Knee Pain wtf

[fortysix&2]

Hoping someone on here might have some insight...

Symptoms:
Dull pain (sometimes a brief sharp pain occurs) in the front of the knee just below the cap, probably a 2 - 4 on the pain scale. It has gotten to the point where I can only ski groomers, and I can't pressure the ski tips because the pain occurs when I weight or apply some force.

Example:
Pulling leg back and pressuring the ski
When I get off the chairlift I can't weight the leg until I swing it back and forth a couple times
Leg lift without locking out the knee (slight bend)


What I've done:
MRI in September, 1 steroid injection in October, 1 steroid injection last week. Nothing really showed up on the MRI...very minor degenerative tearing. The first injection was awesome. I was back to normal activity within 2 days. The latest injection let me get out for 2 hours on the hill, and the pain came back (maybe a 2). I went out again today, and the pain is up to a 2-3. This really sucks not knowing wtf is going on.

Questions:
1. Has anyone gotten an MRI that missed some tearing or other issues that were later found? I'm almost wondering if there is a floater somewhere below the cap.
2. Has anyone had inflammation in the fatty tissue area below the cap (The doc thought this might be what is going on), and were symptoms similar?
3. Anyone have/had similar symptoms get a diagnosis?

Thanks

[Tye 1on]

Arthritis.

[fortysix&2]

Care to expand? Do you have it? If so, what did you do?

I asked the doc, and he did not think that is what it is.

[gointhedistance]

Patellar tendinitis? Try massaging just under the knee cap perpendicular to the tendon. 3-5 min of massages - 3 times a day.

[Bronic]

^^^ this was my first thought

[Orthoski]

Does sound like a patellar tendonitis vs. inflammation of the fat pad that lies inside the joint underneath the tendon. My logic is that if the first injection into your knee helped, it's almost certainly something going on inside your knee joint. All the painful motions you're describing are those that load the patella and it's tendon - lifting your leg when the knee's bent at 45 degrees, pressuring the ski tips, etc. I'd venture that things like sitting on a plane for a few hours also isn't great without getting up and straightening your knee. That fat pad that lies behind the tendon is exquisitely sensitive. Years back some crazy (and brave) docs did a study where they performed a knee scope on one of the docs while he was awake so that he could rate which areas within the knee are the most painful - the "infrapatellar fat pad" was far and away one of the most sensitive. Some avoidance of extremely rigorous activities and strengthening of the quad, etc, may be your best option for now. As any FYI, these can be frustrating injuries because you didn't necessarily break, tear, or "do" anything to your knee, but it can still take quite a while to get better. Best of luck!

[systemoverblow'd]

It's just worn out

[mel221]

Sounds like patella tendonitis which has about a bazillion causes.

I have been struggling with this pain for 2 ski seasons now.

In my case, the patella does not track properly as the knee bends. When skiing, the patella will grind along other tissues; causing swelling and pain at the bottom of the patella and extending along the tendon.

My tracking problem appears to be caused by the VMO not pulling in sync with the rest of the quad muscles. It fires late. So when the VMO does start to contribute to pulling the patella, the patella is already out of position.

Your getting an MRI and steroid injection is curious. These problems tend to be caused by muscle imbalances and are usually treated with stretching and strengthening... unless some kind of trauma is suspected. IMO, steroid injections cause more problems than they solve.

I recommend you visit a physical therapist for an exam and diagnosis.

In the interest of full disclosure, I have seen 1 doc (x-ray) and 3 different Physical therapists over the past 12 months and have done all kinds of hip and VMO exercises. I am still having problems skiing and jumping.

[rip]

I spent 2+ seasons dealing with similar issues.

Kelly Starrett is on point about this

learn proper squat technique

pt1

pt 2

http://youtu.be/a72IhKe_2cs

3

http://youtu.be/fd17fdN6tNM

These videos have helped me tremendously. Also, I noticed a huge improvement after moving back to "narrow" skis when its harder snow conditions (95mm or so)

[kokomas]

i had something milder but similar this offseason. i hadn't gotten much exercise except walking 20 flights of stairs per day and playing basketball once a week. I had a lot of pain in one knee right below the kneecap but not the other. It was painful when bent and when backpeddling in bball. I self diagnosed patellar tendinotis (i think that is slightly different than tendinitis but not sure). My chiro thought that plus perhaps some bursitis below the tendon. He says this can be brought on by a tight quad muscle, especially on the inside of your quad just above kneecap. I guess that muscle attaches through the knee to the patellar tendon and if the muscle is tight it leads to discomfort in the tendon as well. He loosened the quad up some and I did a lot of stretching. That helped a little but I still had lingering pain until i headed out west and pounded my legs skiing a bunch of days. Weirdly the pain began to subside 5 days in. I'm assuming that i had been unbalanced in my quad strenth and the skiing helped balance it out. I can still feel tenderness at the bottom of my patella but no pain.

this is a long way to say i agree with the previous posters...check out patellar tendinotis/itis and the physical therapy route. From what I understand this nagging injury can become quite debilitating if left alone

[rod9301]

There is a bone below the knee cap, about an inch.
If this is where iy hurts, it's patellar tendonitis.
I had this a while ago, took one year off from skiing, and no improvement. And I ski 100 days a year, live in squaw, so for me it was a huge deal not to ski.
This is also called runners knee.

