Question on Knee pain

[Gadge]

Greetings,
First time poster, long time.. yada yada. :)

Anyways, I was wondering if anyone could offer me a bit of help, or any suggestions. I have noticed in the last few weeks that on my left leg, right directly below the knee (The muscles and bone therein), feel like they are being pulled out whenever I do stuff that involves that leg; Horse stance, kicking, walking, sitting up, laying down.. you know.

Anyone have any suggestions on something I can do to try to make this pain go away, any exercise I can try? Please keep in mind, I am human... I have read those scary cyborg blogs on this board, like Sevens and stuff. o.O I swear, I would think he was the Terminator if it wasn't copyright infringement.
Reason I am asking: You guys tend to have answers for everything, and I a lot of what is posted in response to questions is really thorough and impressive, so I figured I could turn to you for medical help like so many others!

Down with hospitals, up with wise martial artists!! and freakish superhumans!!

[BoulderDawg]

I hesitate to give any kind of medical advice but it sounds like maybe you hyperextended just a bit and now it's a little inflamed.

Treatment? The pain will let you know. But I think it will get better in several weeks...less time if you're 20...more time if you're 50!:D

[cjurakpt]

Greetings,
First time poster, long time.. yada yada. :)

Anyways, I was wondering if anyone could offer me a bit of help, or any suggestions. I have noticed in the last few weeks that on my left leg, right directly below the knee (The muscles and bone therein), feel like they are being pulled out whenever I do stuff that involves that leg; Horse stance, kicking, walking, sitting up, laying down.. you know.

Anyone have any suggestions on something I can do to try to make this pain go away, any exercise I can try? Please keep in mind, I am human... I have read those scary cyborg blogs on this board, like Sevens and stuff. o.O I swear, I would think he was the Terminator if it wasn't copyright infringement.
Reason I am asking: You guys tend to have answers for everything, and I a lot of what is posted in response to questions is really thorough and impressive, so I figured I could turn to you for medical help like so many others!

Down with hospitals, up with wise martial artists!! and freakish superhumans!!

sigh...

don't waste your time getting advice on an internet forum from a bunch of laypeople and where no one can examine you directly in order to properly evaluate something that could be one of any number of musculoskeletal issues, from a simple local strain, to a periosteal tear to Osgood Schlachter's disease

go find a good orthopod / sports medicine guy to rule out any nasty stuff like osteomyelitis, and the have a qualified PT also take a look at you functionally; get it properly assessed and properly treated and for crying out load never assume that it will just "go away" - that's a great way to ignore it until it becomes a chronic problem...

[Fuzzly]

How bad is the pain?

I would still get it checked out if the pain does not go away in a couple days. You have pain for a reason.


Also, talk about knee pain, 3 weeks ago I tore one of the ligaments <sp?> in my knee in a freak training accident. My shoe stuck on the mat as I was being took down, and my body twisted, but the bottom half of my leg didn't.

*SNAAAAP*

Terrible pain in my knee/leg. I take of my headgear and just lay on the mat for awhile. When my Sifu and kung fu brother try to help me walk... No dice. Knee won't take any weight. I go to the hospital that night, and from what they gave me an X-ray and some percocets (Wow, those things knocked me on my arse, and I am a pretty big guy!).

Thanks to the Percocets I was pretty much doped up for 3 days. After that I was getting around (just a little bit, like around the house) with crutches. After I took the trip back to school, I was on two crutches for a couple days, then down to one.

I've been pushing myself pretty hard, excercizing as my legs as much as I can stand, and, on the advice of my Sifu, really pushing the un-hurt leg.

For the past week and a half I've been walking without crutches at all. I can't handle any impact on it greater than walking, and I have a serious problem when I try to straighten my leg out, it seems like the leg wants to hyperextend and nothing is stopping it from doing so.

Anyways, I finally got the MRI a couple days ago (Really busy at school, seriously swamped.) and I have an appointment this week to get the results.

My training has greatly suffered. Other than doing the SNT (Or SLT, I get those mixed up so bad, heh) I haven't trained or been to class. (Car was taken away because of injury, supposedly I can't drive.)

Today I tried to do some light grappling with the on-campus MA club. Short story- it wasn't a good idea.

Where was I going with this? Oh yeah, be careful with your body man, you only get one.

