Pain in both knees

[Jaf]

Hi, I'm a 34yo woman with pain in both knees.

History: 7 years ago I was pretty fit, cycled 8 miles to work up and down steep hills every day. One day when I got off my bike my left knee gave way. I strapped it up and carried on, 2 weeks later the right knee went too. Both knees were painful so went to my gp who said rest them. A year later I saw a sports physio as although they were a bit better they weren't great. He was horrified at gp's advice and worked on my knees with electric shock treatment. Very painful but they felt a bit better. I put up with the pain for another 3 years and then the pain got worse and knees started locking. By this I mean they'd get very stiff and felt as if to bend them would break them. They'd unlock by forcing them to move, they'd give an almighty crack and then by ok but sore. Been to see orthopedics who took X-rays and MRI (with have been lost), knee caps are slightly off centre. Sent to physio who taught me to walk properly (oops!) and my knees no longer lock. After teaching me to walk properly she discharged me even though I can't do the exercises she wants me to do (steps and back against a wall then lowering bending the knees). I am left with both knees always hurting but particulary when going up stairs, standing or walking for more than 5 mins. I have a cycling machine but that too hurts. One surgeon suggested I might need my outer thigh muscles cut to re-align my knees caps! Another thought it was chrondomalia patella (is that right, it's soft knee gunge I think). I'm seeing another doc who wants to put a camera in my knees.

Would a camera in my knees hurt? Is it any better than an MRI? Any other exercises I can try?

Many thanks.

[Canuck Physio]

Hello,

Have any of the investigations, assessments revealed anything in particular?

Is the knee joint space diminished, are there bony spurs, have tests been completed to confirm this?

Often conditions such as chondromalacia are either due to or intensified by muscular imbalances of the quadricep muscles, as these attach to the knee cap (patella).

I reckon since this is an ongoing problem, there may be significant muscular adaptations around the knee joint. The stresses that are being imposed on the knee joint may be due to the incorrect muscles activating during movements. It appears that gait re-training helped in this respect.

I would be weary about going under the knife considering you have not really achieved recovery with physiotherapy. Unless it is indicated I would get a re-referral to a Physio who is willing to help you workout the strength imbalances that are affecting the knee in particular.

Regards

[Jaf]

Hi Canuck, Thank you for your reply.

The MRI was lost inbetween the hospital being closed, going to new hospital and then being referred to a 3rd extra-special hospital. The 1st hospital didn't have the actual scan pic but did have the write up. It seems that all is ok apart from the patella being off track, no bony spurs or anything else mentioned. The 3rd hospital has been trying to get hold of MRI for 8 months.

When they physically manipulate my knees they don't exactly hurt at the time but a couple of minutes later they feel very sore. There seems to me to be a lot of movement and popping in my knees, but they said it was normal.

I'm going to take your advice and go back to physio. Gait re-training was a wonder, I thought I'd not be able to walk anymore as it was so painful.

Thanks very much.

[Canuck Physio]

HI again,

Good to hear.

Please be very specific about your concerns, you must tell them about the situation. If there is patellar mal-tracking then this can be solved with a graded muscle balance program. The problem is that you have been cycling, so the issue may be related to the hip, and that problem may need to be overcome for the balance work to be effective to finally influence the knee.

If all signs and investigations are clear, then there is a strong possibility that you should recover with soft tissue work, strengthing, balancing, and management as well as pain control and activity education such as gait.

Please keep us informed

[Jaf]

Hi, have booked in to a physio next tuesday. I'm actually feeling quite hopeful. Have you to thank for that.

In Spain for a couple of months looking after my folks' house so going private! 20euros shouldn't break the bank.

I will tell the physio all about the problem and will be back to tell you! I hope it's not connected to hips as well, though one is more flexible than the other. Have noticed that one foot has started curling round again, tut.

I guess by graded muscle program you mean start gently and work up?

One more request, can you recommend a pain killer? I've tried paracetamol, codeine, iburofen, asprin, even migraine tablets and nothing helps. I'm worried that physio will hurt the first few times.

Thanks!