Please not the other knee as well!!!!

[Pinkie]

Just as I thought I was doing really well (nearly 5 months post TPF), I was working with my personal trainer last night and felt a sudden pain in my good knee. When I got home it had swollen up a bit and is pretty sore today. The pain is right in the middle of my knee, sort of under the kneecap. I'm really hoping this is just stress on my good knee from overuse but just wondered if anyone had experience a similar thing? I had just managed to ditch my crutch for the first time this week and am now back to hobbling on one (even contemplated using 2 crutches this morning). Does anyone have any suggestions? SHould I battle through it and keep working on the exercises (that have been doing such a good job in the last couple of weeks), or should I just rest? I'm contempating going to see my GP in case I've done something serious but don't want to be melodramatic. Any opinions would be greatly appreciated - am feeling massively annoyed now as this has happened just as I was starting to make some progress....

Sarha

[eslteach]

Ouch...that's been one of my concerns too...the stressing of the "good" knee while waiting for the TPF one to heal.
I bought a pull up brace for the good knee to give it support.
Do the basics...ice & elevate...see the doc if the swelling/pain continues.
Let us know how things are going.
Ali

[maryc]

Sarah - I agree with Ali - go back to the basics with the "good" knee - rest, ice and elevate. continue to do the basic quad exercises for your "bad" leg. If it's not better in a day or 2 I would call my OS, not my GP. I would also browse through the general rehab and soft tissue sections here and see if I could pick up some more information.
Sending healing rays your way.

[step]

My good knee had also started to hurt while I was recovering from a patella fracture on the other knee. In my case it had been indeed inflammation caused by excess stress, but manly because of the bad posture I had acquired. The hips were twisted with the side of the good knee pushed ahead. This posture favoured more pressure on the good knee especially while exercising (squats, for example). The twisted hip gives the good leg a slight turn-in, while the feet are parallel - so the knee will compensate, twisting to allow this. Therefore, the good knee not only gets most of the pressure, but also gets it at a wrong angle (upon the slightly twisted knee), which can lead to injury.

So in addition to the good advice in the previous posts, my advice - in case this is not already taken care of - is to carefully watch the posture during all exercises. Legs, hips, ribs, shoulders, all have to be in perfect symmetry - and during squats, knees have to advance at the same time - and with equal distance.

I hope your good knee will be much better tomorrow,
Lennie

[Pinkie]

Thanks all for your advice. Lennie - it was actually when I was doing squats that this happened so sounds like you may have hit the nail on the head. I've been taking it easy for a couple of days and the swelling's gone down a bit. Seeing my physio tonight as well so I'll see what she says. Just so annoyed at the set back!!

Sarah

[heather_rae]

Sarah:

Same thing here! I did bump/bruise the good knee in the accident, too. It was O.K. for a long time and then all of the sudden, when trying to squat (I have to shift my weight to that side) to get some thing down low, the good knee made an out of this world ripping noise! It's hurt off/on ever since. I told the OS about it and he says I have chondromalacia. PT has been taping and icing it now, too. The exercises I do work both quads. Different kind of pain that the fractured one. Directly over the kneecap itself.

Interesting, I've recently started seeing a massage therapist (MT). I have torqued my hips and the muscles on the injured side are so tight that it's pulled the leg shorter than the good one now. It was such a problem previously that my foot was turning in when I walked. The Baps Board is a great exercise tool for that. I could see where you could injure the good knee in having an altered gait. The MT says I have a constant fight/flight state in my system thinking it still needs to protect this injury. The good leg has over-use "hot spots", too.

Guess one realizes what happens to the rest of you when you injure yourself. It seems to affect everything! I would tell your OS and PT about it anyway because the good knee now needs care, too.

Good Luck!

Heather

[step]

Sarah, glad it's getting better - good luck, and I hope the PT can help this evening.

