Weak in the Knees

August 14, 2006 6:45 AM

What can I do about weak and painful knees? I'm a 21 y.o. male with weak, creaking, grinding, and occasionally dislocating knees. Cause/options/suggestions?

I'm a (just-turned) 21 year old male, and I have a problem: I have really cruddy knees. Both of my knees are weak and problematic. Each of them grinds noisily when climbing the stairs or if I stand from a squatting position.

Not only are they noisy but they also hurt - I can feel an awful weakness when climbing the stairs or carrying heavy loads, especially from a squat. They also feel dangerously likely to dislocate. If I'm carrying a heavy load and misplace a step even slightly, I can feel the joint misalign and almost slip out - an awful feeling (not painful in itself, but it's the awareness that it's about to dislocate). Even when running or exerting myself (playing catch, any sort of physical activity that relies in frequent change of direction, etc), I can tell that my knees are a very weak link and could go out any time.

I have dislocated my left knee twice. Interestingly, both times I've experienced a dislocation were while dancing. The first time I was just being silly when my joint popped sideways. I had just placed my weight on that leg so I immediately collapsed and it popped back in when I hit the ground. The second time I had a partner on my back and was doing some pretty intense spinning when it popped out badly and we both crashed to the floor. The joint popped back in when I hit the ground again.

The second dislocation was about 6 months ago. I've been wearing an elastic-nylon knee-brace on that left knee ever since, and it seems to help add some strength to the joint. I can tell it helps the reduce "almost dislocation" feelings greatly. My right knee has never dislocated that I can recall but it shares the same weaknesses as the left - in fact it often hurts more when climbing the stairs. Sometimes I switch my knee brace to the right knee just to provide a day of relief (I only have 1 brace at the moment).

So I'm wondering a couple things here: WHY am I experiencing this? I'm barely 21, I'm relatively in shape (6'1", 160lbs, slim build), and I've never done any regular team sports or anything. The only thing that I can think of that would have caused a permanent problem for me knees was when I was 14: I got hit head-on by a go-kart traveling 40-50mph. Someone was driving this home-built go-kart around this parking lot and thought it would be funny to drive toward me and dart away at the last second. Unfortunately he didn't let me in on his plans, and when I noticed him barrelling toward me I decided to jump out of the way. Well, he turned into me and hit my left leg square on - breaking both lower bones (tibia & fibula) clean in half. I spent the summer in a full leg cast from toe to groin, but it healed up quite nicely (though I do have a nice 6" scar to show off). I wonder if it stessed my left knee joint greatly. This doesn't explain the weakness in my right knee, however.

So why is this happening? And more importantly, what can I DO about it? I have a feeling I should see a doctor. Should I go to my family doctor or can I go to an orthopedic specialist directly (without referral from my family doctor)? What can I expect for treatment options and therapy? Is surgery a likelihood?

I have a pretty good insurance plan at my current job so if something really needs done then I suppose now is the best time to do it. Besides, I'm thinking that because I'm pretty young I should get this taken care of ASAP, because the longer I let it go the less they can do? Isn't it true that if I've lost some of my tendon/ligament/fleshy parts in the knee joint then it's only gonna get worse unless I get it fixed?

Sorry for the LONG post, but that's the whole story. Thanks for your thoughts and input.

posted by sprocket87 to health (11 comments total)

Of course it would be best to have them evaluated by a good sports medicine oriented orthopod, or other experienced professional such as a physical therapist or a trainer. You can likely prevent some of these problems by strengthening the muscles around the joint thereby stabilizing it. The usual course is to see the orthopod and then get a prescription for a course of physical therapy where you will learn the proper exercises and stretches.
posted by caddis at 7:18 AM on August 14, 2006

I dislocated both my kneecaps in high school, about a year apart. And both times for me I was dancing as well. Up until that time, I hadn't had any trouble with my knees. My father had (and still has) a lot of knee problems starting in college, and dislocated his kneecaps a few time. So it looks like I inherited some bad knees. Thanks, Dad!

Let me tell you: it sucks. I haven't had any more dislocations in the 15 years since then, but I get crackling and sometimes a lot of pain in both my knees. I've been to a few doctors about it and have gotten sort of general "Well, we're not quite sure, could be early arthritis, blah blah blah." A few years ago, the pain was getting pretty bad and I was worried that I might injure them again, so I got some physical therapy. Basically what that entailed was building up the muscles in the calf and thigh so that the pressure is taken off of the knees. I would look into going to PT right now while you have insurance and you can start getting out of bad habits into good ones. Go to a doctor, and have him recommend PT.

One other suggestion. A friend of mine with a lot of knee problems just had surgery (not very successful) and has had a hell of a time rehabilitating from it and has not had much success with PT. She got this book (Yoga for Healthy Knees) and highly recommended it. It seems to have helped a lot in pain reduction for her. I just ordered it myself, so we'll see how it goes.

I've found that you really need to listen to your body when it comes to this stuff.
posted by witchstone at 7:20 AM on August 14, 2006

I don't know about the creaky, grinding part of the symptom but I have a dislocating knee. It dislocated so badly that I had to have my entire leg casted several times to stop it slipping out. I dealt with it by undergoing months-long physiotherapy at a sports medicine clinic and was referred there by my family doctor. I was also fitted for a special brace specifically designed for dislocating knees that I wear while playing sports (basically anything except running). Surgery was presented as an option for me, but I declined. Defiinitely see your doctor - s/he can outline options for you and get you into a specialist, which sounds like something you need quite badly. I know how painful this problem is - good luck!
posted by meerkatty at 7:26 AM on August 14, 2006

I dislocated my knee in a fall off a short ladder, and attempted to wait out the pain for a few weeks. It didn't get much better, and was quite swollen, so a trip to the doctor resulted in x-rays, an MRI, and an appointment with a specialist.

