Knee problem

Hi

This may be long but please help if you can.

Approximately March 2009 I first started to get pain in my knee, on the front under the knee cap. I rested it and the pain seemed to go away, then when I was back playing football again in June 2009 as I kicked the football I felt a sharp stabbing pain in the same area as before, only this time I couldn't put any weight on my left leg.

Due to this I went to see my GP, and he gave me the diagnosis that it was Patella Tendonitis and that all I could do was a few exercises but mainly just rest the knee. I tried this and after about 6 weeks I started to do some running again and my knee felt fine, so after a few weeks of just running I started to play a little bit of light football but any twisting or turning that I did resulting in more pain.

In August 2009 I booked myself in with a local physiotherapist for them to take a look, he did so and suggested it might be either Patella Tendonitis (like my GP had said) or a minor tear in Meniscus. I went back a week later and after more examinations he decided it was just Patella Tendonitis and all I could do was just to rest it. Which with me being a very active person it was really frustrating.

After resting it, there was no improvement in my knee, I still had the pain twisting and turning. I've been to a different physiotherapist at the beginning of 2010 and completed exercises he gave me to strengthen my muscles around the knee to help take away some of the stress. This seemed to help and after about 4-6 weeks doing this I started to get back into running and playing football again and everything seemed fine, it felt like I was over the injury. But then during a match all I did was jump up and all of the pain returned and felt much worse.

I decided to complete the exercises the physiotherapist gave me to see if that improved it like it did before. Unfortunately to this present day the pain still persists.

The pain mainly persists in the front of my knee cap, with after any form of exercise swelling appearing on the front of the knee cap and occasionally pain at the top of my shin bone. Whenever I wake up my knee is really stiff, and I struggle to walk up or down any stairs without pain.

I did have an operation as a child to straighten my shin bone.

I know it has been a long explanation but I didn't want to leave anything out that may be important to the answer.

Any replies would be greatly appreciated and any questions you have please ask :)

Thank you

Rob

Hi Rob

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The pain mainly persists in the front of my knee cap, with after any form of exercise swelling appearing on the front of the knee cap and occasionally pain at the top of my shin bone.

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It is a bit hard to tell what you have from your description. There are a number of structures close to that area that can be involved. Yes it could be inflammation of the patella tendon. Another possible structure is that there is a very intricate structure behind the patellar tendon call the fat pad and it is very sensitive to pain. this could have become irritated. there is also a bursa (a thin cushion of synovial tissue that lubricates between tendons and bone where they rub past each other) in the front of your knee cap that may have got inflamed. Another very common problem is patello-femoral pain due to "tracking" difficulties of the knee cap on the front of the knee. However that last options sounds a bit less likely.

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Whenever I wake up my knee is really stiff, and I struggle to walk up or down any stairs without pain.

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. The stiffness in the morning ((along with the swelling) is a sign of inflammation. Inflammation is worse first thing in the morning as the inflammatory process is more active at night and the tissue at rest swells - this eases off after a while as you starting moving the inflamed tissues around. Difficulty going down these stairs is common in any one of these problems listed above.

At this stage the proper diagnosis needs to be made and rest is really an inadequate treatment. One thing that really needs looking at is WHY the problem occurred in the first place and what keeps it being irritated. Often there are altered biomechanics that may put more than usual stresses on the structures in the front of the knee. This could be related to your childhood surgery and/or Imbalances in the muscles that control the knee could be part of the problem. Muscle imbalances are where one muscle is weak or lengthened out and one is strong and too shortened. A really good analysis of your walking and running is a good idea. Sometimes it isn't so much a biomechanical problem at the knee but due to the hip or ankle/foot so there are lots of things that can be looked at.

I suggest you go back to a competent sports or musculoskeletal physio who can do a good biomechanical analysis of what is going on as well as diagnose exactly what the offending tissue is. There are a lot of techniques that can be helpful once the problem is really well analysed.

In terms of managing the inflammatory component of the problem there are anti inflammatory gels that can help and sometimes the application of an ice pack can calm things down - these are of course immediate solutions - not getting to the crux of the problem - but they can help in the overall management.

Thank you for the quick reply, it is greatly appreciated. I have took everything you've said onboard and I'm going to book myself back in to the doctors, or maybe even a knee specialist if I can to try to solve the problem.

It's hard to describe the problem exactly on here, I find it hard to explain to the doctors/physios etc. So i really do thank you for trying to decipher the problem. :)

Rob

You are welcome. All the best with getting it sorted out.