ITBS/ITBFS & malalignment of the patella

[FindnNemo91]

I am new to the forum.
I just wanted some advice on how to deal with the pain from ITBS/ITBFS and a malalignment of the patella. I am supposed to be in Pt, but i have been denied by 2 places because they do not take my insurance. i cant seem to find a place to go and the pain is overwhelming. I am getting ready to go to Canada for the Victoria Day Parade and will be marching in it with my school's band. I, along with my band director are concerned about the 2 mile march and the pain or effects that it will have on my knee. I cant really march that far without pain, but i am determined to go. Does any1 have any ideas how to make this more comfortable. (keep in mind with advice, that i will wear a brace and that anything that u suggest needs to fit on a bus and a ferry for 10 hours.)

Thank you sooo much,
jacqui

[alophysio]

Hi Jacqui,

1. It sounds like you are from the US - where exactly are you from - city that is?

2. There are 2 main philosophies on how to deal with ITBFS (BTW, how do you know what you have???)
a. deal with the movement of the patella over the knee
- what this means is that people try to move the patella to stop it maltracking. Kinda like trying to move the train back onto the tracks (if you know what i mean!)
- this often involves lots of stretching and massage and McConnell taping to help the patella track better.
- IMHO i think this is a simplistic approach. The patella is a floating bone that helps change the angle of the tendon that moves your knee. It is subject to the net forces of all the muscles, ligaments, fascia and bone alignements from the pelvis down to the feet - what this means is that a foot problem can cause the ITB to become tensioned and strained. Smae for a hip, SIJ, etc.Therefore there is the second philosophy...
b. Address the reason why the ITBFS is occurring in the first place - yes it may be "tight" but it is non-contractile tissue therefore something else is making it tight. A good PT should be able to locate the CAUSE of the problem that is resulting in the SOURCE of your pain (ITBFS). So the cause in your case is unknown at this stage (because i haven't seen you) but the source (assuming you are correct) is the ITB rubbing over the lateral femoral condyle.
- This is kinda like moving the tracks so the train stays on them - it makes more sense for the body to change under the moving bone since it is VERY difficult to make the patella move over the tracks...

Now before other people tell you about VMO exercises, i would like to point out that Jenny McConnell takes the approach i advocate (Philosophy B). Obviously we need to loosen any structures that have adaptively shortened but addressing why these structures "tightened" in the first place is the main issue.

There are many things you can do Jacqui. However, i think you need to see someone about it first because if i told you to do a one-legged squat, it may not be the right time for you to do it or you may do it incorrectly.

When you do get in to see a PT, make sure they look at:
1. Your SIJ, hip, knee, ankle and foot function and position
2. Your overall posture (you are still in high school and sudden growing - even a few years ago - can make a difference)
3. You are a girl therefore you will eventually have a higher "Q angle" as you develop into a woman and your hips widen. The Q angle can cause problems if it is too high. Google Q angle knee and look up some info on it - but ignore the surgical options!
4. Don't let them put you on machines - you have a functional goal to march 2 miles, you need to be doing exercises to get better, not just have pain numbing treatment.
5. Don't just let them give you knee only exercises - make sure your whole "lower limb kinetic chain" is addressed - squats, lunges, hip bridging, glut medius exercises, core stability training, ankle and foot exercises, etc etc
6. This is a VERY common problem. With the right treatment, you can achieve your goal of marching 2 miles.

BTW, i play tenor sax - what do you play???

Hope this has helped. If you could give us more history on your circumstances, how it occurred, your age, when you started your groth spurt, where the pain is, what you have done to try fix it, etc etc, that would be helpful.

