Over a year and frustrated

[kawi_girl]

I was in a MVA last year, hit by an oncoming vehicle that crossed the Centre line. Complained about right knee pain upon admission yet main focus was a broken pelvis. When I started getting active again, soon after my right knee started hurting. Saw my doctor many times and went through lots of PT for patella femoral pain, due to possible muscle imbalances. Did this PT for 7 months with no real change. Now waiting for an MRI (xrays inconclusive) Am told perhaps a meniscus tear. I’m at the end of my rope! Bad days I can’t do much, good days I can maybe walk two kilometers or bike 6 kilometers. Still always have an awareness that something is not right.
I wish I knew what was going on!
Any thoughts out there? I also just needed to vent I guess.

[vickster]

Wait and see what the MRI shows. Do be prepared for it to show nothing (if it could be PFS) , arrange to see a knee specialist (maybe another specialised in PFS if needed) to discuss the findings and next steps.

Good luck

[kawi_girl]

Thanks for your reply. Can PFS get so bad that some days it’s hard to walk? I made it through my workday with a sore knee yet this evening I am limping around the house. It just feels like it’s getting worse lately. A bad flare up?

[Ruby.P]

Sorry to hear what you are going through and yes pfs can get so bad that it's hard to walk - I'm right now about to start my exercises but scared as yesterday they set off a full day of pain - I'd previously been really optimistic as had a few good days - one incorrect movement can start it all off again - my knees are the last thing i think about before i go to sleep and the first thing when i wake - its draining but I will fight on regardless x

[kawi_girl]

Thanks for your reply. The MRI showed possible fat pad impingement. This could result from the patella not tracking well. What I find frustrating is how am I supposed to do PT if I am in pain? Yet that is the treatment so far. My doctor did give me an injection of cingal yesterday, so far today it just hurts more.

[vickster]

Has your physio taped the patella into the right position and away from the fat pad. Are you icing the fat pad area to reduce any swelling.
What's Cingal? A steroid? It'll probably hurt for a week or so (that's normal) and then hopefully it'll feel better as the inflammation subsides.

Edit-it's steroid plus hyaluronic acid? Do you have arthritis?
Although a combo can help with more general inflammation, and dryness in the joint. In my experience, I've had a few (HA and steroid, not together), it'll be sore for a good few days and then if (no guarantees) it's going to help, it'll take a month to have an effect which should then last a good while

[kawi_girl]

Hello! Thank you for your reply.
Yes, Cingal is hyaluronic acid and a steroid. I do not have arthritis (at least not that has been diagnosed) My dr. (He is an orthopedic surgeon-and a very good one) was hoping it would help me to deal with the chronic inflammation. He said yesterday that he could feel (when doing the injection) that my knee capsule was very hard (sign of it being very ‘angry’)
Yes, I do ice my knee. It does offer some relief yet the inflammation has been going on for so long that it didn’t seem to have any lasting effect. Hard to do PT if I’m in pain.
My last PT did tape my patella, which seemed to help a lot initially and then suddenly did not. It has been like that for all (3) PT programs I have followed. Initially things seem promising and then back to increased pain. My knee has never been swollen, which seems bizarre. Yet the medial side has a burning feeling within it. If that makes sense. I know that one has to be dedicated to the program and put the work in, and I can honestly say I did everything that I was told to do, religiously. That is what makes this so frustrating, it’s not like I have been expecting a magic bullet yet even all the work and time has not paid off.
Sigh.
I hope that your thought about the injection working eventually is correct. Then I can at least get back to PT-I will be seeing a very experienced team so perhaps I’ll have some luck. I need to have hope or I’ll sink deeper into depression than I already am.

[vickster]

Do try to ice the knee a couple of times a day (x15 mins) now you've had the jabs to deal with what sounds like a post jab / steroid flare

I saw a PF expert physio a couple of years ago, very familiar with fat pad issues, she advised me to focus icing on the fat pad area, oil the skin with bio oil and rub an ice cube around the area for 5-10 minutes, keep the cube moving on the slippery skin to avoid burn

Do you use a topical inflammatory gel (in UK it's called Voltaren), assuming there's no reason to avoid NSAIDs of course, try that a couple of times a day to see if it helps.  I use the stronger one myself on various sore bits including the knee

[kawi_girl]

Thanks for your suggestions. I will do some icing twice as day as you’ve recommended.

