Calling all doctors: Knee swelling with calf pain, long-term
June 27, 2015 12:39 AM Subscribe
My right calf has been bothering me for a couple years now, off and on. It was better for a while and it started bothering me again recently. Today, I tripped over something and caught myself with a big step on my right leg, which made it hurt more. A couple hours later, I was in a hurry and started to turn my brisk walk into a jog and soon as I did that, I felt something pull or twist or rip or something in my right calf... (continued below)
Now my calf hurts badly enough that when I walk on it, I am avoiding putting weight on it. I can still walk, but it hurts and I am hobbling slightly. Doesn't really hurt when I'm sitting, but if I press on it I can very slight pain. The calf seems slightly swollen too.
I've asked about my right calf, and also swelling in my right knee before here. My calf question. My knee question. I feel like they may be related somehow. The swollen knee seemed to kind of get better, but not really. I just sort of accepted that my knee was slightly puffy sometimes. For the knee question, I had an X-ray which didn't find anything. I had an X-ray of my calf around the time of my calf question, nothing showed up. I also had an ultrasound or whatever to check for blood clots, which came up empty. With whatever I did to my calf today, I feel very slight pain in my knee, where the swelling is on top of the knee cap, which makes me think they are related.
What on earth could be the problem and was sort of test would diagnose it? If I already did X-rays and a venous ultrasound, what should I do next? Is it possible I tore something or damaged my muscle or ligaments, and it's never healed after all this time? Is it possible surgery could make the pain go away? I'm no athlete, but if I were an athlete, I feel like someone would find what was wrong and fix it. Doctors haven't been that helpful. I will go to a doctor again, but I'd like to know what kind of doctor to see and what to ask for. Also, I can't see a doctor for another week or so, so please tell me this isn't urgent. Thanks!
Now my calf hurts badly enough that when I walk on it, I am avoiding putting weight on it. I can still walk, but it hurts and I am hobbling slightly. Doesn't really hurt when I'm sitting, but if I press on it I can very slight pain. The calf seems slightly swollen too.
I've asked about my right calf, and also swelling in my right knee before here. My calf question. My knee question. I feel like they may be related somehow. The swollen knee seemed to kind of get better, but not really. I just sort of accepted that my knee was slightly puffy sometimes. For the knee question, I had an X-ray which didn't find anything. I had an X-ray of my calf around the time of my calf question, nothing showed up. I also had an ultrasound or whatever to check for blood clots, which came up empty. With whatever I did to my calf today, I feel very slight pain in my knee, where the swelling is on top of the knee cap, which makes me think they are related.
What on earth could be the problem and was sort of test would diagnose it? If I already did X-rays and a venous ultrasound, what should I do next? Is it possible I tore something or damaged my muscle or ligaments, and it's never healed after all this time? Is it possible surgery could make the pain go away? I'm no athlete, but if I were an athlete, I feel like someone would find what was wrong and fix it. Doctors haven't been that helpful. I will go to a doctor again, but I'd like to know what kind of doctor to see and what to ask for. Also, I can't see a doctor for another week or so, so please tell me this isn't urgent. Thanks!
And I see from your previous questions that you have seen an orthopedic before. In that case definitely go back (or to a different one if you didn't like the first one). In general physicians look for and treat more common/less serious things first, then dig deeper if their first course of action doesn't work. So it is important to let them know that the problem is getting worse so they will know to look at other causes.
posted by TedW at 3:29 AM on June 27, 2015 [1 favorite]
posted by TedW at 3:29 AM on June 27, 2015 [1 favorite]
I think your mother had it. Muscle knots absolutely are a thing, as are tears in muscles chronically tightened due to the presence of untreated knots, as is joint pain caused by the same chronic tension. Knots are more likely to occur in muscles overworked occasionally rather than frequently worked within their limits.
Don't reach for the scalpel just yet. Give what is almost certainly a little tear in your calf a week to settle down, then hie thee to a masseur.
Until then, Epsom salts in a hot bath will be your friend: magnesium is good for loosening tight muscles, and you can absorb useful amounts through your skin from the bathwater. If your diet is light on for fruit, you might also benefit from a vitamin C supplement.
