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Offline HelpMePls

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PFPS - I'm desperate
« on: April 19, 2018, 12:09:58 PM »
Hi!
I came here to seek for advice, because I'm really desperate.
The thing started in 2015 probably due to the sedentary job. I was feeling some little pain after a long sitting, but could still walk normally. I just stopped running. In 2016 my car broke so I began to ride a bike to work. In the beginning I felt uncomfortable even riding on the first shift, but my knees improved in a few months so I was able to ride even on a 4th shift. In 2017 I was snowboarding comfortably and I was on a mountain trip hiking for about 5-7 hours daily and felt no pain or inflammation. Then in the fall of 2017 I stopped riding bike and my knees started to become worse. In November I injured my knees (by jumping on some fitness classes) so much that they were hurting for a few days. I think this is a real starting point for the state I'm now in.
In January I was feeling good and went on a bus trip. After a whole day of walking I was feeling that one of my knees is tired. I found Richard Bedard's book and tried to follow his advice. I also read about dr Dye etc. and figured out that I need to exercise more, but with less weight so I bought a walker and tried to walk for about an hour without any problems.
My knees got worse and worse and I think I still overused them. I am on a sick leave from the middle of March. A month ago I was still able to walk in my flat a little, but now... I am unable to even use the walker, because I feel the inflammation going on after a few hours. Generally, my knees don't hurt right now, because I am just laying in my bed now. Last week I tried to roll a bottle or do some other gentle exercises, but my knees didn't tolerate even a minute daily of this and became inflammed in the evening.
I consulted several doctors. One of them said that I have a big fat pad and was suggesting a cortisone shot. Should I try it? I am also supposed to have arthroscopy, but I am a little afraid of it as I have read a lot of negative opinions.
I am also afraid of muscle atrophy, but my legs still look quite muscular as I was doing a lot of training in 2017. I also fear CRPS, because lately my feet become a little red when I sit. I am using TENS to avoid a full-blown CRPS.
In March I used to take NSAIDs for about a week, but I didn't feel the difference. I started taking NSAIDs again though (after reading the story of SuspectDevice) and I use a topical Voltaren gel.

I live in a lame country where my private healthcare provider didn't even perform MRI because it's too costly for them even though I have MRI mentioned in my health packet. I will have it in May in the public health hospital.
I had my knees examined on USG and the doc said I have chondromalacia level I/II.

I will be very grateful for any advice. Should I rest the knees more and then try to exercise following the tissue homeostasis paradigm?
« Last Edit: April 19, 2018, 12:20:28 PM by HelpMePls »

Offline exrunner1

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Re: PFPS - I'm desperate
« Reply #1 on: April 19, 2018, 03:01:08 PM »
Hi!
I came here to seek for advice, because I'm really desperate.
The thing started in 2015 probably due to the sedentary job. I was feeling some little pain after a long sitting, but could still walk normally. I just stopped running. In 2016 my car broke so I began to ride a bike to work. In the beginning I felt uncomfortable even riding on the first shift, but my knees improved in a few months so I was able to ride even on a 4th shift. In 2017 I was snowboarding comfortably and I was on a mountain trip hiking for about 5-7 hours daily and felt no pain or inflammation. Then in the fall of 2017 I stopped riding bike and my knees started to become worse. In November I injured my knees (by jumping on some fitness classes) so much that they were hurting for a few days. I think this is a real starting point for the state I'm now in.
In January I was feeling good and went on a bus trip. After a whole day of walking I was feeling that one of my knees is tired. I found Richard Bedard's book and tried to follow his advice. I also read about dr Dye etc. and figured out that I need to exercise more, but with less weight so I bought a walker and tried to walk for about an hour without any problems.
My knees got worse and worse and I think I still overused them. I am on a sick leave from the middle of March. A month ago I was still able to walk in my flat a little, but now... I am unable to even use the walker, because I feel the inflammation going on after a few hours. Generally, my knees don't hurt right now, because I am just laying in my bed now. Last week I tried to roll a bottle or do some other gentle exercises, but my knees didn't tolerate even a minute daily of this and became inflammed in the evening.
I consulted several doctors. One of them said that I have a big fat pad and was suggesting a cortisone shot. Should I try it? I am also supposed to have arthroscopy, but I am a little afraid of it as I have read a lot of negative opinions.
I am also afraid of muscle atrophy, but my legs still look quite muscular as I was doing a lot of training in 2017. I also fear CRPS, because lately my feet become a little red when I sit. I am using TENS to avoid a full-blown CRPS.
In March I used to take NSAIDs for about a week, but I didn't feel the difference. I started taking NSAIDs again though (after reading the story of SuspectDevice) and I use a topical Voltaren gel.

I live in a lame country where my private healthcare provider didn't even perform MRI because it's too costly for them even though I have MRI mentioned in my health packet. I will have it in May in the public health hospital.
I had my knees examined on USG and the doc said I have chondromalacia level I/II.

