Chronic anterior knee pain // chondromalacia patella // patella femoral pain
History: Let me begin with some backround. I am 23 years old male currently living in Canada. I have had anterior knee pain in my right knee for over 6 years. It started when I played soccer, and it just got worse. My IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them. I have tried physiotherapy from multiple physiotherapists, ART, trigger point dry needling, acupuncture, massage therapy, foam rolling (lacross ball, PVC pipe, rumble roller), suction cupping, strengthing glute medius and maximus, VMO strengthening, orthotics, prolozone, joint supplements, heel wedge for leg length discrepency (my right leg is 1 cm shorter). I dont do any physical activity besides physiotherapy. My pain is at a constant 5/10, sometimes its lower, but sometimes like in rainy days or cold days its even higher. Basically all the physiotherapists are perplexed at my issue and they say that I should not be feeling so much pain. They think my overall mobility and flexibility isn't that bad. But when they massage they notice that my soft tissue is really tight with lots of "junk", adhesive knots, and scar tissue.
1) NEM - natural egg shell membrane (500mg)
2) pycnogenol (100mg)
3) fish oil (2000mg)
4) krill oil (500mg)
5) curcumin (500mg)
Note: They dont seem to have helped much. I am thinking of replacing my curcumin with Thorne Meriva (a high potency curcumin, with 20x more absorption) based on all the good reviews. Someone even said its worked better than cortisone shots. I have also tried MSM, glucosomine, and chondroitin, and type 2 collagen from fortigel.
Other supplements for general healthy
2) Vitamin D
Diagnostic imaging done:
1) X-ray - showed nothing abnormal besides patella tilt
2) ultrasound - showed mild inflammation in my right knee, nothing serious
3) MRI - getting it done in January
1) Physiotherapists - looked at mobility, muscular imbalances, glute medius, glute maxmus, VMO strengthening, stretching, self myofascial release, foam rolling, suction cupping, ART, massage therapy, orthotics, gait analyses, heel wedge for leg length discrepency, trigger point dry needling, acupuncture, postural work, went to Fowler and Kennedy sports medicine clinic in London Ontario, and many other places
2) Dr Robert Banner (London ON) - 6 treatments of Prolozone injections, once every month so far. Only noticed temporary relief of pain, maybe for 2 weeks after each injection. He has recommended EMF (electromagnetic field) protective devices such as diodes. He says it may help since my symptoms are worse on rainy days
Prolozone solution includes: ozone, dextrose, vit b12, lidocaine
Possible Future treatments:
1) Botox (Dr. Gordon Ko in Markham) - into the vastus lateralis (any maybe hip flexor). This has shown to be effective in some recent studies for patients with refractory anterior knee pain. The idea is you shut down the vastus lateralis for 3 months, and you continue to do physiotherapy, this gives you a window of time for selectively strengthening and isolating the VMO. This will help with tracking and tilt issues, and can give symptomatic relief of muscle tightness during the 3 months. Its good for addressing muscular balance issues. Dr. Gordon Ko also does PRP, prolotherapy, hyaluronic acid, and botox into the joint.
2) HGH or testosterone or IGF-1(self injection) - have read this has helped some people on this forum. Particularly Irentat. I am looking into injecting into my own knee to save thousands of dollars. This can help regenerate possible cartilage damage I might have.
3) Dr. Anthony Galea (Etobicoke/Toronto) - he is a prominent sports medicine physician infamous for treating athletes and giving them HGH. Don't know what kind of treatment he would give me. I know he does PRP, but I dont know if he can give HGH anymore since its illegal here in Canada and hes gotten in trouble for that.
If anyone can provide any help on what I can do to help my case, It would be greatly appreciated. I feel like I almost tried everything, and I have gotten almost no relief in knee pain. The only thing that has improved is my muscle tightness, and IT band tightness, but even this might be temporary, as I work my IT bands and muscles every day, and see someone every week for them to be massaged or released.