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Author Topic: Knee cap popping out of place laterally (subluxation) and lateral pain  (Read 2030 times)

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Offline runner7

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Hey everyone!

It's been a while since I posted on here.  My original injury (medial femoral osteochondral fractures in both knees) hasn't improved any in 10 months unfortunately, but I'll save that for a different post.  My question actually pertains to a new injury that has developed.

I haven't been able to run or walk very easily in the past 10 months, but cycling had not been a problem as it never put weight on the location where my osteochondral fracture was.  So I'd been cycling quite a bit from February to June.

Well about mid-June, I started to develop problems while cycling.  The pain was on the outside of my right knee.  I didn't know exactly what the pain was -- it was (and still is) very hard to pinpoint its location exactly.  So I stopped cycling completely and waited to see if this problem would relieve itself.  It didn't.

In late July, I went to see my orthopedic surgeon about my original injury.  While there, I mentioned this new injury, and he kind of blew it off.  He asked "How much have you been cycling?"  I said, "Well, I haven't cycled at all in a month because it's hurt a lot and hasn't gotten any better".  He said "Well how much were you cycling when you could?" to which I replied "An hour a day".  He proceeded to tell me that was far too much and that's a crazy amount of cycling (any cyclist will tell otherwise).  Anyway, he decided it was an overuse injury and I should "stretch".  Lot's of help right?

So since July, I've been stretching and foam rolling the heck out of the thing, not to mention an hour a day of physical therapy (with my trainer) to build up glutes, hamstrings, quads, etc.

It's now October and that stupid pain still hasn't gone away.  Everyone thinks it's IT band syndrome, but I have some serious doubts about this.  For one thing, it hasn't responded AT ALL to any of the normal treatments for this.  Not to mention that ITBS syndrome is supposed to be well localized and cause well-known specific pains as the tendon snaps over the femoral epicondyle.  I have none of this.

Instead, I have made my own pseudo-diagnosis and I'm afraid something isn't tracking right.  Ever since mid-June, my patella (kneecap) has been sliding/popping.  What I mean by this is that if I'm sitting and I extend my leg, occasionally, the kneecap will visibly jump sharply and pop.  It's not the same type of pop as when you crack your knuckles -- it's like a "the knee cap is sliding over something sharply and makes this loud sound".  I told my OS this and he said "Oh, that's normal; everyone's knees pop".  I'm pretty sure this isn't the "normal popping".  But some doctors are just difficult to talk to.

So anyway, what I notice with cycling is that at the beginning of my rides, when my knee is almost at the downstroke but not quite all the way extended, it occasionally jumps/pops on its own -- painfully on occasion.  And this is the same location that feels painful/uncomfortable/weird for the rest of my ride.

One other thing I've noticed is that when I'm sitting, if I extend my leg straight out all the way, on the top lateral part of the patella I feel a grinding sensation.  I don't feel this grinding in my left knee.

In essence, I'm really worried that I have worn out cartilage in that area because my patella isn't tracking correctly and that's where all the pain is coming from.  Even though all of the doctors and trainers still think it's ITBS.  I have a recent MRI (for my other injury) and there's no cartilage damage visible in the location where it grinds so they don't think anything is wrong there.

So....

Has anyone had a situation like this?  I'm getting exasperated.  I can neither run nor bike now and swimming isn't especially fun.  The doctor says he'll give me a cortisone shot if I want one (again, he thinks it's for treating IT band syndrome), but I know cortisone can also relieve pain from cartilage damage, so either way I'm thinking it should help.

What do you guys think?  Sorry for the ridiculously long post.

Offline aaa

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Re: Knee cap popping out of place laterally (subluxation) and lateral pain
« Reply #1 on: October 30, 2011, 09:07:51 PM »
I've had something like this.  After years of left knee problems, and constantly overusing my right leg, I started getting right knee pain .... pretty frustrating.

I haven't had symptoms quite as bad as yours, but the part about biking and the bottom of the stride being difficult is something i've experienced.  I can feel my kneecap as if its pulling a bit to much laterally and its an uneasy feeling.  I haven't had the grinding / popping ... I had an MRI on the right which an extremely qualified OS who is a patellofemoral specialist look at and said 'looks perfect' and 'lose 15 pounds and see what happens'.  We also thought that once the left knee is fixed, the right will be ok.

For me, physiotherapy targeting the hips more helped me out.  I've been able to make some progress and keep it under control with hip strengthening exercises, particularly abductors - e.g. lateral band walking, side lying leg lifts. I found a 'hip hiking' exercises also helps, do a youtube search and will give the basic idea.  As always, see someone qualified to start any programs, but just trying to give some things that might be worth exploring. Also, trunk rotations worked quite well for me - lying flat on back with knees bent 90 degrees, keeping knees together and rotating the trunk to either side, again a youtube search will give basic idea.

I also found hip flexor exercises, and 'bird dogs' help a bit.  Also squats with an elastic around the knees, and bending from the hips first.  Stretching / warmup is always important ... hip flexors, hamstrings, quads (heel to butt), foam roller, and I also do an IT band stretch by tying a rope to my ankle while lying flat on my back and pulling my leg across and upwards past the midline with leg straight.  Stetching calfs helped as well.

Not sure if the above helps you any, but for me again PT really helped quite a bit.  I've also been doing patella mobilization pushing the kneecap medially




Offline runner7

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Re: Knee cap popping out of place laterally (subluxation) and lateral pain
« Reply #2 on: November 09, 2011, 02:49:57 AM »
Hey, thanks for the reply!

I've been doing hip exercises for about 2 months, but I haven't noticed an improvement yet.  How long did it take in your case?

Offline aaa

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Re: Knee cap popping out of place laterally (subluxation) and lateral pain
« Reply #3 on: November 10, 2011, 03:10:29 PM »
Looks like lately some of my symptoms have returned!

But, it is still a lot better than in the past.

In my case, I'm finding a lot of it has to do with how I have adapted to favoring my right knee.  With my left knee basically shot, I've got into the habit of 'pivoting' of my right knee / spinning on it and keeping it stiff / straight.

Its now a challenge to flex my right knee properly, so I have to remeber to try and bend my right knee when moving around, but it is really a challenge as trying to be concious of this all the time when moving isn't easy

I also have a lot of foot pronation, even more on my right then left ... I try not to let my arches fall in too much and am starting to work on some 'foot gymnastics' and work on the arches, there are some exercises for this.  Also I have to remember to follow through with my foot when walking, i'd developed a habit of stiffining up on the right foot

Its been more than a few months ... but it probably didn't have to be that long , each case is so unique , the challenge is finding someone who knows about the problem.

i believe there is almost always somebody who knows the solution, its a matter of finding the right person ... you may want to consider seeing a patellofemoral specialist ... check out the patellofemoral boards, or PM me and I will try to recommend someone
















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