Forgot something that might be important: the first weeks, the PT had forgotten to do with me a stretching routine after each session of strength exercises. I had started to develop shorter muscles on the bad leg, which again can cause injury, as the legs work 'differently'.

And the warm-up is always very important before exercising: lack of warm-up can also cause too much stress on ligaments and cause injury.

Heather, interesting you mention the 'shorter' leg, it might be quite a frequent posture problem: my good leg had also 'become shorter' through this rotation of the hips and 'pull' on muscles. I needed many months of massage and exercise to overcome the worst of it (my fracture was nearly two years ago). I've been doing Pilates in addition to the specific leg routine.

The pain directly on the patella might be from an inflammation of the patellar tendon: patellar tendinitis was one my biggest problems during recovery, and it also hurts mostly on top of the patella.

I wish you good recovery,
Lennie

[heather_rae]

Lennie and Sarah:

OMG!!! Patellar tendonitis is AWFUL! I've been plagued by it for months. PT pushing on the tendon will make you see stars! Jeans and any kind of bedcovers is intolerable. Lennie: How did you ever get yours resolved? PT treats mine with steroids fed into it by like an electric current- iontophoresis. It's a series of 12 treatments and I've just completed round 3. It comes back to haunt me in the same spot (right above the knee) after a while, though. Hope it's gone for good now.

PT has never instructed me to do warmups, so, what do you do? They've also always stretched the leg either before or after exercises. I've graduated to a step down program and will be working independently after having had one solid year of PT, now. So, your suggestions would be most helpful and appreciated. No wonder I feel like I need to stretch at the parallel bars between some of the exercises. The PT assists. just force me along, like they don't have the time to wait for me?!? I also stop sometimes to let the pain settle down, muscle cramps to stop, and massage the knee. My little girl challenges me to Pilates sometimes as it is part of her dance class warm ups. Can't quite get some of that stuff, yet. But I can't do a triple pirouette right now, either. My next goal is to master the Eliptical.

I hope I am doing the right thing in having massage therapy, as I am quite sore today. Have your ever heard of stripping the muscles to help them heal correctly? She also did some pushing technique that make the muscle scream and then as you breathe deeply, the muscle relaxes. Wierd!!

Lennie: I am VERY curious about your pain now. My OS said it takes about 2 years for it to settle down. He has recently referred me to a cartilage specialty OS. So, if the pain is most likely to get better over the next year, I may just sit and wait. Really wanting to avoid the scalpel, you know, AGAIN! Thanks a bunch!

Heather!

[step]

Heather,

Wow - triple pirouettes. I'm still trying to get the simple one correctly, am landing all over the place.

You have a great personal trainer in your little girl

Tendon-wise, I would try to stay away from surgery too. I learnt that most cases of patellar tendinitis heal without needing surgery. Good PT should do the trick. My tendon is fully healed now: I remember my PT said this condition should be treated without delay and then it can be healed in a few months. If it becomes chronic it takes longer to heal. The PT used to be very annoyed with me whenever I did something to make it worse, such as going up stairs carrying a heavy suitcase.

The treatment I got was:

1. To rest the knee. I did continue to work to build muscle, but no jumps, no squats, no weight-carrying, nothing that would make the knee hurt.

2. Tendon massage therapy (transverse friction massage) several sessions a week (30-45 minutes a session just for the patellar tendon). In addition to these sessions, I had to also do the massage at home every day - wasn't having the same effect as when the PT did it, but still helped.

3. An anti-inflammatory patch on the knee. The PT said the first choice was to use a Flector patch every night for two weeks (it contains Voltaren and should be placed over the knee). The second choice - as I tolerate medicines very badly - were traditional medicine patches: of all things fresh cow's cheese spread on the knee and covered with a tissue and then wrapped with an elasticated bandage. Cheese did wonders for me . The iontophoresis therapy you are getting is certainly a more powerful anti-inflammatory therapy. As you mention, the pain returns after a while, but through the treatment it should gradually decrease.

