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Author Topic: Knee injury - IT band? PFS? Help!  (Read 5224 times)

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Offline frzg

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Knee injury - IT band? PFS? Help!
« on: March 14, 2011, 10:40:04 PM »
Hello all!  Quick recap,

On December 11th, I was sitting in my office chair (I haven't exercised for 2 months at this point as work had been incredibly busy) and I put my left leg folded under my butt and sat down.  I felt a sharp pain and immediately moved my leg.  I was worried and waited 5 minutes and tried to stand up and I had a horrible pain and sat right back down.  At this point, my wife was 9 months pregnant and my business was as in the busy season so I did not have time to do anything.  I went to the doctor the next day and they moved my knee in every position and determined that I didn't have any tears and an xray confirmed that.  They were convinced I sprained or strained my MCL.  I was so distracted with my pregnant wife and work that I wasn't able to do any rehab or even ice it and I had to continue to carry heavy boxes up and down the stairs for work.  I limped on my leg for 1 month and did nothing to help it.  Finally when worked slowed down, on January 20th I went back into the doctor to make sure nothing was further injured and they said it seemed fine.  At this point, my knee was popping on the outside and I was told by an orthopedic surgeon that it was my IT band catching on my patella. 

At that point I started doing a lot of exercises and strengthening techniques and over the past 2 months my knee pain has decreased a lot.  I'm afraid limping on my leg for 1 month might have thrown my knee cap off alignment or something.  I went in for a massage and was told my IT band was really tight and my adductor magnus was very tight and sensitive to pushing as well.  For the past week I've been using a foam roller to stretch it out, but I'm still getting the catching of what I believe is the IT Band on my patella.  I get random knee pain on the patella when I step and when I have it straight for too long I will bend it to a large popping sound with occasional pain if it pops really loud.  I've been told that its possible my IT band or PFS, but from what I've gathered both are caused by excessive running.  Is it possible this happened because I limped and favored the leg for a month?

What should I be doing to rehab and fix this?  I really want to get rid of the catching altogether as its very uncomfortable.  I've been able to jog and ride a bike, but it still scares me to know it can give out.  On January 20th when I decided it was time to rehab, I tried a few squats (I know, bad idea) at the time and it was very painful for each squat.  Now I can do them no pain and go down pretty far.  I'm pretty sore right now, but I can't tell if its from the knee injury or from excessive exercise on one leg.

Does this sound like an IT band issue, PFS, or something else altogether?  And as far as stretching/strengthening, what should I focus on to strengthen the leg in order to get rid of the catching.  Hamstrings, quads, glutes, or?

THANKS FOR ANY INSIGHT!!!

Offline smillie

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Re: Knee injury - IT band? PFS? Help!
« Reply #1 on: March 14, 2011, 11:51:32 PM »
PFS and ITBS don't have to be caused by running. That is just one source. When I first came here, I found it really helpful to go to the information hub and read the general knee information and especially the patella section. That might answer some of your questions. There is also an area of this forum just for patella issues. You might find some helpful posts to read there.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline Snowy

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Re: Knee injury - IT band? PFS? Help!
« Reply #2 on: March 15, 2011, 05:49:02 AM »
Quote
PFS and ITBS don't have to be caused by running. That is just one source.

Seconded - I stopped running after a knee injury in 2005 and have battled chronic PFS for years, so I can vouch for that from my own experience. Funnily enough I had to start running again recently as part of my ACL rehab, and immediately triggered ITBS - which I'd never suffered from before! Every individual is unique and what worked for me may not work for you, but I'll share my experience with the PFS in the hopes that it will help and maybe give you some new ideas. Your symptoms do sound very similar to the ones I suffered from, especially the anterior knee pain and that catching feeling.

My PFS still isn't better, but it's more controlled right now than it has been for many years. When it was originally diagnosed I was put through several physiotherapy programs through the NHS in the UK, none of which really helped. They were very focused on muscle strengthening, and lots of quad building exercises like squats and leg extensions. One physiotherapist also tried taping, which did help. The problems were so persistent that I was eventually referred for a scope, but after bouncing around NHS waitlists for a couple of years I moved to Canada before it took place.

The problems persisted here and my family doctor referred me to an orthopedic surgeon and sent me for an MRI. The MRI revealed no significant problems and the OS actually advised against surgery. He told me that my kneecaps were out of alignment and tracking badly, which was causing the PFS. Surgery would mean a lateral release, which he said I should only consider as a last resort. He suggested bracing and more physiotherapy, so I went out and purchased the unloader braces that he recommended. They improved things dramatically, and I resumed all activities with minimal pain. The braces worked so well that I didn't actually follow up on the PT recommendation.

