis from spasm. But then whilst trying to do glut medius strengthening exercises my left knee started hurting and it still does now and it won't get better!!

So it was summer 07 that I tried doing 5 shallow 1 legged dips and I got a sharp pain above my knee cap and to the inside (vmo muscle area). I then rested it for a week and tried again and got sharp pain again. I then tried swimming and it flared up big time so that I couldn't walk on it. It was slightly swollen in the same place I had the sharp pain (around the top right hand corner of the knee cap) and felt hot.

I was given gentle physio exercises and told to rest and walking became easier over a couple of months.

Now I have seem to have got stuck, I can walk for about 5-10 minutes on the flat without pain but anymore and the knee starts to get sore and hot and swells slightly. I haven't been able to go upstairs since the summer and anytimes I have tried has ended up in the same results of a sore knee, swelling and heat. Going downstairs makes it worse but not as quickly and just one squat flares it up. So basically I can't do much.

I have been diagnosed with patellofemoral pain now and have a nasty uncomfortable feeling under my knee when the dr pushed the palm of his hand down onto my knee cap. I have also developed pain in my tendon under the knee cap and have just recovered from fat pad impingement using tape. Also my knee is uncomfortable bent but feels great when I do nothing!!

My left glutes are really weak from the limping and my quads are wasting away. My itband is quite tight but apparently not pulling on my knee cap. The knee cap is mobile. I have orthotics.

I am in the nhs system and expect I will have an mri at some point.

The last thing I was told by a physio was that pain on the top half of the inside of the knee wasn't normal so he didn't know what to do. Also he was a bit concerned that my knee had swelling.

Has anyone got any ideas on what I have done?
Thanks in advance

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[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.

[Yarok]

Hi

i do agree with Iceman, proper assessment and treatment umbar/pelvic part, followed by correct programme of lower limb re-education.

[Yarok]

Hi

re, at this stage to retrain/balance quads/knee joint you should try nonresistive in free of pain range of motion exercises and stretchings as well as exercise accesory muscles influancing knee ( hamstrings, calf, hip adductors,abductors)

re clam shell- this is not the best exercise for glut medius cos strain ITband which pulls a patella

[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.

[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.

[markmiller]

Here is my #1 recommendation. Get a tennis ball and work the gluteus medius. Imagine you have a rope tied around your neck and it is tugging on it. The problem isn't in your neck- it is the rope. Work out the knots in the gulteus medius and that should take a great deal of strain off the knee. Then, you can work the IT band with a foam roller as well as the inside part of the thigh, right above the knee joint. This should help relieve the pressure on the knee.

Best,
Mark

[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?

[christy t]

i hope the tennis ball and it roller have helped. when i massage ppl with knee pain sometimes that pelvis gets hiked up and pulls on thehamstring and it band attachments at the knee. i see a chiro when that happens and get my hams stripped out deeply by an art or massage therapist.
i also have glut atrophy on one side that is severe. My right external roators have hurt constantly for 2 years. i am sched for a labral tear reconstruction with Dr. Philippon and yet know my piriformis is over stretched from the hip joint leaning anterior from the unstable cartilage. why is there so much wasting for me when my nerve conduction test shows normal but i do have a herniation at L5/S1.
my next visit is to a neurologist. i also just did cortisone in the hip today and may get it in the piriformis to see if that helps. keep me posted

[davisjone]

You can try the following exercises for knee pain:
Hamstring Stretch
(back thigh)
• Sit with one leg straight and the other bent to the side.
• Slowly lean forward with your chest until you feel a stretch along the back of your thigh. Keep your back straight while leaning forward.

• Do not reach forward with your hands.

Calf Stretch

• Place one foot with toes pointing forward behind the other foot.
• Keep the back heel down and back leg straight.
• Slowly bend your front knee until you feel the calf stretch in the back leg.

Sanding Quad (front thigh)

• While standing on 1 leg, bend your opposite knee and hold the ankle.
• Slowly pull on the ankle until a stretch is felt in front of thigh/hip.

Cross Over (outer hip)

• Lie on your back and cross the injured knee over your other leg.
• With the opposite hand, pull your knee up and over toward the opposite shoulder.
• Keep your foot flat on the ground.
• Hold when you feel an outer hip stretch.

[HumanTouch]

sounds like you were getting somewhere at this point, did you see this therapist again? It sounds like you are hopping from one therapist / therapy to another and not trusting any of them with your problem so that they can see you through until the resolution. This therapist was using the 'functional' approach which comes from the latest in evidence based practice. I'm sure she would have reverted to more 'hands on' approach as necessary or got you the help you need in some way if you had continued with her.



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.

[KattyS]

You can perform following exercises to treat your knee and thigh pain :

• Water Walking
• Hip and Thigh Stretch
• Side Leg Raise