To discourage future calf knots, do some gentle calf stretches as soon as your walk has warmed them up a little, then another set when you're done. Preventive self-maintenance costs less and works better than post-injury medicine.
On medicine: you might want to visit a podiatrist and get your gait and posture checked over.
posted by flabdablet at 4:45 AM on June 27, 2015 [1 favorite]
Don't reach for the scalpel just yet. Give what is almost certainly a little tear in your calf a week to settle down, then hie thee to a masseur.
Until then, Epsom salts in a hot bath will be your friend: magnesium is good for loosening tight muscles, and you can absorb useful amounts through your skin from the bathwater. If your diet is light on for fruit, you might also benefit from a vitamin C supplement.
To discourage future calf knots, do some gentle calf stretches as soon as your walk has warmed them up a little, then another set when you're done. Preventive self-maintenance costs less and works better than post-injury medicine.
On medicine: you might want to visit a podiatrist and get your gait and posture checked over.
posted by flabdablet at 4:45 AM on June 27, 2015 [1 favorite]
IANAD. My only claim to any knowledge is that I have chronic left knee arthritis/degenerative pain, and I've also spent the last near-decade reading hundreds of thousands of orthopedist reports, MRI reports, and more, for Bodily Injury insurance claims that often involve knee injuries. This is not advice. It is just information to consider bringing up with your doctor.
Xrays are a conservative, first-step diagnostic test. When xrays aren't showing much or anything, and you've had these complaints for months or years (however on-and-off these complaints may be) and other conservative treatment has not worked for you (physical therapy, etc) it's very likely time to have a CT scan (which it appears you did have) - better yet, an MRI - to determine what, if any, underlying musculoskeletal issues may exist. MRIs are more costly, but they can help the doctor in finding objective sources of joint diseases like bursitis, ligament or tendon tears, and so forth.
Physical therapy is another conservative treatment to pursue before coming to an MRI, but if this was me, I'd want to see a physical therapist in tandem with an orthopedist. They can determine if and when you need an MRI; and if invasive interventions like knee arthroscopy or fluoroscopic steroid injections may eventually be warranted. I also would not rule out seeing a rheumatologist, just for a second opinion.
Knee pain can come from many places - again, this is why it's probably necessary to find yourself a good specialist doctor like an orthopedist (you may prefer one who focuses on sports medicine, since you're active and jog, or one who is known to specialize in knees). As flabdablet said above, your gait and posture are one thing that could be responsible, and a podiatrist can help you there. For example, your illiotibial (IT) band controls your hip movements, but is also responsible for stabilizing your knee. If your gait and posture are putting undue wear and tear on your hip and thereby your IT band, for example, that could be partly or wholly related to your knee pain or your knee's vulnerability.
Concerning the calf, it could be radiating pain or referred pain from the knee. From what you've described, trigger points come to mind. If you see a doctor who agrees, this is where foam rolling or Rolfing may be a solution.
So, as you suspected, it could be a lot of things. Again, if this was me (and I'm not you!), I'd be asking to see an orthopedist, and asking if it's time for an MRI so we can figure out what's going on below the surface.
If surgery is not for you, or even if it is but it's not 100% effective, some people eventually choose to see a pain management specialist.
Some things I do at home for knee pain, but please review with your doctor first:
- I take collagen supplements (I find that it has helped, but studies are not yet definitive)
- I take liquid fish oil (one study indicating its impact is similar to NSAIDs but probably safer than NSAIDs)
- Yoga, but avoid those contraindicated for knee pain unless otherwise advised by your doctor
- Foam rolling, but be mindful of what you're rolling
posted by nightrecordings at 9:13 AM on June 27, 2015 [1 favorite]
Xrays are a conservative, first-step diagnostic test. When xrays aren't showing much or anything, and you've had these complaints for months or years (however on-and-off these complaints may be) and other conservative treatment has not worked for you (physical therapy, etc) it's very likely time to have a CT scan (which it appears you did have) - better yet, an MRI - to determine what, if any, underlying musculoskeletal issues may exist. MRIs are more costly, but they can help the doctor in finding objective sources of joint diseases like bursitis, ligament or tendon tears, and so forth.