Fast-forward to four years later, and during a house move I spent two weeks hauling heavy boxes up and down stairs and on my knees laying floor. The PFS returned with a vengeance, worse than before. I struggled on for about six months with no improvement (and minimal relief from the braces) and then went to see a sports medicine doctor, who referred me to a physiotherapist with an excellent reputation for dealing with knee problems.

This PT took a totally different approach. He made me stop doing everything that was causing pain - basically everything except cycling and swimming. (His reasoning was that I was locked in a cycle of inflammation, and we had to calm that down before we could begin addressing the problems.) Then he very, very gradually introduced strengthening exercises focusing on the VMO. For three weeks, all I did was 1,000 quad flexes a day. Then I started sitting with a towel clenched between the knees, and then rising from sitting to standing doing the same thing. Single leg dips of just a few degrees followed, and we gradually worked up to more intense strengthening exercises like the leg press and squats. He also got me into custom orthotics to correct the overpronation in my feet that was a significant contributor to the maltracking, and used IMS (intra-muscular stimulation) to release tight leg muscles that were countering the action of the VMO and pulling the kneecap out of place. After six weeks on his program, I'd stopped using the knee braces and could walk up stairs without pain for the first time in years.

Unfortunately at that point I blew my ACL and had to go and have reconstructive surgery, but that's a completely different story.

The take home message is that it usually takes a variety of approaches to fix a chronic problem like this. In my case it was a combination of settling down the inflammation, strengthening the VMO, dealing with the muscle tightness, and addressing the overpronation in my feet.

The other important thing to be aware of is that maltracking kneecaps are a symptom, not a cause. The cause is usually either muscular/gait related (as in my case) in which case a correct combination of conservative measures will be a big help. If the cause is structural, more drastic surgical measures are required. The only way to identify structural issues is via x-rays and CT scans that capture the kneecap as it tracks through a typical movement.

It sounds like your IT band is a big source of problems, so I'd definitely encourage you to see if IMS is available in your area. I found this phenomenally effective for releasing the tight muscles. Now I can keep things under control with a foam roller, but when things were really bad IMS was a godsend. It's not very pleasant (they stick a needle into the muscle and if it's tight, it cramps for a second as it releases) but it works.

The other thing I would really stress is that pain is a very important message from your knee. If something really hurts, don't do it. This was the mistake the NHS programs I was enrolled in made - they got me straight onto extensive programs of squats and leg extensions, and my knee simply wasn't able to cope with them and they most likely made the inflammation worse. Building up gradually is really important. I also can't emphasize the importance of finding a good PT enough; if I hadn't been sent to my current guy, I'm quite sure I'd still be in the same rather painful boat that I was in five years ago.

Hope this helps. As I said, each situation is unique and it's unlikely that you will have the exact same underlying causes that I did - but hopefully this will give you some ideas for how to proceed.
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 sor

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Re: Knee injury - IT band? PFS? Help!
« Reply #3 on: March 16, 2011, 05:29:06 AM »
Did you ever get an MRI? X-rays don't really show squat, even MRI's aren't foolproof. Xrays show bone. Most knee issues are not bone-related, if I've learned one thing. IT issues and patellofemoral crap I've learned about the hard way since last Oct/Nov. It is true that the outside of the knee is more easily victim as we tend to move front and back, not laterally, so the muscles are imbalanced from the get-go. R.I.C.E is usually a good idea (I was not able to apply this, either. :(  ) But I would get an MRI if you haven't yet, just to KNOW. I mean, it IS your knee. And find a different ortho, geeze. Doesn't sound like your current one is that great if your knee is popping around, you're in chronic pain, and they don't want an MRI? Maybe I missed something.

Offline frzg

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Re: Knee injury - IT band? PFS? Help!
« Reply #4 on: March 18, 2011, 05:57:10 AM »
No MRI, just an xray which I forgot to mention as the xray revealed that I have a bipartite patella back in December.  No one seemed to concerned about it but I'm curious if this is part of the issue.  I'm not going to lie, I'm not in much pain anymore as it has been improving the past 2 months.  But the only thing that hasn't gone away is the uncomfortableness of the kneecap when I turn a certain way or push off randomly I get a pulling sensation on the knee cap.  But as of now, I can run, do squats, jump and do normal activities its just I have a ridiculous pop in the outer knee which I can visibly see as I bend my knee (thats what they say is the IT band).  I've used a foam roller the last 2 weeks and my IT band is no longer tight at all and there is no pain on the roller but I still have the popping.  Does it take a while for it to back to normal even without the tight IT band? 

My biggest problem is lack of trust with my knee right now as the popping/cracking bothers me and it scares me to push it.  When I have my knee straight too long and I bend it, the crack is loud and a bit painful.  I've been doing 200 leg lifts a day the last week and riding the stationary bike as much as possible, i just want the cracking and awkward feeling kneecap to go away!  As I sit here in type this, I'm not in pain, but my knee just feels tight and nothing like my right knee.