Knee problems

[bill bowden]

Lately I've been experiencing some pain in my left knee on downhills. the center is behind the kneecap. Years ago i had thispborblem and dealt with it by a combination of hamstring curls and quad extensions but I now have pain when trying to do the quad exercises.

I'd love an explanation of what is going on; suggestions for what has worke dfor others are also welcome.

 

[Neil]

I oughta open an internet healing center!

Sounds to me like a case of Patello-femoral syndrome which is a term that means: get ready...pain behind the patella. It's due to all the abuse you've been heaping on that little sesamoid bone (the kneecap) by making it rub along the femur as you go up and down the mountains.
Why one side and not the other? The exact cause in your case? How to fix it? Those answers are beyond the clinical competence of the internet.

 

[DougPaul]

Your symptoms sound consistent with chondromalacia patella.

However, a lot of things can go wrong with knees--get it professionally diagnosed. Once you have a diagnosis, you can start asking the right questions and searching the net.

I had chondromalacia patella and was able to beat it with a straight-knee isometric exercise and time.

Search on chondromalacia for past discussion of this topic.

Doug

edit: orthodics also helped. But what helped me may not help you...

 

[David Metsky]

See your doctor. There's no way to accurately diagnose a problem with a joint as complicated as the knee over the internet, especially with people who are not medical professionals. People can give you some ideas of what could be wrong, but not what is wrong with you. Following incorrect advice can do damage to an already compromised knee.

See your doctor.

-dave-

 

[Kevin Rooney]

Uh, Dave .... Neil's a chiropractor -

 

[dr_wu002]

Small Animal Psychiatrist

Uh, Dave .... Neil's a chiropractor -

Well, according to his own website, I think he moonlights!

Any pet problems?

-Dr. Wu

 

[Neil]

.... Neil's a chiropractor -

Actually, I'm a chiropractor in my spare time only. My day job is hiking.

I'm always skeptical of what someone thinks cured them (you should hear the stuff patients tell me) and I always wondered about DougPaul's (and others) isometric exercises for his knee problem. They and variations are commonly used non-pharmaceutical interventions. A good hypothesis for why it worked, if indeed there were no co-interventions, is that his quads and maybe of lesser importance, his hams may have been weak and/or lacked endurance so when descending his patella was allowed to move all over hell's half acre in there. Getting those muscles nice and strong may have stabilized the pat-fem joint.

A lot of people have a weak VMO muscle (Vastus Medialis Obliquus) which is really just a portion of the VM muscle which is important in keeping the patella in its track along the front of the femur. Standard protocol is to extend the knee to 5-10% less than full extension and do a series of little 10 degree flexion/extension. You rotate the hip joint externally so the foot is pointing outwards at about a 45 degree angle. I like 20 reps with the 20th being very very hard to do.

I have no idea if this has anything to do with Bill's problem, it's just interesting stuff to know. Like the man said, see a doctor. There could be a foot problem contributing too.

 

[Neil]

Well, according to his own website, I think he moonlights!

Any pet problems?

-Dr. Wu

Oh $hit, I'm busted! Thanks Wu, wait til I get a hold of your cat and destroy its mind.

 

[AdkWiley]

my left knee has been bugginme latley also, and especially on teh downhill unless i try ot stiff leg it. Good info so far, I've been wrapping it with an ace bandage for a little extra support but was wondering if an actual brace would help, but from teh sounds of thing it sounds liek the knee would benifit more with a little exercise. Scary stuff though, my hiking buddy jsut had surgery on his acl lst week. hes out of the hiking picture for awhile now

 

[Neil]

my left knee has been bugginme latley also, and especially on teh downhill unless i try ot stiff leg it. Good info so far, I've been wrapping it with an ace bandage for a little extra support but was wondering if an actual brace would help, but from teh sounds of thing it sounds liek the knee would benifit more with a little exercise.

That sounds like a cartilage issue. The swinging (circumducting) the straight leg is a tip-off. It can ruin your day if it's bad enough. It can hurt like hell and then the next day evrything may go back to normal. All clinical tests and imagery normal too. If the cartilage has a tear in it though that will show on MRI or be visible on arthroscopy. I don't think taping, wrapping or bracing is any good for it, if that's what it is. Believe it or not but it is possible to manipulate that cartilage back into place right there on the trail and perform a miracle. There's no way I'm going to tell you how to do it here though!

The best advice given so far on this thread is to see a doctor.

 

[jjmcgo]

Hey Neil

My right elbow hurts when I do this ....

