Knee pain... need help with diagnosis!: Triathlon Forum: Slowtwitch Forums

Knee pain... need help with diagnosis!

Nov 28, 04 10:28

Post #1 of 9 (1513 views)

I know knee pain is probably a very common topic on this forum, so please forgive me.

I'm suffering from severe pain on my left knee and need some help with the diagnosis since I've a appointment with the doc but it's only next week and I don't wanna do anything wrong. First I'll give some background info.

I was off-season for 2 weeks after a 5 month season of short-course triathlon. I came back three weeks ago and since then I've been running 3x a week (no more then 50min each), biking 5 hours in 3 workouts and hard swimming. The swimming has had a lot of kicking drills (sideways, straight, etc). On thursday, one week ago, I fell during the run. I hit my knee badly on the ground (car road/sidewalk). After that I got up and started to run slow to see if everything was ok and my knee was hurting a lot but the pain went away after say 2-3 min of slow running so I was able to finish my workout. When I got home, everything was ok, no pain at all. Well, 5 days later, I was doing some sprints (with hard kicking off course) in the pool and my knee started to hurt like hell, right on the same spot. In that day I tried also to bike but was impossible. The pain was to much to handle. It hurts on the knee cap; I really feel it when I am going up and down the stairs. It also hurts when I walk but it's a "light" pain.

I've been doing ice for 3 days now and Voltaren also and it hasn't improve that much. Voltaren works also has a pain reliever but the pain (or the NO pain) hasn't improve that much. It still hurts. The pain is at the top of the knee, no on the side, and seems just under the kneecap on the knee joint. I've been "virtual" diagnosed with "chondromalacia patella".

Does anyone have any insight on this? How about a personal diagnosis?

Thanks in advanced.

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Last edited by: Klep: Nov 28, 04 10:33

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Re: Knee pain... need help with diagnosis! [Klep] [ In reply to ]

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Ian MacLean

Nov 28, 04 10:59

Post #2 of 9 (1494 views)

IMO, you lost the battle when you finished the run after falling. Should have walked, crawled, called a friend, iced it immediately, taken a few days off and then EASED back into things, ie, no sprints in the pool. But all that is too little too late. Sounds like damage to the patella, the patellar tendon or possibly the underlying cartilage. Don't scew with it, and don't go to a regular MD unless you trust him and he knows what you do to your body. A sports medicine clinic would be a better place, as they understand athletes bodies much better.

Knee injuries, no matter how insigificant the accident may have seemed, can lead to alot of trouble down the road. I'm reminded of Bettini at Worlds this year. Smacked his knee against the team car door, and just like that, race over.

Until you get it properly diagnosed by a pro, don't do ANYTHING that it hurts to do. Rest, rest, rest. Crutches if needed.

Probably doesn't help you much, but that's all I've got.

Good luck and keep us posted.

Ian MacLean
http://www.imfit.ca
Success comes when fear of failure goes

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Re: Knee pain... need help with diagnosis! [Klep] [ In reply to ]

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freestyle

Nov 28, 04 12:23

Post #3 of 9 (1466 views)

Hey Klep I hope you feel better. This is what I've been able to find:

PATELLOFEMORAL PAIN (KNEECAP PAIN)

Patellofemoral pain can occur in one or both knees and it is one of the most common causes of knee pain. Patellofemoral pain is felt in the front of the knee and occurs when the patella is compressed against the femoral groove. The compression forces increase the further the knee is bent and as a result pain usually increases as well. Therefore, patellofemoral pain may be made worse by activities that involve repetitive bending of the knee. Pain is often felt going up or down stairs or after sitting for long periods of time. Patellofemoral pain can be accompanied by "clicking" or "grinding" and sometimes by a feeling that the knee "catches" or wants to "give way".

Patellofemoral pain describes the location of the pain but not its cause. Overuse ("too much, too soon") or previous injury to the knee are common causes of patellofemoral pain. Biomechanical factors such as poor tracking of the patella in the femoral groove, flat (pronated) feet, weak inner thigh muscles and tight outer thigh muscles and/or ligaments can also cause patellofemoral pain . Sometimes "wear and tear arthritis" (osteoarthritis) or damage to the articular cartilage (chondromalacia) on the back of the patella causes the pain but in most cases of patellofemoral pain the knee joint is normal.

Examination techniques that detect biomechanical problems are helpful in the diagnosis of patellofemoral pain. Xrays are often done to assess the shape of the patella and to rule out osteoarthritis of the knee. Rarely are other tests such as Magnetic Resonance Imaging (MRI) required.

