1st time knee problem

[skigrl27]

So maybe some of you knee injury experts can advise...

My right knee (after a big day at Mad River Glen 3 seasons ago) has always made a kind of "crunching" noise. Going up stairs, bending down, etc, etc. Crunch, crunch, crunch.

Last season, before skiing started, I decided to get it checked out my an Orthopoedist. They X-rayed and looked and said it was nothing - but that I would likely have arthritis in that knee as I got older.

Well, after our first HUGE powder weekend, last night, I got home and my knee swelled slightly and is VERY stiff. And it just simply hurts. Something is definitley not right. It doesn't hurt when I ski, just walking and extending...kind of strange. My ski stance feels fine and I got through the whole weekend charging pretty hard. It's hard to pin point where the pain is - but mostly on the inside sort of under my knee cap. Ugh.

I'm going tomorrow morning back to the same doctor to get it re-checked. I'm so afraid of what they may say. I will be devastated if I they advise me not to ski - I would probably break out in tears right there in their office.

I'm definitely stressing about the check up tomorrow.

 

[altagirl]

sounds like a meniscus problem to me. Generally you only have surgery on that when the pain gets to be too much or your knee starts locking up.

Sorry to hear about it! Hope it's all okay.

 

[MaineSkiLady]

Noise is very indicative of chondromalacia, which can be quite uncomfortable. This is more of a chronic problem than anything else, and there are ways to get it to settle down, with variations in preferred methods according to physical therapist of choice.

 

[SueNJ]

I agree with MSL--the crunching sounds like it's chondrolamacia, and that could cause the pain and swelling as well. There should be no reason for you to stop skiing. I've got full-blown osteoarthritis in both knees, with bone-on-bone in the left, and I still ski. It's all the more important (now that you know you've got something going on) that you keep up with balanced strength training and flexibility/stretching, to protect the knee joints.

Keep us posted on what the doc says!

 

[altagirl]

Noise is very indicative of chondromalacia, which can be quite uncomfortable. This is more of a chronic problem than anything else, and there are ways to get it to settle down, with variations in preferred methods according to physical therapist of choice.

Yeah - and that's one of those very annoying diagnoses that might as well say "general knee issues for a variety of reasons that we don't have a separate diagnosis for..." But that's likely something you will hear.

But yeah - probably you can be helped through physical therapy and fixing any muscle imbalances, etc.

 

[MaineSkiLady]

Actually, it's a patella-tracking issue. When, for whatever reason, be it former injury/irritation/instability, the patella gets out of the intended groove and stays there long enough, the tell-tale "crunching" noise presents. There are innumerable ways to improve on this, which, as previously mentioned, will vary between physical therapists.

(skiergirl, if your insurance allows you to self-refer to pt, this might be your better option - it's a problem frequently seen and addressed by pt, esp those geared towards sports rehab)

In addition to specific VMO strengthening, taping the patella to a more favorable tracking position helps it "relearn" where it's supposed to be, relative to where it has wound up in the tracking process. Took me forever and a day to get the hang of doing it right, but it truly works well. No noise. What VMO strengthening exercises are rx'd are also at the discretion of the pt, but some are definitely to be avoided, like the bend-to-straighten leg raises with weights that one might do from a sitting position on equipment.

Yeah, that described noise upon straightening was the red light in this description in re: what this might be.

It can, over the long term, be degenerative, so you'd best get on it and find out what you do to get things realigned. Yes, mine would ache pretty seriously, especially after a skiing session the likes of which you just had.

Good luck.

 

[altagirl]

Actually, it's a patella-tracking issue. When, for whatever reason, be it former injury/irritation/instability, the patella gets out of the intended groove and stays there long enough, the tell-tale "crunching" noise presents. There are innumerable ways to improve on this, which, as previously mentioned, will vary between physical therapists.

By definition, "chondromalacia" just means a cartilege defect. (Technically chondromalacia can occur in any joint, but we're obviously talking chondromalacia patella here). And it can be caused by things other than just tracking issues.

