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Author Topic: Advice about how to manage a PFS pain flair-up  (Read 207 times)

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Offline reader278

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Advice about how to manage a PFS pain flair-up
« on: June 16, 2020, 02:32:27 AM »
Hi all, I have had PFS for maybe 3-4 years now. In both knees. But it's been dormant for a long time, like about a year or so. I was not doing any leg strengthening exercises, just regular walking 30 mins to an hour a day. Recently I started hip abductions and leg extensions, and also started bending my knees in as far as they would go to start improving my range of motion. I think it was the bending in my of right knee (plus I've been using a lot of stairs lately), that has caused a flare-up of PFS pain, my old nemesis. I'm terrified because I remember how long this effing pain used to last. I'm worried I've set off a months to years long process of recovery again. I cannot rest because I am taking care of a new born. Should I stop the walking and gentle PT, or continue those for fitness and strengthening purposes? What is the best course of action to get over this flareup? I also can't take anti-inflammatories bcause I'm breastfeeding.

Offline kawi_girl

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Re: Advice about how to manage a PFS pain flair-up
« Reply #1 on: June 16, 2020, 05:25:42 PM »
Hello!

Iím sorry to hear that your PFPS has flared up again. I am not a medical professional yet since I have also been struggling with this issue maybe there are a few bits of advice that I can offer.

First off, letís look at anything that may have triggered your symptoms. There are two things that stand out for me based on what youíve shared. You mentioned stairs. Stairs are VERY bad for people like us, the force on your knees is greatly increased, going up and especially down, even more so if you are carrying anything. I have found that my symptoms have finally started to show some (slow) improvement only after I cut out stairs as much as possible. Which means going up and down the stairs at home on my butt (yes it looks silly and takes a while to get things done) and avoiding stairs in public. It takes some time and commitment yet necessity is the master of invention, so even using a small backpack to get laundry up and down the stairs in my home is something I have done. Seriously, stop those stairs if you can.
You mentioned that you now have a newborn. (Congratulations!) obviously there is some more lifting going on now. Do you have help from family, friends or a spouse? Anytime there is an opportunity to sit rather than stand while holding your baby, take it. If someone else can pick your child up and bring to you, take it. Even bringing a stroller into the house for walkabouts is an idea rather than carrying your baby around is something to consider. Be inventive. Even though you donít want to hear it, holding and carrying that little bundle of joy is going to add more stress on those knees, so be as careful as you can.
Leg extensions can be stressful for some with PFS, did you maybe do too much, too soon? Are you using weight? How often and how much did you starting the bending that you mentioned?
Thereís nothing wrong with the gentle PT, yet it needs to be right kind for you. Maybe if you could more details of exactly what the routine is.
As far as the walking goes...for myself I purchased an odometer to track my steps, and found that I had to cut way back, with the plan to slowly increase over time. You may be tracking extra steps now at home with your newborn to care for without even realizing it, so the length of your walks is pushing you over the top. Walking itself is good for your joints, as long as you can stay within your envelope of function. Which is easier said than done! I know it can be extremely frustrating.
In the meantime, for pain. I always found icing my knees for 20minutes, up to 3 times a day would help, as long as you donít use the relief it gives as a ticket to do more. Also, using voltaren has been helpful, and as itís topical and not systemic I would think it should be safe to use for you, yet do check with your doctor first. Also, massaging around your knees can be helpful, be gentle and avoid working deep where you bursa are. (You can look that up online for exact locations). I donít like taking meds either if possible, and all three of those things have given relief for me.


Offline reader278

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Re: Advice about how to manage a PFS pain flair-up
« Reply #2 on: June 17, 2020, 02:48:14 AM »
Thnaks for the advice. I can definitely do the butt schootching thing for stairs, I've done it before.  Do you think gentle PT has helped your knee pain? The last time the pain went away it was after a prolonged period of near total rest but I can't do that now becaues of a baby, and also I lost a lot of muscle mass that I never really got back. My gentle PT is almost nothing- just 10 hip abductions and 10 leg extensions (lying down on my stomach just lifting my legs) daily. Plus rolling out my legs with a massage ball. What PT moves are you doing?
« Last Edit: June 17, 2020, 03:01:29 AM by reader278 »

Offline kawi_girl

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Re: Advice about how to manage a PFS pain flair-up
« Reply #3 on: June 17, 2020, 06:37:05 PM »
I honestly am not sure if the gentle PT I do has helped my knee heal, yet I think it has been beneficial for hip strength, a tiny bit of leg strength and also my mental health, in that it provides some empowerment-I feel like I am still Ďin control.í
I do side lying hip abductions, clamshells, straight leg raises, a seated knee extension (only to 40% for my really bad knee) and a standing knee concentric exercise with a resistance band, from 20% flexion to extension. Iím usually using a 2lb ankle weight for most of these (I started with .5 lb) If any of these trigger discomfort I stop or modify immediately. Fatigue is fine, pain is not. I also make sure I move around frequently (gentle walking) and have been trying to incorporate riding my bike at a very easy resistance. Iím at 4km per ride so far. My step max seems to be around 3000-4000 steps per day so far. I used to do foam rolling yet I didnít feel it was making a difference.

Offline Brandon123

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Re: Advice about how to manage a PFS pain flair-up
« Reply #4 on: June 20, 2020, 11:57:10 AM »
Hi reader,

Sorry to hear about your relapse, I would recommend that you check out the posts by BusterCatLegs, especially the recent ones. Maybe you can find some of her tips and ideas useful!
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reader278

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Re: Advice about how to manage a PFS pain flair-up
« Reply #5 on: June 21, 2020, 05:21:07 AM »
Here is what I don't get: it's not practical nor probably healthy to do total rest for months and months every time one has a flare-up of PFS. For many it's a chronic condition that will likely remit/relapse and this seems like a recipe for going down the rabbit hole of increasing weakness and kinesiophobia. What do others think? I'm definitely going to try to rest it as best I can, but carrying for a newborn there's only so much I can do. Does that mean I'm condemned to never get over this flare-up?

Offline kawi_girl

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Re: Advice about how to manage a PFS pain flair-up
« Reply #6 on: June 22, 2020, 03:04:56 AM »
I absolutely understand. That is what is so frustrating about this problem. Very few have the luxury of time for dealing with this. Especially a new mother. You just want to get on with things, am I right? You can modify things the best you can, rest when your baby rests, if possible.
Have you seen a doctor to try and rule things out? In my opinion there is an underlying cause for the pain caused by PFPS, that diagnosis is just a cop out way of saying we have anterior knee pain yet itís not known why. Yet, in one person it might be overuse, in another it could be serious pronation, in another it could be soft tissue injuries, in another the beginning of arthritis. And yes, the sad truth is that many knee issues-even if you can narrow down the cause, can take a VERY long time to heal. Yet we try to find ways to cope, in the very least. If there was an easy answer we wouldnít be here, thatís for sure. While the most popular way of dealing with this seem to be targeted exercises and avoidance of what causes the pain, SOME people have had good results with orthotics, knee braces or a combo of rest with gentle walking. Massage can also help (learn to do it on yourself). Itís like trying to find the right puzzle piece that will fit your puzzle, in a pile of many optional pieces. Daunting yet there is hope-others have got better, even after years. Donít give up.
Iíve wondered sometimes if I should just go for it and do all the physical activities I long to do-pain be damned. Yet Iím pretty sure that eventually I wouldnít be able to even walk. That is just frustration talking!















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