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Offline knee always hurts

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Re: Sore knees, no diagnosis
« Reply #15 on: July 13, 2010, 03:35:01 PM »
I've had a major setback. I haven't been doing anything differently over the past few days, but my knee is still getting worse. I've even been getting help with virtually all everyday tasks. I'm only walking to the bathroom and back, perhaps transferring my position a few times during the day, and then going to sleep. It is about as minimal a level of walking as you can get. As I mentioned, I'm even using a cane. But still, I can't walk at all without triggering the pain/inflammatory response. I'm at rock bottom here and I don't know what to do next. Literally, this morning I crawled out of bed, used a stool to prop myself up to the toilet and do my business, then crawled down the stairs with the stool, crawled over to the computer, and pulled myself up here. And here I am now. How did I know it would come to this?

I don't know if this is going to work at all. I don't know how long I should try it for, and if it fails, I don't know what I should do next. I know from past experience, as I mentioned, that a period of non-weight bearing seems to increase the tolerance level of the joint. But to what extent? This seems to be about as severe as this can get. I'm really starting to think now, what if all else fails? Do I need a knee replacement? I certainly can't go on like this forever.

My birthday is next month. I'll be turning 26. A year ago I'd never even heard of PFPS, and thought the only way that something like this could ever happen would the passage of a lot of years (maybe when I'm 75), a catastrophic accident where my knee is shattered, or something really horrific like MS. This wasn't on the radar screen. I knew young people didn't get osteoarthritis, so that wasn't an issue. But then it happened. And here I am.

Yesterday, my sister came over to visit. She is a nurse, and I was explaining to her the situation that I'm in, and the path to recovery. She kept saying, "there has to be some treatment, or something else you can do." I just kept explaining that there isn't anything. I think everyone around me feels as helpless as I do. I used to walk all the time with my sister. I guess you could say that we were "walking partners". It was just really hard to explain to her that we might never do that again. Indeed, that I might never walk again at all. I'm sorry that I sound so melancholy here, but I'm truly at a loss. What do you do if any amount of walking is too much? What is the path to recovery? If, as Paul Ingraham writes, this path involves not "biting your cheek", then it seems like I'm going to have one very sore cheek for too long a time to contemplate. I've tried to chew, and I just can't anymore.

So that is the story now. Maybe I'll try to walk again tomorrow, I don't know. I know you've mentioned that it's been up and down for you as well. At one point you said you were able to walk a few kilometers. Were you ever at a low point like this prior to doing that? I'm just trying to keep my sanity here, but the prospects now are truly frightening to me. I feel alright as long as I have hope, but that was seriously deflated yesterday. I'll post when I start walking again, and I hope to have better news. But you just never know. If this doesn't work, then it seems like the end of the road for me. Like the poor souls in Plato's Allegory of the Cave, condemned to stare at crude shadows of a real human existence until the end of time, the real form being denied to me forever. I suppose in their case, they never knew otherwise. But when you know what you are denied, it is a far greater torment.

Maybe the Buddha is right. Maybe there is no abiding essence to anything, no "real form" which is being denied to me, just an endless round of sense impressions which arise and then fall away. Just an endless round of suffering, of stress. The arrow which has pierced me, is not in my knee but in my mind.

Offline knee always hurts

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Re: Sore knees, no diagnosis
« Reply #16 on: July 14, 2010, 04:02:43 PM »
Hello,

I was attempting to do some research this morning into PFPS and I came across a sports medicine site which mentions the "tissue homeostasis" theory. Here is the link: http://www.clinicalsportsmedicine.com/chapters/24b.htm

I noted that they actually gave this condition a name, peripatellar synovitis. I googled this condition, and what do you know? A link came up to a medical journal article written by our good friend, Dr. Scott Dye. In it he outlines the theory which has been expounded upon here over the last couple of weeks. But more interestingly, he describes a surgical procedure called a synovectomy that can actually remove the swollen and inflamed synovial tissues. I don't like the idea of surgery if it is unnecessary, but it may be coming to that. It seems utterly absurd to have a knee replacement if this far more conservative procedure could give me the results I'm looking for.

