The patello-femoral joint :

patella dislocation...hiking fatigue? - - Posted by utahhiker (utahhiker), 9 August 2004

hello everyone.

I am new to the board. I found it while searching online.

I am 21 and from utah area. I went hiking in Utah mountains about 3 weeks ago. I didnt have any injuries on the hike and  I had the expected muscle aches after the hike. But I continued to have pain in right knee only when I walked a lot like in a grocery store or a mall.

I had mentioned it to my GP, who didnt think it was serious untill yesterday when he ordered an X-ray of my knee. After showing me the x-ray, he said that my patella had move a little to the right, and hence the the distance from the knee joint was asymmetrical. I was given crutches to use and prescribed about 800mg of ibrufen 3 times a day.

I am kind of getting anxious over all this. I had been active before the x-ray and now all of a sudden I am given crutches. I had to cancel several hiking trips this month. It is really frustrating as summer is the best time to explore the moutains. The biggest gripe was having to miss out on a yellowstone hiking trip.

I start PT tommorrow. I just wanted to know if there are people out there with similar conditions and who can offer me some advice on recovery period.

The scary thing has been that while searching online, it seems that I will not be able to go backpacking or longer hikes.
Posted by Ron22 (Ron22), 9 August 2004

hi utah...oh yeah..i can relate..happened on a business trip to sf last yr..take a look below..pf is just one of my flaws....how is the pain..don't worry about pt..just listen to your body and  let the pt know when you hit the pain wall...be careful..rest..RICE...and distract yourslelf with movies music or reading..take care of your self..sending good thoughts your way..let me know how it goes..

best

ron
Posted by Ron22 (Ron22), 9 August 2004

hi utah..hope you saw my reply last nite...how are you..hope you're havin a good pain free monday

best

ron
Posted by utahhiker (utahhiker), 9 August 2004

hey ron,

Thanks for your reply.  I just got back from the PT. The revised diagnosis was that it is patella femoral synd.
He bent my knee in all directions, and  I didnt have any pain as such. So he did the regular ice, ultrasound, and electric simulation.

So I guess I just have to be patient about the whole thing. I guess I might  have an anxiety problem. I met with another person who had an ACL and I guess he was able to keep calm. He had had plans for summer too.

I might have been selfish in thinking that only my plans were ruined. The positive side of the whole thing is that Yellowstone is not going anywhere. I can still hike it next summer!!

Till then I am just going to drive around canyons, rent movies like Patch Adams and find new ways to have fun indoors.

Thanks for you support Ron.

Lesson of the year for me === Patience is a virtue!!!
Posted by Ron22 (Ron22), 9 August 2004

hey utah...let me know if you have any questions or want to bounce things off me..i have had pfs for yrs along with a list too long and boring to torture you with check out the bottom of the screen if you want ....hang in there..lemme know if i can help in any way...i know the frustration and anxiety you must be feelin bout now..when this all started at 19 and i had to miss a hoops and football season i could hardly bear it...

best

ron
Posted by utahhiker (utahhiker), 25 August 2004

Its been abotu 5 weeks when i supposedly injured my knee during my hike and ended up with diagnosed PFS.

Its getting really frustrating not being able to be active in  social sports like tennis or raquetball. Heck, I havent been able to go on hikes.

As far as the pain, it has subsided. Of course that has been with an addition to 1200mg dose of Ibrufen three times a day.

I am just happy to be able to drive around. I just attended a friend's wedding in Baltimore. It was fun. For some reason, I guess I was able to walk around fine during some sightseeing in Washington DC. We covered most of the Smithsonian Musems at a good pace. I am amazed at myself that I was able to do about  I guess 5 miles of walking with extreme humidity. I was not exactly even taking my prescribed dose of Ibrufen. I did have fatigue in the leg muscle that night but no knee pain.

I am just waiting for this whole PFS to pass so that I can be more active.

At the same time, this condition has made me more aware of other people with worse knee conditions, and just a hope that things will get better.

Posted by mainegal (mainegal), 25 August 2004

I feel your pain.. I haven't been able to do any serious hiking in about two years, due to my right knee. I go in for surgery on Tuesday (Yeah!) and get to spend the following six weeks on crutches. I have every intention of finally hiking Mt Washington next summer.

Don't push the knee too much. As you pointed out, Yellowstone (and all the other good hikes) aren't going anywhere.

One thing I did have to do when I was hiking was change my hiking boot style. I found the least amount of knee pain came when I wore my Merrills with a really stiff and high "top".  I had a brace but I never wore it because it had the most uncomfortable seam across the back of the knee.  

Good luck with the healing. Let me know some good hikes out west - I am from Maine so 90% of my hiking has been in Maine and New Hampshire (White Mountains).

Melissa
Posted by utahhiker (utahhiker), 27 September 2004

Hi all!

This PFS thing is just killing me!!!.

