Feel like diagnosing knee pain over the net?

[Tom]

Here's the deal: left hip hurts like hell for years. No real diagnosis except for one doc telling me the gap between ball and socket is getting less than it used to be. These days it isn't hurting hardly at all.

Now my left knee hurts a lot. A zzzziiinnnnggg zing zing zing type pain, kind of feels like a bone bruise flavor of pain, top of the tibia where the tendon comes down from the kneecap. No acute onset, just sort of arises over time. It doesn't like it when I sit with weight on my hamstring or I push on my IT band. It gets better if I stretch, but ironically I'm the most limber I've been in years. It doesn't totally get relief if I straighten my leg out. Sitting with my leg bent 90 degrees and pressing down can make it happen, but some times not, though. I don't think it is related to the weather. Two Advil doesn't even touch it. It is not sensitive to the touch anywhere and testing for 'runner's knee' is totally painless, and it doesn't spur it to hurt more. Knee is not discolored or swollen anywhere.

It seems to be getting worse with time, but slowly. It started up about three months ago.

I guess I'm gonna go see the doc, what should I be asking them and what should I make sure they ask me?

[Viper]

Patella tendonitis
Chondromalacia
Plica Syndrome
Old age (LOL).

These are terms to do homework on etc atmo.

Since reverse psychology is most effective on the internet...do not stretch your quad while lying prone on the floor, do not sit on the floor and do hamstring stretches, do not find a staircase to do calf stretches, do not go out an buy Arnica Montana gel, do not rub that gel around the patella, do not rub your patella tendon deeply, do not rub it east/west (across like a guitar), do not ice the knee for 20 minutes three times a day, do not elevate the knee, do not take Ibuprofen, do not take a little time off the bike and do not take that time to focus on TKE (terminal knee extension), do not do quad sets, do not focus on the VMO muscle, do not see a real massage therapist for the leg, do not run out an buy Hyaluronic Acid (in pill form) do not take it every day and certainly, do not listen to me. :D

Edit: And pain is not a sign that something is wrong and do not think that because there is not visible swelling, that there isn't any inflamation. atmo.

[David Kirk]

I have advice despite not being a real doctor. I do play one on TV but I don't feel that counts.

Two things.........first it sounds like you have a strength and/or flexibility difference between your quad and your hamstring. Second is that I'd recommending trying to find a good sports chiropractor. We have a very good one here that can diagnose things like this and put you on a course of stretching and exercise that will make it go away. I speak from experience here.

Is there a real doctor in the house?

Dave

[Viper]

Is there a real doctor in the house?

Dave

I have a Jedi Knight Degree in knees. Darth Vader calls me, I let it go into voicemail. :D

[Dave]

Go to an orthopedic surgeon specializing in knees. The doc will ask the appropriate questions (like where does it hurt), move your knee around and poke a bit to get an idea of the problem, take an X-ray, then prescribe an MRI, often done at another location. Without the MRI, they won't be able to tell what's going on. While you're there, you may as well get the hip looked at too.

I've had three orthrascopic surgeries for torn meniscus. My knee joints still have good joint space, but the doc says I have have almost no cartilage under my kneecaps. So far I've had no pain that I can relate to that problem, but I've been warned to expect it. I'm trying to pedal wisely, using lower gears and more cadence, although that's always been my style - never have been a masher.

My experience with knee pain relative to saddle position seems to be the opposite of most people, perhaps because I spin and don't mash. I've never had pain develop and persist, just because my saddle was a few millimeters higher, lower or further forward or back. I've experimented with fore/aft positions over a 3cm range and probably 1-2cm in height over the years.

[93legendti]

Here's the deal: ...It seems to be getting worse with time, but slowly. It started up about three months ago.

I guess I'm gonna go see the doc, what should I be asking them and what should I make sure they ask me?

If it was me, I'd also check to make sure my cleat(s), seat and/or seatpost had not changed position and the bb/cranks and pedals still felt smooth. This could be as simple as a minute change in position or something in the pedal/crank interface that was putting extra strain on your left leg and/or knee.

[Fixed]

bro has anything changed over the last 6 months on the bike ?
cheers

[PaulE]

It may be that your IT band needs to be stretched. I am having good luck with a physiatrist and physical therapy. Somehow I've developed a knot in my left glute about the size of a golf ball and my hip was hurting like hell when I walked any distance.

[Ginger]

Orthopedic surgeon is going to look at you, order an MRI (you haven't damaged it, they might find inflammation...maybe that bone bruise you think you have) and send you to a physical therapist with a script that says basically: diagnose and treat 3/4 times a week 4 weeks.
PT will do some stuff to reduce the inflammation (heat/ice, maybe ultrasound etc.) and get your stretching and weight working to balance out all your muscles.


