UKC

Hi Ladies & Gents

Thought some of you clever people might be able to come up with some ideas for what's up with my knee.

I should say I have been to the doc's & been refered to physio (i am on physio number 2), that was Novmber last year. My knee is pretty much as it was, I am still seeing physio but he seems at a loss for what to do.

So here goes;

1. I have pain in the rear of my right knee in the region of the biceps femoris tendon.
2. The pain is uncomfortable most of the time but does come and go during the day. It is least painful first thing in the morning but comes on within 10-15 mins.
3. I have had the pain on and off for the last few years (time flies), it is not so severe that I cannot run and and neoprene type support whilst running seems to control it a bit. I was running pretty regularly through most of last year with the injury/pain at a manageable level. just decided towards the end of the year to try to get it sorted...failed on that one so far!
4. The biceps femoris tendon is not particularly painful to touch but is painful if touched/massaged with enough force (aren't most things?)
5. My right hamstrings feel pretty tight and a bit strained most of the time. They feel hyper fragile.
6. My right achilles is also a little tender.
7. My right leg is 1/2 inch shorter than the left.
8. I have been using orthotics for the last 6 weeks with no effect.
9. Physio number (Private) one diagnosed a tight ITB causing biceps femoris tendonitis. She put me on a course of ITB & glute strenthening & stretches, along with ultrasound on the ITB & then bicep femoris tendon. This had little/no effect.
10. I haven't run for the last seven months.
11. Current physio (NHS) suspects some nerve snagging/shortening. So I am doing some stretches to try to correct this, though I am not convinced. He has suggested that running should help this (bonus!). He has considered an MRI scan but does not think it will show anything.
12. All the knee pain tests the physio has tried e.g. pulling, pushing & twisting do not elicit any pain.
13. A tubigrip tends to reduce the pain level (perhaps just in my head though???)
14. I climb as well so god knows what bizarre strains get put on to knees & legs from this. i know there have been lots of ham & knee tweaks from heel hooking.
15. I am neutral from a gait point of view. I have new running shoes.
16. I have a desk job.

What do you think am I doomed....doomed?

Seriously any ideas by way of diagnosis or other stuff to ask the physio or suggestions are all gratefully received. It is most depressing having to more forwards at the pace of a geriatric slug.

Thanks & regards

Mike

In reply to mikedelderfield: silly question, but do you stretch often? pilates is quite good for combating pain from the source by stretching what becomes tight by maybe working behind a desk

In reply to heathermeek:
Hi

I am not great at stretching, I am as flexible as a brick. I tend to only stretch when I am injured. So I am currently trying to stretch my hams & ITB.

I think I have injured myself by over/incorrectly stretching in the past.

I will take a look at pilates (don't know anything about it), but I have often wondered about trying a general conditioning routine/sport to help prevent injury.

In reply to mikedelderfield:

Then that might be part of the problem. The older you get you should always stretch both before and after exercise. Yes it's hard at first but the more you stretch, the easier it gets.




Never heard of anyone injuring themselves by "over" stretching - and I've been stretching in cycle racing, rugby and running since the late 80's....

There's a good article on treating knee injuries in the June issue of Climb Magazine. If you can't get access to that, drop me a PM and I'll scan it in and email it to you.

In reply to mikedelderfield:


Mike, that really sounds like it could be a major cause of whats happening. Try to get yourself a little routine of stretching in front of the TV each night, don't push it but eventually you will start to feel more flexible. May be find your local pilates class and buy yourself 10 sessions as an incentive and try it maybe once or twice a week Hope it starts to get better soon.

Maybe print yourself a small picture with stretching ideas and keep it on your coffee table for when you have a bit of spare time each day http://losingthisweight.com/why-is-stretching-important/

In reply to mikedelderfield:
Watch what you are doing. If you have torn or damaged the tendon you may detach it from its attachment point. I am presently waiting to have one of my hamstrings in my right leg reattached. Did this whilst climbing through a very powerful bridging move. Went to physio and was told that it was pulled muscle. Ultrasound scan revealed tendon seperated from the ischial tuberosity. Results are similar to popeye bisceps but with a great deal more complications as the weaker leg affects your gate and may lead to copmlications in the other leg/joints as yo try to compensate.The short and long is that i can survive with out it but will have complications later on in life. Inability to run/sprint is a classic symptom. Hamstring injuries are generally to do with maximun loads, see sprinters grab back of leg or slipping and contracting moscles to avoid falling. Sorry if long answer but get a specialist to look at it. Private or referral through your GP. My physio has helped olympic athletes, I am not one, but they missed it and went on my symptoms. Apologies for spelling. I will get round to regestering. Ken

In reply to mikedelderfield: You're sure it's not illiotibial band syndrome? Sounds like it. I had that for years, until I decided to get "serious" about it.

As already mentioned, stretch.

Secondly, I might add that I went to a massage therapist and they performed something she called "myofascial release". MOST painful thing I've ever had done (I've had 4 root canals and I just fall asleep in the dentists). That along with regular stretching, and self massage of my ITB religiously, the symptoms have disappeared.

My physio recommended a self massage using a foam roller as shown in this guide: http://www.rowingaustralia.com.au/docs/ais-self-massage-booklet.pdf

Good luck, knee pain sucks.

In reply to mikedelderfield: Have a look at mobilitywod.com . Have a search for knee pain, hamstrings or just start at the beginning until you have a few things to work on. Lots of stuff for upper body mobility too.

This website and the trigger point therapy workbook seem to keep me going and help sort any niggles when I get them.

In reply to Jack:

Thanks all. I will look at all your suggestions.

I have looked at hamstring stuff on the tinternet till I'm blue in the face. There are so many possibilities and potential causes that I find it difficult to focus on anything with much confidence.

