It's been a super busy weekend for me, so I'm just getting around to this blog post now.
I thought I'd keep this short today and ask if anyone out there is struggling with a particular problem when it comes to their knee pain.
Want to share? Someone here (either me or one of the regular blog visitors) might have some ideas about what you could try next.
Or, if you'd prefer to discuss something else, that's fine too. The comment section is wide open.
Meanwhile, I hope you're all staying safe. In America, the vaccines are becoming more widely available. I haven't been able to get one myself, but my mother has, and my father is getting close.
We just have to hang in for a few more months, then hopefully life starts to return to normal.
Best wishes to all, and keep moving those knees!
I have been dealing with a knee issue since mid 2017 when I felt something "tweak" while doing "sissy squats" as part of a strength training program for mountain endurance sports (mostly trail running).
ReplyDeleteSince this incident this knee has bothered me off and on (mostly on) and several Orthos have diagnosed it as Patellofemoral Syndrome or PFS, with pain symptoms seeming to jive with the diagnosis.
Running and cycling both aggravate it, sometimes one aggravating more than the other and vice versa. I've tried the following methods for relief/cure:
- Rest from running/cycling. I had a 4-5 month period of rest from running/biking when I had a minor hip surgery. As soon as I got back to running/biking the pain came right back.
- Strength training, particularly those described as targeted for relieving PFS (quad strengthening). Step ups, and wall sits can really aggravate it although after a few reps the pain lessens during the activity (just as it does with running/biking), it comes back after as if I've damaged something.
- Robin Mckenzie "treat your own knee" regimen - Mostly the isometric holds that he recommends. I've gotten relief from this, but not a cure.
- Stretching and tissue work that supposedly helps PFS - Mostly foam rolling the quads and IT band and similarly stretching these areas. Similar to Mckenzie's regimen, this helps but does not cure.
- Treating my symptoms as Dr Sarno's "TMS". While this treatment has worked with other chronic pain I've experienced, this knee pain has not responded to that methodology at all.
- NSAIDs/Anti-inflammatories - Naproxen/Ibuprofen will knock the pain out altogether after a few days of steady use, but this isn't a long term solution.
What has been maddening about this condition is that sometimes, out of the blue seemingly, I will have a "good day" and the pain will be gone and I'll be able to cycle or run with no pain at all. I'll be able to ascend/descend stairs with no pain at all, and I'm left wondering what was it that I did that precipitated it? I haven't been able to solve that riddle though and the very next day it will be back with a vengeance.
So, I'm willing to try something new or welcome suggestions on what I might be doing wrong. Thanks for providing this forum for discussion.
I think that with regard of "good day" and "bad day", Richard solved this in his book.
DeleteThe first thing to realise is that PFS is not really a diagnosis. It is that the 'experts' trot out when they can't see an obvious cause of the pain.
DeleteMy definition of PFS is the Dr Scott Dye definition - chronic inflammation of the knee structures which causes anterior knee pain/burning/stiffness, almost always due to overuse.
A 'tweaking' does not fit with that definition, as a 'tweaking' during exercise sounds more like an acute injury (e.g. cartilage or tendon tear, fat pad impingement' rather than inflammation from overuse.
And the fact that your pain will disappear for a day, then come back does not tally with the Dr Dye definition of PFS either - though as said above, PFS is not really a 'thing'.
Where exactly is the pain (lateral, medial, under kneecap, back of knee, joint line?). That is your first clue as to what it might be.
The pain is directly behind the kneecap. Sometimes, particularly when cycling I can tell it moves a bit more towards the inner part of the kneecap but that's rare. I feel a stabbing when I go up stairs usually, almost always going downstairs, and oddly when the knee is bent and I am moving around in bed, or getting out of bed. I point out that last aspect because there is no weight/load on the knee at that point.
DeleteThe "tweaking" was definitely an event I remember, I felt a sharp pain during those sissy-squats and this issue has been with me ever since. I suppose it could coincidence and that acute-injury healed and this other issue took its place. However, 4-5months of rest did not resolve anything when I had my hip surgery.
ReplyDeleteThose symptoms sounds more like patella chondromalacia = damage to the cartilage on the back of your kneecap. I've had that for 40-odd years. It comes and goes, but is much easier to handle than chronic loss of knee homeostasis.
DeleteThe conventional wisdom is that this is a condition that might need surgery (e.g. the dreaded shaving/smoothing of the cartilage on the back of the kneecap, or micro-fracture where they drill small holes which then heal with a cartilage-like substance). Or physios will tell you it is patella tracking problem - which I think is bunkum in most cases.
Anyway, I never had surgery and my symptoms are now much, much better which tells you it can heal spontaneously. In my case, I think the things I was doing to cure my loss of knee homeostasis also helped my patella chondromalacia....and that did not involve complete rest.
