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Author Topic: Patellofemoral Pain? And a question about anatomy.  (Read 6250 times)

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Offline marksalot

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Patellofemoral Pain? And a question about anatomy.
« on: July 31, 2010, 05:34:24 PM »
YES, THIS IS LONG AND BORING.† IF YOU DONíT WANT TO READ THE WHOLE THING, PLEASE AT LEAST READ THE LAST THREE PARAGRAPHS FOR A BASIC QUESTION ABOUT ANATOMY.

Over the past three months, Iíve been battling an ache in my right knee.† Iím still optimistic that I can beat it, and I think I have a good enough understanding at this point.† But I wanted to see if I could get some comments from this community, just as part of my efforts to learn as much as I can, as early as I can.† I tried to keep this as short as possible to avoid wasting everyoneís time, but this is the best I could do.† Sorry!† ;)

Diagnosis

Iíve been to the doctor twice.  The first time there was no diagnosis, but a general recommendation to just rest for six weeks, and gradually return to exercise as tolerated.  The second time, he does some manipulation of the leg, orders an x-ray, and diagnoses patellofemoral pain syndrome/chondromalacia patella.  The x-ray was normal.  Iíve been in physical therapy now for three weeks.

Iíve also finally found a really nice article online, well worth the $20 price: http://saveyourself.ca/tutorials/patellofemoral-pain-syndrome.php.  This really hammers home the point of resting and GRADUALLY returning to activity, avoiding all pain if possible.  Looking back, maybe I should be healed by now, but I repeatedly sabotage my progress by trying to do too much, too early.  Hopefully I can avoid causing any setbacks from now on.  (By the way, that article is heavily influenced by articles available at http://kneeexpert.com, which I also recommend reading.)

History

It starts during a quick hour-long bike ride after work.† About 1/4 of the way out, I notice my right kneecap catching during extension.† Normally when this happens, Iíll just take my feet off the pedals, stretch my legs, and it will be fine after that.† This time itís not quite perfect, but it feels good enough to keep going.† Halfway out, it really starts to hurt, and I decide to turn back and return home.† I do some Google searches, decide that I'll just stop riding for a while, and go to bed.† (By the way, this paragraph might not be very accurate.† I didn't recognize that this could be serious, and I'm not really paying attention yet.)

So I am resting for a couple weeks, when I notice a change.† It starts to hurt just laying in bed, when I'm trying to go to sleep.† I normally lie on my back with my legs straight.† But I try lying on my side also, and can't seem to find a good position.† Depending on my position, it either feels like it is twisting, tugging, or compressing the sore spot, which is the medial part of the knee.† I eventually fall asleep within an hour or two, but it's annoying.† No matter what position I go to sleep in, I usually wake up on my back, and my knee is usually pain-free.† I also notice a red spot on the medial side of the knee, near the kneecap, but it is hard to tell if this is exactly where the pain is or not.

It generally worsens over the next six weeks.† I go to the gym occasionally, but that just results in an aching knee.† The worst pain occurs on the medial/anterior part of the knee.† Walking or driving will make the ache gradually increase.† Eventually it gets to a point where I can barely walk.† That medial/anterior corner of my knee is getting stressed whenever I take step, so I start trying to walk on the lateral side of that leg.† That makes it bearable, but it still aches.† And I wonder if I'm doing more harm than good if I am putting stress where it isn't supposed to go.

Eventually I figure out that stretching my legs (mainly the quads) provides relief instantly.† I can go to sleep with almost no trouble on some nights.† I use my normal sleeping position on my back, but with a pillow under the knees.† At one point I get so excited that I take a jog around the house.† The knee does ache a little afterwards, but no big deal.† (Probably enough to do some harm though.)

So itís feeling pretty good, and now I want to see if I can increase my exercise a little.† I head to the gym again.† I can do the leg machines, but I have trouble finding a good angle for extensions/curls that won't irritate the knee.† I try an exercise bike and hop off in about 10 seconds.† The knee just doesn't feel right.

I go to physical therapy now, and she has me stretching and performing various exercises.† Generally the exercises do not cause pain.† Sometimes I have to be careful with my form to avoid putting too much pressure/torque on certain areas, and I try to not tolerate pain at all.† But sometimes I have to tolerate some pain while Iím searching for the correct form.

