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Offline SqshPlr8

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To scooter or not to scooter?
« 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

Offline kscope09

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Re: To scooter or not to scooter?
« Reply #1 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?
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 SqshPlr8

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Re: To scooter or not to scooter?
« Reply #2 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)?


Offline Lottiefox

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Re: To scooter or not to scooter?
« Reply #3 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  :)
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: To scooter or not to scooter?
« Reply #4 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.
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 weirdknees

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Re: To scooter or not to scooter?
« Reply #5 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 :)





knee pain since very young
2008 - diagnosed with patella tilt
2010 - partial meniscectomy

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #6 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! :) 

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #7 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!

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #8 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!

Offline Snowy

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Re: To scooter or not to scooter?
« Reply #9 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.
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 SqshPlr8

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Re: To scooter or not to scooter?
« Reply #10 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?

Offline Lottiefox

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Re: To scooter or not to scooter?
« Reply #11 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
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 knee always hurts

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Re: To scooter or not to scooter?
« Reply #12 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!

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #13 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!  ;)


Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #14 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.