Knee Pain

Re: Knee Pain

Thanks for updating me Virender; I am so pleased this worked for you. Keep using the strap until the New Year then take it off but keep it in your kit bag, just in case!
 
Re: Knee Pain

Hi Liz. Hope I'm posting in the correct place here. :confused: We spoke previously about my knee injury. I was diagnosed with patella tendonitis and torn medial meniscus in my left knee. I have been undergoing physio and rehab work with some sports injury specialists. I was advised that I go on an eccentric training programme and not play for 3 months as well as no running. I've been doing the programme for the past 3 weeks (out of 12) and my knee has definitely felt stronger. I have even seen some muscle growth in both my upper legs. I haven't felt any pain recently but then yesterday I was having some sharp shooting pains in my knee while walking which changed to a throbbing pain when I sat down. My wife asked me an interesting question though, I had eaten red meat about 2 or 3 hours earlier which I hadn't done in a while, and she asked me whether this had anything to do with it. She said that she noticed this previously as well. Do you think this has any substance? It's feeling a bit better today which makes me wonder whether my diet does indeed have anything to do with it as well, or do you think that it might just be due to the fact that I have upped the resistance in my training too much this week. Also, our season resumes in about 4 weeks time, by which time I was hoping to start some light runnning. Is this advisable or should I wait until after the 12 weeks? How long do these injuries normally take to heal?
 
Re: Knee Pain

Hi Shane,

How did you sustain this injury? Did you get a knock, perhaps whilst playing football?

Forgive the question but have you noticed a difference in the colour of your urine?

Although diet can play a part in recovery, I suspect the connection in this instance is purely coincidental. It probably has more to do with the intensity of the workout and/or your alignment. However, if you would like either David or me to take a look, please let us have your five day (min) food diary, containing everything, drinks, chocolate bars etc.

Can you tell me if you have noticed any of the following:

Locking of the knee (unable to bend)
Inability to fully straighten the knee
A popping or clicking sound or sensation

If there is no damage to the anterior cruciate ligament or the medial collateral ligament, everything should be going to plan and you should be able to start light exercise by the start of the season, if not the week before.

Quite often, once the initial knee pain and swelling of the joint subsides, normal activities may be resumed because the tear is small and does not affect the mechanics of the joint. However, do watch for the above mechanical symptoms as well as the knee 'giving way'.

I trust you are paying particular attention to your warm up and cool down.

It is hard to say how long this injury will last without knowing the extent but I recommend using a knee strap when you start running, jumping etc.

Please keep me informed of your progress.
 
Re: Knee Pain

Hi Liz.

The injury was sustained when I was walking down some temporary steps. Just felt a sharp shooting pain in my knee and thought that some rest would do the trick. I played one pre-season match and it was painful when I had to set off when running or fielding or changing direction suddenly. There's no ligament damage, only a clicking sound. I've enquired about this but they seem to be of the opinion that I shouldn't worry about this unless its causing me pain.

I've spoken to the specialist 2 days ago and he said that I cannot start running yet as its too soon and I should avoid all impact exercises and any exercises that involves the knee bending more than 90 degrees such as lunges and squats. (That basically rules out my one-leg squat exercises I've been doing on the neuromat.) I'm currently doing the eccentric training (30mins/3 times per week) on a bicycle which runs in one direction (either forward or backwards), and I resist in the opposing direction with a particular force (predetermined based on my body weight and height). This includes a 4 min warm up cycle and I usually end off the session with some stretches. I felt some stiffness after the first 2 days but haven't felt it since (I make sure I stretch afterwards! :) I've got a gym ball and a "neuromat" at home. What sort of exercises can I do besides the training I've been doing on the bike to aid the recovery and strengthen the knee area but not aggravate the injury?


The specialist said I should be concentrating on light weights and more repetition. Also suggested pool training as this is easier on the joints. Which sort of exercises can I do in the pool?

The pain hasn't really subsided and was a bit sore this morning whilst driving. Which leads me to my next question, should I be driving at the moment? I drive a manual-transmission car.

I'll keep you updated on progress.
 
Re: Knee Pain

To be honest Shane, I am a little lost here; I am struggling to find a pattern and I would have expected you to feel a little better than you are now. Do you think you are having problems with the meniscus or the tendon?

Was this injury diagnosed via MRI or x-ray?
Is it a Degenerative Change, Longitudical Tear or a Bucket-Handle Tear?
Did you have a McMurrays Test?

When you were walking down the steps, do you remember twisting your knee?

As for the driving, I am assuming you have a right hand drive car, if so, driving will be a problem with the patella tendinitis, especially if you have a heavy clutch. I would recommend you strap your knee whilst driving.
 
Re: Knee Pain

Shane,

Having thought about your difficulties overnight, I have to say, I am a little confused.

Bearing in mind that I have not seen your knee and it is very difficult to ask all the questions I need to, I would like you to consider the following.

I have been concentrating on your meniscual tear but I suspect your main problem is with the patella tendon. Could this have been causing you difficulties prior to the sensation felt whilst walking down the steps? I cannot see how the injury could have been caused in such a way.

