How should I care for my knee injury until I can get to the doctor?

April 2, 2012 3:16 PM

I've been experiencing moderate to severe pain in my knees for awhile. My doctor referred me to a sports medicine doctor and I have an appointment at the end of the month, but what can I do until then to minimize pain and lessen further damage? Ice? Stretch? Strengthening exercises? Resting is only an option up to a certain point.

My knees started hurting months ago, for reasons that seem to be related to bicycling, as the pain started when I started riding my bike more, farther, and harder. The pain feels rather like I've got sandpaper under my kneecaps, and there also seems to be some inflammation going on, as well as some very entertaining and loud snap-crackle-pop whenever I move. I've gotten a new, better-fitting bike and have been working on improving my form (higher saddle, higher cadence, proper pedaling technique) to reduce stress on my knees, and the pain isn't getting worse like it had been before I started working on this, but it's certainly not getting better. My appointment is with a well-regarded specialist in my region, but isn't for another four weeks.

I'm resting my knees/body as much as I can, but realistically, staying off the bike for the rest of the month is not an option. The bike (combined with local transit) is my primary form of transportation, and I have a chronic foot injury that makes walking the distances I travel on my bike painful. I'd like to do what I can to minimize the pain and lessen the chance of further damage, though.

What I've been doing: the aforementioned bike/form improvements, taking 600mg doses of iburprofen (as recommended by my doctor) a couple times a day, icing my knees with ice packs at the end of the day when I've been riding, and trying very hard to break my habit of sitting with my legs curled up under me (which seems to aggravate the knee pain). What else can I do? Ice more frequently? Take some other sort of anti-inflammatory? I'm tempted toward stretching or strengthening exercises, but I don't know if that would make the injury better or worse.

You're not my doctor, but maybe you're *a* doctor with an understanding of how these this part of the body works, or you've dealt with this yourself. What might you recommend? What's worked for you?

posted by rhiannonstone to Health & Fitness (15 answers total)

Without knowing what part of the knee is damaged, it is really hard to guess what to do to help it. One recommendation might work for one condition, and hurt another condition. The only thing I can think of is to double down on making sure your form is correct for the biking and every other thing you do.
posted by gjc at 3:36 PM on April 2, 2012

If you're not already taking them, you might try fish oil supplements and glucosamine/chondroitin supplements.

For the latter, I am a particular fan of Schiff's Move Free line, as their pills are coated and easier to swallow and you need fewer, and I see they have relatively recently introduced one that is claimed to "repair" cartilage mo' better, but Move Free Advanced is the one I've used.
posted by kindall at 3:38 PM on April 2, 2012 [1 favorite]

I've dealt with a variety of knee pains over the last few years, and I find that naproxin sodium (sp?) seems to work better than ibuprofen. Icing is almost always good.

I was given a variety of stretches and strengthening exercises, but I'm not sure if they'd be the right ones for your particular knee issues. One thing I do remember was the PT telling me that having strong thighs/quads helped with knee stability. I did a lot of leg lifts IIRC.

FWIW, I found cycling made my knee feel better after my most significant injury, although I was riding a bike with a very upright position at the time, so that might've been part of it. I was also on stair restriction for several months. If you're in a situation where you're often taking the stairs, maybe try using the elevator?
posted by epersonae at 3:53 PM on April 2, 2012

Are your hamstrings tight? For me, aching under the kneecaps (never popping though) gets sorted out with serious attention to stretching my hamstrings. YMMV.
posted by lab.beetle at 3:58 PM on April 2, 2012

I have chronic knee pain and something that helps me sometimes is to elevate my knees at night. Just put a pillow behind your knees while laying on your back.
posted by postel's law at 4:28 PM on April 2, 2012

Nobody but a PT is qualified to give you exercises or stretching advice.

Having strong muscles around the knee can help protect ligaments, and may provide some relief for damaged joints. Slow controlled lunges are an excellent exercise for this type of thing, but could also make your knees worse if your form is bad.

I do not recommend trying to stretch the knee joint, this will only result in looser ligaments, and a destabilized joint.

For my crunchy knees, I have found the best thing is to move my knee joint through its natural range of motion without any weight on it.

Generally, I sit on the ground in a comfortable position, bring one flexed leg up to my chest, and then I bend and straighten the knee a few times so I can move the knee joint from complete flexion to complete extension.

The knee joint is a complex joint though, not just a simple hinge. While fully flexed, many ligaments go slack, and the knee joint can actually be very gently, very delicately 'circled.' Lateral movement of the knee joint should only be performed while nearly fully flexed and should be EXTREMELY minimal(like a centimeter minimal). You have to really listen to your body to do this without stretching any ligaments, but I have found this was the trick for my bad knees.
posted by satori_movement at 4:35 PM on April 2, 2012

For anyone with kneepain, particularly a runner or cyclist, it's really worth checking out if your ITB is causing it. You could try a quick session on a foam roller, and if it hurts really badly on your side, and your knees feel much better afterwards, then you'd know you're onto something.

