KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: SqshPlr8 on August 30, 2010, 10:08:49 PM

Title: To scooter or not to scooter?
Post by: SqshPlr8 on August 30, 2010, 10:08:49 PM
Hi all!

I have had bilateral knee pain for ~ 4 months.  I stopped playing squash and running in mid-May after twisting my left knee.    Had x-rays, MRI of my left knee (only x-rays of my right), which revealed nothing.  I was diagnosed with fat pad impingement and CP, for which I had a six-week stint at physical therapy and then a three-week protocol of Voltaren (10 days) and simple stretches, both of which didn’t help. I’ve been swimming which, at first, helped a tremendous amount with pain.  Now, though, even swimming – both breaststroke and flutter kick – can be bothersome. 

The most annoying thing, however, is everyday activities.  Walking anymore than 100m aggravates my knees.  I can characterize the pain as a din of discomfort punctuated by specific, spear-like sensations behind and below my patellae. Sitting for long periods of time sucks, too.

I was just tested for rheumatoid arthritis and Lyme disease, which, thankfully, came back negative.   I see the doctor again in two weeks, but my biggest concern at the moment is simply trying to deal with physical reality of everyday life. 

I’ve tried tracking braces and tape, along with orthotics, but they haven’t really helped.  I’ve also tried crutches to no avail. The pain is not debilitating – though it is verging on intolerable—but I seem to be aggravating it by everyday movements.  As an interim measure, I have thought of renting a scooter to get to, from, and around work, at least until the pain comes down and I can see the doctor. (I already take the bus, but it is ~1/4 mile away from me, which already seems to make things worse) 

Few questions: 1) Has anyone here had PFS, CP, fat pad impingement symptoms that affected their everyday movements? If so, what did you do to cope?

2) Is the scooter a good idea? I don’t want my quads to waste away, but I don’t know what I should do.  My PT and doctor said that walking is fine, but the pain just seems to be getting incrementally worse day by day. 

3) Has anyone here with PFS etc. used a scooter/wheelchair for any period of time to let the symptoms die down before going back to rehab?  If so, could you elaborate on the success/failure of your experience.

Thank you so much! ;D

26 y, M
Title: Re: To scooter or not to scooter?
Post by: kscope09 on August 31, 2010, 11:59:22 AM
I'm not sure if scooters or wheelchairs are a good idea.  You will rely on them more and more to the point you will need them all the time.  There are people who are confined to wheelchairs who would love to be able to walk even if it was painful.  Your quads will waste, yours legs will wither away and you will get ostoperosis, you will also loose cartliage becaue your cartliage needs to be weightbearing and to be used.  Not doing things can give you OA as well as doing things painfully.  A scooter is like admitting defeat and it will be a slippery slope.

What can and can't you do?
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on August 31, 2010, 02:05:39 PM
kscope09,

Thanks for your post.  I understand and appreciate your point.  I, too, cringe at the ridiculousness of it.  I work with and volunteer for people who are confined to wheelchairs or are bed-bound, so I am especially sensitive about this issue and feel a bit guilty for even contemplating it.

But I am concerned.

My thought with the scooter was to use it for a few days while continuing a basic exercise regimen for my knees, like using the elliptical which, while painful, is not nearly as bad as walking.  I work in a lab all day, which requires a mix of standing and walking 40 meters down the hallway to retrieve yeast and other molecular biology goodies. I have tried, of course, to limit my trips to and fro in the lab, along with using a swivel chair to propel myself (canoe by land!), but by the end of the day, I am nearly in tears. Week by week, the trajectory of my pain is increasing.  NSAID's don't seem to limit the pain -- or at least whatever pain they do mitigate is negated by my everyday movements. That said, I don't even think a scooter would help all that much since my knees flare up sitting at 90 degrees flexion anyway...

Pain Summary
Deliberate, gentle walking: generally uncomfortable with spikes of pain beneath, below, and around the rim of my kneecap. Increases with every block.  Have to stop after 500m.  Occasionally feel that my knee is "off the tracks" but I can still extend and flex my knee. I rotate my knee and leg a bit, hear/feel a snap and it kind of goes back into place.
Moderate walking: spikes of pain, stop immediately.
Jogging (not on purpose, but, say, to avoid a car in the crosswalk): VERY SPIKY. Reflexively unbearable.
Stairs up (5 flr walk-up): painful around superior pole of kneecaps, not as bad as walking though
Stairs down (""): painful around inferior pole of kneecaps, walk down sideways
Stationary bike at lowest setting: somewhat bearable for first ten minutes, but then painful
Elliptical: not too painful for first 10 min, but then pretty damn painful
Standing for more than 5 min: din of discomfort with spikes of pain every now and then
Floating in water/using a leg buoy: no pain
Flutter kick: painful below the knee after 20 - 30 min.
"Hydroexercises": actually pretty painful
Straight leg raises: not all that painful, but my history at PT seems to suggest that they and other extension maneuvers really flare the area below and around my kneecaps
Squats: spiky pain, bad
Lying down with legs at full extension: painful, which is why I sleep with a few pillows underneath them, which helps a bit.  Though recently I wake up in the morning and feel a general pressure around and underneath the kneecaps.  Once I start walking around, the general pressure is supplanted by spiky pains.

After reading what I just wrote down, it doesn't seem that bad especially in light of the many ailments you guys go through.  Yea, daily life is rather uncomfortable, but I still have ROM and can still walk, which are blessings.  But what concerns me the most is the trajectory of the pain.  I haven't done any strenuous, weight baring activity (i.e. running, squash) in months, while doing PT and non-weight bearing things (e.g. swimming), and yet I am getting worse.   NSAID's don't seem to do anything for me.   Floating in water seems to be my only sanctuary at the moment.  Unfortunately, I am not Kevin Costner and this is not Waterworld.

Kidding aside, while I am worse off after my six-week stint at PT, I still think -- or at least intuit -- that I have a biomechanical issue(s) that has gotten a bit out of control, perhaps exacerbated by an incorrect diagnosis and/or faulty execution of rehab program.  I still want to give PT another crack, but how the heck can I do PT if my knees are this painful to begin with?  Is it Cortisone-ville for me?

Anyway, what do you recommend I do in the interim prior to my next doctor's appt (2 weeks away)?

Title: Re: To scooter or not to scooter?
Post by: Lottiefox on August 31, 2010, 03:00:25 PM
Can I ask what they had you doing in PT? I have PFS/early OA of both kneecaps. One PT last year put me into freefall - swelling, pain at night, you name it. Took weeks to get a semi normal knee back. A new PT this year started at the basics and its helped. Knees are still cranky but they function far better. It isn't a quick fix for PT - 6 weeks isn't long but if its the wrong PT it won't help at all and might make things worse. I've also started a COX-2 NSAID for the OA which appears to be helping but thats my personal choice and not for everyone, but it has calmed down the niggly inflammation sensations.

I don't think the scooter is a terrible idea, IF you only use it very short term, find a decent PT program and both rest yet strengthen the knees (contradictory as that sounds) but remove the inflammatory walking for a few days. You won't get leg atrophy and osteoporosis using a scooter for 10 days or so. A cortisone shot *might* calm things down but personaly I am not keen on them direct into the knee. Having said I had a systemic one for hay fever over the summer and my knes really liked it! Problem is that it doesn't last, might not work for you and isn't a cure. I also ice my knees quite regularly, especially after walking or gym. I haven't done anything impact based for a year now. YAWN!! (apart from walking!)

You also need to look at WHY the PFS is happening. There will be a reason - did your PT check muscle strength, muscle imbalances, patella tracking, etc etc? I know you've tried taping and bracing which didn't help (for me neither) but I did find some orthotics in my trainers helped for gym stuff along with avoiding shoes that didn't support my feet (I pronate quite badly and have tilted kneecaps).

PFS is hideous, don't feel bad about your symptoms. Yes people have more major things going on but we're all here to help and share.

Good luck

Lottie  :)
Title: Re: To scooter or not to scooter?
Post by: kscope09 on August 31, 2010, 03:29:04 PM
A scooter still sounds drastic.  How about using a can or crutches for a week or so just to take some of the strain off, while still using the knees?  I would definatly try that before even thinking about wheelcahirs and scooters.
Title: Re: To scooter or not to scooter?
Post by: weirdknees on August 31, 2010, 04:47:03 PM
Hi

I do agree with KScope, it may be a little drastic.  However, it does depend on how you feel and only you know yourself what helps you.  It is important with PFS to have strong leg muscles, so relying on a scooter is not so good for the long term. 
 
I have also thought about getting a scooter on the odd occasion, but that's more due to a disability that I have than my knee problem.  However, my knees do feel bad when walking, so I do understand where you're coming from and how frustrating it can be.  I don't see myself getting one any time in the near future though. 

Six weeks of phyiscal therapy is not enough for CP as it can be chronic problem that needs constant attention.  Once you keep your muscles strong (not just your leg muscles), you'll find a large difference in your walking.  Your doctor will probably do an MRI to check for any mechanical problems that you might have, unless he has already, and I'm sure he will suggest what is best for you.

I hope you get it sorted soon, any questions, let me know :)





Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on August 31, 2010, 05:48:01 PM
weirdknees and KScope,

Thank you for your input!  I think you both are right.  A scooter is drastic, and if I were to use one it would be for the very short term while maintaining some strength with exercises. 

I just felt like my time at PT was a pickle, a Catch22: I need to do exercises, I do them, but they ultimately increase my pain.  Feel stronger, not better.   I am an empiricist right now, trying different things, as the conventional rehab guidelines have not seemed to help me out -- yet.

Anyways, I am hoping that I am just in desperate need of a rehab program that fits my biomechanical state. 

I'm a patient guy, and will hope for the best! :) 
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on August 31, 2010, 05:52:18 PM
Lottie,

Thanks for your reply.  My PT started me off with bike, leg press, extensions, raises, one legged squats, swivel chair curls, and hamstring stretch.  He also massaged the fat pad and my ITB. He said my kneecaps track to the outside when I walked, but otherwise did not remark on any other biomechanical abnormalities.  During the 4th week I went on vacation and did a lot of swimming (mainly breaststroke, which may explain some of the issues later on), which at the time was fantastic as it really alleviated the pain -- both in and out of the water -- and I could actually push myself without fear of screwing something up.  Swimming seemed to make things better.  Or so I thought.

Went back to physical therapy and things went south very fast.  Straight leg raises and sideway walking with theraband were particularly grating. PT took me off offending exercises, but by that time I could barely bike.

Since my prescription had run out by that point anyway, I went to a sports medicine MD who I saw as an adolescent.  He said I had, in simple English, "pissed the hell out of my knees." He prescribed me 10 days of Voltaren and some simple stretches (quad, ham, ITB).  The Voltaren didn't seem to help much -- or at least whatever positive effects it may have had were negated by my everyday activities (e.g. walking and sitting at work).  My brother's wedding, which was a lovely event, felt awful.

Since testing RA and Lyme's disease (came back negative), I've noticed that one of my quads (rectus femoris?) in both knees was extremely tight.  I did some self-massage and stretches and it seemed to REALLY help.  I did the massage/stretch routine every couple hours, along with some strengthening exercises.  My quasi-bliss only lasted a day, and I went back to square one.  My quad actually feels a lot looser now, but I still get the pain in the knees -- and even a sense of instability in the kneecap itself.  Yet muscularly, I actually feel good.  Good in the sense that I feel strong even loose, but I am (obviously) not strong in a symmetric sense. 

Obviously, I need some balance.  And custom orthotics might help (have only tried OTC recommended by doc).  I have serious instability in my left ankle (along with my shoulders).  In fact, prior to my first OS appt. about my knee, I sprained it walking to work, got it x-rayed, and the doc said that "at least there's no calcification."  Now when I come to think of it, my symptoms in general started to take a dive after the spraining...

Thanks for the encouragement!
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on August 31, 2010, 07:05:29 PM
Hey SqshPlr8,

Welcome to the forum! You posted on Sore knees, no diagnosis thread, but I figure I might as well respond to you on your own thread.

Hopefully you've ready fully through that thread. If you have, you'll have an idea of how truly difficult the road of recovery is going to be. I wish I could offer something more positive, but this is the reality and I would be deceiving you to say otherwise.

As is probably clear to you by now, this is no normal pain. In fact, describing it as downright bizarre is probably not far off the mark. Generally speaking, when you have an ache or pain, it will generally subside on its own over time. Sometimes, pain is simply part of the process of healing. Or, it might be a result of a bio-mechanical abnormality that needs to be corrected. The thing about PFPS is that it is none of the above. True, it is sometimes related to an improper walking gait, which is the result of muscles which may be too tight or weak. If it is, you need to correct this if you want a recovery to full normalcy.

PFPS is really a sui generis condition which has its own unique progression, and path to recovery. Similar conditions are rarely seen in the other joints, and this is related to the uniquely tremendous forces which the knee is subjected to. What is so unique about PFPS is that, for many of the tissues in the knee, once irritated for the first time, they are subject to further irritation. What this means in practice, is that once irritated, the threshold of pain changes. In other words, doing something that was completely tolerable before suddenly falls outside the range of acceptable movement. And there is really no limit to how much this threshold of pain can change. Each time you irritate your knees, you'll be able to do less than your were able to do before without triggering pain.

Reading your post, it sounds like you are in a real danger zone right now. Those "spiky pains" that you describe are likely what highroller and I describe as "sharp pains" on the Sore Knees thread. Every time you are feeling this, the level of function in your knees is going to decrease. I don't want to scare you, but if you don't change what you're doing, you're going to get to the point of complete incapacitation. When it happened to me, I was utterly shocked. I'm only saying this because, hopefully you'll be able to avoid what I've had to go through. You actually sound like you're not far off from reaching this point, so you'd be best advised to change course now.

The good news is that it is possible from the condition to significantly improve. There was once a point when my knee was in an absolutely dreadful state. There was this feeling of pulsating pain, accompanied by horrid inflammation. It was so severe that I couldn't really even stand for any length of time without feeling like something was being crushed inside my knee. The good news is that it has dramatically improved over the last month and a half or so. I've had a few setbacks (which is inevitable if the condition is severe enough), but the general trajectory is on an upward swing right now.

Let me address your question about the scooter, and also relate it to your overall routine. From what you have elucidated about your movements around your workplace, it sounds like you are aggravating your condition. I think you really have two choices here. Either take some time off of work, or use the scooter as you are suggesting. Yes, quad wasting is a threat, and yes, if you go too far in this direction, you will cause yourself further problems. But I have an easy solution to that. You need to integrate some level of activity into your daily routine. If you are currently in the thrall of a severe bout of pain, I think 2 or 3 days of compete rest could be warranted. Otherwise, even if you are using the scooter at work, you need to stand and walk a little at least at some point every day. Even just a little activity will prevent a lot of the quad wasting. Doing straight leg raises will also help. Even just standing helps with calf atrophy.

Now comes the really strange part. It is true that activity is the cause of PFPS. But it is also the cure. If you do nothing, you knee would forever remain in stasis, not likely getting worse, but not improving, either. Think of this as being a Goldilocks condition. Too little, and there is no improvement, too much, and there is further deterioration. Get the level of activity just right, and you're on your way to recovery. I'll tell you though, it is easier said than done.

I'll give you a few helpful pointers. First, if your condition is currently very severe, PT is going to be essentially worthless. If there is nothing you can do at PT without irritating your knee, you are wasting your time. You need to coax it back yourself to a point where it will be receptive to the PT. Based on my personal experience, it is at this point that a good PT is invaluable. I've never irritating my knee doing any of the exercises under the supervision of my PT. The only reason I've had setbacks is that I've been overeager to get back to movement. This is a psychological hurdle that has to be managed, but nevertheless is going to be something that will likely cause you setbacks at some point. Most crucial to understand, though, is that a good PT will be giving you exercises that are appropriate for the current condition of your knee. These exercises might be moderately uncomfortable, but shouldn't be at all painful. As you improve, the PT will also analyse your walking gait to verify that you are correctly walking.

