Knee pain above and to the outside of my kneecap

November 2, 2009 5:58 AM

Knee pain concerns: I have a small pain that feels like it is coming from the upper outside of my left knee. I've had this issue on and off for a long time and it doesn't prevent me from doing anything, but it has me worried.

I'm in my mid 20's and am a pretty hardcore mogul skiier and I do lots of mountaineering. I'm unable to see a doctor for a few months and I'd like some insight into what this might be.

The pain seems to happen when I am extending my leg under load, for example, when I'm climbing stairs. It also comes up when I'm riding a bike. I've never had any major knee injuries but this feels like it is gradually increasing over time. Sometimes, when I'm running up stairs I get a little twinge and I have to stop running up stairs for a day or two before it goes away. When this happens in the middle of a multi day climbing expedition I can still continue but I have to be a little gentler on the knee. So this is not debilitating pain, I just want to make sure I'm doing everything possible to preserve my knees.

Looking at this picture, It feels like the LCL but I'm not sure. If you are looking at my left knee from the front, the pain is at about 2 o'clock, about 1-2cm (radially) out from the edge of the kneecap.

So I'd like some attempts at diagnosis, is this a tendon problem? Cartilage? Muscle? (I know this is frowned upon here, but I'm not able to get proper medical attention for a few months and I'm going to be climbing a mountain soon) Also, some advice about what I can do to prevent further damage. Would a brace help? If so, what kind? Are there exercises or stretches that would help? Currently I try to stretch the affected area by pulling my heel up to my butt. Seems to help.

Also, for many years I think I was riding my bike with the seat too low and I get a feeling that this is related.

Thanks!

posted by Popcorn to health & fitness (16 answers total)

Also, somewhat related, my knees pop quite a bit. There is no pain, but they do pop a lot. Is popping bad in and of itself even when there is no pain associated with it?
posted by Popcorn at 6:02 AM on November 2, 2009

I should also add that there is no swelling associated with this, it's more of a chronic thing.
posted by Popcorn at 6:04 AM on November 2, 2009

Sounds like IT band.

Get yourself a foam roller and roll, roll, roll every night before bed. It'll hurt, but it's IT band the roller is a huge help.

Here's one from Target with a DVD.
posted by 26.2 at 6:39 AM on November 2, 2009

IANAD, but recently suffered from significant knee pain. Had some IT band issues too (which this does sound like). My physiotherapy has involved strengthening other, non-obvious, muscles, like quads and calves, but also front and side straight leg lifts with small weights, which as much as anything strengthened my hip muscles. Also ibuprofen and ice is recommended to reduce inflammation. Maybe some piriformis stretches too. If your knee is "popping", it might not be tracking correctly, which might indicate muscles out of balance. You might have some very strong muscles in your legs, but others might not be getting the attention they need.
posted by idb at 7:02 AM on November 2, 2009

I had a lateral collateral ligament tear that completely sidelined me for three weeks on the couch and crutches. It seemed acute at the time, but for a few months before that, I had the same chronic ache in that same area that you describe after I over-exercised.

During the recovery time from the injury, I iced the area almost 24/7, took prescribed anti-inflammatory for the first week, kept the leg elevated, and put no weight on it. It all healed without surgery, but it took nearly three weeks of immobilizing the affected leg. After it healed, I did recommended exercises that strengthened the nearby muscles. Once I was walking and began to lightly exercise again--weeks later--I immediately elevated and iced the affected leg immediately afterwards, and took ibuprofen if I felt even the tiniest twinge. No problems at all since doing all this. I no longer have to ice it or take the ibuprofen, but if I get that ache you describe again, I'll do all of what I'm suggesting.

I highly recommend cutting back on the activities that worsen this, which I wish I had done. When you do exercise, immediately apply ice afterwards and take some ibuprofen if you get that ache to deal with the inflammation. See a physical therapist to get recommendations for strengthening your knee. Good luck.
posted by Elsie at 7:32 AM on November 2, 2009

Could it be runner's knee?
See my previous comment - I also get "popping" which freaks me out, but it just means I'm out of line.
posted by smartypantz at 7:35 AM on November 2, 2009

I find relief from knee pain, similar to yours, by using a Cho-Pat. This is just one of many they have available.
posted by Lynsey at 9:34 AM on November 2, 2009

So I'd like some attempts at [self] diagnosis...I know this is frowned upon here

The knee is the most complicated and vulnerable joint in your body -- if the pain is significant (maybe it's not), then self-diagnosis is foolhardy and pointless.

Can you really not see a doctor for "several months"? I find that hard to believe. Do you really have to go climb that mountain? I find that also hard to believe.

Try to think long-term: don't trade thrills and spills today for chronic pain down the road. When you're in your 20s it's hard to understand and appreciate how your body breaks down 10 or 20 years down the line, but it's a very worthwhile mental exercise.
posted by randomstriker at 10:13 AM on November 2, 2009

Be careful when following the advice of one single doctor, specifically, Dr. John Sarno. His ideas about pain and his "tension myositis syndrome" is not backed up by science, clinical trials, or any other appropriate evidence. "All on and off knee pain is psychosomatic" strikes me as a dangerous generalization.