I will be very grateful for any advice. Should I rest the knees more and then try to exercise following the tissue homeostasis paradigm?

I had the same problem. Whats working for me might or might not work for you. If you have a choice, give ur problem knee complete rest while trying to figure out what exercises you can tolerate to build up your muscle. You are only supposed to what does not give you pain. For me at some point that was almost everything. Strengthening helped to some extent but following the envelope of function is helping more.  Start with 5 mins of walking and then increase it by 10% every week.


Offline HelpMePls

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Re: PFPS - I'm desperate
« Reply #2 on: April 19, 2018, 07:52:19 PM »

I had the same problem. Whats working for me might or might not work for you. If you have a choice, give ur problem knee complete rest while trying to figure out what exercises you can tolerate to build up your muscle. You are only supposed to what does not give you pain. For me at some point that was almost everything. Strengthening helped to some extent but following the envelope of function is helping more.  Start with 5 mins of walking and then increase it by 10% every week.

Hi :). Thanks for your response. Unfortunately I can't walk even for 10 seconds, because my knees become inflammed after such activities. But I will try to give total rest a try. Have you used NSAIDs or some other things like topical gels?

Offline exrunner1

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Re: PFPS - I'm desperate
« Reply #3 on: April 19, 2018, 09:05:29 PM »

I had the same problem. Whats working for me might or might not work for you. If you have a choice, give ur problem knee complete rest while trying to figure out what exercises you can tolerate to build up your muscle. You are only supposed to what does not give you pain. For me at some point that was almost everything. Strengthening helped to some extent but following the envelope of function is helping more.  Start with 5 mins of walking and then increase it by 10% every week.

Hi :). Thanks for your response. Unfortunately I can't walk even for 10 seconds, because my knees become inflammed after such activities. But I will try to give total rest a try. Have you used NSAIDs or some other things like topical gels?

Try to keep your knees above your heart. That is when you are on the bed, keep your legs on a few pillows. I used NSAIDS but they have side effects. Use a brace if you cannot avoid walking. I believe rest and strengthening(atleast to the point you can walk for a few minutes) are must. What kind of exercises are you doing? Have you seen a physical therapist?

Offline exrunner1

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Re: PFPS - I'm desperate
« Reply #4 on: April 19, 2018, 09:25:20 PM »
Hi!
I came here to seek for advice, because I'm really desperate.
The thing started in 2015 probably due to the sedentary job. I was feeling some little pain after a long sitting, but could still walk normally. I just stopped running. In 2016 my car broke so I began to ride a bike to work. In the beginning I felt uncomfortable even riding on the first shift, but my knees improved in a few months so I was able to ride even on a 4th shift. In 2017 I was snowboarding comfortably and I was on a mountain trip hiking for about 5-7 hours daily and felt no pain or inflammation. Then in the fall of 2017 I stopped riding bike and my knees started to become worse. In November I injured my knees (by jumping on some fitness classes) so much that they were hurting for a few days. I think this is a real starting point for the state I'm now in.
In January I was feeling good and went on a bus trip. After a whole day of walking I was feeling that one of my knees is tired. I found Richard Bedard's book and tried to follow his advice. I also read about dr Dye etc. and figured out that I need to exercise more, but with less weight so I bought a walker and tried to walk for about an hour without any problems.
My knees got worse and worse and I think I still overused them. I am on a sick leave from the middle of March. A month ago I was still able to walk in my flat a little, but now... I am unable to even use the walker, because I feel the inflammation going on after a few hours. Generally, my knees don't hurt right now, because I am just laying in my bed now. Last week I tried to roll a bottle or do some other gentle exercises, but my knees didn't tolerate even a minute daily of this and became inflammed in the evening.
I consulted several doctors. One of them said that I have a big fat pad and was suggesting a cortisone shot. Should I try it? I am also supposed to have arthroscopy, but I am a little afraid of it as I have read a lot of negative opinions.
I am also afraid of muscle atrophy, but my legs still look quite muscular as I was doing a lot of training in 2017. I also fear CRPS, because lately my feet become a little red when I sit. I am using TENS to avoid a full-blown CRPS.
In March I used to take NSAIDs for about a week, but I didn't feel the difference. I started taking NSAIDs again though (after reading the story of SuspectDevice) and I use a topical Voltaren gel.

I live in a lame country where my private healthcare provider didn't even perform MRI because it's too costly for them even though I have MRI mentioned in my health packet. I will have it in May in the public health hospital.
I had my knees examined on USG and the doc said I have chondromalacia level I/II.

I will be very grateful for any advice. Should I rest the knees more and then try to exercise following the tissue homeostasis paradigm?

Cortisone shots mess up the good cartilage too. There are a few examples of that on the web. Use it at your discretion.