From looking at your Pain Summary, it is clear that there are lots of things you're going to need to change. I would suggest stopping any motion which involves substantial flexion of the knees, like squatting and going up and down stairs. If you have no alternative to stairs, then you're going to need to figure out a way to ascend and descend without irritation. A couple of the ways that I have done this involved sitting down on the steps and pulling myself up and down using only my arms. Eventually, I figured out that I could using a cane and holding the railing and this was sufficient. It might take a bit of experimentation, but this is essential. Perhaps the most important thing is walking. You need to figure out how you can walk without pain. Discomfort is fine, it's not going to feel like a a bed of roses until you fully recover. But pain is simply exacerbating your condition. One of the things I learned is that, when the pain is severe, you really can't walk too slowly. It took me a while to figure out just how slow I needed walk, though. Conjure an image of a turtle, or a 100 year old here. That's what we're talking about. If that is what you need to do, then so be it. If there is anything else that triggers pain, you need to stop that, too. To be clear, all such activities must cease, or you'll never recover.

I hope this will be of some help to you. I noticed that you and I are of the same age. I know how difficult it is to go from being a young, active individual to being essentially incapacitated. But you have to expunge from your mind any notion of a quick recovery. This will only make it psychologically more difficult to do what is necessary for recovery. And make no mistake, you probably will be able to mostly or completely recover from this. But it is 100% dependent on what you do. It won't happen independent of that. You're going to need to make this the central focus of your life. If you do, you'll probably find that your condition is significantly improved within a couple of months, although full recovery might take quite a bit longer.

Good luck to you!
Title: Re: To scooter or not to scooter?
Post by: Snowy on September 01, 2010, 06:32:47 AM
Hey,

So sorry to hear about your knee woes. PFS is a brutal condition, and not fun to manage at all. I've been battling it on and off for the last 15 years; while every experience is different, I can share a couple of tips from my experience that might be helpful.

The first and most important one is that PFS is a symptom, and it won't completely get better until you figure out the underlying cause. It's only since I finally started working with a PT who actually understood this that I've seen real improvements. My current PT identified maltracking patellars as the problem, and got me into some custom orthotics and very specific strengthening exercises. The improvements were dramatic, and I've been able to discard the braces and tape that were previously the only thing that gave me relief.

You also need to make sure, as others have stressed, that your PT isn't overloading you given the stage you're currently at. I spent years working with PTs who sent me off to do massive amounts of strengthening exercises like squats, extensions, etc; I'm sure these were helping the right muscles, but they also resulted in significant increases in pain. My current PT made me stop every activity that caused pain (everything except for cycling and swimming) and had me doing thousands of quad flexes each week for the first month. Then we very gradually introduced strengthening exercises, and my knees were able to tolerate things that had previously caused a lot of pain.

Good luck - I hope you're able to find some strategies that improve things for you without the need for a scooter. That said, I totally understand the urge - there were days I would sit at my desk with both knees aching like rotten teeth and I would have liked nothing better than to avoid walking on them until they settled down. PFS is a complex condition, and I think the key is finding a PT who really understands it and is able to figure out the source of the problem.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on September 01, 2010, 03:17:10 PM
knee always hurts and snowy,

Thanks for the advice!  The "turtle" and "100 year old man" analogy was particularly helpful.  I seem to be able to walk sans "spiky" pains for the most part, even though today I am worse shape than usual.

Also, the psychological obstacle is right-on: last week I was feeling "quite" good (e.g. I could walk gingerly with little sharp pain) and I decided to walk to work (~1 mile), you know, as a treat. Next day, SPLAT!  I have to accept that I am at a hilariously sensitive state at this moment, and that even when I feel "okay" I have to cool it, however hilariously constrained the measures may be.  (Snowy, you are right.  I need to find the right PT who understands the precarious state in which I currently reside.)

That said, as all of you have stressed, I need to maintain some level of strength and activity.  Yesterday, I monitored a couple things quite closely, which were one part disturbing, but the other part (hopefully) illuminating.  While I was doing SLR's I noticed that my VMO was not activating, like, at all. I thought it was, but upon touch, it obviously was not (perhaps it never was activating...).  My lateral/rectus, yes! VMO, no!   In order to activate it, I extended to "complete lockout" and, voila, pain!  I was doing 7 freaking lbs of that at PT! 

This can explain my general discomfort associated with SLR's, not necessarily that they hurt at that moment, but that my condition would deteriorate over the next couple days after doing them, presumably as a result of seriously exacerbating muscular imbalance.  Even though I am frustrated with the PT and myself, I am optimistic that, hey, at least I have identified one serious error.   

Another good thing. Extensions over a foam roller were a lot better: activated VMO well below lockout, little or no pain.

I think I have at least a couple things going on in my knees, which, hilariously enough, contraindicate each other.  Extension maneuvers generally irritate the inferior side of the patella (fat pad?), whereas flexions generally hurt the superior side.  So when I was raising/extending I was either A) not activating the VMO --> imbalance; or B) activating VMO --> irritating the fat pad. And when I was doing, say, one-legged squats, I was probably irritating the superior area/underbelly of my patellae, even if I was activating the VMO.  “Too much/too soon” resulting in an unfortunate Catch-22, perhaps? Does that sound reasonable?

While I hope to schedule an appt. prior to the September 13th date, do you guys recommend any other (relatively) benign maneuvers that may help in the meantime?


Thanks again! ;D

PS knee always hurts: 26 too, eh?  Was there something in the water in 1983/4?
Title: Re: To scooter or not to scooter?
Post by: Lottiefox on September 01, 2010, 06:27:48 PM
Just a quick chiming in - alongside the quad work I have found my most valuable exercises to be glute and hip focused. Lots of glute bridges, both legs, single legs, hold, raise and down many times, progressing to feet on an unstable surface like the foam roller or BOSU......the glutes impact a lot on the knees and mine were seriously shaky. I also got lots of hip abduction and adduction - side lying leg raises, clam shells lying on side with legs bent and heels together lift top knee upwards, keep hips perfectly aligned etc...I also have my knicker elastic one where you tie a resistance band around a table leg, step inside it, and pull to stretch it and then gently flex the knee and straighten against the resistance. Nice extension but completely closed chain exercise. Mini extensions over the foam roller is a good one, you can hold the VMO and feel it fire.

You do need to go right back to the basics as Snowy said. Forget single leg dips and weighted extensions - your kneecap won't tolerate them at the moment. My PT said I might never manage decent single leg dips as I have so much missing cartilage but hey, I am working on it!!

Lottie  :)

PS And foam roll every bit of your legs. Lots!!!  8) :o
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on September 01, 2010, 06:48:01 PM
That's the way it is!  Get an image in your mind's eye of "The Evolution of Man", but place it in reverse. You're no longer a bipedal creature, and you won't be for a while. Sobering, it is true, but c'est la vie for those with PFPS. You've just got to embrace your inner 100 year old. You'll get the hang of it in time!

I think you're splat incident perfect highlights why you're going to need a good PT. With a PT, you'll be able to progress at a controlled rate, with regular measurements of where you currently stand. You're PT will give you the OK when you are able to do more. Just "feeling" when you are ready to progress isn't going to work. To be honest, even though I know I'm being silly, on a number of occasions I've been unable to resist "treating myself" as you put it, and so my experience has largely been two steps forward, one step back (I'm still making progress, fortunately!).

I do think, though, that you shouldn't overemphasize those strengthening exercises, important though they may be. You'll have plenty of time for that when you're further along on the path of recovery. What trips many people up, and this included me at a time, is that they get locked into the predominant paradigm of assuming that their problem is mostly biomechanical in nature. The problem is that, whenever a pain response is involved, we are also talking about a neurological condition. While it may have started as biomechanical, it is now something new. Interestingly, it is possible to have PFPS without having any biomechanical problems at all. (Though I suspect there usually are some.) I know that my original problem in my left knee certainly started as such. And if you would believe me, it was also after spraining my ankle! We seem to have even more in common. But the problem in my right knee started after using crutches for an extended period of time. (This was when merely standing produced a crushing sensation. I now regret using the crutches, but wasn't sure of an alternative at the time.) When using crutches, my weight was unevenly balanced on one leg. Over time, I started to get an uncomfortable sensation in my knee, and eventually, when lifting myself off of the sofa with just the right knee, I started to get this terrible ache. Certainly, this was also biomechanical in nature. But not because of muscle imbalances or fundamental lack of strength, but simply from using crutches! And it still hasn't stopped aching after 2 months. So this can get quite complicated, indeed.

Good biomechanics is a lot more important if you are engaged in the sweeping cadences that characterize normal human walking locomotion, or even more importantly, in running and other sports. On the other hand, if your walking currently resembles the locomotion of a turtle, which it probably ought to if you're serious about recovery, then as long as you're strong enough to comfortably stand, you're probably fine right now. If you're triggering pain trying to strengthen your muscles, then what you're doing is counterproductive. Save it for when you're in better shape.

The knee is perhaps the most complicated joint in the body, with all of its multifarious structures and tissues, most of which are designed to cushion the knee from those extraordinary blows that it will face over the course of a lifetime. It is certainly possible for irritation to occur to more than one location under the kneecap, or to more than one structure in the same location. This simply serves to complicate recovery even further, as it reduces the range of acceptable motion, and makes it difficult to pinpoint precisely what activities are irritating what structure. If you are quite certain that some activities irritate one part of the knee, and a completely different set irritates a different tissue, you might eventually have to focus on just one part first. Then, if you make enough improvement there, move on to the other part. Try to rehab the whole knee first, but if that fails, I wouldn't give up on it.

Post an update if you've found that comfortable balance where you can go through a day without pain. Once you know what you can do and what you can't, it becomes easier, as you generally start to make progress which will increase the range of acceptable activities over time. It is psychologically cathartic when you know that your condition is improving, even if the change is more week over week, rather than daily improvements. You start to think, maybe there is hope after all. There were moments when I honestly thought that I'd never walk again. I still don't know if I'll ever be completely "normal", but I'm pretty sure that in not too much time I'll be able to perform everyday activities without constant anxiety looming over my every move. And that is a very good feeling, indeed!

I think I read in some obscure hydrological journal that there was an excess of deuterium in the water that year. That must be it!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on September 02, 2010, 05:53:04 PM
Hey guys,

My left knee was really bothering me the last couple days.  It wasn't really subluxing, but something was off, as if my kneecap was catching something or getting stuck.  So I saw my sports medicine doctor's referring physician.

It was kind of bizarre, but in a good way. 

The appointment lasted an hour.  I am so accustomed to 35 second appts that I was kind of surprised!  He answered my list of questions (scooter included) and was very curious about my past knee history.  Most importantly, though, he was able to identify that my left knee's medial plica was hilariously inflamed (perhaps accounting for the "catching" sensation), along with the fact that my hip's neuromuscular function was very, very off.  So, "knees always hurts," you were spot on!

He asked about my PT experience and personally offered to set up an appt. with PT's with whom he is familiar. 

He recommended, naturally enough, ice, prescription Aleve, and isometrics for the VMO for the next 4 or 5 days, then start PT up again next week or the week thereafter.  At the end, I asked about the scooter and he was definitely against it.   However, he also said to take it as easy as "humanly reasonable" this weekend. 

I was satisfied with the appt. and impressed that the doctor took serious time going through my history. I hope to find a PT of similar mindset.

Hopefully this Labor Day weekend will bring me back to a level of tolerable discomfort!  ;)

Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on September 02, 2010, 06:41:40 PM
One last question: What is your guys' experience/thoughts with iontophoresis? Dr. prescribed it to PT it for the medial plica.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on September 02, 2010, 11:51:28 PM
I think it's fantastic that you've found a doctor with such a superlative bedside manner! Most doctors that I've dealt with have been either rude, eager to rush me in and out of their office, or both. To actually find a doctor willing to listen to their patient, address specific concerns, and form a specific plan for recovery is amazing. Perhaps if you were going to have surgery, but for PFPS? That's extraordinary. Or at least that has never been my experience.

So now you know what's wrong, and the likely biomechanical culprit. I'm definitely in agreement with the doctor about the hip dysfunction. I think the latest research is corroborating this as well. It's certainly my personal experience. The muscles emanating from the hips are actually the primary drivers of human locomotion. And if they're not balanced properly, what you have is a horizontal rotational torque being exerted on the tissues under the knee cap. Although the knee can tolerate some of this sort of force, the problem is that these forces are really traumatizing the knee with every step. Resolving that is essential for recovery.

Remember though, as I've taken pains to emphasize, that PFPS is a multi-factorial condition. The biomechanical and neurological aspects are intertwined. My primary error was that I thought once I resolved my biomechanical abnormalities, I'd be good to go. Sadly for me, it doesn't work like that. There is no royal road to recovery. You're going to have to slog it out at PT, and it's probably going to take a while. My condition actually progressed to its worse state, after I dealt with my biomechanical issues. But that was when I wasn't under the supervision of a PT, and when I didn't really comprehend the complicated etiology of PFPS. Since you do understand, don't make the same mistakes I did! You sound like you're in good hands, though. Good luck!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on September 03, 2010, 12:29:06 AM
knee always hurts,

Agreed!  And thanks for all your help!

Luckily, my expectations have been so lowered by the last 4 months, I really don't expect anything extraordinary.  In fact, a big part of me thinks that while PT will (hopefully) help me walk (hopefully) free of pain, the idea of returning to squash without mechanically getting some of that junk out of there (e.g. arthroscopy) seems a bit farfetched.   (I guess the trinity of barely being able to walk, feeling that fibrous mass of plica, and the thought of "What-the-hell-else-is-in-there?" has just imprinted itself in my head)

Even then, I don't think it will be "cured."  But, just maybe, "cured enough" -- whatever the criteria of that expectation may be.  And I say this in a completely optimistic vein, devoid of irony.

The plica and hip aren't the entire story.  I'm sure my back is largely responsible for this cascade within cascades of neuro-muscular-endochrinic-lymphatic-socio-political warfare that is PFPS.  Hopefully PT will sort some of this out. But I I think my most reasonable hope is that I'll be able to get the inflammation down to a point in the next week that I'll at least be able to start the sparest of spare PT (scheduled next Friday, thanks Doc!).

Anyway, I will keep you posted.  Thanks for your help!!! Best of luck to you, too!!
 