My question is this: Given that Dr. Dye's theory is on the cutting edge, how can I find a surgeon who would be familiar with this procedure, and willing to perform it on me if all else fails and it is in fact medically indicated? I don't want to waste my time consulting with a orthopedic surgeon who is only going to recommend a lateral release or some other such useless or counterproductive procedure. If I'm going to have surgery, it needs to be as close to certain as possible that it's actually going to work. Here is the link to that journal article:
http://docs.google.com/viewer?a=v&q=cache:sIxlKJaiqGYJ:rehabeducation.com/main/wp-content/uploads/Therapeutic%2520implications%2520of%2520tissue%2520homeostasis.pdf+peripatellar+synovitis&hl=en&gl=us&pid=bl&srcid=ADGEESgJblYrmnEPa2PN31zzj4W09zVDfFmScJ4ecwcRm37IhjMt7u90rdhitEmaDRGt_6-h9MycFKDYKguOWrMs3tz-AsjhPWb9m4uZGxNuHVkpyKKDMggbbajsQAcN1b8bYLTxaEi3&sig=AHIEtbQBlnP0zzXSVU7HZrcFbzOb2qldhQ

If you could, ask your OS about this procedure. I'd be willing to bet, though, that they've probably never even heard of it. I think this procedure should be a last resort, but at least there is potentially something that could help.

Offline highroller

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Re: Sore knees, no diagnosis
« Reply #17 on: July 15, 2010, 08:29:17 AM »
I'm also starting to lose hope that complete rest will facilitate repair and expansion of the envelope of function. Like yourself, I literally couldn't be restricting my movements any more within the limits of practicality. I haven't left my apartment for nearly 3 weeks now and for the last week, after abandoning my experiments with light repetitive movements, I have spent almost the entire day lying in bed save for the occasional hobble to the toilet or kitchen. Despite this, I can't detect even the slightest improvement. If anything the pain is getting worse. My sleep is quite disrupted now which wasn't the case previously. It's possible that the healing process is underway internally and it will take a bit longer to manifest itself symptomatically but it's hard to believe that my condition would be static or regressing at this stage.

I will persevere until my OS appointment on July 26 and review the situation then. I will ask my OS about the synovectomy procedure. Apparently there were no signs of any synovium damage or inflammation from my arthroscopy but perhaps there are tests that can be conducted to diagnose issues that are not visually detectable. From reading Dr. Dye's papers, it does seem to be a tissue that is heavily implicated in PFPS. As I mentioned before, I am also keen to get a bone scan done as that can reveal markers of increased metabolic activity consistent with irritation of osseous tissue.

As for my low points prior to recovering enough to walk a few km's, looking back, it's basically been a series of lower highs and lower lows with my current state the overall nadir. Prior to surgery in April, I was at the point where I could walk maybe a block or two in considerable discomfort. After surgery, I had no option other than rest because of the post-operative swelling but I was weight-bearing after a few days and at the 2 week mark I could walk a few blocks with much less pain than immediately prior to surgery albeit with a certain amount of discomfort still present. After that, I gradually extended my walking range over a few weeks until the setbacks took hold. The period from Oct last year to April was a gradual oscillating decline in retrospect but the intermittent recoveries were enough to keep me optimistic. It's only now that I am really starting to confront the reality that this could be a long-term or permanent condition that may even deteriorate further. Not a pleasant prospect.

I too have been dwelling on matters philosophical and spiritual of late but my attachments to the world of form are winning the struggle for now. Perhaps this ordeal will spur my conscious growth to a place of enlightened contentment unruffled by the tribulations of my physical avatar. But probably not - most likely I will continue to feel sorry for myself and whinge up a storm!


10/09: knees sore from gym, MRI ok, fluid in fat pad
01/10: knees worse, OS recommends PT
03/10: barely able to walk
04/10: arthroscopy left knee, no problems found, fat pad trimmed
08/10: begin PT, rheumatoid arthritis ruled out
09/10: neuropathic pain diagnosed, prescribed Amitriptyline

Offline kscope09

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Re: Sore knees, no diagnosis
« Reply #18 on: July 15, 2010, 11:17:53 AM »
You really need the opiion of pt or surgeon.  I don't think complete rest is the answer, but no-one on here can say do this exercise or do that exercise because you need to be examined and have thwem given by an expert.  resting for weeks on end is very dangerous because your uslces will waste quicker than you will believe.  The muscles went right down on my left knee which hurt like hell but was still walking and doing stairs, and I wa still exercising them.  I think you need urgent advice from someone qualified very quickly before things turn really nasty.  Atrophy is muscle wasting that most commonly occours after surgery and it is very ahrd to get he muscles going again and this can happen while you are exercising.  If you don't exercises for weeks and you get true atrophy it will eprmenantly waste your muscles and however hard you try you will not get the strength back.  I don't want to frighten anyone but beware.  The more the muscle wastes, the more pressure is carried by the joint when you stand or walk and the more damage is done to the cartliage.  I know that pFS isn't as simple as some people make out but a good pt should be able to help in the maentime.

