I know that we have a number of knee experts on SH's. I have a recurring problem with my knee and before I go down the route of Dr's visit and waiting months for a physio I thought, if I described it, maybe someone might know enough about knees to suggest a suitable exercise that might help.
I have a problem with my right knee in particular - very occasionally it hits the left one, but the pain I get in the right one is really bad.
It happens when I walk downhill. On the flat or uphill I don't seem to get a problem, but within about 50 strides of walking downhill I get the most incredible pain in my right knee. It is located at the bottom of the knee cap between the front centre and the right (outside front edge) of that area. It catches me as I take the stride from behind and try to swing the leg forwards and downhill (ouch, ouchy, ouch!!). Walking poles help a little, but on a walk of any length I end up turning to face right and almost walking the right leg down sideways. I walked a long way down a mountain on Saturday and can still feel that the right knee had problems as that area at the bottom of the knee cap is still tender.
I've never knowingly damaged my knee, Though I did have problems with it as a teen, but the doc put it down to cycling at the time.
If anyone recognises what might be wrong and could suggest a suitable exercise that might help, I'd prefer to try something at home prior to going down the NHS route. I suspect it could be one of those tendons that skiers seem to damage with some regularity which makes me think it's worth describing here.
Any thoughts or exercise suggestions would be very welcome. Thanks!
Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Sounds like one of those self-limiting patellar problems. Do you wear high heels? You need to wear flat shoes as much as possible. High heels will make it worse
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peanuthead, high heels only rarely, I've lived in good running shoes with Superfeet green insoles for the last year.
Megamum, I agree with peanuthead that it sounds like a patella issue (from experience of hubby with dodgy knees) but I'm no medic and if it was me I would go to my Physio if I was concerned. However, if you want to try something at home then google up VMO exercises and try those for a bit and see if you get any relief.
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Anyway, snowHeads is much more fun if you do.
sarah wrote:
if it was me I would go to my Physio if I was concerned.
Having keyhole surgery on my left knee in 3 weeks, hope to fit for 2 weeks at Christmas and the New Year.
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Megamum, sounds like similar pain i was having last year on one of my knees.
Having visited a physio myself, he diagnosed it as cartilage wear, due to my patella not quite running correctly over the cartilage. When under strain (running / downhill walking) the patella rubs on the wrong part of the cartilage, causing the pain & swelling.
He said it was a hugely common problem, due to the stresses knees take, and suggested the best way to reduce the pain would be to strengthen the quad muscles in my legs (to ease the force going through the knee in the first place).
I've found cycling, pilates, and doing some simple quad strengthening excercises each day (brushing teeth whilst stood on 1 flexed leg & alternating every 30 seconds) has helped massively.
Hope this helps.
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After all it is free
yup definitely sounds like cartilage wear n tear.. I have exactly the same thing. Currently waiting for my French social security number so I can get keyhole out here!
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online internet advise, or professional physio, if it's that bad I'd be going for the latter myself...no two issues are similar, get some professional advise IMHO........exercises and physio first before any operation would be my advise.............
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Megamum, another recmmendation for seeing a phsyio. I discovered recently that in our area you can now self refer to an NHS phsyio without seeing a doctor. The form was on the website of my doctors surgery.
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Dont know why everybody is just suggesting a physio, they don't tend to diagnose, you need a doctor for that surely? Physios offer rehabilitation for a specific, diagnosed injury do they not?
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Joe_BnB, in my experience physios tend to be as good, if not better, than doctors (I'm talking GPs not specialists) at diagnosing soft tissue injuries / maltracking / pains due to imbalances. If a physio isn't good at this I'd suggest getting a better physio!
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Batman_123, +1. Having had a torn ACL, torn medial meniscus cartelage and strained MCL. I visit to the GP will just suggest Physio first for those symptoms. If there was permanent swelling then the GP may refer direct to a consultant (who would then refer to Physio themselves as well). My GP (who I saw a few weeks ago about my shoulder problems) referred me to Physio (though I had already filled in self referal form 2 weeks before when I made the GP appointment) said that the NHS Physio can refer to a consultant if needed.
You know it makes sense.
You know it makes sense.
