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Author Topic: Pain After Taping+Miserable Malalignment  (Read 577 times)

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Offline Freya

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Pain After Taping+Miserable Malalignment
« on: October 16, 2020, 08:42:30 PM »
Hello everyone! I'm so glad I found this forum.

Has anyone had a knee "injury" after taping?

I was diagnosed with miserable malalignment and patellar maltracking last year on my birthday  :'(
The pain was in my knees was minimal but annoying, I started physio and the first thing the physio therapist did was tape my kneecaps medially (It wasn't sports tape, it was some kind of rigid tape) she told me to leave it on for a couple of days.

After the tape was removed the pain started. I was limping for almost a week after and It hurt to put any kind of pressure on my knees. I can't lay on my belly anymore. I can't sleep with my knees touching.
The pain is always there, somedays are worse than others. When it flares up it's SEVERE and it feels like my legs are on fire. it's concentrated on the medial side. No amount of pain killers, ice or heat will help relieve it.


The doctors are always quick to blame the malalignment but I never had this pain before the tape  :-\

MRI of the right knee was normal. I'm so frustrated.

Offline The KNEEguru

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Re: Pain After Taping+Miserable Malalignment
« Reply #1 on: October 18, 2020, 10:12:50 AM »
That is really unfortunate. If you read the CONCLUSIONS here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323297/ - you get the idea that increased pain is not a common outcome.

Perhaps you can note if the flare ups are associated with any change in your footware?
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Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #2 on: October 19, 2020, 07:27:27 PM »
That is really unfortunate. If you read the CONCLUSIONS here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323297/ - you get the idea that increased pain is not a common outcome.

Perhaps you can note if the flare ups are associated with any change in your footware?


I know, it's very strange  :( I'm not sure about the footware, I was referred to a sports doctor and will see him next week. Hopefully I will get an answer.

Thank you for the reply!

Offline Tuggers1994

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Re: Pain After Taping+Miserable Malalignment
« Reply #3 on: October 19, 2020, 08:08:14 PM »
Just a thought...did you do more when you had the tape on? Maybe you've overdone it with your knee if it felt more stable when it was taped? With miserable malalignment it seems to be very easy to sprain/sublax the knee, for me anyway. I managed to sprain my knee walking along a pebbly beach although what finished it off was walking across the kitchen when it just gave out under me. Stairs are also not my friend! The physio only ever put stretchy tape on my knees so can't really help you I'm afraid. Seems to be quite a few miserable malalignment posts cropping up atm so someone else might be along later.

Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #4 on: October 20, 2020, 06:30:27 PM »
Just a thought...did you do more when you had the tape on? Maybe you've overdone it with your knee if it felt more stable when it was taped? With miserable malalignment it seems to be very easy to sprain/sublax the knee, for me anyway. I managed to sprain my knee walking along a pebbly beach although what finished it off was walking across the kitchen when it just gave out under me. Stairs are also not my friend! The physio only ever put stretchy tape on my knees so can't really help you I'm afraid. Seems to be quite a few miserable malalignment posts cropping up am so someone else might be along later.

I didn't do anything more than usual with the tape on, which is why I'm so confused  :-\ I wish I had never gone to the physio. The pain I started with wasn't bad, I couldn't sit with my legs bent at 90 degrees and I couldn't sit on my knees anymore, but I had zero problems standing or walking. Now the pain is constant and I don't know if it's just the beginning of the symptoms of miserable malalignment or something else?

Ah that must have been horrible spraining your knee like that! I read some of your other posts about having surgery early next year? good luck!

It hasn't been easy finding much information about this syndrome, so I'm shocked I'm seeing people who actually have the same issues as me.  It really sucks.
« Last Edit: October 20, 2020, 09:18:08 PM by Freya »

Offline Tuggers1994

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Re: Pain After Taping+Miserable Malalignment
« Reply #5 on: October 20, 2020, 07:24:29 PM »
It's so frustrating being in loads of pain and not even knowing what you've done to set it off, if anything.

I don't know how old you are but my pain has definately got worse as I've got older, especially over the last few years.

Thank you. Last week I was relieved that something could actually be done after physio's, podiatrists and even another orthopedic consultant telling me alignment was fine when it's clearly not but now the reality of it is starting to sink in. I was on the verge of talking myself out of it but did a pros and cons list earlier today and the pros was definitely longer but it's still pretty scary.

Have you tried Biofreeze gel? It's pretty good stuff I think.

There's not a lot of information out there about miserable malalignment which is probably why so few physio's etc even know about it and how to check for it. I think it gets picked up more in children now though.