Or, you could start taking fish oil and have yourself tested by a good PT (or doc like Dave says) or whoever and get on with your strength and stretching exercises and see if that helps without the MRI.



Oh...On the hip pain: Do some self traction for your lower back and see if that doesn't help the hip pain. I had all sorts of problems with my legs and hips and the pain evidently was actually from the nerves getting compressed in my back.

(and check that your cleat hasn't moved...Are you riding outdoors or indoors?)

[thwart]

Orthopedic surgeon is going to look at you, order an MRI (you haven't damaged it, they might find inflammation...maybe that bone bruise you think you have) and send you to a physical therapist with a script that says basically: diagnose and treat 3/4 times a week 4 weeks. Probably true a good part of the time, sadly. That's why they have "surgeon" in their name... If you need surgery for your knee---Great! They can help you! If it's a "soft tissue", or overuse/inflammation problem, then they're not nearly as excited or helpful about things. There are exceptions here, of course. There are orthopedic surgeons that are great with soft tissue issues.

A sports medicine doc (or chiropractor) will offer you much more help, in all likelihood. A PT is another good option.

Sometimes asking your FP doc or internist for a referral to one of these specialists (if they haven't been able to figure things out so far) is a good idea. One of the realities of being a generalist doc is that they can't figure out every problem---but without hearing from you that things aren't improving, they can't point you in the right direction.

You're more likely to get help there than here on the Forum, in spite of good intentions.

[manet]

Two things.........first it sounds like you have a strength and/or flexibility difference between your quad and your hamstring. Second is that I'd recommending trying to find a good sports chiropractor. We have a very good one here that can diagnose things like this and put you on a course of stretching and exercise that will make it go away. I speak from experience here.


Dave

psoas muscle

[Viper]

psoas muscle

In western Tennessee that means, "Sore arse muscle." atmo.

[David Kirk]

psoas muscle

major or minor?

Dave

[markie]

Sounds like it might be Chondromalacia as the first reply suggested. Normally Advil/ibuprofen works for that, though....

Hmmm, if I were you I would read this:

http://www.cptips.com/knee.htm

Again, as others point out have you made any changes recently?

[manet]

major or minor?

Dave

do not let karin stick her thumb in there when she's pissed at you, for say having eaten the last cookie, or standing in front of the fridge in your 2 day old pull-ups slugging down the last of the organic 2%.

[David Kirk]

do not let karin stick her thumb in there when she's pissed at you, for say having eaten the last cookie, or standing in front of the fridge in your 2 day old pull-ups slugging down the last of the organic 2%.

Way too late.

Dave

[Viper]

major or minor?

Dave

I do lunges with dumbells for the sore arse muscle, in TN they call it major loin and eat it atmo:

"Based on the anatomy and physiology of a cow, this muscle is the tenderloin, and tends not to be called upon to do a lot of work, thus it remains underdeveloped, resulting in a cut of meat that is known as the most tender. It forms the basis for several succulent dishes, including chateaubriand, filet mignon and Beef Wellington."


http://en.wikipedia.org/wiki/Psoas_major_muscle

[sailorboy]

unless you want surgery at some point. sort of tongue in cheek, but the old saying goes (among us PTs) that there are two types of people in an orthopods waiting room, those who have been operated on, and those who will be. Translated this means, and with no offense, that they are not experts in movement or kinesiology, they are surgeons who fix problems that can't be fixed any other way. And, depending on how ethical they are, if you go to them enough times complaining of the same issue, they will be more likely to do something invasive such as injections or surgery when you may not need it, or worse yet, be made worse by it.

Go to a board-certified sports or ortho PT, or as Dave said sports chiro (my PT brethren would shudder at that recommendation, but sometimes that's all you have, and sometimes they are actually good at this stuff)

I don't want to get into diagnosing on the net, but basically if you are not swelling intermittently, or there is no clicking, locking or catching in your joint, or your knee doesn't feel unstable, then an MRI won't likely tell you much. At least not until some other conservative measures have been attempted and failed. Save the money on all that other stuff and put your fate in the hands of a qualified PT. And PS, if you're not icing that hurt, whatever it is, after your activites; YOU'RE WRONG!! :D

[sailorboy]

just read the part where you've alredy had some surgery and are lacking cartilage under your kneecap...this is called chondromalacia and can be graded in severity--I think from I to IV--if you have III or IV, then you are in the population that has been found to benefit from long-term use of glucosamine/chondroitin preparations. Found to be as effective as non-steroidals in folks with advanced degenerative changes, and it is non-prescription, get it anywhere basically. You gotta take it for 3-4 weeks though before you will notice much, and keep taknig it.