Joe_BnB, I saw a physio rather than a GP for sharp upper leg pain.it hurt so much I thought I must have done something serious, but some time with a physio was excellent, who diagnosed the problem and helped me sort out the problem. The physio I saw had volunteered at London 2012 and really knew what to do. So much better than a GP in this occasion
Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
I had a similar dilemma some years ago.
Go see the doctor, let his ascertain whether there is an underlying medical condition (could require a further specialist visit or scan).
If physiotherapy is the answer, or one of the possible answers let the guy with the qualifications make the judgement.
Poster: A snowHead
Poster: A snowHead
Megamum, I agree that a good physio is what you need, BUT around our way it takes forever to see an NHS physio. I'd be inclined to ask around for a good sports physio and make an appointment (ie private). Don't delay - if it's a problem which can he helped with focussed deep massage and exercise the longer you wait the harder it will be to deal with. But ideally you need a personal recommendation from somebody who has first hand experience, preferably also with a knee problem.
Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Many thanks all.
pam w, I was thinking 'private' might be the way to go this morning. I'll look out for your recommended 'Sports' Physio and see if I can find one. In fact I think one of the mum's at the dancing school might be a physio - she might be able to help or recommend someone. At the moment mum has produced a band that fastens just under the knee cap. It feels as though it is holding something in place, though obviously is not fixing any underlying problem so I think I need to find a physio as people above have recommended.
Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Quote:
mum has produced a band that fastens just under the knee cap
Megamum, I have a minor knee problem that has been bothering me for years, but only when it recently started clicking every time I bend it (stairs are particularly annoying), did I decide to get it looked at. I went to the local GP, who I knew wouldn't be able to diagnose it, but requested a referral to a specialist. I saw the specialist this morning at the MSK clinic (3 weeks since seeing the GP), and he will now refer me on to the physio. There are at least 3 NHS physio clinics within 10 mins drive of here, mostly dealing with sports injuries as far as I can tell. I expect it to be about another 2-4 weeks until I get my first physio appointment.
So that is my experience of going through the NHS. My partner injured his knee in a chairlift exit fall 18 months ago and went through the same system and saw the same specialist. His injury was different to mine, but he seems fine now.
One of the reasons I wanted to get a diagnosis was that because I don't understand the problem fully, I have no idea if the types of exercise that I do are likely to make it better or worse. The specialist also noticed some stiffness in my hips which I hadn't really considered, or noticed that much, so the physio should be able to help with that too.
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I have intermittently dodgy knees and have for yeas.
They got way way way better after I bulged a disc in my back and after that I strengthened my whole core and all my leg muscles.
Hi Megamum. I've had similar problems for years. I have consulted doctors but found them lacking in knowledge but reluctant to admit it. I've had some limited help from physios but they generally give the same basic advice and short of paying out a fortune for regular visits they've not helped much.
I've done a lot of research and manage the problem myself. Quad strength and flexibility are important but don't neglect balancing the quad strength with hamstring strengthening/ flexibility as well. Other areas that are very important for the integrity of the knee are the gluteals, particularly the gluteus intermedius and minimus. Mobilising and strengthening these muscles should make a surprising difference. You should also make sure you stretch the TFL, the muscle that controls the tension of the ITB (this runs down the outside of the leg and attaches below the knee) Using a foam roller to help with breaking down adhesions is a good idea. Regular exercise is vital to maintain mobility and paying attention to good mechanics will also help.
I'm 56 and maintain full activity with just occasional painful periods usually when my training has been disrupted. 20 years ago I had days when I could only get downstairs in the morning by sliding on my backside and could barely stand up from a crouched position.
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gryphea wrote:
I have intermittently dodgy knees and have for yeas.
They got way way way better after I bulged a disc in my back and after that I strengthened my whole core and all my leg muscles.
Agree with the poster that said strengthen quads
I had similiar pain after I began more loaded knee exercises - sharp pain right under the patella after doing squats and lunges at the gym.
I was seeing Physio already for rehab after Back op and immediately diagnosed it as "patella tracking" issue (where the muscles etc that should hold the patella in its track as you move up and down, especially in a loaded or larger than normal range don't have the strength or flex etc to do so). In my case more and different exercises, sorted it super fast. As above, Hamstring, core, It band and calf muscles. All v good for skiing as well!
