Struggles To Overcome Runner's Knee...

[AsWeCit]

I am a 26 yr old life long basketball/biker/rollerblader/mobile individual. Been very lucky in life to have avoided serious injuries. Come Jan ’12 I had fell into a routine of playing 3 times a week, officiating the game the other 4 days. Because of this I developed extreme knee pain, and what my doctor told me was runners knee. For the next 3 months I did his recommended stretches, exercises, icing, and rest. I had good days; I had bad days, and saw very little improvement in the pain. Had not run, or played basketball, even biking and swimming irritated it enough to set me back a week in progress. In May the pain became so back I went back to the doctor. He convinced me to get an MRI, it showed nothing, he felt nothing new in the examination, gave me some new stretches, and sturdy brace to keep the kneecap in check, and told me “It will get better”. I have been reading other posts and understand it takes time. Since I last went to the doctor in May, I went through phases of it getting better, but then randomly with one wrong step on flat ground I will feel the knee pop and know I just fell 2 weeks backwards in progression.

The whole thing is driving me nuts. I have respected the injury and the healing. I wore the brace, I did the stretches, I ice constantly, I have been taking Ibuprofen routinely since Jan, I have yet to run or really even tested the knee other that extended period of walking. About a week ago I was in the best pain free position I had been since the injury. Barely any pain, didn’t need to wear the brace, was walking well and developing strength while brace less. It has been my understanding that the best way to regain strength and confidence before jogging would be light biking and swimming. I hopped on a bike for a ¼ mile ride over to the pool, only peddling with the strong leg while letting the weak knee just go through the motion. When I got off the bike and began to walk over to the pool, I notice the knee was very weak, but I figured it was just from not experience that motion in months. I got into the pool, began to walk, and did some light jogging motion underwater. I immediately noticed that this did me no good. The knee was painfully popping multiple times with each flex, its felt extremely weak, and the swelling was coming right back. I stopped immediately. Im now back to square 1 with the pain, weakness, and immobility. Should I have worn a brace on the bike and in the pool even though it brings discomfort?

The stretches my doctor recommended initially were
-Standing alternate TFL stretch
-Quad flexion SLR stretch
-Clamshell for gluteus maximums strengthening

I will admit these stretches did help in the recovery when I was initially doing them in May, however when I do them now I see no strength added, and in fact bring about more pain while completing them.

This is the brace given to me by the doctor.

http://www.betterbraces.com/donjoy-lateral-j-patella-knee-brace

It helped stabilize when pain was at its worst; however there have been many times throughout this whole ordeal where I begin to feel that the brace is actually irritating the injury even more. Also, due to the metal stabilizers on each side of the brace, it is too uncomfortable to wear when sitting with the knee bent (I slide down the brace to my ankle, and pull it back up when standing up. Is this normal?) Any recommendations on brace style to wear while starting to perform physical activities?

Bottom line, I am completely lost on how I can fully recover. It has been 9 months now. I feel like for the 10th time I am back to beginning in my recovery. When I am able to walk normal without a brace I am waiting AT LEAST a month before I even so much as jog. I am scared to death of getting on a bike again or even getting into water to test the knee even more. If and when I do this should I be wearing a brace? I am reaching out and would appreciate any advice, wisdom, guidance, stretches, exercises, do’s/don’ts, recommendations. My health insurance ran out 3 months ago, currently unemployed. What I keep reading about is getting the knee scoped. I don’t know how I could currently pull that off financially. I want to beat this, I know I can beat this, but everything I have done can’t get me over the hump of pain and discomfort.

Thank you all in advance for any wisdom / advice.

 

[MagnusTheBrewer]

As someone who has an artificial knee and had it replaced once already with all the attendant recovery and therapy, I can give a little insight. First, you need to exercise the knee and yes, it will hurt, pop and, suck generally. Moderate exercise is best til your muscles build back up. Second, the pain, occasional feelings of weakness and, prior athletic ability may NEVER fully return. It sucks but, that's life. Pain is good, it means you're alive.

There are multitudes of braces out there. If what the doc recommended isn't working for you, try something else. Don't be afraid to get a second opinion from another doctor. You might want to look at applying for your States medicaid health insurance program generally available at the dept. of economic security.