best of luck to both of you.
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 Lottiefox

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Re: Sore knees, no diagnosis
« Reply #19 on: July 15, 2010, 11:32:02 AM »
I have to say that I tend to agree with kscope - I have PFS (with confirmed grade3-4 cartilage lesions on the kneecaps thru MRI)  and whilst SOME rest from activity that aggravates the symptoms is sometimes essential, doing nothing simply isn't an option. PFS sets in for a HUGE variety of reasons and yes, inflammation inside the synovium is an issue but whether this is a cause or a symptom is not really known. What IS known that without strong and effective muscles around the knee it has no natural brace or support. Those braces with the cut out holes for the patella? They try and help the natural brace effect of the muscles. Even if you're avoiding activity you should be doing quad exercises, hip abduction and adduction, calf stretches, ITB stretches, hamstring work and stretches and making the muscles fire. Lying in bed is a recipe for less muscle activity, increased instability of the patella and probably depression to boot!

Just my two penneth worth! And I do know JUST how frustrating PFS is. Trust me!!  :D

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline kscope09

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Re: Sore knees, no diagnosis
« Reply #20 on: July 15, 2010, 11:50:05 AM »
You must go and see someone ASAp but for now you could try the straight leg raises as they can't realy cause you any damage, just start off with a few and increase gradually.  What kind of symptoms are you having?  Pain under the kneecap? with a large helping of rice crispies?  Do you have medial or lateral pain as well?  Do you ahve anterior pain that goes down the tibial tuberosity?

Don't think about srugeries just yet, see someone who can take a look at you and see what they say.  If it is PFS they might say they can get you back to normal in 3 months but the more you rest now the harder it will be.
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 knee always hurts

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Re: Sore knees, no diagnosis
« Reply #21 on: July 15, 2010, 02:47:47 PM »
I'll mention that sometimes the pain feels worse when you are going non-weight bearing for a while. Still, it seems that the "envelope of function" will be improved upon resumption of activity. With this severity of the condition, not that much better, though. So take it as easy of you can when you resume walking. If you weren't getting any sharp pains, there should be some improvement.

If you are having trouble sleeping, I'd recommend an over the counter sleep aid. I've been taking a pill with 25 mg Diphenhydramine HCl, and I've gone from being fortunate for getting 4 hours of sleep a night to now regularly getting at least 7 or 8. If the pain is too much for you to fall asleep initially, ice it before bed.

I hear you when you speak of a new "overall nadir", with high lows and low lows. The state that I am now in was triggered when I brilliantly thought that I was perhaps better enough for some more extended walking and even some squats. Well I was in for a pleasant surprise that night. I felt some of the worse inflammation that night that I had ever experienced. Since then, my envelope of function is seemingly permanently altered. Of course, I haven't tried "everything" yet. My recommendation would be, to use what might be one of your last opportunities here to try things a little differently. Progress even more slowly than you have in the past. As much as you'll want to do more as quickly as possible, you know it is anathema to recovery. Remember, as saveyourself.ca points out, even if an activity is pain free, you might be bumping up again the outer limits of your envelope of function. This makes you quite vulnerable to relapse of symptoms. But the fact that you could increase the envelope at all should give you some hope.

Good luck with the bone scan, hopefully it will help you understand finally the location from which the pain is emanating. If it's not the fat pad or synovium, though, what else could it be? The actual bone tissue itself? How would that be treated?

To the other posters, thanks for your two cents. I fully understand the dangers of muscle atrophy, but am at the end of my rope. Both highroller and I are not able to do any level of activity without triggering a pain response. This means that we can't even walk to the toilet without risking worsening the condition. What I'm doing is a last ditch effort to open up a larger space of function so that rehabilitation is possible. What good is my quadriceps if I can't walk anyway? I'm completely disabled right now. I can't go anywhere or do anything. My life is at rock bottom. There seemed to be no prospect that what I was doing before would ever work. So this is what I'm doing. Perhaps I'll try to integrate those straight leg raises, though. If something could prevent atrophy, that would be a positive thing. But I don't see the alternative to what I'm doing. If you have a better suggestion, I'm open to it. But continuing to antagonize the irritated tissues doesn't seem like a good one.

