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Author Topic: Crepitis Questions  (Read 1564 times)

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Offline MG01

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Crepitis Questions
« on: September 29, 2010, 05:09:53 PM »
Hi - first time poster looking for help / advice.

30yrs old, male, 6'1", circa 14-14.5 Stone, reasonable fitness level, very active rugby player between 10yrs old and 20yrs old.
For the guts of the last 10 years I have had some crepitis (grinding) in my knee under my knee cap. For the first number of years it wasn't a problem, for the last 5 it has probably got progressively worse to the point now where I would describe it as a constant awareness extending to pain (ache) in my right knee - the sound of it bending now is clearly audible to those around me. I still go jogging 3 times a week, I manage the runs pretty well but I'd notice a slight swelling of the knee after the run for the evening and possibly the guts of the next day.

Went to a GP who 'specialised' in sports injuries 5 years ago - he told me it was just the knee cap scraping, common, no need to do anything, get fit and forget about it. Not very satisfactory and the injury has got progressively worse since then - I'm paranoid that in 20 years time I'll only be 50 but barely able to walk with the pain.

So - question is - whom should I see next - GP, some sort of specialist or try a physiotherapist (I have a good one I've used for other injuries previously). I'm not made of cash so I'm reluctant to go on a spending trail of GP to consultant to physio if there's a decent chance going straight to physio would be best.

Anyway - advice / thoughts very welcome.
Thanks in advance

Offline Kimberly 77

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Re: Crepitis Questions
« Reply #1 on: September 30, 2010, 05:06:59 PM »
I would go straight to a orthopedic surgeon or specialist. There are injections that can help with this or you can have a scope and have them clean the knee cap up, thats what I just had done and so far I am still in pain. Creptis can be a sign of arthritis and when associated with pain usually is arthritis. There is no cure for arthritis just treatments. Most Dr. will treat conservatively at first (physical theraphy, injections, braces, ect.) but if that fails you will probably end up with some kind of surgery and the surgery don't always work and can sometimes make it worse. A general practioner will probably just send you to a ortho anyway. Physiotheraphy wouldn't be a bad idea either it is used for treatment of arthritis too.
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 Lottiefox

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Re: Crepitis Questions
« Reply #2 on: September 30, 2010, 06:30:14 PM »
Painful crepitus usually indicates a degree of inflammation and some degradation of the cartilage under the kneecap. You can try various conservative and/or surgical options to help things - usually things like PT, medications, activity modification and so on are used initially to see if things settle. A scope to shave or debride might reduce some of the noises and symptoms especially if you have catching or locking but it won't put back what is worn out - techniques exist for that but they are LONG, HARD, uncertain and not suited to the patella....

My advice? 1. Stop running for a bit and let the inflammation settle down. 2. See a decent sports physio who can explore WHY the kneecap is wearing out. The wear is a symptom, not a cause. Is the kneecap tracking right? Do you have muscle imbalances? Do you over pronate? etc etc....and then a very basic, slow, comprehensive set of PT exercises might arrest the symptoms and let things settle. Check out thread on here regarding PFS problems - Knees Sore, No diagnosis comes to mind along with healing my knees or similar....

I would not rush into surgery until you know why things have started to get worse. I have very similar problems. My kneecaps have made noise since i was 17. At 40 they began to hurt when they made noise and that was accelerated by trying to run through it. I switched to bike work, gym, weights, cross training, boxing etc....no more impact. Its taken me 12 months to get things settled. I have extensive cartilage defects (grade3-4) and that won't go away. But I am not convinced someone shaving off some of the rough spots will buy me any decent time, not for me at this time. I know I'll need new knees one day - hopefully not just yet!

Do you have issues with both knees?

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 MG01

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Re: Crepitis Questions
« Reply #3 on: October 01, 2010, 08:09:33 AM »
Thanks guys - great feedback there.

The problem is most pronounced in my right knee but I can feel some minor abrasion in my left also - this doesn't give me any trouble though. It's like a dark weight hanging over me - I'm dreading being told I have arthritis and that I'll never run again...perhaps I'm fearing the worst.

I booked a physio appointment for next week with a sports physio - figure I may as well start there and I agree about being slow to jump to surgery.

Will post again after that to provide more info.

Thanks again and any more tips / thoughts please send them my way - the more info the better at this point.

