Young'un needs help with PFPS

[ayno0118999]

I'll keep the backstory simple: I'm 18, started running twice a week at 16, generally did all the fun and stupid stuff that teenagers do at that age (sports, jumping off stuff, etc). Lockdown made me inactive and sitting 8+ hours a day and I moved house, but continued to run regularly in the hilly area that I now lived. In hindsight my knees were already protesting a bit (weird sensations in the kneecap when I ran), but the final blow was when I was on a simple walk 7 weeks ago and suddenly felt like I was being stabbed in both knees.

Went to my GP who told me to stretch and walk. Stretching hurt more than it helped and I overdid the walking initially, leading to absolutely no improvement at all. I have now been struggling with what I assume to be PFPS for 7 weeks. It has gotten a bit better about 4 times before, only for me to completely blow everything up again by overdoing things.

Following reading the stuff of Ingraham, Bedard, Dye, et al, I have been doing a lot of rest, propping my legs up when I sit, and getting up once an hour to walk 100-200 steps around my flat. I think on average I walk about 1500-2000 steps a day. However, leaving my house to go anywhere requires me to walk down slopes and stairs, which I know has previously exacerbated things.

I have two general questions.

One, how can I keep within my envelope of function enough that I don't keep blowing up my knees, while being able to fulfil the daily tasks I need to do to stay alive? Ingraham in his book talks about 'Jan' who took four weeks off work and had a family around her to help her do things like cooking and housework, and Bedard quit his job. I'm lucky enough to not have too much to do in the way of work/study for the next few months, but I still have to do activities of daily living and I live alone, so there's not much way around that.

Two, I have some other symptoms that I don't think are exactly just PFPS. For example, apart from stabbing and burning in the kneecap, I also get a lot of burning just above and below the knees, at the tendons, which persists even after the kneecap problems subside. There's also the quad burning (but not a deep burn, just seemingly at the skin) and the pinprick feelings on my quads and knees (not painful, but annoying). Finally, even when I have relatively few knee sensations, there's a part of both my medial knees that are painful when I put weight on my legs while the knee is at an angle, and are often achy. Could this be a meniscus tear (and what is the conservative treatment for that because as I've gathered from this forum, surgeries are bad)?

[ayno0118999]

Things I've tried that HAVEN'T worked:
- ice (just didn't have any effect)
- taping (good as a distraction but no real effect overall. also the tape irritated my skin)
- quad strengthening exercises
- "walking it off" for km on end (especially when you live on a hill)
- sleeping with a pillow under my knees

Things I've tried that HAVE worked:
- sitting with straighter legs (solves the medial knee aching when I sit with bent knees, however this is pretty difficult to achieve in public)
- relative rest (probably the biggest thing)
- moisturiser (not sure if it helps the joint but it makes the skin burn less)

Things I haven't tried and want advice on:
- anti-inflammatories (do I need them? concerned about GI and heart issues)
- physio (probably can't afford an appointment)

[Brandon123]

Hi there!

Things I haven't tried and want advice on:
- anti-inflammatories (do I need them? concerned about GI and heart issues)

NSAIDs can sometimes work wonders for these type of problems, and I would recommend trying them out for let's say 14 days, and see of you notice any major difference after that. If you're worried about GI and heart issues (which should not be a problem if you're an otherwise healthy 18-year old) consult a doctor before trying and he/she can give you a green light, or not. Also, PPIs can help a lot with possible GI side effects. Read the story of @suspectdevice for more info on how NSAIDs can help with PFPS.     

[vickster]

Have you seen a podiatrist to see if orthotics and different footwear may help given your issues seem to have been caused or exacerbated by running and walking?

[ayno0118999]

@Brandon123
Hi, I've read a lot of yours and SuspectDevice's (and others') posts in the past couple of weeks, but I've only really started taking rehab/recovery seriously in the past 2-3 weeks. I actually bought some Neurofen in case I wanted to give NSAIDs a shot, but I haven't opened them yet. Currently I'm tracking my steps and making myself walk short distances regularly, but I might try NSAIDs if that doesn't help very much. Mainly worried about the GI issues because I'm the kind of person who somehow managed to get heartburn even with Red Bull! But am willing to give them a whirl if the gentle walking regime doesn't work out.