Short answer: Keep doing the stretches, exercise and, get used to pain.

PS. Talk to some physical therapists. They often have better insight with specific exercises than doctors.

 

[SociallyChallenged]

There is no way that you should ever have to deal with pain for 9mo before seeing a specialist. At 6mo, both doctors and insurance companies support more drastic interventions (like PRP injections, cortisone, surgery) because that is far, far too long to last. However I don't even suggest these at this point because other options haven't been explored.

Where do you have the pain exactly? Above, below the kneecap? Underneath the kneecap? On the inside/outside of the kneecap? Or does it not have anything to do with the kneecap? A doctor shouldn't be prescribing that many exercises (except in standardized cases like early post-surgery) because they can't routinely re-assess how you're doing. This is a case where you need to go to physical therapy. With your descriptions of popping, it could be general patellofemoral maltracking or iliotibial band sydrome, both very common in high-volume runners. However, exercise is not the primary intervention initially. Manual mobilization is and it's not something you can do on your own. Also, stretching, in the early stages, will make it worse. It's like if you think of a rope with a small tear in the middle. If you put more tension through it, it will begin to fray more. That's what you're doing with a simple stretch.

Because of this, PTs utilize joint mobilization and soft tissue mobilization (i.e. massage) to improve muscle length. Because a muscle needs to be able to lengthen, move side to side, and broaden, you actually gain length due to improving overall mobility. It's very effective at reducing pain and allowing normal healing processes to occur. This is completely unreasonable that your doctor hasn't done more for you.

Also, I do not agree with what Magnus says. Every good therapist I've met uses the phrase, "Let your symptoms be your guide." That means, you stay on the good side of your pain when rehabbing. Exercises should be mildly painful at most and should not aggravate your injury for longer than 10-15min. Ideally, the manual therapy (hands-on work) should be the most uncomfortable in the process, but will make you feel 10x better afterward. You've got with this for too long. Ask your doctor for a prescription for physical therapy, as nothing he's doing is working at this stage. If he doesn't want to give you one (seems like he's trying his hand at it arbitrarily), then get one from another doctor. It's an easy prescription to get typically and it's something you should definitely try.

 

[MagnusTheBrewer]

Also, I do not agree with what Magnus says. Every good therapist I've met uses the phrase, "Let your symptoms be your guide." That means, you stay on the good side of your pain when rehabbing. Exercises should be mildly painful at most and should not aggravate your injury for longer than 10-15min. Ideally, the manual therapy (hands-on work) should be the most uncomfortable in the process, but will make you feel 10x better afterward.

Generally you give good advice but, as someone who's gone through the recovery twice, three times if you count the recovery before I got an artificial knee, I can tell you it sucks. Studying is good but, personal experience trumps. It hurts when you're exercising and it hurts when you're not exercising and, the pain is why so many give up during the critical stage of recovery.

If by "making you feel 10x better afterwards" you mean 3 months later, you are correct. 10 minutes later you just want to shoot the therapist. I've been fortunate to have very good physical therapists and every one has caused me a great deal of pain.

Pain, learn it, love it, live it.

 

[SociallyChallenged]

Generally you give good advice but, as someone who's gone through the recovery twice, three times if you count the recovery before I got an artificial knee, I can tell you it sucks. Studying is good but, personal experience trumps. It hurts when you're exercising and it hurts when you're not exercising and, the pain is why so many give up during the critical stage of recovery.

If by "making you feel 10x better afterwards" you mean 3 months later, you are correct. 10 minutes later you just want to shoot the therapist. I've been fortunate to have very good physical therapists and every one has caused me a great deal of pain.

Pain, learn it, love it, live it.

I do not mean there is not pain involved, but there is a fine line between therapeutic and aggravating. I have personally gone through the rehab of almost every major joint. I have pushed it and I have learned to pull back. In my personal experience, slow and steady is much better than flare up, calm down, flare up, repeat. Granted, there will be discomfort, maybe even significant amounts, but you should not have full blown pain. As a therapist, I personally induce more discomfort than the exercises as I can personally attend to the patient's pain levels and modify the therapy accordingly. We may have differing opinions, which is fine. Mine is safer, based on my clinical experience and life experience, but is by no means the only option. It may not even be the best option. There's no way to prove one way or the other, but it is the approach I use and have had success with.