Last weekend, I had a setback when I was experimenting with my gait.† I was trying to put my weight more evenly on both feet, and also trying to control where my kneecaps were pointed.† Looking back, I did have it aching more than normal, so I shouldíve quit that right away, but it didnít seem like much of an ache.† Now I canít walk without pain again.† Iím optimistic that I can get back to where I was a week ago, but Iíll have to be careful.

One more thing that I always have to mention:† In December, I took a tumble while skiing.† One ski came off, the other did not.† I dusted myself off, and kept skiing the rest of the day.† I donít remember thinking of it as anything serious, and it didnít hurt later in the day, so I really donít think it hurt anything.† I did notice some bruising a week or two later (not sure which knee), but that resolved fairly quickly, and my knees were very strong since then.† I had been on a bike plenty times since then with no trouble.† I suspect that I was just overdoing it around the time the trouble started.

Questions

Right now the first thing on my mind is resting my knee, but itís difficult for me to find any comfortable position.† I feel like I have to constantly keep my muscles ďtensedĒ in order to hold the tibia in a comfortable position.† If I try to relax completely, it will start to ache.† Itís not always the same spot, but something eventually starts to ache.† Depending on the position, it feels like tugging, twisting, or compressing something.† The worst is when Iím sleeping, because I want it to feel ďreally goodĒ when Iím going to sleep.† I have a Genumedi sleeve that compresses the whole knee, with a silicone ďOĒ around the knee.† That seems to make it feel better, but I donít like the idea of going to sleep with something like that on.† Any suggestions for good sitting/sleeping positions where I can relax my leg completely?

Also, when Iím sleeping on my back, my right foot will hang down a little more than my left foot.† Is there a name for this?† Iím not sure if itís my femur rotating outward more, or if itís just my ankle allowing the foot to drop a little more.† (Or I guess it could also be the tibia rotating out at the knee, but I donít think thereís any movement there.)

Iíve tried icing the knee, but that generally makes things seem tighter and causing more ďfriction.Ē† A hot shower seems to help.† Is this common?† Is the heat actually helping it somehow, or does that just relieve pain?

My second question is about this red spot.† It gets brighter as I irritate it more, and sometimes it goes away completely.† It follows the skin as I flex and extend my leg, so if I put a finger on it and flex, the finger will stay on it as it moves away from the kneecap.† (Or the kneecap moves away from it, I guess.)† To my untrained eye, Iíd say itís on the femur.† The red spot is about the size of my fingertip, or about 1/2 inch diameter.

Hereís how to pinpoint the exact spot.† Sit in a chair and flex your knee 90 degrees.† Take your finger and put it on the most ďbulgingĒ part of the knee on the medial side, and imagine a horizontal line going from your thigh out toward the knee, passing thorough that point.† Push your finger out toward the knee along that line, and when youíre about an inch from the end of the knee youíll feel like youíre pushing against a little ridge of the bone.† Thatís where the red spot is.† If you reach the patellar tendon, youíve gone too far.† If you reach the patella, youíve gone too far, AND youíre too high up.† Actually, if you push beyond the ridge, you should probably end up right where the patella attaches to the tendon.

That ridge is a little tender for me, but when I do it on my left leg it seems like itís a little sensitive too, so I donít know if thatís significant or not.† Please give this a shot and let me know if you can tell me what is here.

If youíve read any of this, thanks for your time!† Again, Iím hoping that none of this is relevant, and by resting and progressing slowly everything will just take care of itself.† But until that happens, I feel like I have to keep learning as much as I can.
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT

Offline knee always hurts

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #1 on: August 01, 2010, 04:55:25 PM »
Hello Marksalot,

Welcome to the kneeguru forums, and welcome to the Petellofemoral Pain club! I noticed that you mentioned that the pain is localized to the medial part of your knee. While I'm not a doctor, I have done extensive research on various aspects of the knee's anatomy as it relates to my own condition. While I don't think I have this myself, you may have plica syndrome, which in your case would be inflammation of the medial plica. I would suggest reading up on it and see if it sounds like the pain you're having. Here are a couple of links to get you started:

http://www.kneeguru.co.uk/KNEEnotes/knee-dictionary/synovial-plica
http://emedicine.medscape.com/article/1252011-overview

