Being kind to my cranky knee
September 14, 2015 2:42 AM Subscribe
I have the beginnings of knee pain and instability that's not doctor-worthy yet. Patellar tendon area. What's going on mechanically and how can I help it recover?
Since starting this Ask yesterday I've now got bonus stiffness, tenderness and gentle swelling in my left knee, so I'd like to start up preventative treatment ASAP.
I have a long term very very minor recurring instability in the knee; I don't remember having injured it, and I don't have joint or connective tissue problems generally. It currently hurts when I step onto the leg while walking, unless I protect it by either stepping onto an already-bent leg or tense the knee straight. It's tender when the knee joint rotates while bearing weight. When actively straightening my leg - this is the bit I understand least - I have to not apply too much muscular force, else there's the same below-kneecap twinge and it feels like my joint is about to hyperextend (not something any of my joints do except a busted thumb!) and the kneecap pop off somewhere.
So Dr Google diagnoses likely runner's/jumper's knee and an unhappy patellar tendon, but I'm awash in a sea of not very helpful info. It's suggested that the cause is muscle tightness/weakness elsewhere and I'm finding it hard to sift and process the info on how to address that. I'm looking to understand more about the biomechanics of this cranky (and now slightly creaky) knee. What should I do from here?
- what exercises should I (carefully) try - which muscles make my knee more stable?
- would a patellar strap help, Rafa Nadal style?
- what should I NOT do? avoid high-impact stuff, sure, but anything surprising?
Info: I walk and cycle day to day, and don't run or play sports. I'll overhaul my bike and finally put the saddle to the right height to prevent further injury (sorry, knee, love from brain). I wear comfy flat shoes everywhere, or go barefoot. Often carry heavy loads. My weight is stable. I'd find it quite challenging cognitively to break habits of sitting cross-legged or curled up, but I can try. I've got tight calves and outside of hips/psoas region, loose hip rotation externally (half lotus is super comfy, touching my toes to my opposite shoulder in front is easy), weak lower abs and lower back, short hamstrings. Cranky knee actually developed this time following stiffness of the calf muscles after overuse - relevant? Incomplete dance training means I have super proprioceptive/mechanical awareness but not the practical self-physio experience of isolating and solving specific problems in the body. Have been practising one-leg balances while brushing teeth/waiting around to rehab spring left ankle sprain. I'm right-handed and my right leg is my dominant cycling leg - my left's the one I put down at lights or when dismounting, power when pushing off comes from the right. Lastly, I don't have a yoga or conditioning practice, but I'm thinking the long-term solution will skew that way; I'm just not quite sure where to focus specifically.
Thank you from me and my knee!
Since starting this Ask yesterday I've now got bonus stiffness, tenderness and gentle swelling in my left knee, so I'd like to start up preventative treatment ASAP.
I have a long term very very minor recurring instability in the knee; I don't remember having injured it, and I don't have joint or connective tissue problems generally. It currently hurts when I step onto the leg while walking, unless I protect it by either stepping onto an already-bent leg or tense the knee straight. It's tender when the knee joint rotates while bearing weight. When actively straightening my leg - this is the bit I understand least - I have to not apply too much muscular force, else there's the same below-kneecap twinge and it feels like my joint is about to hyperextend (not something any of my joints do except a busted thumb!) and the kneecap pop off somewhere.
So Dr Google diagnoses likely runner's/jumper's knee and an unhappy patellar tendon, but I'm awash in a sea of not very helpful info. It's suggested that the cause is muscle tightness/weakness elsewhere and I'm finding it hard to sift and process the info on how to address that. I'm looking to understand more about the biomechanics of this cranky (and now slightly creaky) knee. What should I do from here?
- what exercises should I (carefully) try - which muscles make my knee more stable?
- would a patellar strap help, Rafa Nadal style?
- what should I NOT do? avoid high-impact stuff, sure, but anything surprising?