[Gadge]

Well, I think mostly I was looking for things that can build the knee up without killing it in the process. I went to a hospital once, I will die before that EVER happens again. So, I guess I live with the pain. :p

Yeah, btw, I think I phrased that way wrong. I think I was looking for suggestions on things to work around the pain, something like that. I, of course, wouldn't take medicine or do anything like that; however people who have experienced knee pain, or right below the knee pain, might have a bit of insight as to what caused theirs.

[BoulderDawg]

Oh yeah by all means go to the doctor if you feel you need too. However, as displayed in the above post, if you tear something you usually know it.

Reading between the lines of your post I got the idea that your pain was not that severe. Hell I have sore joints all the time and I can tell if something is seriously wrong.

[Shaolinlueb]

i'm no doctor. that stretch where you put the leg behind you and you grab with the opposite hand helps stretch all that out in there. heat it also if its inflammed or soemthing.

i had bad knee pain so i trained my stances. horse, lots of cat stance and just trained. it was hard at first, soemtimes when i got up from cat stance i would collapse cause my knees were so bad, and they would give out. i took soem glucosamean (sp?) too at the timein the begining. now i have less kneee problems. still get pain every once and a while cause i've been slacking. but they pretty much went away.

all in all, go see a doctor ;)

best thing to do is go easy, heat it and relax a bit cause doing stuff wont help heal it.

[cjurakpt]

I hesitate to give any kind of medical advice

yet somehow you manage to get over your inhibitions pretty quickly, so here we go...


Ibut it sounds like maybe you hyperextended just a bit and now it's a little inflamed.

really? what makes you think a hyperextension injury would present with pain in that location? what do hyperextended "just a bit" and "a little" inflammed mean? if it's a hyperextension injury, what was the mechanism - open or closed chain? if it's inflammed, is it acute, subacute of chronic?[/QUOTE]


ITreatment? The pain will let you know.

huh? good lord - if you knew anything about pain, you'd know that it can be one of the most unreliable indicators regarding the nature of a musculoskeletal issue, and as far as it guiding treatment, that's even more innacurate; how about letting a proper assessment and diagnosis guide the treatment...


IBut I think it will get better in several weeks...

really? wow, that's impressive that you can give such a specific time frame:rolleyes: BTW, why exactly do you think that? psychic friends network? magic 8-ball? look bro - do yourself and others a favor - stick to what you know, don't play doctor - and I wold extend that to everyone on this forum; and if you are a health care professional, only post about generalities, do not ever give any advice to a person specifically about their situation, because there's no way you can do it validly and reliably (you can read ever post I've ever written and in no case do I ever tell a person exactly what happened to them, exactly what to do to make it better and I certainly never have said anything about prognosis - it's hard enough when the person is in your office!)



Iless time if you're 20...more time if you're 50!:D

I dot even agree with that, but never mind...


the above post serves as a perfect example of someone with subjective anecdotal experience extrapolating innapropriately to a situation about which they have no information and know nothing about; only an idiot would listen to the above "advice"; I have been doing adult orthopedics for over 11 years, and i would NEVER hazzard a guess as to what was going on with someone specifically based on the information gieven in the first post; even with follow up questions I wouldn't be able to tell for sure, for the simple reason that I NEVER SAW THE PERSON - people can report whatever they want (often innaccurately - taking a good subjective history means rewording questions several ways and teasing out details constantly), but w/out an objective exame you've got nothing

caveat emptor

[BoulderDawg]

Well I think it's much better than the advice you have given which the poster has already said that he would not do.:D

Perhaps you would like to pay for his treatment?

[cjurakpt]

Well, I think mostly I was looking for things that can build the knee up without killing it in the process. I went to a hospital once, I will die before that EVER happens again. So, I guess I live with the pain. :p

just because you had a bad experience in a hospital once shouldn't inhibit you from having it looked at; besides, don't go to a hospital - look around and get a reference for a qualified professional near you and go to their private office; as far as not taking medicine, well, look - some anti-inflammatories may be all you need to resolve this; on the other hand, maybe not - if it's not too complex, there's a good chance that some good hands-on treatment could resolve the issue satisfactorially