@Vickster
No, I haven't seen a podiatrist. I feel like I might have some kind of alignment or orthopaedic issue as my ankles tend to roll outwards, but I am a bit puzzled as to how an orthopaedic issue could be 1) unnoticed for 18 years and 2) only cause issues now instead of in my earlier youth. Am also concerned about the issue of cost, but again am willing to give a podiatrist a try if what I'm currently doing isn't working.

[vickster]

Perhaps because you’ve overstressed the knee for a more sustained period of time and have now a chronic level of inflammation?

What were you wearing while running footwear wise, did you get a gait analysis/ proper fitting for your trainers?

If concerned about taking ibuprofen, always take with food and ask your GP to prescribe a PPI like omeprazole if you can’t get it over the counter depending on what country you are in (it’ll ease general heartburn too). You could also try a topical NSAID like Voltaren gel which is less harsh on the stomach

Good luck

[John42]

I have read the previous three posts, and noted that you have visited your GP only once.  Self diagnosis is not the way to go forward - My suggestion, is that you must insist with your GP to see an Orthopeadic Consultant who is qualified to see if a MRI /scan is required to prevent any further damage to your knee.

Best/JohnK Manchester UK

[vickster]

How and where did stretching hurt? Did you have swelling in the knee afterwards? Or obvious heat/inflammation.
Or did it hurt because the muscles (which ones did you stretch?) are shortened/tight/weak which can be a cause of knee pain (potentially all and any from lower back down to feet)?

[ayno0118999]

Perhaps because you’ve overstressed the knee for a more sustained period of time and have now a chronic level of inflammation?

What were you wearing while running footwear wise, did you get a gait analysis/ proper fitting for your trainers?

If concerned about taking ibuprofen, always take with food and ask your GP to prescribe a PPI like omeprazole if you can’t get it over the counter depending on what country you are in (it’ll ease general heartburn too). You could also try a topical NSAID like Voltaren gel which is less harsh on the stomach

Good luck

The first one seems pretty likely to have happened.

About the sneakers, no, would I just go to a normal shoe store that does foot analysis/shoe fitting (the ones with the machines out front)?

I'll have to check up on what's in the antacids I normally use, those tend to work fine but I have absolutely no idea what they're made of!

How and where did stretching hurt? Did you have swelling in the knee afterwards? Or obvious heat/inflammation.
Or did it hurt because the muscles (which ones did you stretch?) are shortened/tight/weak which can be a cause of knee pain (potentially all and any from lower back down to feet)?

I tried stretching twice in total during the past 7 weeks. Once after my GP told me to stretch, for about a week. Pretty much just googled "stretches for knee pain" and tried to find the most reputable-looking source. Kinda worked, pretty slow improvement though, so I stopped and the pain actually went away 3 days after stopping the stretches. Then I went and overstressed the knee again because I thought I was perfectly healed (facepalm) and literally went back to square one. The second time I found a pdf of exercises from the NHS, from memory it was things like quads, hip flexors, hamstrings, etc. My left knee was fine afterwards but my right knee hurt right after and the next day I had pretty sharp kneecap pain.

I generally don't have swelling or obvious inflammation.

I have read the previous three posts, and noted that you have visited your GP only once.  Self diagnosis is not the way to go forward - My suggestion, is that you must insist with your GP to see an Orthopeadic Consultant who is qualified to see if a MRI /scan is required to prevent any further damage to your knee.

Best/JohnK Manchester UK

The reason I haven't gone back to the GP is because it actually improved once since I saw her then I blew my knees out like 2 weeks later. I probably will go back and see her and get a referral if the situation doesn't improve, because on the one hand it kind of has since I last blew them out (for the 4th time) but on the other hand it's not happening very quickly. But yeah thanks for the suggestion I'll probably take it if nothing gets better.

[vickster]

What country are you in?
In the U.K. at least, you need a sports shop that is focused on running, there are independents and chains. However, they’ll be closed now in lockdown!
The specialist ones have a machine to analyse your running or walking, and your pronation. Then they can suggest the right shoes for your running ‘style’ and orthotics if needed.

A podiatrist can also check this, you’ll need to go privately for this. NHS podiatry won’t do that, they focus on actual medical issues with feet like infections, diabetic ulcers etc not sports injury.