It's good that you bought that saveyourself.ca ebook, as I've found that it well describes my own struggle with PFPS. If your pain is not plica inflammation, it is likely the synovium or bone as the book mentions. I only wish that I had purchased it sooner, as it might have saved me from much misery. I have one piece of advice that I believe is true irrespective of the underlying cause of your patellofemoral pain. If something is causing you pain, you need to stop it! This can't be stressed enough. I know you were probably active before you got this pain, and you probably are extremely eager to get back to whatever you were doing. But you have to realize that it can get worse. Much worse. It's difficult to tell from your post just how severe your case is, but if you are able to walk and do everyday activities (things that are not considered exercise, but are essential to your everyday wellbeing), then you aren't as bad as me. But I was where you are a couple of months ago. Now I can hardly walk at all. Every step is tentative, and I'm always at risk of antagonizing my knee further.

My quality of life has been completely destroyed by this condition. You may have heard that Patellofemoral Pain does not usually become severe, and that it can usually resolve itself with time. This is true, but it is in complete dependence on what you do. It is not something that happens independently of your activities. If you stress it enough, you will disrupt the homeostasis of the tissues in your knee, and you will be asking yourself "What if?" for a long time. It's better to rest and let yourself recover, than to regret your decisions potentially for the rest of your life.

There is an ongoing exchange between myself and another forum member named highroller which has chronicled our struggle with PFPS. There is also some input from other members of the forum. If you're want, feel free to join in. In any case, it serves as a cautionary tale, and should give you some helpful tips on how to avoid worsening your condition. Here is the post:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52020.0;all

« Last Edit: October 09, 2018, 08:10:42 AM by Leah »

Offline marksalot

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #2 on: August 02, 2010, 01:31:22 AM »
Hey, thanks for the reply.  I actually did read your topic (every page of it) - I found it when I did a Google search about saveyourself.ca.  Looking at your timeline, I agree it is frightening how easily my story could turn into something similar.  At this point, I think I have finally accepted that I have "lost" the summer, and hopefully I can make some better decisions now.  Sorry to hear that you had a setback recently though.  Mine was last weekend, and I still haven't recovered.  I'm going to ask my PT about removing some of the exercises I was doing, since I seem to be tolerating them less each day.  (Before the setback I was doing fine with them.)

As far as my activity, I'm sure I've got nothing to complain about.  I can usually walk without pain as long as I don't overdo it (though it's more of a waddle right now), and I'm still working.  Today I bought some ibuprofen and a heating pad.  I haven't used ibuprofen in a while, so I figure it's time for another shot at it.  The pad is actually really nice: it's made by Theramics, and you just put it in the microwave and it stays warm for an hour or so afterwards. I've had some success lying down with the heating pad on my knee.  That red spot is lit up when I get up, but at least it doesn't hurt.  It's the closest to "really good" I've felt so far.

It is interesting you zeroed right in on the synovial plica thing.  The descriptions sound very similar to what I've got.  And in fact, if I am locating the plica correctly, part of it seems to be right at that red spot.  The only problem is that there is no pain when I roll my finger over it.  Most articles I find seem to suggest that it should reproduce my pain, and it doesn't.  For example:

"Patient pain and irritation upon the examiner rolling the medial suprapatellar plica under his or her fingers is a classic finding on physical examination." - http://emedicine.medscape.com/article/89985-overview

But it will be worth a mention to my doctor next time I'm in just to see what he says.  Luckily, the initial treatment seems to be very similar to general PFPS: PT to strenghten the quads and stretch the hamstrings.

Overall I'm very reluctant about surgical options, so if my doctor refers me to an OS I'm going to ask for the most conservative one he can find.
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT

Offline knee always hurts

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #3 on: August 02, 2010, 08:48:37 PM »
It's good to hear that you can still perform most everyday functions. It will also be an easier recovery if it isn't particularly severe. I actually had a less severe case of PFPS earlier this year, and almost made a complete recovery. Unfortunately, I decided to do a little running and that's where I started to get some pain again. Ever since, it's been a vicious circle leading up to the extreme episode of inflammation on June 13th. The amazing thing is that I went from being able to walk up and down stairs, as well as a pretty functional level of walking on flat surfaces to my current state in just one day. If you get any pain from stairs I would recommend avoiding them. Excessive walking can also be a problem. Even if you think your current level of walking is OK, if your pain is on a downward trend you are doing too much. Faster than you know it, you'll be in the same situation that I'm in. What you want to avoid at all costs is deep squatting. As the saveyourself.ca E-book points out, you're putting a load 8 times your body weight on your knees when you squat deeply. This is a recipe for disaster for someone with PFPS, and it's how I triggered my current state of affairs. You might think that you can just do a few and you'll be alright, but that could be enough to send you straight down the road to perdition.