 

[ibex333]

Why not stop running and start biking instead? Or if possible.. Jump-rope? Although it may be bad also because of the knees. But worth a try! If all else fails, try swimming.

Really, running is overrated and not everyone has to do it. There's plenty of other great cardio.

 

[SociallyChallenged]

Why not stop running and start biking instead? Or if possible.. Jump-rope? Although it may be bad also because of the knees. But worth a try! If all else fails, try swimming.

Really, running is overrated and not everyone has to do it. There's plenty of other great cardio.

Changing activities doesn't necessarily mean his tissue will just recover. Activity is one small part of why people get injuries. He may have weak or may underutilize his glutes and therefore overuses his quads. That'll happen in any activity, if that's the cause. Also, jump rope is actually just as bad if not worse for provoking true runner's/jumper's knee than running. I agree he can choose to do other things, especially in the meantime, but there is no way he should go untreated. He should go to PT, it's the most viable option at this stage considering he hasn't tried it yet.

 

[AsWeCit]

Thanks for all the responses and advice, here is where I stand 1 week later from the post. Things have improved a bit to where the pain has reduced a bit, but the knee is still very weak. I spent alot of time on my feet this week, just standing. I wore the brace 75% of the time while standing ( I wanted to test the strength I had in the leg periodically gage progress ). In doing this, I was putting alot more weight on my strong leg, which eventually became very sore. The pain I feel still remains like it comes from "inside the knee", which is what I was told is the symptom of the irritation under the knee cap. Basically it feels like I have no muscle / strength in my knee. It is clearly very weak from months of hobbling / walking after recovery / reinjurying the knee / hobbling again. I do agree with those who believe that this issue besides the knee cap irritation comes down to "patellofemoral maltracking or iliotibial band sydrome". What would your recommend to rehab this? Does this diagnose help explain why the moment I started pedaling a bike 2 weeks ago and then then did 30 seconds of light simulated jogging in a pool I basically threw everything out of wack and the extreme pain came back instantly setting me back another 2 weeks of recovery?

At this moment the pain has reduced enough where I want to begin going on mile long walks re-teaching the legs how to walk correctly, and begin trying the recommend PT exercises. My question with the walks is, should I continue to wear the brace for stabalization, or to I need to begin to ditch the brace to regain the strength in those muscles it assists?

Thanks again, every day is alittle bit better than the last.

 

[SociallyChallenged]

Your questions needs to be addressed by someone who has specifically examined and assessed your injury. You need to see a PT and ask them these questions. All we're doing is speculating at this point.

 

[AsWeCit]

Understood. Unfortunantly finacially seeing a PT again isnt possible. I understand a appreciate all and any advice.

A few more questions,

Should I be wearing the brace when I so my PT exercises, or do I need to do these braceless to build up strength?

Should I countine to wear the brace overnight until I am pain free?

Does wearing a brace hinder certain muscles from regaining strength due to limping from the injury for so long?

 

[AsWeCit]

These straight leg lifts are what my PT recommended initially 5 months ago. I did them, they felt like they worked to build up strength. As I continute to have re-injured the knee over the last 5 months, I go back to that step and begin with the exercises again. However, doing the straight leg lifts brings about irritation to the point where I didnt want to do them during the day (because I didnt want to wreck the rest of the day with alot of irritation), and at night was intimadated to do them (because I didnt want to wake up to alot of irriation). I have not done any leg strengthing exercises in 2 months do to this reason. I seem to have this idea stuck in my head that then best and least painful way to regain strength in the leg is to just spend 10 minutes walking on a straight, flat, path focusing on nothing but walking correctly. I know I have to do more, I am asking for any recommendations / ideas because at this point I feel like have tried everything.

Can you recommend some other strengthing execises / routines? The 2 exercises recommended by the PT were ...

