Does my knee sound injured or just tendonitis from overuse?

[surfandski]

So some may know that I recently had my right ankle fused back in April. Over the past 3 years since my motocross injury, my left leg has had to work over time as my right ankle joint deteriorated to where I could barely walk. Last ski season we spent nearly 2 months in Colorado where I skied 6 days a week and my left leg was carrying about 65-70% of my body weight (more if it got bumpy). Then, as my right ankle would swell up after skiing, I'd be nearly hopping around on my left leg when not skiing. The 2nd to the last ski day in Colorado I noticed a burning sensation right above my left knee cap. It wasn't a really sharp pain like what I'd imagine tearing a ligament would feel like and it does not hurt to torque my knee in any direction so nothing seems torn. I was able to ski my last day without pain other than the burning sensation above the left knee cap.

That was 5 months ago and am still having issues. The worst is going up stairs whenever my left knee has to catch my body weight and lower it down. One time I caused it to flare up by doing leg extensions with fairly heavy weight and that caused it to bother me quite a bit for a week so immediately eliminated that exercise. I haven't tried squats yet. It also flares up at night sometimes. I tend to sleep with my knees bent and a body pillow in between but sometimes I'll wake up with it burning until I straighten out that leg which eliminates the pain/burn. When I first got back into cycling this spring it would burn while pushing down but for the most part it has diminished in every situation to where it is just a dull burning sensation that's just enough to know it's there but not enough to hinder my activities.

Does this sound like something is just inflamed like tendonitis or does it sound like a bigger issue? Having just had a major surgery and another check up on my lungs, my insurance company is on high alert and not likely to approve an MRI unless I really push back if it truly seems like a major injury. It is fairly diminished right now to where it's not holding me back but my fear is that it flares up next ski season and causes me to have to pull the plug on our trip when we've already bought season passes and rented the house in Colorado.

One thing I wondered is if I should get a brace that keeps that knee straight when sleeping or at points throughout the day to give that knee a break. With all of the sports and crazy crap I've done thru the years, I've never had knee issues but this knee had to work double duty for the better part of 3 years so it's currently unhappy.

What do y'all think? Thanks!

 

[Dave Marshak]

You have all the classic symptoms of patellar tendonitis. If that's what it is, you need to keep the inflammation under control, and then strengthen the tendon. Immobilizing the knee with a brace will not help.
The usual advice is prescription amounts of ibupropen, or voltaren. Then moderately increasing exercise whenever there is no inflammation. But probably better to consult a doctor. Good luck.

Also, what kind of crappy insurance do you have that you are afraid to take an injury that restricts your activities to a doctor?

dm

 

[Corgski]

Not tendinitis at this point, you are long past that stage. Could well be what is referred to as tendonosis or tendinopathy. Repeated overloads with possible tendinitis at the time that did not get a chance to heal properly. If that is what it is, you may well be able to get it back in reasonable shape by ski season. Anti inflammatories are not going to do anything for you, may set you back. I'd suggest doing a little background reading see if the tendonosis/tendinopathy symptons match yours and read up on recovery protocols. (Note that I am not saying it is not a more serious injury, just suggesting feasible alternatives).

While aimed at strength training, this is quite a comprehensive review, worth reading even if you are not interested in squatting or not able to squat.
https://www.strongerbyscience.com/squatting-with-patellar-tendinopathy/

If this is what it is, you have to be very disciplined to progress in steady small increments and to avoid overloading. What usually happens, one starts feeling better, start pushing a little harder and sets oneself back a few weeks (or months).

 

[coskigirl]

Halfway through your post I immediately started thinking patella tracking disorder and/or the tendinitis Dave mentioned. Along with Dave's suggestions try some cross friction self-massage right above and below the kneecap. The imbalance may have caused the patella be pulled off its normal track by tight attachments. It's more common in women because of wider hips causing the attachments to pull more outward but men do have the issue as well.

https://www.arlingtonortho.com/conditions/knee/knee-patellar-tracking-disorder/

 

[Mike King]

you didn't mention how old you are. It might be arthritis. I had a big flare up of arthritis in my right knee after I had a brush with a tree. It wouldn't really settle down. I'm just coming into my 6th week after PRP (platelet rich plasma) treatment and while I was initially a skeptic, it seems to have done the trick.

