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Offline theycallmej

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I feel helpless
« on: May 05, 2010, 06:19:54 AM »
Hey guys.

I'm writing tonight because I need to get this all out, it's been in my mind every single day the last few years and it's bugging me constantly.

What I'm suffering from right now I can't name-- I don't know what it is, but it is nagging and always bothering me. I have a knee problem and what is going on is that it bugs me to extend the knee-- I'll be sitting down and I'll straighten the knee and I'll feel a pop just before extension (I can hear it sometimes, but most often I feel it). I get pain at times, often when standing and walking around, but I'm bothered most when I'm doing lunges or squats it seems. I just want it to go away, I want some relief and I can't find it anywhere I look.

This all started when I was 16-- I was doing some one-legged squats with poor form at the time and on extension my knee made a noise that sounded like tin foil. I didn't know what it was so I rested it, but probably didn't rest enough. The knee felt funny afterwards and I stupidly continued to run and train (no squats though). My knee just stayed the same-- clicking and popping at times, nothing really to note though. One thing that happened for that period of time is that I'd feel an odd sensation in the knee when I'd be standing, so I would push my leg forward and put my weight forward and the knee would seem to pop back in place-- it felt good for a short while then would just feel loose. I don't know what it was.

I went to a few doctors-- they took x-rays and said they found "minor arthritis" in the knee but that really didn't reveal any information to me-- when I asked the doctors again, they said that I looked perfectly fine. I wound up asking again and they said I might have poor patella tracking so they recommended physical therapy. On going to physical therapy, things went pretty well, I had hope for the knee to get better and it did after a while. I didn't run during physical therapy, then one day went and ran with some friends playing ultimate frisbee and my knees felt fantastic. I kept up with physical therapy but tapered off. My health insurance was over soon after that so there wasn't really a reason to go. Just before my health insurance ended i went to see an orthopedic surgeon. He did a patella grind test and I confirmed that it hurt in both knees. He told me that I'd be okay, it was just general change over time and that I'd be okay. That did a lot to console me, I wish I could see him right now and see if he would say the same.

About a year has passed now and things have changed-- I had a period of time in the summer where my knees felt great-- the weird thing was, I wasn't doing my physical therapy exercsies, then I went on a very, very long bike ride out of the blue and my knee started acting up. Up until the the middle of summer it was just my left knee bugging me-- suddenly my right knee started acting up. It seems they only act up one at a time now anyways-- but the same symptoms began developing. Anyways, I tried orthotics, all of these different padded or overpronation shoes and more and i didn't find any benefit. Things have gone on almost without a break to now. I have some pain, it's mostly a dull ache in the kneecap and sometimes I get a quick "jab" that will occur somewhere around the knee. I get creptius and grinding at times after squatting a bunch, but I've committted to doing my physical therapy exercises.

I take glucosamine and chondroitin and have had no real good effects that I can measure. The only thing that seems to have helped a good degree is joint juice, but it might be a placebo effect for me.

Can anyone help me figure out what to do with this? I'm sans health insurance right now and one of my major goals in life is to hike the appalachian trail-- is it still possible to do with knees like this that pop and feel funny and ache quite a bit of my time? It just feels like my attention is on them all day, even just sitting and more, they either feel tight or loose or just plain wrong.

Have had MRI done by the way-- they said they didn't find anything. :-/. Either way, that was a year ago and quite a lot could have changed.

Offline Silkncardcrafts

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Re: I feel helpless
« Reply #1 on: May 05, 2010, 10:21:41 AM »
Hi there,

It sounds like you may be suffering from some maltracking problems.

I would recommend going to see someone that specialises in knees, preferably a sports physician.

If you have patella maltracking problems MRI scans are next to useless. The best types of scans are CT scans and plain x-rays.

Hope this helps.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline crankerchick

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Re: I feel helpless
« Reply #2 on: May 05, 2010, 01:35:04 PM »
Hi. I remember when you posted a while back. I agree with Kirsty and I think I said this when you posted before, but it sounds patella related to me too. Not sure how this can work out with you not having any medical insurance, but it sure sounds like you need a good orthopod or sports med doc along with a good set of xrays (sunrise/merchant, lateral, and full leg length) and perhaps a CT scan.

You can try McConnell taping to see if that helps. If it does, that might be an indication that it is indeed a tracking problem. A good brace might help too.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline kscope09

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Re: I feel helpless
« Reply #3 on: May 05, 2010, 01:43:34 PM »
The pt should be able to tell you if your knee is tracking and some Mcconnel taping should help.  I've had good results iwth it myself
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline theycallmej

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Re: I feel helpless
« Reply #4 on: May 05, 2010, 05:22:43 PM »
Hi. I remember when you posted a while back. I agree with Kirsty and I think I said this when you posted before, but it sounds patella related to me too. Not sure how this can work out with you not having any medical insurance, but it sure sounds like you need a good orthopod or sports med doc along with a good set of xrays (sunrise/merchant, lateral, and full leg length) and perhaps a CT scan.

You can try McConnell taping to see if that helps. If it does, that might be an indication that it is indeed a tracking problem. A good brace might help too.

