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My knee hurts. I've been suffering from what I think is piriformis syndrome (basically a type of sciatica) for three months. I have seen a chiropractor and a physio and I'm not getting any better. I've been to my GP, she looked at me blankly and sent me for an x-ray, which came back clear, so I'm guessing there is no disc issue.
Over the last couple of weeks I've been getting a fair bit of knee pain. It came on suddenly one afternoon when it basically throbbed every twenty seconds. The pain feels like it is behind the knee cap. I don't experience it every day. As well as this, it clicks badly. If I'm sitting, and I straighten my leg in front of me with my right hand placed over the knee cap, as I bend it through 90 degrees, there is a real thick and obvious click at about 5 o'clock.
I've not been through anything like ths before. Does anyone feel familiar with my symptoms? Could the knee issue be a cause or symptom of my sciatic pain?
What makes you think it's piriformis syndrome? Sounds like a classic case of GKS to me.
Ok, what is GKS?
I've been assuming it's piriformis syndrome because I basically can't sit down. Half an hour at my desk and I get sciatic pain, which is relieved by standing up. Also have pain and tightness deep within glutes on RHS. I will be thrilled if someone says it's something else. Figure 4 stretch feels very tight but doesn't seem to be sorting it out. Have been focussing on hamstring and calf stretches, as well as loosening hip flexors.
Has STW got collective knee-ache? All from the last 24 hours....
http://singletrackworld.com/forum/topic/is-my-knee-going-to-fall-off
http://singletrackworld.com/forum/topic/running-knees-shoes-getting-past-it
http://singletrackworld.com/forum/topic/knees-and-spds
http://singletrackworld.com/forum/topic/help-a-new-sport-or-hobby-that-spares-the-knees
http://singletrackworld.com/forum/topic/knee-go-on-guess-whats-wrong-with-mine-i-dont-have-faith-in-my-physio
http://singletrackworld.com/forum/topic/help-buggered-knee
GKS = Gammy Knee Syndrome.
Surely a nerve problem which piriformis syndrome technically is would present with nerve symptoms, such as numbness, p&n, shooting pains, weakness etc etc etc. Clicking sounds like any number of other non-nerve related things.
What did the physio say they thought was wrong?
No but your lower leg might.
Ok so the two probably aren't linked then. 😆 at Gammy Knee Syndrome
Well if the piriformis is shortened/tightened and it is aggravating the sciatic nerve, are you saying that pain alone would not indicate that, but instead I would be experiencing more of what you mentioned, ie p&n, numbness etc as well?
Aargh! Now I'm even more confused!
Physio, who I saw before Christmas, didn't diagnose anything, just confirmed where I was tight and gave me a stretching routine.
Piriformis syndrome is what is known as an interface problem wher the neve doesnt slide through the muscle quite like it should. Sciatic pain is usually down the back of the leg and more often than not stops above the knee. Nerve pain usually presents with the things I mentioned up there.
Clicking in your knee could be anything from boney fragments floating around inside your knee, muscle tendons clicking over boney points, your patella clicking into the groove underneath it and a hell of a lot of other things.
As strengthening regime will help with flexibility and should sort out a lot of your pain IF it is the most obvious conditions. Work on balance and joint position sense.
A sports massage might be a good idea to get your nerve moving through your piriformis.
Usual caveats apply. I have not examined you.
Thanks for the advice - much appreciated. Sounds like two probably aren't linked then - I did wonder if they would be given that the piriformis muscle is related to rotation. How do I go about establishing the cause if the knee pain then?
Honestly, I'm so f***ed off with being in pain whenever I'm at work, I'm totally at my wits end.
Easy answer - go see another physio.
Email me and i'll give you some more advice off forum.
Hmmm....
When my knee went all clicky, I was told by several different docs (a) bursitis (housemaids' knee), (b) definately a meniscus tear (by my neighbour, a consultant orthopaedic surgeon) and (c) psoriatic arthritis (and I don't even have psoriasis)
Turned out it was just full of rubbish from 30 odd years of misuse. Quick arthroscopy clean up, and I was back on the bike very quickly, and I'm running half marathons a few years later.
Not saying this is you, but my experience is that diagnosis seems difficult with GKS.
I'd be surprised if the two were related.
Your knee pain sounds very mechanical and if it doesn't settled down an MRI scan would be a good idea to see if any thing is floating about in there. Your GP could sort it out or refer you to an acute knee service.
Piriformis syndrome is a rare cause of sciatica (which does radiate below the knee often) as far as I understand and is difficult to distinguish from more common cause of such pain like a slipped disc.
Keep up the stretching and healing vibes!
Piriformis syndrome is a rare cause of sciatica (which does radiate below the knee often) as far as I understand and is difficult to distinguish from more common cause of such pain like a slipped disc
My limited understanding is slightly different, in that piriformis syndrome is actually quite common, but the way it is distinguished from slipped/herniated disc is that the sciatic pain stops at the knee, which mine does.
😥
SBZ - shall I email you on the hotmail address you used to send me the bike fit spreadsheet?
Wallop - yeah that'll do.
Google piriformis syndrome and you'll find all sorts of talk about it being common, often to sell you a service. In practice it is rarely seen on scans though. Shame, as it would be a nice procedure to free the nerves passage through the muscle.
I don't think whether the nerve is compressed as it exits the spine (slipped disc) or passes through the piriformis wouldn't dictate whether the pain stopped at your knee or not though.
Hope it settles soon.
I don't think whether the nerve is compressed as it exits the spine (slipped disc) or passes through the piriformis wouldn't dictate whether the pain stopped at your knee or not though.Hope it settles soon.
That's a very good point. The danger of self-diagnosis by internet I suppose 😆
Thanks
Shame, as it would be a nice procedure to free the nerves passage through the muscle.
Powerofra, are you a surgeon or something of that ilk? I've read many times about this surgical procedure, which does indeed sound lovely, but I couldn't imagine how you might find someone to do it.
I don't think whether the nerve is compressed as it exits the spine (slipped disc) or passes through the piriformis wouldn't dictate whether the pain stopped at your knee or not though.
I would think that it would do just that. Difference between nerve roots and peripheral nerves....
I am. A very bored one, on a quiet on-call! You would need a proper diagnosis and a scan which would happen via a referral from your GP.
As I say, I think it is rarely done as its an uncommon problem.
All the best.
Go and see an osteopath. Tried lots of other types of treatment but it worked for me. It also bloody hurt, but felt 10 times better the next day!
Interesting OP - you've just described exactly what I had from November through December!
With the exception that my physio had me doing strengthening and balancing exercises! Now no pain in my knee and the exercises are getting easier although knee still feels a bit tight. She was ace and also alerted me to shortened hamstrings, weak hip flexors and flat feet. Working on exercises for all of these too now. Can't thank her enough - my knees still click incidentally but at least they don't grind - that scares me!