The treatment of patellofemoral pain depends on it's cause and may include stretching and strengthening exercises, relative rest, icing, medication, foot orthotics and bracing. In rare cases surgery is required. Doctors and physiotherapists trained in treating patellofemoral pain can outline a treatment plan specific to each individual.

To read more about how orthotics can help patellofemoral pain click here. To read more about patellofemoral braces click here. Please visit the links section for additional information on patellofemoral pain. Links have been provided to other websites as well as online medical journals. Other knee injury topics can also be accessed.

http://www.kneepaininfo.com/

go to "knee topics" then under "kneecap problems"

Get better soon!

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Re: Knee pain... need help with diagnosis! [Klep] [ In reply to ]

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lsilverman

Nov 28, 04 12:24

Post #4 of 9 (1465 views)

I see a lot of knee injuries but I'm no doctor, coach or professional of any kind.

Still, Chondramalacia Patella seems like the wrong diagnosis -- that's when the cartilidge is irritated and/or damaged by abrasion. It's almost always a condition brought on by overuse, not by sudden trauma.

Ian's suggestions all make sense. Feeling pain when walking down steps is usually related to your patellar tendon -- the one that connects your kneecap to your shinbone. If you injure it, or injure the places where it connects to the kneecap or shinbone, it'll hurt when your quads resist extension -- which is what happens when you go down stairs. It'll hurt less but still hurt a little when you go up stairs.

It could also be that your fall created a hairline fracture in your patella -- depends how hard you fell. No way to know that except with an XRay, and if it's small enough it might not show up.

Ian's also correct that you should go to a sports medicine doctor if at all possible. Preferably someone who works with runners, but definetly someone who sees athletes a lot. I have a recommendation for someone in NYC, but that probably doesn't help you much.

Ice is good, almost no matter what the injury. So is rest -- no kicking in the pool, no running, no cycling. Swim with a pullbouy or a big rubber band around your ankles. If you're doing weights, stick to upper body until you know what's going on. (I know, you know this, but it doesn't hurt to hear it.)

I don't know anything about Voltaren, but for most people an anti-inflamatory like ibuprophen works well for these kinds of injuries.

Good luck, and take it easy! You've got months before the season starts again.

Lee Silverman
JackRabbit Sports
Park Slope, Brooklyn

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Re: Knee pain... need help with diagnosis! [Klep] [ In reply to ]

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ironmanjp

Nov 28, 04 13:37

Post #5 of 9 (1444 views)

Hi Klep,

This sounds a LOT like what I have, since you fell down while running it's not an overuse injury. I hurt my knee while trail running over a year ago and dealt with the pain by taking ibuprofen, icing it etc. in order to make it through the tri season with the intentions of resting and recovering during the off-season. After my off season I slowly began training again but the pain immediately came back...I then went to see my family doctor and got a referral to an ortho surgeon...it turns out i chipped the kneecap and two small fragments of bone embedded themselves in my patellar tendon and have calcified (got bigger) I wasn't able to train regularly this year and am going to physio right now using ultrasound to try and reduce the size of the deposits. Surgery isn't an option since they would do more damage to the tendon to try and get the pieces out. This probably could have been avoided if I had to see the ortho right away...but then again I'd still have the bone fragments in my tendon. I am going to try a few different things this off-season, acupuncture, Sonnorex therapy, etc. hopefully I'll make it to IM Canada this year so I'm doing whatever I have to do this time of the year to be ready for August...let me know how you make out with yours.

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Jets

Nov 28, 04 15:49

Post #6 of 9 (1399 views)

I had a knee injury and the x-rays did not show it but I had a crack in the patella. Once the surgeon got in he saw it and had to buff it up in addition to the torn cartilage that was removed. I don't mean to scare you but it sounds similar to the pain that I had. I had knee pain off and on during one summer and then was trail running in the fall when I was running down hill fast and boom! Pain in the knee cap! Work outs should be what you can do without causing any pain. The sooner you get it checked out the better. Good Luck!

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Krepster

Nov 29, 04 1:42

Post #7 of 9 (1351 views)

Thank you guys. I think I need to do some XRays to see what's up.

I've been only swimming with the pullboy, no run or bike at all. I will continue doing ice on it till I talk to the fisio. I was hopping this would go away without going to the doctor cause I know he will want me to rest for a couple a days. Anyway, as I've 4 months before my season starts, it's better that way.

Once again, thanks!

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smartasscoach

Nov 29, 04 5:01

Post #8 of 9 (1331 views)

Knee pain... need help with hypocondria!

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"Yeah, no one likes a smartass, but we all like stars" - Thom Yorke

smartasscoach.tri-oeiras.com

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