Anterior knee pain in both knees - 21 years old

June 21, 2009 3:02 PM

I'm 21 and for the last 10 months or so I've been having knee pain above both kneecaps. The pain isn't confined to a point but instead spread over the area above my knee caps, and occurs whenever I bend the knee with weight on it. I've been to a surgeon who wants to do an arthroscopy but he doesn't know what the problem is and hence doesn't know if it will do any good. Has anyone had a similar kind of pain and if so how did you solve it? And could it be plica syndrome even though the pain is above the knee and in both knees?

I've played soccer all my life, as well as various other sports including squash and cricket. Te pain started though about a month after I started taking up jogging seriously. It came on one day and I immediately stopped running and haven't done any since. I have played the occasional football match and the pain usually gets better as the game goes on only to get worse the day after.

I have stretched every day for at least 6 months - including hamstring, calf, quads, gults and hip flexors. I tried quad strengthening for about a month and it did make an improvement only to then get worse again. At the moment I am strengthening my external hip rotators but yet to see any difference.

I have got orthotics from a podiatrist to help with my over pronation, and I have tried physical therapy. I'm desperate for a solution so surgery seems attractive as a "quick fix" but I've never heard of someone having knee surgery and making a full recovery, so I'm scared of having an arthoroscopy at only 21.

I've tried relative rest for extended periods of time but it doesn't seem to make a huge difference. I also went through a few weeks of icing every day and taking ibuprofen - no difference.

While searching on the internet I came across a condition called plica syndrome which sounds promising but it seems like you can't tell if it is that unless you get an arthoroscopy - and even then it may be missed. Does anyone know how you can self diagnose this problem?

Does anyone have any experience in these kind of problems and how to get over them?

Thanks

posted by Xeract to Health & Fitness (13 answers total)

My bet is your have aggravated your IT bands. It's a thick band of connective tissue that runs from your knee to hip, it's too wide to be a tendon but it's similar.

IT band pain is associated with running, especially on hard surfaces, the pain is located above the knee (though usually more on the outside and above than central) and it is a bitch to get rid of. A PT who specializes in IT band syndrome and can basically prove to you that they have had success treating it is your best bet though you are on the right track with the hip flexors, I think. It was surprising to me how strong I had to get those muscles to fix the IT band, and I was pretty fit to start with. You can buy a foam roller to help you "stretch" your IT band, it really hurts a lot but it seems to help a bit.

I also found hot room yoga very helpful but a lot of people injure themselves more doing that (and PTs hate it) so ymmv.

Your instincts about the doctor are right on. Don't ever let a surgeon go in there just "to look around" or without a very clear agreement of what they are and aren't allowed to try and "fix". In writing. Signed by you both and reviewed the day of surgery. I say this from experience.
posted by fshgrl at 3:12 PM on June 21, 2009

I have stretched every day for at least 6 months

IANAD and I'm speculating wildly.

If you're doing static stretches, it's possible to over-stretch and "weaken" the joint. Until you figure out what's going on, I'd suggest moderation in all things. (Running, lifting, stretching.)

I'm guessing something (or multiple things) are either too tight, too weak, or imbalanced.

Pain *below* the kneecap can be caused by quads that are too strong or hamstrings that are too weak. (I think.)

Jogging overpronation can cause your IT band to tighten up.

I think you're going to have fit puzzle pieces together about what might be happening and then test specific fixes. Or you can take a more blanket approach like all of your stretching, but, again, it sounds like you're overdoing it. Before you test a fix, take a break to let inflammation and aggravation go down a little bit, so you can get good feedback from what you're doing.

I've been pretty pleased with this product line over pretty much everything else I've ever looked at, including Pavel's stuff, various physical therapy books, etc.:

http://www.bulletproofknees.com/
http://www.magnificentmobility.com/
http://robertsontrainingsystems.com/products/
posted by zeek321 at 3:18 PM on June 21, 2009

*Jogging and overpronation
posted by zeek321 at 3:19 PM on June 21, 2009

Go to a rheumatologist, Xeract. They're the ones who know about your kind of pain and how to relieve it. Orthopedic surgeons are great if you need surgery - the problem is they always think you do. A rheumatologist will put everything in perspective, be aware of your age and timeline and understand your reluctance. Surgeons, bless them, just want to get in and have a go, the earlier the better.

Things are more complicated, so you should get as many medical perspectives as you can. Your pain is a problem that can (and perhaps should) be addressed separately. There may be no quick and dried surgical solution that won't create problems and timelines of its own. Knee prostheses are notoriously unsatisfactory and troublesome but the main problem is how long they last (around 20 years, if you´re active) and how much more difficult it will to replace the replacement when you're only 41 or, third or fourth time unlucky, 61 and 81.

I'm not a doctor, of course, but I've suffered a scary MRSA-riddled hip replacement and would like to suggest your problem might be simple but your quandary (which solution is best) is not. There's best for now; there´s best in the long term; there's best for you. Go for best for you, I'd say

Pain can be managed; things can be postponed; advice differs; best solutions change; you learn to live with doubt and you come to appreciate there are always options open to you.