The other name for Patella Tendinitis is Jumper's Knee. This is common in sports people and there are a few members on this site suffering from the same. It can also be caused by your alignment whilst driving, especially with a heavy clutch.

I was wondering if it could at all be possible that because of the impaired strength with your patella tendon, you damaged your meniscus whilst overcompensating when walking down the steps.

If this is the case, then your injury will not recover until you address this. If your main problem was the tear, I would have either expected the injury to be mild enough for it to have eased considerably by now or bad enough for surgery. Even then, recovery is unlikely to be so long!
 
Re: Knee Pain

Hi Liz.

Yes I had an MRI scan done from which the tear was picked up as well as some inflammation. I had a cortisone injection and then had the injury reassessed 2 weeks after.It was at this reassessment that I was advised to go on the eccentric training program. Its a 12 week program which involves the exercises mentioned earlier. They will then see how my knee responds and determine whether surgery will be needed.

The pain is definitely from the tendon. You mentioned impaired strength in the tendon. Is it possible to strengthen it? If so what do I need to do to help the situation? My understanding is that you strengthen the muscles around the knee?
 
Re: Knee Pain

OK Shane, this makes a lot more sense to me.

I am going to forget the tear for now, it just clouds the issue.

Your treatment seems fine; gentle stretching is important as soon as pain will allow, particularly the quadriceps. Hold stretches for around 10 seconds and repeat 5 times. Aim to stretch at least 5 times a day. This should be progressed as time goes on and you should continue long after the injury has healed to avoid reoccurrence. As well as the quadriceps it is important to stretch the hamstrings, calf muscles and iliotibial band as well. You may find the main cause was a tight iliotibial band!

Pain free strengthening should begin as soon as possible, starting with static contractions of the quadriceps. Strengthening of the calf muscles and hamstring group of muscles is also very important with progressive 'eccentric' resistance exercises. This means exercises where the muscle is contracted through lengthening, for example the downwards phase of a squat involves the quadriceps muscles contracting but lengthening at the same time. This must be pain free; any pain means you are doing more harm than good. Apply ice after exercises to prevent inflammation.

I did not mean impaired strength [sorry] I should have said impaired stability. This can also cause problems with your good leg; putting extra weight on it can develop abnormal movement patterns, causing imbalances and further injury.

Were you told what grade of injury you suffered? Grade 4 can take anything from 6 to 12 months to 'fully' recover!

When you can complete pain free single leg eccentric squat strength training exercises you can start a gradual running programme.

The problem is Shane, your driving may be holding you back. Monitor this; see how you feel each time you drive and do get yourself a knee strap for this.

In the meantime, if you have access to a pool and you enjoy swimming, go for it. Do gentle exercises in the pool, if you feel pain, stop.
 
Re: Knee Pain

Thanks Liz.

I'll take heed of the advice and keep you posted. Regarding the grade of injury, I wasn't told which grade it is but will find out on Monday when I have my next session.

Thanks again for the help and hope you have a wonderful Xmas!
 
Re: Knee Pain

Hi Liz.

To keep you updated, I've played my first match in about 4 months last Saturday and my left knee came through fine. There was a bit of stiffness in both knees the next day but otherwise the left knee is doing fine. I'm supposed to have arthroscopic surgery done on it to file away a pronation of the bone as its scraping against my kneecap and causing the clicking sound. I'm looking to have that done in the off-season as its not really hampering me at the moment.

The first question I have is this. Can this pronation cause the tendinitis in my knee which I've been struggling with? I'm trying to avoid surgery as far as possible and if its not necessary then I won't have it done.

My second question/issue is this. After last week's match my right knee started acting up. Initially it felt tight as mentioned earlier. By Monday evening I had sharp pains on the inside of my right knee. The pain occurs each time I ground my right foot when walking and I tried jogging lightly on Tuesday but couldn't as the pain was too severe. The knee also feels as if its twisted even though I don't remember twisting it. It difficult to explain but I'll give it a go. If you're sitting on a high chair with your legs dangling, if you move the part of the leg below the knee slightly from side to side, it hurts. I hope that makes sense.

I saw the specialist yesterday and he did some prodding and pressed on the side of my knee and found the spot that was hurting. He diagnosed it as a sheath of something
(sorry I forgot the name) running down the side of the knee from the hamstrings to the area close to knee and shinbone. I was given some oral anti-inflammatories and some anti-inflammatory pads which have to be placed on the affected area and replaced every 12 hours.

Do you think the diagnosis sounds correct or could it be something else? I have to play tomorrow again (its a 2 day match which started last week and finishes tomorrow) and still need to bat. Is it advisable to so or should I rest it completely? I was told to continue at 50% and then build up again but unfortunately I can't play at 50%. I might have to bat with a runner. (It felt ok with batting pads on as I think it slightly stabilizes the knee)
 
Re: Knee Pain

Interesting Shane, I thought it was the torn meniscus that was causing the clicking. If a bone (which one by the way) is scraping against your patella, then it is highly likely that this is causing your tendinitis and it will continue until you get it fixed.

