Accepting and Managing Chronic Knee Pain

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.

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!

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.

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.

Ive been doiphysical therapy for years and never had anything like that mentioned or checked .

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. 

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.

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. 

 

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.

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. 

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. 

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.