A private sports physio with knowledge of PFS can also review gait, but if you need custom orthotics they’ll refer you on. The physio can also assess your muscles and recommend exercises

Rehabilitating muscle tightness may well take months of effort not days or weeks unfortunately. I should know, I’ve been rehabbing knee and other injuries for over 10 years! Some are due to anatomical issues like high arches (I have custom orthotics), others overuse or poor gait (or cycling techniques)

A PPI is not an antacid per se like Rennie or Tums which just neutralise the acid. PPIs reduce acid production pharmacologically

Generally orthopaedic surgeons are mostly focussed on serious injuries (severe soft tissues injury such as tears, bone breaks, deformity) , not so much for inflammatory issues, muscle issues, pronation issues. A sports physician, physio or even a rheumatologist if multiple joints are inflamed without any obvious overuse or injury cause (unlikely in a healthy 18 year old).
Are you male or female as certain anatomical anomalies are more common in females?

[ayno0118999]

Am in Australia, fortunately we don't have too much in the way of lockdowns and such yet. I think The Athlete's Foot does something like that here, will have to check though.

I'm female, I think my legs might be a bit wonky but they've never caused this level of problem before.

It's honestly kind of frustrating because I feel like I've kind of run the gamut of knee-related symptoms in the past couple of weeks. Stabbing? Check! Aching? Check! Random burning/prickling? Check! It's not really localized to one area either, because every other pain/weird sensation comes and goes, apart from the fact that the medial side of both knees will have a twinge of pain if I make a movement resembling that of kicking a football with the side of my foot (like exerting force at an angle).

Yeah I understand that the muscle tightness could take a very long time, makes me regret not taking full advantage of the gym in the two years or so before coronavirus hit (had a massive fitness kick in the past two years after about five years of inactivity in my teenage years).

Recently (in the past week) I haven't really had any of the stabbing kneecap pains, and only sort of general aching/PFPS-esque (no idea if it is, but judging by others' testimonies it sounds likely) pain, so I think I'll give it another week of gentle movement and see how things go and if it doesn't improve I'll see my GP again and see what she says and ask about a sports physician/physio/podiatrist/etc if needed.

One thing hanging over my head in terms of always wanting to get through this quicker is the fact that I'm meant to be off to university in February, which is going to be pretty difficult in the current circumstances. Well, not difficult, since I can move around as much as I want, it just hurts to do so. I guess with coronavirus it's not too big a deal since I don't think in-person lectures are going to be a thing yet, even in Australia. But yeah I keep thinking I'd really like this to be over with before I have to be up and about a lot.

[SuspectDevice]

Am in Australia, fortunately we don't have too much in the way of lockdowns and such yet. I think The Athlete's Foot does something like that here, will have to check though.

I'm female, I think my legs might be a bit wonky but they've never caused this level of problem before.

It's honestly kind of frustrating because I feel like I've kind of run the gamut of knee-related symptoms in the past couple of weeks. Stabbing? Check! Aching? Check! Random burning/prickling? Check! It's not really localized to one area either, because every other pain/weird sensation comes and goes, apart from the fact that the medial side of both knees will have a twinge of pain if I make a movement resembling that of kicking a football with the side of my foot (like exerting force at an angle).

Yeah I understand that the muscle tightness could take a very long time, makes me regret not taking full advantage of the gym in the two years or so before coronavirus hit (had a massive fitness kick in the past two years after about five years of inactivity in my teenage years).

Recently (in the past week) I haven't really had any of the stabbing kneecap pains, and only sort of general aching/PFPS-esque (no idea if it is, but judging by others' testimonies it sounds likely) pain, so I think I'll give it another week of gentle movement and see how things go and if it doesn't improve I'll see my GP again and see what she says and ask about a sports physician/physio/podiatrist/etc if needed.

One thing hanging over my head in terms of always wanting to get through this quicker is the fact that I'm meant to be off to university in February, which is going to be pretty difficult in the current circumstances. Well, not difficult, since I can move around as much as I want, it just hurts to do so. I guess with coronavirus it's not too big a deal since I don't think in-person lectures are going to be a thing yet, even in Australia. But yeah I keep thinking I'd really like this to be over with before I have to be up and about a lot.

It sounds identical to my symptoms.

I read the 'Jan' story too, but there is no way I could shut down my life that much.  I still needed to go to work.  Hence I ended up on Celebrex after at least 5 years of symptoms and that was the start of a huge turnaround.