Thank you for the response(s). It's nice to be able to talk about this without getting the standard answers I've received from Orthos/PTs.
ReplyDeleteOne very consistent symptom with my situation is that activity relieves the pain. For example, I can start a run and feel twinges and pains in the first mile or 2 but it eventually evens out and goes away altogether. That relief will even last for some time post run.
Same thing when cycling, I'll have that same ouch sensation early on, but then the knee "fills out" (hard to describe the feeling) and I'm good for the ride even long 3+ hour rides. For a long time, and sometimes the rest of the day, the knee is fine.
But then it's back at night, or definitely the next day.
As I said above, occasionally I'll get those days that from the very first step or pedal, there's no pain at all. Those are very rare though.
Oh yeah, mine was exactly the same. My knees would feel shit for the first 5mins of a run, then as they warmed up, the pain would go away. But later that day or the next day, the chondromalacia patella pain would come back. Pushing in the clutch in the car was always painful when it was flaring.
DeleteI always found my knees were better running straight off a bike ride as they were nicely warmed up. That is still the case today....when I can run. Other running-related injuries mean I can't get any consistent run training done these days which is frustrating, though my bike & swim fitness is improving nicely.
It sounds like I might have this same condition then, what did you do to help yours?
DeleteIt happens the Same for me.. I always wonder why Pain appears at Second ot third day.. Not when cycling....any other advice..
DeleteI did nothing specifically aimed at fixing my CP Brian. I was knocked out of almost all exercise except swimming with a pool buoy and my ankles strapped together (i.e. no kicking) for over 5yrs due to loss of tissue homeostasis in both knees following a meniscus surgery. i.e. exactly the same thing Richard had - it was his book and this blog that helped me diagnose that. The CP just improved as a result of not being able to run or cycle any more.
ReplyDeleteThen as I got better, I got back into more core/hip/glute strengthening and I think that helped me return to cycling (and a little running) without the bad CP problem. This makes me think the cartilage can heal to an extent. Research in Richards book supports this.
So it seems prolonged rest from aggravating activities (i.e. years) and re-balancing my muscles helped.
BTW I think my CP and my loss of homeostasis, and possibly my meniscus tear which required surgery was brought on more by grinding big gears on the windtrainer rather than running. My online triathlon coach at the time had me doing some brutal windtrainer sessions and I don't think my knees/hips/core/glutes could handle it. I've concluded online coaches who can't actually see you are dangerous - their cookie cutter method does not cater for different body types (i.e. I have chicken legs - not enough muscle to support big gear grinding). Now I do far less big gear slow cadence grinding and much more more spinning at 90-100rpms.
Interesting stuff, thanks for sharing. As a result of my hip surgery in 2018 I have been hyper-aware of the hip/core/glute strenghening routines and do several of those routines 5+ times a week.
ReplyDeleteSome of the knee-pain-fix sites can attribute part of the problem to weak hips/glutes, or lack of flexibility in those areas. So, I've been trying that the last few months to see if it makes any difference. I figure it's a no-lose situation, that type of core work is good for athletic health anyway.
So in addition to Dr Robin's isometric holds (which can alleviate the pain almost immediately sometimes), I do band work to target the mid/medial glutes and roll/stretch the glute/hip/ITBand/Hamstring area daily.
Seems to be helping, my pain level is less than it was when I started all of this but if it's truly cartilage-related then I have several more years of incremental improvement ahead of me before I'm pain free. I'm 49 so healing is only going to continue to slow as well.
You mentioned wind-trainer, I have an elliptgo-arc that I ride to supplement my run and bike fitness. Nothing aggravates my knee like that Elliptigo though, something about the way the knee rolls-over on its cadence is just bad on that thing. The reason I bring it up is I haven't ridden it much this year, maybe my improvement is just attributed to not aggravating it on the elliptigo.
I have been struggling with knee swelling/pain sporadically over the past 7 years and got frustrated with the Ortho's recommendation of RICE... I finally got an MRI and found out it is a real problem - stage IV Chondromalacia, no cartilage in part of my knee joint. I found your book on google and then Doug Kelsey's book and now I'm starting online therapy with the PT he recommends - I'm so grateful. What I'm curious about is if you've known much success of people in their mid 30s in surgery. I seem to see pretty low success rates so I'm not seeing the point of paying a ton in surgery... any thoughts?
ReplyDeleteI was also curious if you ever got an MRI and diagnosis of Chondromalacia? If so, what stage of chondromalacia were you at?
ReplyDeleteI am 29..stage 4 of chrondomalacia. Currently doing physio sessions hoping to regenerate my cartilage soon. How is it going for you?
ReplyDelete