Anyway, nothing worked,pt, whatever.
I ended up having an operation, they removed the bursa behind the patellar tendon, rehab 6 weeks, then full activity, and never bothered me again.

Operation is very minor, and the bursa grows back.

Sent from my SCH-I500 using TGR Forums

[splat]

I spent 2+ seasons dealing with similar issues.

Kelly Starrett is on point about this

learn proper squat technique

pt1

pt 2

http://youtu.be/a72IhKe_2cs

3

http://youtu.be/fd17fdN6tNM

These videos have helped me tremendously. Also, I noticed a huge improvement after moving back to "narrow" skis when its harder snow conditions (95mm or so)

Thanks!1

[fortysix&2]

Thanks for the great responses. Orthoski, thank you for the info. You nailed it - about 45 degrees to 5 degree range is where I get the pain.

I don't have any tender feelings when I press the patellar tendon area. A friend of mine is a PT, and she did a bunch tests to my knee and agreed that it doesn't appear to be Patellar Tendonitis. It only hurts when straightening the leg from a bend. She thought it could be a floater that got missed in the MRI.

That said (and based off some of these responses), I'm wondering if I could have patellar tendinitis, but just without that tendor and/or swelling symptom of the tendon.

There is a bone below the knee cap, about an inch.
If this is where iy hurts, it's patellar tendonitis.
I had this a while ago, took one year off from skiing, and no improvement. And I ski 100 days a year, live in squaw, so for me it was a huge deal not to ski.
This is also called runners knee.

Anyway, nothing worked,pt, whatever.
I ended up having an operation, they removed the bursa behind the patellar tendon, rehab 6 weeks, then full activity, and never bothered me again.

Operation is very minor, and the bursa grows back.

Sent from my SCH-I500 using TGR Forums

This freaks me out - taking a year off and no improvement. Heck taking a week of w/o improvements is frustrating.

The injection seems to be providing some relief. I went skiing today for about 3 hours and it only hurt mildly to get off the chair lift.

[rod9301]

Btw, steroid injections are really dangerous.they weaken the tendons and ligaments and they could rupture.
Only old school doctors full give them, if they have no experience with athletes

Sent from my SCH-I500 using TGR Forums

[fortysix&2]

^^Makes me think I need to get another opinion. The doctor I have seen is considered one of the top knee specialists in our area, and athletes come from all over to see him.

[homeeey]

Didn't read the entire thread, but did anyone suggest acupuncture?

I normally would be the last to suggest such a thing, but several years back I experienced exact symptoms, one treatment, boom no more pain.

[neufox47]

Does your PT friend work with a lot of athletes? If so I'd go back to her and try to develop a strengthening program. If not, I'd look for a DPT with some training experience. It may be muscular issues that are manifesting in your knee. Could be about 8 billion different things.

[Orthoski]

Btw, steroid injections are really dangerous.they weaken the tendons and ligaments and they could rupture.
Only old school doctors full give them, if they have no experience with athletes

Rod - not sure what experiences you may have had to feel so strongly about this. One definitely should be judicious when using steroid injections (and some might argue that they're overused), but steroid injections still have a very real and beneficial role in treatment decisions. Just don't want community members to think it's this black and white.

[splat]

Ditto on the steroids. I had patellar tendonitis and it healed overnight with one prp injection. That fatty pad underneath, like orthoski said and from what people have told me, is another issue. But I wouldn't doubt if a prp shot would help that, too.

[jellero]

i believe the pain is caused by skiing with the brakes on, like an instructor might do, or slipping a course before a race in a snowplow. i've noticed it myself. j

[fortysix&2]

... As any FYI, these can be frustrating injuries because you didn't necessarily break, tear, or "do" anything to your knee, but it can still take quite a while to get better. Best of luck!

Hopefully, I'm closing the loop on this thread.

Well, 8 months later and it looks like I might have an answer: lateral patellofemoral syndrome. The doctor who diagnosed this played with my patella for less than a minute, and said the patella did not have the proper tilt. So, I'm trying PT for a few weeks and if that does not work, I'll probably get a release which has 6-8 weeks recovery.

As Orthoski pointed out, this has been a very frustrating experience. Doctor visits, injections, research, home remedies, depression, weight gain, loss of strength and endurance over the summer - the list goes on. Sadly, this is not difficult to fix from what I understand.

[Shadam]

do come back in here and update us as many are interested ...

swimming was the best thing for me after I hyper extended my left knee, it swelled up like a balloon !!!
and I went under the knife.

the full body work out with low impact on the knees, I can;t recommend it highly enough,
but one does need axcess to a lap pool.