Ultimately, the formula is pretty simple. If your condition is worsening, you have to do less than you have been. Probably quite a bit less, as each time you irritate the tissues the threshold of pain changes. That's what happened to me. Every time I did something that triggered a significant amount of inflammation, I would lower my level of activity. But it was always too little, too late. It really needs to be a lot less. Since your daily life is mostly unaffected, it would probably be wise just to cut out all exercise. From there, you will probably notice a gradual improvement, and then you can start slowly reintroducing some additional exercises.

As you noted, conservative treatment options tend to be similar for any sort of PF pain. The etiology of the disease is similar irrespective of the specific site of irritation in PFPS. Whether plica, synovium, fat pad, or subchondral bone, the disease starts with an unusually great load on the knees, causing irritation, and then subsequent irritation of the affected tissues causes further changes in nerve response. This can be the case even when there is little or no underlying structural damage, as is confirmed by arthroscope in highroller's case. While there is a dearth of good studies on eventual outcomes for PFPS patients, it is likely that some people can never fully recover. It's at this point that it might be useful to know the specific tissue which is the sole or primary culprit. You should certainly try for many months before even considering surgery. But, if that fails, your only choice is either pain management for the rest of your life, or surgical excision of the pathological tissues. In a case like highroller's though, the pain is peripatellar and so not very well localized, and is not associated with tissue destruction. There are certainly cases like this, which are almost medical mysteries. Your best hope for recovery is to avoid descending to such a nadir in the first place, because as you can see, it is not an easy hole to climb out of once you've fallen in. The problem with surgery is that it often creates its own peculiar problems. Even surgeries that are represented as being straightforward, as in excision of problematic plicas, where you would expect relatively little risk in the procedure since plica is a vestigial tissue, can result in chronic knee problems as many posts on this very forum testify to. For any sort of PF pain, surgery is absolutely a last resort.

I certainly think that PT is a good idea, and as I mentioned in the Sore Knees thread, my problem originated with tight muscles causing my leg to rotate with every step, producing a rotational force under my knee cap which then irritated my knee, which of course then left it more vulnerable to further irritation. You certainly want to deal with any such issue if this was the origin of your pain. Remember though, that rest is the most important component to recovery as the condition progresses. Stretching seemed to help a lot more when my condition was in its mild phase. Now, I really don't notice a difference. It's interesting to note that it was after resolving the problem with my gait that my condition worsened to its current low point. The tissue was already irritated, and thus vulnerable, and so it didn't matter that my biomechanical abnormalities were resolved. That can't be overemphasized. If anything, the fact that I thought I resolved my issues with muscle tightness actually gave me a false sense of confidence about my ability to exercise. My mind was stuck in the mire of the predominant paradigm of knee pain as a function of biomechanics. That's certainly how it's represented in almost all conventional publications, with their admonitions to strengthen the quads, or stretch the illiotibial band, and this is perfectly swell, but it neglects the reality that the underlying tissues need time to restore their homeostasis. If I had known a couple of months ago what I know now, I'd probably be pain free. Instead, I likely have months of rehab ahead, with no certain outcome.

I hope this is helpful!

Offline marksalot

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #4 on: August 03, 2010, 02:02:42 AM »
Your advice is definitely helpful.† It is amazing how much information you can get from the Internet.† I hate to think of what people had to accept just 20-30 years ago.

I mentioned my concerns to my therapist today, and we decided to remove a bunch of the exercises for now. I would eventually feel some friction/pain during step-ups, shallow squats, marches, and the bicycle - basically anything involving repeated knee flexion/extension - so we got rid of them for now.† I still did the straight-leg raises, quad sets, heel raises, and balance exercises.† (Standing on one leg actually seems to make it feel better, as long as I make sure I keep the weight on the outside of my foot.)† I also got rid of the calf stretches, but the quad and hamstring stretches are fine.