Try to get it from Balco labs, they might have a little of the cream or clear mixed in :banana:

[Hardlyrob]

if you have III or IV, then you are in the population that has been found to benefit from long-term use of glucosamine/chondroitin preparations. Found to be as effective as non-steroidals in folks with advanced degenerative changes, and it is non-prescription, get it anywhere basically. You gotta take it for 3-4 weeks though before you will notice much, and keep taking it.


Yes Yes Yes!!

I had a bad cartilage tear in my right knee and most of the medial meniscus was taken out, but only after about a year and a half of walking around on a traumatized knee. The result is severe osteoarthritis, and as my knee doc says - it's not a matter of IF we replace all or part of the knee, it's just a matter of WHEN.

Glucosamin / Chondroitin allows me to be basically pain free with a knee that crunches so much the PT's were really uncomfortable working with me. I've found that the brand does make a difference and had very good luck with Cosamin DS - buy it at Costco, it's cheaper than anywhere else.

YMMV

Rob

[TimD]

Mmmm, is Bill Frist reading this board?

[Tom]

Mmmm, is Bill Frist reading this board?

Yeah, he sent me a PM saying he could tell I was sentient. That's when my suspicion he was a quack was completely confirmed.

[Viper]

Tom, I'd just like to offer one more thought; the person who will make their knee better or allow it to get worse is...you. I've had five knee operations, I really effed up my knees. I was in the gym last night, steam room, stretching, dumbell lunges, hamstring curls, calf raises, bike/treadmill, popped a few hyaluronic acid pills and rubbed the knee down with some Arnica Montana gel.

So, what have you done for your knee today? It's 9:59am, do you know where your knee is? :D

[Ginger]

Tom, I'd just like to offer one more thought; the person who will make their knee better or allow it to get worse is...you.

So, what have you done for your knee today? It's 9:59am, do you know where your knee is? :D


Yep Yep. The thing you learn after several surgeries and time in PT is that it's not a one time shot and riding a bike will not be all it takes to make it better and KEEP it better.

Constant maintenance work really is required.

Better to figure out the maintenance before you get a surgery because perhaps that all you really need.

(And I didn't mean to say that an orthopod sending you for an MRI and PT was a bad thing...I'd rather they didn't find anything to make money on...)

[BumbleBeeDave]

A few thoughs based on my personal experience . . .

Based on your description I'd guess it's not Chondromalacia. I've had that for many years in both knees and it's a very distinct--and often audible--grinding when you bend the knee. If you can't feel any grinding when you do some dumbbell squats or go up stairs carrying something, then that's probably not your problem. Mine also gets obvious if I sit in a cramped space--like a theater seat--for a long period of time. It's like the kneecap comes out of the track the patella is in and there's a very distinct feeling when it goes back into the track.

Also, I agree with others about Glucosamine/Chondroitin. My doc referred me to a JAMA article about five years ago that summarized research and gave a final recommendation saying there was a clear, though variable benefit and it was better to take it than not. Can't hurt, most likely helps . . . doc said that was good enough for him, given the generally conservative nature of JAMA recommendations and the heavy peer review of all their articles. So I take it every day.

My gut reaction to your description is tendonitis of some sort. I had it in my elbow from lifting last winter. One particular tendon--the "funny bone" tendon--really hurt and the pain was aggravated whenever I did arm curls, etc. But then I laid off the weights all summer while riding, it went away, and has not recurred this winter.

I know from your other post you're concerned about winter weight gain, but is simply resting for a few weeks an option at all? Heating pad, advil, and just rest?

BBD

[marcus]

Tom,
There is no substitute for a thorough knee exam. You just can't do it yourself. Sometimes it can be hard to find someone that really knows how but that's what you need to do. When done properly, the knee pain can be reproduced most of the time, and if certain tissues are cleared as being the culprit, this tells you a lot as well. Another thing to consider is that the hip can refer pain into the knee. This is not so reliably reproduced on exam. If a thorough exam by a competent provider is entirely negative, then, given your history of hip problems, referred pain from the hip at least has to be considered. Good luck and let us know what shakes out.
Best regards,
Marcus

[Alan]

You have gotten excellent advice from fellow forumites. You may want to ck out Andy Pruitt's book about cycling sports medicine. You can ck it out at:

http://www.amazon.com/exec/obidos/ASIN/1931382808/bookstorenow600-20

His book is excellent once you know your situation. I have used it many times.

Alan