Over a year and frustrated

[kawi_girl]

Yes, I am going to PT, usually once a week. That’s just for a follow up,and some modalities and we talk about things that are working and things that aren’t. I also research and bring ideas for her to consider and we decide if it’s worth trying. Much different than my previous visits to physio, I was more hopeful then and have tried 3 other 6 plus week programs. The last one I did for 12 weeks. It’s not like I thought the PFP would be completely gone yet I never had even a bit of lasting improvement. So this time I am getting much more involved, informed and asking way more questions.
Between visits I follow a home program. We are going to try some exercises every second or third day now, yet when I do them work to 70% muscle fatigue. The idea is to have a rest day in between as rest is part of making gains. There are some things I will still do everyday.
I feel like an experiment!

[Userhere123]

Yes, I am going to PT, usually once a week. That’s just for a follow up,and some modalities and we talk about things that are working and things that aren’t. I also research and bring ideas for her to consider and we decide if it’s worth trying. Much different than my previous visits to physio, I was more hopeful then and have tried 3 other 6 plus week programs. The last one I did for 12 weeks. It’s not like I thought the PFP would be completely gone yet I never had even a bit of lasting improvement. So this time I am getting much more involved, informed and asking way more questions.
Between visits I follow a home program. We are going to try some exercises every second or third day now, yet when I do them work to 70% muscle fatigue. The idea is to have a rest day in between as rest is part of making gains. There are some things I will still do everyday.
I feel like an experiment!

It's awesome that you doing a research any trying new things.
I was going to a PT before, where I blindly trust her and go with the things she said. I went to that pt for about 14 visits i.e around 3 and a half months. No improvement in my symptoms. I never been to PT before. So, I just trusted her and she only gave me basic strengthening exercises.
Then I switched to a different PT. He tried aggressive dry needling for quad and scar tissue. He revised my home exercises and his approach was completely different.
He tried various things in the clinic and told me to do exercises at home. My previous pt ask me to come twice a week, the new PT ask me to come in once in 2 weeks.
The new PT also tried foam rolling. So, that gives new discomfort and pain in the knee. He said it's good that it makes some changes inside rather nothing.
So,I don't know what else to try.  I am just doing the exercises everyday. How often you get pain?
My pain is like burning pain throughout the day and night. Whenever I sit, stand and lie down. So, it's been throughout the day. The same level of burning pain. No changes in the pain from day 1.
Due to the current Coronavirus situation, PT office having tele appointments. So I am not going to PT. Best keeping up with home exercises. 

[Userhere123]

Yes, I am going to PT, usually once a week. That’s just for a follow up,and some modalities and we talk about things that are working and things that aren’t. I also research and bring ideas for her to consider and we decide if it’s worth trying. Much different than my previous visits to physio, I was more hopeful then and have tried 3 other 6 plus week programs. The last one I did for 12 weeks. It’s not like I thought the PFP would be completely gone yet I never had even a bit of lasting improvement. So this time I am getting much more involved, informed and asking way more questions.
Between visits I follow a home program. We are going to try some exercises every second or third day now, yet when I do them work to 70% muscle fatigue. The idea is to have a rest day in between as rest is part of making gains. There are some things I will still do everyday.
I feel like an experiment!

It's awesome that you doing a research any trying new things.
I was going to a PT before, where I blindly trust her and go with the things she said. I went to that pt for about 14 visits i.e around 3 and a half months. No improvement in my symptoms. I never been to PT before. So, I just trusted her and she only gave me basic strengthening exercises.
Then I switched to a different PT. He tried aggressive dry needling for quad and scar tissue. He revised my home exercises and his approach was completely different.
He tried various things in the clinic and told me to do exercises at home. My previous pt ask me to come twice a week, the new PT ask me to come in once in 2 weeks.
The new PT also tried foam rolling. So, that gives new discomfort and pain in the knee. He said it's good that it makes some changes inside rather nothing.
So,I don't know what else to try.  I am just doing the exercises everyday. How often you get pain?
My pain is like burning pain throughout the day and night. Whenever I sit, stand and lie down. So, it's been throughout the day. The same level of burning pain. No changes in the pain from day 1.
Due to the current Coronavirus situation, PT office having tele appointments. So I am not going to PT. Just keeping up with home exercises. 

