The return of 16 years of mystery knee pain

portland_bill

Afternoon all! I would have posted this over an hour ago had I not been drawn in and consumed by the "Girls in Lycra Shorts" thread.

I wasn't sure which was the best forum to post this in, but I figured it didn't really fit any of the other forums, so I thought I'd give it a shot in here, but I do apologise if it should be somewhere else.

When I was 14 I was the captain of our school rugby team and one day during a match I developed a pain in my left kneecap so at the time I just had some time out until it went away and carried on until we ended up having a massive fight with a neighbouring school during a match where one of the teachers ended up with a bloody face, so the whole thing was stopped and even though they started the whole thing, the rugby team was disbanded. I guess our good behaviour focussed catholic school just couldn't bear the idea of us defending ourselves in a violent manner but there you go.

Anyway at the time, the pain would come and go every few months and then it disappeared for a few years. When I was 23, for apparently no reason whatsoever it reappeared with a vengeance and it literally got to the point where I couldn't walk on my left leg, so I went to the doctors and they referred me to hospital for an MRI scan. I spoke to the specialist afterwards and he suggested that nothing really obvious showed up on the scan and that there is a chance that one of the muscles surrounding my knee may not be as strong as the other muscles and that is what is causing the pain. He gave me some stretches and exercises to do and sent me on my way. I kept the stretches and exercises up for a good few months as directed and the pain seemed to go away so eventually I stopped.

When I was 25, I was feeling a bit overweight as I wasn't really getting much exercise so I started running and after a few weeks I got shinsplints, so I eased off and when I was sufficiently rested, I started again (albeit a little more gently) and although I could still feel the shinsplints, I could vaguely make out the pain in my knee again but it went away again. A few weeks later it came back again, and again this time to the point where I could barely walk on my left leg, so I paid my doctor another visit and all she had to say was that I clearly wasn't built for running and that I should try something else with less impact and practically hurried me out of the door without any further help or advice.

I tried swimming for a while, but asides from being mind-numbingly boring and time consuming, it too made my knee sore.

Now I've ridden mountain bikes on and off for years now doing trails and a little downhill etc, and for some reason it's never caused me any problems whatsoever so I figured I'd get myself a road bike instead of starting another failure bound attempt at getting into running.

I've had my road bike for about a month now and have worked my way up from doing a 12 mile circuit around my local area to commuting to work and back which is 18 miles in each direction. I've done that 5 times now as it's not something I can fit in on a daily basis with having to collect my son from the childminders etc, but I rode to work on Monday, and when I arrived at work I could feel my knee hurting a little, so I dosed myself up with Ibuprofen and got some Deep Heat/Ralgex on it and it calmed down, but when I set off home within the first few miles I was considering stopping and getting my wife to come and collect me because my knee was hurting too much, but I just slowed down a little and kept my revs as consistent as I could and as I warmed up, the pain seemed to subside a little and I made it home without too much discomfort.

A friend of mine invited me along to the gym yesterday evening and without even thinking about my knee I agreed and went on the treadmill for 30mins and did intervals of 3 mins fast paced walking and 2 running, becoming 2 walking and 3 running by the end of the session, but by the end of the session my knee was hurting again and I had a strange sensation down my left leg which I've never felt before. On the left hand side at the top of my shin on my left leg, it almost felt like something was missing or wasn't working properly. It's really hard to describe but almost a loose feeling in the left hand side of my lower left leg which seemed to correspond with the pain in my kneecap which is always just to the right of where I can feel my patella. I searched online last night for pictures of the muscles in and around the knees, but there doesn't seem to be anything that attaches around the inside of the patella that then travels down the ouside of the lower leg.

At the end of the day, I'm at a complete loss as to what to do about it. My doctor (although not the same doctor as I last contacted about my knee since I moved from Newcastle into Northumberland and I've made an appointment to see him on Friday) doesn't seem to be able to find anything wrong with my knee, as was the case with the MRI scan and the specialist, but there is clearly something wrong with my knee and it just doesn't seem to matter which form of exercise I choose to do, my knee always seems to cause me problems and ruin my efforts in exercising.

