Knee Pain

Disclaimer - I am not a doctor.

Qualifier, I have had 4 knee surgeries.

Inside of knee in the soft tissue next to the kneecap? that kind of fleshy spot there? No swelling? Just hurts, not giving out from under you? Treadmill no good, elliptical trainer ok.

Hmmm... First guess? Meniscus cartilage, maybe a small tear, but no loose bodies.

Second guess - tendinitis

Advice - no HEAT!! Ice, rest, elevation, compression.

AND, GO SEE AN ORTHOPEDIST, find a sports medicine guy in your area.

STAY OFF THE FRIGGIN' EXERCISE MACHINES UNTIL IT FEELS BETTER.

Send me $200 for the consultation.

Dave

 

Agree on all points. Sounds like meniscal tear to me but hopefully just tendonitis. Orthopedic doc is a must. No offense to general practitioners but ortho needed on this one. $200 for second opinion. Bill in the mail.

 

I agree with the previous points but have a few to add.

Typically meniscal tears will bother you more with weight bearing activities and less with activities like the bike so your symptoms point to a possible meniscal tear. There are external tests that can indicate a meniscal tear but the best manner to diagnosis is a MRI.

It could also be, although a lower likelihood, patellar tendonitis or chondromalacia patella.

Did you have any trouble with your knee locking and an inability to fully straighten or bend the knee, and/or swelling?

 

Could be iliotibial band syndrome. Google it and see if the symptoms fit yours. I had this problem a few years ago when if first started using clipless pedals on my bicycle. I treated it with complete rest for about a month and then went back to pedals with toe clips. That worked for me.

 

I would agree that might be the cause if his symptoms were on the lateral side of the knee.

 

Although even an MRI can miss this. Had a nasty tear in mone, guy reading the MRI said he didn't see anything, doctor said let's go look anyway, and found a pretty good sized mess in my knee. {quote]

It could also be, although a lower likelihood, patellar tendonitis or chondromalacia patella.[/quote] Pretty easy self diagnostic for this last one. Straighten your leg about 95%, but keep thigh muscles as slack as you can. Place a hand on the top, not the front, the top of your knee cap. Now, tighten your thigh muscle, which will pull up your kneecap. If that hurts like a *****, you probably have chondromalacia, which is a roughening of the surface of the underside of the kneecap. Can hurt like a *****, not all that easy to fix, but I wore a neoprene device for a while that helped my kneecap track straighter, which alleviated the pain.

That would maybe indicate loose bodies in the knee, right? And the potential for a meniscus tear. What you have to watch for here is that loose body getting in the joint at the worst possible moment, like half way up a flight of stairs, where you suddenly find yourself traveling down the stairs, caused by the knee collapsing from the loose body lodging in the joint. BEEN THERE, DONE THAT. Not fun.

DM

 

Pretty easy self diagnostic for this last one. Straighten your leg about 95%, but keep thigh muscles as slack as you can. Place a hand on the top, not the front, the top of your knee cap. Now, tighten your thigh muscle, which will pull up your kneecap. If that hurts like a *****, you probably have chondromalacia, which is a roughening of the surface of the underside of the kneecap. Can hurt like a *****, not all that easy to fix, but I wore a neoprene device for a while that helped my kneecap track straighter, which alleviated the pain.

That would maybe indicate loose bodies in the knee, right? And the potential for a meniscus tear. What you have to watch for here is that loose body getting in the joint at the worst possible moment, like half way up a flight of stairs, where you suddenly find yourself traveling down the stairs, caused by the knee collapsing from the loose body lodging in the joint. BEEN THERE, DONE THAT. Not fun.

DM[/QUOTE]

I agree that MRI can miss many things but it is the best tool we have other than surgery to detect internal derangements.

Inability or locking of the knee can indicate loose bodies or a torn flap of a meniscus getting caught in the joint line.

Pain and swelling shut off muscle activity. This is the main cause of the "giving out" feeling experienced post injury.

The bottom line is have it checked out by a physician for appropriate diagnosis.

 

This just in.

PhilNotHill captured in a future photograph after insisting his knee was "Just fine!"



DM
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Just go get it checked out.

Having also had both knees done (former professional ski racer), it could be a number of things. Best to get a physical evaluation. If it's not obvious, your Orthopedic guy will order up an MRI (most likely), and then you'll know for sure.

Also, given that ski season is right around the corner, you don't want to try and get up on the hill if it's not right. Better to get it checked, and (if necessary) fix it, rehab it or just rest it.