-the straight leg lift
-clam shell leg lift (lay on side, knees bend, lift open up top leg) to strengthen hip flexors

Again, as much as id love to, (and hear how much swim/bike is good rehap), those 2 exercises are the reason I keep reinjuring the knee when it feels decent enough to push it to the next level of recovery, if even just minimally (I biked for 30 seconds, then jogged underwater for 10 seconds, crazy pain, havent felt that painfree since before that day 3 weeks ago.

I agree with the valid point made about not trying to push it until you can go 2 weeks without knee pain. This is my current goal at hand. I am playing this head game throughout each day about when to / when not to wear the brace. My main thought here is it feels like when my knee is irritated the brace should be worn, but when irriation isnt that bad I dont want to wear the brace because...

1. Isnt wearing the brace limiting normal muscle use in the leg in favor of stablility and support?

2. I sometimes feel the brace can stimulate irration if worn for a long period of time when not needed?

Is there any logic in these ideas?

Should I begin to wear a Patella tendon strap all day instead of the full support knee brace?

My leg feels best while resting with the leg extended out (while wearing the brace). I remove the brace when sitting with the knee bent (it is incredible uncomfortable and resistant when wearing the brace in this position. I also sleep with brace on and legs extended. This usually results in waking up with the leg feeling great, then slowly degressing as the day goes on.

 

[SociallyChallenged]

I cannot give you any real answer because I haven't evaluated you. I can't tell you what will help and what won't because I honestly can't. Braces help some stay out of pain. They don't help others. You are asking specific questions for you with a pathology that I haven't assessed. While I do sympathize that you PT may not be easy for you to attend, even just an evaluation session will be enough for a PT to answer these questions for you and get you on your way. I apologize for not being able to help more, but you must understand that the answers to your question depends greatly on what the problem is.

 

[Instan00dles]

Best thing I found for me when my knees bothered me was squats. I never lifted heavy, think I got to about 3/4 body weight (135 lbs) at my highest and it helped stabilize my knee when running. Its just really important to do the squats properly, progress slowly and concentrate on proper form then constantly increasing the weight and reps. Now I run pretty much pain free except for the bone spur I have under my knee cap.

 

[Chrono]

It's crazy... but I'm 32 myself and I weigh 200lbs. I lift 3x a week heavy weights and I also play bball about 4-5 times a week. Out of the 4-5 times of bball it's about 2-3 days of full court basketball for 3 hours at a time. I also ride my mountain bike/road bike about 1x a week...

I used to have runners knee often... but what really helped was stretching + squats. I currently squat 405lbs. I think if strengthened the quads your knee will probably get strongly and have better support as well. Of course, go lightly... and slowly work your way up.

 

[AsWeCit]

Today was the first day I was able to stand still with no pain in the knee, which is a great step forward fromt the past 3 weeks! I standing alot (6+ hours) during work (which has made this recovery so difficult). The problem is, my other knee is all worn out from standing with the majority of my weight for the last 3 weeks So I need to begin to even everything out.

I took a good look at my legs as a whole for the first time and my quad of the injuryed knee is significantly smaller then my other leg (which is bulging with muscle for carrying the weight for the last 7 months. It's crazy. Now that the pain is reducing, and not it is just popping and shifting of the knee cap, I need to begin to strengthen the weak leg.

 

[AsWeCit]

Update:

And now, as of yesterday, I am once again 2 steps back. After feeling stronger, and the confidence to go braceless, I made it 2 days before the knee became tweaked (a crack or pop in the knee) from light walking. I had 2 good days of doing my PT exercises and night, woke up feeling good, then within 2 hours of being awake had the knee crack/pop while walking, and knew I was no longer making progress. I now wear the full brace at all times. I have come to realize that the most difficult part of walking is when turning corners. This is when the knee feels at its weakest. I feel that my next step once the knee feels better, and I downgrade from wearing the full brace (I still feel that wearing this only helps when in extreme pain and support, as well as when I sleep), to wearing a stabalizing knee sleeve. I want to continue to wear the sleeve brace during the day (avoiding the large stabalizer brace) to allow my whole leg to gain its muscle back / avoid even a slight limp, but I am worried about another reinjury.

Here is a question I have. No matter which brace I am wearing, whenever I am sitting down and the knee is bent, it is always uncomfortable to wear the brace (I always slide it down my leg). Is this common?

