Author Topic: Knee  (Read 3078 times)

clarion

  • Tyke
Knee
« on: 12 September, 2008, 02:41:34 pm »
I'm old.  well, old-ish.  And I should expect a few aches & pains.  But I've picked up an odd one.

I have a history with knees (and I've been a bit squeamish about them since I felt my patella move whilst kneeling on a stone step in a church).  I played rugby, and got them trodden on in a ruck.  Later, when arrested by the lovely BiB, I had a plod stand on them.  And they worked hard for a living - loading & unloading trucks, climbing etc, as well as hilly cycling.

But they worked OK - maybe a small twinge in the winter.

Till this summer.  Riding on the tandem, I picked up a pain in my right knee, sharp and directly on the kneecap.  It passed.

But it's back.  Only thing is, I don't get it when I'm riding.  It's the other times - at night, at work etc. :(  I hope it's nothing of import, but it's unpleasant enough, and I just want it to go away. :(
Getting there...

Eccentrica Gallumbits

  • Rock 'n' roll and brew, rock 'n' roll and brew...
Re: Knee
« Reply #1 on: 16 February, 2009, 01:42:41 pm »
Is it gone?

I have knee pain. I think I hurt my knee last week when I was shifting the cooker to retrieve my earring (which is still under the floorboards  ::-) ). The back of my left knee has been moderately sore since last Wednesday night, and worse today after I turned sharply and attempted to run for a bus. It's worse on flexion than extension, and even flexion when not weight-bearing is sore.

NHS Lothian physios have an online knee thing where it asks you lots of questions, cogitates your answers and gives you suggestions/advice for treatment/exercises. I went through it earlier and it was fine until I got to the answers page which are blocked by my work server! I'll have to do it again from home.
My feminist marxist dialectic brings all the boys to the yard.


Re: Knee
« Reply #2 on: 16 February, 2009, 01:52:45 pm »
Old + Cold = knee pain.
I had knee pain after starting the London Etape in shorts in cold rain.  It took nearly a year to go away. Now I cover my knees with Tubagauze and tights with double thickness knees unless the temperature is in double figures.
Any sign of rain and the Rainlegs go on.

Raph

Re: Knee
« Reply #3 on: 17 February, 2009, 12:32:03 pm »
I had knee pain when I was younger - I went to a physio who came up with some convoluted explanation as to why, and the long and short was that I did weights and cured the problem in a weekend. I was 30 but had had the problem since about 14. A couple of times since then it's come back cos I've gone directly from overworking sedentary couch potato to doing 10,000ft climbs in the Pyrenees without any preparation, but the preparation and the cure are the same - weights.

All the usual stuff e.g. keeping knees warm applies. I think worn joints - i.e. cartilage or bone damage - are very rare, the most common knee pain is caused by tendons. If that's the case with you then I recommend looking into weightlifting - you don't need fancy gear, I've strapped dumbells to a pair of defunct mountain boots and I lie on a sofa on my back with my legs hanging over the edge, knees on the armrest, and do a couple of hundred or so lifts, then still on my back I cycle in mid-air, and do a bit of side-to-side and in-out stuff. I'm sure it looks utterly ridiculous but it works. For the very rare occasion that the back of a knee hurts i do the same on my front - the options are less amusing but the principle is the same. Less weight and more movement is better than piling them up and straining. 6-8kg on each is plenty. I only need to do this when I'm about to go on a trek, or when I've come back from one that I didn't prepare for and therefore knackered my knees on the way down mountains with that 25kg backpack. Cycling has never messed up my knees since I started doing this - basically it was a one-off cure, and cycling has never again caused a problem. Once in a blue moon I get twinges at the beginning of a ride but they disappear when I warm up.

The kneecap should be a loose piece that you can wiggle around - in the bad old days mine was stiff, this is what the physio found - he said the kneecap should be loose and floppy - the tendons around it were stiff, and basically began to tear when under stress. The full programme should include deep-massaging them with very firm pressure, which I sometimes still do, to relax them and get blood flowing to maximize repair and regeneration. The physio also did other voodoo such as ultrasonic gizmos and electric current and stuff but I never found the need to go back to him for that - just weights, massage and yoga-style stretching did it, and I do all those at home for free (except the dumbells cost £20). I'm certainly not a body-building type but I have to admit that the weights are the single most effective part of it.

Ideally I'd have got a machine I sit on and straighten my legs in front of me and ropes and pulleys would lift the weights - but the dumbells method is so good that I couldn't be arsed with the expense and storage of the proper equipment.

PS about massage - some of the relevant tendons go under the kneecap - it's hard to get to them, and very unpleasant trying, since you hit a sort of funnybone (the one that makes your leg kick when you hit it) - but it's important to get in there and give everything a gentle pummelling to loosen it all up.