I didn't need an MRI for my orthopedic surgeon to diagnose the problem, it showed up on X-rays. About $150.

 

[luliski]

Did you go to PT after your ankle fusion? I would go to them and see what they think.

 

[graham418]

I am not a doctor, but a patient. It sounds to me like an overuse situation that could be on the way to becoming a chronic condition. I trust that you have a good PT , and that they are guiding you in the rest and rehabilitation . Is your PT also a kinesiologist? I had some lower back / hip issues years ago that were solved by a kinesiologist addressing some imbalances in my gait and posture.
I don't know if that would apply in your situation, but I am sure it would be well worth the price of a consultation.

 

[surfandski]

Thanks everyone for the comments and it definitely sounds like tendonitis (or beyond) and it makes sense that I need to slowly strengthen it as opposed to trying to rest it. I had my final visit with my ankle surgeon today and the bones are fully fused so he has cleared me to resume all activities. Over the past 3 weeks there has been steady improvement in my ability to walk normally without limping or putting additional stress on my healthy left leg and I would say that the burning sensation in my left knee has diminished as well so I'm hoping as my right leg is nearly back to normal, that the knee tendon issue will continue to recede now that it won't be working overtime. My fused ankle is far from pain free but the pain is manageable enough that I haven't needed any pain relievers/anti inflammatories, nor do I need to limp to ease the pain under normal conditions.

That strongerbyscience article was very educational and I think I'm going to use their method for testing out the tendon and rehabbing it SLOWLY. Our home weight room has a squat rack and leg extension machine so I think it's time to very cautiously ease into some strengthening exercises and see how it responds. They mentioned initially limiting the range of motion both in leg extensions and squats and slowly increase ROM over time and this makes sense because the biggest flare up I had with this tendon was doing leg extensions with maximum extension and too much weight. Outside of that flare up the pain never got above a 3 but that took it to probably a 6 so I stopped trying to exercise the tendon figuring that rest would help.

The good thing from that article is that it sounds like I should know within days or a week if it's worse than I realized and I need to see someone. Do you know if one of those compression knee braces would beneficial or would it not help my situation? Thanks again for your input and I'll keep you updated.

 

[SBrown]

Leg extensions are hell on bad knees ....

 

[Corgski]

Leg extensions are hell on bad knees ....

Yes, however the extensions in the article are isometric holds to 60 degrees from straight, this is quite far from a normal leg extension. If one does not want to do the leg extension there is a Spanish squat exercise which can be used.

 

[Kneale Brownson]

I wouldn't wait to see a sports physician.

 

[Wilhelmson]

If you're self treating have you tried exercise that doesn't put your body weight on the affected area, like spinning? I'm 42 and re-busted my rib and no way am I hitting any heavy weights until it gets better. Been there done that.

 

[surfandski]

Halfway through your post I immediately started thinking patella tracking disorder and/or the tendinitis Dave mentioned. Along with Dave's suggestions try some cross friction self-massage right above and below the kneecap. The imbalance may have caused the patella be pulled off its normal track by tight attachments. It's more common in women because of wider hips causing the attachments to pull more outward but men do have the issue as well.

https://www.arlingtonortho.com/conditions/knee/knee-patellar-tracking-disorder/

Coskigirl, I read that article and it doesn't appear to be a tracking issue but my wife had that to the point Drs told her she had rheumatoid arthritis. Over a year seeing specialists before a quick chiropractic visit revealed here knee caps were rotated out of position. A few weeks of knee extensions and she was good as new and hasn't had any issues in 15 years. I forgot about that until reading the article and it encourages me that getting my legs back in shape will take care of this issue. I've also been using a mixture of DMSO and Linament oil the past 2 days and it seems to be helping. As soon as I fly up to NC this weekend I'll start lifting and see how that does.

BTW- what is cross friction massage?

 

[Dave Marshak]

I have had both a seriously misaligned kneecap and multiple tendinitis injuries. Strength training managed my kneecap tracking issue. At the time, I was racing bicycles and was told to spin faster with lower pedal pressure until my knee improved. That never worked. Finally, a sports medicine doctor got me doing strength training, first isometrics then short, high pressure intervals on the bike, and I got better. One key was never train when I felt soreness.