Many gyms have a foam roller if you ask, and it is well worth paying the casual rate for one entry to the gym to try it out. Also, lots of sports stores or physical therapists that sell foam rollers will let you try it out without any obligation

You can get guides on youtube by searching for ITB and roller:

One Example
http://www.youtube.com/watch?v=oANQDEtHNQo
posted by surenoproblem at 4:55 PM on April 2, 2012

I've been dealing with runner's knee, which like your knee pain also began after what turned out to be an ill-advised "more, farther, and harder" stepup in my routine. No telling if yours is the same as mine, but what seems to be working for me is resting as much as possible and taking it real easy when I do run, wearing a knee brace when I run, icing for half an hour immediately after running, heating for a half an hour before bed, putting some real time and effort into stretching my legs (particularly my hamstrings), and doing these quad-strengthening exercises every day.

Good luck. It sucks when your body betrays you like that. I learned the hard way that you always want to make sure any distance/speed/intensity changes are made gradually, to avoid injuries that really set you back. Also, don't take that ibuprofen before you ride if you can help it. You really do risk injuring yourself further if you just numb the pain and keep on doing the thing that's causing it.
posted by Balonious Assault at 5:43 PM on April 2, 2012

I take Mobic as my NSAID of choice. And I try and keep my bicycle seat high so my knees bend less deeply when I ride. I came to this through trial and error (and I'm still experimenting). Just some anecdata.
posted by Obscure Reference at 5:52 PM on April 2, 2012

Important to bear in mind that knee pain isn't necessarily indicative of a problem located entirely in the knee joint. Being among the most stable joints in the body the knees will often be the first to feel the effects of any postural misalignments located anywhere else up and down the body, such as lack of mobility at the hip or ankle (and cycling, a highly repetitive, limited ROM exercise, is associated with both of these).

One common example disorder is externally-rotated femurs caused by tight posterior hip muscles - easily fixed with a few weeks of consistent MobilityWOD-type stretching and myofascial release, yet there are doctors who would readily cut open a patient's knee a dozen times sooner than think to look for such a simple muscular issue going on in the adjacent joint. Hopefully you'll get a good PT who won't treat your body as a collection of separate and distinct parts - if they fail to assess your body as a whole, leave and find someone more qualified.
posted by Kandarp Von Bontee at 5:53 PM on April 2, 2012 [1 favorite]

I spent some time recovering from "patellofemoral pain syndrome"; I would second "Nobody but a PT is qualified to give you exercises or stretching advice." I would also encourage losing the "but I have to keep repeating the action that causes the pain" idea; of course staying off the bike for a month is an option. You are unwell and not getting better. Take taxis, put the word out to friends that you're injured and bum rides, stay home, etc.

Can you not get into see a physiotherapist ASAP? I saw a specialist and it was not an appointment worth waiting for; I went regularly to a good physio and was diligent with the prescribed exercises (and icing and so on), and while I wouldn't quite take up jogging now, my knees are no longer painful and they don't make noise.

Be wary of supplements; a lot have really limited research to back them, or research that suggests they may be helpful for people with specific forms or arthritis etc.

I have been at some points pretty crippled with a variety of joint hassles in recent years and I really wish I'd committed to resting at the first sign of a problem instead of buying my ibuprofen at Costco and pressing on. You are unwell; treat yourself appropriately -- accept that rest is a big part of the appropriate treatment at this point.
posted by kmennie at 8:08 PM on April 2, 2012 [1 favorite]

I fell on my knee earlier this year, and have been in PT for a few weeks. Most of the exercises that I am doing have little to do with my knee right now, but with strengthening other muscles in my legs. This has helped immensely, since when my knee was inflamed, some of the muscles stopped working.

I still ice after my exercises, so it is not a bad thing that you do ice.

Don't try stretching/exercises on your own before getting a medical opinion, maybe you can get in with a more common sports medicine PT sooner than the end of the month? See if they think stretches/exercises will help, and get you started.
posted by effigy at 8:36 PM on April 2, 2012

Seconding what kmennie said. A couple weeks of an annoying commute is not worth exacerbating an injury.
posted by vasi at 9:04 PM on April 2, 2012

I'm not your PT, but like effigy said, strengthening the muscles around your knees and core will help a lot (and is probably what your PT will prescribe).

If you really want to do a few exercises while you're waiting for your appointment, try these two. My PT had me do 2-3 sets of 10-15 every other day, among other things. Lift and lower your leg slowly to make sure your muscles are really engaged. I felt both of these more with my foot flexed.

Icing works for my knees too, but no more than 10-15 minutes in one spot. When I had a knee injury, I would wear a brace during the day and try to sleep on my back with a giant pillow under my knees.

Listen to your body. If it says no, then take it easy. I think you should pursue options for minimizing your cycling until you can talk to your PT.
posted by stompadour at 8:05 AM on April 3, 2012

Response by poster: To follow up: I rested when I could and applied ice and ibuprofen liberally, and when I got to the doctor he said that was the right thing to do while I was waiting--and that the injury I have (patellofemoral pain disorder with chrondomalacia patellae, whee) is not exacerbated by cycling, as long as I'm not grinding up hills on high gear. I was prescribed physical therapy with the core- and quad-strengthening exercises and foam rolling many of you mentioned, and given a blessing to keep cycling (with proper form) and try swimming, too.

This will not necessarily apply to anyone else's particular injury, but there it is just in case you were curious or someone else finds it useful.
posted by rhiannonstone at 12:33 PM on May 3, 2012 [1 favorite]