Pain in the Knee

[chipc]

some more info

http://www.merck.com/mmhe/sec06/ch078/ch078d.html
Some more info on pain relievers and anti-inflammatories. While the page is from Merck, the "Merck Manual" is a well-respected reference.

Just one other point is that NSAIDs such as Ibuprofen can be taken at two dose levels: 1) relatively low analgesic doses to relieve pain (the dose on the label) and 2) higher anti-inflammatory as guided by your doctor.

An anecodotal experience. Last summer I had pain in one of hamstrings that sometimes went extended to the hip. I had taken for a week or two Ibuprofen at low dose which was only somewhat effective at pain relief. After going to the doctor who was thinking that I have might sciatica, she first suggested hitting it hard with Ibuprofen. Within a week at the higher anti-inflammatory dose the pain went away and has stayed way. Conclusion was that I had tendonitis in the hamstring, not sciatica and that I hadn't used a strong enough dose in the first place.


(usual disclaimers in place - please see a health professional!)

 

[JohnL]

I had a very painful case of ITBS last year during two long hikes, the first manifesting itself at 20 miles and the second at 10 miles. A professional diagnosis and treatment (simple stretching) has kept me pain free since then. I continue to perform the stretches on a regular basis. Interestingly enough, in both cases, I was pain free three days after the hikes (this was prior to diagnosis and treatment) and I continued to exercise as before, even doing heavy squats without discomfort.

As for painkillers, there is some evidence that you can actually assist in the deterioration of cartilage by using NSAIDs to relieve joint pain. Google NSAID + joints + cartilage for more information. There is growing evidence that glucosamine with chondroitin is a better long term solution.

But as said before, consult a medical professional. I am not one.

JohnL

 

[Lawn Sale]

I had a form of ITBS back in April when I went in for knee pain (from Carrigan and Owl's Head). I went to a specialist and they found it to be the lower end of the ITBS. I have had my back aligned, am wearing orthodics, and with the strength training and ultrasound, I am once again back to normal. Well, as normal as I was since I still have arthritis, but I'm cycling often and have started running again, both pain free (in the knee, the muscles are still getting used to running again).

I definitely recommend seeing a specialist and working with them, a good one is worth their weight in gold.

 

[Aviarome]

To address the kidney problems of NSAIDS, basically, NSAIDS block the antiinflammatory properties as mentioned above. These include prostaglandins, which are important regulators to sodium and water reabsorption, and helps regulate blood flow to the kidney. When you take NSAIDS at chronic, high doses, you can decrease the blood flow to the kidney that could potentially cause renal failure. Also, by affecting the sodium and water reabsorption, it can affect blood pressure.

aviarome

 

[arghman]

One downside of these drugs is that by treating the pain, they encourage one to over use the structure in question. It would be nice if there were a similar (OTC, nonprescription, nonsteroidal) drug which treated the inflammation, but not the pain.

amen to that.

 

[CaptCaper]

I would get a second opinion. Get Xrays, and more importantly MRI.

I had two different doctors fouled up on me over the years. They make wrong calls like any of us.

I'd go and see a knee surgeon. Lucky that I found Dr. Chen in Litttleton NH who's the US Ski team surgeon. He fixed me up fine.

 

[jrichard]

asprin

Little known fact (probably due to marketing): In high quality studies, no NSAID pain medication (ie motrin) has been found to be more effective or safer when compared with asprin. Tylenol is gentler on the stomach, but it's not really an anti-inflamitory either.

Edit: The above could be worded better - the studies show that asprin is the safest and most effective of the NSAIDs.

 

[jrichard]

I feel your pain. I've been diagnosed with ITBS, as well as a few other knee-related syndromes - the symptoms didn't change, the diagnosis did. I did some research and found that a "syndrome" diagnosis really means that doctors don't know the real cause and are only making a best guess of a fix based on what worked for others with similar symptoms. This seems to be a gray area in medicine so your milage may vary.

Anyway, what worked for me:

- follow the prescribed exercises and stretches
- build up to bigger hikes (no more weekend warrior stuff)
- lighten up on pack weight and body weight

 

[jjo]

As Doug says, stick w anti inflams like Advil or Aleve. Don't use Tynenol which only relieves the pain somewhat. Just MHO...

 

[chipc]

more on NSAIDs and heart problems

possibly even more to be concerned about:

http://news.yahoo.com/s/nm/20060522/hl_nm/common_painkillers_dc

 

[HikerAmiga]

Thank you all for sharing and great advice!!

Wow! This thread certainly generated a lot of feedback!

