Update on Knee Problem

C

clothesminded

Cathlete
Well, after meeting with the orthopedic guy last week and the X-rays not showing anything, I had an MRI of my left knee. Got the results back yesterday, and my knees seems to be normal, except for chondromalacia patella (AKA runner's knee). I was given a prescription for Naproxen and a script for physical therapy, which I start tomorrow.

According to the doctor, my "condition" is due to weak inner quad muscles, which basically causes the patella (knee cap) to move around. It certainly feels like it's not stable. This is the most common knee problem and happens mostly in active, healthy women. I thought that the billions of squats, lunges, deadlifts, and step-ups I've done for the last 3 years would strengthen the quad muscles, but apparently I'm wrong! I looked up some of the exercises recommended to strengthen the vastus medialis, and they look so simple. I'm confused on how heavy leg weight workouts can't strengthen the muscle, but these straight leg lifts and wall squats, with no weight, can.

I'm thrilled that there is nothing major wrong with my knee, although it sure the heck hurts like there is. But then again, I feel like I may never get better. I know the Naproxen will eventually make the inflammation and pain go away, but am I doomed to repeat this cycle all over again?!

The doc recommended 3 times a week for 4 weeks of physical therapy. That seems like a lot, especially at $30 every visit. I want to just learn the exercises and do them on my own. I will faithfully do that. I just don't see the need to drive 30 min. to have someone watch me do simple exercises with no weights.

So, someone please set me straight here. Am I just being stubborn? I know I haven't been yet, so I'm just planning ahead and "what if-ing" everything. I've never been to physical therapy before and don't know what to expect. But when I walked through on my way to have the MRI and saw people squeezing balls with their hands and doing a cardio machine, I thought "Heck, I can do this on my own once I know what to do. " Am I being arrogant?! Is this really going to be worth my time and $360? I so desperately want to get better, and really want to do what I have to in order to do all different forms of cardio, maybe even jog again.

Hopefully, my rant and rambling can actually help someone who is experiencing knee pain similar to mine. If not, my apologizes!
 
I've been through pt for my back, knee and shoulder. For my back and knee insurance covered everything. For my shoulder I went to a sport med clinic affiliated with Ohio State and wound up paying about what you're paying. The only thing they did I couldn't do myself was Saran-wrap a bag of ice to my shoulder for 15 minutes. I could have easily done the exercises at home and probably should have because it got expensive. When I went for my back I got massage (which was wooooonderful) but the insurance allowance ran out before they got That Knot out of my lower back. Years later and it's still there. I don't want to advise you as to what YOU should do but, if it were me (and I had/have the same problem), I'd go just long enough to either get the routine down or get the sheet(s) of exercise diagrams & descriptions so I could do the routine at home. Just make sure you do the exercises religiously. I didn't and I still have issues. One thing I remember about the knee cap issue was being made to do front and side lying leg lifts with ankle weights...
 
I had the same thing wrong with my knee that you do and needed to strengthen that VMO (inner quad) muscle. Mine was a little different from yours because I had to have surgery since my knee cap could not be moved back into place by exercises. However, as far as PT goes, 3 times a week sounds really excessive to me. I went 2x a week and at times that seemed like too much. I think that once you get the exercises you could do them at home and then maybe check back with the PT in a week or so so that they can make sure you are doing the exercises correctly. Also, they will do various modalities on you like e-stim, ultrasound, etc... They help some people, but some they do nothing for. I guess just go with your gut and feel it out and see how it goes. Though I really think that 3 times a week is a waste of money.
 
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Physical therapy is always optional. You don't have to do it. That said, i would do it as the doctor recommends for a few weeks, at least, so you can get the feel of things. Ask your PT questions in detail, so you can make sure you're getting the most out of each session, and so you can take away as much knowledge as possible. Then, I don't see anything wrong with doing the exercises at home.

I used PT for a while when I injured my calf. It definitely has value, and I learned a lot. But you're right - it can go on for a long time, and it's expensive!
 