If I was back there, and could not take Celebrex or similar, here's what might have worked if I'd been very careful:

Very gentle slow flat walking for 20mins each day;
Regular icing - 2 times/day for 15-20mins;
TENS machine every day for 45mins
Gentle stretching of hammies, lower back but absolutely not of the knees, and nothing that puts any extra load on the knees
Swimming with pull buoy and band to maintain some fitness and sanity, with absolutely zero kicking and no hard pushes off the wall with legs
No stairs
No kneeling or squatting
No quad strengthening of any kind
No heavy lifting or carrying
Never sit with knees bent - always out straight propped up on a box or something
Experiment with strengthening exercises for glutes/hammies/core, but this is very risky.  Once the Celebrex started to significantly improve my symptoms, I found exercises like deadlifts, kettlebell swings and later Belgian squats 2x/week, 5-10 reps of each, 3 sets of each really helped my progression.  They would inevitably cause some symptoms, but did not lead to long-term setbacks.


Just my theory of course given what I know now.

[ayno0118999]

It sounds identical to my symptoms.

I read the 'Jan' story too, but there is no way I could shut down my life that much.  I still needed to go to work.  Hence I ended up on Celebrex after at least 5 years of symptoms and that was the start of a huge turnaround.

If I was back there, and could not take Celebrex or similar, here's what might have worked if I'd been very careful:

Very gentle slow flat walking for 20mins each day;
Regular icing - 2 times/day for 15-20mins;
TENS machine every day for 45mins
Gentle stretching of hammies, lower back but absolutely not of the knees, and nothing that puts any extra load on the knees
Swimming with pull buoy and band to maintain some fitness and sanity, with absolutely zero kicking and no hard pushes off the wall with legs
No stairs
No kneeling or squatting
No quad strengthening of any kind
No heavy lifting or carrying
Never sit with knees bent - always out straight propped up on a box or something
Experiment with strengthening exercises for glutes/hammies/core, but this is very risky.  Once the Celebrex started to significantly improve my symptoms, I found exercises like deadlifts, kettlebell swings and later Belgian squats 2x/week, 5-10 reps of each, 3 sets of each really helped my progression.  They would inevitably cause some symptoms, but did not lead to long-term setbacks.


Just my theory of course given what I know now.

Hello Suspect. It is somewhat reassuring (probably not the right word to use but you get my meaning) that my symptoms sound identical to yours because you're in a much better position now which gives me some hope.

Yes, I agree with you about Jan, perhaps a good idea in theory but the rest of us have to live some kind of a life with all the responsibilities and activities that entails.

I have been walking around my apartment (that being the only flat area near me), fairly slowly, probably somewhere like 2500 steps per day cumulatively.

I might try the icing and stretching again, and you do make a good point about doing absolutely nothing with quads (which I tried to do in the past 3 days again, probably ill-advised, but we move).

Will avoid kneeling and squatting in future, that probably doesn't help. In terms of lifting/carrying I haven't really been aware of this but I'll probably try harder to in future.

The no stairs rule is a bit of an issue I must admit, have been trying to avoid those but as I've said a few times before I live on a hill, so to get anywhere it's either stairs or a downwards slope. Just wondering if you or anyone else on this forum has an idea of which would be preferable.

I do have vague plans to give strengthening a try but only when I have access to a gym that doesn't cost the value of my limbs (so probably in uni). It will probably be risky and I wouldn't do it until doing normal stuff didn't hurt.

Just as a general update to anyone who is interested: haven't had any of the stabbing pains for... probably two weeks now. Did have some quad burning and kneecap pinching and just general aches and stuff. Weirdly in the past two or so days I've had periods of essentially being perfectly fine for like 20 minutes, which is great but also becomes depressing when pain/weird sensations return.

Have a bunch of university interviews in two weeks time (no need to travel thanks to corona), so am still hesitant to have a go with NSAIDS, but would consider them afterwards if no improvement. Will probably see the GP sometime in December as I have an appointment scheduled with her anyway, though I'm not sure what can be done in the short period of time between now and me going off to uni.

Thanks for your feedback and I'll definitely take your advice Suspect.

[ayno0118999]

Ok it's been 10 days since my last post and I may as well do some kind of short-term update.

