Accepting and Managing Chronic Knee Pain

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I'll start with a history:

At 13 (2000) I was goofing around before practice for Basketball and a friend hit me in the front of the left knee with a 50lb back pack. My leg snapped back and I face planted. Shortly after, being a sports kid, I got back up and hobbled my butt down to the gym. There I explained to my coach I was in pain and they encouraged me to run through it. I did but not without trouble. At the end of practice I informed my parents, they didn't take it seriously, every day after I complained about the pain and got no response. I was encouraged to continue pushing through it, so I did. 

Three months later I broke my ankle on my right leg during a game that injury healed fine but the added pressure to the left knee did not improve the condition. Finally a year later I was taken into the surgeons, after some awfully painful pre-tests he agreed to go in and do arthroscopy even though the MRI showed nothing. When he went in he found that my miniscus was partially peeled off and that I had dime size dents in my bone. 

The arthroscopy went as well as could be expected I kept up my mobility and was non-weight bearing for 2 weeks, however at that point I was pushed by my mother to remove the crutches against the doctors 1 month oders and start walking, so I did. The leg managed to heal up enough to gift me 4 years of playing softball during highschool. 

During my senior year the knee again gave out. At this point I stopped doing sports but continued a strong excercise regimen including running, stretching, and a generally active lifestyle. 

About 3 years ago after running my knee became swollen and remarkably painful, so I empoyed the usual rigamarole of Rest, Ice, Compression, and Elevation, however after a week with no relief I went to my doctor. They suggested that I see a new surgeon. I followed through and saw the first surgeon who got MRI's and X-rays of the joint. He then informed me that nothing was wrong with my leg it was all in my head. Knowing that wasn't true I found a new surgeon, he said the same thing. I pushed and went to a third surgeon he came in five minutes after seeing my MRI and said "Well you obviously have that defect that you already knew about..." Turns out all three doctors had used the same MRI and only one located the bone spur in my knee. 

The doctor then followed up with physical therapy, Euflexxa shots, Cortizone Shots, and weight loss as due to the now year and a half of constant pain I had gained about 35 lbs. By this point I was getting sick 1-4 times a day due to pain. I passed out several times at work because I couldnt keep enough nutrition in my system. I was going home at night and laying on my couch in the dark, skipping functions I enjoy generally the pain was winning to no end. None of these helped in the least so he finally went in and did arthroscopy. He found that I had a chunk of my cartilage floating around, another piece missing, and the bone spur, he did what he could to fix it, that was September 3, 2013. 

I followed through with Physical therapy, supplements, joint and healing enhancing diets, alas in September of 2014 I had to concede that the surgery was not a success.

I went back to surgeon #3 to discuss further options and was informed that he had no further options but would get me a MRI, Brace, and a new doctor who specialize in cartilage issues for younger patients. When I went to see that doctor his assistant informed me that I had Hoffa's syndrom and even showed it to me. When the surgeon came in he told me nothing was wrong with my leg and that I needed to "rethink" how I felt about my injured leg and represcribed physical therapy and that I was to take zero pain relievers. 

I did as he told me to knowing that the psychological aspect can make a huge difference, however after 12 weeks I had not had one withdrawal from pain medicine, my very expensive physical therapy had gotten me no where but helping me lose 25lbs to throwing up several times daily, and put onto anxiety medications as the pain was spurring on rolling anxiety attacks.

At the end of the twelve weeks I decided I was done with doctors for the time being so I tried a holistic home approach. I began taking Tumeric, Ginger, Strawberries, Peppermin, Glucosamine & Chondroitin, and Green Tea every day and supplementing it with a healthy dose of St. John's Wort. The swelling improved very slightly but not enough to lower the pain, I managed to rebuild a decent amount of muscle but not without a cost to the rest of my body and mental sanity.

Last week my primary doctor requested I see one more surgeon, begrudgingly I have agreed to try again. I know and have accepted I may never get to play sports again or go to a show and be able to hang out standing with my friends all night without at the least paying for it the next day, but I can't find a way to even manage the pain and I am getting to my wits end about it. I'm a fighter so I definitely won't stop trying, but I don't know how to go about accepting and managing chronic knee pain to get back living my life. I spent the last two nights up way too late getting sick or having so much pain I couldn't relax to sleep, which I know starts a cycle that makes pain worse. In the last few years I have been on meds for my stomach, the pain, sleep, anxiety, and also gone through stints as long as 4 months with none hoping my body would fix itself if I gave it the chance.

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  • Posted

    Questions:

    How is your range of motion- entension and flexion?

    How is your walking gait? Does it feel normal?

    Do you have any muscle imbalances- strong or weak?

    Some side effects of meds are pain- go figure. Check into

    what you are taking as they can cause more pain the next day.

     

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    • Posted

      My leg can hyper extend about 10 degrees so currently i have a brace that has assistance to assure that i can no longer hyper extend when i walk i have had it about 6 months. My flexion is that without weight i can with little to no increased pain bend my knee until my foot reaches my butt, with weight the oain increases at about 90 degrees (where my last arthroscopic site was).

      my walking gait pre surgery was awful however since regaining walking ability i have focused on maintaining a healthy balanced walking gait which i manage to keep up with great difficulty and focus about 75% of the time.

