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Author Topic: To scooter or not to scooter?  (Read 13368 times)

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Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #15 on: September 02, 2010, 11:51:28 PM »
I think it's fantastic that you've found a doctor with such a superlative bedside manner! Most doctors that I've dealt with have been either rude, eager to rush me in and out of their office, or both. To actually find a doctor willing to listen to their patient, address specific concerns, and form a specific plan for recovery is amazing. Perhaps if you were going to have surgery, but for PFPS? That's extraordinary. Or at least that has never been my experience.

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

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

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #16 on: September 03, 2010, 12:29:06 AM »
knee always hurts,

Agreed!  And thanks for all your help!

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

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

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

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


Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #17 on: September 03, 2010, 12:40:12 AM »
You are truly a man of elevated scholarship and towering intellect! Distillation of PFPS down to its roots in the geopolitical and sociocultural dialectic of hegemonic warfare is indeed a rare gift and spot on might I add. I think you're going to make it after all!

Offline Kimberly 77

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Re: To scooter or not to scooter?
« Reply #18 on: September 03, 2010, 03:13:14 PM »
You know this is a hard one for me. I am a right leg amputee and have been since I was 6 years old. I have never worn a prothesis becuase I am a hip disarticulate and have graphed skin. I have walked with crutches on my one leg for 26 years now. I have never let life go by around me, I have always worked hard to be mobile and do the things I enjoy, but all of that has gotten me where I am now. I have destroyed my knee and like you live in a lot of pain everyday. My family keeps saying well if you wouldn't have walked all those amusement parks or canoed all those rivers, maybe your knee wouldn't be like this now. But hey I have no regrets if I would have been one of those passive people who feels sorry for myself and never let myself enjoy living then I wouldn't be who I am today. I am very proud of all the things I have been able to do in my life. I have always told people I would never let myself sit in a wheelchair because I don't know anyone who ever used one and was able to get back out of it. Once you give in to that it is hard to rehab yourself back to normal. I have now purchased a wheelchair but it never leaves my house I walk everywhere I can to avoid being in the chair permanately. I use it just to do housework or cook. I feel it is important to stay active and remember that pain is mind over matter. However it don't hurt to give your body a rest when it needs it, meaning a scooter would be a good idea as long as you still enjoy other things without using it. Keep up your exercises and don't let your muscle waste but rest when you need too, I wish I had all of these years!!!
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12

Offline highroller

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Re: To scooter or not to scooter?
« Reply #19 on: September 07, 2010, 04:19:19 AM »
I was led here by your post in the 'Sore Knees No Diagnosis' thread that I started a while back. I'm a bit late to the party and there's really nothing I can add to the excellent advice already submitted. You seem to be on the right track so for now I'll wish you good luck with your recovery and look forward to hearing about your progress.
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 Nettan

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Re: To scooter or not to scooter?
« Reply #20 on: September 07, 2010, 08:46:48 AM »
To read this story is to read my life when I was between 18 and 23. I had the same problems, the same issues and about the same trying out everything and nothing worked. When you have this condition it's a tough balance between to do enough but not to much.
To use a scooter/wheelchair is just to make this condition worse, that's facts. Maybe use only if you are out for walking for hours.
My solution during these years was crutches simply when needed. But in end it was hard to getting off them.
I had a excellent PT helping me out. A lot of my PT consisted in doing exercises in a pool, but just a few everytime and be sure to rest after.
Like you when all started I worked in a lab, to be honest I had to quit and find another kind of job and living.
I tried out and then later went to school and started working with youth and youth with special needs. Then I had the opportunity to stand, sit and rest when I needed to. I know this with changing job is a tough decision, but I think you should think about that. Because this is not a condition that just walks out from your door and say byebye and never bother you more. Many has this problem more or less continuing.
After all I went through I had a couple of years living pretty good.
Unfortunately I had an accident in 1997 and got severe problems with my left ending up in the painful nervcondition CRPS/RSD and I also have a spinaldamage. Therefor I am in wheelchair 24/7.
But I just needed to share some words with you cause there is hope BUT maybe you need to look on your whole lifesituation to get more improvement. I wish you though the best.
Don't hesitate in contact me if you ever need any feed back.
All best /Nettan
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #21 on: October 05, 2010, 01:10:27 AM »
Hi guys,

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

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

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

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

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

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

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

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


Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #22 on: October 05, 2010, 04:56:28 PM »
Welcome back to the den of despair! It seems that we will be commiserating over our shared conditions again. I am fortunate that my bizarre case of inflammatory arthritis has subsided, but I'm still left with a pair of knees that aren't of much use. It's that same dull ache that you're describing.