M


Offline Lottiefox

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Re: Crepitis Questions
« Reply #4 on: October 01, 2010, 09:30:41 PM »
MG - When my problems started I feared the word arthritis more than anything. But, any form of degeneration your cartilage means you have an element of arthritis. It isn't great, but its life and LOADS of people have this, especially if you're active. I'm 41, fit, active and yet my kneecaps are well past their sell by date. The noise my left one makes wakes the cat up. My husband has similar noises but NO pain - but then again his approach to exercise is the odd round of golf and watching the football on TV!!  ::) :P

 It isn't a death knell for your running, IF you get the right advice and treatment and take things slowly and see how things go. There are many KG members with OA in their knees who run (check out runlolarun; she has issues but now runs again) - I don't because my biomechanics are too far skewed for it to be sensible and whilst PT helps to some degree it won't sort my rotational issues. You may well respond very well to muscle work, strengthening and a focus on what needs to be done to stop the rot and get you back functioning again. Everyone is different. Have you ever had your gait analysed for your running too? That can really help.

Good news on the appointment. Why not just rest the knees from impact for a few days, be religious with your ice and stretching and focus on other forms of training until you see what the PT says.

Keep us posted

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 knee always hurts

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Re: Crepitis Questions
« Reply #5 on: October 02, 2010, 12:14:41 AM »
I definitely agree with the advice here, stop what you're doing and let those knees settle down. I had an injury last year that somehow changed my bio-mechanics and my knees are ruined as a result. And I'm only 26. Since I've posted about this many times before I'll just post a link:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=53060.0

Take a look at the other links in that thread. You'll notice that I favor a somewhat unconventional approach, but PT failed (actually made some problems worse) and I'm not too keen on surgery. So that's where I'm at now. Interestingly, one of my knees (probably the worse one at this point) doesn't feel like it has underlying damage, but it still aches constantly. Just goes to show you that PFPS is not necessarily a result only of cartilage damage. There is certainly a correlation, as there is far more pressure on the underlying tissues if cartilage is worn away. But pain is possible irrespective of damage. And some who have damage are pain free. You might be able to restore a good deal of function even if you have significant damage. But you have to go easy on your knees. If you keep doing what caused the pain in the first place, you're guaranteed to only make the problem worse.

Good luck and feel free to ask if you have any questions!

Offline MG01

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Re: Crepitis Questions
« Reply #6 on: October 12, 2010, 10:06:33 AM »
Hi there - so - went to the physio there last Friday.
Pretty good news in general I think. It is crepitis or condromalacia patella, bad, but not beyond hope at this point. No more running or anything for the moment - ice 4 times a day and some exercises to strengthen my glutes to help take my weight more on my rump than on my knees when walking / running. Back again in 2 weeks to begin some strengthening exercises then.
Overall she reckoned that my movement range at present is good and thought that I would be back cycling within 6 months and perhaps back running in a year depending. We'll see how it goes.
Fingers crossed anyway...now to find some other way to keep fit (that doesn't cost money!).
Thanks for the advice and if there's any more keep it coming.
M

Offline Lottiefox

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Re: Crepitis Questions
« Reply #7 on: October 12, 2010, 10:41:02 AM »
The rump/glute exercises made a big difference for me - more so than any endless quad lifts etc. Glute bridges on both then single legs, moving from floor to unstable surface for the feet really helped. Plus hip work, endless lying leg lifts with weights or without, pulsing, holding etc - all those Jane Fonda moves do work!! I find if I neglect these, even though my knees have calmed a lot and I'm cycling up to 30k a time, the knees start their aches....so its back to the glute bridges. I would say I was doing these 2-3 times a day, for reps of 15-25 a time repeated twice....yawn! Obviously your physio will have your own regime but hang in with it.

For keeping fit - I found pad work/punching with a partner and pads good fun and you can stabilise and not pivit or use your legs or even punch sitting down upwards and outwards and stuff and get the heart rate up. Arm bikes are quite god for cardio too if your gym has one, (but dull though!) and once my knees settled down I started biking with very low resistance to get some herat rate going but no stress on the knees. Do you swim? Check with PT but aqua exercise can help fitness levels be maintained, but be careful of kicks/movements that flick the kneecaps around.

And ice is great - I always ice now, even when the knees feel fine. I need a freezer bag with me.  ;D

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....