      And i totally agree on the pain medicatuons. I as a habit suffer through about 4 days a month by removing myself from the meds to assure that my body and mind show no withdrawals from the medication and about once rvery 6 months i go two weeks. Also from november 13 through january 13 i took nothing at the recommendation from a doctor to assure that the pain medicine was helping my pain not decreasing it.

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    • Posted

      Sorry i was attempting to address all of your questions there is definitely a muscle inbalance my right leg is considerably stronger than the left injured leg. However i can comfortably say that i have doubled the muscle on that leg in the past three months by shear stubborness!
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    • Posted

      So range of motion is o.k.

      My concern with the muscles is that you went through surgery

      and pain trama so I was interested in your muscle balance- but only on the good leg. I have a medial vs. outer quad imbalance that is pure hell

      because the outer quad takes over, as well as the hamstrings. This causes tightness where it should not be. My vmo side shuts down and my knee kills me in different spots- pain moves around to familiar spots. Last MRI was very good.

      Do you workout with weights? Have you test your strength on the one leg with various machine weights? If you have any issues you WILL find them. If a muscle is not firing properly, you will know it because your good side will tell you 100% what  movement feels like. 

      Does your pain ever move around? Are you sure your muscles on the previously injured side are working in sync? When I start feeling my vmo fire, which is still rare, my knee pain improves 90-100%. Everything starts to "work." My alignment is miraculously improved. No more foot turned out, etc. Physios are not so good unfortunately. My main focus for now on is inner quad vmo exercise via the leg extention machine. Anything else will recruit other muscles too much hampering my progress and re-inforcing muscle issues.

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    • Posted

      I havent done a lot with any qeights above 12 lbs on the bad leg due to the doctors recommendations but i can definitely look into the good leg. And i will have to look up what your talking about there to better understand vmbut it definitely makes sense if things arent firing like theyre suppose to it would pull the joint off place. And yes my oain does tend to shift, i usually have a chisel like feeling in the center of the knee and the other oain can shift a lot.
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    • Posted

      When I first started PT I was put into a general "strengthening" program. He barely checked anything. After 7 weeks I was now on crutches for 4 days and quit because the next session would have been wheelchair time. I then got my second MRI in April which was flawless. (First showed a grade 2 mcl sprain which was not true and a minimal low grade chondromalacia- second mri showed nothing and honestly my cartilage feels fine in isolation).

      Before I quit the first PT, I was dong isolation work with ankle weights at most. My vmo (inner quad near knee) was all but gone. I did some leg presses at his office, and afterward my legs were shaking so bad it was unreal. In other words, they were gone and trying to refire.

      I'm shocked you are only doing 12 lbs. max- that is nothing when walking requires your most of your bodyweight for one leg plus impact forces! I started leg extensions at 10lbs for my bad leg- in all honesty it hurt so bad it I could barely do them- I used my other leg to start and did short arc range of motion. There were a few days I could not do them at all and left the gym. This was the only way to hit my inner quad because of the imbalance that started because of the knee pain- I had to favor my outer quad. Last week I hit 170 lbs. with both legs- 3.5 months later! I can do 80 lbs on the bag leg now- maybe more and the pain is minimal if any now for the last three sessions. I overdid some other exercises the other day and I am paying for it but hopefully tomorrow or Saturday I can get back to the vmo/inner quad only work.

      That fact that you are only doing 12 lbs. is stunning and telling. If indead te knee is o.k. is has to be taking a beating from your weakness and imbalance. Your muscles are suppose to take all the pressure off the knee joint- when my muscle fires it is night and day.

      It is NOT easy, but you have build strength. You are young for friggen sakes so you should be able to do it. It will hurt but it is your only way out. Just do not do anything that hurts too much- you will likely know the difference. It is one step forward, .99 steps back, sometimes worse. Most physios have their heads buried in their book training and do not really understand how to rehab an injury because in many cases the muscles do not respond to normal protocol.  

      Oh, do me a favor and let me know what happens. When sitting with leg extended in front of you, contract your lower quads on your good leg. Take notes, and then contract your lower quads (near knee) on the bad leg. Let me know what you find. 

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    • Posted

      Thank you! I appreciate the advice very much, trying to find any specific and helpful advice and knowledge can be a nightmare. I was speaking with someone today trying to find a new good PT. Im not afraid of pain if its helping i just cant seem to figure out what helps and what hurts. I just completed a 5th visit with a chiropractor who is breaking up scar tissue using a new method its a mix between gua sha and graston and today was the first day i noticed a decrease in swelling In a very long time. I will most definitely be printing out your response to take with me to the surgeons monday and any physical therapist i meet.

      Also i did the excercise you told me. I certainly have a more defined muscle on the good leg, but i do not have any different of a shape from one leg to the other. The muscles seem balanced the same.

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    • Posted

      I try to help when I can. So when you contract your vmo on either side you see it bulge before or inline with the other quad muscles? That is something I am struggling with but making some progress. My outer quad and hamstrings like to contract first. That is not good for walking as they will tighten up, and shut off the vmo.