Title: Re: To scooter or not to scooter?
Post by: knee always hurts on September 03, 2010, 12:40:12 AM
You are truly a man of elevated scholarship and towering intellect! Distillation of PFPS down to its roots in the geopolitical and sociocultural dialectic of hegemonic warfare is indeed a rare gift and spot on might I add. I think you're going to make it after all!
Title: Re: To scooter or not to scooter?
Post by: Kimberly 77 on September 03, 2010, 03:13:14 PM
You know this is a hard one for me. I am a right leg amputee and have been since I was 6 years old. I have never worn a prothesis becuase I am a hip disarticulate and have graphed skin. I have walked with crutches on my one leg for 26 years now. I have never let life go by around me, I have always worked hard to be mobile and do the things I enjoy, but all of that has gotten me where I am now. I have destroyed my knee and like you live in a lot of pain everyday. My family keeps saying well if you wouldn't have walked all those amusement parks or canoed all those rivers, maybe your knee wouldn't be like this now. But hey I have no regrets if I would have been one of those passive people who feels sorry for myself and never let myself enjoy living then I wouldn't be who I am today. I am very proud of all the things I have been able to do in my life. I have always told people I would never let myself sit in a wheelchair because I don't know anyone who ever used one and was able to get back out of it. Once you give in to that it is hard to rehab yourself back to normal. I have now purchased a wheelchair but it never leaves my house I walk everywhere I can to avoid being in the chair permanately. I use it just to do housework or cook. I feel it is important to stay active and remember that pain is mind over matter. However it don't hurt to give your body a rest when it needs it, meaning a scooter would be a good idea as long as you still enjoy other things without using it. Keep up your exercises and don't let your muscle waste but rest when you need too, I wish I had all of these years!!!
Title: Re: To scooter or not to scooter?
Post by: highroller on September 07, 2010, 04:19:19 AM
I was led here by your post in the 'Sore Knees No Diagnosis' thread that I started a while back. I'm a bit late to the party and there's really nothing I can add to the excellent advice already submitted. You seem to be on the right track so for now I'll wish you good luck with your recovery and look forward to hearing about your progress.
Title: Re: To scooter or not to scooter?
Post by: Nettan on September 07, 2010, 08:46:48 AM
To read this story is to read my life when I was between 18 and 23. I had the same problems, the same issues and about the same trying out everything and nothing worked. When you have this condition it's a tough balance between to do enough but not to much.
To use a scooter/wheelchair is just to make this condition worse, that's facts. Maybe use only if you are out for walking for hours.
My solution during these years was crutches simply when needed. But in end it was hard to getting off them.
I had a excellent PT helping me out. A lot of my PT consisted in doing exercises in a pool, but just a few everytime and be sure to rest after.
Like you when all started I worked in a lab, to be honest I had to quit and find another kind of job and living.
I tried out and then later went to school and started working with youth and youth with special needs. Then I had the opportunity to stand, sit and rest when I needed to. I know this with changing job is a tough decision, but I think you should think about that. Because this is not a condition that just walks out from your door and say byebye and never bother you more. Many has this problem more or less continuing.
After all I went through I had a couple of years living pretty good.
Unfortunately I had an accident in 1997 and got severe problems with my left ending up in the painful nervcondition CRPS/RSD and I also have a spinaldamage. Therefor I am in wheelchair 24/7.
But I just needed to share some words with you cause there is hope BUT maybe you need to look on your whole lifesituation to get more improvement. I wish you though the best.
Don't hesitate in contact me if you ever need any feed back.
All best /Nettan
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 05, 2010, 01:10:27 AM
Hi guys,

It's been, what, over a month since I last wrote?  I would have written sooner, but, alas, I developed a pretty nasty case of wrist tendonitis, presumably a result of heaving myself up and down five flights of stairs.  :D  Though they seemed to have calmed down quite a bit, hence my typing.

Anyway, after a one week stint of bed rest at a hotel and a month of PT, how do I feel? 

Overall, I have to admit that I feel a bit better, but more than anything, I feel different.  I am not really getting sharp pains, but I have a duller, more intense pressure behind my kneecaps. I attribute that partly to my altered lifestyle, what with barely walking at or outside of work, along with keeping my legs propped up most of the time.  And boy, does this condition fluctuate!  It's useless to go through all the peaks ascended and valleys dropped into, but like many of you, it's the delayed pain that gets me.

Last week, for example, I had my *best* PT session: no obvious discomfort with more resistance/weight, felt good.  Perhaps it was the 10 minutes on the bike at a slightly higher resistance or increased weight on some hip exercises or standing at a lecture or the weather or the Spanish Inquisition...but I could barely walk the next day and the day after. 

Anyway, I seem to have recovered from that episode, and I have PT tomorrow and a follow-up with the doc on Wednesday, so we'll see how that goes.  I do wonder at times whether my condition has improved as a result of -- or in spite of -- PT. So, I think I might take off a few weeks or a month before going back at it. 

I've been looking at the "Beating Chronic Knee Pain" thread and decided to try some stuff out.  Since my knees seem to be too taxed by walking in intervals (or, more likely, they are too taxed getting up and down from my bench) I decided to try out some more conservative measures. 

Though the results are extremely preliminary, gently moving a swivel chair underneath my bench with my feet for ~15 minutes/5x a day seems to be a lot more helpful than simply propping my feet up.  And at the gym, I lie on my back, place my foot on a medicine ball, and extend my leg back and forth, which feels really nice; it seems to reduce that general, gnawing pressure under my kneecaps quite a bit.  Though watch out: you might notice your hip flexor tightens up after a few minutes.  At least mine did.  In this case, I sit up and hold my thigh while doing the "rolling extensions."  You are, effectively, your own passive - okay, assistive - motion machine! Either way, it's the first thing I've done in a while that 1) didn't hurt, 2) actually felt therapeutic, and 3) no signs of delayed ache (not yet, at least). 

Thanks for all your support!  I hope to reply more often!

Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 05, 2010, 04:56:28 PM
Welcome back to the den of despair! It seems that we will be commiserating over our shared conditions again. I am fortunate that my bizarre case of inflammatory arthritis has subsided, but I'm still left with a pair of knees that aren't of much use. It's that same dull ache that you're describing.

I've been trying those intervals as well, and it's much the same story. The walking doesn't bother me much, but then that diffuse pressure and aching returns with a vengeance later in the day, or perhaps the next. So I'm quickly coming to the conclusion that I'm going to have to try something else. I think the basic approach makes sense, but the specific regimen that rbcyclist implemented is simply too overtaxing for my knees at this time. Maybe you could describe that swivel chair dance with a little more detail? It sounds interesting. I haven't got my groove on in a while!

My own PT sessions ended a couple of weeks ago. After the inflammatory condition cleared up, I concluded that the sessions weren't helping much, or truthfully, were actually making things worse, as far as the aching is concerned. So I'm on my own again, with only fellow travelers on kneeguru for comfort.

I hope you'll stick around for a bit this time and tell me how to get rid of this rotten condition! I've tried it all:

Philosophy: It turns out that this helps you manage the pain, but doesn't' actually get rid of it.
Geopolitics: We both recognize this as a factor in the condition, but it turns out that the world hasn't actually changed much in the last few thousand years. This is a dead end.
PT: It might have helped with the other condition I had, but it may have just been "in spite of it", as you say. Either way, it wasn't helping any longer.
Rest: It may be that I'm resting improperly, or not enough, but this works to reduce swelling, but it seems that just as soon as I'm moving again, my knees let me know of their displeasure!
Perambulatory therapy: I like the principles behind this, but it's just too much for my knees. I need to rest and rehab them enough to build up this the point where this would be efficacious.

If doing a knee jig on a swivel chair would help, I'm all in! Definitely report back if you've made any progress with this!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 06, 2010, 09:48:32 PM
hey knee always hurts,

For the swivel chair dance, I sit in a chair  (a swivel chair, no less) and kind of tether my feet under the spokes of another swivel chair and push (extend) and pull (flex) with my feet.  Does that make sense?  At home, I do a similar thing with a foam roller.  Just get anything that rolls. Flex and extend in a comfortable range.  Again, though, I personally need to watch out for my hip flexors as they seem to tighten up after a few minutes.  In that case, I semi-assistively pull and push my thigh with my arms, recreating the same motion but deemphasizing the muscle output. It's still in its beta stages for me, but seems to help. 

So I just saw the sports medicine doctor, and told him basically what I put here: I feel better than a month ago, but still have difficulty with everyday things.  That band of tissue, presumably the plica, is still riding in on the medial rim of my left kneecap and femur, causing more irritation and so on.  Apparently the plica is the size of the diameter of a pencil and appears to be my main source of pain.  My right knee is dodgy, but is better than my left, and the plica is not inflamed. 

The doctor asked if I could tolerate the exercises, to which I gave a "yes and no" answer: Yes, in that I felt no immediate discomfort. But no, in that sometimes I would ache a few days thereafter.  Of course, my everyday activities, which I've tried to mitigate as much as possible (e.g. transportation to/from work, crutch up five flights of stairs, legs elevated, walk no more .25 mile in a stretch, etc.), may have exacerbated things.

Anyway, the doctor said that I could have made things a lot easier if I came in and said A) I feel great or B) I can't tolerate the exercises.  If A, then continue PT for another month.  If B, try one, and only one, cortisone shot.  Since I am neither A nor B, but somewhere in the middle, he suggested that I give PT a try for another 2 - 3 weeks, and if I can't flutter kick without pain in the next few weeks, get a cortisone shot. 

I asked whether taking a few weeks off work and/or PT was a reasonable idea, just doing light, somewhat passive exercises.  He said he would not encourage it for my case given that he wasn't too sure that would help.  (And given my one week living in a hotel and chomping on anti-inflammatories, I wonder that, too. Darn plica seems really stubborn.)  He said he wouldn't leap into arthroscopy either considering most (~90%) plica cases in his experience seem to resolve without surgery.

After I royally failed my first stint of PT, I was against getting a cortisone shot (though no one offered it to me at that point). Depending on how the next few weeks go, however, I am considering it for my left knee.  I think the second round of PT/lifestyle changes has helped in some ways: it has generally taken away the "vaguer" symptoms I had beforehand, and has left me with this annoying, sore band of tissue that is pinching its way between my kneecap and femur.  Frankly, I am concerned about the damage/irritation that this thing will do/is doing to the surrounding structures.  As such, it seems imperative to slim this thing down to stop the vicious  feedback loop of irritation, inflammation, more irritation, more inflammation...genuine damage.  The fact that my condition "feels" more clean-cut (at least in comparison to where I was at beforehand) encourages me a bit more that, hey, maybe this intervention could be right-on. (At the same time, a part of me is asking is it only the plica/synovium? Perhaps a new image would confirm the status of my cartilage (last MRI done in June)?  Maybe that would put my mind at partial ease.)

I don't know.  If I am still in bad shape in a few weeks, I might take a 3 week "Saveyourself.ca vacation" of discomfort-free rest and see how that goes. Or perhaps take a vacation now.  Or maybe they should just scope it out now.  After all, if the tissue is really fibrous to begin with, could cortisone -- or time -- really shave that away? 

Geez, I should really make brevity a more common practice. What do you guys think: For my age (26), is one cortisone shot worth the risk?




 



 

Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 06, 2010, 09:59:37 PM
*Obviously, my treatment would not stop with the shot.  Hopefully the shot would calm things down enough so that I could continue and progress in PT.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 06, 2010, 11:40:29 PM
It's been said that brevity is the soul of wit, and such may be true, but how many things of true importance are said in few words? Better to err on the side of too many words than too few, if you want to get the best advice. So long as you don't exhaust the reader, anyway.

There is a risk inherent in a cortisone shot, but according to this site, it helps about half of people with plica syndrome:

http://www.niams.nih.gov/Health_Info/Knee_Problems/default.asp

In the specific case of plica syndrome, it seems like a cortisone shot may have a chance. If it reduces the size of the plica, it may give it some breathing room to calm down and break the vicious circle. But that assumes that the main problem is the expanded size. Since it does seem like your plica has expanded into a pathological structure, it would seem a decent bet that there would be some benefit. But as you note, if your activities were enough to irritate one structure in the knee, the pain may not only be limited to the plica.

I'm usually skeptical of the benefit of a lot of procedures that are used to treat knee pain, as it seems like doctors are simply exhausting every option so that they can at least "try something". But this seems a surer bet than most, without that much risk if you're only going to have one shot. But if you're able, it might make sense to try conservative treatment a bit longer before you try the steroids.

It seems that you are having the same issues with PT that I was. I was able to do the the exercises without tremendous pain or discomfort, but often times my knees seemed worse for days afterwards, especially after we started doing squats. For whatever reason, in some cases the knees will not give an immediate reaction to activities, but still respond with swelling or inflammation later, which will prevent you from ever recovering. That's why I'm looking for exercises that are lighter than walking, which still seems to give me trouble. I think that an exercise bike would probably be ideal, because of the greater range of motion and extremely low impact nature of the exercise. But not having access to that, I'll have to give some other things a try.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 07, 2010, 02:11:21 PM
Thanks for the link and the advice.  I’m going to wait a few more weeks, see how PT/rest goes, and hope for the best.  I relooked at the Saveyourself tutorial—and might I say I really appreciate Ingraham’s skepticism and bluntness—which has made me reevaluate whether I have “truly, truly” rested.  It’s something I need to mull over, but before I do anything invasive—like surgery, less so for the shot—I would at least like to have the peace of mind that, hey, I “truly, truly” tried my best, however inconvenient that may be.     

I hear ya about walking being a bit too taxing, though.  Yea, sure, I can walk--not all that far without some discomfort setting in, but I can walk.  And it's not so much the pain itself that gets to me (though that is no pleasure) it's the idea that with each step I am just irritating something, thus making the quest for recovery longer.  Hopefully the swivel chair thing or self-made passive motion machine will help you out.  Or maybe a cheap ($50), tiny, modified exercise bike could do the trick?: http://www.footsmart.com/P-InStride-Cycle-XL-30729.aspx?mr:trackingCode=F334A30B-75B0-DF11-92F8-0019B9C04BE4&mr:referralID=NA&srccode=WBGOOGLE&cm_mmc=perf-_-k232270-_-Google%20Product%20Listing%20Ads-_-Primary
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 08, 2010, 12:40:37 AM
Whoa, talk about thanking somebody for a link! I'll have to at least consider that thing. I've never seen anything like it! I wonder if it would work though? But $50 is not much to spend for something that could help me get my life back. I'm just thinking out loud now. Are you considering getting one of those? I can just imagine myself lying on the bed for a few days, stumbling to the toilet a few times a day, but otherwise just using that thing. It might do the trick. Pardon me for thinking out loud. Cycling is gentle on the joints. A lot more so than walking. And with a greater range of motion. What do you think? Enough thinking out loud. I'll at least consider it though. I've got to consider all options. It's amazing the stuff you can find networking with other people. Thanks again!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 10, 2010, 03:34:50 AM
Was thinking the same thing.  I figure it wouldn't hurt.  I hobbled to the gym today and sat on the recumbent bike and did intervals of 4 mins on, 2 mins off/ x 5 at the lowest resistance (machine barely turned on, but when it did it was ~ 45rpm).  It was okay, though the lateral rim of my better knee got sore, so I stopped. 

A few hours later, though, I feel like my joints are better "oiled."  Also, the sensation that pulsating water balloons are pushing against my kneecaps is substantially less.  I think this image does justice for what's going on: literally pumping out stagnant, accumulated fluid in the joint (taken from a website on the research of continuous passive motion, post-surgery):http://www.rehab.research.va.gov/jour/00/37/2/images/odri-f02.gif

This is another website on CPM research and its founder (take a look at the premises for research):
http://www.continuouspassivemotion.org/


Lastly, if the tiny cycle doesn't work out, here are some relatively cheap bikes (upright and recumbent $170 and below)
http://www.modells.com/search/index.jsp?kwCatId=&kw=recumbent%20bikes&origkw=recumbent%20bikes&sr=1&s=A-StorePrice-MOD

Anyway, we'll see how I feel in the next 24 to 48 hrs...

Let me know how the exercises work out!
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 10, 2010, 08:49:57 PM
I've decided to get that little bike you suggested, as it's about the cheapest option to get my knees moving. If it doesn't work, it's only a small loss.

My knees almost always felt better after using the bike at PT than when I first walked in. Call it lubricated, or well oiled, or slick, but that was the feeling in the joints. Whether or not it produces a delayed reaction, though, is of most concern to me, but only experimentation will tell. I think you really do need to have something at home. Just going once a day to the gym isn't going to be enough motion, and will likely incline you towards overdoing it, so as to get in your whole day's worth in the one session. You need to do several gentle sessions interspersed at regular intervals throughout the day.

I think that feeling of lubrication is pretty close to what is actually happening. Many of the tissues in the knee, especially the cartilage, need that motion to flourish or even to survive. The tissues are becoming stiff and brittle, but the motion is allowing nutrients into the tissues and allowing them to restore to health. I think this applies to soft tissues other than just cartilage. The really bad knee condition I had during the summer would calm down when I was using crutches, but as soon as I would stop using them, the inflammation quickly came back, full blast. And it was about as bad as it gets. But, by slowly reintroducing activities to the tissue, I was able to coax it back to health. Perhaps it is as you write, that the stagnant fluids were draining out. All I know is that something was getting severely impinged in there, and that now it is mostly or completely better. It is hard to tell as I now have other problems with that knee. But perhaps that same principle would apply to your inflamed plica. Let's hope, I suppose.