Hi Clothesminded,
I was wondering how your knee appointment went! Don't you hate it when they can't just wave a magic wand and make it better???? I got my cortison shot in the knee last week and am feeling some relief but they did tell me it would take time. The hardest part for me is not being able to pop in a DVD and go for an hour like I used to. Patience is not my strong point.

Anyway, glad to hear you're on the road to recovery and hopefully it won't take too long.

Darlene
 
As someone who's been through the PT thing a few times, 3 times a week for 4 weeks doesn't sound excessive to me.

Go to the PT. In my experience, they did more than just give me exercises to do. I also got deep tissue massage, myofascial(sp) release, and ultrasound therapy (like Karin mentioned).

Go for two weeks, as prescribed, and re-evaluate. The PT may agree that you can back down the number of visits. That was basically how I worked with mine.

Also, depending on how you've been doing a lot of that heavy leg work previously, you still may not be firing all those little stabilizer muscles that are really important in knee stabilization.
 
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I've been battling knee pain also due to my knee cap pointing outward instead of straight ahead. Doing excessive squats and lunges makes it worse. What were some of the exercises they gave you to do? I also thought PT was a joke. My sessions ran about $100 a pop.
 
I had knee surgery at the end of March to resolve a similar problem. The doc partially sliced the muscle that was pulling my knee cap to the outside. I did 8 weeks of physical therapy to strengthen the VML. My perscription was for 3 times a week, but I went 2 times a week, and that was plenty.
The first 4 weeks were focussed on reducing swelling and regaining mobility. The last 4 weeks were to bring me totally back to running and Cathe capability.

The things they used to really strengthen the inner knee muscle were a lot of balance exercises. I would do one legged squats on the tramp, stand on one leg while tossing a medicine ball to PT (they would toss to my side forcing me to rebalance), lunges onto a bosu, stand on one leg on bosu, do one leg squats on a balance board placed one of the racks with a backboard that slides at a 45 degree angle. I would also do the weight machines for leg press, leg extension, and hamstring curls.
Since I do not have a tramp or bosu, it was worth it to go to PT, and my insurance covered everything. I also did 20 min of electric stim and ice at the end of every session. The PT said the stim and ice were mostly useful for reducing the swelling from surgery.
I also liked having the PT there to tell me that I was not pushing too hard, a nice sanity check.

I was really surprised by how much 2 times a week of all the balance exercises really made me stronger than even working out with Cathe. I can now do Cathe lunges with about a third of the pre-surgery effort.

Hope that helps you figure out if PT would be worth it for you,
 
Hey, good to hear from you! I guess we're peas in a pod. My diagnosis was the same, with a touch of synovial plica syndrome on the side. And of course some good old-fashioned tendinitis to set everything off in the first place. I got Naproxen, a couple rounds of methylprednisolone, cortisone shots, and a topical ketoprofen cream. My dog wants nothing more than to lick the ketoprofen off my knees. I have to shoo him away and he sulks off with his ears back and his tail between his legs. I guess it smells pretty enticing.

As far as the PT goes, I told my doctor right away that I'm flat-out unable to afford this stuff. I don't gross enough money to cover 3 visits per week ($150 per visit after insurance). We set up one appt, with a follow up every 4 weeks. Aside from her showing me how to tape my knee, which made a WORLD of difference btw, she honestly did not give me any info I couldn't have gotten off the internet myself. I'm actually doing more than what she told me to do, like using a foam roller, stretching my soleus, hamstrings, and IT bands. When I told her that, her attitude seemed indifferent, like 'go ahead if you really want to'. My ortho on the other hand, told me that it was great, and I was doing everything he would've told me to. I just got fitted for braces and they should be coming in this week. Hopefully that'll get me back on track, har har. :)

I basically do my PT by myself every day. On upper body day, I also do the weighted leg lifts. On 'lower body day', I do the B&G floor section, plus firewalkers and dead lifts. There's a few moves I can't do, so I just do leg lifts instead, but keeping the same rhythm as the dvd. I also make sure to stretch at least three times a day.