That approach doesn't work with tendinitis. Your muscles always build strength faster than tendons because muscles have better blood supply. Tendons and ligaments need light exercise to stimulate blood flow, and cortisone shots.

Voltaren is better than ibuprofen for inflammation. It's a gel that's absorbed through the skin, and probably way better than off label use of DMSO. Voltaren is over the counter in Canada but prescription on the US, which is another reason to go to a doctor.

Leg extensions are hell on bad knees ....

All gym machines are a waste of time at best or harmful. When I was a USSA coach, we never used any machines or even heavy weights, it was all body weight exercises on stability balls. Machines all isolate particular muscles, and take the load path away from core muscles. You end up with some strong muscles, but not the strength and coordination you need to stabilize your core when you use that strength. Using leg extension machines and leg press sleds, you can easily strengthen your quads enough to break your ACL. Better to do squats and deadlifts with free weights, which will strengthen your core, quads and hamstrings in a balanced way.

I wouldn't wait to see a sports physician.

That's the most true post I've read here.

dm

 

[Kneale Brownson]

Voltaren is better than ibuprofen for inflammation. It's a gel that's absorbed through the skin, and probably way better than off label use of DMSO. Voltaren is over the counter in Canada but prescription on the US, which is another reason to go to a doctor.
dm

Is that the same as Arnicare jell? You can get that in the USofA.

 

[Corgski]

I wouldn't wait to see a sports physician.

One also needs to assume a generic disclaimer with any advice given here in that sharing resources and experiences is not a substitute for medical advice. I think these discussions can be useful in a post rehab context when one is trying to develop a long term exercise routine with pre-existing injuries. The average personal trainer does not have the required knowledge and most of us do not have the option of having a PT for a personal trainer. A do it yourself approach of rehab when dealing with a flare up of an old injury is one thing, trying to do it with a new unfamiliar injury where you are not sure what is going on is different.

Thanks everyone for the comments and it definitely sounds like tendonitis (or beyond) and it makes sense that I need to slowly strengthen it as opposed to trying to rest it. I had my final visit with my ankle surgeon today and the bones are fully fused so he has cleared me to resume all activities. Over the past 3 weeks there has been steady improvement in my ability to walk normally without limping or putting additional stress on my healthy left leg and I would say that the burning sensation in my left knee has diminished as well so I'm hoping as my right leg is nearly back to normal, that the knee tendon issue will continue to recede now that it won't be working overtime. My fused ankle is far from pain free but the pain is manageable enough that I haven't needed any pain relievers/anti inflammatories, nor do I need to limp to ease the pain under normal conditions.

That strongerbyscience article was very educational and I think I'm going to use their method for testing out the tendon and rehabbing it SLOWLY. Our home weight room has a squat rack and leg extension machine so I think it's time to very cautiously ease into some strengthening exercises and see how it responds. They mentioned initially limiting the range of motion both in leg extensions and squats and slowly increase ROM over time and this makes sense because the biggest flare up I had with this tendon was doing leg extensions with maximum extension and too much weight. Outside of that flare up the pain never got above a 3 but that took it to probably a 6 so I stopped trying to exercise the tendon figuring that rest would help.

The good thing from that article is that it sounds like I should know within days or a week if it's worse than I realized and I need to see someone. Do you know if one of those compression knee braces would beneficial or would it not help my situation? Thanks again for your input and I'll keep you updated.

Keep in mind that we have no idea whether anything we suggest is a good match for you, especially considering your other injury. The article is aimed at people who have a well established weight training routine. Even if it is a good match, performing these exercises correctly can be a challenge, a squat and its many variations can be a remarkably technical exercise. You need some guidance here, do you have a PT you have been seeing?