I hope the sports doctor can help you, let us know

Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #6 on: October 20, 2020, 09:12:36 PM »
It's so frustrating being in loads of pain and not even knowing what you've done to set it off, if anything.

Exactly! I squatted today to pick something up and it triggered it, it's ridiculous.

I'm 32, but I never had any issues with my knees or hips growing up. I had been exercising pretty intensely with a personal trainer for about 3 and a half years until my knee issues started about a year and a half ago.

Thank you. Last week I was relieved that something could actually be done after physio's, podiatrists and even another orthopedic consultant telling me alignment was fine when it's clearly not but now the reality of it is starting to sink in. I was on the verge of talking myself out of it but did a pros and cons list earlier today and the pros was definitely longer but it's still pretty scary.

It's definitely terrifying, but from what I understand, you've been dealing with this for most of your life? And you're only having surgery on your tibias?
I was in denial when I was first diagnosed, I thought and I still think the surgery is insane, but it looks like I'm headed down the same road as you. I feel like there's no way around it, either surgery now or wait until the knees are destroyed and have surgery then with knee replacements  :-\

Hopefully the sports doctor will find the source of this pain.

I just recently started using voltaren gel. It's been much more helpful than the constant paracetamol and ibuprofen. I'm surprised I haven't given myself an ulcer  :o



Offline SuspectDevice

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Re: Pain After Taping+Miserable Malalignment
« Reply #7 on: October 23, 2020, 10:07:00 AM »
I think the kneecap malalignment thing is complete bollocks in 99% of cases.

I'm guessing the 3.5yrs of intense PT pushed your knees beyond their envelope of function (read everything you can find on the web by Dr Scott Dye on this issue) and they got somewhat inflamed (probably synovial inflammation). The taping possibly made that worse.

Now you may have chronic synovial inflammation (loss of tissue homeostasis as Dr Dye calls it) and you need to get it under control.  For me, the only way I achieved that was by stopping activities which aggravated it (I was very bad at achieving this), and 5-6mths on an anti-inflammatory called Celebrex.  Then a very gradual return to strengthening exercises - not so much the quads but the supporting structures of glutes/hips/hammies/core/lower back.  I had many setbacks so it took me about 7yrs to get on top of, but read the books by Richard Bedard & Paul Ingraham for a smarter path than I took to get on top of it.

Forget any notions of knee surgery/knee replacement until you have tried their methods (and Dr Dyes) for at least 12mths.

I was crippled with burning pain/stiffness/aching for 5-6yrs, but am now back doing short triathlon - no thanks to any physiotherapist, sports doctor or 'knee specialist'.  All thanks to the people I mention above.
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 Tuggers1994

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Re: Pain After Taping+Miserable Malalignment
« Reply #8 on: October 23, 2020, 07:37:53 PM »
I feel your frustration with the bending down to pick something...it's so annoying not knowing which aspect of daily life is going to get you every day. Usually the stairs for me!
Quote
It's definitely terrifying, but from what I understand, you've been dealing with this for most of your life? And you're only having surgery on your tibias?
Yes, just tibias which is apparently easier to recover from. Makes sense in my head as less muscles are involved A few years ago I would have weighed up the pros and cons of surgery and decided to leave it well alone! But when you realise that people with prosthetic legs can do more than I can it made me realise that however normal this is for me it really isn't normal.

Did the sports doctor have any ideas? Would be interesting to know.

Ulcers are a concern. I try not to use ibuprofen too much for that reason but ibuprofen gel is better than it used to be I'm sure.


Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #9 on: October 28, 2020, 10:29:36 PM »
I think the kneecap malalignment thing is complete bollocks in 99% of cases.

I'm guessing the 3.5yrs of intense PT pushed your knees beyond their envelope of function (read everything you can find on the web by Dr Scott Dye on this issue) and they got somewhat inflamed (probably synovial inflammation). The taping possibly made that worse.

Now you may have chronic synovial inflammation (loss of tissue homeostasis as Dr Dye calls it) and you need to get it under control.  For me, the only way I achieved that was by stopping activities which aggravated it (I was very bad at achieving this), and 5-6mths on an anti-inflammatory called Celebrex.  Then a very gradual return to strengthening exercises - not so much the quads but the supporting structures of glutes/hips/hammies/core/lower back.  I had many setbacks so it took me about 7yrs to get on top of, but read the books by Richard Bedard & Paul Ingraham for a smarter path than I took to get on top of it.

Forget any notions of knee surgery/knee replacement until you have tried their methods (and Dr Dyes) for at least 12mths.