Yeah, btw, I think I phrased that way wrong. I think I was looking for suggestions on things to work around the pain, something like that. I, of course, wouldn't take medicine or do anything like that; however people who have experienced knee pain, or right below the knee pain, might have a bit of insight as to what caused theirs.

speaking very generally, it's possible there was some strain of the quad tendon, unless there was direct trauma to that area; you could also have some bursitis - it's really hard to say specifically - as for resolution, if it ain't better in a week, thats often a sign of something that's unresolving - again, it depends on the initially mechanism of the injury coupled with your intrinsic physiology

[cjurakpt]

Well I think it's much better than the advice you have given which the poster has already said that he would not do.:D

that's because you are completely clueless in this regard and should really refrain from further discussion on the subject (just a suggestion, do what you like of course, it's a free internet, etc. etc. and everyone has the right to talk out of their asz)
BTW, i never told him to do what he didn't want to do, which was a) go to a hospital - why would he do that for something like this? b) take medicine - it's one option, but not mandatory; in the final analysis, whether he wants have someone look at it or not is his choice - but even if he doesn't want to, it doesn't invalidate the quality of the suggestion - and while it's unfortunate he had a bad experience once, it's his choice whether he will let that interfere with seeking proper treatment this time around - (maybe don't go back to the same place / guy? - see above)


Perhaps you would like to pay for his treatment?

what does that have to do with it? or did I stumble into a meeting of the international brotherhood of non sequitors? look, if you want good treatment, you pay; if you don't want any treatment, you don't pay - at least not at first; but later on when the thing you ignored becomes chronic and starts creating problems elsewhere, then you can pay for all of it then...

BTW, it was really awesome how you managed to answer all my questions regarding how you knew so much about what happened to him and what the prognosis was...

[franco1688]

I would say definitly get it checked out to make sure you don't have any tears. But, in the mean time I'd take some ibuprofin, ice the knee at night and wear a spandex knee brace, at least. Try to avoid movements that jar your legs. I'm no doctor but, god knows, I have had my share of injuries. As I said in the beginning, definitly get it checked out before it gets worse. It's better to take some time off to heal than it is to push yourself further and suffer a more serious, possibly career ending (as far as martial arts are concerned) injury. Your knees and your back are two areas you don't want to mess around with. If you injure them seriously enough there's no going back.

[cjurakpt]

I would say definitly get it checked out to make sure you don't have any tears. But, in the mean time I'd take some ibuprofin, ice the knee at night and wear a spandex knee brace, at least. Try to avoid movements that jar your legs. I'm no doctor but, god knows, I have had my share of injuries. As I said in the beginning, definitly get it checked out before it gets worse. It's better to take some time off to heal than it is to push yourself further and suffer a more serious, possibly career ending (as far as martial arts are concerned) injury. Your knees and your back are two areas you don't want to mess around with. If you injure them seriously enough there's no going back.

the bolded out part is the BEST "advice" I've read coming from a layperson who references his own issues but doesn't overgeneralize them to someone else

one thing though - ibuprofin, wonder drug that it is, isn't for everyone, especially if they have a history of gastrointestinal issues - it may need to be taken in a modified manner, or could be contraindicated

oh and the whole ice versus heat thing: typically ice is for acute, heat for chronic; however, some people do like icing into chronic phase (as opposed to heat in acute phase - that just increases inflammation);

[Fuzzly]

Here's a quick compilation of what I see to be the main facts.

1) Take some anti-inflamitories.

2) If your knee is not better in a week, get it checked out.

3) Take it a little easy for awhile.

4) Don't give any advice unless you happen to be an expert, or cjurakpt will be very, very upset. =)

[BoulderDawg]

that's because you are completely clueless in this regard and should really refrain from further discussion on the subject (just a suggestion, do what you like of course, it's a free internet, etc. etc. and everyone has the right to talk out of their asz)
BTW, i never told him to do what he didn't want to do, which was a) go to a hospital - why would he do that for something like this? b) take medicine - it's one option, but not mandatory; in the final analysis, whether he wants have someone look at it or not is his choice - but even if he doesn't want to, it doesn't invalidate the quality of the suggestion - and while it's unfortunate he had a bad experience once, it's his choice whether he will let that interfere with seeking proper treatment this time around - (maybe don't go back to the same place / guy? - see above)



what does that have to do with it? or did I stumble into a meeting of the international brotherhood of non sequitors? look, if you want good treatment, you pay; if you don't want any treatment, you don't pay - at least not at first; but later on when the thing you ignored becomes chronic and starts creating problems elsewhere, then you can pay for all of it then...