The problem with your right knee sounds like an overcompensation injury. You say it is on the inside of the knee, this makes me think it is the medial collateral ligament but the specialist has identified the origin of the pain towards the rear of your knee, possibly the sheath of the iliotibial band (?). It does not matter, the cause would be the same. Again, this will continue until you get the pronation sorted and your knees strengthened.

The common procedure for this type of injury is rest, ice, compression, elevation so, rest is the order of the day I'm afraid, but a runner just may be the answer.

If there is no bruising, make sure the knees are heated before you play (did you complete a thorough warm up by the way?) and you have ice ready to apply when you finish. Make sure the oral anti-inflammatories are handy at all times ;)

Sorry Shane, doesn't sound like you have a choice. Let us know how the match goes.
 
Re: Knee Pain

Thanks for the advice again Liz. Any specific warmups that would be suitable for my situation? I normally involve quite a bit of running/jogging in my warmups but unable to do so at the moment.
 
Re: Knee Pain

Hi Liz. Just to keep you updated. Played on Saturday but the match didn't last too long. We were bowled out in our second innings within the first 2 hours of the day's play and lost by and innings and a few runs. I was last man in with a runner and finished 4 not out. So in terms of our match things didn't go well but in terms of the amount of time I needed to spend playing with an injured knee I suppose I should take it as a blessing in disguise. I did feel a bit of pain afterwards though in just playing a forward defensive shot. Was quite painful yesterday as I didn't have my medication with me but feeling a bit better today. I'll sit out this week's match, which is another 2 day affair played over 2 Saturdays, so that'll give my knee 2 weeks of rest.

Liz Ward said:
Interesting Shane, I thought it was the torn meniscus that was causing the clicking. If a bone (which one by the way) is scraping against your patella, then it is highly likely that this is causing your tendinitis and it will continue until you get it fixed.

Its the bone at the outer top bone of the knee/bottom of the thigh of my left leg, if that makes sense.

Liz Ward said:
The problem with your right knee sounds like an overcompensation injury. You say it is on the inside of the knee, this makes me think it is the medial collateral ligament but the specialist has identified the origin of the pain towards the rear of your knee, possibly the sheath of the iliotibial band (?). It does not matter, the cause would be the same. Again, this will continue until you get the pronation sorted and your knees strengthened.

Thats what the specialist said as well re: overcompensating.


Liz Ward said:
If there is no bruising, make sure the knees are heated before you play (did you complete a thorough warm up by the way?) and you have ice ready to apply when you finish. Make sure the oral anti-inflammatories are handy at all times ;)

Always do a warm up ever since my groin injury problems! ;) I think it may have been more to do with my cool down as I was doing some stretches and then we lost a few quick wickets at the end of the 1st day's play and I suddenly had to pad up and get ready in case we lost another wicket. I didn't stretch again after that.
 
Re: Knee Pain

In terms of recovery time from this injury, do you think that I should reassess the injury after the 2 weeks and decide whether to play again this season ( we still have four 2 day matches left this season) or should I consign myself to having the op now and then just work on getting back next season. What is the typical recovery time for this sort of injury.

Its been quite a frustrating season for me as I'd been doing a lot of work on my strength and fitness in the off-season (using David's core strengthening program), only to get the initial injury and then miss the first 4 months of the season, come back and then injure the other knee.

I initially decided to delay the op until the end of the season so that I wouldn't miss out on the rest of the matches, but if it means a recurrence of the injury, then I might as well have it done sooner rather than later. Apparently I can be back to normal within 2 weeks of having the arthroscopic surgery? Does this sound right or is it dependent on the individual?
 
Re: Knee Pain

I am not sure if the stretch is specific to your circumstance, but I had a very low intensity one recommended by a physio which I briefly had last year.

Stand with one step on the bottom step of your stairs and the other hanging off. Slowly lower the hanging leg to the floor, bending your supported knee in the process. Do it as slowly as possible but do not touch the floor. Start off with 10 reps just once or twice a day. Hanging on to a chair or something else, will help lessen the pressure.
 
Re: Knee Pain

Thanks for that Manee. I'm familiar with that exercise. I was doing it as part of my physio program as well. Unfortunately I was told by the specialist not to put any weight on the knee and had stop doing it. Its a great one for strengthening the quads and I will resume with it once I'm over the injury. ;)
 
Re: Knee Pain

I think you have a good plan here Shane. Rest for two weeks, reassess the injury, if no better have the op.

I know how frustrated you must feel, especially being on top form for the start of the season but '...best laid plans of mice and men...' and all that.

You should recover from the operation quite quickly and two weeks is a good measure if you behave yourself ;)

Having said all that, even if your knee feels better after two weeks rest, it will not perform as it should and you will easily re-injure it; it is not really just a case of resting the tendon, if it is catching on the bone, it will always catch on the bone until you have it operated on. Continuing to play may cause tears.

Perhaps having the operation as soon as possible will get you back on form by the last few matches. Whatever you decide, keep your upper body fitness maintained and keep us informed of how your season progresses; op or not.
 
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