 

[Neil]

My right elbow hurts when I do this ....

Keep doing it and it'll go away, then later on you'll get a headache. 50 bucks please.
Next!

 

[AHIKER]

Can I assume you are using poles???

Can't take anything for granted these days so I have to ask...are you using hiking poles??? I think it was back in the early 90's that I had thought I'd be giving up hiking with a pack because my knees hurt every time I went out. It would start a few hours down the trail and I knew it was "over" after that as it would just get worse. Someone told me to try hiking poles. I have been hiking an average of 600 miles a year since then and no knee problems!!! I am 67 now and have already done 300 miles this year. I am off to Tenn in two weeks for a 130 miler on the AT. I'm surely glad someone told me to invest in a pair of poles! If you are already using poles I can't help you - sorry.

 

[--M.]

==They're all right: see a (highly qualified sports) doctor. It made a big difference for me, including orthotics, NSAIDs and perspective. Just don't feed their massive egos by buying their stuff uncritically.

==Poles: YES! They take pressure off the knees and build upper body strength. "Twenty bucks at Ocean State Job Lot," as someone here told me. Also, I saw a southbounder do the most unbelievable maneuver with them last year. Happy to share upon request (slightly OT).

==Weights: Hitting the Nautilus and beefing up helped me a lot. Just had to make sure I did it progressively and gently. No more macho for me.

==Proper footwear: ankle support, stiff sole. Limmer.

==Pare down weight.

Best wishes, and don't make it worse!

--M.

 

[Jazzbo]

Jazzbo's 2 cents

I'm firm believer in trekking poles. I went hiking with Bill last weekend. No disrespect and I truly hope he will continue to hike with me but Bill uses one old beat up ski pole. Two poles are twice as good as one pole and like previous commenter said they do take alot of load off knees especially for us high mileage older dudes. Tip to you younger guys and gals ... taking the long range view .... IMHO Judicious use of poles starting at an early age could help postpone your eventual knee/hip replacement surgery by good 5 years. Improved balance also helps avoid slips trips fumbles and tumbles!

 

[CaptCaper]

Lately I've been experiencing some pain in my left knee on downhills. the center is behind the kneecap. Years ago i had thispborblem and dealt with it by a combination of hamstring curls and quad extensions but I now have pain when trying to do the quad exercises.

I'd love an explanation of what is going on; suggestions for what has worke dfor others are also welcome.

Go see a doctor ( Arthroscopic Surgeon ) because if you had damage it will make it worse. I hope he puts you in for a MRI as that showed my damage some of it anyway. The doctor before him didn't and the damage did more damage with time.

The worse part didn't show until he went in with the small scope and saw it.

The operation was great. In and out in one day. I wish I did it years ago. Now I want the other side done next year.

 

[jmegillon149]

had similiar problems last summer, my knee got really stiff on the home stretch of longer hikes, sounded similair, few things, keep in mind I am not medically trained, but am a longtime athlete and am offering advice purely from experience

1. I already used poles, and definately use two, the reason one is hurting is possibly due to favoring by using one, also the factor that no one truly carries all their weight evenly, especially on uneven terrain

2. I stopped running, I think the impact bothered me

3. Carry icy hot sleaves in the pack, they help a lot when stiffness hits, and you can look Shaq-like!

4. Ditto for back and body specific painkillers, more focused pain relief than the regular stuff

 

[griffin]

One more voice for "see a doctor/orthopedist" - ESPECIALLY before you start doing strengthening excercises.

I too was starting to have trouble with my one knee, and was diagnosed with patellar chondromalacia (which, having researched it online, can be something of a catch-all term). The Rx was to let it rest until it felt better, then a stint in physical threrapy to strengthen the muscles supporting my knee, and correct a bit of an imbalance that was adding to the problem, and it's made a huge difference.

Here's the trick though - a number of well-meaning friends had suggested excercises they'd been given over the years, all of which I could have done on my own, but serveral of which would have actually made matters worse had I done them (mostly by exacerbating the above-mentioned muscle imbalance)

 

[bill bowden]

Correction

I'd like to add a minor correction to Jazbo's comment. The ski pole is pretty new, it's me tha is old.

Hamstring curls are helping significantly in reducing downhill pain

 

[Seeker]

I certainly wouldn't try to diagnose, but I can comment on a couple of things that have helped me with knee pain.

Strength training.

Ice, of course.

Shorten your stride when descending. This actually helps quite a bit--not sure. Why.