Finally, the Internet is crucial once you know what your problem (and suggested medication) are (doctors don't have the time to go into detail and can't know everything) but it's crap when you don't.

Here's hoping you get on top of your situation. You seem to be doing it very well already, with an enviable mix of autonomy, respect and intelligence. I wish I had been as mistrustful and uncertain as you...
posted by MiguelCardoso at 3:35 PM on June 21, 2009

Has any imaging been done? MRI, or even x-rays? And you might want to check with someone other than a surgeon on this - a plain primary care doctor or possibly a sports medicine specialist.
posted by dilettante at 4:35 PM on June 21, 2009

I get the same pain in my knees when I run. If had not read and absorbed Dr. John Sarno's writings, I would still have the pain.

I strongly urge you to read Dr. John Sarno's writings before buying into what the medical establishment is trying to sell you.

Yes, your pain is real, but it's not anything in your knee that's actually causing the pain.

Drop me an email if you need any more info on this.
posted by Zambrano at 4:45 PM on June 21, 2009

And all of the explanations and remedies you have read above -the "bulletproof knees", training, "your IT bands", stretching, MRI, orthotics, "pain can be managed" etc.. is a load of shit. It's all placebo effect nonsense.

I'm telling it to you straight: almost all non-trauma-induced pain (pain that just appears out of nowhere) in your knees, back, shoulders, neck etc is caused by rage, stress and unresolved psychological issues (these are normal things almost everyone has).
posted by Zambrano at 4:53 PM on June 21, 2009

almost all non-trauma-induced pain [...] It's all placebo effect nonsense.

Whoa. I've read Sarno, and his stuff has helped me a lot, and his stuff might be helpful for the OP. But, Zambrano, you're vastly overgeneralizing. Over and out.
posted by zeek321 at 5:23 PM on June 21, 2009

I have "Patellofemoral Pain Syndrome" which I throw out at you just to give you another thing to Google.

Physiotherapy has been useful for me; perhaps it would be worth seeing what a physio would tell you?

(My non-trauma-induced pain in my knees is caused by having spent nearly two years strollerlessly hauling a baby and then toddler everywhere, and up and down the stairs of a three-storey house, Zambrano aside.)
posted by kmennie at 6:07 PM on June 21, 2009

I have this pain. Like you, it's only when putting weight on the knee when it's bent. Basically it only hurts when I walk out stairs.

My doctor said its from roughening behind the kneecap. She said it's pretty common and knew what it was as soon as I described it. She said that to prevent the pain I need to strengthen the muscle on the front of my upper leg that supports the knee and holds everything in the right place so the roughened parts don't rub. She told me to do some strength training of that muscle, basically sitting in chair and raising my feet straight out in front of me. When I do the exercise my knee is basically fine, when I don't the pain comes back. Swimming also seems to help.

You may well have the same thing, so try some strength training on that muscle before doing invasive testing or treatments.
posted by If only I had a penguin... at 7:03 PM on June 21, 2009

Oh, and resting didn't help me at all. I spent a week in the hospital in August (on an unrelated matter) and really hoped that it would fix my knee since I didn't go up or down a single step all that time. Outside the hospital I couldn't avoid doing at least some stairs every day-- at home and at the office I have to go up or down stairs just to get to/from the elevator). A week without a single step and it was bad as ever when I got out. Strength training on the other hand makes it better.
posted by If only I had a penguin... at 7:07 PM on June 21, 2009

You are rightly skeptical of arthroscopy as it cannot diagnose or repair many problems, and frequently misses problems, and is the first thing many surgeons will suggest because...they're surgeons.

My advice - get a second opinion from an orthopedic doc who specializes in sports injuries. A general ortho surgeon is not your best bet here as the knee problems of the general population are different from athletic folks. Ask around your soccer circles for recommendations, research on the internet, etc to make sure you get the best care possible. If you haven't had an MRI you should get one. Yes, both the MRI and doc are expensive with or without insurance, but if you don't fix whatever the issue is it could easily become chronic and debilitating over the course of years.

Also - THIS IS IMPORTANT - Be very careful with the self-prescribed exercises and treatments as it is very easy to make a problem worse when you don't know the root cause (as it seems you may have already learned). Knees problems are tricky to diagnose and can be even harder to treat. It sounds like you could have a muscle imbalance issue, in which case general strengthening exercises may not help and could hurt - focus is required. I know this because I developed a quad imbalance from cycling where the outer head of the quad was much stronger than the inner resulting in my kneecap tracking improperly and causing pain above the kneecap. (I am not suggesting this is your particular condition)

Just to give you an idea of the wacky issues hat can be had I also had this problem despite not showing the classic symptoms when my knee was manipulated by the doc, and it appeared on MRI. One cortisone shot and some focused physical therapy later, things are slowly improving.

Good luck.

posted by kgbrion at 3:11 AM on June 22, 2009

You are incredibly young and you have been active your whole life. I think it is unlikely you have injured your knees permanently. Perhaps you need to eat more anti-inflammatory foods, foods high in omega 3s, fruits, vegetables, etc.
posted by satori_movement at 8:56 AM on June 22, 2009