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Author Topic: chronic bilateral anterior lateral pain and minor swelling below the kneecap  (Read 429 times)

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Offline haughki

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I'm essentially looking for help diagnosing this issue.

I'm a 47 year old male, have been very physically active my whole life. Did a lot of long distance backpacking and rockclimbing in my teens and twenties. Not a runner. Amateur freediver in my thirties/early forties -- lots of swimming and kicking with very big swim fins.

Pain ranges from 0 to 4-5 out of 10 at the worst (when I decide to back way off or totally rest). Not a sharp pain -- diffuse ache.

From my perspective, looking down at the left knee, the pain is just below and to the left of the kneecap. It's a little "under" the left edge of my patellar tendon, and extending out to the left an inch or two. It's on the "outside" of the knee (as opposed to deep in the joint), and if I fully extend my knee, there's a subtle 'bump' which is soft to the touch. All of the pain feels like it's in this squishy little tissue right there. See also attached pics.

So far, I can't seem to get any clear diagnosis from GP or PT (GP sent me to PT).

I've had this pain off and on for ~15 years. I first noticed it doing yoga -- seemed to me like all of the "knee locking" (fully extended knee with quadriceps fully contracted) was the source of the problem. Stopped the yoga and the pain went away, but would return sortof whenever -- it was never 'serious', and went away quickly. I always though it was related to some minor patellar tendon tendonitis that I've had a few times (currently not at all, and not for a few years).

Originally the pain was pretty much bilaterally equal. Now, the left side is much worse -- the right is pain free at this point. It's gotten worse over the last two years: starting with another try at yoga (foolish) where it pretty suddenly resurfaced in a bad way. Since then, the left side just won't seem to subside. If I rest it for a week, the pain slowly diminishes to nothing, but as soon as I start back with _anything_, the pain starts up again and gets worse. At this point, I'm down to a minimal workout on the recumbent bike, and that's it: no squats, no leg extensions, no zoomers in the pool, no elliptical. Even walking on flat ground for for more than 1/2 a mile seems to aggravate it. Adding any weight (my two year old son -- 30+ pounds) makes it worse.

Based on advice from PT, have been doing clamshells with theraband -- 3 sets of 15 ~3 times a week. Also glute bridge holding for ~1min (sometimes with added weight). PT also recommended hip internal rotation with theraband, which I did for a few weeks, but seemed like it was straining rather than helping. PT also recommended various hip stretches which I haven't been doing :(

I ice it almost every day at the end of the day. Usually off and on, ~15 mins at a time, with 15 min breaks, x3. Also take ibuprofen, 400 - 600mg when it gets "bad" (I don't do this more than 3 times in a week). All of this stuff helps a bit, but it really seems like the only thing that _really_ helps is rest.

Having written this, I'm thinking that I need to give it some more lengthy rest -- two to three weeks. Then get more committed to the PT without adding anything else for a while. Of course, I'm getting paranoid about the overall loss of muscle, which is why I keep trying to do some kind of workout. I have some guesses about a diagnosis, but would love some fresh perspective.

Hawkeye Parker

Offline vickster

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Have you had a scan to check there's nothing damaged or mechanically wrong?
If so and nothing has shown up, it's most likely some degree of patellofemoral syndrome. In which case you could potentially be looking at months of real slow down of rest which you say helps alongside gentle back to basics physio. Has the physio or a podiatrist reviewed you foot alignment and gait. Why aren't you doing the hip stretches?

PFS often down to muscle imbalance impacting the knee, could be in the hips or glutes or down in the ankles and feet

You might find hydrotherapy useful, doing the exercises while supported by warm water

There's plenty of info around the board on PFS, e.g. The patella primer in the learning portfolio

Good luck
« Last Edit: June 14, 2018, 06:07:28 PM by Vickster »
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Offline BenAldridge0

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Hi VICKster. I have a question regarding PFKS. Could I get into touch with you?

Right now, I'm not able to send a message, presumably because I'm still a newbie and haven't posted that much.    Thanks