I believe I learned a few things here and I am happy to report that already with the stretching, NSAIDS, icing after use and just taking it a bit slower when active, I am feeling better!!

Guess I may be "nipping it in the bud" as they say!

Happy trails everyone!

 

[jjo]

Forgot to suggest: Use hiking poles. Takes much of the stress off the knees.

 

[Paradox]

I have delt with ITBS, twice. Both times when I was running on a regular basis. Walking was no problem. I could run for a certain distance, the first time 5 miles, then a few years later about 1 mile. Each time the pain would come on at specific distance and in about 10 paces I could no longer run. Walking was fine. I stopped running altogether. At the time I had a book "Lore of Running" third edition by Tim Noaks, MD, that gave a pretty poor prognosis for ITBS. 6 years later I purchased the 4th edition (2001) and he describes a better program for rehabilitation, and gives it a much better prognosis for the sufferer.

5 years later I'm fine. I still do the stretches on an irregular basis. Run only about twice a month never more than 5K, and use the elliptical trainer almost daily. The only time I take naproxin is as a preventative just before starting a long hike. And that is to prevent runners knee on the decents rather than ITBS. Do a million crunches, situps and back extentions. Rest the knees and do your stretches, you will do fine. Ask your physician about having a cortisone shot just before taking on your goal. That might help.

 

[Paradox]

Iliotibial band syndrome (ITBS) is different from the runner's knee that I describe above. ITBS is usually felt on the lateral aspect (outside) of the knee just where a large tendon (the iliotibial band) rubs over a bump on your large thigh bone (the femur). Press hard here and flex your knee you will feel the band move back and forth across the bump. The runners knee is in front at the bottom of the patella (knee cap) it is much more common, and is usually a much quicker fix with proper stretching and better fit shoes. The "Lore of Running, 4th edition" is excellent, I recommend it strongly.

 

[Puck]

Plenty of discussion here of allopathic OTC treatments and the adverse events they could cause.

There are alternatives. This is a great book with alot of A&P to help you understand what is going on with your injury. It has a heavey slant toward runners.

 

[jjo]

You guys know about my knee condition which has been sporadic, hanging around longer now and severely impacting my time hiking..My mri's just came back and spoke with M.D. last week. In addition to chrondomalacia, I also have IT Band condition. Had my first appt with a PTherapist last wed, and started the exercises. Already, the knee feels stronger (maybe psy effect) Going tommorrow for 2nd appt and she'll probably "step it up". I'm encouraged...Stay tuned. All I know,I miss the trails. Right now, I'm landlocked. Thanks for this thread...

 

[LivesToHike]

HikerAmiga - I don't think I have experienced IBFS condition you mentioned. But a couple weeks ago I fell on the way up the Valley way on snow and ice, aggravating Chondromalacia Patella, a condition I had 20+ years ago when I was running alot more often but not doing any lifting. I haven't been to an physician yet. I'm trying to strengthen my quads. I'm still walking, hiking and bicycling, but I've cut my mileage considerably and avoiding any running for now.

I hoping that you find the right combination of pt, shoes, Rx and other adjuncts. I hope that you heal well and soon. Good luck with it.

--LTH

 

[HikerAmiga]

Thanks for this thread...

You are most welcome!! ITBS is very new to me and I think that because I lucked out on having it checked out early on, I was able to nip it in the bud and am feeling much, much better! I sense from this thread that many of you have suffered for far longer than I had and may even have a more serious condition than mine and other conditions as well.

I sense too that people like us are open to healing whether by our own means and/or by medical doctors/therapists but also want to maintain the balance of remaining active and not letting these conditions deter us. Hence, I believe this thread has provided a wealth of information for all of us at various stages of knee discomfort in finding ways of dealing with these conditions.

I am very happy to have provided an outlet for many via this thread! (Makes the RED square I received for posting this in the wrong category a bit more tolerable).

Much luck to all and may you heal well and fully!

 

[Waumbek]

The ITBS stretching exercise that works best for me was suggested by a great PT. It's hard to describe. Lie on your side right along the edge of a bed with the affected leg or knee on the upper side; allow the affected upper leg to dangle down over the side of the bed. Do not fall out of bed.

 

[LittleBear]

One real problem with ITBS is that if it is not treated promptly it can become nearly impossible to remedy. I experienced it several years ago while descending from Osceola. Took me an incredibly long time to get back to the car. Each step down brought excrutiating pain. I thought my hiking days were over. After four weeks of icing, stretching, ibuprofen, and no hiking, I was back on the trail - pain free. I have had two minor incidences since then, each responding almost immediately to stretching.