Overuse problems of the knee :

ITB Problems - - Posted by wimple (wimple), 6 November 2004

Not sure this is the right place but....
Had an accident in March 2003 where I slipped on a toy and did the splits sideways, ended up caught up in the NHS system for far too many months and finally had an athroscopy in July 2004, where the OS removed plica. He was also intending to do a lateral release but changed his mind as the lateral reniculum (sp) wasn't tight. Started PT two weeks after athroscopy and all the exercises were concentrated on strengthing the VMO as it was very very weak. This was going reasonably well, but started having pain lower down on the outside of my knee rather than on the patella femoral joint where it had been pre athroscopy. The PT tried ultrasound, this did nothing at all. She has now started talking about the iliotibial band and says that it is severely irritated, the pain actually gets worse and worse when she stretches it and then massages up towards my hip? She seems to think that this band has become irritated because of a biomechanical problem ( I wear orthotics under both feet as my 'roll mechanism'  does not work thanks to spraining my ankles too many times to count) the orthotics stop my feet rolling and hence my ankles do not sprain any more. She seems to think that my tibia is not lining up properly? Has anybody ever heard of this and do you have any idea what kind of treatment an OS might suggest? Physiotherapy hasn't worked despite them trying everything they know, I remain in a lot of pain, can't kneel, squat, stand for more than a few minutes, walk for more than about 5 minutes (feels like something moves across as I'm walking, hear an almighty crack and then the moving feeling begins again) but keep being told that there can't be anything moving as the OS would have seen it during the athroscopy. I also fell again at the beginning of October, hit the front of my knee, A & E doctor also felt something moving but reckoned there was nothing there that could move!!!! Started blathering about tiny structures in the knee ( in other words he didn't know)
I don't see the OS until December 22nd and feel at my wits end, any insight would be appreciated. The pain is always on the lateral side of my knee towards the bottom, when I sit it is just like having toothache, constantly gnawing at me, when I walk it feels like fire, burns and is very very painful. HELP!!!!!
Posted by Teresa_S (Teresa_S), 10 November 2004

You just described the exact pain that keeps me awake all night. Not only does it hurt,but it feels like I am trying to stretch this gigantic tight , wide band, that is fighting me, and pulling from the top to the bottom of my knee. My thigh is killing me, and my foot, and ankle hurt too. although sometimes the foot actually feels numb, and the tibia and fibula are hurting . THey tell me that alot of the pain in the thigh and groin area are from the hip, not the knee, although my last knee surgery was only about a month ago. I actuallly lost this pain for about the first two weeks after the surgery, but it has returned with a vegenance since my PT has taken off a week. Meds don't help much. Find any ideas, I'd love to hear them. Teresa
Posted by treeskater (treeskater), 20 November 2004

Another possibility could be a partially dislocated head of the fibula.  Because it is outside the knee joint, it is not commonly picked up.  Usually the cause is a fall sideways, like sliding into home plate (baseball.)  The peroneal nerve runs along the outside of the knee (lateral side and can mimic the ilio-tibial band syndrome.)
The pain can be unrelenting.  

I mention this as my first ice skating fall was forward on my right knee taking the most impact and resulted in a torn medial meniscus, along with other injuries to ankle and tendons.  But when the pain persisted, it was the back PT that finally layed me on my side, worked his hands from my toes upward, and found the head of the fibula movable.  He used his hand to push the bone back into place and we both heard a 'pop.'  By then most of the damage was done and even now I have times when I get such a burning pain on the outside and below the knee.  Most people immediately think of a tight IT band, but I think it is because of the dislocation and nerve stretching and probably the head of the bone is still a touch movable.

This is a rare event but there has been some literature done about it.  Just thought you might check into it as another possibility of your distress.  I wish you well!

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