knee injury . advice?

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  • knee injury . advice?
  • Premier Icon HansRey
    Subscriber

    hi,

    i think i’ve buggered up my left knee, and i’m not sure what is the problem.

    The symptoms are flashes of pain down the inside, front of my left knee. These end at my patella. There is significant tightening in the Vastus Medialus. The pain develops after cycling any more than 2km, at a walking pace, on flat terrain. I tried cycling 4 days as i thought i’d just had some dehydration. Now i’ve done the overreactive bit and searched on google, i’m a bit worried.

    Walking a couple of km is uncomfortable, but not painful.

    I’m going to book a doctors appointment tomorrow. Besides PRICE and HARM, can anyone offer any advice? Should i brace it? Avoid walking completely?

    rich

    DanW
    Member

    Could be a VMO tear??? The VMO is mainly active towards full extension of the knee and not really used too much during walking. If stairs/ cycling/ fully straightening the knee are very painful it is at least possible.

    These things are very hard to describe and judge even for your Doctor. If you have damaged a ligament then the GP should be able to pick this up by pulling your knee bout (technical description).

    The only way to tell for sure if you have any other soft tissue damage is to have an MRI although your GP will be very loathed to give you one as they are very expensive. If there is some soft tissue damage then chances are that by the time you actually get an MRI it might not be the best timing.

    On the other hand, it might just be something minor and one of those annoying niggles which goes away quickly hence why a GP will not be rushing the expensive MRI unless something really jumps out to them. Most likely you will get ibuprofen and be told to rest for 6 weeks.

    For the time being, I think the only advice a Doc would give you is to only do as much of anything as you are comfortable with. Bracing is most likely OTT, especially until you see the Doctor tomorrow.

    GP is the only route to any form of investigation or treatment so it all depends on your persistance/ symptoms really.

    Oh and yes, I am very cynical of the NHS mechanisms for sorting knee injuries but can fully appreciate why everything is as it is πŸ˜€

    glupton1976
    Member

    Anterior knee pain, or patellofemoral pain syndrome. IF you’re worried about it go and see a physio – they’re far better placed than a GP to diagnose knee pain issues.

    DanW
    Member

    Aaargh! “Anterior knee pain” and “patellofemoral pain syndrome” is basically a doctor/ physio telling you that you have pain at the front of your knee and they don’t know what to do about it. You can tell them you have pain at the front of your knee! Anterior knee pain is especially hard to get to the bottom of hence why it is generally referred to as an all encompassing “pain syndrome”.

    A private physio will still need an MRI to base their diagnosis/ treatment on (to include or exclude a multitude of possibilities). In theory a GP should be able to perform the same quick clinical tests a physio would do in the first instance but I guess this depends heavily on the GP. NHS physio is perhaps better as in most places they should be able to arrange a referral if they think you need the scan after some time trying various options. Still need to visit a GP first to get the NHS physio appointment.

    Sorry for the continued cynicism πŸ˜•

    Basically the best advice I can give is see your GP and if you feel something is really wrong and you are in a lot of pain be pushy for some action and don’t get fobbed off with 6 weeks, upon 6 weeks of rest to see if anything changes…

    Persistence with the GP/ Physio is key as most people they see day to day will be happy to sit behind a desk all day with a bit of knee pain. If you like to ride a lot/ enjoy your sport then chances are you will be much less happy so need to push a bit more to get the extra time and money invested in trying to get to the bottom of it. As I have said though, you may find everything is fine next week which is why the NHS won’t go overboard with thing immediately.

    yunki
    Member

    I got as far as the MRI scan and still no wiser.. 2.5 years of debilitating knee pain and counting

    glupton1976
    Member

    Aaargh! “Anterior knee pain” and “patellofemoral pain syndrome” is basically a doctor/ physio telling you that you have pain at the front of your knee and they don’t know what to do about it.

    And it’s as good a diagnosis as you’ll ever get on the internet.

    A private physio will still need an MRI to base their diagnosis/ treatment on (to include or exclude a multitude of possibilities).

    Pish.

    In theory a GP should be able to perform the same quick clinical tests a physio would do in the first instance but I guess this depends heavily on the GP.

    Pish – they dont have the same training.

    NHS physio is perhaps better as in most places they should be able to arrange a referral if they think you need the scan after some time trying various options.

    By the time you get anywhere near a physio in the NHS you’ll have a chronic problem which will be much more difficult to remedy.

    Still need to visit a GP first to get the NHS physio appointment.

    Also pish – most places have self-referral to physio now.

