 Poster: A snowHead
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Any advice on this? I'm having worsening issues for over a year. My knee characteristically gets sore couple of hours after a run rather than during, but it has definitely got bad enough now to seriously curtail me. Knee then aches at rest and sore going up stairs, though usually much better in 24 hours. I have seen physios who are sure it is patellar tracking disorder. MRI showed trace fluid but otherwise normal. Jave tried strengthening exercises, cycling, rest, and still struggling. The general pattern is for a few weeks I'm improving, then some exercise that I thought would be well within myself causes serious return of symptoms. If I rest then just standing and walking around at work seems to make it worse. I was able to ski unhindered last year but worried I'll run into problems after few days this time. Any thoughts appreciated
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Get proper medical advice. But if you don't have time for that before going skiing, take loads of ibuprofen with you. Try taking 200mg 3 times a day. If that is not enough, increase to 400mg. Gels also help. If that does not work, see a doctor.
I used to ski on anti-inflammatory pills, but I now need annual steroid injections in the knees because of wear and tear on the patella due to leg alignment being a bit off.
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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?
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You havent said where the pain in your knee is and is it only running and skiing that causes it? If it is I would say have you checked you are wearing the right trainers? A shop that has decent gait analysis may be able to help.
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I have similar pains, and two physios have both said the same as yours - Patella tracking disorder, which, after years of exercise, causes some wear and tear within the joint. I was told similar to you, exercise, build up the surrounding muscles, basically it's something that with age is fairly normal and not a lot can be done.
I've had the issue for a couple of years and find more weight bearing exercise more troublesome - running especially so. I find cycling doesn't irritate, long walks can do so a little and running is definitely avoided. Thankfully, for me at least, skiing doesn't irritate it - I'm guessing there is less "impact" than running? Might also have something to do with the alcohol that tends to be in my system or the fact that my legs ache anyway lol!!
As per the above, take loads of pain killers with you and keep hydrated, hopefully like me the knee wont be too badly affected!
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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For years I had a sore knee after exercise after breaking my leg in my youth and then suffering a torn ACL. I put up with it for 20 years before deciding I should get it looked at. MRI scan came back very similar to yours and eventually after getting a bit of physio was diagnosed with a patellar tracking problem.
In my case it only took a few weeks of fairly easy VMO exercises, in fact just doing step ups regularly is enough to keep my knee happy.
I think it's important to recognise that for me there was a clear historical problem that caused me to under use the knee and lead to a visibly obvious under development of the VMO muscles in one leg. In your case I suspect it's probably important to understand what might be causing the patellar tracking problem and then to remedy that rather than just carrying on blindly and hoping for the best.
A few things I would add are:
1) What do your physios think is causing the patellar tracking disorder?
2) I assume you are focusing on strengthening the VMO muscles and not the quads in general. It's usually an imbalance that causes the patella to mistrack.
3) I have seen that hip problems can lead to the leg rotating inwards and result in knee pain. This is why I think it's important to understand what the root cause is.
Mike
Last edited by Anyway, snowHeads is much more fun if you do. on Fri 13-11-15 13:28; edited 1 time in total
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You'll need to Register first of course.
You'll need to Register first of course.
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It took trips to 3 different physios to resolve it for me. In the end it was solved by both correcting muscle imbalances and crucially increased hip and glute flexibility. The lack of hip flexibility and strength was the route cause which is apparently very common in runners and cyclists.
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I have a similar problem, but mine is due to being hyper mobile, so my ligaments are too loose causing tracking issues. Muscle strengthening helps to some degree, as it takes up some of the 'slack'. I find rotational movements the worst, such as pivoting while running. Walking, especially downhill can trigger pain, running always triggers pain, cycling is usually fine. I am usually ok while skiing, now that I've worked on my ski posture, no A-frame any more, yay. I've been told there is nothing much they can do, as my ligaments are well outside the normal range.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| peanuthead wrote: |
| Any advice on this? I'm having worsening issues for over a year. My knee characteristically gets sore couple of hours after a run rather than during, but it has definitely got bad enough now to seriously curtail me. Knee then aches at rest and sore going up stairs, though usually much better in 24 hours. I have seen physios who are sure it is patellar tracking disorder. MRI showed trace fluid but otherwise normal. Jave tried strengthening exercises, cycling, rest, and still struggling. The general pattern is for a few weeks I'm improving, then some exercise that I thought would be well within myself causes serious return of symptoms. If I rest then just standing and walking around at work seems to make it worse. I was able to ski unhindered last year but worried I'll run into problems after few days this time. Any thoughts appreciated |
That sounds like a classic history of patella tendinopathy.
A very difficult condition to cure.
You may have got caught out by not getting the order of events correct in arriving at the correct treatment plan.
You need a clinical diagnosis before you have a scan. Relying on an MRI to make the diagnosis leads to problems,
In addition many patients with patella tendinopathy have features that are common with patella tracking disorders.
You need to see a competent specialist to get a clear diagnosis before wasting time and money on treatments.