4. Continuing to strengthen the quads, as they protect the tendon.

What do do for warm-up: if the PT session is not too demanding, then a walk before the session, some rotation of joints and five minutes of 'dynamic stretching' before the session are OK. I also did several dozen leg slides to warm up the legs and knees. Often the PT starts the session gradually, and the initial exercises are lighter and represent the warm-up for the rest of the session. As for the stretches, there should be five minutes at the end - you can do them after you finish the session with the PT. And during the session, whenever you need to stretch, the PT can advise how to best do the movement to target the muscles that hurt. It's usually good to stretch after any set of exercises that are tensing muscles badly: helps avoid muscle pain later in the day.

For the exercises, what I learnt through this rehabilitation is to do the exercises that make me feel better afterwards and do not make me hurt . Not meaning one should not make any effort: sweating and making a muscle shake with effort is ok - but pain in joints, sharp pain in muscles, any kind of pain in tendons, during or after the session are not ok.

You mention massage therapy: it sounds your PT is trying to relax the trigger points in your muscles and that should help. Muscles with trigger points do not work properly, so they create pressure on tendons and other muscles. In addition, they generate 'reflected pain' in other parts of the body. It's important to check nearby muscles if they do not have trigger points too and equally relax them, as otherwise the tension will just be 'pushed' to the next muscle then return - that was my experience.

Sarah, I hope your knee is getting better. From what I read on this forum and from my own experience, I think it is almost impossible to have a steady recovery from a knee injury: it's almost impossible to foresee what of the mandatory strengthening exercises will end up hurting the knee and set us back. And the best way to protect the knee is to build the muscles, so at first there is always the risk to do too much and hurt the knee. Another thing I found important is to get the muscles to work in harmony, that is, have the correct posture and ask the PT's advice to constantly correct movements, otherwise not all muscles are re-built.

Me I'm still training - and the left leg is still thinner than the right one grrrrrr.
On the positive side, I am much more aware of the need to exercise the entire body, to have a correct posture, to care for my health.

Lennie

[heather_rae]

Lennie:

Wow! How did you ever manage to get a suitcase upstairs? I still have trouble getting myself up and down them. I absolutely know what you mean about carrying things. Carrying a gallon of milk will cause pain in the knee?!? I can't jump, run, squat, or kneel yet. Beginning to wonder if those activities will ever return. You're right about my daughter. Her ballet teacher mandates correct body allignment and form at all times. Something must be working correctly for her in the dance classes because her tiny frame has the strength of a football player. She is a great trainer! But she steals my therabands all the time!! And she reprimands me for not pointing my feet!!

About the PT, just about everything in my exercise log causes knee pain to some degree. I'll run down the list here from start to finish. If you wouldn't mind commenting, I'd appreciate it. I have to start with the harder exercises, otherwise the leg gets so fatigued/painful by the end, I could never finish. 1- leg press/calf raises. 2-leg curls 3-abductor machine 4-stairmaster 5-quad board 6-walkouts overhead and side/side with therabands 7-Bapsboard 8-treadmill, backwards and sideways 9-ball squeezes 10- At the parellel bars: TKE's, 4 way kicks using theraband on ankle and kicking with good leg, minisquat walking side/side, lunges, and heel touches off 2 inch board 11- short arc quads with 2 lb ankle weight. Then I have ice to both knees for 7 minutes and I am done. The knee pain after this usually comes on really hard about 4 hours later and I feel even stiffer than the knee already does the next day. I think the patellofemoral problem with the cartilage damage is what's preventing exercises from making me feel better. Since the PT is officially done in doing the passive stretching, I'll try some of it on my own. Before, during, and after.

I've been doing deep massages around the knee with the heel of my hand since the steristrips fell off after surgeries. Also the cross friction, as much as I can tolerate. I honestly believe it's more of a scar tissue problem as the OS says my knee is full of it. Wonder if scar tissue can make tendonitis a chronic problem? How does cow's cheese work for that? Interesting!