    DanW
    Member

    Can you explain patellofemoral pain syndrome then Glupton? I am yet to hear a consensus as to the causes and best treatment including international medicine/ orthopaedic/ biomechanics conferences/ papers/ clinics.

    Even the wealth of reliable ( πŸ˜• ) information that is Wikipedia says: “
    Clinicians have traditionally used a variety of treatments for patellofemoral pain syndrome, many of which have little supporting evidence”. The name “pain syndrome” gives away the lack of underlying understanding of the vast majority of anterior knee pain.

    Unfortunately the practical training a physio gets is as variable as GP experience these days. Any GP should be able to perform basic clinic tests and have a rough idea of what might be going on… however they should also be able to take bloods but I think I have only ever met one GP prepared to do it themselves πŸ˜€

    Yes a private physio might be able to help to some degree but to get to the bottom of a lot of the potential knee issues an MRI really is important. This is of course highly dependent on the injury but if I were in a lot of pain and thought there was some soft tissue damage I would be pushing for an MRI while seeing a physio in the mean time.

    Unfortunately too, for a lot of people getting physio through a GP is still the only option. Of course if the OP can self refer then why not πŸ˜€

    glupton1976
    Member

    PFPS – pain in and around the interface of the patella and femur caused by any number of things. Any number of causes = any number of solutions. As I said – as good a diagnosis and you’ll get on the internet.

    Anterior knee pain – pain at the front of the knee area. Any number of causes = any number of solutions. As I said – as good a diagnosis and you’ll get on the internet.

    There is no lack of understanding of either condition.

    Practical training for physios is variable – how folk can do a physio degree in two or three years is beyond me. Probably why the NHS in England seems to favour people who studied the 4yr course in Scotland.

    Your insistence that an MRI is needed to get to the bottom of a knee injury is absurd. Would you be saying the same about sprained ankles, wrists etc?

    DanW
    Member

    I am a bit confused, are we agreeing PFPS as a diagnosis is not very helpful? πŸ˜€

    What you are saying is not incorrect about PFPS nor is the point I was trying to make, which that PFPS as a diagnosis does not tell you the underlying cause for the pain nor the right solution. As you correctly say, the causes and solutions are many which is why I find PFPS as a diagnosis frustrating- it really tells you no more than you already know which is that the patient has pain. You can rule out many of the more well known causes but what do you do when you exhaust the well known possibility? You are still left with a patient with pain and no better understanding of what is causing them the pain. The lack of understanding part comes from many patients not ever getting to the bottom of the pain when it isn’t one of the more obvious causes yet still have “PFPS”.

    The large number of possible knee issues when faced with pain and the relatively high reliance on soft tissue structures for stability/ function of the knee is why personally, as a patient, I would want as much information as possible to direct treatment (or at least rule out several possibilities). Not pushing for this reasonably early gets you in exactly the position you describe with waiting for NHS physio which is a perhaps relatively easily treatable condition turning in to much more trouble than it needed to be a year or two down the line. From a clinical point of view perhaps a little absurd in the early stages of the pain but from a patient point of view, potentially quite important in the long term.

    What would be your flow of action and timescales as a patient with a lot of knee pain, feeling something was quite wrong? I would have thought involving the NHS GP and physios as early as possible, even if seeing a private physio on the side right at the start is the best way forward to avoid long delays if anything further is required beyond the scope of a private physio.

    glupton1976
    Member

    I am a bit confused, are we agreeing PFPS as a diagnosis is not very helpful?

    Yes. πŸ˜€ Crap diagnoses that I view as a bit of a cop out.

    You see with a lot of injuries you don’t really need to know what is going on. Treatments tend to be along the lines of get pain under control, get range of motion back, improve joint control, strength and positional sense. Personally, the most important treatment that I tend to use is reassurance. Reassurance that the persons leg isn’t going to fall off and they are not at risk of imminent death from their knee problem.

    What would be your flow of action and timescales as a patient with a lot of knee pain, feeling something was quite wrong?

    Subjective> Objective> Discussion of probable/potential diagnoses with whys any why nots. If there are any indications that there is a nasty going on – refer to appropriate person.

    The scope of a private physio is the same as the scope of an NHS physio.

    Premier Icon HansRey
    Subscriber

    hmm, interesting. I’ve tried bracing it and it’s helpful at the start, but then it hurts. Booked a GP tomorrow, who will probably refer me to a specialist.

    Good call about seeing a physio, i’ll ask about that too. They may be able to help. I’ve found them to be really good over here, certainly better than the doctors.

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