Thanks

[FindnNemo91]

Thank You sooo much for posting some help for me.
I am 15 years old. I have been playing sports for my whole life, a catcher in softball, and a goalie in hockey. I have been having knee pain for about 8 years now. i have had my share of sprains and strains. currently, i have to wear a brace everyday, because walking is like a chore without it. BTW, i play the flute. I am also trying to find a pt to accept my insurance because i moved to Oregon from Virginia, completly different coasts and my insurance is basically a east coast insurance. i have been denied by 2 pt places and i am looking for someone right now. thanks for the advice. i dont think that i can accomplish my goal in 2 weeks because i leave for canada the saturday after next. i am thinking about buying some crutches to use for the parade and walking around downtown. I am also going to ice my knee while i am not doing anything. I noticed that u asked something like what exactly do u have? I just got back from an os on mon. and he said that i had ITBS/ITBFS (same thing i think, right?) and a malalignment of the patella. he said that everything looks good in the long run and that i dont need surgery. he said that my mri and xrays looked fine. just something inside me is telling me that something is really wrong. I almost buckeled in pain today, and i was crying because of soooo much pain. i just cant seem to find the right thing to do and different docs tell me different things. (srry for the length, i just need to vent) the os said that i can play any sports that i want just not to continue if there is pain, but there is, all the time, and it wont stop. i am only 15. the os told me that i am about done growing, no more than 1 more inch. I am, right now, 5'7 and 1/2" I am sick of not being able to continue doing things that i love. i cant really walk far without pain. i can barely run. again. i am determined to go to the parade, even if i am in a wheelchair or on crutches.

Thank you for writing to me and listening to me complain about this stupid knee of mine.
Jacqui

[FindnNemo91]

I really didnt answer all of ur ?s in the last post so here are some answers. I live in Lake Oswego, Oregon. I dont really know when i started my growth spurt, if at all. I have tried stretching, RICEing, swimming, laying off of it, and not playing any sports for 3 years.
Here is a VERY COMPLETE list of symptoms. (i took them with me to the OS and he loved it)
? clicking on the back
? sharp, stabbing pain 4 inches above knee
? sharp pain right above knee and on the outside
? spasms
? instability
? hit knee hard on edge of table
? pain worsened after hitting it
? feels like something is floating and ?stabbing the bone? (like a needle)
? pain radiates into calf and thigh
? pain in calf is like someone is pinching a tendon or muscle or nerve or something (very painful)
? pain where the femur connects to the shin
? heard pop and grinding sound, some pain
? lump on thigh
? intense pain on outer side of knee
? ankle and foot goes numb sometimes
? really sore after icing
? sore after elevation
? hard walking stairs and down hills
? feels like a needle poking around in my joint (on the inner side) when walking without a brace
? can?t really straighten all the way
? walk straight legged to relieve some pain
? NSAID?S (Lodine, Naproxen, Motrin and Aspirin) doesn?t help
? can?t run more then 2-5 seconds without pain
? wear a brace everyday, can?t really function without a lot of pain without it
? knee brace doesn?t relieve any pain, but provides a feeling of stability
? can?t play any sports
? swimming made the pain worse (no frog kick)
? did straight leg raises everyday (very painful) (20-25, 3 times a day)
? stretched before swimming, from stretches online
? pain and stiffness when bending the knee
? pain wakes me up at night
? interferes with everyday activities like walking, going up stairs, and taking a shower
? can?t stand for more then about 10 minutes without pain
? can?t balance without pain and a little shaking
? Balance weight on right leg so as not to have pain in left
? Can?t ride exercise bike or bike because of ITBFS
? cracking/popping a lot
? knee pain was still present even when quads were strong (during softball and hockey)

I know it is long and i may have written two of the same things. AGAIn, thank you soooooooooooo omuch for ur time.

Jacqui

[alophysio]

Hi Jacqui.

Ok. Number 1 - you can't write too much in my opinion - the more info the better so don't apologise anymore ok?

The list of symptoms you gave is very complete. I will try to help you over the next 2 weeks to get well.