Offline Geronimo

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Re: PFPS - I'm desperate
« Reply #5 on: April 25, 2018, 10:26:40 PM »
i would definitely try  cortisone/synvisc before going for arthroscopy.

also, what do you  mean by you  feel your knees are inflamed? there is a huge difference between joint pain and soreness from being tired. what I would definitely recommend is to try to keep your muscles as fit as possible, it will be hard to build them back with knee issues.

Offline reader278

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Re: PFPS - I'm desperate
« Reply #6 on: April 26, 2018, 06:17:05 AM »
You can get a step counter-start to monitor how much you can actually tolerate- it may be very little in the beginning. keep a diary and track what causes exacerbations. I wouldn't do complete rest because you still need some gentle loading to maintain homeostasis.  Track your pain levels too. Increase your envelope of functioning slowly by 10% per week. Remmeber knees with PFS can often heal slowly, so don't get discouraged. Also what helps me with the pain is capsaicin cream 0.1% and myofascial release with a ball- rolling out my IT bands especially. also if I were you and I were worried at all about CRPS see a pain specialist ASAP to get it under control and hopefully get it into remission. also remember it's a very lonely isolating experience but we're all going through it and can hopefully support each other with progress/tips.

Offline SuspectDevice

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Re: PFPS - I'm desperate
« Reply #7 on: April 26, 2018, 11:46:56 AM »
it's a very lonely isolating experience but we're all going through it and can hopefully support each other with progress/tips.

This is a very accurate comment. 

And everyone's journey seems to be different.  There is a whole lot of frustrating trial and error to make gains.  I took anti-inflammatories (Celebrex) for about 5 months (though I did start getting some relief after a week or two).  Short bursts of icing (15mins 1-2x/day) also helped, as did the TENS machine when the burning was really bad.

I agree about the need to do some movement to keep some leg strength.  For me it was a slow flat walk of about 18mins most mornings.

I think intensity is also a factor for me (e.g. 3hrs of easy bike riding over 3 days on a bike tour in NZ had me worried, but my knees just got better as I went).  But a really hard 30min bike session could produce a major setback.

And sometimes, even now, it defies all logic.  For example on Sunday I did my first ever 1hr MTB race and it was hard, but my knees were really good.  A week or two before, a far more moderate road bike ride caused a flare up.

There is no silver bullet answer.  You just have to commit yourself to a long haul of experimentation and learning.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline HelpMePls

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Re: PFPS - I'm desperate
« Reply #8 on: April 26, 2018, 03:32:58 PM »
Hello again :).
Thank you for all the responses. Today I was visiting neurologist about this CRPS thing and he told me that I should not worry about this, but try to move more. He said I shouldn't go for the arthroscopy. I was thinking about the surgery because I probably have some plica/fat pad problems, but I am not convinced and probably won't go.

I am very happy right now, because I was in the bed for the whole week (pure rest) and I am finally beginning to feel better. Yesterday I even made a couple of steps with a walker. It used to hurt two weeks ago, but now I'm fine doing it!!
I won't go for this cortisone shot. I am getting better, but it will probably take moths to be able to walk again.
I have a really small envelope of function right now, so walking 5 minutes seems like an abstract thing for me, but I will try 30 seconds with a walker today.

I'll also try to keep a small diary here and report every week.
« Last Edit: April 26, 2018, 03:35:06 PM by HelpMePls »

Offline reader278

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Re: PFPS - I'm desperate
« Reply #9 on: April 27, 2018, 04:39:35 AM »
I am still using 1 crutch since my surgery 2 months ago, what I'm finding is that very short trips every hour allows me to tolerably increase my step count without exacerbations (for the most part). I'm setting an alarm to get up and walk to my kitchen or bathroom every 60 minutes. I am also using a BFR and feel it's helping with muscles.

Offline exrunner1

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Re: PFPS - I'm desperate
« Reply #10 on: April 30, 2018, 02:29:53 PM »
I am still using 1 crutch since my surgery 2 months ago, what I'm finding is that very short trips every hour allows me to tolerably increase my step count without exacerbations (for the most part). I'm setting an alarm to get up and walk to my kitchen or bathroom every 60 minutes. I am also using a BFR and feel it's helping with muscles.

Can you please clarify what it BFR?

Offline vickster

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Re: PFPS - I'm desperate
« Reply #11 on: April 30, 2018, 02:42:13 PM »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline exrunner1

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Offline Christine10S

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Re: PFPS - I'm desperate
« Reply #13 on: May 13, 2018, 04:57:17 AM »
Hi-
Iím also suffering from PFS, on my 8th Month... injured (sprained) both knees doing a wall squat :(.   MRI & x rays were perfect; but my OS said I have PFS w Patellar tendinitis, which is pretty painful around the patella.  Iím finally (after 6 mo of no progress) working w a great PT.  I can now walk on a treadmill for 15 min @ 4 miles per hour, & then do the elliptical for 12.   Stairs do not bother me.  But the second I try any lunges it brings me right back to square 1 w the pain. Im 49 & im excellent shape... I feel like Iím never going to get better....itís a painful mental game for sure...
How are you doing?
-Chris















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