I think the only thing we have to go by is the rather amorphous feelings in our knees. If it feels better, it probably is doing something good. I have only one question: If you've got water balloons in your knees, why would you want to get rid of them? It sounds like the most fun somebody is going to have with knee pain!  :P
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 10, 2010, 09:05:51 PM
Well, this is a little embarrassing. My goodness, I am cheap. Well, anyway, I was about to purchase the bike you mentioned. I had found it cheaper on Amazon.com, but then noticed another bike that was even cheaper! So I went for that one. Here:

http://www.amazon.com/Drive-Medical-Exerciser-Attractive-Silver/dp/B002VWK09Q/ref=sr_1_1?s=hpc&ie=UTF8&qid=1286740793&sr=1-1

I'm hoping this will do what I need it to do. As long as it does that, I'm golden. And I got nice, hardcover history book with the savings from getting the El Cheapo model (as if the other one wasn't).
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 11, 2010, 05:18:34 AM
Thanks for the super El Cheapo link!  I should be ordering one (maybe two: one for home, one for the lab) soon!

I've been doing the foam-roller jig in the apartment during the day, but go to the gym to preserve some sanity.  But I think the pedal-exerciser will do a better job.  If that doesn't work, I am in the process of making a crude passive motion machine.  Think duct tape plus remote control cars. 

This patellofemoral conundrum is an interesting one: How does a Schrodinger world respond to Newtonian insults? And what if Schrodinger is really, really, really pissy? Although I find "translational research" an overused, bloated term, I think that if there ever was a field that desperately needed a "bench to bedside" approach it would have to be the one in which the knee resides.  Perhaps a career in mechanobiology is in the works! 


Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 11, 2010, 06:15:32 PM
I think the quantum world view would respond to Newtonian derision in much the same fashion as humans have always dealt with their ideological opponents. Perhaps with a "My God is bigger and better than your God." Or the more grade schoolish: "My Dad is bigger and smarter than your Dad." The adherent of the quantum view would suggest to Newtonian physicist that he wouldn't exist without the quantum God. After all, were it not for the random perturbations of fundamental particles in the early universe, the universe might have perfectly evenly expanded into an ever cooling uniformity, lacking all differentiation. The nearly even cooling of the Cosmic Microwave Backround Radiation certainly establishes the Big Bang model of cosmology, but those minor differences confirm that the layout of the universe as we know it derives from those earliest nanoseconds. And of course this led to stars, which led to planets, which led to life, and then finally humans, with their attendant nervous systems and knees, placing me and you in a whole lot of pain.

But perhaps not so much as if we irritated Mr. Schrödinger, which my imagination tells me would have the result of us being placed in a steel encasement connected to a Geiger counter. I don't know about you, but I don't want to think about what he'd see when he decided to "observe" us.

I'm in full agreement with the translational research comment. There is quite a good deal of high quality research that is being conducted on a regular basis by the medical community, but good luck seeing that translate into better care for the patient. I've written about that on the "My Success Story..." thread. Unfortunately for the patient, there is a lot more money to be made by surgeons and physical therapists by doing surgery and physical therapy and keeping the patient in the dark than by giving the patient information that might actually be relevant to their condition. Nothing more threatens the establishment than a disturbance in the inegalitarian relationship between professional and patient, which this access to information results in. Think of the midichlorians of a Dark Lord of the Sith responding to the presence of a Jedi, and you've got the idea.

You've got to be kidding me! You are making a passive motion machine? I'm trying to envision those remote control cars in my mind, but coming up blank. I guess I'm not so creative. Maybe they are going in a circular motion on a track which extends and flexes the knees? What do you do with the duct tape? You'll have to tell me how it goes.

You know, I think we have the makings on this forum of a revolutionary new approach to knee rehab! We could start a new biotech company. What do you think?

knee always hurts - CEO (Now calm down, I thought of the idea so I get to be CEO) and evil mastermind
SqshPlr8 - CTO and resident engineering guru (We'll get that motion machine onto the market)
rbcyclist - CFO (Duh, he is a financial journalist) and lead therapist
highroller - CCO (Chief Crocodile Officer) After all, and as well all know, every Australian is an expert in crocodile training. And what do you do with a whiny patient who doesn't respond to treatment? He can be honorary poet laureate as well if he likes.

Darn! I've got to remember, "Brevity is the soul of wit." Well I better stop typing now. Keep me updated on your condition and how the El Cheapo thingie goes for you.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 14, 2010, 02:22:17 AM
Let's cash-in infomercial-style!  We need to convince the audience that they desperately need to purchase a crude, cheap passive motion machine ("Just, only 13 12 simple, easy payments of $59.95!") that can only be ordered off the TV between the hours of 2:30 - 4:30 AM!  We just gotta get a catchy name -- like Sham-Wow, but, like, for knees. Knees-Now? Knee-No-Ow! [Something followed by an exclamation point]!  Let's get this thing cooking!

(I have seen a passive motion machine for the back on TV at 4am [http://www.hammacher.com/Product/79124?source=FROOGLE], so maybe we should be taking this more seriously!)
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 14, 2010, 10:33:23 PM
Knee-No-Ow? I suppose if you're marketing to cavemen. Although it worked for Geico. You might be on to something here.

While what I had in mind for the business was something a bit more durable, the shady world of late night infomercials might be the best route for a duct tape and remote car passive motion amalgamation machine. Given the unfortunate passing of Billy Mays, will Anthony Sullivan do? He'll be given an unkempt beard and caveman drag. I think the contrast with the accent and voice will be a real winner.

At least all financial worries will be over. Hey, if people can make a living with El Cheapo bike floor thingies, you just never know. By the way, the ECBFT will be delivered on Tuesday. Maybe this will finally be something I can tolerate? Only time will tell.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 15, 2010, 08:05:53 PM
Yea, I figure sleaze sells.  Sullivan is a great choice. His accent will undoubtedly add a certain credibility (or incredibility!) to the product.

Kidding aside, I hope the bike helps you out -- I think mine comes next week or the week thereafter. Let's see how it goes.

Best of luck.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 16, 2010, 09:51:07 PM
Let not hilarity be set aside just yet. ECBFT arrives! Yep, three days early. The look of surprise on my face when the Post Man was coming up with that package. I knew what it was right away. Assembly was quick and painless. A few thoughts on the thingie (I could call it a widget, but thingie somehow seems more fitting.) itself:

It is cheap. You're getting your money's worth, though. Expect to have to place it against a wall or object, or otherwise immobilize it, because it's not going to stay put otherwise. And it does wobble a bit in operation. But it does what it needs to, and takes my knees from full extension through 90 degrees of flexion. Not bad.

Only time will tell if it will work. My left knee, the one with the probable chondromalacia, seems to tolerate it pretty well. But the right knee, which is likely irritated before I even jump on, or whatever it is you do with this thingie, is another matter. Through experimentation, I've discovered just how low a level of tolerance my knee really has. I think I've already exceeded my envelope of function hobbling to the bathroom in the morning. This is going to be a literal nightmare figuring out a range of acceptable motion, if it's possible at all. But I'm committed to trying everything before giving up. If all fails in the end, it's back to the doctor's with me. But that's a while away yet. For now, ECBFT is my new best friend.  8)
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 20, 2010, 09:58:49 PM
Just got the ECBFT today.  We'll see how it goes!

Has the ECBFT helped you out -- or at least not hurt you -- at all?   

In the meantime, I've gone to the pool. With a pool buoy between my legs, I alternate between no kicks and very gentle kicks (from ~ 120 - 170 degrees of flexion), and have yet to experience "catching" or pain in general, sensations that I would get occasionally on the bike.  I like this swimming thing because I can easily adjust my range motion and gravity is no longer a factor.   Even better, for the first time in a month I've woken up without that nauseating feeling of silicone implants pressing on the backs of my kneecaps! We'll see how long this lasts...

During the summer I was swimming, which seemed to make things much better -- than much worse.  Of course, I was swimming as a cross-training regimen, and therefore was really trying to exert myself.  After all, my knees weren't THAT bad... Now, I barely get my heart rate above 90 bpm for 1 hr (4 min on/2 min floating).  When not in the pool, I'm keeping at it with the foam roller jig, but swimming seems to be a big relief. 

I know a Waterworld existence is not ideal, but maybe try out the pool?   
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 20, 2010, 11:21:44 PM
Everybody ought to have an ECBFT. For that price, it would be worth it as a decorative piece alone!  :P

Now, as to whether it's done a pair of knees any good. Well, I can't say I've responded negatively to it. But since the most limited amount of walking imaginable seems to irritate my knees (or at least the right one), by the time I even get to using the ECBFT, it's already beyond hope. Or at least it seems to be that way. I felt like I had managed the pain fairly well over the last few days, although I can't say that I sensed any improvement. Then, this morning, I actually felt pretty good upon waking up. Even so, I didn't do anything differently than normal. All of the sudden this vicious, lancinating pain shot through my knee. As if that wasn't bad enough, the pains kept shooting sporadically for several hours after I sat down. It's calmed down now, but any chance that I was making progress has certainly evaporated at this point. What's remarkable is just how little I did. I really can't do any less within practical limits.

I am thinking of trying taping, although reviewing your previous posts, I can see that you won't be able to offer any encouragement there. I suppose it's worth trying everything, as every case is different.

It's funny (OK, none of this is actually funny) how I could've written your first post. Everything from the

"The most annoying thing, however, is everyday activities.  Walking anymore than 100m aggravates my knees.  I can characterize the pain as a din of discomfort punctuated by specific, spear-like sensations behind and below my patellae. Sitting for long periods of time sucks, too."

to the bit about rheumatoid arthritis and Lyme disease (I actually requested these myself!)

all the way to the 26 y, M.

My pain tends more towards the lateral side of the knees, though. I think you have it more medially? But it's the same darn thing, isn't it? Why does the patellofemoral joint get itself into these predicaments? Darned gravity. I'll confess that I'm starting to become a bit batty. I barely even leave the house anymore. When is this going to end? Nobody can give me an answer. I wonder if there are people out there who eventually realize that they'll never recover, and just decide to go about their lives anyway. I guess the pain is generally not debilitating. But it is a miserable experience to walk. I know this is a bit off in the distance, but if you don't make progress with conservative measures, and lets just say that removing that inflamed plica doesn't work, what is the next option? Is a PFJR something to consider, or should one just live with the pain? I think psychologically, it might be a relief to stop continuously thinking about rehabbing my knees, but on the other hand, I don't think I'd find much pleasure in doing what I used to enjoy. I'm not ready to give up just yet, but how much longer can this be maintained?

If I had access to a swimming pool, that would be a different matter. You and highroller. Jeez. He has a little jacuzzi thing to kick around in, and you've got a pool. Luxury for PFPS sufferers. Where is the pool, anyway? Even if I could get access to one, I'm not sure how much it would help as just walking to it would probably spell the end of my knee health for the day.

On second thought, my knees don't feel much like yours. Silicone implants? I don't even want to know.  :o

I'll probably end up getting that tape, but I can't say that I have much reason to believe that it's going to help. After that, I'll probably be making another appointment to the doctor. There may be something there that will turn up on a scan and they'll be able to treat it. But with anterior knee pain, the story is seldom that simple. We'll see. I hope that swimming regimen works for you.  :)
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 21, 2010, 02:46:38 AM
May I recommend nihilism?

I'll share.

A few weeks ago I was absolutely miserable.  I couldn't find any comfortable position.  The knees were constantly angry regardless of what I did or did not do.  On top of that, my wrists were so sore (because of the stairs) I couldn't type or write.  Dejected, I just said, "Screw it," and walked to the museum, which is about .5 miles away, in my pajamas.  I didn't care anymore.  I had spent an obscene sum living in a hotel, withdrew from my friends and family, and what did I have to show for it?  Two angry knees, two angry wrists, and just friggin' angry in general.

At first, my walk to the museum was, as expected, awful.   The pain was not debilitating, but it was, as you say, miserable.  My knees were full of fireworks and it was July 4th.  I think I muttered some lines from the 1976 movie Network, but with a patella slant.  I also imagined myself as Walter from Big Lebowski when he confronts the German Nihilists, expect instead of being German, my enemies were material representations of PFPS.   

Incidentally, I came upon a German-American Day parade, which made me giggle, as the mere sight of lederhosen makes me giggle.  I somehow forgot about my knees, continued walking, and made it into the museum.  I sat in the atrium making a lame attempt to write down things I needed to take care of: moving out of my apartment, leaving my job, reconsidering career options etc.  Unfortunately, my right hand was shot, so I switched to my left hand.  That hand was shot, so I double-fisted the pencil and block-lettered my To-Do list.  Guilty of my self-pity, I then block-lettered what I was thankful for.

I laugh at the image of such a thing: some dude in flannels and a Spongebob Squarepants shirt, samurai-swording a pencil in front of a Picasso. Haha, Jesus...

Anyway, after finishing this exercise of illegibility, I got up from the bench fully expecting -- and fully willing to accept -- another glorious flare.  But it wasn't that bad.  Of course, the balloons/implants were still there, but it wasn't that bad.  The rest of the day I walked 20 steps, sat for 10 minutes, went to the next work, sat, and so on...Rbcyclist's method meets the Renaissance!

Why do I mention this?  For one, I realized that while it is ridiculous that at age 26 I am miserable walking, I can still walk and therefore should just give it a go but in somewhat measured (or not fully nihilistic) fashion. Although we all have questioned the doctor's diagnosis or the radiologist's interpretation of the MRI or the PT's stressing of biomechanics, there wasn't anything SO obviously or structurally wrong with me that I risked genuine damage to my joints by walking a bit more.  At least that was my interpretation, however antithetical.  I just figured: "Let's give it shot.  What's the worst that could happen?  Another nasty flare? Bring it on."

Basically, I seemed to have -- or perhaps partly perceived to have -- pissed the hell out of my knees earlier in the day, and yet I was (relatively) fine by the end of it.  Why? Maybe it was the pajama-clad-catharsis?  Perhaps, but I think it was more just about moving around and -- although this runs contra to what we all have discussed here, both in terms of experience and theory -- distracted myself enough to get past my obsession with the initial pangs of pain which may have been the result of simply not doing much. In this case, the benefit of movement outweighed the cost of irritating them, I guess. (Of course, your experience seems to suggest that one inflammatory episode screws you for the day.  That was my experience, too.  But then this happened.)  In my experience, I was at my worst when I did the least. 

That said, do I do this everyday? God no.  At least not the walking part.  The pajama-clad-catharsis, of course.  Walking isn't ideal, that's why I jig and swim.

I'll give another example:  Yesterday, I had a long meeting at work.  Knees were getting restless -- angry, as it were.  Usually, I would just go home and ice.  Instead, I took a cab to the pool at the gym I go to, and it seemed to calm them down, more so than ice or an NSAID.  Much to my delight, I woke up this morning without that Jello-balloon-implant feeling.  Obviously this is not scientific, but it suggests to me that this pool thing can actually be therapeutic and perhaps even prevent a full blown inflammatory episode. 

In short, I was in CONSTANT state of irritation for a month, and moving seemed to get me out of it, even though it initially caused discomfort.  Further, the swim thing seemed to prevent or at least mitigate an otherwise inevitable inflammatory episode.  I seemed to have overcome my coefficient of static friction and am now going all kinetic, I hope.

Screw brevity.  I am mad as hell and I'm not going to take it anymore!!  Without a hostage, there is no ransom. That's what ransom is. Those are the friggin' rules, er, PFPS!

Nothing is fudged here, dude. We got this.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 22, 2010, 06:07:24 PM
Thanks for that. A very human story. I probably shouldn't be whining on here. Everyone is in pain or they wouldn't be here. But it was quite depressing to be having those sharp pains for no apparent reason.