Info: I walk and cycle day to day, and don't run or play sports. I'll overhaul my bike and finally put the saddle to the right height to prevent further injury (sorry, knee, love from brain). I wear comfy flat shoes everywhere, or go barefoot. Often carry heavy loads. My weight is stable. I'd find it quite challenging cognitively to break habits of sitting cross-legged or curled up, but I can try. I've got tight calves and outside of hips/psoas region, loose hip rotation externally (half lotus is super comfy, touching my toes to my opposite shoulder in front is easy), weak lower abs and lower back, short hamstrings. Cranky knee actually developed this time following stiffness of the calf muscles after overuse - relevant? Incomplete dance training means I have super proprioceptive/mechanical awareness but not the practical self-physio experience of isolating and solving specific problems in the body. Have been practising one-leg balances while brushing teeth/waiting around to rehab spring left ankle sprain. I'm right-handed and my right leg is my dominant cycling leg - my left's the one I put down at lights or when dismounting, power when pushing off comes from the right. Lastly, I don't have a yoga or conditioning practice, but I'm thinking the long-term solution will skew that way; I'm just not quite sure where to focus specifically.
Thank you from me and my knee!
I just saw you are in my home town - memail me if you want a specific recommendation.
posted by crocomancer at 2:58 AM on September 14, 2015 [1 favorite]
posted by crocomancer at 2:58 AM on September 14, 2015 [1 favorite]
I've got a busted ACL and am awaiting surgery to repair it. I do know exactly how I did it as it was a very painful experience but I laboured under the impression for many months that it was just a strain. I think I certainly made it worse by continuing to do high impact exercise/sport.
It manifests itself as feeling really unstable when twisting to the point where my knee locks up entirely and I have to slowly stretch it back into place. I often get a dull ache that can get worse if I'm active and I can hear creaking when I flex the knee (not sure if the noise is as a result of the ACL tear or not).
I saw a sports physio first off who sent me to see my GP with a letter saying that he suspected ligament damage. Next step was an MRI which confirmed my ACL had torn.
So yea, if nothing improves get it looked at. I wish I'd gone sooner.
posted by Ness at 3:03 AM on September 14, 2015
It manifests itself as feeling really unstable when twisting to the point where my knee locks up entirely and I have to slowly stretch it back into place. I often get a dull ache that can get worse if I'm active and I can hear creaking when I flex the knee (not sure if the noise is as a result of the ACL tear or not).
I saw a sports physio first off who sent me to see my GP with a letter saying that he suspected ligament damage. Next step was an MRI which confirmed my ACL had torn.
So yea, if nothing improves get it looked at. I wish I'd gone sooner.
posted by Ness at 3:03 AM on September 14, 2015
I'm not (a or your) PT but a little icing is a good idea if there's swelling. I've always had good luck with wearing a n elastic knee brace for a few days/weeks. Balances while doing something else seems like a bad idea when all is not right so that's probably something to take a time out on. When the swelling and pain go away some weight bearing knee lifts done carefully might build up the support muscles. As will doing plie's carefully and **correctly**!
posted by sammyo at 3:42 AM on September 14, 2015
posted by sammyo at 3:42 AM on September 14, 2015
Best answer: I'm baffled as to why you are saying this is not worth a doctor's visit. What is it you are imaging the actual threshold for that might be? You have persistent, deteriorating pain. See a doctor!
posted by DarlingBri at 4:48 AM on September 14, 2015 [7 favorites]
posted by DarlingBri at 4:48 AM on September 14, 2015 [7 favorites]
Best answer: Please go and see an osteo or a physio ASAP. It sounds like you could make the problem even worse by compensating for the issue.
posted by kinddieserzeit at 4:55 AM on September 14, 2015 [4 favorites]
posted by kinddieserzeit at 4:55 AM on September 14, 2015 [4 favorites]
Avoid stairs for a while... down as well as up.
Make sure your shoes are supportive.
Very gentle lateral leg exercise, such as the clam exercise (no added weights or bands), may help with stability. It's best if a PT showed you.
posted by zennie at 5:34 AM on September 14, 2015 [1 favorite]
Make sure your shoes are supportive.
Very gentle lateral leg exercise, such as the clam exercise (no added weights or bands), may help with stability. It's best if a PT showed you.
posted by zennie at 5:34 AM on September 14, 2015 [1 favorite]
IANAD but this sounds a lot like IT band syndrome. It's a form of tendonitis, and the treatment for ALL tendonitis is rest, ice and anti-inflmmartories. You should still go see a doctor. If you believe tightniess may be a cause for this, I highly recommend yoga, specifically Yin yoga, which is meant to work the deeper connective tissues as oppose to superficial muscles.
posted by Brittanie at 6:20 AM on September 14, 2015 [1 favorite]
posted by Brittanie at 6:20 AM on September 14, 2015 [1 favorite]
Personally I found that side lying hip abduction exercises helped tremendously when I had knee pain.
posted by exogenous at 7:31 AM on September 14, 2015 [3 favorites]
posted by exogenous at 7:31 AM on September 14, 2015 [3 favorites]
Knees are complicated. With my knee, and similar symptoms, the doctor's test of the knee fluid said it was gout-related.