1. When you say "clicking on the back" - do you mean in your lower back? or the back of the thigh or knee etc?

2. Is it on one side only?

3. Can you stand on one leg with your eyes closed - does it feel the same from side to side?

4. Can you lie down on your back. Now lift one leg up about 12 inches off the bed. Note the effort required and then do it on the other leg. Are there any differences?

5. Can you stay on your back and straighten one leg up to the ceiling - hold behind that leg - does it pull anywhere or reproduce your pain? Now with your leg in exactly the same position, point your toes and turn your foot inwards - does this change the pain in any way (same better or worse)?

6. I don't know anyone in oregon but you can email diane lee from vancouver canada or LJ Lee from Vancouver Canada to see if they know anyone who can treat you. You may have to pay for some treatment in cash...websites are dianlee.ca and ljptconsulting.ca

If you can let me know the answers to these questions, i am sure we can help in some way!

[FindnNemo91]

Thanks for the response.

Here are my answers to ur ?s.
The clicking is in the back of my knee
It is only on my left knee (sometimes my right gets a little twinge, but thats normal)
I cannot balance on my left leg with my eyes open or closed
Some pain on my left knee, slightly above the patella
For the next one, i cant even straightne my left leg up. i can get it up but is bent (definately not straight)
Thanks for the other people, but iwont be in canada for a while, only four days. i am still trying to find someone, but it is the weekend and everywhere is closed. I was in sooooo much pain last night, i cried myself to sleep. I could barely deal with. i got kinda sick from crying sooo much. i cant take Lodine or Naprosyn because of the side effects and i was taking aspirin, but my heart started fluttering (a result of that i dont know) and i stopped ibprofen cuz of the long term effects it had on the stomach. i was on a hospital dose. (800mg every 4 hours) which is kinda hard to do especially in school and class. nothing has really seemed to help. I have tried glucosamine and chondroitin (Spelling) but i have read that it is really no use taking cuz they take sooo long to work and i would be out of them b4 anything really happened. I have also tried flaxseed (ground up) YUCK!!! and flaxseed oil pills, (Didnt seem to do anything)
Thank you for all of your time,
Jacqui

[alophysio]

Hi Jacqui,

I am sorry that you are in so much pain. Let's just get through it very slowly and find a good physio to give you a diagnosis more specific that ITBS (BTW syndrome just means a collection of symptoms that are associated - it doesn't actually tell you what is wrong!!)

I gave you those websites because these people might know someone in your area who you can go to see.

For my question 4 above, you didn't tell me about the effort - i think you just told me that it hurt near the patella. Pain is not important in this test. It is the effort required to lift your leg up 12inches on one side compared to the effort on the "good" side.

Is there any other way you can stop aggravating your knee pain? Have you tried massaging your bottom/gluts/piriformis? Get your mum or dad to do that for you lying on your side - it might help the pain.

Do you have any pins and needles or numbness anywhere at all?

Thanks

[FindnNemo91]

Thanks for responding.
i can tell that there is slightly more effort required, overall, leg lifting is hard anyway. there is just more pain on the left. i had a flare up last night, which was very painful, so i am home from school today. i have tried having my mom massaging my knee, calf, and thigh. it feels awesome, but afterwards, like a couple hours, it always makes the pain worse. yeah, sometimes there is some numbness, if i sit for a while, my ankle and foot goes numb, same if i have my knee elevated. my calf is also numb sometimes.

thanks for ur time,
jak

[FindnNemo91]

I have an OS appt at 12:15 today and i am probably gonna get my first cortisone shot. i am kinda worried about the side effects. i would like to hear some things from people who have had them before!!

1. does it hurt?? (the #1 ?)
2. worse after the shot??
3. can the pain be severe enough that i need crutches??


anything else that anyone might want to add would be greatly appreciated.

thanks,
jacqui

[FindnNemo91]

no cortisone shot!!!! he said, i dont know why u r having such severe pain for such a minor problem. get some crutches ice it and start pt ASAP!! he was in and out of there in like 5 minutes. i hate knees!!


jak