I have it pretty good behind one of my patellas and it's from smacking it into a rock, not tracking problems. The cartilege is all cracked and looks different in the pics from my scopes than being worn away from being rubbed against the wrong groove.

https://healthguide.howstuffworks.com/chondromalacia-patella-dictionary.htm
https://www.mayoclinic.com/health/chondromalacia-patella/DS00777

Not that you're wrong, because what you're describing is chondromalacia, but it's not that narrow of a definition. I believe Patellafemoral Syndrome is more specific to tracking issues. And chondromalacia patella is (while not a very specific diagnosis at all) more specific to describing pain caused by damage to the articular cartilege behind the kneecap (which could be caused by PFS or trauma or other things).


But I totally agree, that if that is the problem, it is degenerative. And the longer you try to ignore it the more cartilege you're wearing away. So if your doc tells you do to physical therapy, take it seriously!

 

[MaineSkiLady]

Indeed. I stand corrected. Very much a "catch-all" term. But, in the absence of a known trauma (like you had), the most common cause is the patella mistracking - at least according to the physical therapist who diagnosed (in, like 10 seconds) and treated mine.

 

[altagirl]

But, in the absence of a known trauma (like you had), the most common cause is the patella mistracking - at least according to the physical therapist who diagnosed (in, like 10 seconds) and treated mine.

That's probably true!

 

[sibhusky]

I've got the darn noise issue as well, it's due to breaking my knee cap. But the severity of the "pop" is decreasing as I build up strength. I think when all the muscle melted away while I was in my splint, it just didn't come BACK TO LIFE completely yet and when everything is back to its former strength it will clear up.

I'll let you know as the season progresses.

 

[skigrl27]

Just got back from the doc. Lots of fluid and swelling in there. He didn't drain or do a cortizone shot - but said it's an option if it gets worse after more ski days.

He did say my alignment was off and that it was more common amongst women. He cleared me to ski - but said that my knee will likely continue to swell and hurt unless we fixed it.

So for now, i'm icing and taking anti inflammatories - but i've got the green light to ski. He suggested a brace. Then he said he could do a full realignment surgery for a more long-term fix, once we are out of the ski season.

He prescribed strenghening my quads and stretching too.

but I'm happy...I guess. Certainly seems like something I'll need to deal with more seriously down the road.

 

[MaineSkiLady]

Okay. This is okay news. Beats some of other possibilities, by a long shot. Welcome to my (clears throat, grunts) boat.....I hope you have the same luck as I did in finding a physical therapist who can help with both exercises and alternatives to surgery. As a last resort, cortisone does work well (I haven't had it in my knee). There really are ways to coax a better alignment with specific exercises, and - as mentioned before - the interesting taping method. I had very good luck with it last season and noted a definite improvement. Wishing you well! Baby it for a bit.

 

[altagirl]

So is it your patella alignment or your knee alignment in general that has a problem? What is the surgical procedure that is a possiblity?

And I would also advise caution with the cortizone shots. I know they help relieve pain, but they apparently do a number on your cartilege in the process. So I wouldn't jump into that until you've exhausted other options first.

 

[MaineSkiLady]

(gosh I hope she's okay...:()
Agree that cortisone injections should be a very last ditch option, way down the road. Try everything else first. I'll be curious to hear if this is full knee or just patella misalignment. This doesn't sound like easy surgery If patella, there is a ton that pt can accomplish. Have to be regular with mine, though, even in off-season, or things want to go back to their "old, familiar" (and INCORRECT) position.

I'll be doing battle with this for the rest of my days, but it pales in comparison to knee replacement

 

[skigrl27]

We didn't get in too much detail because he didn't do an MRI. I believe it's just my patella.

I think that if after my next ski day it swells a lot again and does the same thing (which i'm sure it will) i may suck it up and get a cortizone shot and drain it out. He said it could last me a few months and that sounds good to me right now.

He said all my spaces between bones are there - which means i still have cartilege and everything is functioning properly. He compared it to last year's xrays and they looked the same.

When I got back to the office and mentioned surgery possibly being in my future, both my boss and the CEO said the best Ortho doc around is in Vail. Stedman something. And that they wouldn't go anywhere but there for a 2nd opinion and if surgery is necessary then that's the only guy they'd use. Good to know.

So I may dope myself for this season if I find myself in too much pain - then head to Vail for a follow up when the snow melts. The Aspen guy said it was a pretty serious surgery with a long recovery time.