I was crippled with burning pain/stiffness/aching for 5-6yrs, but am now back doing short triathlon - no thanks to any physiotherapist, sports doctor or 'knee specialist'.  All thanks to the people I mention above.

I'm so glad you found something that works and that you're feeling better! I looked up Dr.Dye and watched a couple of videos of him speaking. Very interesting. My MRI did show some effusion but according to the report it was insignificant.

They do love their quad exercises. That's a good idea, not starting with the quads, that's probably what aggravated my knees recently.

I will definitely give the celebrex a try. There is definitely some inflammation going on, otherwise my knees wouldn't get so warm and red. I don't expect my knees to ever be back to 100% because of the underlying malalignment in my legs.

Thank you so much for you reply and all the helpful info!

Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #10 on: October 28, 2020, 10:42:50 PM »
Yes, just tibias which is apparently easier to recover from. Makes sense in my head as less muscles are involved A few years ago I would have weighed up the pros and cons of surgery and decided to leave it well alone!



The less bones they have to break, the better!

Have you seen this? https://www.youtube.com/watch?v=GiCoZ8NX224
It's a different surgery technique where they don't have to cut through everything.

But when you realise that people with prosthetic legs can do more than I can it made me realise that however normal this is for me it really isn't normal.



This.



I just saw the sports doctor, he wasn't helpful. He looked at the imaging and said nothing was wrong and referred me to a pain management clinic :) He said maybe my nerves were irritated..







Offline SuspectDevice

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Re: Pain After Taping+Miserable Malalignment
« Reply #11 on: October 29, 2020, 09:23:35 AM »
. There is definitely some inflammation going on, otherwise my knees wouldn't get so warm and red. I don't expect my knees to ever be back to 100% because of the underlying malalignment in my legs.


Yes, warm & red was definitely one of my symptoms.

But I'm still a bit wary of the 'malalignment' diagnosis.
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 SuspectDevice

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Re: Pain After Taping+Miserable Malalignment
« Reply #12 on: October 29, 2020, 09:26:37 AM »


This.



I just saw the sports doctor, he wasn't helpful. He looked at the imaging and said nothing was wrong and referred me to a pain management clinic :) He said maybe my nerves were irritated..

I went through that rubbish too.  CPRS diagnosis.

All the experts were wrong.  The problem was chronically inflamed synovial lining (and perhaps other structures in the knees).
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 Brandon123

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Re: Pain After Taping+Miserable Malalignment
« Reply #13 on: October 29, 2020, 09:34:58 AM »


This.



I just saw the sports doctor, he wasn't helpful. He looked at the imaging and said nothing was wrong and referred me to a pain management clinic :) He said maybe my nerves were irritated..

I went through that rubbish too.  CPRS diagnosis.

All the experts were wrong.  The problem was chronically inflamed synovial lining (and perhaps other structures in the knees).

I was sent to pain management as well...but the pain specialist didn't find any (nerve-related)problems.
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 SuspectDevice

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Re: Pain After Taping+Miserable Malalignment
« Reply #14 on: October 29, 2020, 09:40:58 AM »


This.



I just saw the sports doctor, he wasn't helpful. He looked at the imaging and said nothing was wrong and referred me to a pain management clinic :) He said maybe my nerves were irritated..

I went through that rubbish too.  CPRS diagnosis.

All the experts were wrong.  The problem was chronically inflamed synovial lining (and perhaps other structures in the knees).

I was sent to pain management as well...but the pain specialist didn't find any (nerve-related)problems.

It's what they do when they run out of ideas within their limited structural paradigm.
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 Tuggers1994

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Re: Pain After Taping+Miserable Malalignment
« Reply #15 on: October 29, 2020, 01:39:07 PM »
So based on this envelope of function theory my envelope is empty?

I'm trying to build up to being able to do some sort of exercise but it just ends up in my being in so much pain it makes me cry. I thought swimming would be ok but I've tried it a few times now and it's really not ok.

I find scientific papers really hard to understand so if you have any key points you could put in easy to understand English that would be great SuspectDevice. From what I could understand he doesn't advocate being sedentary but I don't really know what else I can do - I need to be able to sleep and work so tend to try and avoid doing things that make the pain unbearable.

If I stand with my knees pointing forward my feet are sticking out at 45-50 so I'm guessing malalignment is most probably my issue and maybe it's just a case of just coping with it for the next few months.

Offline SuspectDevice

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Re: Pain After Taping+Miserable Malalignment
« Reply #16 on: October 29, 2020, 08:58:56 PM »
So based on this envelope of function theory my envelope is empty?