 

[hans007]

Jumpers knee straps. Lot better than braces for me . I've been playing ball for 20 years and thought I was done 4 years ago until I got those. Really stops soreness. That and lose weight.

That's what I did anyway

 

[AsWeCit]

Thanks for the advice on the Jumpers knee straps. This is crazy but I just moved to Culver City from MN. Can you recommend a good place to buy the knee straps you spoke of in the area? Or was online the best way to go?

 

[hans007]

Thanks for the advice on the Jumpers knee straps. This is crazy but I just moved to Culver City from MN. Can you recommend a good place to buy the knee straps you spoke of in the area? Or was online the best way to go?

they sell them at like big 5 sporting goods for like $10.

they do work really well. http://www.yelp.com/biz/big-5-sporting-goods-santa-monica

is probably the nearest one, maybe they'd have them at like target / walmart or other sports stores too. now that you live in culver city (crazy coincidence) you can maybe get your knees together and play on one of the billion IM basketball teams on the west side.

could just buy them online. http://www.amazon.com/McDavid-414R-J...rs+knee+straps

i have these, but theres a ton of different brands.


oh also, i guess as a basketball player, one thing you want to learn how to do is drive left and dribble left handed if you are say right handed. mix up your game. even out which direction you go to the basket and it wont put as much strain on either of them. that initial first step and the jump etc on say a layup will kill your knee. it will save your knees (well if you are a guard type). also dont play outdoors as much, find somewhere with indoor courts. i'm willing to bet if you are right handed, your left knee is the one killing you.

 

[AsWeCit]

I picked up one of those jumper straps that you recommended. It worked ok, I think it will be something I wear when I can actually run again (still struggling to walk consistantly). My main issue now is my knee buckling when it goes from a bent position to a straight position. The number of times I go from bent to straight in a given day determines the amount of irratation and pain in the knee.

Had any experience with this in your knee injury?

Thanks,

Stephen

 

[OILFIELDTRASH]

Might be time to seek a professionals opinion. Im all for trying to rehabilitate yourself as I've done it successfully a number of times being a basketball junky myself. I've had knee, ankles, hip, spleen,etc.. all give me trouble at certain points and have rehabbed myself back from some major injuries. After 9 months though and you still can't bend your knees sounds like you should get it checked out as something is majorly wrong in there.

 

[AsWeCit]

I was saw a specialist twice, once in Feb and Once in May. In May they took an MRI and told me the same thing as Feb, Chondromalacia Patella. The recommended rest, icing, and PT exercise. I spend the last 4 months doing different versions of all of these, with different braces that wouldn’t aggravate the kneecap. I am now at the point where I can keep the pain from being extreme by avoided the amount of times I bend the knee throughout the day. I do this because the bending causes the knee to buckle 3-4 times. I believe this is why when I hopped on a bike for 30 seconds to try that rehab exercise I was in extreme pain for the next 3 weeks. It all comes down to controlling the buckling.

I currently wear the Cho Pat double strap whole walking to hold my kneecap in place; I also have started wearing PK tape in a Patellar Tendonitis formation. Too early to tell if it has make a difference. I was told it is all about raising the kneecap and allowing the irritation to settle. After 9 months with this, I just can’t make that happen.

Any thoughts / advice?

Thanks

 

[SociallyChallenged]

A full, customized PT evaluation and treatment plan is what you need. Nobody else can really suggest much else that will help. Your options are conservative management, where PT is the most effective for this, or surgery, which is a total knee replacement. The pain is still present and I doubt you want surgery. It may be time to try to make PT work. Find a trusted physical therapist in the area and make it happen. Some PT offices will work with you when it comes to payment. You can't afford to live with your knee like this - you may as well see if you can afford PT somehow.

 

[episodic]

Not to start a political argument, but this is what sucks about the US medical system. In every other '1st world' country - you could have a doctor's appointment for the taxes paid. Here you have to pay the same excessive taxes AND somehow manage to pay for health insurance which rises in cost faster than most people's pay checks (or they keep the cost the same, covering less).

I'm with ya, I need an arthoscopy myself - but I'm just letting it ride as all I can afford is high deductable insurance.