subluxing knee and clicky hip

I have bad knees and suffered a complete dislocation of my right knee six years ago (i'm 29 yr old female) i couldn't walk properly for 6 weeks gradually as time went on i got the use of my leg back, know both knees feel unstable i get some subluxing of my left knee. My right ankle clicks (alot) and now my right hip is clicking/snapping every morning, it goes off once i have been walking around for a while, it sometimes comes on when i have been sitting for too long and will click again, i can't hear it but i can feel it and if i put my hand there i can also feel it.
I suffer with anxiety and have been googling and come up with Hip-dysplasia /snapping hip. I just want to be normal but now every morning before i get out of bed i am waiting to feel the clicking and then i think what damage am i doing!!
The days that my hip wants to click after a while my hip starts aching it feels like all the muscles surrounding it are sore.
My right knee clicks a lot now, when i climb the stairs quite often by the time i get to the top my knee will have clicked.
Any advise please help.

Hay Loopy :)

Just thought I would throw some ideas your way as you suffer from anxiety and no-one has answered your post yet! Don't want you to wear out that refresh button :)

Just want to start out by saying your best shot is to get it looked at by a good musculoskeletal physiotherapist, as your condition sounds quite complex.

Hip dysphasia is abnormal structural positioning of your hip or local structures, this is likely picked up @ birth, but you can get acquired hip dysphasia. I would be lying if I said I knew a lot about this condition, however I think it is more likely to be a form of "snapping hip syndrome" (a blanket term for hip clicking/pain these days)

Snapping Hip Syndrome or clicking/pain in the hip can often be broken down into two main causes.

Intrinsic factors:
There are several structures in your hip joint which, if injured or not working correctly, will cause pain and clicking. I suggest getting some investigations to clear these.
Have you had any previous serious injuries to your hip? I.e. dislocation/trauma/severe acute pain? You mentioned dislocating your right knee, but nothing about your hip. Was the pain in her hip slow onset over time? If so you can likely rule out most intrinsic factors for now, you may have some mild degeneration of your hip joint however.

Extrinsic factors:
This is more likely your cause. There are several muscles which surround your hip, some of these muscles go on to form a band a fascia running down the side of your leg called your ITB (iliotibial band). When this fascia and supporting muscles become tight, they can flick over a bony prominence of your femur (greater trochanter) and give you clicking sensation. This irritation of clicking over this feature can also irritate the muscles and cause an aching pain on hip flexion and extension (i.e. standing up from a chair). This band can be tight due to a large number of reasons including overactive hip muscles due to knee instability!!! Ring any bells? Can also be due to muscle imbalances, weaknesses etc. list is quite large.

External snapping hip can also be due to your iliopsoas muscle which sits most towards your groin, however this muscle will generally SOUND louder than it feels. You have stated you can feel it but not hear it, so I don't think this is currently affecting you.

A VERY good resource for snapping hip:
http://www.nsmoc.com/files/pdfs/OP%2...ping%20Hip.pdf

This article is very informative, if you don't understand any of the terminology, look it up! If you understand this you will better understand what is happening to your hip!

Could be a number of other things however, but on your information the above is probably up there in terms of likeliness.

My advice would be to start an exercise program which includes stretches of your lateral hip muscles / ITB, along with strengthening of your hip and knee. Improving your knee stability and control will allow some of the muscles at your hip to rest more often, reducing over activity and tightness. You would have to likely get your foot, knee and hip mechanics assessed to get the appropriate exercises.

Some ideas MAY be however:

Use of an ITB roller to release your ITB
Stretches of your glut max/med/ITB (Can likely google these, let me know if you can't)
Some good HIP exercises can include (only do painfree exercise!)
- Crab walk : get an elastic band and put it around your feet so it pulls them in. Stand in a very small squat and walk sideways keeping your feet at least > 60cm apart at all times. After 10m Waddle on the spot keeping your legs > 60cm apart still. 5 sets.
- Wall Ball: Put a fitball against the wall and lie on your back, put your foot up against it. Roll it up and down slowly about 20cm each way. Only put minimal pressure against it. Every 3 times up and down increase your pressure by 25%, so you do 25/50/75/100% pressure. This is a great exercise for ankle, knee and hip stability. The aim is to go slowly and keep it controlled, not wobble around. To make it harder close your eyes.
- Side lunges to the right (make sure they do not stir up your pain)
- VMO activation exercises (look these up on google) It is more than likely you have poor VMO activation of your quads (VMO = vastus medialus oblique, a part of your quads which greatly helps knee stability and tracking of your knee cap!)
- Some people may give single leg squats, but for knee snapping syndrome this can aggravate as you are constantly flicking your ITB over that bony prominence. Feel free to give it a go but do not continue if it aggravates symptoms.

Plenty more, the above were just some ideas. If you still feel stuck let me know. :)

Only planned to be quick, already a long post. Will give you some good places to start researching, coming up with a more accurate idea of your situation.

As I suggested earlier though, these kind of things can be quite complex, and I may have overlooked some fairly major components as there is a lot to assess. Please go get this checked out by your local PT :).

Regards,
Musculoman! :)

Hi, thanks for such an informative reply.
No i have never injured my hip so to speak but about 1 1/2 years ago i woke up in bed with terrible pain in and around my hip i could hardley turn over but once i had and was laying on the side that hurt i fell back to sleep and in the morning was fine, then about a month later the exact same thing happened again, luckily that hasn't happened again but that is the only time i had serious pain in my hip.
I will try some of the excercises, unfortunately i can't squat now without pain in both knees usually at the outside.
I am just worrying that the more i am oing physically the more i am aggravating my joints :(
I suppose it will take time.

No dramas,
The first thing you should know about snapping hip and most knee pain (ITBFS or something similar might be the cause of your lateral knee pain, which ties in with our current ideas of your ITB being a problem) is that you should immediately decrease ALL aggravating activities over all else.

So yes the exercises below might help, but only ones which do not cause pain. So forget the squats etc. Might be better to do some VMO activation exercises lying in bed etc. have a look for some on the net. If you can't find any I can try and type you up a program.

Have a read of that article and look for some exercises etc. then let me know if you are still stuck with ideas. Don't just passively think it will take time and not do anything about it. It will likely not improve.

:) We are here to help remember!

Regards,
Musculoman

Many thanks, (you definately sound like you know what your talking about)
I definately want this sorted (or be as good as it can be) as my anxiety levels are going sky high!!
Will let you know how i can on.
Thanks again you have been a great help.
Laura

hi there.

some very good info from musculoman there.

you really do need to see someone skilled face to face by the sounds of things. i, personally, would start with motor control and strengthening around the hip. i wouldnt even start to stretch anything out initially. i imagine you have really poor hip stability with probable hyperactivity in tensor fascia lata, which is the muscle that attaches to the ITB as musculoman described, as it attempts to exert some sort of control over the hip. in some cases there is no point stretching out the ITB if you dont strengthen your glute medius, which is the muscle that should be providing a lot of hip stability.

also musculoman has listed a number of exercises but i would start you off by isolating glute medius in sidelying (google "clam" exercises) to really get this muscle firing before moveing onto any type of dynamic stability or higher level strengthening exercise. its imperative that your exercises are done the right way with good form and are progressed appropriately, this is why you need to visit a good physio.

you need to have your pelvis/hip examined in detail to see what your strength/stability/control is like and what compensatory strategies you've developed that are adding to your problem. only then will you and your physio know what way is right to proceed.