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Author Topic: PFPS- injury vs. chronic inflammation  (Read 338 times)

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Offline BusterCatLegs

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PFPS- injury vs. chronic inflammation
« on: July 07, 2018, 11:52:15 AM »
Hello All,

I'd like to discuss a bit more what you all think about what this syndrome actually is.

My injury started walking on the treadmill uphill. There was a sharp burning pain under the patellar tendon. Weeks later I had a much more severe pain here. Fast forward to my corticosteroid shot in my knee- the day after my entire knee was on fire. That lasted for a few weeks. Had an MRI that showed a mostly normal knee but an effusion in the right knee. Doctor told me to rest for a week. I basically did a total rest, I would say I walked maybe 200 steps a day max. Tons of ice, maybe 10 times a day and elevated knees a lot of the time.

After one week the burning pain was basically gone. And the pain overall in my left knee was even gone. Right knee was back to what seemed like the original pain with an injury pain type feeling under the patellar tendon area.

Soooooo, it seems like PFPS sufferers are dealing with two issues here- many of us with extreme cases are dealing with a whole knee inflammation that we can't get rid of while others are dealing with a more localized injury plus inflammation in a local area? Synovitis vs....injury?

Anybody have any comments on this?

By the way, I took stairs about 5 days after I felt better. Ruined everything, back to total inflammation for 10 days now. I think I'm going to try total rest again since it worked last time. Really struggling to get rid of this whole knee burning. GGRRRRRRR.

I am seeing a specialist in two days and am very concerned she will send me to physical therapy. Do we agree that this is not the answer for a completely inflamed knee? It seems that if you're experiencing total knee inflammation, which of course isn't visible from the outside but you can definitely feel it- they (medical community) doesn't necessarily get it. What would Dr. Dye do? He seems to understand. I'm considering making an appointment and heading to San Fran.

Curious to hear if you all have similar feelings about this issue. SuspectDevice, I think you definitely do of course. :)




Offline Brandon123

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Re: PFPS- injury vs. chronic inflammation
« Reply #1 on: July 07, 2018, 02:08:01 PM »
This is a very tricky question indeed. And I remember we have touched upon this whole "inflammation issue" somewhere in an old thread. I recommend reading it if you haven't yet. At least we tried to sort some things out :)

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=67816.0

PT (or any other activity for that matter) sets my right knee on fire, making it all red, stiff, and hot. Still, nobody has found any objective signs or evidence of inflammation or synovitis. Only patella cartilage damage. In my surgery report from 2009, it even says "no signs of synovitis." It seems Dr. Dye's concept of chronic inflammation/synovitis is different from the mainstream orthopedic understanding of the same thing. I think this is important to keep in mind.   
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline BusterCatLegs

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Re: PFPS- injury vs. chronic inflammation
« Reply #2 on: July 09, 2018, 12:21:22 PM »
Thank you for pointing that post out to me. Super interesting and basically what I was looking for.

Even though there are no signs of inflammation on any MRI I am sure by now you know the difference in what is inflammation and what is acute pain in the knee. It is unmistakable and I don't care what any doctor tells me- I CAN FEEL that my knee is inflamed even if it doesn't look inflamed. Inflammation is a very complicated process and there doesn't necessarily need to be a sign of it on an MRI to be true. At least that is what I think! You can't tell me that when you sprain your ankle the next two days you can see the inflammation on an MRI. This is where the bone scan comes in I guess?? But this shows an irregularity in the bone making and eating cells- does this change happen due to inflammatory process or we aren't sure on that?

Time to get ready for my $50 cab ride to my second specialist. I have very low expectations.  :(

Offline Brandon123

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Re: PFPS- injury vs. chronic inflammation
« Reply #3 on: July 09, 2018, 01:14:05 PM »
Yes, inflammation is a very complicated process indeed and there are many different forms of inflammation. I believe this is one reason for all the confusion. If you don't have acute inflammation with visible signs such as swelling, redness etc. it all of a sudden becomes much more difficult, and some OS seem to doubt whether you even have a "real" inflammation. Once, I was told I couldn't have any inflammation because there was no obvious swelling or fluid in the knee!

Still, I have some kind of low-grade chronic inflammation in my bad knee that clearly responds to heat, cold, activity etc., but it is usually not visible on the outside and definitely not on MRI, no inflammatory markers in the blood etc. I'm not sure what the bone scan says in regards to inflammation, maybe somebody else knows? 

Good luck at the specialist, please let us know what he/she said!
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline spiderplant

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Re: PFPS- injury vs. chronic inflammation
« Reply #4 on: July 09, 2018, 04:53:05 PM »
Dr. Dye calls it loss of homeostasis, not inflammation. I don t think they are the same thing, necessarily.
My bone scan showed nothing wrong in the bones. but I do have excess synovial fluid/synovitis, and some neovascularization in my fat pad (related somehow but I forget how).
I cant type much right now because I have strained my hands doing too much quad massage,and generally helping out the knees.   Arggh!!!  no more upper body work for now either.

good thing I like reading as thats all I can do now besides TV.

Offline reader278

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Re: PFPS- injury vs. chronic inflammation
« Reply #5 on: July 11, 2018, 06:10:20 PM »
I too had to give up upper body work but for me it was due to elbow pain. it seems that the pain /inflammation spreads to other areas after awhile, or other areas overcompensate