It's mostly good news! I've definitely been feeling less pain in general and I can do most day-to-day things fairly comfortably (walking, downhill and uphill, sitting in a chair for a good while). This is definitely going in a positive direction. No stretching but I did ice with a big chunk of ice in a plastic cup for the past week and a half (not every day and not for the 15-20 minutes as suggested, but definitely on a fairly regular basis and after every time I went out or exerted myself). I did start off with aiming to do more walking, but that kind of fell off.

I did get a bit of a setback middle of last week after a horrific bout of some kind of 24-hour-stomach-flu but that seems to have gone away now (both the setback and the stomach nastiness). The only major things that seem to be 'wrong' are that I've got some kind of non-painful crepitus and that I don't feel entirely comfortable walking for longer distances yet. The former is like the knee-pinching I felt before but without the pain, just the movement, and the latter again isn't painful but out of the ordinary for sure.

Gonna be honest when this all started out I definitely wasn't expecting to not be fully recovered 10 weeks in but what can you do? --\(O.O)/--

Going forward I feel like I'm doing the right things, maybe I'll try to ramp up the walking a bit and see how things turn out.

[Brandon123]

Overall, seems like things are going in the right direction!

[ayno0118999]

11 days later update.

Kinda messed up almost immediately after writing that last update. Got finished with some personal stuff I'd been working on for a long time and decided to go out to celebrate. Ended up clocking up 10+km in walking, actually it wasn't too unpleasant until I followed it up the next day with 6+km which I think my knees didn't enjoy at all because a flare-up followed the next day. Same deal as before, icing and rest etc, tbh I wasn't taking the rest all too seriously like still doing the same kind of stuff around the house and whatever because I noticed this flare-up was pretty much how my knees had felt on a daily basis for like 6 weeks before they got a bit better. Also no stabbing which was great so I figured out it wasn't serious. It was pretty much 90% of pre-flare-up by Wednesday anyway.

Now we have kind of a second problem which is that Christmas is coming and Australia is very much not under lockdown, which means I have relatives to see and I definitely want to go places (is this a foolish thing to do? maybe lol but it's Christmas and there are obligations attached to that to some extent, also I still want to have some fun). So the chances that my activity level will be higher than before are high. I also kind of want to accelerate this whole process (being 18 and impatient and all), so I started some Ibuprofen 3 days ago (aiming to knock out inflammation, not really for pain at all tbh). Nothing excessive, just the recommended dose according to the packet (2 pills a day for the past 3 days). Idk if this is just my body or if the Ibuprofen has actually worked, but I've since been out twice in a row(6km and 3km) and not had a flare-up, wheras previously I probably would have. On the other hand it's offered absolutely no pain relief  whatsoever as I don't feel any different to how I would have (and after the Ibuprofen would have worn off I don't feel different than when it would have been effective). I don't intend to keep on with it for too long, maybe just a week, and see how that goes. It's preventing full-on flare-ups now, so I hope those can be gone even after I stop the NSAID.

Still keeping up with the icing and not bending the knees too much when sitting. I definitely have a bit more of a positive attitude generally now, because it has gotten better so I know it's definitely possible to get back to pretty decent shape. Also I'm wondering if when I get to attending uni regularly, I might recover faster/more as I realized that when I was attending school in-person I was walking ~3km/day not counting walking around the house as normal (maybe one or two days would be more or less than that, especially weekends), so perhaps its the contrast between relative inactivity and going out for long periods of time that's doing my knees in a bit. So I guess that theory will be tested in February or March?

Yeah in conclusion, to cut a very long update short, went out to celebrate something and overdid it, got back to ~90% of pre-overdoing it, started maybe a week or so of Ibuprofen because I foresee myself being slightly more active over Christmas.

[ayno0118999]

Very quick update! Had the last Ibuprofen on Monday while I was out (that trip was kind of painful and I was kinda worried that I'd flare something up again because of it). Haven't had an NSAID since but it's actually gone pretty well? For example yesterday I went out for groceries and I felt some weird sensations but not pain until the very end but I was going home then anyway and even then it wasn't very painful. Hopefully this continues.

Also I've been exclusively wearing shorts because it turns out wearing any kind of pants that could put any pressure at all on my knees is kind of uncomfortable. It's not a deep discomfort, like into the knees, just more surface level. Lucky it's summer in Australia lol, inconvenient but not too bad?

[Brandon123]

Great that you're seeing some progress! Take it easy and I'm sure you'll continue to improve.