I'd definitely go for the initial PT appt, and if you're just blown away by it, by all means, go as much as you can. I think it's a lot more useful for the type of person who's never exercised before and needs to be told everything. Mine told me I should avoid walking down hills. REALLY??? I had no idea! :rolleyes:

Rest those knees!

Nadja
 
dragonf1y said:
I had knee surgery at the end of March to resolve a similar problem. The doc partially sliced the muscle that was pulling my knee cap to the outside. I did 8 weeks of physical therapy to strengthen the VML. My perscription was for 3 times a week, but I went 2 times a week, and that was plenty.
The first 4 weeks were focussed on reducing swelling and regaining mobility. The last 4 weeks were to bring me totally back to running and Cathe capability.

The things they used to really strengthen the inner knee muscle were a lot of balance exercises. I would do one legged squats on the tramp, stand on one leg while tossing a medicine ball to PT (they would toss to my side forcing me to rebalance), lunges onto a bosu, stand on one leg on bosu, do one leg squats on a balance board placed one of the racks with a backboard that slides at a 45 degree angle. I would also do the weight machines for leg press, leg extension, and hamstring curls.
Since I do not have a tramp or bosu, it was worth it to go to PT, and my insurance covered everything. I also did 20 min of electric stim and ice at the end of every session. The PT said the stim and ice were mostly useful for reducing the swelling from surgery.
I also liked having the PT there to tell me that I was not pushing too hard, a nice sanity check.

I was really surprised by how much 2 times a week of all the balance exercises really made me stronger than even working out with Cathe. I can now do Cathe lunges with about a third of the pre-surgery effort.

Hope that helps you figure out if PT would be worth it for you,
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I want your PT! Maybe I should shop around. Mine showed me leg lifts, isometric contractions, and runner's quad stretch. What exactly was the name of your procedure? My doc said a few more months and we'll have to start thinking about a lateral release, but apparently the success rate isn't all that impressive. Your post honestly gives me a lot of hope, thank you :)

Nadja
 
Nadja Z said:
I want your PT! Maybe I should shop around. Mine showed me leg lifts, isometric contractions, and runner's quad stretch. What exactly was the name of your procedure? My doc said a few more months and we'll have to start thinking about a lateral release, but apparently the success rate isn't all that impressive. Your post honestly gives me a lot of hope, thank you :)

Nadja
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Nadja, not dragonf1y, but I had lateral release surgery last March. My knee cap is staying in place now so I guess it was successful, but my recovery was pretty tough. I don't know if everyone else's recovery from lateral release surgery is or not. Hopefully yours can be corrected with exercises. I know I read that you don't have extra cash for PT, but like you said finding another PT might be a good idea. I too had lots of cool exercises like dragonf1y which helped a lot. I still do them today.
 
Thanks to everyone for their tips and wishes for a quick recovery.

Please allow me to reflect a bit with the hopes that someone else will benefit.
I just got back from the PT, and I must say I'm a little shocked at how much I liked it. I was assigned a PT who is built, very fit and healthy. This guy played college ball, ran marathons and triathlons, and lifted competitvely. I felt like he really "got" me and my fitness goals, and could really relate. He told me about how our bodies change when we get older and how his own goals have changed now that he's older. He said that now he does a crosstraining program (push-ups, pull-ups, etc.) and only uses weights (not even heavy ones) for some leg work. And he works out at home. Said that he realized that he could maintain his results without lifting like he did back in college. It helped to really see someone who doesn't kill himself to be fit, but still has a lean, muscular body. It was one of those light bulb moments for me. Yes, I knew all of this before, but I didn't actually think it applied to me. Ha! I finally realized that I'm not going to compete in any fitness competitions, I will never have huge, round muscles, but instead have the longer, lean look. On the way home, I thought about all I'm thankful for- my 6-pack abs from basically doing nothing (genetics- thanks mom and dad), my nice shoulder muscles, my slim body (never had any weight problems or needed to lose even a pound). And I thought about what my husband tells me all the time- that my body looks 10 years younger and if I were to compared myself to 30 year-olds (and not the 20 year-old group), I would always be at the very top of the group, both in appearance and ability to do things. So what if my butt is a little too round for my taste. I will never have a butt like Cameron Diaz, just not built that way.