However, until you can get in to your Orthopedic guy, make sure you ice it (30min on, 30 off). Keep the inflammation at bay. Also, one or two advils before you work out. That may make a BIG difference. We're not getting any younger, you know...

CW

 

Good for you on the appt. Does your wife know that sex isn't a problem?

 

Makes since. When you walk on your toe you also flex your knee so you are decreasing pressure on the meniscus.

 

Here ya go...

http://www.amazon.com/Sexual-Positions-Patient-Joanne-Arczynski/dp/0965056104/ref=sr_1_1/176-6054627-4750820?ie=UTF8&s=books&qid=1288222204&sr=8-1

CW

 

Hope ski season is in six months. Even if it is a simple Meniscus tear and you can get it done arthroscopically, it takes way longer to heal up than the 6 weeks you hear about for athletes to come back. Twinges of pain last quite a while...and the worst part is you have these three or four little butterfly bandages on you knee that look like nothing, but you are on crutches. Here's hoping for the best for you.

 

The fact that you are able to load the knee, even to a small degree, while cycling the joint through significant flexion / extension range of motion (in plane) --- as you would have doing the above exercises --- tends to rule out damage or inflammation of the meniscus.

A sprain of the Medial Collateral Ligament (MCL) is a possibility, as restricting the motion to in-plane movement will relieve stress on that ligament --- thus, allowing your pain to be absent during such activity.

Other activities, even walking, require the joint to stabilize itself against displacement in both the lateral / medial and the anterior / posterior planes as well as against rotation. This requires involvement of the MCL and, hence, stresses it ---- causing pain if it is sprained.

Stay off the knee, and protect it, as much as possible for 2-3 weeks. Wear a supporting brace while sleeping --- to prevent accidental aggravation. Take Ibuprofen as needed, and per dosage directions, for pain (it will also help with inflammation). Avoid heat !! Ice pack, for no more than 20 minutes at a time, may help with pain as needed.

Probably not necessary unless it doesn't heal (pain resolves) after 2-3 weeks. But, if you are worried about it, and have good health insurance, sure --- go see an Orthopedist if you wish. Be forewarned, that unless there is a sprain / tear bad enough to benefit from surgery (which is unlikely) --- he won't be able to do anything for you, anyway Although you may get some benefit from a prescribed physical therapy regimen.

Yes. For at least one additional week AFTER the pain is completely gone. Then, return gradually to your normal activities. Stop immediately if the pain returns, and go see the Ortho.

FYI --- Except for offering some protection from further injury during sleep, knee braces don't do sh**. Health care folks (even some Physicians) may tell you otherwise --- because they are in the business of selling medical supplies But, years ago, I was involved with extensive studies conducted at the Steadman-Hawkins Clinic (in Vail) on the performance / effectiveness of various knee braces. And, the data collected proved that they (braces) are not at all effective.

 

Also, if you do choose to see an Ortho ---- get in your car, and drive over to Vail or Summit County .........better Docs over here than in Aspen

 

I have to agree that the knee (hip, shoulder, etc.) guys here in Vail are TOPS. I had a VERY serious knee injury January of 09. So serious, I almost lost the leg from the knee down. Thanks to them, last season, I skied ~40 days, and I'm hoping to step it up this season. I was lucky they could put humpty dumpty back together...

CW

 

The question I have on this statement is this??? Did the test subjects in this test have strong to average knees or was it based on subjects with several types of knee injuries???

The reason I bring this up is the fact that both of my knees are shot and very much unstable. I currently wear Don Joy Armor Action braces when I go jet-skiing, dirt bike riding, golfing, snowboarding etc. Wearing the braces I can feel the stability increased in my knees at the end of the day of activity I have no to very little pain in the join. If I were to play a round of golf without the braces my knees are sore and stiff for close to a week. As for the sleeping at night I don't wear the braces. Instead I untuck the sheets from the end of the bed so I don't twist my knees while tossing and turning in my sleep.

The only down side I see to wearing the knee braces is the fact that they destroy the seat cover and graphics on my dirt bike and eat out the knee area of my riding pants.

 

For sports, due to my injuries, I wear Cti2 custom braces on both knees now. Custom braces fit better but are much more expensive. However, they will reduce the incidence of re-injury and do help protect against a number of types of injury. At least, that's what my knee surgeons say.

Off the shelf will provide less benefit because they don't fit as well. Better than nothing, but not the full protection.