Luckily, it was only a partial ligament tear that did not require any surgery. After a good 3+ months, my knee is back to normal, with the occasional clicking and soreness in the morning.

I would recommend going to your regular doctor first, they can get the preliminary diagnosis out of the way. My regular doc was also able to get me an appointment with the specialist much sooner than I could have on my own. Good luck!
posted by shinynewnick at 7:57 AM on August 14, 2006

I've had the grinding knee. It turned out to be patella femoral syndrome (PFS). It was caused mainly my an imbalance of strength beteween my quadricep muscles. My dr. prescribed leg extensions, but I managed to keep it in control by paying attention when I walked and lengthening my stride.

I'm not a doctor and this may have nothing to do with your problem, but it's not necessarilly something really bad.
posted by jefftang at 8:07 AM on August 14, 2006

As a teenager my left knee had dislocated a couple times. I went to my family doctor who sent me on to an orthopedic surgeon and it was decided I should have knee surgery. In the surgery they tightened the ligaments in the knee to hold it in place better. They also put in a screw for stability that was taken out a year later. I can say that the recovery period from the surgery was quite painful and then I was on crutches for two months and physiotherapy for another three months. It has been almost twelve years since that surgery and though I don't think my knee is as strong as the other one (probably something I could remedy if I stuck to my physio exercises) and it does still make the grinding cracking noises when going up stairs, it has never dislocated since my surgery. - Wife of Jaybo.
posted by Jaybo at 8:13 AM on August 14, 2006

If your blood type is O (+or-) stop eating potato's. I thought my knees were shot from 12 years of construction but once I gave up potato's I could do squats like a teenager. Find out about the blood type diet
posted by sgobbare at 9:15 AM on August 14, 2006

I have the same problem and recently decided (read: have health insurance) to investigate. My doctor thinks I need to strengthen the muscles on either side of my knee. One exercise is to lean your back against a door, squat with a ball between your legs and squeeze the ball. I am still going to have an MRI for the creaking and crunching sound, but he had me do some duck walking and says it is unlikely that there is structural damage.

If you can afford to see a doctor, do it.
posted by terrapin at 10:34 AM on August 14, 2006

Yup, had this two years ago skiing, the right knee popped out. The good news for me (and you, it seems), is that there was no ligament damage. Get a referral to an orthopedist, and they can confirm.

So after some rest I tried to play some ultimate frisbee, and it popped again. This time I went to a physical therapist.

Basically what happens is your kneecap is a fulcrum for your legs. It is held in place laterally by two muscles, one running up the inside of your thigh, and the other running up the outside, up to the top of your buttal area...

In my case the right kneecap popped out, to the right. One reason was that the muscle on the outside was too tight. How to fix it? Keep that muscle stretched: Lay on your back and pull your right knee up to your left shoulder. If you do it right, you'll feel a nice stretch in your lower back.

The other reason is that the muscle on the inside is too weak. How to fix it? Get that muscle stronger. Lay on your back and point your right foot outwards (so that the side of your foot is flat against the floor). Then lift that foot only 3-4 inches off the ground. When I first started this, there was much pain in my knee this leg lift. Over about 3 weeks I was able to add 8 pounds to the ankle and really work that muscle into shape.

I know that the reason my knee popped was because of an unrelated ankle injury that had me sidelined for a few months. My leg muscles simply atrophied. Just keep to a regular workout schedule... cheers!
posted by joecacti at 10:51 AM on August 14, 2006

It sounds like you have some ligament damage. Was this not diagnosed when your leg was broken? If you have insurance get an MRI done as soon as possible and see if your ligaments are intact.

I tore my Anterior Cruciate Ligament (ACL) about 10 years ago and never got surgery to fix it. I've compensated by doing regular exercise that strengthens my leg muscles, especially biking and some weights. Still, occasionally my knee will give out on me a bit if I make an awkward lateral movement (dancing drunk will do it), also, playing most competitive sports is right out as lateral movement is key.

I regret not getting surgery to fix the ligament at the time, but at my age (I'm pushing 40) I'm not going to have major surgery on my knee so I can play pick up basketball again. I do just fine biking and swimming. At your age, however, I definitely would get surgery if I needed it, because in the long run the 6 months of rehab that you will have to get through will save you from a lot of other inconveniences.

Good luck.
posted by sic at 1:41 PM on August 14, 2006

I torgued my knee in high school & was diagnosed with torn cartilage.
PT exercises helped, but my knee kept slipping out.
A decade later, orthoscopy showed frayed ligament.
Three lessons that may apply:
1. The job I had before the surgeries included climbing ladders;
this overbuilt my hamstrings and pulled my lower leg back to an unstable position.
2. As my shoes wore down, my knee got more unstable.
3. My knee kept slipping until I started doing a southern-style kung-fu.
The style is based on a very low horse stance.
I think this worked, where the PT didn't, because it built the support structure
which wrapped around the knee area,
while PT focused on the muscles in a more linear way.
At any rate, I made changes based on these points;
no knee slipping for over a decade.
posted by dragonsi55 at 2:17 PM on August 14, 2006