Chronic Ongoing Knee Pain -- Desperate for Help

[badpairofknees]

I ran a half marathon in June 2010.  For two weeks after the marathon, my knees were in pain (as expected).  During the third week, the pain went away, but it came back all of a sudden during the fourth week.  Now, it's been 7 months since the marathon, and my knees are still in a chronic pain.  They are always aching, and I experience a ton of sharp pain (below and underneath the kneecaps) when I walk.  I cannot stand for more than 3-5 minutes (standing is harder than walking), cannot walk more than a few blocks, and I can only go up and down the stairs sideways.  Sitting with the knees bent for more than 30 minutes is tough on my knees.  Also, I hear something on the lateral parts of the kneecaps (maybe tissues?) catch/click when I bend and unbend my knees.    

I've had a bone scan and an ultrasound on both knees and an MRI on my left knee, but they did not show anything.  I have seen a few different orthopedic surgeons, sports medicine doctors and physical therapists, and I've been diagnosed with PFS, overuse injury and misaligned kneecaps.  The doctors have told me that PT should help, but no, it has not helped (and I have religiously done the PT exercises for 5 month).  One doctor recommended a lateral release surgery, but all other doctors were against it.  Most doctors were against a cortisone injection, as they felt that it would not have a long term relief.     

I'm very frustrated and depressed as my everyday normal activities are severely limited, and no one that I've seen seems to know what can help my knees.  I am in my 20s and cannot imagine living with this pain for the rest of my life.  I do not care to run again, but I want to be able to stand, walk and sit for a reasonable amount of time.
 
If others have had a similar experience, I would like to hear it and see what has helped them.   Also, if anyone has recommendations on books or other research materials relating to chronic knee pains, please share.  Thanks.

[Lottiefox]

There are many threads on here about this kind of "non specific" chronic knee pain. Have a look for rbcyclist and kneealwayshurts as posters- they have similar issues.

I share some of your problems although I never managed a half marathon. My kneecaps gave up in summer 2009 after increasing my recreational running. I have poor alignment of my kneecaps (they sit laterally) and my glutes and hips were not strong enough, whilst my calves and hammies were tight. That added up to miserable pain and an MRI showing significant cartilage loss. I have also done PT, and it took a while to kick in. I also took a course of Celebrex (a COX 2 NSAID) to reduce the inflammation which certainly helped a bit. Alongside that I had a Euflexxa injection, a lubricating kind of thing which I think helped a bit too. I have avoided steroids; to be honest I think they are toxic junk and long term they just destroy the very thing they are meant to help.

The only advice I can offer is that inflammation after an extreme event takes MONTHS to settle down in the knees. I would say it took me nigh on 10 months to get back to normalish function and I still can't load up my knees at certain angles, but I have do have underlying cartilage samage. You sound luckier than that. Are you still running? If so, I would say STOP at the moment. I would also avoid any impact training - I switched to biking, weights, Pilates type stuff, lots of balance and core work, boxing etc.
Hope things improve soon, 

Lottie

[knee always hurts]

As lottie said, it does sound quite a bit like the problems I'm going through, though the problems differ in each of my knees. I my left knee, I am in absolute agony if I overdo it, so for the last 2 1/2 months I have been using crutches. In the right knee, there is a constant soreness in the knee, which worsens with with increased activity. In both knees, there is lateral catching and clicking, similar to what you describe. I do not know if I have chondromalacia in either knee, because despite having problems for over 16 months now, I've yet to secure an MRI. I've recently been searching out new doctors, and the current crop seems more in line with what I've been seeking. In fact, the new doctor I'm going to on Friday is probably one of the best arthroscopic doctors in the world, and was one of the pioneers in the field.

What is most strange to me, is that before Sept. '09, I never had any pain in either of my knees. Literally nothing. Since then, it has been only down hill.  I'm going to be continually updating my thread with new developments, if you want to follow it:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=53451.0

Perhaps this new specialist can identify the problem, which may be relevant to your own case. I'll keep you updated. 