My OS has recently referred me to see another OS who specializes in cartilage repair and soft tissue trauma. I sustained a very large cartilage defect in the femoral grove. I am wanting to get this leg as strong as possible as quickly as I can. The problem now is that the knee pain stops me before the leg fatigue does. Very fearful of additional surgery, as I would be taking two steps back with progress. Thanks for the exercise tips!! Take Care!

Heather

[step]

Heather,

Your routine looks good and really balanced.

I have one question: are the leg-curls the ones for the VMO, done in a sitting position, or the ones for the hamstrings, done lying prone? The sitting leg-curls (for VMO) were an absolute no-no for me: PT said they are very hard on the patellar tendon. I was not allowed to use the stairmaster either - PT said it would not reproduce exactly the move on the stairs and it could hurt the knee (but I think this depends on the type of machine you have): it did give me knee pain. I had to exercise on actual stairs, going up and down, then going up and down two steps at a time.

The pain after any training session should go down gradually the next days - if not, there might be a specific exercise that your knee dislikes. There are small mistakes, for example, failing to lock the knee at the end of the quad arc, or moving the knee beyond the toes in mini-squats, that are most often to blame. Maybe it would help if you tried the routine leaving out weights for a week or two - after consulting with the PT - as this is likely to reduce the stress on the tendon. You are right to do the stretching on your own - it's very useful as it gives more flexibility to muscles, so less stress goes on the tendon.

Concerning the scar tissue, if the tendon gets tiny injuries through stress, these create scar tissue on the tendon itself. The friction massage (transverse to the tendon fibres, on small surfaces at a time, without rubbing the skin but sliding the skin over the tendon, should help the tendon get more blood and this should help a little against formation of scar tissue on the tendon).

Jumping, squatting, running and kneeling will come on their own as the knee heals and the leg strengthens. I had acquired the tendinitis precisely rushing with these: besides the suitcase-on-the-stairs thing, I tried to jog a bit on the treadmill (because I love running), then pushed too fast with the last degrees of ROM to be able to do the full squat. These happened within a month, and the knee said 'enough', with the patellar tendon flaring up.

The story with the suitcase - don't ask. Rushing to catch a connecting train. Brain started working post-factum (the uh-oh stage). As for carrying things: even opening a heavy door made my knee hurt

Ha, the cheese . I read it works as anti-inflammatory: but I guess little is known on why and how it works, just that they even use it in orthopedic wards here. Lots of knee injuries in the ski season, and there's lots of cheese around. I got addicted to it, always keep an 'emergency pack' in the fridge.

I'm inpressed by what you say about your daughter: she must be making her ballet routine correctly if she became so strong: so trust her advice . My PT said to me when I was hopelessly trying to keep my balance on the wobbly board, that she'd seen only one of her patients standing absolutely still on that board: a ballerina. So dancing must indeed strengthen the body but in a nice way: one does not see bulky muscles on ballerinas. And the pointed foot helps the foot and calf muscles . I think ballet is a good example of building strong muscles through gentle but precise routines - I think a similar approach will help your leg a lot, especially to avoid further injury.

Good luck with the recovery - and let me know how it goes,

Lennie

[heather_rae]

Lennie:
As you can see, I am vegging out and relaxing while on the computer today. Did a rather crazy thing yesterday involving rollercoasters and am truly PAYING for it today. Miss Ballerina slept 13 hours after that one. She will be starting her 9th year of dance next season and is now 12 yrs. old. Even as small and thin as she is, she has the typical heart shaped calves, rock hard biceps and quads. And the speed/endurance of a cheetah!!! She is also a sprinter in track. If all that hard work builds that much muscle and strength, I am definitely taking an adult ballet class when stronger. Haven't taken professional dance since childhood myself. We laugh about a movie we watched called "Game Plan" when the ballerina tells the football player " If football were any easier it would be called ballet." He is just dying and sweating bullets at the barre. Funny!!!