My plan right now is to try to walk again tomorrow. I honestly have no expectations at this point, but if I could just get through a couple of days without pain, I might have a chance. We'll see.

Offline kscope09

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Re: Sore knees, no diagnosis
« Reply #22 on: July 15, 2010, 03:09:25 PM »
I'm really sorry about this, really!  I know what its like when people better off than me tell me what I should be doing and it feels terrible.  I like you have a real problem with depression and feel like tearing my hair out sometiems because my life isn't what it used to be and I'm trying to get back what I can but I know I'll never be the same.

I think you've really got to get to a doctor, a pt or a surgeon as soon as you can or at least speak to someone over the phone.  I don't think complete rest is the answer, maybe a couple of days but no more.  After my surgery I was told to try to walk as normally as I could and not to try to limp, which was impossible.  When you walk try to do it as slowly as you can and take small steps, don't try to march around as you might have when you are well.  The cane is a god idea though to help with balence and maybe a pair of crutches will help you get about for a week or two.  When my left knee flared up in May the pt told me to use crutches for a week and just get a bit of weight off it but still keep it moving and do exercises.
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 knee always hurts

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Re: Sore knees, no diagnosis
« Reply #23 on: July 15, 2010, 04:32:35 PM »
kscope09,

Thank you for your comments. I certainly agree that too much rest could be counterproductive. Honestly, I don't think I'll be doing more than 2 or 3 days of rest at this point. That should do the trick, and if it doesn't I'm really out of options. I'll try this for a few more weeks I think, and then it's time to enter the medical system. I've just read so many horror stories of people whose condition was worsened by surgery, and I'm doubtful that PT could do much for me. I suppose they could pump me full of narcotics, but is that really a worthy life? I don't think that's something that could continue indefinitely, anyway. This is the most frightening thing I've ever faced in my young life. I know I have a long road ahead with no certain prospects. But for now, I have to keep my hopes up. I don't think I could live the rest of my life like this.

Offline kscope09

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Re: Sore knees, no diagnosis
« Reply #24 on: July 15, 2010, 04:47:28 PM »
To be honest I thnk from what you've said you seem ready for the medical system, by that I mean the physio because you certainly don't want to jump into surgery.  i think you shouldn't even contemplate surgery at the moment.  Just take things one step at a time and get a diagnosis.. Mris, x-rays, even just examination by the right people will  all be helpful.  With me I had the scans and the pts opinions and  they all said I was fine and to stop wining.  I saw a surgeon and he took a look inside and found all manner of nasties, just read my signiture.  Now when I go to doctor I get taken a bit more seriously.
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 Snowy

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Re: Sore knees, no diagnosis
« Reply #25 on: July 16, 2010, 05:32:24 AM »
As a fellow PFS sufferer, I have a huge amount of sympathy for what you're going through - I know that feeling all too well when the knees just feel like a giant pair of rotting teeth.

However, I have to echo the concerns that Lottie and Kscope09 have expressed about the total rest regime. While I'm no expert, nothing I've ever been advised over my years of treatment for PFS indicates that a total avoidance of all activities is a good idea for this condition. While avoiding certain activities will undoubtedly help with inflammation and pain, the muscle atrophy around the knee resulting from total rest is very likely to end up making things worse. I would seek medical advice ASAP, rather than continuing on this course of (in)action.

I did notice that earlier in the thread you discussed synovectomy, and were concerned that it was a cutting edge procedure that would not be widely available. The good news is that if this is the right route to help with your knee issues, it's not an uncommon procedure and there are quite a few folk here on the board who have been through it. If you browse through the post-op diaries and other sections of the forum, you'll find threads from people who have had (or are thinking about) the surgery which may be helpful for you.