 

[Arlaquinn]

Strengthen quads but don't forget your hamstrings!

So I learned the hard way...tore my ACL playing soccer...missed last years ski season....if your quads are considerably stronger than hammy's it puts your ACL at risk!
Leg press is good....Quad extension (in my book is BAD)!

so here is some cut and paste info form this link
https://www.athleticadvisor.com/Injuries/LE/Knee/preventing_acl_tears.htm

Weight room activities should focus on exercises that improve hamstring strength and coordinated firing with the quad muscle group. Examples of these types of exercises are: hamstring curls, squats, power cleans, and dead lift.
The balance of power and the recruitment pattern of the quads and hamstrings have been shown to prevent ACL injuries. The quad muscles are an ACL antagonist, that is they place stress on the ACL when contracting. The hamstrings are an ACL agonist, removing ACL stress when contracting.

Due to this, if the hamstrings are excessively weak or inflexible they may not adequately protect the ACL during a strong quad contraction. Also, if the quad group is excessively strong, relative to the hamstrings, the ACL may be torn due to a lack of hamstring “protection.” ACL injury prevention should then focus on a balance in strength between the hamstrings and quads. It is recommended that the hamstrings should be 60 - 80% as strong as the quads.

 

[skigrl27]

k so after talking with many other knee injured people, i decided to go get my knee drained tomorrow morning. I was so scared at the term "drained" that i was like "no way!!" when i was at the office this morning.

But then about a dozen people were like...it would have made your knee feel SO much better! Why didn't you do it?? So to relieve some pressure I'm going for it.

Tomorrow, 8 AM. Knee drainage. I'm SCARED!!

 

[altagirl]

I've never actually had that done. So fill us in afterward with what it was like!

And get the name of the surgical procedure they are discussing too... We're nosy!

 

[itri]

Skigrl, the clinic in Vail is Steadman-Hawkins and they are world-renowned for their work with knees and shoulders, as well as with skiers in general. I would DEFINITELY get a second opinion from them before getting anywhere near surgery for a patellar tracking issue! My orthopedist has done some training with Dr. Steadman and he believes that the surgery that is done for patellar tracking issues really doesn't help all that much in the long run. Your best bet is to get into PT and get on a serious strengthening program. You didn't say if your doctor prescribed PT or not, but if he didn't, PLEASE ask him to do so tomorrow. That should be your first step before doing anything else, and definitely before a cortisone shot.

Altagirl, usually what they do for patellar issues is a lateral release. The theory is that the muscles and tissues on the outside of the knee are too tight so they "release" them to allow the patella to track properly. In reality, this should only be a last resort when PT and a major VMO strengthening program have failed. Even then, it's not really a guaranteed fix.

 

[pinto]

Altagirl, usually what they do for patellar issues is a lateral release. The theory is that the muscles and tissues on the outside of the knee are too tight so they "release" them to allow the patella to track properly. In reality, this should only be a last resort when PT and a major VMO strengthening program have failed. Even then, it's not really a guaranteed fix.

I had a lateral release when I was 16. I had dislocated my left kneecap eight times, so I guess I qualified for "last resort." It worked for me ... no more dislocations. I still have some issues with that knee, mostly due to the injury under the kneecap from all the dislocations, but nothing major since then.

Like I said, it worked for me, but I also know that it is kind of controversial because the success rate is only so-so.

You might be a good candidate down the road, maybe not, but I absolutely would NOT do it at this point, skigrl!!! When you go to the surgeon, he likes to operate. I mean, not all of them go there first thing, but that's what they're trained to do, so that's what many want to do.

Typically, I go to my physical therapist first. He's trained to fix people without operating. If it's beyond my physio, then I go to the doctor. (My insurance allows pt visits without a script.)

You've gotten some good advice about exercises, taping, even a brace (although I think tape helps more than a brace, and it's less bulky under ski pants) -- go to a physio and learn the taping procedure and some exercises. Use ice and ibuprofen; don't squat, don't jump (too much, or at least make sure the landing is really soft), don't bend your knees past 90 degrees, do lots of straight-leg lifts to strengthen legs without stressing knees ... there are lots of things you can do before even thinking about surgery. It is a fairly extensive rehab. Not ACL-extensive, but it's more than a simple cartilage snip.

Good luck!