[kawi_girl]

Yes, my PT has also been cancelled and I don’t have the online option so I’m just continuing on my own.
My pain is worse in my right than the left, and lately feels like my knee is full of pressure and there is pain with bending with a load, so up and down stairs is difficult. The pain will fluctuate over the coarse of the day. I use ice at least three times a day for 20 minutes and that seems to finally have started to reduce the inflamed feeling that I experience. That is after over a month of icing in that manner, and I say that it’s somewhat improved yet my answer there is guarded.
I am trying a different approach to my hip and leg strengthening in that I do reps and sets to about a 7/10 muscle fatigue yet have at least a days rest in between. So different exercises each day with some days having more to do than others.
Quad sets are done everyday, to help with my synovial fluid...the idea there is to help heal the joint. I’m told that can take up to two months before any improvements may start to show.
As I may have mentioned before, it’s just one big experiment yet I don’t feel completely blind as I’m basing my plan on lots of research and keeping in mind all the things I’ve tried that haven’t been successful.

[SuspectDevice]

Userhere123: Boy do I understand your frustration and I hope that you get some answers soon or at least a good routine to try. We all need hope and as long as you can keep learning about your issue and trying things to help you can maintain hope.

Mind you, I sure have my moments of doubt, and confusion as to all the different approaches out there.

I just finished  a book by Doug Kelsey and while I thought it provided some insightful information, it also has confused me a bit. Some say to do your knee strengthening up to 3 times a day, where his approach is different exercises every second day. Working up to mild muscle fatigue. His thoughts actually make more sense to me, isn’t one of the keys to strengthening is providing a rest day?
Also, while his program sounds good and he says he doesn’t endorse and equipment manufacturers, I feel what he is then lacking are alternative exercises you could do if you don’t have the stuff he’s using.
I do agree with the use it or lose it idea. Yet he doesn’t talk about how much rest, or whether it’s ok to have some discomfort while carrying on. I am finding that the rest I’m taking is not making much of a difference, an some days it seems to make thing worse.
SuspectDevice, I am hoping (againj for your thoughts here!

My path was pretty much just a random wander in the park!

I did not have the Kelsey equipment either (the Total Gym) but was able to rig up something in the gym which was similar.  But I didn't stick at it for long as it did not seem to be helping.

Then, once things felt a bit better due to the Celebrex, I started doing my own things which were a much heavier load than he was suggesting (i.e. deadlifts, kettlebell swings, sissy squats using a frame for balance).  I only did those things 2-3x/week max, and I got some discomfort during, and pain after, but I persisted out of frustration of having lost so much strength.  After maybe 6-12mths, I saw good improvements, and have kept up those heavier sessions 2x/week.

[kawi_girl]

“Random wander in the park...” that sounds about right!
I’m finding that every bit of information I read, I have some take away from it (I am trying the 100 times a day quad sets Doug Kelsey promotes) while still customizing what works for me.

Ever heard of blood restriction training? Seems to be a way to gain strength easier when you are injured. I haven’t tried it, I’m just reading about it at this point.

What a journey.

[Userhere123]

“Random wander in the park...” that sounds about right!
I’m finding that every bit of information I read, I have some take away from it (I am trying the 100 times a day quad sets Doug Kelsey promotes) while still customizing what works for me.

Ever heard of blood restriction training? Seems to be a way to gain strength easier when you are injured. I haven’t tried it, I’m just reading about it at this point.

What a journey.

100 times a day quad sets? What's that?
My pt office is closed for past few weeks and I am just doing my home exercises.
What are the quad , hip and leg strengthening exercises you are doing?
My daily home.program is,
1. Foam rolling thigh area
2. Isometric ball extension
3.side step band
4. Hip flexion elastic
5.calf stretch straight
6.piriformia stretch
7.stablisation Superman
8.proprioception unilateral
9.Stretching piriformis
10. Alternate heel tap
11.hip abduction
12. Glute bridge with ball squeeze
And few exercises for my hand and shoulders. I got some issues in my hand later on. Looks like mild tennis elbow/shoulder bursitis. So, doing those exercises along with this.
Is there any other exercises required for Patella subluxation and alta? PFPS.