I'm trying to build up to being able to do some sort of exercise but it just ends up in my being in so much pain it makes me cry. I thought swimming would be ok but I've tried it a few times now and it's really not ok.

I find scientific papers really hard to understand so if you have any key points you could put in easy to understand English that would be great SuspectDevice. From what I could understand he doesn't advocate being sedentary but I don't really know what else I can do - I need to be able to sleep and work so tend to try and avoid doing things that make the pain unbearable.

If I stand with my knees pointing forward my feet are sticking out at 45-50 so I'm guessing malalignment is most probably my issue and maybe it's just a case of just coping with it for the next few months.

The 'envelope of function' theory is basically about pushing your knees beyond a point they can cope with and recover from normally.

Once you have reached that point, there are biochemical changes in the knee (note - not structural changes) where various inflammatory proteins etc. become dominant and persistent = constant burning/ache/stiffness/fullness sensations.  It is absolutely miserable and feels like all your cartilage has disappeared in a very short time (which of course it has not, but the long-term biochemical changes can definitely accelerate cartilage degeneration).  The inflammation affects the synovial lining of the knee which is the most pain/sensation sensitive part of the knee.

I'm not sure about your feet being at an angle, if that is a mal-alignment problem that would cause pain or not.  There is a theory that many people have various mal-alignment problems, but because they've had them for years, their knees have adapted and they cause no problem.

My experience is that sorting out if you have a 'loss of envelope function' as opposed to something else is as follows:

Loss of envelope seems to have the following features:


it comes on quite suddenly (weeks or months not years) and following some particularly intense knee exercise or in my case after years of hard triathlon, but then really ramping up the training to do long course

Burning/heat/knee discoloration are key symptoms

The pain is not in a very specific location - it is more over much of the front of the knee & medial, but the focus of the pain moves around a lot

It is hard to identify activities which definitely flare the symptoms, and often there is a 1-2 day delay between an activity and worse symptoms

The pain may radiate up into the quad and down below the knee

Swimming also made mine worse, even gentle freestyle kicking.  Hence I did all my swimming with a pull buoy and ankles strapped together so zero kicking.  Mentally, this was great as I was able to maintain some aerobic fitness, get some exercise endorphins but not aggravate the knees

My envelope of function was very low - almost empty.  But I'm a stubborn bastard, so kept trying to get back to some exercise and failing.  The constant pain for years did my mood/personality no favours at all and for me, a long-term course of Celebrex to get on top of the chronic inflammation after 5 years of failing was probably the only option.  I had no ill-effects from Celebrex at all, but some people do.  As my pain levels improved (this took months) I was gradually able to introduce strength training which had another positive effect - but it was in no way a linear progression.  There were still many many many! ups and downs.  There still are.  I'm doing a short triathlon tomorrow and my knees are in a bit of a down phase atm, but I'm locked in  :o

The other route is the Richard Bedards/Paul Ingraham route of massively, massively modifying your lifestyle/activities and very very slowly building back up.  This works of course, but you need to be much more patient than me to do it.  However, I did go for a very slow 15-20min flat walk each morning which helped both mentally & physically. I still do this.  It is not exercise by any means, but it helps loosen things up at the start of the day.

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 Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #17 on: October 31, 2020, 11:35:25 PM »


This.



I just saw the sports doctor, he wasn't helpful. He looked at the imaging and said nothing was wrong and referred me to a pain management clinic :) He said maybe my nerves were irritated..

I went through that rubbish too.  CPRS diagnosis.

All the experts were wrong.  The problem was chronically inflamed synovial lining (and perhaps other structures in the knees).

I was sent to pain management as well...but the pain specialist didn't find any (nerve-related)problems.

Honestly that's what I'm expecting the pain specialist to tell me too. Either that, or he'll try to inject something that would cause more harm than good.

Offline Freya

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Re: Pain After Taping+Miserable Malalignment
« Reply #18 on: October 31, 2020, 11:56:02 PM »



Burning/heat/knee discoloration are key symptoms

The pain is not in a very specific location - it is more over much of the front of the knee & medial, but the focus of the pain moves around a lot

It is hard to identify activities which definitely flare the symptoms, and often there is a 1-2 day delay between an activity and worse symptoms

The pain may radiate up into the quad and down below the knee




Omg it's like you're describing my pain, it's exactly like this!

I've stopped all exercise involving my legs and I'm still always in pain, even basic repetitive side to side movements made me miserable after. Should I start slow after finishing the course of Celebrex? (The doctor before last prescribed me 2 weeks worth) And by slow, do you mean walking?



I hope your knees weren't mad at you after the triathlon!















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