@SBrown is right, leg extensions are known as not being knee friendly, it is important to understand why and how it is being used in this context. Firstly, the goal of increasing angle range is for the squats, not the leg extensions, 60 degrees from straight was what was used and at these angles the potential risks of leg extensions is supposedly reduced. Also @Dave Marshak is right about isolation exercises in general. The reason why leg extensions is used in a rehab context is that in this case they DO want to isolate the quadriceps and patellar tendon. Generating the desired loading in the quadriceps in a compound exercise could be problematic (remember they want to go above 70% of 1 RM). Generating that in a squat could require a barbell heavier than the patient which would raise a whole new set of issues. However isolation exercises are best avoided when developing a long term exercise routine. Also way too easy to overload a tendon with isolation exercises (been there, done that).

While I have been a long time fan of Voltaren gel, anti-inflammatories, along with icing, appears to hinder more than they help. Cortisone is also contra-indicated and increases the chances of rupture.

While rest does not resolve the chronic problem, any form of flare up is acute and resting for a week or two before resuming is probably a good idea. Insufficient recovery from the acute stage can make a temporary injury chronic.

Warm up adequately. Personally I find walking on a treadmill at an incline at low speed to be useful warmup when dealing with a knee injury. The concept of warming up needs to be taken literally as well, if in a cool environment sweatpants can help.

Start much lighter than you think and build up slowly. Don't suddenly try to increase the rate of progress when you feel better.

Would not try a brace without expert advice.

 

[Corgski]

Is that the same as Arnicare jell? You can get that in the USofA.

Voltaren is a prescription anti- inflammatory that one can get in gel form which one rubs on the affected area. Here the gel form is prescription only but internationally the gel form of anti-inflammatories are considered safer than the oral form and have been available over the counter for at least 20 years (at a much lower cost as well). Ibuprofen is available in gel form as well, I haven't used it in many years but I found it reasonably effective too.

Very popular, you get a much higher concentration locally without the gastrointestinal issues and flooding your whole system with the stuff. Everywhere else considered safer than oral for a very long time, here in the USA, the gel form is considered more dangerous than the oral form, only to be used in bad cases where all else has failed. I have yet to hear a reasonable explanation why.

Edit:
I found Naprosyn Gel (Aleve in gel form) to be the most effective. For some reason it does not seem to be available in any English speaking countries.

 

[surfandski]

This issue seems to be subsiding and I'm sure the fact that my fused ankle is getting back to almost normal, healthy levels is part of it. I did squats and leg extensions yesterday with limited ROM and light weight and felt zero pain in my knee. I figured with the limited ROM of my fused ankle that squats would be very difficult but with a 10 lb plate under each heel, I was actually shocked at how balanced and normal I felt given that I hadn't done squats since leaving for our ski season last December.

I don't want anyone to think I'm dismissing the advice to see a PT or doctor. I'm aware that I don't know a lot of things about PT but wanted to cautiously test it out and see how it went. Over the past 3.5 years since shattering my ankle (and 13 other bones thru the years) I've been to a number of them and occasionally found someone good at sports therapy but so many of them were probably great at helping a lethargic person get off the couch, but found most of them used such basic exercises that I was doing far beyond that in my own rehab at home. My ankle surgeon who did the fusion and I discussed PT and he said that my lifestyle was 10x the PT I'd get seeing one so I haven't since the surgery and my gate is finally back to where no one can tell I had a fusion until I mention it. I'm back to being able to do long hikes in and out with 60lbs of kayak gear on my shoulder and my ankle and knee are feeling good.

Regarding anti-inflammatories, I haven't been using anything lately for that or pain relief. Is it more to reduce pain, which I don't need it for, or is the anti-inflammatory part critical as I rehab this tendon? I hate taking meds unless I absolutely have to so I'd prefer not to unless there is a solid reason.

Thanks for the help! Heading to the river......

 

[Pequenita]

Regarding anti-inflammatories, I haven't been using anything lately for that or pain relief. Is it more to reduce pain, which I don't need it for, or is the anti-inflammatory part critical as I rehab this tendon? I hate taking meds unless I absolutely have to so I'd prefer not to unless there is a solid reason.

The medical and sports science community seems to be mixed these days as to the utility of anti-inflammatories. A newer school of thought is that the body part needs to inflame to heal, more traditional school is that anti-inflammatories reduce pain and swelling, which would allow use and consequently circulation to the body part.

 

[Jenny]

FWIW my ankle doctor's office told me I could take anything except ibuprofen. Not sure why that nsaid is different from the others, but that's what they said.