I also started using the heating pad a couple times during the day and using a cane for most of my walking around the apartment.† It's nice to have that "unloaded" feeling for a while at the end of the day.† I tried freezing the pad and using it as ice, and it actually seemed to help too.† I think my main problem with icing was that I would try to walk right afterwards, while everything was still tight.† As long as I don't move the knee while it's cold, it seems to be good.† Maybe even better than heat.† Occasionally I'll throw down an ibuprofen, but I don't really notice anything from it.† That's more just for the idea of reducing inflammation.

My next PT appointment is Friday.† I think I'll take your advice and really lay off the exercises (even the "good" ones) until then.† I already feel like it's getting a little better, but a lot of that is probably psychological because I'm trying a bunch of new things.† But now whenever I catch myself getting excited I am very quick to calm back down.† I think I just have to take things a week at a time.† There's so much variation from one day to another, but after a week it's easier to look back at it.

Now I have to go watch It's Always Sunny in Philadelphia and laugh my butt off.
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT

Offline knee always hurts

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #5 on: August 03, 2010, 03:28:36 AM »
I think that's definitely the right mindset. With time, your knee should fully recover. I know that might be hard to imagine now. But the pain in my knee was quite horrendous back in April, and I almost made a full recovery. There was a point when I thought I would never be able to walk again, but lo and behold on May 15th (A day that great tends to stick in your mind!) I went on a nice, brisk walk with perhaps a slight bit of soreness but considering that it was 30 minutes in length, and that I had been in the depths of despair just a fews weeks prior, nothing too bad. If only I'd taken it easy for a couple more weeks, but then I wouldn't be here relating my experiences and hopefully preventing someone else from going through the same thing.

The approach you're taking is what is warranted, I think. You should abstain from all exercise, except under the direction of your PT. You want your progress to be measurable. It will also be clearer if you are backsliding. I don't want to get your hopes up too much, but it's possible that you'll be back to normal again in a few weeks if you pace this right. I'll only suggest here that you always plan your next move, and don't suddenly start doing something out of excitement. If you think you're making a breakthrough, you might find yourself doing something inadvisable. Don't let that happen.

Keep posting updates, as I'll be looking to see how you're making progress!

Offline soldiergh

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #6 on: August 04, 2010, 05:03:22 AM »
I had orthoscopic surgery to repair a torn miniscus back in 1994 when I served in the Army. I recently went thru the cortizone shots and I'm still hurting. A few yrs ago I was diagnosed with DJD. I do the ice pack/heat pack while elevated everyday. As a result of not being able to exercise, I'm 50 lbs overweight and am waiting to go thru a Medical Evaluation Board to see if the military will medically retire me after 16 honorable yrs of service or kick me out with nothing!  :'( Other than pool exercises, does anyone know a better way to drop weight fast? I can't run or do sit-ups,crunches! Thanks!  ::)

Offline kris_83

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #7 on: August 04, 2010, 11:49:50 AM »
just popping in to caution you against heat. I had a plica and a bunch of other stuff (see sig) and I was using heat for months before I was properly diagnosed. It did make me feel better, but I've since found out that I was probably just increasing inflammation and "cushioning" my problems. Try ice- even though it makes everything feel "stiff" it does help!
12/09 dx- patellar subluxation (not!)
1/10 mri- neg; PT rx failed
4/10 more PT
5/10 dx patellar hypertension
6/7/10 chrondroplasty, patellar decompression, synovectomy and plica excision
5/6/11 dx RA, sjogren's

Offline knee always hurts

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #8 on: August 05, 2010, 12:24:15 AM »
soldiergh,

Welcome to the Kneeguru forums! I understand the difficulties you're having with exercise! Even though I have PFPS and not osteoarthritis, I really can't do much in the way of cardio. It's really frustrating not being able to exercise. If you enjoy swimming and you're able to do it without pain, I'd suggest you keep that up.

I'd submit that you shouldn't throw up your arms in defeat though. You have other options to control your weight. If you can't exercise, you really should consider modifying your diet. The trick here is to find food options that are amenable to maintaining a healthy weight and will be sustainable for you. Starving yourself won't work. The main things to consider about what you're eating are:

#1: What is the caloric density of the food?
#2: How filling are the foods you are eating relative to the number of calories consumed?

For #1, the main thing you want to look at is the fat content. Fat contains more than twice as many calories per unit of weight than carbohydrates or protein. Consuming lots of high fat foods, therefore, results in weight gain over time. In practice, this means eating more fruits and vegetables. You should also eat lower fat cuts of meat and reduced fat dairy products. Also be wary of processed foods, as they tend to have added oils, which can add a lot of calories.