I eventually worked out that a glass a day of Trader Joes tart cherry juice keeps the inflammation at bay. (There is something in cherries that counteracts gout, although I don't think anybody has ever taken the trouble to work out what ingredient or why, which is a shame).
posted by w0mbat at 7:38 AM on September 14, 2015 [1 favorite]
I eventually worked out that a glass a day of Trader Joes tart cherry juice keeps the inflammation at bay. (There is something in cherries that counteracts gout, although I don't think anybody has ever taken the trouble to work out what ingredient or why, which is a shame).
posted by w0mbat at 7:38 AM on September 14, 2015 [1 favorite]
It could be patellar tendinopathy, or it could be a few other things (more than one would imagine! Fat pad impingement is a thing, for example :/ - bursitis, loads of things).
It's tender when the knee joint rotates while bearing weight.
I believe that that could mean a meniscus tear or an MCL thing, but only a sports med or physiotherapist could say, after an evaluation and some images. If you can't bear weight without doing funky stuff, it's really past time to get it looked at. Try not to walk in a funny way, because that'll make it worse - walk with steady pace, just go slowly to avoid risking making this worse via compensations. Or if that's agony, borrow someone's crutches. Stay away from exercise full stop, I think, until you know what to do.
I tried to self-PT for a very similar knee pain I'm having right now and made it worse. My PT is treating it first with a few sessions of electroacupuncture. (I asked "why not exercises immediately"; she said that with me, my VMO [inner quad] isn't firing properly, and that exercising without getting it to wake up is only going to reinforce faulty biomechanics. I have unstable, loose knees & unstable, loose other joints, and it's hard to isolate the VMO with regular exercise.)
It's totally worth having someone work it out. Sorry for your knee pain, it really sucks.
posted by cotton dress sock at 7:50 AM on September 14, 2015 [1 favorite]
It's tender when the knee joint rotates while bearing weight.
I believe that that could mean a meniscus tear or an MCL thing, but only a sports med or physiotherapist could say, after an evaluation and some images. If you can't bear weight without doing funky stuff, it's really past time to get it looked at. Try not to walk in a funny way, because that'll make it worse - walk with steady pace, just go slowly to avoid risking making this worse via compensations. Or if that's agony, borrow someone's crutches. Stay away from exercise full stop, I think, until you know what to do.
I tried to self-PT for a very similar knee pain I'm having right now and made it worse. My PT is treating it first with a few sessions of electroacupuncture. (I asked "why not exercises immediately"; she said that with me, my VMO [inner quad] isn't firing properly, and that exercising without getting it to wake up is only going to reinforce faulty biomechanics. I have unstable, loose knees & unstable, loose other joints, and it's hard to isolate the VMO with regular exercise.)
It's totally worth having someone work it out. Sorry for your knee pain, it really sucks.
posted by cotton dress sock at 7:50 AM on September 14, 2015 [1 favorite]
This is already a doctor-worthy situation, sorry. Best take care of that asap.
posted by poffin boffin at 8:04 AM on September 14, 2015 [2 favorites]
posted by poffin boffin at 8:04 AM on September 14, 2015 [2 favorites]
Best answer: Knees are complicated little beasts. Please go see a doctor. Being able to walk as you get older is important.
posted by The Almighty Mommy Goddess at 9:05 AM on September 14, 2015 [1 favorite]
posted by The Almighty Mommy Goddess at 9:05 AM on September 14, 2015 [1 favorite]
Physio! Definitely see a physio first. They are better at diagnosing MSK problems than the average doctor, and the first-line treatment for most knee problems (even things like osteoarthritis which aren't caused by muscle problems) is physio to strengthen the muscles supporting the knee.
posted by tinkletown at 9:14 AM on September 14, 2015 [1 favorite]
posted by tinkletown at 9:14 AM on September 14, 2015 [1 favorite]
As others have said, consult someone to analyze your gait for lopsidedness. My knee was bad for years until it was pointed out that I wasn't bringing that foot entirely under my centre of gravity. It probably started in my teens, when I had some minor foot surgery but the compensation became habitual and lead to weakness and overcompensations and eventually showed up as patellar clicking/pain.