I have to do leg curls in both ways. Hamstrings at the curl machine and Short arc quads over something that looks like padded wooden bar which bends the knee to about 60 degrees and you have to pick up the lower leg. That one really hurts!!! I've backed off from that one the last few sessions. As far as pain, it is also there to some degree. Mild at rest and moderate with increasing intensity with activity. If I am sitting down, I immediately experience discomfort when I stand up. If I push it too hard, I am up all night with it.

As my tendon was disrupted in sustaining that nasty fracture and then opened with 2 surgeries after that, it's no wonder I have tendonitis. I suppose it would also be majorly stressed when exercising after having complete muscle shut down of the quads. Very tricky not to make it flare up again. I'm glad cheese helps you. Don't think I'd ever have the chance to use it. I buy cheese and my ballerina gobbles it up before anyone has a chance to get to it. Maybe it's the dairy products that make her strong!!!

The stairmaster that I use has many settings. It it set to keep the degree of flexion smaller and I can hang on for support. I can do about 3 min. now. It doesn't take much effort to push the step down at that level, either. I find it much more difficult using standard stairs. I have so many stairs in my house, I could never get away from them so, I get lots of practice there. Getting better at it. Thinking about asking PT to switch to the Elliptical, which I believe would be just as beneficial. He has forbidden me to use the bike in saying that would placed additional stress on the joint surface. He has also told me NO about trying to squat, kneel, or run for the same reason. How long did it take you to do them? Do you have pain? Also wondering if you had significant strength differences with your legs. THANKS!!!

Heather

[step]

Hi Heather,

I'm at work, but what are lunch breaks for ?

Sorry about the rollercoaster "hang-over": one needs the fun though, especially after so much focus on serious health matters. Quite brave of you to go on one of them

Nine years of ballet training - I admire your and your daughter's determination: this will help her for a lifetime. It means it was serious ballet routine if she already has strength and flexibility. And I agree with your daughter's assessment of cheese: too good to be used on knees

Your PT sounds competent and attentive. I think you were right not to do the exercises that made your knee hurt badly: those are likely to increase the inflammation, and your goal now is to stop that. Tendons heal slowly, and when new stress comes on them, the healing does not catch up with the injury. I was lucky not to need surgery as my fracture was aligned, even if the bones were apart, but still the tendon had been badly injured and took much longer to heal than the bone. And of course my leg looked like a matchstick once the bone was healed . Like you, I could not use the bicycle at all (did leg slides instead and found them sooo soothing), and was not allowed to do any impact exercise (no running, no jumping), nor squat, nor kneel. You can find a bit more about the patellar tendinitis on sports sites under "jumper's knee", which is a similar condition (I think it's tendinopathy, but the rehabilitation protocol is quite similar).

My patella fracture was in October 2006, and my injured leg is still weaker, more noticeable so on precision expercises (more difficult to get these right than the strength ones), but getting better. Last autumn, I did just what you plan to and enrolled in an adult ballet class (twice a week), and it helps me hugely, in addition to Pilates that I'm doing on my own mostly from DVDs, but I also go to physiotherapy once a while, to make sure I do the exercises correctly. I do not have regular pain any longer. It was quite hard to do the ballet routine at first, and my left leg was too weak to allow me to do many exercises, but it got much better in one year.

The pain and stiffness just faded away towards the end of last summer: one day I woke up and the knee was simply normal, after months and months of constant pain, and of needing to bend-stretch-bend-stretch... to remove stiffness every time I would be lying down more than five minutes. Also the knee stopped swelling when standing, which had been the rule many months after the fracture. Pain was on and off, but fading away too. I still keep an up-side-down box under my desk at work, so that I can hold my feet on it and keep my legs straight while sitting, otherwise the knee hurts after long hours sitting.