I hope I don't sound as though I'm trying to come across as knowledgable - this is just in my experience and it's been very positive, whereas knackering my knees regularly used to blight my life. If your sore knees are due to something else, a cracked bone or something, then the above may be totally irrelevant.

simonp

Re: Knee
« Reply #4 on: 17 February, 2009, 08:46:33 pm »
Warning, I am not a doctor:

The kneecap runs in a groove in the femur.  The joint (the patellofemoral joint) is prone to problems if the kneecap is pulled sideways out of its groove for any reason e.g. muscle imbalance, tight ITB, etc.  This can cause irritation of the cartilage behind the kneecap (I think I read it's the thickest cartilage anywhere in the body because of the loads it takes).

Things like descending stairs place particularly heavy loads on the patella.  If there is maltracking then this will increase the load on one area of the cartilage causing irritation and pain - and eventually damage to the cartilage.  Pain around the kneecap is the most common injury associated with cycling.

I've been having problems - physio is helping but it seems to be a slow process.  I'm also taking glucosamine sulphate, cod liver oil, and chondroitin.  Not sure if they help but there is evidence of effectiveness in reducing the effects of osteoarthritis:

Glucosamine and arthritis update [Mar 2001; 85-2]



Chris S

Re: Knee
« Reply #5 on: 17 February, 2009, 09:04:54 pm »
I have never had knee problems, until last year.

After that audax when my left knee went BANG!, it was like walking around with a bag of marbles in my pocket; talk about clicking!

Been fine since about August last year.

Strange things... knees.

Raph

Re: Knee
« Reply #6 on: 17 February, 2009, 09:27:30 pm »
Unless there's a good reason to suspect that there's real damage to bone or cartilage, that "twingeing" one often gets in the cold is very likely to be tendons - the bit that joins muscle to bone - it doesn't generate heat the way muscles do, but if it isn't nicely loose and elastic it doesn't do its job as well and it's more prone to being stiff and un-elastic when it's cold.


"Things like descending stairs place particularly heavy loads on the patella" - yes, thumping down rocky slopes with a rucksack a third of my own weight, where there isn't the choice to land softly on the ball of your foot and roll onto the heel, is a sure way to mess up knees. In cycling the more common cause seems to be imbalance between various muscles pulling on the kneecap - in either case weightlifting sorted me out. It did feel originally as though my knee joints were wearing out - so I was surprised when the physio mentioned weights, but it really did work like magic. Unless a doctor advises against it, I'd try the dumbell trick - or put a load of baked bean cans in the pockets of a "one piece" pair of oven gloves, drape it over your ankle and lift that a couple of hundred times, then do the other leg. I did that before getting dumbells - apart from it falling off it worked quite well.

simonp

Re: Knee
« Reply #7 on: 18 February, 2009, 12:53:49 am »
Strengthening the quads - yes.  I've done exercises for that.

I'm currently being advised against knee extensions though.  The problem is that puts high loads on the patella, so there is a risk involved of exacerbating any existing damage.

The other issue is tightness - I have very tight hamstrings.  According to the physiotherapist, this is in part because I have weak ACLs (she did a specific test for this - the effect is that the knee joint has too much longitudinal freedom of motion) which results in the hamstrings compensating.  This leads to them being naturally tighter.  Apparently I will never be very flexible because of this.

Progress is being made.  I haven't got the levels of discomfort right now that I had even 2 weeks ago and back in December the day after I played football last my left knee was a bit puffy.  This has stopped - I may have to resign myself to never playing football again.

I also have flat feet and thus the way I stand puts strain on my knees, so I have orthotics for that now.

Re: Knee
« Reply #8 on: 18 February, 2009, 10:26:05 am »
I have a knee. I keep meaning to take it to the physio, but as soon as I think of that it ceases to bother me.

As Clarion's, it's fine on the bike, but it got to the point recently that when I got off the bike I couldn't walk.

Then, climbing a steep knap on fixed, it went twang and really hurt. Since then it seems to be recovering. I still think I really ought to get it checked

Re: Knee
« Reply #9 on: 18 February, 2009, 01:34:46 pm »
Strengthening the quads - yes.  I've done exercises for that.

I'm currently being advised against knee extensions though.  The problem is that puts high loads on the patella, so there is a risk involved of exacerbating any existing damage.