I think I've always tended towards the nihilistic, anyway. My rational mind looks at the universe and sees a certain, unbending determinism, like it knew where it was going from the beginning of time. But as a being, sometimes the seeming sheer randomness, and senselessness, and absurdity of it all gets to you. When everything is going alright, you can ignore that nagging feeling that it might all be pointless by distracting yourself with trifling pleasures. But with this constant reminder, it is all too overwhelming sometimes.

I remember the first time that I felt like I was entombed in my body. My hearing had been damaged, and as I result, I experienced a constant ring in my ear. It wasn't stopping, so I did a bit of research. I started reading that it might never go away. After a couple of weeks, I realized that this was probably true for me. The thoughts crossed my mind. I'll never experience silence again. Just the pure, unadulterated joy of silence. I can't escape this ring. For several months, it drove me crazy. But finally, acceptance. It's still there, and there is still no silence almost 4 years on now. But it doesn't really bother me much at all.

But as annoying as a constant ring can be, it's not really the same thing as pain. It doesn't really affect any other aspect of my life. This seemingly changes everything. The fact is, I guess, that I am still capable of doing quite a lot, as long as it is walking on a flat surface. It's interesting that I can barely walk a few steps without triggering an ache in my knee, yet I could probably walk 1000 times that without it getting that much worse. The anxiety comes from the fact that it is a seemingly inescapable situation. I've been buried alive, and nobody can hear me pounding on the lid of the casket.

I've avoided thinking much about it, but I do recall in the saveyourself.ca e-book that it was noted that some people never recover. There is no chance of recovery, because any amount of load starts that pain response cycle again. Even if you irritate your knee quite quite a bit, it seems like it will calm down again in time. But never enough so that you can really recover. That's not like the condition I was facing a couple of months ago, where there was hell to pay for overdoing it. That may not be the case with this, but that isn't much consolation. I know enough about the mind to know that the main problem, ultimately, is my own perception of the pain. But how does that change? The part of the mind that governs these things is subconscious. I can't just inoculate myself by resolving to not be bothered any longer. It doesn't work like that.

The friggin' rules are the friggin' rules, I guess. For PFPS and everything else.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 22, 2010, 08:02:00 PM
No apologies needed, man.  I completely empathize with the feeling -- in fact, at first I felt a bit awkward about sharing that story, but in the end I am glad I did (movie quotes and all). Of course it is always important to keep perspective ("I CAN do this or that"), but it is equally important to acknowledge how you actually feel at that moment, however "over-reactionary" it may be.  That's at least one thing I've learned.

This is a (semi?)anonymous forum; this should be the very place where one can express his/her feelings without fear of being judged.  Frankly, I think the reason my condition deteriorated to such a degree this summer was my self-denial: Pain when walking? Can't be, I'm 26 and otherwise healthy...Pain when sitting? Can't be...Perhaps it would be a good idea if I took a cab? Time off work? Nope, can't do it...

Your advice to walk like a "turtle" saved my knees.  Had I kept on walking and walking, it surely would have spelled catastrophe. 

That said, I probably took it to an extreme. I was terrified of pain.  I avoided it at all imaginable costs -- for good reason, of course, as I had kept getting worse and worse over four months.  But I think I went too far.  I started to get these constant horrendous aches.  Walking was slightly better but sleeping and just lying down were quite difficult. 

Perhaps I was strangely lucky that I couldn't escape the pain, as it forced me to wave my "white flag," act somewhat irrationally, and just try something else: start moving with some level of discomfort and through those initial, sharp pains.  I think this helped me both psychologically and physically, even though I intended only to improve the former.  I gave up on the latter.   I felt completely stuck.

The irony is, however, that my "surrendering" is the very thing that -- knock on wood -- has helped out my knees.

If not in a pool, perhaps try putting your legs in a full bath?  I don't know your pain, but I can tell you that my knees, even when actively irritated, have responded well to passively kicking -- or just floating -- in water.   Have you tried any caspacin creams? (I think I read about it in one of the articles you posted about the PFPS "nerve model")

I'm not out of the dark by any stretch.  I could just as easily flare up and end up in a state of perpetual pain.  But there is hope.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 22, 2010, 08:45:27 PM
I figure that you might as well say what's on your mind. Speak the truth of your emotions, of your experiences, of your mind. It's often the only antidote to that heretofore mentioned absurdity. Who cares what somebody else thinks, anyway? If they judge somebody that harshly for expressing genuine feelings, what good is their opinion? That's not a good character trait in my book, and rather disqualifies any other of their views from my consideration.

I'll have to try that bathtub idea. I sit down to take a shower, anyway, so maybe I'll just take a bath. It's worth trying anything, I suppose.

I purchased the tape today, got 16' for about $10. It does help with some people, though whether the relief constitutes actual therapeutic benefit, or is simply temporary relief, is something which the verdict is out on. But maybe it will help me.

I didn't have any sharp pains yesterday, and haven't had any yet today either. But that persistent ache is omnipresent. It just doesn't calm down. Maybe water can deload the knees just enough to let them rest a bit. That makes some sense.

If you're still having trouble sleeping, find something with diphenhydramine HCl in it. It really works. When my previous condition was at it's worst, I would wake up some nights with my knee on fire. Many nights I had trouble getting 2 or 3 hours of sleep. As soon as I started taking the sleep aid, I never slept less than 7 hours. I don't need it now, thank goodness. But it was useful then. Lovely fat pad impingement. At least that's gone. I guess you have to try to look on the bright side of things, even when life isn't a glittering rainbow with unicorns dancing beneath.
Title: Re: To scooter or not to scooter?
Post by: smillie on October 23, 2010, 02:41:45 AM
Anonymity on these boards is such a good things. There have been many things that I've said here that I would never say to my friends, and perhaps not even my family.  We're all in pain, we're all frustrated, or most of us, anyway, so we understand each other or at least get where we're coming from.

So, sqshPlr8, did you ever decide what to do about the scooter? I just took a little tour via crutches around my house and surveyed the scene. The laundry is piling up, but I can't carry it all to the laundry room. There were dishes to do, and I can figure out how to get them done eventually, but good heavens, it takes forever. I homeschool my kids and haven't done as good a job as I should have this week. And there are a million other things to get done. I'm tired of asking for so much help and would love to just get things done. I'd like to carry my dishes to the kitchen after I eat, for that matter. I can be patient for a few days or even weeks if I know the end is in sight, but I don't know where that end is or what it would look like.  I want to be mobile in my house! I've tried scooting around some in my desk chair with limited success. It's just really tempting to get a wheel chair so I can be productive.  That would probably totally freak out my family. They're already befuddled with the crutches coming out again.

Ugh...I just need some way to bypass the knee and get on my merry way!  <My ideas may get really creative this evening as I'm medicating with margaritas tonight...>
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 24, 2010, 04:17:24 PM
Margarita induced, eh? I've never been intoxicated during any of my rants. Guess I'm just crazy!

It sounds like you're a super-mom, smillie. I know the type. My sister home schools her kids. Holy moley, she would be miserable in my condition. In a way, I'm glad it's me and not her. I certainly don't have anything like the level of responsibilities that she has. I just can't imagine that, trying to take care of a family in this condition. My own belief is that you ultimately have to do what works. Have some goals in mind. How long can you tolerate trying a conservative approach? For most people, most of the time, a conservative approach would probably work. That's just the body's amazing ability to heal itself. But then there are those cases where, despite the best efforts of patient, this simply doesn't work. You have to have a plan for what's next. Don't take no for an answer. Be willing to travel if you have to.

There is a confluence of birthdays in my family in mid-late October, so we had a family get-together yesterday. My aunt has had a double TKR, because her knees were ruined by rheumatoid arthritis. A family friend had hip dysplasia, and ended up having both hips replaced at quite a young age. My uncle recently had avascular necrosis of the hip and the joint is just destroyed. He has no choice but to have a hip replacement now. If that is the only way for you to be pain free, accept it, and be willing to fight for it. These people's quality of life was dramatically improved by the treatment they got.

I am fortunate in that I live in the Boston metro area, which is where much of the joint replacement technology and arthroscopic surgery was pioneered. If I do need it, I'll probably be able to find a doctor who will deliver top notch, cutting edge care. If there is one thing I'm sure of, it's that I'm not willing to live the rest of my life in pain. I don't care what I have to do, but I'm going to beat this thing. If that involves a subtle coaxing back to health, great. If I have to chop that darn patella out of my knee, and get a prosthesis, so be it. One way or the other.

Keep moving forward!
Title: Re: To scooter or not to scooter?
Post by: smillie on October 24, 2010, 07:24:31 PM
The medical community around here is definitely not cutting-edge. There are plenty of guys doing TKR, but that is NOT what I'm looking for at this stage of my life. It keeps coming back to travel, but travel=$$$$ and that's a problem right now.  So I keep hoping to find a local option.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 24, 2010, 09:55:45 PM
In the end, I did not get a scooter.  However, I have modified a number of portions of my daily life: crutch to go up/down five-floor walk-up, keeping my legs extended at work, conscientious movements etc. 

Yea, chores have kind of gone down by the wayside (standing is the most difficult thing at the moment).  I heave my laundry up or down each flight of stairs while I am crutching.  Frustrating.  For dishes, I sit down with my legs propped up on a stool.  I could not imagine vacuuming or dusting, though...

As knee always hurts suggested earlier in this thread, if one were to use a scooter or some mobile device you would still need to incorporate some movement/loading into your daily routine.  Ideally, you would do this in intervals so as not to provoke another round of inflammation and pain. 

knee always hurts, I feel ya man.  It gets to a point where you have to ask yourself, "Is this working?" As for my plica, I am asking myself similar questions.  Although I have had some success with reducing my symptoms and gaining more mobility recently, I think I might try out a cortisone shot sooner than later.  The band of tissue is huge and catches pretty regularly, causing discomfort; it is not slimming down.  If the inflamed plica is my primary problem at the moment, then perhaps the shot could be "curative" in a sense.  Of course there are risks, but there are also risks with snapping this thing over my femoral condyle every time I flex my knee.  The ECBFT is a no-go as the plica is constantly getting impinged.    On a positive note, I seem to have quieted down my other, more diffuse symptoms in the meantime.  So we shall see.
Title: Re: To scooter or not to scooter?
Post by: smillie on October 24, 2010, 11:49:41 PM
Mine is finally calming down a bit. I got more sleep last night than I have in several weeks. It took a LOT of modification to get there. Tomorrow I'm going to start trying those intervals to see what I can handle. It might just be 10 unassisted steps, but I'll start there. I still need some way to do my daily tasks, though, without causing a flare. I think it's going to be a good long while before I can stand in the kitchen and cook dinner and do the dishes without causing harm.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 25, 2010, 10:10:07 PM
I think that I'm not going to have any choice but to increase my activity level, as lying down most of the day is starting to cause a significant amount of back and hip pain. I can't risk the deterioration of other joints. For the first time yesterday, it was actually quite painful to walk as a result of my hip hurting. I could actually feel the soreness in the place where the ball of the femur articulates with the hip. It was a strange sensation since I'd never felt anything there before, I suppose because that joint just worked. So I've got to move more.

The next step for me is trying to find a decent arthroscopic doctor. I don't trust the local doctors at all, based on my experience with them. There are some really fantastic doctors in Boston, and I'll hopefully be able to eventually secure an appointment with one. I've got to get this whole process moving forward, so that if I do need surgery, I won't have to wait for several more months.

My right knee has actually been feeling a bit better the last few days. Though there is still that omnipresent soreness, it may have decreased a bit, and there hasn't been any sharp pains for probably 5 days or so. My left knee is really starting to flare up, though. I think it is possibly the worst that it's been since this new problem developed. I can hardly walk even a short distance without sharp pains in the irritated spot. It seems that one of the main triggers for my left knee is bending the knee past 90 degrees, even though it isn't under load. It's not easy to avoid doing that 100% of the time. If I could just clear up the problem in the right knee, I might have a chance with the left following rbcyclist's approach, since I think that there are probably some chondral defects there. I'm not going to get my hopes up yet, though, since every time I've thought that my right knee was improving, it suddenly becomes much worse again.

You may end up needing that cortisone shot, SP. I think with some tissues, like the synovium or subchondral bone, that the tissues don't necessarily change that much in form and so are merely irritated but don't actually become impinged. The tissue homeostasis model really makes the most sense in cases like that. But in the case of the plica, it can become a pathologic structure that is so damaged that it won't return to it's previous form. In that case, you've either got to remove it, or otherwise cause it to return to its formerly lithe self.

Smillie, that is good to hear. It's always frightening when you can't walk at all without irritation or pain, and you think the situation is hopeless. But if there is improvement for the better, there is hope!
Title: Re: To scooter or not to scooter?
Post by: smillie on October 26, 2010, 01:00:41 AM
I'm here to rain on the parade. The interval (walking to the bathroom unassisted) was a bust. So I focused today on good form with about 50% weight as tolerated. Did OK. Then I tried to fix dinner without much weight bearing. Super simple meal and I did it, but I had a meltdown at the end when one of my kids gave me some flack. I didn't realize how much I was hurting because I was focused on getting it done. It was horrible.

In other news, I found a local knee guy to try, so I will be giving him his audition  ;) on November 5.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 26, 2010, 01:13:55 AM
I'm of the belief that somebody needs to invent an anti-gravity machine. If I could just modulate the gravity to be, maybe, 1/4 the normal force, I could probably walk a good deal more than I am now, lubricating the joints, and within a few weeks get back up to the normal level. We can wish!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on October 26, 2010, 09:22:24 PM
This blog is written by a woman who had a synovectomy by Dr. Dye.  Apparently her synovium had tethered itself to the underside of her patella.   I have yet to read the entire blog, but she had a previous plica resection/fat pad removal which did not go well. 

http://aliraesf.blogspot.com/2009/02/synovectomy-follow-up-appointment.html
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 26, 2010, 09:59:25 PM
That's funny, I was just reading that blog last week. Actually, it feels like something is tethered underneath my patella. From what I read, it seemed like the synovectomy lead to an improvement, but she was still wasn't pain free. Read the one year later post. It sounds like she is actually pain free some of the time. But whenever she does anything above and beyond the usual, the pain is back. Paul Ingraham also made an appearance in the comments of one of the posts, and basically said that dealing with this kind of knee pain is always a struggle with no certain outcome. I guess he googles himself. Maybe if we post his name enough times, he'll make a guest appearance here.

Paul Ingraham
Paul Ingraham
Paul Ingraham
Paul Ingraham
Paul Ingraham
Title: Re: To scooter or not to scooter?
Post by: smillie on October 26, 2010, 10:23:41 PM
LOL It's like the old slumber party game...  Bloody Mary ... Bloody Mary ... Bloody Mary  to see if she appears.  ;D
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 26, 2010, 10:40:07 PM
Well, I never went to any "slumber parties", but I can actually recall speaking the name of the old queen before a mirror at midnight on at least one occasion. I almost thought I saw her. I'm glad I didn't, though. Paul Ingraham appearing, on the other hand, is something that I would regard as quite auspicious and would heartily welcome.

Paul Ingraham, Paul Ingraham, Paul Ingraham <Mirror at Midnight>

So where are you, Paul?
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 28, 2010, 09:08:18 PM
I filled out and submitted papers for insurance yesterday, so when that is all sorted out I can make an appointment to see a new OS. I've been looking and have a particular doctor in mind, but only time will tell if I can get an appointment with him. He does accept the insurance that I'm applying for, and he is supposedly accepting new patients. So I'm hopeful.  8)
Title: Re: To scooter or not to scooter?
Post by: smillie on October 28, 2010, 09:41:41 PM
Good luck! I hope it works out so you can see him. I've made an appointment with a new OS with some really good knee credentials. I'm going in armed with good information and we'll see if we can agree philosophically on things...i.e. my quads are weak because my knee hurts rather than my knee hurts because my quads are weak....
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on October 31, 2010, 05:30:56 PM
Well now, this is not the best day of my life, not by a fathom.