I remember from reading the Pilates history that he developed the exercises initially in order to help bed-ridden patients to re-build muscle. A similar routine for ballet dancers (floor barre) helps injured dancers not to lose too much muscle when confined to bed. So some of those ideas (leg raises lying prone, supine or on the side), etc., helped me a lot and were less stressful to the tendon. But you are right, with the quads not firing, the tendon would necessarily be stressed by any exercise.

Sarah,

Would you let us know if the knee is getting better: wishing you all the best.

I wish everyone a nice day,

Lennie

[heather_rae]

Lennie:

Fortunately, the rollercoasters really didn't bump/jar my legs around. With the help of friends/family, a wheelchair because the place is huge, my kneebrace, and a few pain pills, I had a GREAT time . It was a definite necessity as last summer was HORRIBLE!! The only thing that bothered me was obviously a little over-use because I did a fair amount of walking anyway and the steep incline from one coaster that's over 300 ft. tall it put alot of pressure of the knee. Still sore today. Alot is the right calf, it's swollen too. I had to ice down both knees, quite warm, too. Maybe the MT can help today.

So, did you damage your cartilage, too? Glad the tight/rigid/painful pressure sensations are better for you now. I'm unsure if mine will ever feel better. Luckily your patella fracture was only a couple of pieces. Mine was shattered like a glass on a tile floor. Fragments went flying all through the knee and was piece backed together like a puzzle. Amazing how breaking a bone that small will result in such a downward spiral of events.

I am seriously considering going to pain management. I can finally see a tiny bit of muscle trying to come back in the quads. No where near the strength/muscle mass/tone of the uninjured leg, but much, much better. I have been going to the beach and using a kickboard for swimming. It hurts, but I'm almost positive it's one of the best exercises because the leg is feeling stronger. The pain hits before the leg feels really fatigued with most exercises anyway. And, of course, water takes the stress of the joint. Water ballet would be a good option!! I think the quad board slides helped the balance and control more than anything. I can slam into the side of it when I push off with my good leg. Initially, I was only able to get half way across using the injured leg, but can almost get there now!!

Someone had mentioned to me a needling in/out technique used for chronic tendonitis. It stimulates the tendon to heal correctly. Interesting! Think I like the cheese idea better. As ballet is notoriously hard on the joints, I'm wondering if my little dancer can get the same results in eating all that yummy cheese. Her other areas of dance include: modern, lyrical, jazz, tap, and hiphop. She will soon be taking point ballet(toe) when we get the mandatory clearance from the pediatrician. She keeps me on my "toes". Ha-Ha! Thanks I'll check out the jumper's knee section.

I hope Sarah is getting along O.K. with her other knee. Seems like flareups ARE more common to happen with overuse. Have a great day!!!

Heather!!

[Pinkie]

Hi Lennie and Heather,

Sorry for the lack of reply. I'm been hectic at work this week and haven't had much time to sit and read through everyone's posts! My good knee's still bothering me a bit. It improved towards the end of last week but after my personal training session last night it's flared up again and today I can't decide which knee hurts more!! My trainer's convinced it's something to do with the angle of my foot/ankle (I'm a bit flat footed at the best of times) and has given me some simple exercises to do to try and stretch it out without overdoing it. It's just annoying that I'm not really able to do my exercises for the bad knee as much as I'd like to as I then end up putting too much pressure through the good knee. Argghhhh!!

Does anyone have any ideas for some exercises that will help with extension (I'm struggling to get past 10 degrees on the bad knee) but that doesn't put too much pressure on the other knee?

Heather - you brave girl going on the roller coasters! How good does it feel to feel the wind through your hair?! My parents live on a farm and I had a blast on my dad's quad bike on Saturday which was pretty tough on the knee but soooo much fun. My mum wasn't keen on the idea but it was definitely worth a few bumps!!

Hope you're both having good days. Keep in touch and take care. Love Sarah x