[vickster]

This is a quad set and how to do

https://www.kneeguru.co.uk/KNEEnotes/primers/a-z-rehabilitation-exercises/quad-sets

[kawi_girl]

Thanks, Vickster, for providing the link for quad sets.

Userhere123, I do the quad sets up to 100 times a day (in sets of 10-so 10 on each side about every hour since my knee pain is bilateral). It is not for quad strength, it is to improve the quality of the synovial fluid. I’m probably repeating myself here!

Otherwise, I am slowly doing less strengthening exercises than ever before, and focusing more on frequent, gentle movement of my knee joints. So every 20 minutes I will get up and walk around 70-100 steps or so (if I’ve been resting). Best position for my knees is stretched out, yet I can tolerate some time in a 90 degree bend position. I am also “allowed” to go outside for a 1000 step walk, at a slow pace. Focusing on using my glutes more when I walk-so smooth, controlled and gentle. Three days a week I do core strength and hip strength, with a day off. On the days off I do straight leg work and an arm workout. The quad sets and movement regimen is everyday.

I am of the belief that I need to heal my joints first before any major strengthening can happen, and by the movement and walking (which I will slowly increase) I will stay strong enough to be ready for more, later. When I do the above mentioned exercises, I try to do them to a 7/10 muscle fatigue. Coupled with a proper rest day in between I think that this may be more effective. In the past I was doing a fairly advanced hip/glute/hamstring/quad routine everyday-yet in the end it did not help. I did that for over 12 weeks, so I would say that’s  a fair try!

[Userhere123]

Thanks, Vickster, for providing the link for quad sets.

Userhere123, I do the quad sets up to 100 times a day (in sets of 10-so 10 on each side about every hour since my knee pain is bilateral). It is not for quad strength, it is to improve the quality of the synovial fluid. I’m probably repeating myself here!

Otherwise, I am slowly doing less strengthening exercises than ever before, and focusing more on frequent, gentle movement of my knee joints. So every 20 minutes I will get up and walk around 70-100 steps or so (if I’ve been resting). Best position for my knees is stretched out, yet I can tolerate some time in a 90 degree bend position. I am also “allowed” to go outside for a 1000 step walk, at a slow pace. Focusing on using my glutes more when I walk-so smooth, controlled and gentle. Three days a week I do core strength and hip strength, with a day off. On the days off I do straight leg work and an arm workout. The quad sets and movement regimen is everyday.

I am of the belief that I need to heal my joints first before any major strengthening can happen, and by the movement and walking (which I will slowly increase) I will stay strong enough to be ready for more, later. When I do the above mentioned exercises, I try to do them to a 7/10 muscle fatigue. Coupled with a proper rest day in between I think that this may be more effective. In the past I was doing a fairly advanced hip/glute/hamstring/quad routine everyday-yet in the end it did not help. I did that for over 12 weeks, so I would say that’s  a fair try!

Thank you!!!
Did you do this one quad set( towel under the knee and pressing it) exercise for 100 times a day?? That's really awesome!!! I had this quad set exercise when I started PT in the month of November. Then PT removed this exercise from my program after 2 weeks. So, I am not doing this quad set.
I have few exercises and I do only few sets and repetitions. My total exercises time is 30 minutes including foam rolling.
I do only once a day.
I also did other strengthening exercises for more than 12 weeks and nothing helps. What I am wondering is, none of the exercises improves my symptoms. I still have the same burning pain and swelling. I can't sleep everyday because it burns whenever u stretch my legs out and bend. So, I can't sit and sleep.  I even had a virtual visit with another Ortho from another country recently. They reviewed my MRI and said it looks normal. And they are not sure why I am getting the pain and swelling still.
I don't know how to proceed further. PT office is also closed. So only home exercises now. 
Have you tried foam rolling? I don't know if it helps or aggravate more. I am doing the foam rolling for past 3 weeks. Twice a week only. For about 2 minutes.
I feel the pain is now more after the foam rolling. I don't know if it's good or I should stop doing it. PT is also not reachable. So I am just doing foam rolling twice a week. My thigh and it band have become so hard now. Previously it used to be loosen after the strengthening/stretching exercises.
My previous PT used to tell me that it has to loosen up and she tried a lot to loosen up the quad. Now, it's hard again after the foam rolling. I am with another PT now.
Do anyone tried foam rolling? Does it really help?