Whatever in the heck is going on in my left knee just took an incredibly horrible turn for the worse. It feels like a knife is wedged between my patella and femur. Even the slightest movement is eliciting wince-provoking sharp pains. There must have been some fractured cartilage that broke off, and it's now bone on bone, is the only explanation I have. I'm using a cane 100% of the time today just to take the weight off of my leg. Maybe I'll try crutches.

I don't think there is any way out of this one. Damn, I hope it doesn't take long to get my insurance approved. Because of some strange twist of fate, I live in the Boston Metropolitan Area, which happens to have:

New England Baptist Hospital: One of the best joint replacement hospitals in the US, and they actually performed the first hip replacement surgery in the world decades ago.

Cartilage Repair Center: It has performed the most cartilage transplantations in the US, and the first ACI procedure in the US.

I've got my pick, I suppose. There are probably others as well if I look. I don't really feel any better about this, though. Those are really invasive procedures. But what choice do I have now? At least it is the year 2010! How the heck did people live like this years ago? I don't even want to try to wrap my mind around that one.

Let me just give a little piece of advice for anyone who happens to read this. If you have a knee condition with lots of inflammation, and your doctor diagnoses you with PFPS, then your doctor is clueless. Not only that, but a hole is being burnt right now in your knee cartilage, and your life is going to be ruined by it. Better get to the emergency room now, and get it taken care of before that happens.

Don't think that you're "too young" for that to happen. That's a delusion.

 :'(
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 05, 2010, 05:11:34 AM
I see the doctor tomorrow.  Still not exactly sure what I am going to do next, but I do know one thing: if I don't slim this plica down my conservative efforts will go nowhere. 

(Of course, if it is tethered to the kneecap or medial condyle, I might have to go the surgery route.  But that's a long, long way down the line.  That said, I am really getting sick and tired of crutching, propping, analyzing, theorizing, empiricizing, Vaudville-reenacting, schlepping, and prophesizing about this mess.  Although I work in basic science and believe in the power of logical deduction, I would love me some good ol' fashion, televangelical magic healing right now.  Praise the Lord!)

So what are the options? 
Oral NSAID's? Can't take them as they caused a string of ridiculous GI episodes -- didn't really help anyway.
Voltaren gel? Will ask about it again, though doc said he didn't see decent results with other plica cases.
Cortisone shot? Strongly contemplating it.  But I feel that if I were to do it, I should at least take time off work to let this stuff work. "Masking the pain" is a worry, but I figure if I conscientiously maintain my current "envelope of function" with enough pain-free motion (light swimming) I should avoid that risk. 
Ice? On going, of course. 

I might seek another opinion before getting the shot. Depends on how tomorrow goes.  Let's see.

Hope you guys are feeling better.
Title: Re: To scooter or not to scooter?
Post by: smillie on November 05, 2010, 02:59:36 PM
I saw the new OS today. Not sure what to think. His PA took the history so I talked to her more. When he came in he did the exam, asked some questions and talked fast. I hate that. He reviewed my mri and xrays. He said he saw "arthritic change" in the pf area but didn't see anything surgical needed. He gave me voltaren gel and darvocet to try for a month and come back to see him. At least he didn't say "strengthen your quads." Those were my walking out words. LOL
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 05, 2010, 03:11:13 PM
Just saw the doctor.  He said that if I were still a complete mess, he would have recommended bailing and getting surgery.  However, since my symptoms have improved and I can swim (a bit) -- but I am still having some major difficulties -- he recommended the cortisone shot as a way to calm things down and get rid of the impingement, therefore allowing me to recover more fully.  

I asked whether a new image(s) would be helpful before getting the cortisone shot.  On the basis of his examination and my description of the symptoms, he said that 1) it seems doubtful that anything has changed since the last image, 2) even if things had changed (e.g. slight damage/irritation of the medial condyle) it most likely would not change the recommended immediate course of treatment, and 3) if I were to get surgery -- which I have no appetite for at the moment -- I would get a "battery" of tests prior to the procedure anyway.  (I felt this was a pretty convincing argument and was thinking along similar lines prior to the appointment).

He said it seemed reasonable to take time off work (1 - 2 weeks) after the cortisone shot -- not that I would be a bed-bound; rather, I would be more freely able to dictate my movement and comfort.  Plus, I could (lightly) swim more.  

Finally, he said that if I wasn't substantially better by, say, the New Year, he would recommend the scope.  

Even if I am still really symptomatic in January, I am honestly not sure if I would want go through with the surgery.  But I will cross that bridge when I get to it, I suppose.
 
Overall, I felt satisfied with the appointment.  The doctor satisfactorily addressed my concerns.  At this moment, then, I do not feel that it's necessary to solicit more opinions.   I will wait until January or thereabouts to consider that type of stuff.  For now, I will (most likely) see how the shot goes and conscientiously and carefully move forward.  
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 05, 2010, 04:00:19 PM
Hey smilie,

Are you going to give the Voltaren a try? Or seek another opinion? Or all of the above?

Hope you feel better.  :)
Title: Re: To scooter or not to scooter?
Post by: smillie on November 05, 2010, 10:42:46 PM
Sqsh--sounds like you have a plan for now. That's a good thing.

I'm definitely going to try the Voltaren gel. I had good results from the oral version, but the depression that it brought on was unacceptable. My OS said that the gel should give me the relief without the depression, so I'm hopeful. It was a bit expensive, but if I can function with it, then it may be worth it. I'm hoping that I won't over-do and cause harm as a result, though.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 05, 2010, 10:45:05 PM
That account I posted wasn't even the worst of it. In the early morning, I had awoken in the middle of the night, and noticed that the pain level was higher than it had been. As I was anxiously ruminating over the possibility of a sleepless night, I suddenly started to feel this strange crawling feeling on my foot. Within a few seconds, my heart was racing out of my chest, the blood felt like it was draining out of my extremities, I had trouble catching my breath, and these feelings of unreality, like I was no longer connected to my body, started to overcome me. I literally thought I was dying. I got out of bed and went to lie down on the sofa, and I started shaking uncontrollably. Just before I was to keel over and die, I said to myself, "Hey wait a second, isn't this what is known as a panic attack?" So I looked up the symptoms on the computer, and sure enough, it described it to perfection. Maybe it's time to check into the psychiatric hospital. That was the first time that has ever happened to me, and hopefully the last.

http://www.artchive.com/artchive/M/munch/scream.jpg.html

The doctor said that it can't be "bone on bone" since the joint space looks fine. He suggested that it was probably something other than cartilage, but I'm well aware that only an MRI, or ideally an arthroscope, can detect chondral lesions. They would be smaller lesions, perhaps only on the patella or femoral condyle, though. But could it be that painful? I've read plenty of accounts on these forums of people managing chondromalacia for years, and while it is uncomfortable for them, and certainly limits their activities in many cases, it doesn't sound like what happened to me. But without an MRI, which has been refused to me several times, I'm going to continue to be left wondering. When the insurance application is accepted, I'm going to try to get an appointment with that doctor in Boston. Hopefully it will be soon, or I won't be able to afford my hospital bill!

Are you feeling that spiritual feeling in your bones too, SP? Like an awakening, or epiphany? I remember the time the lame man was lifted before the Lord, and the Lord healed him. Who needs all of this icky science when you've got the good Lord to heal you up? Must have been good times those! Maybe this new Congress we've got here in America can put some funding toward that good ol' fashioned healing! Because heaven knows that science ain't comin' through for me right now. Vaudville-reenacting seems to have about as much promise as the medical establishment toward helping to heal my knees at this point.

All of the research I've done seems to have gotten me nowhere as well. I think I just need to chill out. That panic attack is a wake up call. I found a site describing "health anxiety" (I think that this is a similar thing to hypochondria.), and it sounds quite similar to what I'm experiencing. I've always been a little jittery, I think, but the last few months has me facing a generalized anxiety disorder in addition to the pain. I think I just need to calm down, stop thinking about the future as hard as it might be, take each day as it comes, and follow the basic principle of the "envelope of function", trying to minimize the damage and maximize the chance of recovery. Eventually I'll get an MRI, and hopefully a diagnosis.

I think at this point, a cortisone shot is worth a try, especially considering that you know that it's the plica. One should do the trick, though, and if it doesn't I don't think I'd try it again. You don't want to carpet bomb your poor joint in addition to all it's already been through.

Funny thing, smillie, the ER doctor didn't mention the quad thing, either. But I still feel like I'm getting the runaround. Maybe it's not science that is the problem, but the physics of this ridiculous PF joint. I think we need to replace the phrase "Achilles heel" with "patellofemoral joint". Vulnerable though it may be, at least the Achilles heals in 3 months, even if fully ruptured. The PF joint on the other hand? Sadly, we know all too well!
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 09, 2010, 08:56:28 PM
I've tried getting off the crutches a couple of times in the last week, and it's a no go. The pain and burning starts almost immediately when I try to walk. Walking slowly doesn't help. Apparently I'm going to be on crutches until I get treatment for whatever is wrong, which could take months! I can't even make an appointment, because I still don't have insurance. And I've read it could take up to a month for it to be approved.

The last few days, I've really not slept well at all. I'm lying awake for hours, and sleeping only intermittently. I'm exhausted, emotionally drained, and in constant pain. It's hard to imagine a worse turn of events than this. How is this possible? My joint was completely pristine 6 months ago, as far as I know, and I never sustained any serious trauma that should cause this! This is worse than what I was suffering over the summer, because at least that would calm down when I used crutches. This is hopeless. The vicodin really doesn't help me to sleep, the naproxen caused stomach or intestinal problems, so I stopped that, and the mainstay for so many on here, ice, is verboten because of the strange circulatory problems that it caused. Speaking of which, my foot really doesn't like being on crutches, because when it is just hanging there, the blood seems to pool, and I get problems with tingling, burning, and numbness. My foot turns a reddish hue which only subsides when I put my feet up. I was really hoping that this would be a temporary problem, but after more than 4 months, it seems like a permanent condition now.

Life is really strange. Take a perfectly healthy 26 year old, injure the ligaments in his foot a little, and then set him loose for the next few months without any information on how to manage the problem, and look what happens. One problem led to the next, which led to the next, and then the next. This is almost incomprehensible, but I'm not expecting to ever be "normal" again. I guess any expectation of anything happening is a delusional imposition of the mind, anyway. There's a lot more ways for things to go wrong than to go right, if I'm allowed to call what happens "right" or "wrong". We desperately want things to go "right", though, and we see a lot of people around us for whom things do seem to be going "right". Of course, sooner or later, things don't go right for them, either. Such things happen, and it's a test of our fortitude when they do. And that's a test that I've admittedly failed. Quite miserably really. I've honestly never known anyone personally who has gone through anything remotely like this. Is this response a normal one, or am I just nuts? I don't really know. Some people go to the museum with their Sponge Bob pajamas on and end up having a good day anyway. We were all born naked, bereft of cloths, and thoughts, and ideologies, and of the cold truths of the world. And then we acquire them. Sometimes they have a Sponge Bob print on them. That's just as random and absurd as anything else.

No, I'll probably never be "normal" again. Or maybe I will. And then there will be something else, another obstacle. I used to like to take a walk every now and then. Just in the woods behind the house. Such a simple pleasure. Who would have thought that it might be forever denied to me?

I'm just biding my time until I can see the doctor. There isn't much to do in the interim.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 09, 2010, 10:40:09 PM
Sorry about that, but this week has just been insane. Still, I'm not the only person in the world who is in agony. I just want a diagnosis!

What is the best course of action if this pain doesn't decrease much over the next few days? Go back to the ER, or just wait? I don't know. I'm just afraid of my leg wasting away. The sooner I get treatment the better, but I don't have any other option right now.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 10, 2010, 04:29:51 AM
You have been through the ringer, man.  I am sorry to hear about your latest descent. 

The insurance issue definitely throws a wrench into the equation, but if you are in too much pain to handle then go back to the ER.  Is there any way to expedite the application process? Does Massachusetts allow sub-30 year-olds to go on their parents plan?

In terms of anxiety and panic, I completely understand.  In fact, I started seeing a psychologist to deal with the pain and my handling of it.  I can't say it has helped the pain itself, but it has definitely mitigated my suffering.  I realize a psychologist or health professional may not be in the deck of cards at this time, but perhaps a pain/anxiety support group?  I'm not trying to minimize your physical condition -- quite the opposite -- but talking about it with someone may ease your suffering as it has mine. 

Hope things start to get better soon.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 10, 2010, 05:57:10 AM
I know that this is a knee forum, but I think the mental anguish comes along with the territory. I'm sure that some handle this better than others, but at least for me, recently the mental suffering has been worse than the pain itself. I've noticed that most folks don't seem to mention how well they're handling the pain psychologically, preferring to talk only about the procedures that might help to cure the condition. But I think that mental anguish inherent in chronic pain sufferers should be brought out of the shadows. And what better a place to do that than on a forum where other people might actually have some understanding of what you're going through. It's been just an incredibly lonely experience going through this. Nobody in my family can relate to what I'm suffering. Many days I don't even walk outside. I used to walk 5, 6, or 7 miles a day through the woods like it was nothing. Now I feel totally detached from nature as well. Often I feel this pressure in my head, and I start to feel detached from my body. Maybe I'm trying to separate myself from the suffering.

A psychologist might be in the offing if this doesn't start to improve within the next few weeks. Unfortunately, the cutoff in Massachusetts to be on parent's insurance is age 26. Just my luck, again. An anxiety support group might be a good idea. I'll have to look into that. The things I used to do to manage anxiety are no longer effective, and I feel like I have no control over my thoughts. One moment I feel fine, the next my head is just spinning and I'm overcome with anguish or anxiety. I've had goods days and bad in my life, but never anything like this.

Pain and disability is difficult to deal with in it's own right. But when your mind no longer responds to the circumstances in a rational way, you just start to feel hopeless. Things will probably get better at some point, but it's hard to see light at the end of the tunnel from where I now stand (Well, sit).
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 11, 2010, 04:32:33 PM
Going in for the shot tomorrow, then taking two weeks off work. 

The plan is to take it real easy this weekend -- hopefully there won't be too much of a flare -- then slowly resume my currently non-irritating activities.  Even if something feels "good," but is out of my "pre-shot envelope of function," within this 2 - 4 week window (the approximate time this derivative of cortisone remains in the synovial fluid), I am going to try my best to avoid it.  Hopefully this will slim the plica down and stop the cycle of irritation, inflammation, irritation, etc, which will allow me to start building my joint, and then my muscles, back up again.

Of course, one of these two weeks will be spent with family for Thanksgiving...so I can't really call it a vacation... Just kidding!  :P
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 12, 2010, 05:42:00 AM
This is probably your best hope to beat this without surgery. It sounds like you've got everything prepared on your end. Good luck!
Title: Re: To scooter or not to scooter?
Post by: Snowy on November 12, 2010, 06:05:45 AM
Quote
and I get problems with tingling, burning, and numbness

Have you considered CRPS as a possible cause? Notoriously hard to diagnose, but one of the few things that could explain all your current symptoms and the suddenness of their onset.

The anxiety disorder is no minor thing, either. My partner has suffered from severe panic disorder for more than 15 years (to the point where three doctors certified that she would never be able to hold a full-time job or live a normal life) and now keeps it completely controlled with very minimal medication. If you find yourself suffering with further panic attacks, let me know and I can get J to pass on some tips for dealing with it.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 12, 2010, 06:16:22 AM
Yeah, if you read in the Sore Knees, No Diagnosis thread I said I thought I had that a couple of months ago (The CRPS, that). But that is probably just crazy speculation on my part. It fits the diagnosis of some sort of venous insufficiency really well. The abnormal blood flow causes a change in sensation. It actually does fit the CRPS diagnosis to some extent, but wouldn't it have been a lot more painful to begin with? The foot thing really isn't "painful" at all, just quite uncomfortable. And could icing trigger it?