Thanks for that-- I'm thinking it is maltracking as well. I get a lot of conflicting information on the internet-- many people say to strengthen the VMO and the quads and then others say the quads may be too strong and that could cause the maltracking. Others say that it is impossible to strengthen the inner quads without strengthening the whole quad muscle so it is useless.
I have previous x-rays from a year ago, I could possible get ahold of those and post those online if anyone would be interested in viewing them? Or to know the results?

Offline kscope09

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Re: I feel helpless
« Reply #5 on: May 05, 2010, 06:17:31 PM »
You can just work the vmo but its not easy.

Sit on a fairly high seat, you that your legs can dangle.  Put the heel of your right foot into the arch of your left.  You squeeze the two together in this position whilefocussing only on tensing the vmo and keeping the femurs pointing straight forward.  It is difficult because it is hard to isolate the vmo.  You can do it with a ball between the knees and it works very well.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline smillie

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Re: I feel helpless
« Reply #6 on: May 05, 2010, 11:50:20 PM »
You're right, there is a lot of conflicting info out there about how to treat patella tracking.  Old school is to strengthen the VMO.  And as you said, it's hard to target VMO without strengthening all the quads.  My PT has me doing straight leg raises, but after I set my quads, I turn my foot inward a bit and then lift.  It puts a little more emphasis on the VMO, for whatever that is worth.  But my current PT also stresses the need to strengthen the hips/glutes in addition to the quads and that is backed up by a lot of current info that I've found on the internet.  So we're working on hips/glutes as much or more than the VMO that my OS requested.  Patella issues are hard to rehab and can be very frustrating.  Hang in there!
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline crankerchick

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Re: I feel helpless
« Reply #7 on: May 05, 2010, 11:54:32 PM »
Hehe and that just goes to show. My physio says to turn the foot out, not in for the VMO. In is for the VL. My trainer says if you desire to turn the foot in to work the VL, only do it ever so slightly.

That said, all my life i've been told to strengthen the VMO and have spent years in PT doing what they say. It turns out that was a load of crap for me because my problem is structural. Got that fixed and now my rehab consists of overall strengthening of quads, hamstrings, glutes, hips, and calves and I couldn't be more satisfied with my knee.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline KW

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Re: I feel helpless
« Reply #8 on: May 06, 2010, 01:15:27 AM »
Hehe and that just goes to show. My physio says to turn the foot out, not in for the VMO. In is for the VL. My trainer says if you desire to turn the foot in to work the VL, only do it ever so slightly.

You are correct....It is out to work the VMO.  When doing a SLR if you turn you foot out to 10 o'clock (left leg) or 2 o'clock (right leg) you will get a really good workout for the VMO.  One of the best ways I have found to work the VMO when injured or recovering from surgery.
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline smillie

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Re: I feel helpless
« Reply #9 on: May 06, 2010, 06:12:16 PM »
OK, that's strange!  Maybe it isn't the VMO we're targeting?  I'm only turning it in slightly and it isn't like turning it to 2 o'clock.  It's a different motion?  Anyway, it seems to target what he's looking for.  That said, the "go to PT and strengthen your VMO" routine didn't work for me the first time and it isn't working for me this time either... so far...
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline theycallmej

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Re: I feel helpless
« Reply #10 on: May 07, 2010, 12:39:26 AM »
This page has some good exercises for patellofemoral syndrome. I've been doing these and they worked very well at first-- I think I overdid them though, so I'm cutting back and resting and then I'll progress slowly.
http://www.fpnotebook.com/Ortho/Knee/PtlfmrlSyndrm.htm

Scroll down, exercises are in there.

As far as targeting the vmo with leg raises, I was always told to turn the leg out. To what degree though, that's the real question. I've been told to turn it out as far as you can and then I've also been told to just turn it to 10 o-clock or 2 o-clock depending on the leg.

I have a few pages for you guys to check out-- let me know what you think of them if you have time:
http://www.posetech.com/
http://www.drbookspan.com/KneePainArticle.html

I found the pose walking style has helped my knees considerably, enough that I'm not getting the sharp pain as much when walking, and then I'm trying to avoid doing lunges and squats, even though it is recommended in the bookspan article. Squatting just hurts my knees and lunges makes them ache as well. If I need to pick something up, I tend to bend from my hips and almost do a stretch like a toe-touch. This might be bad for me, but it seems to stop immediate pain-- anyone have an opinion on that?

Offline smillie

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Re: I feel helpless
« Reply #11 on: May 11, 2010, 02:25:05 AM »
Hehe and that just goes to show. My physio says to turn the foot out, not in for the VMO. In is for the VL. My trainer says if you desire to turn the foot in to work the VL, only do it ever so slightly.

You are correct....It is out to work the VMO.  When doing a SLR if you turn you foot out to 10 o'clock (left leg) or 2 o'clock (right leg) you will get a really good workout for the VMO.  One of the best ways I have found to work the VMO when injured or recovering from surgery.

Cranker and KW, you had me thinking my PT and/or I was crazy.  But no, the way he has me turn my foot inward actually targets the VMO.  I am not rotating my toe like on a clock to the 2:00 position (left leg).  I am turning my foot inward from the ankle like a door on a hinge.  This actually targets the VMO.  I played around with turning my toe like you described to 2:00 and 10:00 and I see how that works.  But the way he has me doing it actually works better for me than turning my toe out and it is, in fact, working on the medial side of my quads.  Whew!  I didn't want to strengthen the wrong area.  I'm already too tight over on the lateral side...   ::)
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled















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