Its been about two months now, and I beleive 6 weeks is the standard recovery period!!
I guess I am an exception to the standard. Also, mostly I have myself to blame. I went like two weeks with out taking the prescribed high doses of Ibrufen (anti-inflamatory). Dont ask why I do that. I just beleive that I am so kind of superman who doesnt need any prescriptions and that I can recover naturally. Also I have my strained my self a bit in early periods of recovery.

I am going to have a final check up this friday. Hopefully I will have good news, although as anxious as I get, I am expecting the worst- surgery!!!. There are also plans of going for a hike in the mountains the coming weekend. The beautiful fall foliage is hard to resist getting out before it gets cold. Hopefully  I will get the green signal from the doc!

best wishes!
Posted by hmaxwell (Heather M.), 27 September 2004

I'm not really sure what your doctor has told you about PFS, but it's not an injury per se.  It wouldn't come on suddenly like you appear to be describing.

PFS is a lifelong condition.  It doesn't go away after 6 weeks--or even six months, although your symptoms may subside.  So it's not like a sprain.  Your best hope is to gradually improve the strength and balance of the muscles in your knee in an attempt to tighten everything up, stabilize the joint, and improve tracking.  You will have to do the exercises for the rest of your life, pretty much.  

Also, there isn't really a surgery to 'fix' your knee.  Attempts can be made to realign the kneecap and improve the knee mechanics, but it's far from a sure thing.  Trust me on this one    I was diagnosed with PFS 20+ years ago and the doctor told me then that this was something I'd struggle with the rest of my life.  He was right.  From that time, I did special exercises, modified my activities (stopped running, stopped swimming breaststroke and individual medley for the swim team, gave up soccer, etc.).  I avoid surger for almost twenty years, and thought I was in pretty bad shape when I finally went in...I would work out and be okay as long as I was careful, but after hiking or being on my feet all day or sitting Indian style too long, I would have pain for the next few days.  I thought (and was told) that surgery would fix everything.  But like many people with PFS, surgery opened a can of worms.  I'm much worse off than I was before my surgery, though of course at that time I thought I was in agony.  I've really learned a lot about knee pain since then.

Anyway, it sounds a bit like you have a hodge-podge of information and some expectations that maybe aren't very reasonable.  I don't know any PT or OS who would promise that PFS would be cured or that the patient would recover in 6 weeks!

Read up on the patella by going to the link across the top of this page called 'general info.'  Step five deals with patellae, so start there.  Another really great source is this one:  http://www.steadman-hawkins.com/pate/overview.asp  Be sure to read through all of the tabs.  Finally, if you already have damaged articular cartilage, this link may be of interest to you:  http://www.steadman-hawkins.com/knee_chondral/overview.asp

Hope this information helps.  It would also be important to know if you actually dislocated your knee as your title states, or if you were experiencing subluxation of the patella instead. Either one can be painful, but a dislocation is usually traumatic...you know when you've done it, certainly, and often ligaments around the kneecap are torn as well.  You'd have a lot more than soreness in the knee if you dislocated.

Have you seen an orthopedic surgeon?  Have you had anything more than x-rays for diagnostic purposes?  Like a hands-on exam by a knee specialist?  GPs aren't the best choice for dealing with knee issues, especially something as complex and nuanced as potentially PFS.  PT's are helpful, but they aren't trained to diagnose and treat knee issues on their own--they usually follow the instructions of a surgeon.  So anyway, your comment that you are 'waiting for the PFS to pass' says to me that you haven't really be well informed about the condition and what your options are.  Try to get in to see an orthopedic surgeon (OS) who specializes in knees.  There are a lot of surgeons listed above in the upper right hand corner of this page in the 'knee surgeons' section.

Heather

PS another great link is www.kneehippain.com Follow the knee pain and patellar links.

Heather
Posted by RGrelsamer (RGrelsamer), 28 September 2004

Sounds like you may have a combination of some underlying kneecap malalignment and overuse from the hike. The kneecap didn't suddenly move, it's been sitting there your whole life. Sounds like PT, anti-inflammatory medication (if you tolerate such medication), and perhaps a knee support with a patella cutout can tide you over.
R Grelsamer, MD
www.KneeHipPain.com

Due to time and legal restrictions Dr. Grelsamer can respond just once to queries on the Bulletin Board. Thank you for your understanding
Posted by utahhiker (utahhiker), 24 January 2005

Its been over six months now. My knee is feeling much better now. As the weather has been pretty crazy outdoors, I have had much of a chance to do hikes, so my knee has got some rest.
At the same time, I have been able to resume some sports actiivity like raquetball. Also I have been trying to stay regular at the gym or play regularly. Lets see, how it goes.
I havent taken Ibrufen for some time now, although I do pop one in even at a slight hint of knee pain.

Also the funny thing is that because I have been resting my left injured knee so much, my right knee pains sometimes randomly!!!

But all in all I am hoping to do some hikes this coming summer, hopefully with good knees.
As long as I keep doing my PT.!!!!

Cheers

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