Knee pain - Advice sought

Cycling is Forever

Hello fellow pain suffers,

I have been experiencing knee pain for around three months now whilst I assumed adequate rest, [RICE] stretches and strengthening would prevail [I have come here].
A little background; I am a runner and cyclist. Last year I came off my bike and hit my left knee very hard on a rock.

As a result I bruised the knee cap badly which meant I could barely walk or bend my left knee, let alone cycle/run.
After a MRI scan revealed the knee cap was healing knee specialist suggested rest and in due time all was good.
Roll on 6 months with no problems either cycling or running I was walking in the Cairngorms I notice a bit of pain when walking down slope in both knees but more in the left.
Figured it was because I was not so use to it, next ride notice no problems either. However after every subsequent ride I notice by knees starting to ache a lot more afterwards.
Slowly I would get a tightness and pain behind left knee cap to the point where I could barely walk I found walking down steps very painful although right would just be a dull ache mostly.
I should add I get this pain whilst running also.

I am now looking for any advice on what my next steps should be? I have an appointment with my GP this week but would appreciate a yes no worthwhile answer to the following.

Since my GP is just that just general and I didn't feel I got too much from the knee specialist last time should I still see one again at least will a MRI be beneficial?
I suspect a biomechanical problem as bending the knee slightly hurts rather than jumping or pounding with say running.
I’ve never has any physio before is this the next logical step to recovery? Any particular types are generic sports ones or cyclist knowledgeable?
Can a physiotherapist really assess problems without some diagnostic means or is it just based on training and experience?
Would a bike fit be next on my cards to do? Even if I’ve never had any problems in my set up from start [5yrs]?

Will all these things talking to the right qualified person seem to be paramount? How does one find or get a recommendation? Is it hit and miss out there?
Can anyone provide names I'm living herts/bucks area working near oxford?
Forgive my long thread but just reaching out!

CiF

oola

Speaking from a point of view of a different injury (shoulder ligament tear) I would skip the GP and go straight to a sports physio. Unless you are very lucky, a GP will not be able to assist ... they will refer you to a NHS physio and that could take a while.

A physio may be able to diagnose and then provide a suitable process for recovery. If they can't diagnose, I'd guess they'd want to get an MRI scan done to provide them with more info to diagnose. In my case, my physio identified my injury and proceeded with acupuncture (which wasnt for me!) and then onto a tens machine to alleviate the pain and get movement back. This worked wonders for me ... I was in such pain I was unable to lift my arm out to the side to even hold its own weight yet within a few weeks I'd gained a decent amount of movement back. Once the strength came back she was able to provide me with suitable exercises to then use the full range of movement in the shoulder.

This was my first experience of a private physio and I would have no hesitation in going back down the same route if I have a similar injury. Once piece of advice she gave me was that I should have taken anti inflammatories as soon after the injury occurred as possible as this prevents the swelling and further potential damage.

Unfortunately I'm not in your area so have no recommendations but in general, get yourself for a proper diagnosis at a sports physio and hope it gets sorted.

Cycling is Forever

thanks oola

I've only considered my GP as I want to go over what options I may have? Also find out how long it would take going nhs?
if super long I'd pay to speed things up.

as for physio, it is the diagnose bit I really can't see a physio being able to do this, just on symptoms alone?

what makes a good physio? just recommendation No?

kajjal

you are right in your post and really need to see the consultant again. That way they will be able to do proper tests to confirm what is happening. A good physio would only really be able to assist if they had access to this information.

To give you my experience I very badly sprained my shoulder and due to the pain could not sleep much even after physio and exercises. Luckily we have private health insurance so I was quickly refered to a consultant. They did X-rays etc and found due to the type of injury it needed an injection to reduce the internal swelling. Physio by itself would not provide a cure. After the injection and several weeks of properly targeted physio the shoulder is back to normal with no pain at all. I can road and moutain bike normally. Without seeing the consultant I would still be in alot of pain.

This may not be the case for you but you really need to know what is happening. Hope that helps and not trying to worry you just make sure you get the right treatment.