Jonathan Bell
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| Quote: |
You need to see a competent specialist to get a clear diagnosis before wasting time and money on treatments.
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I'm sure that's good advice.
But, one thing I didn't know till my sports massage chap told me two days ago is that the gluteus medius (sp?) muscle has a role in patella tracking.
The one that's strengthened by the "clam" exercise.
It's worth doing anyway, regardless of anything else, and I guess wouldn't do you any harm.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Thanks @Jonathan Bell, @pam w, and all
I ended up seeing new physio. Definitely some improvement with taping my patella laterally while running. Doing that clam exercise also and straight leg raises wearing ski boots. Will be looking at footwear in next couple of weeks but physio wants to do one thing at time so we know what problem is. So definitely more optimistic now
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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.
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@Jonathan Bell, apologies for stupid question. But what would be difference in treatment/ rehab of patellar tracking disorder versus patellar tendinopathy
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maybe this is what i have ... at a very slow speed snowplough stop into a lift line, I felt tendons in both knees pull ... a sharp pain which now, after exercise or leaving leg in awkward position when sitting , gives more of a dull ache behind the kneecap and also to the loer inside of the kneecap.
Have stayed away from running, and have been advised to strengthen muscle around knee and to stretch/loosen/foam roller quads et al as the imbalance may have been contributory ( pam w ). Also feel "twinge" when pivoting ...
If tendinopathy is difficult to cure .. what is the thought on bracing as there must be a weakness there now ... a ski mojo ?
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You know it makes sense.
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Another question re patellar tracking disorder versus tendinopathy. Would tendinopathy pain not be more localized to patellar tendon (I have got this before) rather than more diffusely around patella?
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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| peanuthead wrote: |
| @Jonathan Bell, apologies for stupid question. But what would be difference in treatment/ rehab of patellar tracking disorder versus patellar tendinopathy |
In essence deal with any maltracking ( which may involve taping) then usually a progressive loading programme that differs in one specific element:
In patella tracking problems you try not to do exercises that hurt but in patella tendon the exercises are often designed to push you til it hurts.
You would be tender over the tendon in tendinopathy but can also be tender here in maltracking.
It really needs a clinical hands on assessment im afraid.
Both patella femoral pain syndrome and patella tendinopathy can be quite complicated to treat, although Glut exercises are often prescribed.
No t sure about the Ski Mojo for tendinopathy- it might help a bit
There are quite a few posts on our site about Patella problems if you are interested http://www.wimbledonclinics.co.uk/blog/consultant/11/#.VmG7A67hBBw
Jonathan Bell
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Poster: A snowHead
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I had physio some time ago for patella femoral issues. One leg squats and squats against a wall with a ball were the order of the day. My physio was pretty anti taping.
I read recently strengthening hip abductors could be more effective.
Anyone any experience
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@rich, I suppose depends what were the patella femoral issues. See jonathans post above. I had patellar tracking issues. Taping definitely helps
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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?
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| rich wrote: |
I had physio some time ago for patella femoral issues. One leg squats and squats against a wall with a ball were the order of the day. My physio was pretty anti taping.
I read recently strengthening hip abductors could be more effective.
Anyone any experience |
Taping is just one tool. It can be particularly helpful if there is fat pad involvement or a shallow groove (that the patella sits in).
Most people would not need taping.
Most patella pain will settle fairly easily but it is very very common and some patella femoral pain problems can be very complex.
Enough so that my physio wife, who is a patella expert, does two clinics a week filled entirely with 2nd opinions.
I have a very basic generic patella exercise sheet if anyone is interested. It was written by my wife as a "best shot" effort that would help
enough patients that it is worth trying.
Im about to post it on our website as a free download but we are not quite there yet so if any one wants it either pm me or email me.
Jonathan Bell
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You need to Login to know who's really who.
You need to Login to know who's really who.
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A timely thread this, as I was diagnosed with patella tendinopathy a couple of weeks ago after about six months living with of symptoms similar to @peanuthead. Physio has given me a regime of strengthening and stretching - which on the upside she tells me is exactly what I need to do in prep for skiing anyway.
IF I don't start to see an improvement then injections etc would be another step - but must admit not keen on this unless really necessary.
@Jonathan Bell, - will probably drop you a pm re the patella sheet as I feel the more info I have the better - many thanks.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| JonA wrote: |
A timely thread this, as I was diagnosed with patella tendinopathy a couple of weeks ago after about six months living with of symptoms similar to @peanuthead. Physio has given me a regime of strengthening and stretching - which on the upside she tells me is exactly what I need to do in prep for skiing anyway.
IF I don't start to see an improvement then injections etc would be another step - but must admit not keen on this unless really necessary.
@Jonathan Bell, - will probably drop you a pm re the patella sheet as I feel the more info I have the better - many thanks. |
Ive sent the sheet.
It has some stretches on it that could be helpful in tendinopathy. You'll need a more comprehensive program
(upto 4 to 6 months) for tendinopathy so do make sure that is the correct diagnosis as it is otherwise alot of wasted effort.
Jonathan Bell
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