I wish you both luck finding some relief from your symptoms. If it's any reassurance, I found PT to be effective when my symptoms became particularly severe - but it did take finding the right physiotherapist with the right approach.
« Last Edit: July 16, 2010, 05:37:03 AM by Snowy »
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline highroller

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Re: Sore knees, no diagnosis
« Reply #26 on: July 16, 2010, 07:05:31 AM »
A warm welcome and a big thank you to all the new contributors - your time and effort is very much appreciated as is the wealth of knowledge and experience you bring to the discussion. This forum is a wonderful virtual support system to be sure. I hope that over time I can also help some fellow sufferers here as you folks clearly have from your prolific post counts. I'm half way to shedding my MICROgeek status, maybe one day I will attain the prestigious rank of SuperGeek :-)

I very much share your concerns about the downsides of near total rest but as kneealwayshurts has explained, it really is a last resort in a situation where virtually all movement triggers a pain response and may be causing further deterioration. That being said, as well as performing the very low intensity exercises that were prescribed for me post-surgery, I am now endeavouring to experiment with movement patterns where the biomechanics and force vectors are more favourable. For example, I just found that I can tolerate some leg exercises a little better in an inverted position while performing a kind of shoulder stand. A little unorthodox but it could help. I'll play around with a few other configurations and see what works. It's only a preliminary step to allow some expansion of the envelope of function - sufficient hopefully to allow me to embark on a more traditional progressive mobility/resistance program.

I have been considering seeing a physio and almost made an appointment last week but I am going to wait until I've had the consultation with my OS on Monday week, partly because I'm really not comfortable going anywhere at the moment with my limited ability to support my own weight and also partly because I don't have a medically confirmed diagnosis on which to base a rehab process. I have also had poor to mediocre results with physios in the past and I am somewhat wary of the profession generally. I'm not dismissing the value of well applied physiotherapy and I don't doubt that there are competent and conscientious practitioners out there but in my experience they are the exception and difficult to find. I will do my best do find a well credentialled physio with a solid track record in knee rehab this time.
10/09: knees sore from gym, MRI ok, fluid in fat pad
01/10: knees worse, OS recommends PT
03/10: barely able to walk
04/10: arthroscopy left knee, no problems found, fat pad trimmed
08/10: begin PT, rheumatoid arthritis ruled out
09/10: neuropathic pain diagnosed, prescribed Amitriptyline

Offline knee always hurts

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Re: Sore knees, no diagnosis
« Reply #27 on: July 16, 2010, 03:40:33 PM »
Thanks for responding, Snowy. I'll admit, in everything that I've ever read concerning rehab of PFPS, both conventional and unconventional, I haven't seen total rest recommended. My fascination with this approach is solely because of personal experience. A couple of months ago, my condition took a sudden turn for the worse, and I found myself unable to walk without significant pain. I'd had PFPS for months prior to that, and I'd never experienced anything like that. Since it was going to take a while before I was able to get to the doctor, I decided to take matters into my own hands, and since I didn't really know what was wrong, I thought that it might be safest to use crutches until I could consult the doctor. When I finally got to the doctor, it was obvious that he had never heard of this approach either, because from the way he reacted, he obviously thought using crutches was inappropriate. He directed me to stop using them, and despite how badly I had felt before using the crutches, I made an almost miraculous recovery in about 2 weeks after walking again. There were no setbacks, either. Just smooth and steady progress. You can see, given this experience, why I was hoping to recreate these results again. Unfortunately, this time, for whatever reason, this is not working, and I find myself unable to do anything more than the most essential activities. Even that seems to irritate my knee.

I noted in an earlier post that non-activity does indeed result in muscle wasting and should be used as a last resort. I think this is the last time I'm going to try this approach, though. I've started walking again this morning, and if I begin to experience irritation and pain again, which I must glumly concede is the most probable result, it will finally be time to see a specialist. I suppose there are a number of options I haven't tried yet. I might be able to get a more sophisticated knee brace, and taping seems to be an option. I have my doubts about the efficacy of physio at this point, but it might be worth trying with someone with extensive experience dealing with this sort of condition. My biggest fear is that this advances to point of surgery. It's not even the thought of being cut open, even though honestly I have some anxieties about this as well. But the poor track record of surgery for PFPS lends itself to doubts with proceeding down that path. If, down the road, I am recommended for surgery, I'll certain inquire on this forum about the suggested procedure. I don't want to go through with a procedure that might be worthless or make my condition even worse. Hopefully input from members here, with their extensive knowledge and experience on matters of the knee, can help me make the right decision.