      Just so you know, most PT's will shun leg extension exercises saying they are bad for your knees. Well, I used to max out the machine at 250 lbs. before injury and I had no problem with it. You just have to progress slowly and know your limits and range of motion. I had no choice as this was the only exercise I could do to target my inner quad, which is half the stabilizer for the knee- huge in my opinion. My other muscles took over on all the other exercises. Even leg lifts were useless- my hip flexors did the job after a few reps.

      Anyway, have the PT check your strength and flexibility from hip to ankle. The includes your glutes- medius, min and max, quads including vmo, hip flexors, ankle, etc. Check your one legged squat- this is a big one too for strength and alignment. That will expose you. Of course I do not know the exact problem with you knee or muscles so this is just a template to check things out. I passed my last PT consult in November but I think maybe he missed the imbalance in my quads. They like to treat symptoms vs. finding the cause, which can be difficult sometimes. But they do teach the younger, under 45ish crowd to "forget the quads" which is a joke imo. Sure the hips and ankles are important, and I did need some glute work, but that only helped me marginally. I do believe it stopped my knee from cracking. My first two PT's thought that was arthritis or chondromalacia- ya right! These guys only know how to treat acl repairs and the like.They will miss stuff, but you have to learn from that yourself. Ask A LOT of questions!

      Glad to see you are making progress on your scar tissue. I did not not know you could have such excellent range of motion with scar tissue but I am not an expert on that. 

       

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    • Posted

      I saw new surgeon today, I believe my PCP threatened his life if he was mean to me, because he was one of the nicest most respectful orthopedic surgeons I have met in a while. He was unable to recieve my MRI and is awaiting it, he formally diagnosed me with "chondromalacia of patellofemoral join" and severe scar tissue buildup. The doc was also very surprised that I have the range of motion I have with the excessive amount of scar tissue he can feel. He feels that my recovery has gone as well as it could with that amount of scar tissue, but he would like to have me work with a PT to increase weight and activities as the scar tissue is removed by the process I'm currently using to assure that I regain muscle correctly.
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    • Posted

      I am guessing the scar would be removed by increasing the PT if I read that correctly? It sounds like he is passing you off to the PT, maybe he is correct but I hope you find a outstanding PT. I believe I have a mild low grade chondeomalacia in my other knee. Started from a knee injury playing basketball were some idiot kid plowed into the side of my knee while I was trying to make a steal. It sent me flying and disconnected my bicep femor tendon. It rubs on inclines and gets sore. Before I got my latest injury, I worked out for five years before and never had any issues since then. Now I have some again but that is expected when you cannot walk properly anymore. My ortho says he has no cartilage in his patella and keeps it going fine with exercise- he is early 70s. 

      My issue is trying to fix my alignment. I am hoping my 2 orthos I saw are correct in that strengthening my inner quad will fix this. It is 100x worse than the knee pain with the "low grade chondromalacia." 

      I am curious to see what your MRI will say about your situation. I hope it is not too bad. But I agree you need to build your muscles in your leg and become religious about it. 

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    • Posted

      I agree, I showed him the excercises I had previously been cleared for, they are done 4 times a day and I will be excited to get new ones and some new guidance. This doctor has asked to see me every 6 weeks until I am able to resume my old life or something close to it. He is also working with me to find some great financing options so that I can attend PT 3-5 days a week instead of once, I work two jobs and even with that 15$ a pop gets so expensive that affording food becomes an impossibility. I don't know if this will fix it but adding more muscle in a responsible manner is never a bad idea, I am doing my best to be positive and gung ho about the process, I'm not afraid of work, but I definitely need responsible direction. I will definitely keep checking in as I get information and progress. We did talk a lot about the damage and pain that this much scar tissue can cause and it made me feel much more validated and hopeful that this doctor means to stick with me until I'm healed which is a remarkable feeling in and of itself. 

      Since my mobility is actually perfectly fine they will be continuing with 2-3 sessions a week of the graston/gua sha scar tissue removal and massage (massage is a kind word). His hope is that as that procedure removes scar tissue I can work with my PT to build up muscle safely and properly. I appreciate that he is actually adressing the scar tissue, the fat pad, and the pain. 

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    • Posted

      In my opinion 3-5 days per week is excessive. You will likely need 48 hours between specific exercises to rest and recover. As you make progress you will likely need more time in between to recover as weight increases and you build muscle. You should be able to make progress quickly but then again I am not in your shoes and do not know how you feel. I would kill to have my alignment and entension as I think I would near 100% if that is the case. I would have to guess mine is outer quad dominance as they seem to contract along with my inner hamstrings as I stand straight. Of course you cannot contract your glutes and quad if you cannot stand in full extension so it is a difficult thing to resolve. I do not feel weak so much as messed up walking/standing. If by my next appt. if does not resolve I will have to holler for some other test/imaging to see why I am twisted inward with my femur.

      Anyway, target those muscles that need work. Some of them you can hit hard in iso work if it does not hurt the knee. 1-2 times per week for PT should be enough as you can do most on your own in between sessions, or join a gym! Keep us posted.

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