Now, if I do have CRPS, I think I'll probably permanently have panic disorder. If I have another panic attack, I'll post about it.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 12, 2010, 01:56:15 PM
If neurogennic inflammation is the issue, then maybe try capsaicin? For that matter, I wonder if anyone has tried intraarticular botox injections...
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 12, 2010, 08:07:27 PM
Until I had considered venous insufficiency as a possibility, I had thought maybe it was CRPS. There are a few things indicative of that:

1. Skin color changes
2. Sensations are similar to CRPS, but very mild rather than severe
3. The thing that really concerned me was that the condition started only on the left side, and then mirrored on the right after a few weeks. It sounded like classic CRPS to me.

On the other hand, venous insufficiency makes sense because:

1. The skin color changes are primarily when standing up. When I prop my feet up, the color quickly goes back to normal. It is at the worst when crutching, which make sense since the leg is just freely floating there. When there is a malfunction of the valves in the veins, the muscle contractions can still help to get the blood moving. With crutches, there aren't any muscle contractions, and thus a greater insufficiency.
2. The sensations could be caused by peripheral neuropathy, which can be a secondary condition to problems with blood flow in the feet.
3. The condition got a lot better when I was able to walk more a couple of months ago, and the PN was almost gone. It has returned with a vengeance now that I am back on crutches.

Of course, this still doesn't explain why the condition would mirror to the other leg. But maybe the veins are interconnected in some way. I can only speculate, I suppose.

The problem is that the pain along with the tingling was the instigating factor in setting off that panic attack last Tuesday morning. And though I haven't had another, when I wake up with the uncomfortable tingling sensations, I can't fall back asleep because of the anxiety. I know a lot of people with panic disorder avoid the situations that they think set off their attacks. But I can't avoid sleeping, and I can't avoid my knee pain or the neuropathy. So I only slept maybe 2 hours at most last night.

Irrespective of the cause of the foot issues, the current knee pain I'm experiencing could be CRPS. I don't have any other explanation as to why it would suddenly worsen to that extent. Lest anyone think I am in constant agony, the pain has settled down a good bit, but of course I am not walking at all, which isn't tenable in the long term.

I'm thinking that a trip to a vascular doctor is going to be on the agenda as well when I finally get my insurance approved. From what I've read, if it is venous insufficiency, the only treatments are compression socks (No more wearing shorts in the summer, then), or some procedure to close down the offending veins. I just think it's strange that I can't find a single case of someone with a similar situation. Why would icing cause this? I had read, and was aware that over-icing could cause frostbite in an extreme case, but not this.

I think it makes sense to at least get an MRI (And maybe ultrasound on the veins) before considering CRPS. But if the MRI comes back clean, it would be a little frightening to even contemplate surgery, since it's my understanding that it could dramatically worsen the CRPS.

Here I go again throwing myself into a tizzy. But without access to a doctor, what can I do?
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 17, 2010, 03:41:00 PM
The cortisone seems to have helped, overall.  Definitely reduced swelling.  Doctor says that it will be two weeks after the shot to the see the maximal effects.

Have been relaxing and going to the pool, as I have taken a couple weeks off work.  Though last night I went to a friend's birthday party and I probably stood around too much.  So my good knee is bothering me today, which is frustrating as I kind of see this as my last "conservative" effort. 

But we'll see.  Day-by-day.  Breathe. Stick to the plan and hopefully salvage the remaining twelve days of "vacation."

Unfortunately, I got a call this morning that my dad fell down the stairs and punctured his lung, but he'll be fine.  So he's in the hospital for the night.  Ugh. 

This medical stuff never gets old...

 
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 17, 2010, 07:46:42 PM
The best of luck to you. You never know, this might work.

It's good to hear that your father will be alright. My Dad fell last November and shattered his foot. A bloody mess that was. Amazingly, as is often the case with traumatic injuries, he is totally fine now. His foot was swollen for about 2-3 months, but it is completely normal now. On the other hand, these chronic injuries just seem to linger forever. If it comes to surgery, I'm hoping to have as good a result as he did!

It's remarkable how a little band of embryonic vestigial tissue can cause such suffering, isn't it?
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on November 17, 2010, 10:08:56 PM
Crazy, right? So annoying! 

Speaking of traumatic injuries, a colleague of mine shattered her ankles while -- wait for it -- getting up from a couch in her office.  She was good in six months. 

At times I just think (or even say out loud): C'mon! Really? Really knees? Are you that bad? 

Ridiculous.

How are you holding up?
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on November 19, 2010, 12:09:25 AM
I actually decided that I had procrastinated enough and finally called up the Mass Health number. The lady on the other end said that they were sending out the plan information, and it would arrive in 3-4 days. I'm not sure if that is business days or just days, but I'm assuming the former. My understanding is that I'm going to have to select a plan. I'm not sure what my options are going to be, so we'll have to see. Then, I'll probably have to select a primary care doctor, which hopefully will be somebody other than my current useless doctor. Then, I'll probably have to get a referral to that Boston doctor, which I'm really hoping won't be a problem. Only time will tell. There is still a pretty significant chunk of time between now and finally getting that MRI, and then whatever treatment the OS chooses to pursue. I haven't tried to walk for a few days, but I really don't think I could. It doesn't hurt that much right now, but there is a general feeling of irritation. I think it would really start to hurt if I was to walk much at all. I'll probably try again at some point in the next week. I just don't understand why this thing won't calm down. In any case, I'll keep everyone posted.
Title: Re: To scooter or not to scooter?
Post by: vickster on November 19, 2010, 08:12:23 AM
I don't really know how the US system works, but could you not pay for an MRI yourself so that you have it to hand once you do see a doctor?  Obviously an MRI isn't always accurate but seems to be the preferred diagnostic imaging tool .  What painkilers / anti-inflammatories do you take?

Hope you get some answers soon  :)
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on December 05, 2010, 12:22:02 AM
I really hate to ask how you're doing, as I'll assume that your absence suggests an unfavorable result for the cortisone shot. Wouldn't you have run, jumped, and skipped into the forum to tell of the good news otherwise? But, I'll ask anyway. So how did that cortisone shot end up going for you? I'm all the more interested since my knee is doing a quite bit better now, and I'm actually walking a decent amount, and perhaps delusionally, am holding out the hope that a good ole injection of cortisone might be just what the doctor ordered.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on December 05, 2010, 02:48:25 AM
It's difficult to comment on the cortisone shot in itself, but the combination of cortisone and time off work seems to have helped quite a bit.  I still have pretty big undulations, the valleys of which continue to get me down and the peaks of which make me more and more hopeful.  For example, I went out to a couple of bars with some friends last night over the course of ~7 hrs where I intermittently sat, stood, and walked around.  Felt fine.  Today my knees were sore, but nothing in comparison to this summer/fall.  Let's see what tomorrow brings.

The shot itself and immediate aftermath was pretty anti-climatic: no pain during the injection, no obvious flare, no sensation that the immune/inflammatory capacity of my knee was completely shut down and therefore prone to instantaneous combustion.  But it definitely reduced swelling and, with that, pain -- particularly when lying down or sitting which has been a huge psychological relief.  Constant pain sucks.

I'm slowly reincorporating more active aspects of my life since the cortisone is (most likely) out of there by this point.  For example, I've been walking to work, which is about a mile away, with a couple breaks along the way.  I've been using the stairs without the crutch, which isn't too bad and doesn't seem to be causing flares.  Work got progressively easier throughout the week.  Doing the stationary bike for 10 mins w/o too much of an issue.

The plica is slimmer, but still there. 

My good knee has been bothering me some, nothing too bad, but enough for me to contemplate a cortisone shot in that one too, partly so that it doesn't get out of control and partly so that I don't re-compensate on my bad knee. 

The plan is to see how the next month or so goes.  If I am not significantly better by that point, the doctor recommended an OS who specializes in robotic arthroscopy.  It seems like precision would be key in my case.  But I'll cross that bridge if/when I get to it.

Perhaps I should have gotten the shot earlier?  I guess, but I don't know if I would have been as conscientious in my movements and approach, which may have risked a greater chance of failure.  Of course, allowing the inflammation to remain could have caused its own set of problems (say, ongoing ischaemia?).  Whatever. 

Great to hear you're feeling better!  If need be, I say give the shot, well, a shot.  Speaking for myself, my knee hasn't exploded and it seems to have eased me out of a pain/inflammatory cycle.




Title: Re: To scooter or not to scooter?
Post by: knee always hurts on December 05, 2010, 06:54:33 AM
Wow, that actually sounds promising for you! I know that even with treatment these problems can take months to fully resolve, but so far so good it sounds. Hopefully you continue to make progress.

Yeah, I definitely feel a lot better but am still in constant pain, really. And now I'm having a lot more medial pain in addition to the longstanding lateral pain. But it's hard to complain given that I was able to walk a all for almost a month! There are definitely things in there that are not in their proper place. There are all of these strange crunching sensations when I bend my knee. So a cortisone shot might actually help. We'll see what a doctor thinks when I finally get there!
Title: Re: To scooter or not to scooter?
Post by: fischbein on December 28, 2010, 02:29:27 AM
AFTER 12 KNEE SURGERIES AND A FAILED TOTAL KNEE REPLACEMENT I USE A SCOOTER WHEN I AM OUTSIDE AND A POWERWHEELCHAIR AT HOME.  IF YOU FIND A GOOD PHYSICAL THERAPIST LIKE I DID THEY CAN SHOW YOU A NUMBER OF NON WEIGHT BEARING EXERCISES THAT WILL ALLOW YOU TO KEEP MUSCLE TONE BUT AVOID PAIN FROM EXCESSIVE WALKING AND WEIGHT BEARING.  IN MY CASE MT P/T/ SPECIALIST ALLOWS ME TO WALK ABOT 150 STEPS TWICE A DAY AND THAT IS IT BECAUSE THE PAIN IS SO BAD 60 MG. MORPHINE WILL NOT HELP.  MY PAIN DOC SAYS IT IS VERY IMPORTANT TO WALK DAILY AS MUCH AS THE PHYSICAL THERAPIST WILL ALLOW OR HE SAID "YOU WILL BECOME THE WHEELCHAIR".  BY WALKING 300 STEPS A DAY MAX, AND THEN USING THE SCOOTER OUTSIDE OR POWER CHAIR AT HOME I GET BEST OF BOTH WORLDS, I CAN HET AROUND A BIT AND AVOID PAIN THAT EVEN MORPHINE WILL NOT HELP AND STILL HAVE SOME MUSCLE TONE.   IN MY CASE I AM AWAITING A REVISION SURGERY END OF JANUARY OR POSSIBLE ATHRODESIS IF TOO MUCH BONE IS GONE TO SUPPORT A NEW TIBIAL PLATFORM PROSTHESIS.  BUT EVEN WITH ATHRODESIS I WANT TO CONTINUE WALING AND DOING THE EXERCISES THE PHYSICAL THERAPIST SO I WILL NOT LOOSE TOTAL MUSCLE MASS IN MY BAD LEG.  I SUGGEST YOU WORK WITH A GOOD PHYSICAL THERAPIST AND FIND A HAPPY MEDIUM, THAT WILL MAXIMIZE YOUR ABILITY TO LEAd a fuller life and not be totally homebound.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on January 02, 2011, 02:20:53 AM
fischbein,

I am so sorry to hear that you are in so much pain!  Thank you for your advice.  Luckily, things have gotten better over the past few months, so I no longer need to contemplate the question, "To scooter or not to scooter?"

It's been a while since my last post, but things are looking a bit more up.  I am still having discomfort, but it is not that severe and seems to be a result of not being able to do much for several months.  Everyday activities are getting a lot easier and I no longer wake up with pain/discomfort.  In fact, I was able to log in about 40,000 steps over the past three days and swim (pull-buoy/light flutter) a half-hour each day! 

The discomfort that I experience when I walk doesn't seem to carry over to the next day, which I am pleased with.  If anything, the more I walk, the better I feel the next day.  That said, I am still taking things slowly. 

And my plica is still there, which makes biking or seriously flexing my knee troublesome.  As such, I am sticking to walking and swimming.  Admittedly, time to time I get "greedy" and do think of the plica and whether its presence will ultimately halt my progression into more athletic activities, but I then tell myself how far I have come, at least on a functional level.  In four months, I've gone from living in a hotel because I couldn't ascend my walk-up to now being about to walk (cumulatively) eight miles in a day.  Yes, there is still discomfort, but it doesn't seem to have as lasting an effect as it once did. 

Of course, I maintain a skeptical perspective about this stuff.   I can only take each day as it comes, conscientiously assess my current state and adjust.  Hopefully my plica will slim down with time and hopefully it has not/will not cause any serious damage to adjoining structures.  At the very least, I can walk more with a lot less discomfort.  Let's see how the first few months of 2011 go and hope for the best. 

Happy New Year to you all!
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on January 04, 2011, 10:02:32 PM
Well, that is a great thing to hear! You don't even need an ECBFT anymore! As for me, I've got an appointment finally, and it shouldn't be a big deal to get that referral (Or so I hope!). I might even sneak an MRI in before the end of the month. February surgery? You never know. I never thought I'd say this, but I can't wait for that day.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on January 20, 2011, 09:11:34 PM
hey KAH,

Good luck at the appointment!

As for me, things are getting better bit by bit.  Walking and swimming more without too much discomfort. I am able to bike at ~150 watts for 10 minutes without pain, which I found very surprising as I assumed I was very weak, but I guess the past seven weeks of increasing my activity level has paid off in some way -- though my plica still catches.  And I no longer have morning/night pains.

At this point, I am simply keeping my head down: just increase my walking, swimming, and (occasional) biking one small step/flutter kick/RPM at a time.  I still have my reservations regarding a "full" recovery, but I cannot argue with progress. 

Best of luck, KAH!



Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on April 17, 2011, 02:37:48 AM
It's been a while, once again.

As usual, things have gone up and down.  In the past month I've been really bad (e.g. after having the gall to row for 15 minutes at a light pace and modified flexion/extension, I missed a couple days of work) and pretty darn good (I participated in a park clean-up today).

I saw my doctor for the first time in four months, and he recommended that I see the surgeon who specializes in robotic surgery.  I have an appointment for Tuesday May 3rd.  Let's see what he thinks.  Considering I can walk on even ground without much discomfort or pain I am not interested in surgery (though when would I ever be "interested?").  I've come a ways, but am still in a vulnerable territory.  That said, if I can get some more opinions, more tests to see if anything has changed in the past year, I think that would be good.  Where am I? Where am I going? 

In terms of my actual "physical therapy," I have basically been staying with the light walking, swimming, and biking.  However, since I have had some nasty flares recently, I've been cooling off from the "motion-based" stuff.  Whatever's in there -- plica, actual crap -- is still snapping, and remains a source of both irritation and pain.  Been sticking with the walking since it has the least flexion/extension, although it is more weight-bearing than the other stuff.

Above all, however, what has changed the most is that I am just trying to live my life.  For example, I joined an improv class which I knew was a bit of risk, but the benefits (spontaneous fun!) have far-outweighed the physical irritation.  I've been trying to make sense of all of this by writing (humorous?) articles about battling an injury whose rehabilitation has gone (hilariously?) awry.  I'm even trying to go back to school.  What type?  Haha, well, we'll see.

Be well.

PS  This type of stuff -- nasty anterior knee pain whose recovery has no obvious end in sight -- even happens to star baseball players, like the Phillies' Chase Utley.     

http://mlb.mlb.com/news/article.jsp?ymd=20110309&content_id=16874212&vkey=news_mlb&c_id=mlb

As a Mets fan, I'm not that sympathetic.  But as a fellow knee pain sufferer, I hope that he can get back out on the field and avoid crippling himself.


Title: Re: To scooter or not to scooter?
Post by: knee always hurts on April 17, 2011, 03:14:18 AM
Ooh, robotic surgery. Maybe when we hit the technological singularity someday, our robot overlords will be able to diagnose us instantly and perform a 2 minute procedure which will leave us feeling sweet and fine in a jiffy! That's if they don't annihilate their erstwhile creators first.