I have used Voltaren for a hip injury before yet hated the smell. I have eaten Advil like candy, and am worried about using too much so trying to stick to ice and only use NSAIDS on occasion. I do find that Advil doesn’t always help anyway...these knee issues can be strange.

[vickster]

Ah, I quite like the smell of Voltaren! And it's quite effective for localised inflammation. My rheumatologist is a proponent over orals

If you use oral NSAIDs, make sure you take with a PPI like omeprazole (Losec in US). Maybe you could try a stronger one, like Naproxen or Celebrex (under Dr supervision of course)

[kawi_girl]

Yes, I haven’t explored the stronger NSAID yet, guess it’s just a journey at this point as to what works.

Hoping I’ll start to feel less pain tomorrow and this is just a steroid flare. Ice in the meantime.
Perhaps getting used to the voltarin smell will be something I’ll just have to face. Maybe I’ll go nose blind after a while

[Userhere123]

Yes, I haven’t explored the stronger NSAID yet, guess it’s just a journey at this point as to what works.

Hoping I’ll start to feel less pain tomorrow and this is just a steroid flare. Ice in the meantime.
Perhaps getting used to the voltarin smell will be something I’ll just have to face. Maybe I’ll go nose blind after a while

Hi,
How do you feel now?
I am going through the same thing. PFS for past 6 months. Going to PT for past 3 and a half months and no improvement yet. Is the same burning pain and swelling.
I don't have how to proceed with. I would like to know if you had any luck. What helps in your case?

[kawi_girl]

Yes, I haven’t explored the stronger NSAID yet, guess it’s just a journey at this point as to what works.

Hoping I’ll start to feel less pain tomorrow and this is just a steroid flare. Ice in the meantime.
Perhaps getting used to the voltarin smell will be something I’ll just have to face. Maybe I’ll go nose blind after a while

Hi,
How do you feel now?

Hello! Thanks for your reply and I’m sorry about your struggles. Here is an update on my condition.
So, the flare subsided after three days, and then started to feel a bit better. Shortly after that I had 4 days where I truly thought the injection had helped, yet then went right back to how I was before that.
Currently, the right knee is more sore, ranging from a ‘full’ feeling with an inflamed feeling in the medial area, to a deep ache during flexing while weight bearing. The left knee (no injection) has slightly improved. This COULD be due to a new physio program I started at the end of January. Very conservative, and anything that hurts, even minimally, I say no to.
I am starting to believe that the key to recovery is having a good PT that understands the envelope of function (yes I agree with dr. Dye) and you as a patient need to learn lots about knee function and give lots of feedback. Do NOT blindly trust anyone!
If I take it easy, ice for 20 min 3times a day I can calm the right knee down again. Gentle yet short FAST walks seem ok (I still have to experiment on the length, I’m thinking start with 3 to 5 minutes, hoping to be able to try for 3 times a day, resting in between as a baseline)
The latest news is I have decided to take 2 months of work to tackle this problem head on and with as much dedication as I can. This will start in March, I have one week left of work to go. PT work right now involve foam rolling, straight leg exercises, some stretches and a wall squat of maybe 15 to 20%, with a band, light loading yet no pain.
I have a feeling it’s going to be a long journey....

[SuspectDevice]