I m sure a surgeon could sort it by cutting something out but I would see a good physio first (Good = experienced. The bloke I see is 50ish)
After all it is free
After all it is free
It can be very difficult to find good physios in my experience. They are undoubtedly out there but tend to be expensive. I don't have that sort of money. The ones I worked with needed so many sessions to make any changes that I looked for things that worked from various sources. There is some consensus about effective management of tracking problems which Megamum would seem to be suffering from and it's not too difficult to put a good programme together if you have some background in such things.
There are various reasons for tracking issues as well. For an untrained person, it can offten just be a lack of condition in the muscles that cause the patella to track properly. For others gait issues may be more of a problem. In my case it's due to tibial torsion which manifests itself in more than 23 degrees ofset in my right leg. Lots of alignment problems for my skiing which I've never fully overcome though I keep trying.
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Sounds like patella maltracking cartilage probs and I endorse the physio referral idea. not all GPs are clued up on sports / musculoskeletal stuff, and hence varying quality of your experiences so far. No-one has suggested the importance of flexibility. Skiers / cyclists tend to ge tight hamstrings which pull the tibia backwards on the femur, loading the back fof the kneecap more, Gatrocs vice versa, so calf and hamstring stretching (once a day, 30 second minimum each side, when muscles well warmed up) will reduce the pressure - you won't feel a change for the first 3 weeks. Your physio can teach these
Have a look at skinny woman using a chair and the alternative method if your back is dodgy for hamstring stretches, and gastroc stretch
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Mountain Haddock, I've just been for a bike fit, and I know I have tight hamstrings from hockey and cycling. The guy who did the fit suggested I sit down and try to touch my toe of one foot for 30 seconds. Then relax and try to press the knee down into the floor (ie tighten muscles) repeat x3 then switch over to other leg.
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I get similar problems with my right knee, suspect mountainbiking causes the hamstrings to tighten up. This exercise seems to help my knees and my skiing.
And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Mountain Haddock, it's important in addressing the gastrocnemius that you also work the soleus which is the deeper of the main muscles in the calf. This is activated with the knee flexed and is frequently overlooked in both strengthening and stretching regimes. Just for the record I did stress flexibility if you look at my first response.
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Ade57, Oops - sorry, missed that!
You know it makes sense.
You know it makes sense.
Megamum,
Pain at front of knee on downhill most likely patella, less likely tendon problems or osteoarthritis.
The treatment is always physio first.
Some are simple and require straightforward advice on stretches, advice on how you move and strengthening.
Not all are simple and the same pain can be triggered by a wide range of problems. That's why I would suggest caution in simply following other people's experiences of what worked because they may have a different cause.
Your treatment will be a combination of advice on how to avoid pain or modify activities, biomechanics that may involve insoles, stretches and strengthening . There should be a absence of ultrasound, massage and most other hands on treatments bar perhaps occasionally taping to achieve a cure.
You need an experienced physio who specialises in the lower limb. Even then you may still not settle easily and for that reason we have someone at our clinic who just does patella second opinions which gives you some idea of how common the problem is.
I may be able to give you a recommendation in the South East if you pm me.
Jonathan Bell
Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Jonathan Bell, Completely agree in principle. If like me, however, you find that noone is coming forward with anything that's helpful and you can't afford to keep trying then what would you advocate? I saw several physios all of whom were vague and unhelpful with regard to diagnoses and useless with exercises, the usual basic stuff that I already knew. None ever mentioned the role of the glutes in the whole picture. My Doctor wasn't interested and clearly hadn't a clue either. Short of giving up then finding my own solutions, while imperfect was preferable. I've learned to manage my problem with much reading and a lot of work. That's why I suggested the approach I did.
Poster: A snowHead
Poster: A snowHead
Ade57, sounds like you need a recommended physio !
Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
kitenski, I'd be interested to hear of any in the Greater Manchester area, though I have seen a few and some came recommended. I manage it pretty effectively these days. Thanks for the thought.
Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Ade57,
There are great physios out there but as in any walk of life they are not necessarily the majority.
You do therefore have to seek them out.
Ade57, City Physio in St Ann's square, Manchester have helped with various injuries of mine over the years, including a recent knee problem. I'd fully recommend them.
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Anyway, snowHeads is much more fun if you do.