[dm]

has anyone said anything about your kneecaps sitting too low? sounds like they could be misaligned in that manner, and that you've got some imbalance with the tendons/ligaments/muscles so that they pull funny. What has the pt said about your gait? If you walk toes out, that pulls your kneecaps out of alignment, I'm told, and was told to quit walking like that. Have they said anything about weak vmo muscles letting your kneecaps track laterally?

If I were you, I'd try and find a knee specialist, not just a general ortho, in your area, and get another opinion about your issues.

[crankerchick]

I would say stay away from the doctor that suggested the lateral release surgery, and second dm's suggestion to make sure you are working with a knee specialist and more specifically, one with interest in the patellofemoral joint.

Have you ever had any problems with your knee prior to the marathon?

Have any of the doctors or therapists suggested bracing or taping as means to help keep the patella in place?

It seems like, as Lottie said, the right combination of rest and exercise and stretching is a good path to follow. Gentle strength training, plenty of stationary biking, and stretching of your hamstrings, quads, and calves goes a long way when combined with a regimen of icing and rest.

Beyond that, the customary round of the proper x-rays and possibly a CT scan are the best types of imaging to reveal structural problems to cause the kinds of problems you are describing. The ultrasound, bone scan, and MRI are less useful.

[knee always hurts]

I want to mention a research paper that I read a few months ago, because it sounds like it could be relevant to your case:

http://informahealthcare.com/doi/abs/10.1080/00016470310018225

At the end of the PDF document, there is mention of possible treatment options.

[badpairofknees]

Thanks all for your replies.  It's sad to hear that some of you may have worse knees than mine.

I've been told that my kneecaps are not perfectly aligned, but the alignment is not too bad.  My kneecaps are pulled outside, and the inside is tilted upwards.  I've been also told that my vmo muscles are weak, so I've done PT exercises to strengthen those muscles.   My PTs tried taping 3 different ways, but taping actually worsened the pain.  No one has told me about my gaits, but I recently ordered custom orthotic inserts.  My calves and hamstrings are not tight (I was a yogini prior to the injury), and my glutes and hips are okay.   

Prior to the half marathon, both knees experienced some sharp pain once in a great while, which did not last more than a few hours each time.  I checked with a sports medicine doctor prior to the marathon just to make sure my knees were okay, and he didn't think there was a problem.  The doctors I have seen since the injury are knee surgeons and sports med doctors. 

I am not sure why the pain returned three weeks after the marathon -- I was still giving my knees a rest at that time and did not engage in any activities that were tough on the knees. 

I've not heard of Euflexxa injection until now.  I must look into it. 

I'm worried that as time passes, I'd be doing more damage to the knees.  Would I be confined to a wheelchair?   I feel like the doctors just see the test results and conclude that I should be okay -- as opposed to actually listening to me describe the pain.  I am so frustrated with them, so I am starting to do my own research. 

knee always hurts -- I will be following your thread, and thanks for the article.  Please let me know how your visit with the new specialist goes. 

[amoler]

I'm worried that as time passes, I'd be doing more damage to the knees.  Would I be confined to a wheelchair?   I feel like the doctors just see the test results and conclude that I should be okay -- as opposed to actually listening to me describe the pain.  I am so frustrated with them, so I am starting to do my own research. 

I have been running into a whole lot of NOT "actually listening" too. I find it infuriating.

[badpairofknees]

Update:  I still have a ton of pain.  I recently started going to a new doctor (sports med at a teaching hospital).  He looked at the MRI and said that there's could be a cartilage flap.  (All other doctors I've seen before said that the MRI was clean.) 

The new doctor suggested that I do more PT.  I'm not hopeful that PT would help, since I've done it before without success.  But I'll give it another try.  I'm starting PT with a new therapist tomorrow.  The doctor said that if PT doesn't help in 2-3 months, he'd recommend that I see a surgeon for a scope. 

I'll update this thread with new developments.