Stick8267

Musculoskeletal Physiotherapists tends to fall in to two broad groups, those that treat symtpoms and those that treat conditions. What I mean is that good physiotherapy is directed and specific dependent on a diagnosis which allows targeted rehabilitation. Bad physiotherapy is directed to relieving symptoms without any thought as to whether it is addressing the underlying condition. In the first instance you get better because of the physio in the second you MAY get better despite the physio. Good physios are very capable of making diagnosis and, in some cases, are allowed to order MRIs etc

Musculoskeletal doctors tends to fall in to two broad groups, those that see the diagnosis as an end point and those that see it as a starting point for good rehabilitation. Bad docs are pleased to tell you what is wrong and then give generic advice and good docs tell you what is wrong and then start planning what to do in conjunction with you, your activity and goals, and the physio. With regards your initial Consultant's advice I would say that all rehabilitation is active and so limiting it to 'rest' would indicate they are in the generic advice group.

As is true for most people you seem to know what you really need and that is a complete, multidisciplinary assessment of the problem and your biomechanics with a useful diagnosis and targeted treatment plan which may include any combination of physio, injections or (God forbid) surgery depending on what is found.

The best option is to get yourself referred to a Sport Clinic by your GP but unfortunately these are rare beasts in the NHS. We run one at the Homerton Hospital in East London which has a Consultant MSK Physio, Sport Physician and soft tissue Consultant Orthopaedics working together. If you are willing to travel a bit and can get your GP to refer you through Choose and Book (we have had patients from Watford) it could be a good option.

Cycling is Forever

Thanks peeps for taking the time to give some feedback. I certainly need it.
My plan will include a MRI scan again to have some diagnoses to back up any treatment and or physio

Special thanks to Stick8267 I shall press my GP for a referral for a Sports clinic, I'm not far from Watford so Homerton Hospital is certainly doable and looking at the website looks like the best people & facilities to help me.

Stick8267 do you have any connection to the Homerton hospital? Work or did you receive treatment for a sports injury yourself?
Luckily I suppose I've never had much use of my GP and the NHS so was completely unaware of "choose and book" thanks for the heads up.

I did have medical insurance in my last job but not now; Stick8267 do you know if consultants at Homerton accept private patients to speed up appointments and treatment?
[My impatience versus ££££]

Cheers

Cif

Stick8267

I work at the Homerton Sport Clinic. We have a pretty short waiting list, certainly less than a month and usually more like 2-3 weeks.

If you can't get sorted through your GP there are private options.

Drop me a PM if you want to know anything else.

Cycling is Forever

Re Pm Will do Stick8267 when i can get it to work :?

ai_1

I'd go to a physio first. A GP won't be able to do anything other than refer you to a knee specialist and a physio could do that too if necessary.

It could well be an issue with weakened stabilisation of your knee due to the rest period which is now causing your knee to operate slightly out of alignment as you tire. If so that's exactly the type of thing a good physio is best placed to diagnose and remedy. If they think it's more serious they'll refer you to a consultant as needed.
A bad physio is a waste of space. A good physio is the best first port of call for any musculo-skeletal problem.

Cycling is Forever

As an extra thing I've booked a bike fit next week..
With the nice weather this weekend I'll try a short stint and see how I fare and therefore I might start some Physio too.
Stick8267 I can't for some reason PM you or for that anyone else will try again on my home PC with choice of diff browsers.

ai_1

Cycling is Forever wrote:

As an extra thing I've booked a bike fit next week..
With the nice weather this weekend I'll try a short stint and see how I fare and therefore I might start some Physio too.
Stick8267 I can't for some reason PM you or for that anyone else will try again on my home PC with choice of diff browsers.

Don't put it off too long. If it's just a muscle weakness/imbalance issue then the sooner you figure it out the better.
Most likely, if this is all that's wrong, a physio will spend some time diagnosing the problem, show you some strengthening exercises or stretches to remedy the issue and off you go. No big deal.

Cycling is Forever

Hey Stick8267 if you received my PM just confirm here in thread not sure it worked or not, cheers.