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

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

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

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

If doing a knee jig on a swivel chair would help, I'm all in! Definitely report back if you've made any progress with this!

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #23 on: October 06, 2010, 09:48:32 PM »
hey knee always hurts,

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

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

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

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

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

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

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

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




 



 


Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #24 on: October 06, 2010, 09:59:37 PM »
*Obviously, my treatment would not stop with the shot.  Hopefully the shot would calm things down enough so that I could continue and progress in PT.

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #25 on: October 06, 2010, 11:40:29 PM »
It's been said that brevity is the soul of wit, and such may be true, but how many things of true importance are said in few words? Better to err on the side of too many words than too few, if you want to get the best advice. So long as you don't exhaust the reader, anyway.

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

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

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

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

It seems that you are having the same issues with PT that I was. I was able to do the the exercises without tremendous pain or discomfort, but often times my knees seemed worse for days afterwards, especially after we started doing squats. For whatever reason, in some cases the knees will not give an immediate reaction to activities, but still respond with swelling or inflammation later, which will prevent you from ever recovering. That's why I'm looking for exercises that are lighter than walking, which still seems to give me trouble. I think that an exercise bike would probably be ideal, because of the greater range of motion and extremely low impact nature of the exercise. But not having access to that, I'll have to give some other things a try.

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #26 on: October 07, 2010, 02:11:21 PM »
Thanks for the link and the advice.  I’m going to wait a few more weeks, see how PT/rest goes, and hope for the best.  I relooked at the Saveyourself tutorial—and might I say I really appreciate Ingraham’s skepticism and bluntness—which has made me reevaluate whether I have “truly, truly” rested.  It’s something I need to mull over, but before I do anything invasive—like surgery, less so for the shot—I would at least like to have the peace of mind that, hey, I “truly, truly” tried my best, however inconvenient that may be.     

I hear ya about walking being a bit too taxing, though.  Yea, sure, I can walk--not all that far without some discomfort setting in, but I can walk.  And it's not so much the pain itself that gets to me (though that is no pleasure) it's the idea that with each step I am just irritating something, thus making the quest for recovery longer.  Hopefully the swivel chair thing or self-made passive motion machine will help you out.  Or maybe a cheap ($50), tiny, modified exercise bike could do the trick?: http://www.footsmart.com/P-InStride-Cycle-XL-30729.aspx?mr:trackingCode=F334A30B-75B0-DF11-92F8-0019B9C04BE4&mr:referralID=NA&srccode=WBGOOGLE&cm_mmc=perf-_-k232270-_-Google%20Product%20Listing%20Ads-_-Primary

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #27 on: October 08, 2010, 12:40:37 AM »
Whoa, talk about thanking somebody for a link! I'll have to at least consider that thing. I've never seen anything like it! I wonder if it would work though? But $50 is not much to spend for something that could help me get my life back. I'm just thinking out loud now. Are you considering getting one of those? I can just imagine myself lying on the bed for a few days, stumbling to the toilet a few times a day, but otherwise just using that thing. It might do the trick. Pardon me for thinking out loud. Cycling is gentle on the joints. A lot more so than walking. And with a greater range of motion. What do you think? Enough thinking out loud. I'll at least consider it though. I've got to consider all options. It's amazing the stuff you can find networking with other people. Thanks again!

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #28 on: October 10, 2010, 03:34:50 AM »
Was thinking the same thing.  I figure it wouldn't hurt.  I hobbled to the gym today and sat on the recumbent bike and did intervals of 4 mins on, 2 mins off/ x 5 at the lowest resistance (machine barely turned on, but when it did it was ~ 45rpm).  It was okay, though the lateral rim of my better knee got sore, so I stopped. 

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

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


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

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

Let me know how the exercises work out!

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #29 on: October 10, 2010, 08:49:57 PM »
I've decided to get that little bike you suggested, as it's about the cheapest option to get my knees moving. If it doesn't work, it's only a small loss.

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

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

I think the only thing we have to go by is the rather amorphous feelings in our knees. If it feels better, it probably is doing something good. I have only one question: If you've got water balloons in your knees, why would you want to get rid of them? It sounds like the most fun somebody is going to have with knee pain!  :P















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