Megamum, if you're in the market for not-very-local recommendations, I know an excellent physio (expert in skiing and knees) who came well recommended and who just happens to practise in Wimbledon. That's probably a bit closer to you than Manchester anyway! I came away with a diagnosis, some shoe inserts and some exercises, and with a good idea of the options which will be open to me if and when the condition worsens. I was a very satisfied customer. PM me if you wish to pursue this and I will let you have the details. For a very small fee (only kidding) I could even provide lunch and a chauffeur service to the physio's clinic, if you can get yourself to the centre of the universe aka Clapham Junction.
Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Pedantica, Many thanks for a timely PM , life and the kids back at school kind of distracted me from the knee issue. The strap under the patella that I got helped a little and I never came back to see how many kind people have been chipping in with responses - you must think me quite dreadful
However, I stopped with the strap once I got the kids back at school and once the worst of the pain eased off. However, both yesterday and today as it happens the knee has been twinging. It seems connected with me putting on outdoor boots to do the animals - something I start to do once the bad weather kicks in during the winter. I guess in the finish I will have to resort to getting it looked at by someone, I don't like admitting that I have something wrong with me, but I suspect that things won't get better unless I get some pro help. I've never had much in the way of severe injury that has taken a long time to repair, but I have gone through a number of things which could all contribute to a dicky knee. The thing is my experience of NHS physio teatment was that they just concentrated on putting right the current ailment, rather than perhaps looking for contributing factors that could also be addressed to stop things getting worse in the future.
In terms of what might be contributing conditions, the GP diagnosed a patella issue connected with too much cycling when I was an early teen, then when I was about 21 I came off the horse hit a tree stump with a curved back and turned 3 lower vertebrae into compressed wedge shapes - NHS failed to diagnose a broken back and treated it with painkillers and no physio, since then I've twice had the sciatic nerve in the right leg trapped - once about two weeks after the broken back and once about 2 years ago, I've also twisted my ankle skiing, and had plantar fasciitis which took a year to fix in the last few years.
I don't like going to the doctors (read dentist, physio, hospital etc. in that) esp. not for something that comes and goes. The trouble with this is that I can live with it day to day, but do something stupid like walk down hill and I'm goosed I guess I will have to give in and so something about it. I have been trying some of these exercises for tightening the muscles in the top of the thigh and did hope that they would help, but the current twinges suggest that I'm still not achieving much. So the big question is NHS which I doubt will get to the route of the problem - which could be my back, or private - which might cost me a fair bit in terms of recurring visits. I'm not the worlds best patient either
After all it is free
After all it is free
Jonathan Bell, You have a PM, your valued comments are very much appreciated, thank you for taking the time .
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I had patellar tendonitis, brought on by wearing too high heels then unexpectedly going clubbing then falling on the same knee a few weeks later. I ignored it for about a year but it got gradually worse, especially when walking although cycling seemed to make it better. I then went to the physio for 6 months and while the various exercises I did did help with the pain it never went away totally and would get worse if I walked for any length of time. I eventually tried taping with kinesiology tape and had an almost instant improvement. I wore the tape every day for a few months then just when I was walking a lot or skiing and the pain never came back. I should say I was totally happy with my NHS physio but for me the thing that finally got rid of the pain was longer term strapping. It is pretty easy to do yourself and there are loads of youtube videos. I know wearing brightly coloured tape can make you look a bit of a (sporty) fashion victim but it honestly helped me.
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I slap arnica gel on my knees (as well as doing exercises. Occaionally. ) And yes, I know it can't POSSIBLY help.
FAQ
Poster: A snowHead
That's probably a bit closer to you than Manchester anyway! I came away with a diagnosis, some shoe inserts and some exercises, and with a good idea of the options which will be open to me if and when the condition worsens. I was a very satisfied customer. 
PM me if you wish to pursue this and I will let you have the details. For a very small fee (only kidding) I could even provide lunch and a chauffeur service to the physio's clinic, if you can get yourself to the centre of the universe aka Clapham Junction.
I guess I will have to give in and so something about it. I have been trying some of these exercises for tightening the muscles in the top of the thigh and did hope that they would help, but the current twinges suggest that I'm still not achieving much. So the big question is NHS which I doubt will get to the route of the problem - which could be my back, or private - which might cost me a fair bit in terms of recurring visits. I'm not the worlds best patient either 