It's good to hear that the synovectomy procedure has given some people good results. From my preliminary searches, though, it seems that most references to this procedure are to people with rheumatoid arthritis. How often is it done for severe PFPS?

I am getting to the end of the road for "conservative" home treatment. This is my last attempt, and if it fails, I do believe I'll be making a appointment to see the doctor sometime in the next week. What questions should I ask seeing a specialist for the first time? Is there anything in particular that I should always mention, or a particular test that I should request, such as an MRI? What should I expect to get out of this? I know that this will be a long road forward, but I'm not sure how much longer I can withstand this level of pain and maintain my sanity. I suppose I don't have a choice.

Thank you for any helpful insights!

Offline Snowy

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Re: Sore knees, no diagnosis
« Reply #28 on: July 16, 2010, 05:55:17 PM »
It's always tough working with a condition like this, where finding a viable long-term solution is so dependent on correctly identifying the underlying cause. That's one of the key things to keep in mind - that PFS is ultimately itself a symptom of something else in the knee that isn't working correctly, and while it's possible to address the PFS symptoms you probably won't ever get long-term relief until the underlying cause is identified and resolved.

As I said, I'm not an expert - but after many years of different treatments and all the background reading I've done, here are some thoughts from my experience that may be helpful.

I wouldn't write off PT, but you really do need to find the right physiotherapist and that isn't always easy. I spent a lot of time working with PTs in the UK who always took the same approach, which was a very straightforward approach to muscle strengthening. The problem was that a lot of the exercises they prescribed - squats, leg presses etc - only aggravated the knee further, leaving me in a vicious circle where as the muscle strength improved so did the knee pain.

I didn't really start to make significant progress until I moved to Canada and by default acquired a new set of doctors. My family doctor referred me to an OS after a particularly bad flareup left me barely able to walk. He sent me for MRIs, and was the first to identify the underlying cause - my kneecaps don't track correctly. This patellar malalignment was leading to the huge irritation and pain during certain activities. The surgical procedure for this would be a lateral release (cutting the ligaments around the patellar to realign it correctly); however, my OS felt that my malalignment wasn't severe enough to warrant surgical intervention (refreshing to hear from a surgeon!) and recommended trying bracing and PT first, and following up for a thorough review with a sports medicine doc if the PFS persisted.

Initially, the basic exercises provided by the OS and the braces provided substantial relief. The braces, put on correctly, realigned the patellar slightly so it wasn't causing the same irritation. I didn't even see a PT at this point because with the aid of the braces, I was able to resume most activities. I did drop running and kickboxing as high impact continued to be problematic, but I felt this was a fairly small price to pay. This was about 3 years ago.

Last summer the PFS flared up really badly again. (We moved house and I spent a solid month carrying boxes up and down stairs and on my knees laying hardwood floor, so my own fault.)  When it didn't settle down I got a referral to a sports medicine doctor, who gave me a thorough exam and then put me on a month of high-dose NSAIDs and recommended a PT with specific experience in dealing with knee issues. This PT took a totally different approach to all the others I'd worked with. In terms of exercise, he went right back to basics. For the first few weeks, all I did was hundreds of daily isometric exercises - things like static quad flexes. This strengthened my muscles while the NSAIDs settled the inflammation down. (I was allowed to continue with other exercise that didn't aggravate the pain - in my case, only swimming and cycling.)

The PT also had the benefit of knowing that the underlying cause was maltracking patellars, and we spent some time investigating this. It turned out that most of the maltracking wasn't down to the actual knee structure (hence the OS's reluctance to operate) but down to overpronation in my gait. He got me into some custom orthotics, and they were a real eyeopener - once I'd adjusted to them I was actually able to walk long distances without aggravating the knees.

This combination of really getting to the root cause of the PFS, combined with a PT who really knew his stuff when it came to knee problems, was really a turning point for me. I was seeing great progress in the PFS - it was so much better that I'd even stopped using the braces on which I'd relied for 3 years - and then unfortunately I took a tumble on the ski slopes this March, blew my left ACL, and am now recovering from a surgical ACL reconstruction! That of course is a whole other story. :)

Sorry that was a bit long-winded, but I hope my story gives you some reassurance about how effective PT can be - and the importance of figuring out what it is in your knee that's causing this aggravation. Synovectomy would only be a solution if the root cause of your problems is inflammation of the synovium, but again there's an underlying "Why?" there. For me the surgical route would have been some form of lateral release because my underlying cause was the maltracking patellars, but in fact my OS was spot on when he said that he thought conservative treatment would be sufficient for me. It just took finding the right people to work with.

