How best to reduce inflammation

[RobinJF]

I currently have a patellar maltracking flareup. My GP says don't exercise if it's painful, because that's making it worse, so how do I get to the point where I can start building the quads again?

The obvious answers are rest, ice and NSAIDs, but using all these (though maybe not in the best ways) it's just as bad as it was weeks ago.

I use a crutch and might start using two, though that's awkward for carrying things. Haven't been out of the flat for over a week. I live on my own so can't hand off food preparation etc to someone else. At the moment I'm taking 400mg ibuprofen four or five times a day and icing it fairly regularly. A couple of times during the past month or so it's seemed to be getting better but then flared again, possibly because I've gotten optimistic and been less careful. But I can't link the improvements to anything I've done or not done.

Any suggestions?

[vickster]

That sounds like a lot of ibuprofen. 3 x 400mg is the advised max dose. Are you taking with food always and using a gastroprotective PPI to protect the stomach lining? Is that dose physician prescribed? If it's not working, maybe ask for something stronger like naproxen plus the PPI. Or get PRP (or steroid) for the inflammation?

Are you seeing and doing physiotherapy? That's the best way to strengthen and balance muscles 

[RobinJF]

Thanks Vickster. Sorry, for brevity and simplicity I didn't say anything about the history, which is long and complicated, though I believe it's only the patellar maltracking that's relevant now.

I believe I know what I'm doing with ibuprofen, I've taken a lot over the years and had only very occasional, very short-lived stomach problems, when I missed a meal. By the way, some authorities recommend up to 3200mg/day.

I've seen many physiotherapists and I know the relevant exercises. The problem is that, if I follow my GP's advice (which seems sensible) I can't exercise as long as it's causing pain, I need to get past that point before I can start.

[vickster]

I'd try injections if inflammation isn't settling with such a large dose of NSAIDs

And seek to resolve the cause of the maltracking if it's a chronic issue, be it physio or surgery, with a PF specialist surgeon

Good luck

[RobinJF]

Thanks Vickster

[MyKnee2010]

Hi Robin,
Sounds like you are having basically the same issue as I am. My OS said I need to build muscle so my knees are strong enough to handle every day stress & so they will stop hurting & the fluid & inflammation will go down but trying to build muscle stresses the knees more so I get more fluid & inflammation which makes them hurt more. It is a vicious cycle!

I take 2400 mg of ibuprofen,  20 mg of vicodin (hydrocodone), & 100 mg of amitryptline a day for pain & inflammation. Doesn't seem to help much. When I saw my OS a few weeks ago, he told me to do 5 mins on an exercise bike a day, & then try not to stress my knees for the rest of the day. HUH?! I can't sit for 23 hrs 55 mins a day so my knees can relax. I tried doing less during the day & wearing a brace so the knee couldn't bend (bending seems to really hurt the knees) but it didn't help with the pain at all. All it did was make my knees feel stiffer. I also have a million things to do every day just taking care of the house & my family and the OS never volunteered to come home with me & take over my chores!

I've been waiting for referrals from my doctor so I can go to a couple different pain management clinics as well as starting to do some physical therapy. All are things I've done a number of times before with no luck but what else is there to do? The OS wants to see me again in the spring to see how my knees are doing but I don't know if I'll go back if he is just going to tell me to work on my muscles again!

I'd be interested to hear if you find something that helps your pain!

[pawel.acl]

seem like I have similar Issue, I am 8 week post ACLr, my knee seem to flare up every month so I need it to be drained, last time was beginning of December, now again swollen.

I currently have a patellar maltracking flareup. My GP says don't exercise if it's painful, because that's making it worse, so how do I get to the point where I can start building the quads again?

The obvious answers are rest, ice and NSAIDs, but using all these (though maybe not in the best ways) it's just as bad as it was weeks ago.

I use a crutch and might start using two, though that's awkward for carrying things. Haven't been out of the flat for over a week. I live on my own so can't hand off food preparation etc to someone else. At the moment I'm taking 400mg ibuprofen four or five times a day and icing it fairly regularly. A couple of times during the past month or so it's seemed to be getting better but then flared again, possibly because I've gotten optimistic and been less careful. But I can't link the improvements to anything I've done or not done.

Any suggestions?

[RobinJF]

I've found the answer that suits me but I don't expect it to suit many others. It's very simple, and I'd guess that most people are already aware of it, but I wasn't until recently.

So it's this: if the exercise is painful at the time, it's making things worse, don't do it. But if the pain is delayed, don't worry about it, keep doing the exercise.

I was giving up on any exercise that seemed clearly to be causing delayed pain, because I thought that was making things worse, and as a result it tended not to get better. Now I'm doing it (basically quad building) as long as it's not painful at the time and it definitely is getting better. I'm quite a happy bunny, but as I say, I'm aware this won't help many.

[klk44]

I know your post is well over a year old or so but did you ever get the knee issue stabilized?
I'm having the same issue as far as swelling and trying to make the leg stronger.
Thanks!

[RobinJF]

I was eventually referred by my GP to a specialist who ordered an MRI scan then diagnosed osteoarthritis and recommended a partial knee replacement which happened about six weeks ago.  I believe the arthritis is a consequence of the previous knee problems, which (I very much hope) are all now resolved, so PKR recovery is the only issue I have to deal with, and the long term outlook is very good!  I wish everyone who reads this the very best of luck with their knees! 

[reflex_nl]

wow, PKR is still quite a surgery. Did they also replace the patella? and what age group are you in?

goodluck on the recovery!

[RobinJF]

wow, PKR is still quite a surgery. Did they also replace the patella? and what age group are you in?

goodluck on the recovery!

I still have the original patella. I'm 63, a little on the young side for this op but not massively so, I believe. Thanks for the good wishes, the same to you, whatever your situation.