For #2, you're looking to integrate foods with lots of fiber, as that's going to make you feel fuller. Happily, these tend to be the same foods that are lower in fat. Fruits, vegetables, and whole grains tend to be high in fiber. Actually, only whole plant foods have fiber. Whole grains are also comprised of complex carbohydrates, which will keep to fuller for longer than simple carbohydrates, so try to consume these rather than refined grains. I'd also suggest drinking water with your meals, as you'll feel fuller faster.

It's too bad that you can't exercise much, but if you follow these guidelines you should lose weight pretty fast. Good luck!


Offline gerine9903

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #9 on: August 13, 2010, 05:37:00 AM »
If you think you have any swelling, do not use heat.  I found this out the hard way.  Heat relaxes the muscles and makes the knee feel better but you will become more swollen.  I know ice gives a stiff feeling, but you need to ice for the inflammation.  Afterwards do some stretches to combat the stiffness. 

Offline marksalot

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #10 on: September 05, 2010, 05:03:00 PM »
Just a quick update.  Haven't had too much to report lately, but I'm a little excited now.  First, here's some things I've tried lately.  Generally, these all provided some comfort for a couple days, but don't seem to help with the actual healing.  I still do most of them though, since it still feels like they might be helping some aspects.

Flexible knee sleeve
Ice
Heat (I've quit doing this though)
Dr. Scholls "knee pain" orthotics.  (resists foot pronation)
Various gait alterations involving pronation, leg rotation, knee flexion, etc.

I'm continuing with physical therapy on my own now, and I am making measurable improvements in leg strength.  But it's hard to tell if there have been any real improvements in pain.

Now, here's what has me excited.  "Adolescent patellofemoral pain: implicating the medial patellofemoral ligament as the main pain generator" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656832/

I'm not an adolescent, and my case doesn't fit that article exactly (e.g. I do have crepitus, pain while walking, pain while lying down), but the main idea is that the tension on the MPFL is generating the pain.  I do have other symptoms of PFPS, but right now the most troubling aspect is the medial-side pain when walking, sitting, and lying down.  I don't know if I can locate the MPFL exactly, but I can usually feel tension on the medial side of the kneecap whenever I'm in a painful position, such as lying down on my back.

The real beauty of this is that it gives me a tool to predict whether a position is good or bad, without having to wait until it starts hurting.  For example, sitting down with no shoes and a pillow under the foot, I can find a position where the knee cap has no tension on the medial side.

It seems clear that everyone's case of PFPS is different.  And if this ligament is involved, what I have might not even be classified as PFPS.  (MPFL is mentioned most commonly in patellar subluxation/dislocation cases.)  We just have to figure out what's causing our case individually.  I got an appointment with my GP in 3 weeks, so I'll see what he says about it...assuming I still believe it by then.
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT

Offline knee always hurts

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #11 on: September 05, 2010, 07:54:34 PM »
It's interesting how you can come to a different conclusion when reading something with a fresh perspective. The first time I read your post I just assumed that it was PFPS since that's what your doctor diagnosed you with. But honestly, reading it again, and more closely paying attention to the location of that "red spot", I think it might be something else. I actually followed your instructions as to where to find the exact location of the red spot, which I admittedly didn't do the first time I read your post. It seems to be close to the location where your femur and tibia articulates. I don't know if it actually has anything to do with the pain, but if I understand you correctly, that red spot is close to the location of the pain, right? That combined with the mention of your knee catching on extension, and this sure sounds a lot like a tear of the medial meniscus. Unless you've already ruled that out, perhaps think of mentioning it to your doctor.

Offline marksalot

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Re: Patellofemoral Pain? And a question about anatomy.
« Reply #12 on: September 06, 2010, 05:32:53 AM »
Yup, torn meniscus is definitely still a possibility.  The doc did some twisting, etc. of my leg during the exam and nothing hurt it, which makes it seem less likely.  And the red spot isn't quite on the joint line, it's a little above it...I think.  Also, there's never really been any visible swelling of the knee.  If I'm still hurting in 3 weeks though, I'll probably ask for an MRI just to help rule that stuff out.  (Although an MRI isn't perfect either.)
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT















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