I'm 30 now and I refuse to spend the rest of my life being slightly overweight on the basis that I can't do any exercise without pain or injury. I've also booked myself in with my LBS for a session in the bike fit studio so I can make sure the bike is set up properly for me, but can anybody recommend any routes to try with treatment or therapy that might help me sort this problem out once and for all coz the NHS just don't seem to be able to help. :?

fossyant

Go see a good physio, preferably a sports physio. They should at least give you an idea of the problem, and give you a range of exercises. Keep at it with the NHS route and the GP. PS you are unlikely to get physio on the NHS.

bristolpete

In my experience, it's usually caused elsewhere. Reckon you should get your glutes and hamstrings looked at. As said, a decent sports pyhsio can spot what doctors cannot. I was seeing Bristol Rugby clubs pyhsio back in the summer after my went went pop. However, back on the bike within a week a total revelation in so much the knee was fine, the issue was the rear of my leg manifesting itself in the knee. A few stretches and advice and is all good.

Bobbinogs

Might be worth seeing a decent osteopath. I have always found a combination of sports phsyio and osteopathy to work well on stubborn issues. As posted above, sometimes the body seems to moan in one area but because of pain caused by another area.

I once had a lower back problem but it wasn't sore, it was pain in my ankle that came first, then my knee and then my hamstring. Each area was checked by normal medical staff and found to be fine and after a month or two the pain would subside only to be replaced by another pain in the next area, leaving me feeling exasperated. When my seized lower back was finally diagnosed (by an Osteo) and sorted through a combination of physio and osteo...all the other symptoms went away. Sports physio also helped me with some good exercises to prevent the problem coming back.

portland_bill

Well I went to see my doctor this evening and he was actually quite convincing.

He got me to take my trousers off and sat me on the bed and started digging his fingers in around my knee cap and wiggling my knee cap around asking me when it hurt or felt uncomfortable and he said something along the lines of my calves are potentially stronger in proportion to my quads (years of hill walking and mountaineering could be behind that) and my left quads seem to be allowing my knee to move to the side slightly and he thinks this is why I'm getting pain because my quads should be keeping my knee working in a perfect straight line.

He did at one point drift into the "perhaps you should try something other than cycling" but I promptly stopped him and informed him that I'm now purely into cycling because I couldn't do anything else.

He suggested I get access to a weights bench or mutligym and try to do at least 2 sets of 50 reps twice a day for two weeks and see if I can do a long ride then without any pain.

I've got my bike fit booked in for Wednesday too so hopefully that should help get me set up properly to minimise any pain in the future anyway, so I guess a couple of weeks of squats for me it is.

bristolpete

Interesting in so much that this is the total opposite of what i think you may need. If the quad is out of line thus pulling the knee cap over, over loading it with leg raises and squats will only exacerbate the issue in my humble opinion. I think you should reverse engineer what is happening by lifting your leg in the opposite way to a pedal stroke with a Swiss ball being the ideal tool. Also, lying in your side and lifting the leg from the glutes not the hip to fire the rear muscles which may have been the reason the quads are pulling, simply over use of the quads due to their dominant role on a bike meaning that the glutes and hams are not working like they should.

Last winter I was squatting 200kg and pressing that as well and this year I am not doing a thing based on physio advise aside from using my leg as the weight which as an aside are bloomin' huge.

Lastly there is an interesting article on knee pain in this weeks cycling weekly.

If you pm me I would be happy to give you a call with some advice over the weekend. I work for Specialized and next week I have my refresher training on our new electronic bg fit set up so happily chat to the powers that be ref your issue.

Pete.

jgsi

I think you should persist with the NHS route for a bit.
I dug around in my copy of Sports Injuries -Peterson/Renstroem ( the Knee is the largest chapter btw) and a way forward would be to insist on either an xray or better mri/ct scan to get to the reason of your knee pain. You could have a form of patella instablity, but such a diagnosis can only be comfirmed with a deeper inspection.
From the book by the way, the athlete is advised to refrain from painful activites, use a brace, rice it, and exercise and or stretch the surrounding musculature.
Keep on at the medical route.

portland_bill

Thanks for your help guys and sorry I haven't been back in touch over the weekend. Had a bit of a manic one.

My doctor said to do quad specific exercises for the next few weeks and see if I see any improvement at all. I find this a little frustrating since looking at the historic tendancies of it, it will just go away anyway at some point over the next few weeks and stop bothering me, but will likely re-appear in a year or so and I still won't have got to the bottom of it.

I'll try and persevere with the NHS route but as previously mentioned, I can't see me getting any physio from them.

I just found a phsyio http://www.physioandsportsclinic.co.uk near to me, so I might give them a call and see if I can get their opinion on it, I'm just always wary of private clinics who have a financial interest in my injuries. I just find it impossible to trust them and when I first started getting shin splints from running years ago I went to see an Osteopath who did some deep tissue massage for a couple of sessions but insisted I needed about another 10 or 12 sessions which at £50 a shot just wasn't possible at the time and certainly isn't now that I've got a nipper in tow.