BTW, it was really awesome how you managed to answer all my questions regarding how you knew so much about what happened to him and what the prognosis was...

It is a free internet and everyone has the right to voice their opinions. As far as to whether of not it upsets you.......I could really care less. So here goes again:

Since you didn't refer to one episode where you knew something happened I still say you hyperflexed it in training. It sounds like it's inflamed and should get better in several weeks. If not you might have more serious problems.

There! I'm sure the guy who's playing doctor here is just foaming at the mouth. Tell you what Doctor: There's an area that's about a foot and a half north of my knee that I get pains in every now and then. You can kiss it and make it better if you like!:D :D :D

[SevenHands]

Knee problems suck. I have had minor knee pains for the past year which has hindered my training. The pain began shortly after I started running for cardio. Too much too fast and I ended up with intermittent pain underneath my kneecap. I figured I'd work through the injury, letting pain dictate the cutoff point. So every time I would start upping the KungFu intensity to get back into shape, the knee would start reminding me to lay off. After about a year of this, the pain was still there so I figured I'd go see the doctor (GP). A quick check and X-Ray revealled nothing wrong with the bones or allignment and a diagnosis of chondromalacia patellae, or otherwise known as "Runner's Knee" but there's a possibility it's a torn meniscus. Now I'm waiting to see a specialist (about 2 month waiting period). But 2 months is a long time to wait so....

I've done some research myself on the subject of runner's knee and have figured out that the cause of the injury and chronic pain could be related to muscle imbalance between the inner and outer parts of the quadricep muscle. Could this be related to stance training? Or improperly doing a certain movement. Probably from running though, because that's when the pain showed up.

Instead of waiting idly by for 2 months to see the specialist, I put together a rehab program of stretching and strengthening exercises to increase the strength of the possibly weak part of the quad (inner part) and will see if that helps. Hopefully I'll be able to go to the specialist in a couple of months and get the green light on knee health. I would rather not go the route of arthroscopy or other intrusive procedures to correct this problem.

Now, I just have to go talk to my Sifu about what kind of KungFu training that is lower impact on the knees that I can do until this knee problem gets worked out.

So my advice to a person with a knee problem, other than just minor aches from overuse, is to go see a specialist as soon as possible and don't do anything high impact on it until it's better, then gradually up the intensity. You don't want to do more damage than what has already been done.

[waterleopard]

Yup, they suck alright. I'm 16 weeks post-op from an ACL reconstruction (patellar graft). BTW, good luck Fuzzler, I hope that snapping sound you heard wasn't yours. Glad to see you had the MRI done...

I continued to train for two months after tearing mine, before I went under the knife. It can be done as long as you don't twist and do things that put lateral strain on the knee. Straight-ahead stuff, like running, is okay.

I also tore my medial meniscus, and that gave me more pain than the torn ACL. The torn ACL just provided stability problems.

I'm glad I had it repaired, but I don't want to have to experience this again, that's for sure.

[cjurakpt]

It is a free internet and everyone has the right to voice their opinions.

hey man, never said you didn't have the right to voice your opinion: by all means, go ahead; I will likewise express mine: yours is lousy



As far as to whether of not it upsets you.......I could really care less.

obviously - hence your continued arm chair diagnosis / prognosis; actually, not that you care, of course, but it actually doesn't upset me at all, because it has no impact on my life in any way - however, because I know enough to know that what you advise is ill informed, I'm giving the guy you are giving it to a different perspective so that he can make an informed decision



So here goes again: Since you didn't refer to one episode where you knew something happened I still say you hyperflexed it in training.

gee Doogie, that's really interesting, because in your original post you said:



it sounds like maybe you hyperextended just a bit and now it's a little inflamed (emphasis mine).

:confused: uh, ok, so, which is it? I mean, dude, you can't even get your basic concept of the mechanism of injury straight, and you want people to take you seriously? I know, I know, hyperFLEXION, hyperEXTENSION: whatever...it's all good...