[kawi_girl]

Yes, the quad sets I do most people put a towel underneath their knee, I use a small, soft fitness ball for the same effect. It takes some dedication to get them all done through the day yet they are not hard to do, and I’m home now anyway. Supposed to (hopefully) start having results in about 2 months. I’m one month and 5 days in, so I guess I’ll see!

I can relate to doing all those exercises and have pretty much no result, frustrating, isn’t it? I had been using a foam roller yet I don’t really think it has been helping. I am not sure even about stretching, I may drop that for now, too. I think what has helped the most so far is rest, and the gentle frequent movement. Also, for a whole month I was icing my knees three times a day, for 20 minutes a shot. I bought a pair of really good runners just to wear in the house to help absorb shock while I carefully walk around. It sounds like you may have some sort of inflammation going on, I have read some people talking about that burning being inflamed synovial lining. (That would be the lining of the joint capsule of your knees) I think that I have some of this too, yet haven’t explored the NSAIDS route yet. Others have taken NSAIDS for a period of time to finally break out of the inflammation. I am hesitant to do so, yet may still explore that option-nothing is off the table yet!
As a guide, i would suggest you buy a pedometer. They aren’t completely accurate yet can give you a good idea of your movement patterns. For instance, I notice if I go above 3800 steps that I can expect to be sore that evening or the next day. So I try to keep it under that amount, and plan to slowly nudge that number up. That’s what I am finding with knees. You have to nudge them gently along. Expect some resistance yet one hopes to slowly get there.
One hint with the foam roller that MAY help-those for whom it has worked for, talk about going very slowly and stopping when you get to a painful/tight spot and let your weight do the work. Kind of like Active Release Therapy, if you are familiar with that.
Keep on, my friend. Continue to research as much as you can, you have to be your own advocate for your knees to recover, I think there are many cases that just get the standard treatment PTs learn. You need to think outside the box.

[Aly0108]

Hi All!! Before you started exercise, you have to check your pelvis. If you have a high hip lateral, you will have rotation of femur and tibia.
I had a lot issues with fat pad. Don’t try to strengthen you quad.
You have to mobilize you hip.
It is not knee issues, it is your hip issues.
Dont try strengthening your muscles before you find your cause. You will make things worse. Feel your body.
Take a look to your ITB , lateral side vastus latéral both side.
Take a look to your foot.
You have to know all muscles external rotation and internal rotation. What muscle you have to work to have good tibia and femoral rotation.
My suggestion is to start with your pelvis, the most important think.

[kawi_girl]

Aly0108,
This is a good point that you made, and there is a chance that something like this is going on with me, at least it could be part of the puzzle. My left hip is ‘flattened’ a bit due to the iliac wing fracture and does appear to sit lower. So it’s either because of that or that combined with overloading the right leg when I couldn’t use the left.
I am not doing the quad sets for strength, but for synovial fluid (to help with the quality of it)
That being said, these past few days I am sad to say that the quad sets are becoming a wee bit painful on the right, and I may quit with them for a bit. I am discouraged by this as I was hoping it could help yet I need to continue for another month. If I can’t, that is another experiment failed.
Sigh.
Anyone else who wants to chime in with some advice I would appreciate it. Thinking about Celebrex now. Been also using Voltaren for the past week. Doesn’t smell as bad as I remember, thank goodness!

[Brandon123]

Kawi_girl,

Maybe you should give NSAIDs a try? You could test for 1-2 weeks and see what happens. If you do not have any stomach issues of course... In that case, it might be a bad idea. But even with a good stomach, I think it is a good idea to take proton pump inhibitors (PPIs) at the same time. Consult a doctor if you're unsure whether you can safely try NSAIDs. Even if they will not cure your knee issues long-term, you will most likely experience relief short-term while taking them. And we all just need a (knee pain) break sometimes 

[Aly0108]

Kawi girl

Exercice who help me :
1 clamshell glutes medius
2.strech biceps Femoris( very important because this muscle attaches tibia and can rotate out)
3. Loosing muscles vastus lateral with massage balls
4. Strech calves
5 walking
6. Massage triggers points

Also, the most important to check your pelvis. If you have hike hip, that meat you have to stretch QL muscles .