I truly feel like I got it today! All this fear of not being able to work out and get fat and soft is gone. I really understand that, first, my genetics won't let me to get that way unless I just eat fast food for every meal (my mom, at 68, has the body of a 40 year-old, walks about 2 miles almost every day, eats decent, and has maintained her weight of 120) and my mind won't allow me to abuse my body to that degree. This knee issue really got me worked up. The truth is that I will always be active to some degree, but I just may not be able to jump around doing plyometrics (wouldn't miss that much either!)

As far as what the PT said, he said that my quad muscles seem strong, and that it's my lack of flexibility that might be the problem. When he did those tests to see how flexible I am, it was shocking, especially the difference between the right and left sides. The stretch for the IT band I would really feel. He also pointed out that my left kneecap points in more than the right. My left foot points out, causing the kneecap and foot to go in opposite directions. Yeah, that could be a problem!

When I asked if the 3x's week for 4 weeks was really nec., he said prob. not. I am going back two days next week to learn the exercises and stretches. He said most of the work is done at home by myself anyway. All of the exercises he mentioned were to try to retrain my left knee from going in. I was also shocked to see how my kneecap rolls in when I do squats. Pretty creepy!

So, all in all, I feel like today was a success. This guy really undestood my personality and said a lot of things about my body that made sense, as far as my problem goes. I finally feel like things have turned around for me, not just with my knee, but with my entire attitude about fitness. Hearing from someone like this guy that I can still remain fit without jumping off of a step, pounding my feet on concrete for hours, or doing tuck jumps was very encouraging. And that I'm very lucky to have a, pretty much, normal body structure, and the minor things can be changed easily.

If you've read this far, I hope you got something out of my rambling.
 
Nadja Z said:
I want your PT! Maybe I should shop around. Mine showed me leg lifts, isometric contractions, and runner's quad stretch. What exactly was the name of your procedure? My doc said a few more months and we'll have to start thinking about a lateral release, but apparently the success rate isn't all that impressive. Your post honestly gives me a lot of hope, thank you :)

Nadja
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LOL! I also really liked my PT. I felt that they were very knowledgable and really helped.
Yes, it was a lateral release, I had a great experience with getting everything done. Great insurance, orthopedic surgeon, anesthesia, PT. And everyone told me that 4 weeks to "capable" and 8 weeks back to "my normal" was super-fast. Since it was only a few months ago, I am not sure that the surgery was "sucessful", but I do not think that I am worse for having it.
 
dragonf1y said:
LOL! I also really liked my PT. I felt that they were very knowledgable and really helped.
Yes, it was a lateral release, I had a great experience with getting everything done. Great insurance, orthopedic surgeon, anesthesia, PT. And everyone told me that 4 weeks to "capable" and 8 weeks back to "my normal" was super-fast. Since it was only a few months ago, I am not sure that the surgery was "sucessful", but I do not think that I am worse for having it.
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I'm glad to hear it went so well for you. How long did you wait to have the surgery after your condition started? I'm going on three months now, and the pain is still constant, every moment of the day. I've definitely built up my medial quads a lot, but doing the exercises themselves seems to up the inflammation so half the time I'm not sure if I'm doing more harm than good. *sigh*

Do you mean that the average downtime for the surgery isn't long, or that you in particular recuperated faster than most other people? It's just frustrating having to wait several months first, all the while in pain, and then make the decision that it's bad enough to require surgery. I'm trying to be patient, but...
I feel like I should be writing "At least I have legs" a hundred times on a chalkboard somewhere. :)

Nadja
 
Nadja Z said:
I'm glad to hear it went so well for you. How long did you wait to have the surgery after your condition started? I'm going on three months now, and the pain is still constant, every moment of the day. I've definitely built up my medial quads a lot, but doing the exercises themselves seems to up the inflammation so half the time I'm not sure if I'm doing more harm than good. *sigh*