It sounds like it's inflamed

that's because, if there's an injury, it is...derrrr



and should get better in several weeks.

again, why should it necessarilly get better? you still have no idea what happened to it - until you know the etiology and have a diagnosis, you don't know what it's supposed to do (even then, it can be unpredictable, which, if you ever worked with a real patient, you would know)



If not you might have more serious problems.

might have more serious problems? wow, what a definitive analysis!

oh, and yeah, really good - advise him to wait and see for several WEEKS if it's something that requires treatment or not - by then it will be sooo much easier to manage when it's become a chronic inflammatory process with accompanying connective tissue changes...



I'm sure the guy who's playing doctor here is just foaming at the mouth. Tell you what Doctor: There's an area that's about a foot and a half north of my knee that I get pains in every now and then. You can kiss it and make it better if you like!:D :D :D

it's a funny thing, this internet tactic of, when someone disagrees with you concertedly, based on an informed perspective, and you really have no basis to refute them, you then try to paint them as some sort of raving maniac who is sputtering and coughing as he writes his lunatic rants...so odd...so sad...

BTW, I'm not a doctor; I'm a physical therapist - the former I don't play at because it's not what I do; the latter i don't play at because it IS what I do, and have been doing for about 12 years; so, obviously I have absolutely no knowledge in this area, for certain, far less then you have in your vast experience...:rolleyes:

i also find it amusing that, if anyone is "playing" doctor it's you, since you make your assessment, recommendations and predictions without any valid basis to do so - but I guess it kills time in between episodes of "Scrubs" and "ER"...

oh, and as far as you getting pain in the aforementioned region "every now and again", I'd suggest having your partner apply some KY on the strap-on prior to insertion...:eek: :eek: :eek:

[cjurakpt]

Knee problems suck etc.

nice post - very appropriate advice, IMHO

as far as your take on your particular issue, it seems that you have identified what you believe to be weakness of the vastus medialus oblique, which is that little bulge of muscle on the superior/medial aspect of the patella; there has been a great deal of focus on this muscle over the years, as it is thought that imbalance between it and the vastus lateralus creates improper tracking of the patella during knee flexion/extension leading to symptoms; hence the whole approach of training the VMO specifically in conjunction with taping the patella so that it doesn't track laterally;

just bear in mind that, like anything, while it works great for some people, it doesn't work for other people at all - which can mean that there is possibly another issue going one, either locally (e.g. - meniscal tear) or ****her away (e.g. - ankle / hip dysfunction); unfortunately, the knee is the "whipping boy" of the lower extremity, so you can get pain there for a whole bunch of different reasons (hence my contention with B-Dawg's insistance that he knows why the other guy has knee pain);

anyway, absolutely noting wrong with trying to rehab it your self, as long as you do so intelligently; what you may want to consider is, if it doesn't work, what your time frame is before you determine it's not effective and seek other options; also, maybe speak to someone about optimal window of intensity: enough to get an effect but not enough to flair it up - this can be tricky if you have done that before...

good luck

[BruceSteveRoy]

i can tell you what i did that helped a lot when i was dealing with knee pain (who am i kidding? i always have knee pain) 600-800 mg ibuprofen to reduce swelling and inflamation every 4-6 hours. it dosnt do much for you if you only take it once or twice a day. you have to take it regularly. also ace bandage company makes a blue on the outside black on the inside knee brace. it helps trap the heat from your body and keeps the knee warm while you are using it which helps circulation. when you get home and are done using it ice it (the knee, not the bandage, that would be just silly). but not for more than 20-30 minutes at a time. and i would be remiss if i didn't say no alcohol while taking ibuprofen because it can cause your stomach to bleed (not to mention alcohol slows healing anyway, unless you are disinfecting a wound) and for whatever reaon my sifu always says no red meat, no lamb, no deer and little or no dairy. until its better. he says those things slow the healing time. hope it helps.

[waterleopard]

Boy, I can't say enough about physical therapists. Seriously. I had my last PT session last Wednesday at the 16th week post-op date for my ACLR. I basically went twice/week until the last three weeks when I went once/week.

I could replicate a lot of the exercises at home, but one of the primary reasons I continued my PT was to know what I shouldn't be doing - even though it was physically possible to do it. For examples: running (not until week 13 or 14, and then lightly); full open-chain leg extensions (on a machine) - still not allowed to go to zero degrees, only 90-45 degrees. (Don't confuse that with me not being able to do normal full extension and flexion. No problem there.)