Physical therapy is another conservative treatment to pursue before coming to an MRI, but if this was me, I'd want to see a physical therapist in tandem with an orthopedist. They can determine if and when you need an MRI; and if invasive interventions like knee arthroscopy or fluoroscopic steroid injections may eventually be warranted. I also would not rule out seeing a rheumatologist, just for a second opinion.
Knee pain can come from many places - again, this is why it's probably necessary to find yourself a good specialist doctor like an orthopedist (you may prefer one who focuses on sports medicine, since you're active and jog, or one who is known to specialize in knees). As flabdablet said above, your gait and posture are one thing that could be responsible, and a podiatrist can help you there. For example, your illiotibial (IT) band controls your hip movements, but is also responsible for stabilizing your knee. If your gait and posture are putting undue wear and tear on your hip and thereby your IT band, for example, that could be partly or wholly related to your knee pain or your knee's vulnerability.
Concerning the calf, it could be radiating pain or referred pain from the knee. From what you've described, trigger points come to mind. If you see a doctor who agrees, this is where foam rolling or Rolfing may be a solution.
So, as you suspected, it could be a lot of things. Again, if this was me (and I'm not you!), I'd be asking to see an orthopedist, and asking if it's time for an MRI so we can figure out what's going on below the surface.
If surgery is not for you, or even if it is but it's not 100% effective, some people eventually choose to see a pain management specialist.
Some things I do at home for knee pain, but please review with your doctor first:
- I take collagen supplements (I find that it has helped, but studies are not yet definitive)
- I take liquid fish oil (one study indicating its impact is similar to NSAIDs but probably safer than NSAIDs)
- Yoga, but avoid those contraindicated for knee pain unless otherwise advised by your doctor
- Foam rolling, but be mindful of what you're rolling
posted by nightrecordings at 9:13 AM on June 27, 2015 [1 favorite]
there are some good suggestions above, but please be evaluated by an orthopedist or sports med doctor before doing massage or rolfing on an acutely injured limb.
posted by treehorn+bunny at 9:35 AM on June 27, 2015 [2 favorites]
posted by treehorn+bunny at 9:35 AM on June 27, 2015 [2 favorites]
Check out the book Walk Yourself Well. Written by a physical therapist, it provides stretching and strengthening exercises to help you correct your gait and posture. It helped me with my intense knee pain. Good luck.
posted by GregorWill at 9:56 AM on June 27, 2015 [1 favorite]
posted by GregorWill at 9:56 AM on June 27, 2015 [1 favorite]
Get it looked at ASAP. Self-diagnosis is notoriously unreliable and would lead to further panic.
Swelling that is not accompanied by pain that increases with pressure (i.e. "feeling tender") at specific locations is more internal than surface problem. You can gently probe around your knee and your calf, with a finger or two, just press down on it and see if it hurts more or less at the swollen sites. Also check if you have muscle tension.
Personally, all of my calf pains are caused by cramps, and only relaxation can "fix" it, and even then it hurts like heck for a while.
Just have a warm bath and soak the calf and the knee. If you can't soak, put warm moist towel on it or such. A massage / massager can help, and don't be afraid of popping a couple OTC pain pills. I keep a bottle of naproxym around, just in case. They are fine for occasional use.
posted by kschang at 2:52 AM on June 28, 2015
Swelling that is not accompanied by pain that increases with pressure (i.e. "feeling tender") at specific locations is more internal than surface problem. You can gently probe around your knee and your calf, with a finger or two, just press down on it and see if it hurts more or less at the swollen sites. Also check if you have muscle tension.
Personally, all of my calf pains are caused by cramps, and only relaxation can "fix" it, and even then it hurts like heck for a while.
Just have a warm bath and soak the calf and the knee. If you can't soak, put warm moist towel on it or such. A massage / massager can help, and don't be afraid of popping a couple OTC pain pills. I keep a bottle of naproxym around, just in case. They are fine for occasional use.
posted by kschang at 2:52 AM on June 28, 2015
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posted by TedW at 3:22 AM on June 27, 2015 [1 favorite]