Hello! Thanks for your reply and I’m sorry about your struggles. Here is an update on my condition.
So, the flare subsided after three days, and then started to feel a bit better. Shortly after that I had 4 days where I truly thought the injection had helped, yet then went right back to how I was before that.
Currently, the right knee is more sore, ranging from a ‘full’ feeling with an inflamed feeling in the medial area, to a deep ache during flexing while weight bearing. The left knee (no injection) has slightly improved. This COULD be due to a new physio program I started at the end of January. Very conservative, and anything that hurts, even minimally, I say no to.
I am starting to believe that the key to recovery is having a good PT that understands the envelope of function (yes I agree with dr. Dye) and you as a patient need to learn lots about knee function and give lots of feedback. Do NOT blindly trust anyone!
If I take it easy, ice for 20 min 3times a day I can calm the right knee down again. Gentle yet short FAST walks seem ok (I still have to experiment on the length, I’m thinking start with 3 to 5 minutes, hoping to be able to try for 3 times a day, resting in between as a baseline)
The latest news is I have decided to take 2 months of work to tackle this problem head on and with as much dedication as I can. This will start in March, I have one week left of work to go. PT work right now involve foam rolling, straight leg exercises, some stretches and a wall squat of maybe 15 to 20%, with a band, light loading yet no pain.
I have a feeling it’s going to be a long journey....

Yup, that's right.  It is a long journey.  I thought I was going to have to live with it forever, but thankfully  I'm a lot better now after 7yrs.

After 2 previous attempts to do the short local triathlons over the past 2 seasons which ended with bad flares, it's 3rd time lucky as I did the local race with no major repercussions last weekend (took me 70mins, which is 12mins slower than my best when I was about 45 just before this knee nightmare started, but I'll take it given I've only done about 25% of the training I once did this past year).

Got 2nd place LOL! Not bad for a 56yo, and I was tussling with a 20-something year old, who only pipped me by 8 seconds (OK the really fast guy who would have beaten us both by 10mins got a flat tyre  ).  We exchanged places on the bike 4 times, and 2 times on the run, which made it the most fun race I've ever done.

TBH, I only went at about 90-95% intensity as I didn't want to kill myself, but it was a big step forward.  Still got a few knee tingles after, but nothing too drastic.

[Userhere123]

Yes, I haven’t explored the stronger NSAID yet, guess it’s just a journey at this point as to what works.

Hoping I’ll start to feel less pain tomorrow and this is just a steroid flare. Ice in the meantime.
Perhaps getting used to the voltarin smell will be something I’ll just have to face. Maybe I’ll go nose blind after a while

Hi,
How do you feel now?

Hello! Thanks for your reply and I’m sorry about your struggles. Here is an update on my condition.
So, the flare subsided after three days, and then started to feel a bit better. Shortly after that I had 4 days where I truly thought the injection had helped, yet then went right back to how I was before that.
Currently, the right knee is more sore, ranging from a ‘full’ feeling with an inflamed feeling in the medial area, to a deep ache during flexing while weight bearing. The left knee (no injection) has slightly improved. This COULD be due to a new physio program I started at the end of January. Very conservative, and anything that hurts, even minimally, I say no to.
I am starting to believe that the key to recovery is having a good PT that understands the envelope of function (yes I agree with dr. Dye) and you as a patient need to learn lots about knee function and give lots of feedback. Do NOT blindly trust anyone!
If I take it easy, ice for 20 min 3times a day I can calm the right knee down again. Gentle yet short FAST walks seem ok (I still have to experiment on the length, I’m thinking start with 3 to 5 minutes, hoping to be able to try for 3 times a day, resting in between as a baseline)
The latest news is I have decided to take 2 months of work to tackle this problem head on and with as much dedication as I can. This will start in March, I have one week left of work to go. PT work right now involve foam rolling, straight leg exercises, some stretches and a wall squat of maybe 15 to 20%, with a band, light loading yet no pain.
I have a feeling it’s going to be a long journey....

Yes. It's going to be a long journey.
I have been dealing with this for past 6 months. The same level of burning pain. PT doesn't help much. It's been 4 months of PT. Changed to a new PT now. The new PT tried aggressive dry needling in the thigh and upper knee area. Had 3 sessions of dry needling. It doesn't help much. He still want to try few more to see if it really works for me or not.  I have given the foam rolling and other stretching/strengthening exercises.
I have a scar tissue from my childhood on the same knee where I am having the pain. PT worked on the scar tissue too. He did with dinner needle kind of thing on those scar tissue.
I feel more sore after that. I really don't know if I need more dry needling or this needling for scar tissue.
How often do you get pain? I get pain whenever I bend my knees and stretch straight. Sometimes while standing. It's kind of burning pain right above the knee and on the lateral side. Hope we get some relief soon.