Do you mean that the average downtime for the surgery isn't long, or that you in particular recuperated faster than most other people? It's just frustrating having to wait several months first, all the while in pain, and then make the decision that it's bad enough to require surgery. I'm trying to be patient, but...
I feel like I should be writing "At least I have legs" a hundred times on a chalkboard somewhere. :)

Nadja
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Nadja, I'm butting in again, but just wanted to tell you about my lateral release with the questions that you asked. I was injured in August 2006 and finally had the surgery in March 2007. I finally went to an orthopedic doctor in the middle of October and he diagnosed me. Then I did PT for 3 months with no avail. By the time the doctor was free and DH would be around to take care of me for awhile it was the middle of March.

Dragonf1y's recovery was quite different from mine. Mine took a long time. I couldn't walk normally for 2 months. I think that some of this might be due to the strength that I lost while waiting around for the surgery and all that jazz. I also had other issues that were corrected with the surgery too so maybe that contributed to the longer recovery time.

Like I said earlier, so far so good and it looks like it worked. Feel free to PM me if you have any questions.
 
Gosh, now I'm getting worried. Surgery?! I freaked out when the doc. mentioned getting a cortisone shot. No thanks. I do not do shots.

For me, it sounded like (or maybe that's what I wanted to hear!) that surgery would be a last option for me. I think the doc and PT are confident that I can improve my alignment with being aware and stretches. I've also read that for this specific condition surgery isn't done too often. Why did your doc. decide you needed it? Because all the other options didn't work?

Were y'all's condition and symptoms similar to mine?

It's been a month of hurting for me, but doesn't seem as serious as what you guys have described.

Do many people "get over" this type of injury/condition w/exercises and stretches?
 
clothesminded said:
Gosh, now I'm getting worried. Surgery?! I freaked out when the doc. mentioned getting a cortisone shot. No thanks. I do not do shots.

For me, it sounded like (or maybe that's what I wanted to hear!) that surgery would be a last option for me. I think the doc and PT are confident that I can improve my alignment with being aware and stretches. I've also read that for this specific condition surgery isn't done too often. Why did your doc. decide you needed it? Because all the other options didn't work?

Were y'all's condition and symptoms similar to mine?

It's been a month of hurting for me, but doesn't seem as serious as what you guys have described.

Do many people "get over" this type of injury/condition w/exercises and stretches?
Click to expand...

Clothesminded, don't worry about surgery. I think that most people's is curable with PT. My knee cap was literally out of the track and ripping of bits of cartilage from my femur. It was almost bone on bone there. Mine was so severe that PT couldn't move my knee cap at all and I had to have the surgery so that my knee cap would stop dislodging my cartilage. I had pieces of cartilage floating around too and couldn't really straighten my leg that well. I actually didn't have too much pain from my knee cap being in the wrong spot, but the cartilage was getting stuck in between my upper and lower leg bones and causing pain behind my knee.
 
Karin- Oh my! That sounds very painful. You really didn't have any other option!
I am so glad to hear that you've recovered so quickly.
Did the doc say why you had this problem? Just alignment issues with the patella?
 
Saran wrap the shoulder with ice???? AHA!!!! Thank you friend, I"m on my way to get it! And to think I remember a day when wrapping myself in Saranwrap meant something lewd !
 
I found out pretty quickly after doing a couple back to back sessions of KPC, that my knees weren't used to high impact. I've always been into cycling, and then in the winter my sports are xc skiing, snowshoeing, etc. I realized my knees ached after tons of jumping, something I've never experienced, then started reading about knee issues here on Cathe. The links below are very interesting in light of this topic. Hope they help.


http://sportscenteraustin.blogs.com/the_view/2005/01/the_number_one_.html


http://sportscenteraustin.blogs.com/the_view/2004/09/how_to_beat_run.html


http://www.bodybuilding.com/fun/peak43.htm
 
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