Again, PT was an education in itself. So was the OS. After I tore my ACL, it took me about a week or 1.5 weeks to realize something was seriously wrong. I would do roundhouse kicks into a focus pad. And when I landed my foot on the ground, I just kept going - the knee would give out. A few of those got me to the OS.

cjurakpt - what type of grafts do you commonly see these days? I opted for the patellar graft as that seems to be the "gold standard." I thought about the allograft, but I couldn't handle it..... didn't even consider the hamstring graft.

[cjurakpt]

cjurakpt - what type of grafts do you commonly see these days? I opted for the patellar graft as that seems to be the "gold standard." I thought about the allograft, but I couldn't handle it..... didn't even consider the hamstring graft.

actually, I don't see any - I stopped doing adult ortho about a year ago to focus fully on pediatrics - actually, even with the adult pop it was mostly complex cases with stuff that they couldn't get fixed elsewhere - (ACL rehab is pretty straight forward, about as "cook book" as you can get, not too much creative thinking there - I guess that I find it much more interesting to work with kids with cognitive deficits and sensory procesing disorders than with adult athletes);

sorry, but if I talk to any colleagues in that area I'll ask them what they see

[cjurakpt]

4) Don't give any advice unless you happen to be an expert, or cjurakpt will be very, very upset. =)

ha! I missed that one...

actually, let me reiterate: even an "expert" shouldn't give specific advice on an internet forum, for the one simple reason that they have not taken a proper history, have not examined that person directly, and haven't treated them, so have no idea how they will respond; personally, I speak in generalities about similar types of things I have seen in the past, but I always tell the person to go get it loooked at directly by a qualified professional...

[Chief Fox]

Disclaimer: I'm not a doctor and everyone that told you to go see a doctor is right.

I have had a lot of injuries and knee pain so I can tell you about some of things that happened to me and what I did to take care of it. I've also seen a few orthopedic docs and have been to physical therapy for few different things.

Does this make me qualified to give you advice? Sure! :D

Most times when I have nagging have knee pain, it's because of an imbalance of strength and flexibility. When it comes to knees, stretch and strengthen is the best way to not get injured.

I've had a similar issure to what you have. I had pain right below my knee cap. Not underneath but right below at the top of the shin. I did a bunch of research on the web and went to see an orthopedic doc. I described everything that was wrong and told him that I did some research. He asked "so what do you think you have?". I said "petellar tendonitis". He said "you're absolutely right".

So how do you get petellar tendonitis? I got it from having tight quads. Tendons aren't really supposed to stretch all that much. Stretching is for muscles. But when muscles are tight, they put A LOT of pressure on tendons and sometimes cause tendonitis.

So the best thing to do is stretch your legs until you're pain free and then start strengthening.

The best stretch for my quads goes like this.

To stretch your left quad, lay on the side of your bed face down with your left leg on the bed and your right foot on the floor. Now move that right foot as far up as it will go on the floor. Now reach back and grab your left foot, (If your quad is really tight you may need some help with this) now pull that foot towards your butt. The goal is to get your right foot as far forward as possible and be able to touch your heal to your butt.

I did this every night and morning for several weeks.

I also did some minor resistance training like wall sits. Stand about 18 inches away from the wall. Rest your back against the wall and slide down like you're sitting in a chair and hold that position. Do sets of 30 seconds or so.

Other things I did.

ICE is your friend. When your knee hurts, put ice on it.

I got a knee strap. http://www.footsmart.com/P-Cho-Pat-Dual-Action-Knee-Strap-20032.aspx

The strap takes the pressure off of the tendon.

I haven't had any knee pain in a while because I do what I consider to be the best exercise in the world for your legs and knees. SQUATS! And when I say squats I mean A$$ to GRASS, but down as far as it can go squats. Not leg press, not extensions or curls but SQUATS! You can do them with or with out weight. Start without. Once your knee is feeling better, get to the gym and learn how to do proper squats and keep doing them. In my opinion, the best exercise for your legs ever!

Well there you have it.

Just remember Stretch and Strengthen.

Oh, and go see a doctor. :D

Good luck.