Long time, no see Sqsh. I'm sorry to hear that you're still having problems. It's the same story over here as well. At least you can get out in the world. I've had a heck of a time keeping my body in alignment, and so most of the time I'm in a lot (http://lot) of pain. Right now, I'm considering making an appointment at the Cartilage Repair Center here in Massachusetts to see if they can get me a diagnosis and possible treatment. I don't even know if the problem is cartilage but it seems likely at this point. Either way, Dr. Minas should be able to get me a decent diagnosis, I think.

More tests seem like a good idea. You can never say what a different perspective might do for you and your condition. Doctors are only human and if your problem does not lie within their area of expertise or interest then they aren't going to be too helpful. On the other hand, finding the right doctor could make all the difference.

I've learned that knees, and indeed bodies, are a strange thing. I pine for the days gone by that I had a decent, functional body. You don't know what you have until you lose it. There may yet be hope in my case but there isn't going to be some dramatic sudden change for the better. I'm in this thing for the long haul. It sounds as if that is case for you as well. Just remember not the overdo things as you don't want to end up back where you were before!

Best of luck to you!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on April 19, 2011, 02:36:23 PM
I, for one, welcome our new robot overlords!  Haha! 

You are right. I am fortunate to be able to get around and do stuff, albeit uncomfortably.  As I read more about this plica stuff, though, I am actually becoming more concerned about the long-term status of my knees.  Plicas appear to damage the cartilage both mechanically and enzymatically (they emit lots of noxious factors that eat away at that spongy stuff).  Then again, I am sure my entire synovium -- or whatever is inflamed/pissed off -- is doing the same thing.  But what is the answer? Cut it out? Let's see what R2D2 thinks.  Either way, I am going to make the best of it.  Just gonna try to live with what I got and be thankful that I can still see and laugh.

Sorry to hear you're still having serious problems. Do you have any more appts lined up? Or any new insights into what's going on?
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on April 21, 2011, 09:20:04 PM
While R2 would be perfectly capable of helping to fly an X-wing, I should think one of the many medical droid models might help! Maybe in a few decades. But that's a galaxy far, far away right now.  :P

I don't really have any new insights. The therapy has basically failed, so I'm looking for a surgical option again. The tissues are damaged to a sufficient extent that I'm think it's my only hope. I called to ask about a referral to a new surgeon, but my GP wants to see me first. That will be next Wednesday. From there, it might take any where from a couple of weeks to a couple of months to get the appointment, I'm suspecting.

I think you're right about the long term damage. Any kind of inflammation, even very low level, is going to damage tissues and cause degradation, even if only in the long term. I wish it wasn't so, but in many cases, it's pie in the sky to expect the situation to resolve itself, even with good physical therapy. The reality is that our bodies can only take so much, and if you exceed a certain level of damage, you're going to need some sort of intervention. That's why we have doctors. If every problem resolved itself we wouldn't need them. I've tried everything I can imagine and my situation has only worsened. I can only hope that there will be some treatment for me.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on May 03, 2011, 10:21:12 PM
R2D2 ordered a new MRI for my left (worse) knee.  He also looked at my old MRI and said that I could have a torn meniscus. Ultimately, he said that he could trim the fat pad and plica, but he didn't seem to be particularly enthusiastic about it ("it's a B+ surgery.")   He mentioned Scott Dye's neurosensory mapping experiment when he spoke of the the highly sensitive fat pad.  I'll get the MRI done in the next week.

I wasn't expecting much going into it.  The doctor was nice enough, addressing my questions about potential for cartilage damage and reservations regarding surgery.  Can't say I'm convinced a "clean-up" will help things out substantially.  But at least a new MRI might shed light on any unresolved issues.  Obviously, if I seriously consider surgery, I'll seek more opinions. Hopefully, I will get better in the meantime.  We'll see.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on May 05, 2011, 05:05:47 PM
Wow, sounds really advanced. Just don't let the robots get into your brain. I repeat, never let them into your head! You should be alright otherwise.

I've come to the conclusion that most knee procedures are really "salvage" procedures, meaning that there is little guarantee as to the result. The procedure could be a total failure, or even make things worse. Or maybe, things improve dramatically. You just don't know. What I'd want to ask any surgeon is to delineate the relative risks. Why is it B+? Is it just that the results are unpredictable?

The good news as I see it is that knee surgeon is probably amongst the safest surgeries. Your chance of facing life threatening complications is exceedingly slim. The biggest risk is probably arthrofibrosis. At least in my case, I consider it well worth the risk at this point.

I called my doctor this morning and he said that he set up an MRI at the CRC! He is quite amazing. It'll be good to know that not only am I getting an MRI, but I'm getting one with the latest technology and one that is specifically calibrated for the knee. Hopefully I can finally get a diagnosis. I'm only half eager about getting this done, knowing that it is well past time to know, but also frightened by what it may show. I'm hoping I'll get the MRI done in the next couple of weeks, but the doctor should be getting back to me on the scheduling by later this afternoon. Let me know what shows up on your radiology report!
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on May 07, 2011, 03:20:54 AM
Great to hear, KAH!  Let's hope for the best!

So advanced, I know...  B+? I know. One part: not all that predictable.  Second part: it's usually not just the soft tissue; something more complex is going on (Translated: "The heck do I know!"). 

I'll let you know about the radiology report.  I am having this one at a different facility (HSS now; Cornell the first time).  I'm curious to see if there is any cartilage damage to note as none showed up a year ago. (No contrast the first time; I don't know if I'm getting contrast this time) Maybe the past year of inflammation has chewed some stuff away.  Then again, MRI's, as we all know, aren't all that predictive of cartilage damage.  At some point I think I will need to get the other knee checked too.  I'm guessing there's at least an enormous suprapatellar plica there, though.

A part of me is guessing that there isn't going to be much or any damage.  I think I'm in a bizarrely nasty bout of soft tissue inflammation, that's it.  My synovium is a giant plica, my guess. 

Best of luck!



Title: Re: To scooter or not to scooter?
Post by: knee always hurts on May 07, 2011, 06:09:34 AM
Are you leaning towards the surgery if the MRI results come back with something that the surgeon thinks they can treat? I know in my case, I was dead set against any surgery at first. But it weighs on you after a while. At some point, you start to think, if this has a decent chance of restoring some pain free, or even mostly pain free function, it's worth it. I would just really make sure I found out about how my prospective surgeon deals with arthrofibrosis. That seems to be the main complication of knee surgery. It may be less of a problem after an arthroscopic procedure, but still, the potential is there. I mentioned my concern to my aunt who has had multiple knee surgeries and was shocked to find out that she doesn't even have 90 degrees ROM in her operated knee! This is years later, so it isn't ever going to change. It sounds like, if it is treated correctly early on, most of these complications can be prevented.

http://www.kneeguru.co.uk/KNEEnotes/node/633
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on May 07, 2011, 06:58:27 AM
Surgery is something I'm considering.  As you mentioned, I'm concerned about arthofibrosis  Honestly, it feels like have garbage under my patella.  Am I better than I was in the autumn? Of course.  But if I did anything resembling what I did during the summer, I would be just as bad if not significantly worse.  Then again, that I am no longer in constant pain is, relatively speaking, awesome.  So: Am I willing to risk arthrofibrosis or total pain in the hopes of restoring myself to more normal function?  Difficult question to answer at this moment.  Hopefully the new image will reveal something.  Maybe the radiologist will accept that plicas can be pathological and, therefore, of note (assuming that HSS's MRI-robots can visualize plicas).

If I could have a recovery like this person (she had plica + nasty, general synovitis), I would bow to our robot overlords. (A post taken from a runners site: http://www.runnersworld.com/community/forums/injury-prevention/injuries/re-plica-syndrom)


I got plica syndrome in 2005. It developed when I started running again after a pregnancy (bones and ligaments relax during pregnancy and continue to stay relaxed with breastfeeding).

Anyhoo. I was first diagnosed with "Runners Knee" (which is patellar subluxation irritating the cartilage) and advised to stop running by the Sports Med physician. I started cross-training with weights and biking and entered Physical Therapy. After about 2-3 months, it was just getting worse and worse, so I had them do an MRI. MRI showed torn mensicus, so I signed up for arthroscopy. Roll Eyes

During the procedure, the surgeon found my mensicus intact, however my plica tissue was inflammed and enlarged. He scraped out the portion that had been pinching between my leg bones and I rehabed from that for another 4 months. Rehab for arthroscopy is usually 6-8 weeks, but the plica was so inflammed that I had also developed synovitis (inflammation of the thin tissue lining of the knee joint).

Sooo. long story short, rehab made it worse. cross training made it worse. arthroscopy helped some. The key to complete recovery for me was this:

1. Rest completely for 2 weeks, followed by cross-training that ALSO rested the knee joint completely. I swam with my upper body and let my legs drag behind. I focused on upper body weight training to take my mind off running.
2. Anti-inflammatories - a heavy dose approved by my physician. In fact, I first tried Ibuprofen without success. I switched to Naprosyn and it worked like magic! After about 4 weeks of Naprosyn antiinflammatory treatment, we slowly cut back, then slowly added in running.

My case was pretty extreme - especially since the mis-diagnosis and biking and PT exacerbated it.
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on May 08, 2011, 05:52:08 AM
Funny thing is, the right knee with the junk under it has change quite a bit in the last few months. Last summer and fall, I couldn't even sit for more than a few minutes without the knee severely aching. That is no long the case, which is surprising. I guess that those sorts of things can improve in the long term. Yet, if I extend my knee, it still feels like bands of tissues snapping under there. I have a feeling that if I was to do a lot more, the pain is going to come right back. But that is a later concern. It's pretty cool that I can actually sit normally without a tremendous amount of pain now. It's not comfortable, but it's also not unbearable.

That does sound like an encouraging case. But you just don't know if you're going to be that person. It's always going to be a roll of the dice.

Hmm, I need to learn to read more carefully. I'm sorry, but for a second I had a big  ???  ???  ??? moment. I got lost somewhere at the breastfeeding part, imagining some alien species from Alderaan or something. Maybe you fled the planet before it got superlasered. I'm thinking, in what galaxy can a guy breastfeed! Then I'm like, oh, that's from that link he posted. Gosh, that was strange for a moment, though.   ;D
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on May 12, 2011, 08:53:37 PM
Haha! Nope.  No breastfeeding...yet.

Just got a call from the doctor who took a look at my MRI.  He noted that my left knee has some scarring on the lateral side (I think over the LCL, but I am not sure, although I imagine this was a result of the original twisting of the knee last May where it "bowed out").  He also said that I do have a small tear in my MCL which he can't do much for.  He didn't note any cartilage damage or chondromalacia, which I know doesn't mean much, but at least my cartilage isn't so obliterated that it is easily visible by MRI.

In the end he recommended the scope: cleaning up the fat pad and plica.  I asked him if this was an unusual case, where everyday things were affected.  He said that that I was a pretty complex case, as he has mainly operated on "soft tissue" patients whose difficulties laid almost exclusively in the athletic realm.  I expressed my reservation regarding surgery given the ostensibly "hyperactive" nature of my tissue.  He said that he couldn't make any guarantees -- I may get worse -- but that I would more than likely get a decent dose of relief without that scarred up fat pad and plica. 

In closing I asked him if I risked any further damage if I were to give my knee another 3 to 6 months.  He said no, and suggested that I contact him after the summer.  And, I suppose, that's what I am going to do.

In the next couple months, I will solicit a few more opinions, and probably give another Paul Ingraham rest period a shot (lots of "motion-based rest," voltaren, etc.)  I might even bring back the old crutch to walk up to my fifth floor apartment.  I should get the actual report tomorrow. Let's see how things go.
Title: Re: To scooter or not to scooter?
Post by: Stasha83 on May 13, 2011, 12:28:13 PM
Hi there

I have been reading through your posts on and off for a while now but feel I should add my two pennys worth now. I had a surgery involving my fat pad last June. I now have Arthrofibrosis and a wrecked knee and will never make a full recovery. At the grand age of 27!

I think it may be worth you having a look at a few of my posts. They are not very well written but it may be helpful for you to see what it's been like for someone first hand as such.

I am sure I am just a very un-lucky case and most people would not encounter the complications that I have. Of course I do not want to put you off as it may well be the solution that you have been looking for.

Another thing I would add is that the fat pad is the most sensitive part of the knee. My physio told me a story about an OS who scoped his own knee without any anesthetic or pain relief. He prodded the meniscus, ligaments etc and felt no pain. He then prodded the fat pad and passed out due to the pain it caused. Mine certainly did not appreciate being operated on despite masses of pain relief!

I wish you the best of luck and hope that you make a great recovery.

Stasha
Title: Re: To scooter or not to scooter?
Post by: knee always hurts on May 18, 2011, 12:27:29 AM
I think that makes a lot of sense, given the potential for complications. Best to avoid surgery altogether whenever possible, I always say!

I think it's a bit uncertain as to how much inflammation is involved in something like an impinged plica. But to the extent there is any, it is almost certainly a very low level inflammation. I'd think that it would take years before it made much of an impact. It's good that you don't have any cartilage damage, at least that the MRI picked up. One thing you can do is to press your patella firmly while flexing and extending the knee. You should experience a distinctive grinding sensation, like there is sandpaper inside your knee if there is cartilage damage. If you don't feel that, then I'd say it's nice and smooth in there.

That being said, inflammation definitely does damage cartilage. As I've said before, I believe that's what happened to me. I was in agony for about a month, so that's when it happened I suspect. It's disconcerting when you realize that life is a physics simulation that only runs in one direction. We usually feel like everything is the same because of our body's regenerative capacity. When that doesn't happen though...

Your surgeon sounds decent. Let's hope you can work with him to figure out what the best course of action is.
Title: Re: To scooter or not to scooter?
Post by: SqshPlr8 on May 20, 2011, 06:37:09 PM
Stasha,

Thank you for your comments.  I read over your posts (which were detailed and well-written, by the way!). I was wondering how are you doing after your last surgery?  I have more detailed questions, but will ask them later.

KAH,

Thanks for the encouragement.  R2D2 seems like a reasonable guy, but I am going to consult with more patellofemoral docs -- perhaps even Dr. Dye -- and see what they think.   In the meantime, I'm going to give the voltaren gel and "crutch-up-the-stairs-routine" another shot.  Fortunately, I am in a better place now than I was in the summer/fall, so maybe it will help out to a greater extent.  That said, I am in the midst of a bit of a flare after digging holes in a park last Saturday. 

How are you doing?  Do you have a scheduled MRI and/or doctor appointments yet?  Have you been able to resume any more normal aspects of your life, even if you must use some form of help (e.g. crutch)?

Take it easy.

Sqsh

Below, I included the report.  Essentially what the doctor said, but I figured I'd throw out the "official" one.

Report (Left Knee MRI, no contrast)

The anterior and posterior cruciate ligaments are intact, as are the collateral ligaments and popliteus tendon insertion.  The proximal medial collateral ligament is moderately scarred thickened.

Evaluation of the menisci demonstrates no discrete medial or lateral meniscal tear.  The meniscocapsular junction of the posterior horn of the medial meniscus is mild to moderately scarred.

Cartilage over the medial and lateral femorotibial compartments is preserved.  There is no discrete chondral thickness defect over the trochlea or patella. 

The extensor mechanism is intact.  There is a trace amount of fluid within the joint, without an overt synovitis.  There is no fracture or osteonecrosis.  There is a trace amount of fluid within the deep infrapatellar bursa.

MRI of the left knee demonstrates a moderately scar thickened proxima medial collateral ligament.  There is no discrete meniscal tear, chondral defect or synovitis.  The meniscocapsular junction of the posterior horn of the medial meniscus is mild to moderately scarred.

Soo, scarred MCL and meniscus.  Bit of fluid.  I should be doing depth jumps in no time, right?