Remember, kids, the plural of anecdote is not data!
posted by tybstar at 11:12 AM on November 2, 2009 [2 favorites]

I had pretty much the same thing, and was diagnosed with IT band tendinitis. I have very low arches, and do a lot of running--excessive pronation was the culprit. My doctor prescribed Superfeet inserts for my running shoes and that has helped. The recommendation upthread about rolling it out with a massager will help the symptoms too.
posted by Kafkaesque at 11:15 AM on November 2, 2009

Thanks all, this is some good info. This IT band thing sounds like a possibility. I've looked at the Wikipedia article and it sounds familiar. For those of you that were properly diagnosed with IT band syndrome, do you remember any of the diagnostic procedures that were involved in your diagnosis?

Also regarding IT band syndrome, is this a permanent issue or something that can be rectified with physical therapy? Is this more like a genetic condition or the result of an old injury that never healed properly? If it is in fact ITBS, am I permanently damaged or do I just need to add some additional exercises to my regimen?

Randomstriker, as far as the significance of the pain, it's not really pain I have so much as a tingling consciousness of the meat in that area. I would describe it as more of a warning than pain. The feeling I get is that If I was climbing mountains every day for a few weeks straight, pain would develop, but at this point It's more like my knee saying "this might be a problem later". To describe the magnitude of the pain-like feeling, it's not nearly enough to make me wince or immediately shift the weight off the knee. This, as opposed to a sprained ankle for example where the instant you load the ankle there is an immediate instinct to re adjust things. Regardless, point taken.
posted by Popcorn at 1:37 PM on November 2, 2009

Sounds just like the symptoms I get with my ITB. For what it's worth, it totally went away with lots and lots of stretching targeted against ITB. Took about 6 months (without stopping my bothersome activity, jogging) for it to go away. I've dropped off the frequency of doing the stretches and it hasn't come back (yet).
posted by i_am_a_Jedi at 3:02 PM on November 2, 2009

Physical therapist here. (I am not your PT) Even though a lot of people here are chiming in with IT band issues, there is really no way to know what is going on with your knee without getting a thorough orthopedic assessment of it, and nobody is going to be able to do that without physically touching your knee. Go to an MD, get a prescription for PT, then go to the APTA website here and click on "Find a PT." Find someone in your area who has sports or ortho experience -- if they have the letters SCS (Sports Certified Specialist) or OCS (Orthopedic Certified Specialist) after their name, then they're going to be more than competent to figure out what's going on with your knee.
posted by jennyjenny at 4:21 PM on November 2, 2009

Jedi, could you please describe the ITB targeted stretching routine you did?

Jenny, I agree, unfortunately, I am stationed in a developing country and my org provides little in the way medical support. I'll do my best to find a local PT, but I doubt I'll be able to find one here. Chances are that I wont be able to see a professional till I return to the states. Could you suggest any physical signs that would help confirm or deny this internet diagnosis? Is there some text based resource somewhere that is the PT equivalent to the DSM IV in psychiatry? Some sort of diagnostic manual that would allow me to be a little more informed while I investigate this?

Alternatively, could you tell me what physical examinations you would do if someone presented these same symptoms in your office? I know this is no substitute for actually seeing a professional, but I have to do the best I can given the circumstances.
posted by Popcorn at 5:36 PM on November 2, 2009

IANAD but had what (after googling and looking on mefi) seemed like ITB issues while cycling. This and this helped mine.
posted by polyglot at 6:16 PM on November 2, 2009

I'm sure we didn't do an MRI. I remember telling the doctor where it hurt and when it happened during runs. In about 10 seconds he said, "Oh, IT band. This was the same conversation that I'd had with my running coach and teammates - all of whom had also said IT band. The doctor did an assessment of how tight my muscle was which was sort of useless since I'm flexible as Gumby from years of yoga. Then he sort of pressed on the part where the band connects to my knee. When that gave me pain, we had a confirmed Dx.

I had several sessions with PT, but mostly because I was mid-race season and not stopping my training. PT was just a way to have my insurance pay for regular assessments. The therapist taught me some stretches (similar to the ones linked above) and did a massage that's very similar to the foam roller - only much more painful and precise. About 3 months of consistent stretches and rolling, it was gone. I've not had a problem since. (Still rolling semi-regularly after 3 years.) If you have access to PT, I'd recommend it.

I've used the Cho-Pat and it mostly worked for me when I still had issues. People who use the Cho-Pat seem to love it. During the San Diego marathon I've seen many runners stop and get that brace from someone who's there to support them. (That marathon has about 2 miles of road that slopes so one hip is lower than the other. It's a horrible run if you've got IT problems.) Having said that, when I mentor on my run team I tell people that any kind of brace or orthotic really should be fitted by a professional. Your circumstances may not allow that.
posted by 26.2 at 4:46 PM on November 3, 2009