posted by bonobothegreat at 9:46 AM on September 14, 2015 [1 favorite]
posted by bonobothegreat at 9:46 AM on September 14, 2015 [1 favorite]
As someone with knee issues I was vaguely aware of but didn't understand until I dislocated one of them, I'd strongly encourage you to see a doctor now to make a preventive plan rather than waiting until you injure yourself or experience severe pain. As much as you can (and should) do good things for your body on your own, keeping your knees healthy is something worth consulting an expert on.
posted by Meg_Murry at 10:00 AM on September 14, 2015 [2 favorites]
posted by Meg_Murry at 10:00 AM on September 14, 2015 [2 favorites]
Most important: Go to your sporting good store and get the best shoe you can afford for high impact. This will probably be a running shoe. Also pick up the best possible high impact protection inner soles you can get and put them into those shoes you just bought. These shoes and inner soles should be replaced every six months you if you walk regularly. The impact protection is crucial the most important thing you can do for you knees. Your body was not designed to walk on rock all the time and that is what you do if you walk on roads, sidewalks and floors. Wearing the high impact shoes will help.
Lie on your side with both legs straight and raise your top leg without bending it. Repeatedly do this several times a day but not so much that you feel it afterwards. Do it on both sides. This will help stabilize your pelvis.
Get a small ball about three inches in diameter and hold it between your knees while sitting down. Squeeze it gently. This will help exercise your knees. Again, do this for several repeats, several times a day, but not so much that you feel it afterwards.
Get someone to check your gait. Are you pigeon toed? Knock-kneed? Look up exercises to correct these if so.
Do not do ballet exercises unless approved by a physiotherapist.
Find a badly maintained field of grass, one that needs to be leveled. For best results find a meadow that has been walked in by cows, in wet weather so that it is dimpled all over instead of flat. Bonus if it is also a hill. Walk around on this grass. With every step you will have to alter the alignment of your feet to allow for the non-level ground. This will be good exercise for your ankles and feet and knees and also good for your balance. If you get good at this take to running around the field lightly.
posted by Jane the Brown at 3:41 PM on September 14, 2015
Lie on your side with both legs straight and raise your top leg without bending it. Repeatedly do this several times a day but not so much that you feel it afterwards. Do it on both sides. This will help stabilize your pelvis.
Get a small ball about three inches in diameter and hold it between your knees while sitting down. Squeeze it gently. This will help exercise your knees. Again, do this for several repeats, several times a day, but not so much that you feel it afterwards.
Get someone to check your gait. Are you pigeon toed? Knock-kneed? Look up exercises to correct these if so.
Do not do ballet exercises unless approved by a physiotherapist.
Find a badly maintained field of grass, one that needs to be leveled. For best results find a meadow that has been walked in by cows, in wet weather so that it is dimpled all over instead of flat. Bonus if it is also a hill. Walk around on this grass. With every step you will have to alter the alignment of your feet to allow for the non-level ground. This will be good exercise for your ankles and feet and knees and also good for your balance. If you get good at this take to running around the field lightly.
posted by Jane the Brown at 3:41 PM on September 14, 2015
To balance all the "see the doctor / physical therapist" comments, I will add my experience. I developed severe knee pain after going on a rigorous backpacking trip. I was into racing bicycles at the time, but had not done a lot of hiking. After a visit to one of the top NYC hospitals, the doctor sent me to a physical therapist who horribly mis-diagnosed me. She thought my quadriceps were underdeveloped even though I easily moved all the weight she could put on the leg extension machine. I timidly submitted to a pointless regime of such exercise along with electric quadriceps stimulation that did almost nothing. Later I happened upon a series of exercises (primarily side lying hip abduction) got my knees sorted out.
So don't place blind faith in the white coats.
posted by exogenous at 8:09 AM on September 15, 2015
So don't place blind faith in the white coats.
posted by exogenous at 8:09 AM on September 15, 2015
This thread is closed to new comments.
I've had this problem from running and have had very good results from physio and from changes to running style, but I'm reluctant to say "do these things that worked for me" because I just don't know what's causing your problems.
posted by crocomancer at 2:57 AM on September 14, 2015 [6 favorites]