CW

 

You can do some internet searching, and find a variety of brace performance tests done by many institutions on a variety of test subjects and conditions. Our tests done at S-H Clinic focused on "high risk for knee injury" athletes involved in "high risk / high exposure" activity, specifically, professional skiers. The test subjects were all instructors from within the Vail / Beaver Creek Ski School. Multiple comparisons were done considering multiple factors --- different braces, gender, age, prior injuries (yes / no), pre-existing musculoskeletal conditions (yes / no), and measured biomechanical markers (ligament size, joint ROM, hamstring / quadriceps strength, loaded joint laxity, etc.).

Obviously, the entire test group would be considered to be "well above average", as compared to the standard population, with regard to leg strength-to-body weight ratio and overall level of physical conditioning.

And, while our data did identify a few parameters as being potential risk factors for knee injury, which suggested further study, NO statistically relevant correlation was established indicating that braces played a role in the prevention of serious injury. In other words, the test subjects wearing braces were just as likely to suffer a knee injury as those not wearing them --- and the incidence rates of knee injuries (of all types) were the same for all the "braced" and the "non-braced" groups.

Many people engaging in moderate activities do claim to receive a benefit from wearing a brace, and if you fall into that category, go for it --- wear a brace. My comment was directed to, and based upon, the effectiveness of knee braces for snow skiing --- since that is what we tested, and since the OP is a skier --- I assumed that specific information would be of interest to him.

The reality (as far as skiing is concerned) is that while wearing a brace may offer some degree of protection for falling over in the lift line or getting your boot caught in the legs of the bar stool at the end of the day , a brace is no match for the speeds, loads, and kinematics that the activity of skiing can place on the knee joint ---- the equipment itself (the boot & ski combination) is a viciously perfect device for over-stressing every structural element of the human knee.

Knee braces have improved quite a bit over the years, but there still is NOT ONE which can prevent relative rotational displacement of the joint ---- a critical mechanism in most serious knee injuries. Also, while some degree of solid contact can be made between a good brace and the lower leg bone structure, there is no contact available between a brace and the upper leg (thigh) bone structure ---- no matter how strong your quads are, they are always compressible, especially when caught at moments of low tonus.

So, until someone designs a brace capable of being (and a patient willing to wear one ) rigidly fixated directly to the bones of the upper and lower leg ---- ouch !!! ---- the knee joint will always be at high risk when you take it skiing.

 

That clears up the test data on knee braces. The fact of the matter is the test was directed at skiing and nothing else. I myself don't ski any longer as the independent motion of the skis put so much stress on my knees that I cannot walk after 2 runs down the hill. Like I stated my knees are shot!!! After racing motocross and jet-ski racing for well over 20 years of my life my knees took the brunt of all the impacts. My doctor even states that I am a prime candidate for knee replacement except for the fact that I refuse to slow down I would destroy the replacement joints in no time flat.

The plus side of the braces is the fact that I can still enjoy the activities that help me blow off stress and be able to show up to work on Monday.

The down side is that they are uncomfortable, bulky, and my friends call me "Gramps" because I wear them

 

On a personal note (about a thousand years ago), while I was on staff at the Vail Ski School, I completely tore (grade 3 sprain) my ACL. Needless to say, I was not wearing a brace at the time of the injury.

For several reasons, I delayed the reconstructive surgery, and I finished the second half of that ski season wearing a brace. I spent the summer off-season doing extensive conditioning on the affected leg, and at the beginning of the following ski season, tossed the brace in the closet. I taught and raced that entire season without wearing a brace (and without an ACL!!), and I sustained no further injury or new injury. The following summer I had the ACL reconstruction surgery ---- followed again by diligent physical rehab and conditioning --- I have skied every season since (21 years and counting ) without a brace, and without a knee injury

By contrast, a good buddy of mine, and also a former instructor (from the "good ole days"), has blown his ACL twice (same knee) --- the first time without a brace, and the second time (post reconstruction) while wearing one. Another instructor I know has blown both of her ACL's (both legs), blown an MCL in one knee, and shredded her meniscus in the other (all for the first times) while wearing braces, as a prophylaxis measure, because she believed "weak knees ran in her family" ---- unfortunately, she was probably correct.....We are trying to encourage her to switch to bowling as a Winter activity -- lol.

And, oh yes, (at the "tender age of 45") after nearly 40 years of skiing, and 25 or so years of carrying 70lb backpacks through the mountains ----- BOTH my knees hurt much of the time. But, that's the result of early-onset arthritis brought on from "overuse". And, the only thing I've found to help with that pain is taking 2 Advil before a day's skiing, and 2 shots of Jack Daniels afterward ......the Jack is "self-prescribed", BTW .