Knee Pain Help Please

[flamboastin]

Hey guys. I'm new to the forums, and made this account specifically to ask some of you to help me diagnose my knee pain. Any help is appreciated. Thank you.

1. When did the pain begin?
2 months ago

2. What were you doing at the time? Or did the pain come on gradually over time?
It started to hurt the day after 2 consecutive running days. The running days were after about 3-4 months of almost no running at all (I was doing only gymnastics).

3. Where, anatomically, is the pain?
Left knee. It hurts below the kneecap. If you look at your knee, the pain is somewhere between 12:00 and 3:00 position.

4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
It started out as sharp pain, but now it's become only a dull pain.

5. Is the pain constant, or intermittent, or only on certain motions?
It used to hurt to walk up and down stairs. Even a little when I walked.
Now, it only hurts if I bend my knee a lot. For example, one-leg squats or going up ~2ft high steps. I can climb stairs w/ no pain now. Basically, I'm getting more pain-free range of motion.

6. What motions make your pain worse?
Running and one legged squats (it hurts AFTER the work out, not during). However, w/ proper warm up, I feel fine running. Then after the workout there is the dull pain.

7. What, if anything, makes your pain better?
Now, nothing helps much. But I did the following to help go from sharp pain to dull pain: foam/tennis ball rolling on my calves, inner thigh, outter thigh, glutes; intense stretching; applied heat.

8. Does your pain radiate to any other part of your body?
No

9. What things could you do before, that you cannot do now because of your injury?
Nothing.

10. What is your main concern regarding the pain and its consequences?
What else can I do to help get rid of this annoying pain?

11. Have you ever injured that part of your body before? If so, how?
No, but I did sprain my left ankle 6 months ago (same side as the knee).

12. Is your pain getting worse over time? And if so, how much worse over what time period?
No

[flamboastin]

Some more info:
It hurts when I jump.
2 months ago, when it was sharp pain, it hurt below the knee from 9:00-3:00 positions.

[flamboastin]

And any suggestions as to what I can do to help prevent this type of injury from occuring again in the future?

[Mon]

Have you seen a physical therapist and have you had it checked out by a doctor yet?

[flamboastin]

Yes. I went to the doctor about a week after I got injured. He diagnosed it as patellofemoral pain syndrome. However, it was a half-ass diagnosis, based solely on what I told him. He didn't examine anything like my posture or my gait. That's why I'm having my doubts.

[UConnJulie]

It sounds like a patellar tendonitis or maybe a fat-pad irritation. Keep foam rolling and add in some quad stretching (get your heel all the way to your butt). I'd also add in some gluteal activation as many knee problems are gluteal in disguise ... and I'm sure the ankle played into it as well.

How's your single leg balance?

[flamboastin]

Thank you for replying. I'm definitely taking your advice gluteal activation. I'm flexing my butt with every step I take.
The balance on my left leg is noticeably worse than the balance on my right leg. Also, when I land from a jump, my left leg is worse at absorbing the shock. I'm currently working on both of these problems in my workouts.
Just out of curiosity, how is my butt connected to my knee pain?

Plus another important question: Is it okay if I still run? It doesn't hurt to run as long as I warm up, but the pain does come back later. (In fact, I noticed that as long as my knee is warm, and blood flow is good, there is no pain).

[flamboastin]

More information:
I don't know if this helps, but ~4 yrs ago I did scrape my knee pretty badly the same place it's hurting me today. There's a fat ugly scar there now; the skin looks more wrinkly. I don't know if an external injury like this so long ago could have an effect on my recovery of an internal injury like patellar tendinitis or PFPS.

[UConnJulie]

The hip bone's connected to the thigh bone ...

Seriously, the ankle is responsible for the way that the entire kinetic chain interacts with the ground. The hip muscles are responsible for slowing the rate of pronation in the entire lower leg ... they deccelerate internal rotation and flexion and adduction. So if the muscles in the hip are not firing properly, there will be added stress to the knee and ankle.

If your ankle is not interacting with the ground appropriately, then that will cause further stress further up the chain too ... it all works together (which is a big reason why body part splits are not the best way to workout).

I would avoid running for now as you are putting a lot of stress on the healing tissue when running. Better to walk or bike ... and focus on the workouts with a big emphasis on single leg exercises, ankle mobility, and gluteal activation. Also stretching the quads. And ice it when it gets sore/achy.

[flamboastin]

Alright alright gotcha. thanks so much =)
I have one more quick question regarding mobility exercises. From what I've been reading on this site and others, I understand that mobility exercises consist of full-range-of-motion movement of muscles. Is this the same as dynamic stretching?

[UConnJulie]

Sometimes ... depends upon the joint and the movement ...

[Lisa~]

If you're willing to pay for it, Mike Robertson's Bulletproof Knees covers all of this material in detail. It's a great book and I think it's just what you need.

[flamboastin]

Hey guys, it's been a while now. First of all thank you guys for your replies, the knee pain i described earlier is virtually gone now. I'm going to play it safe and continue to swim and stay off it for a little longer.

However, I discovered a "new" pain on the inside of the knee. It's the same knee. When I roll the "teardrop" muscle area with a tennis ball, if I dig deep beneath the muscle about a few inches above the knee, I can feel pain on the inside of the knee. (By inside I mean the right side of my left knee). I could be wrong, but I think I might rolling the medial collateral ligament. Is that a bad thing?
Any suggestions? It feels pretty tight up the whole inner thigh, so I'm starting to stretch it a lot. Thanks in advance.

[UConnJulie]

The MCL is just along the medial joint surface, and is usually easily palpated without having to dig deep into any muscle. You might have found a plica.

You'll know to stop rolling it if it gets irritated and feels worse!

[flamboastin]

Well, I just googled "plica," and you're probably right. They say that plica syndrome and patellar tendinitis are easily confused. Perhaps I have plica syndrome. It's symptoms match all the ones I have had.
What are the chances that I will need to get surgery for plica syndrome?
Anyway, I'll continue to do what I've been doing and hope for the best.

[flamboastin]

Assuming it is plica syndrome, is there anything else I can be doing besides foam rolling, strengthening, and stretching?
Also, should I stay away from leg adductions (ex. breaststroke kicks)?

[UConnJulie]

Plica are normal ... they only need surgery if they are really large (from frequent irritation and subsequent scarring) and/or get inflammed. Which may be your case, I have no way of knowing over the internet!

Avoid things like running, biking, etc and anything else which irritates it as you need to get the inflammation down. Usually it is not straight leg movements (ie hip adduction) but rather movements which bend and straighten the knee. Swimming should be fine ... if the breaststroke kick irritates it then stick with flutter kicking. Stretching is good. Still work on gluteal activation and ankle mobility. I would foam roll the quads but avoid the possible plica area, stick to the mid-muscle belly and the ITB. If you want to do some strengthening, this is a situation where straight leg raises in all four directions is appropriate.

Ice it several times per day. A good way to do this is to use an ice massage. Freeze water in dixie cups and then peel the top away and hold at the base of the cup to rub all over the sore area. Your skin will turn pink. Some areas will take longer, so keep going until everything is uniformly pink.

If in another few weeks, it is still bothersome, you might want to see a good orthopedist ... perhaps someone who specializes in knees.

[flamboastin]

Thanks Julie. I'll follow your advice and see how it goes.
One more quick question. Even though I can walk stairs with no problem now, would it be a good idea to continue wearing my knee brace (the elastic one)?

[UConnJulie]

I don't know that those do a whole lot ... if you feel better with it, by all means, wear it.