I'm not sure whereabouts you are, but this site has some lists of recommended knee experts in various areas and this would be a good place to start. PFS is complicated and can result from a huge number of different things, so don't rely on a family doctor or someone who's not really grounded in knee issues to provide an accurate diagnosis. If you can, find an OS who actually specializes in patellar issues. Talk to their office about recommendations for a PT who really knows what they're doing with knee problems.

Good luck! It isn't an easy road, for sure. I'm sorry things have gotten so bad for you, but hope that you can find a solution that works. 
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline knee always hurts

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Re: Sore knees, no diagnosis
« Reply #29 on: July 16, 2010, 07:12:17 PM »
I need all the information I can get right now, so I really appreciate you taking the time to relate your experiences to me. For me, the amazing thing is that I know exactly what got me where I am, at every step of the way. I'm not sure if you reviewed any of the earlier posts, but I can quickly summarize:

Sep. '09: I injured some ligaments in my left foot while running. I don't know what the relation is between the two, but after my foot healed, and I tried to exercise, I started to get excruciating pains in my left knee after a period of activity. Inflammation followed, and after a week or two I felt fine again. This went on for several months.

Mar '10: I eventually went to the doctor and he recommended some basic strengthening exercises and to wear a knee brace. It actually seemed to work at first, but after about two weeks I started getting the pains again. This time, inexplicably, the condition begins to worsen. Instead of healing as it always did, the inflammation lingers, and I started getting sharp pains even when not exercising. After a few weeks like this, it took a further turn for the worse, and it was painful enough that I thought I shouldn't walk on it. I noted this in my previous post. The interesting thing is, between that last flare-up and this current one, there was a period of about a week when I felt completely recovered. And it was around that time that I discovered the origin of the problem. It turns out that it was an issue with how I was walking. Apparently, for a reason I still don't understand, my groin muscles tightened after I injured my foot, perhaps to help keep pressure of my foot so that it would heal. For reasons I also don't understand, the muscles never loosened up again, even long after my foot healed. When I really started paying attention, I could actually see my leg rotating with every step I was taking. When I lifted my heel off the floor, the leg would abduct. As you can imagine, this is not a good thing. The only joint in between the hips and the ankle is the knee. And my poor knee was being battered by all of the rotational force being exerted on it.

May '10: In mid-May I felt great again. I tried to exercise a few days before, and I had injured my knee yet again, but shortly after this was the point in which I discovered the issue with muscle tightness. Fortunately, I was able to perform some stretches which fully resolved the issue after a few days. I detail this above in an earlier post. In the shortest time ever after injuring my knee, I felt great! So, of course I thought my problem was over. Wrong. When I tried to run, I started to get pain after a few minutes. Interestingly, the pain was much less severe than usual, adding more weight to my belief that the main issue had been resolved. And yet, there was still pain. After this point, it was all down hill, because every step of the way I just didn't rest enough. And so here I find myself. That is the origin of my doubts about how much PT much actually help me. I have no doubt that after the past month, I've had some muscle wasting, and I have no doubt that I have some muscle tightness. But I really didn't when I was running in May. I felt like I was walking and running as straight as an arrow. And yet I still had pain. Why? And why did it just keep getting worse? I know I had an alignment issue, but I took care of it. It was resolved. That's what makes me lean towards the theory that the tissue which was being antagonized all along has now become hyper-sensitized. Highroller details this theory of "tissue homeostasis" in an earlier post. It's really the only thing which makes any sense. Do I know exactly what tissue is irritated? No. I probably need to get an MRI, or some other scan. It might be the synovium, or it could be a fat pad impingement, or it could be something else. But I have my doubts that PT alone is going to make this substantially improve at this point. I suppose, conceivably, that anything which can relieve some of the pressure on the joint could help. I probably am quite weak right now, and I doubt that's helping matters any. And as I mentioned, a better knee brace, or a taping technique, could help. But unless the sensitivity of whatever tissue in my knee is actually plaguing me right now decreases, I'm having a hard time seeing a path out of this.

Jul '10: So that is where I am right now. Thank you all of your input. I'm sure over the next few months I'll end up trying just about everything. There has to be something that can beat this darn knee into submission!















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