I will definitely talk to the physio about massage on my hamstring, assuming that is the cause, I guess it cannot do any harm. I have also acquired a foam roller so will have a do with that as well.

In reply to zerog: Wow! Good pdf, I have tried a bit of (untrained) self massage in the past but probably done more harm than good, I will give this a good read.

In reply to Gordonbp: yhm!

In reply to mikedelderfield: Others have suggested that you're mentioned lack of flexibility might be the cause of your problems and that sound like good advice to me.

Knee problems are notoriously hard to diagnose so you might be better just forgetting what actually is wrong with it and doing everything you can to improve the function of your knees with strength training and stretching. There are two reasons you have knee pain, one you've injured it through trauma, the other is that something isn't working correctly. If it's not the former and the physio can't identify the latter then you're probably going to have to go for the carpet bomb apporoach and just gently strengthen and stretch every thing in your legs over 3-6 months.

There's tons of info on stretching and strength training so it shouldn't be hard to get a good routine going. For stretching you might want to aim for doing 2/3 sessions a day on every stretch, e.g. one in the morning, one if you get a lunch hour and one in the evening. Just keep them gentle if it's tight and be aware that the colder and stiffer your muscles are the more liklihood you'll hurt yourself. All the experts seem to say never stretch cold muscles but if you're trying to increase flexibility you'll have to at some point as no one is going to start doing a warm up in the office!

For strength training you could build up to doing 3 sets of each exercise 3 times as week. 12 reps in each set will be fine for building up strength, as you get better you can increase it to 20 for endurance or add weight to continue strengthening. I was sceptical when I was advised by a physio to keep on with the routine he suggested, especially when it didn't work and his solution was to add weight and do more. I'd been suffering with knee issues for over a year and it did work with me, but it took about 2 months of working my ass off.

It might be worth trying the obvious ones (clam, leg raises, split squats, raised leg bridge, lunges in all directions, eccentric heel drops) before you go to the physio and then getting them to show you what you're doing wrong and how to improve your form. Try each leg for every excersise and stretch, if you notice your good leg is better at one exercise/stretch than the bad leg you might have identified a weakness.

Try lookng at strengthrunning.com, loads of great tips and routines on there.

Everytime the doctors or the physios tell you they don't know whats wrong treat it as a positive thing, get stuck into improving the function of your legs yourself and it will get better. It's when they start saying that something is wrong and you need surgery that you need to start worrying!

Ben

In reply to mikedelderfield:
Sorry, I posted without properly reading your op.

Gentle stretching really should sort that out if you keep at it, you might try flexing the knee while you're at your desk as well, like while you're sitting down gently extending your lower leg while your upper leg is static till your leg is straight. You could set a timer and do 20 every hour or something

Definitely get onto the eccentric heel dips for that, if you can build up to being able to do three sets of 40 with no weight on each leg it should put you in good stead for avoiding any achiles related nastiness.

Do your hips dip if you lift your right leg of the ground?

Make sure you ask the physio to prove why you need them, i.e. make sure they aren't just giving you them because that's what everyone does these days. Why specifically do you need them? And don't just take flat feet for an answer, why have you got flat feet in the first place?

How long did you continue your exercises for? Some people seem to take a couple of weeks doing one excercise and everything is fine. Others take longer.

If you can run for any more than 10 mins without pain then do as much as you can. If you've had a knee problem or you've been running off and on it will take a while for your legs to adapt to the stress again so the more gentle running you can do the better. I'm told that the body needs to "remember" how to run as well as just being strong/flexible enough to do it so the more pain free running you can do the better. Not just better for getting your leg back into shape but when you find your pain reducing you don't want your body's running ability to be at ground zero, having a body unused to running and the fresh motivation that comes from losing a long injury is probably a recipe for getting injured again!

Buy the book "running well" by S. Murphey and S. Connors, it's the only running book I've read that actually touches on nerve mobilisation.

The guy at strengthrunning.com seems to stress how hard it is on your body to do a desk job and then expect it to play in the evenings and the weekends. There's some video's on there that are definitely worth a watch.

You're definitely not doomed! If you need to get your mojo back and find some inspiration read feet in the clouds, read it's not about the bike, Karen Darke's book, anything you can find where someones done something amazing with a broken body! Like a few others have said it sounds like your obvious weakness is flexibility so stretch like mad for the next few months and expect it to take time to get better but you can't doubt it will get better. If the doc/physios don't find anything wrong and in 3-6 months time you have a strong and flexible lower body then how could there possibly be anything that wont be better?

Ben

In reply to mikedelderfield: Not sure if you'll see this at this late stage but I'll comment anyway. I've been climbing for 15 years and running on and off for 12 years. At my peak I would run 8 miles every other day and climb at the indoor wall most night and out on rock every weekend, as well as a physical job that involved climbing ladders all day.
From this I has excessive cartalidge wear which also gives lateral movement in my knee joint-I have to say it doesn't sound like the same problem as yours. several doctors have said its due to the quantity of sport I was doing and I should quit. I didn't stop intentionally but when I did slow up for a period I found I was getting more pain - turns out the sport keeps the muscles and tendons strong and compensates, so no real solution.
I found using a big knee support with articulated metal hinges brilliant (looking at about £80). I use it as a preventative to injury these days for running and skiing.
Hope that helps
Richard

In reply to mikedelderfield: Come to llanberis and see Zac Laraman. http://www.snowdonia-sports-medicine.com/practitioners.php?id=25

He's not cheap but he's great, works with a lot of runners and climbers. I've messed around with other physios, but Zac is top dollar. We also have another great physio Andy Walling area, but he's harder to get appointments with. But those two for a runner are pretty much unbeatable.