The problem with knee extensions for me is that it's only the last little little bit (from 10 deg off straight to straight) that is working the little teardrop muscle near the knee.  And the weakness of that muscle is what is causing the imbalance in the way my patella tracks.  So I have to do single leg squats and lunges to get it to work properly.  It might even have been the quad extensions that caused the issue in the first place...
Obviously, YMMV. 
Seeing a doc is a good idea - if your GP doesn't know or is doubtful, then get referred.  And try not to do the stuff that hurts.
I spent 3 months trying to play football with a torn ACL after being told it was just cartilege damage and I could play if I wanted! :o  It *really* hurt!  They found out the truth when they scoped it.

hellymedic

  • Just do it!
Re: Knee
« Reply #10 on: 18 February, 2009, 08:47:37 pm »
I don't think extending the knee against resistance is a good idea, in general.
Vastus medialis (the teardrop muscle) is only active in the last 5 degrees of extension. To strengthen it, do exercises with the knee straight.
Lie flat, lift straight leg, hold a few inches off floor, repeat.
Repeat with weights on ankle; a 2kg bag of rice or beans is ideal.
If you are sitting on a chair, straighten your knee, hold your foot off the floor as long as possible and repeat.

simonp

Re: Knee
« Reply #11 on: 18 February, 2009, 08:52:57 pm »
My VMO seems to be overdeveloped on my left leg actually.

 ::-)

hellymedic

  • Just do it!
Re: Knee
« Reply #12 on: 18 February, 2009, 08:59:37 pm »
My VMO seems to be overdeveloped on my left leg actually.

 ::-)


Unusual; it's usually an overdeveloped vastus lateralis that causes trouble through patellar maltracking.

simonp

Re: Knee
« Reply #13 on: 18 February, 2009, 10:20:07 pm »
My VMO seems to be overdeveloped on my left leg actually.

 ::-)


Unusual; it's usually an overdeveloped vastus lateralis that causes trouble through patellar maltracking.

Yeh I know - I have weak glutes though which apparently can lead to internal rotation of the femur which then increases the effective Q angle.  Most of the exercises I am doing focus on strengthening these.

The over development on the inside is quite obvious and clearly different to my right leg, which has far better balance afaict.  What I believe has caused it is favouring the left leg when standing e.g. on a train or when washing dishes.  This seems to strongly activate the VMO on my left leg.  These days, after a while the extra load on the left knee starts to make it ache - so I am making a conscious effort to be more balanced.

simonp

Re: Knee
« Reply #14 on: 20 February, 2009, 08:38:06 pm »
Heh.  Part of the treatment I've received has included cupping.

Well I was skeptical but the cupping does seem to have sorted out my tight ITB and quads in my left leg.  They are /much/ more flexible now than a couple of weeks ago.

Bloody painful treatment, cupping.

Re: Knee
« Reply #15 on: 20 February, 2009, 08:46:26 pm »


Bloody painful treatment, cupping.


I thought cupping was medieval quackery, like leaches - (oh, they brought those back, didn't they) - and blood-letting.

simonp

Re: Knee
« Reply #16 on: 20 February, 2009, 08:55:36 pm »


Bloody painful treatment, cupping.


I thought cupping was medieval quackery, like leaches - (oh, they brought those back, didn't they) - and blood-letting.

Yes.  However, as it has been used on me it's more like a very vigorous massage technique as the cup is moved over the skin rather than left in one place.  I had very slight bruising and some tenderness for a few days after the treatment, but now the quads and ITB are much less tight.


Re: Knee
« Reply #17 on: 20 February, 2009, 08:58:21 pm »
I thought it was something else entirely.   ;)

simonp

Re: Knee
« Reply #18 on: 20 February, 2009, 09:05:33 pm »
I thought it was something else entirely.   ;)

Quite.

hellymedic

  • Just do it!
Re: Knee
« Reply #19 on: 21 February, 2009, 09:46:30 pm »
I thought it was something else entirely.   ;)

Quite.


Didn't George Orwell describe another sort of cupping somewhere?

Raph

Re: Knee
« Reply #20 on: 22 February, 2009, 11:04:36 am »
In my experience muscles aren't very clever - (I'll just speak for mine...) - they can clamp up as if being tense all the time is better than just contracting when needed and relaxing the rest of the time. Pounding them into submission is sometimes the only way to loosen them up, what they usually do if they've been tense for a while is to hurt like hell if stretched or massaged - and I mean hard massage, not namby pamby stroking.

My other half goes for Chinese Tui Na massage, apparently it's agony but it works. Ideally if you're in a good state and your muscles and tendons are all flexible and loose and floppy as they should be when not "in use", deep massage shouldn't hurt.

Still haven't a clue what "cupping" is!

Re: Knee
« Reply #21 on: 23 February, 2009, 09:21:24 pm »
My knee injury was a couple of years ago.

I was walking through the warehouse at work & went to make a 90 degree right turn  by pivoting myself round on the ball of my right shoe. Unfortunately, the shoe & its inhabitant stayed stuck to the floor & my whole body weight was pivoted around on my knee.

Couldn't put any weight on it for hours & every so often since, it goes & I can't walk on t for an hour or so.

Moral of the story. Get it seen to!