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Pain IN/ON my kneecap

post #1 of 17
Thread Starter 
Ok, went mountain hiking a weekend ago.
I the downclimbing on teh steeps has resulted in a pain and discomfort in/on my kneecap a day or two after. It's now been a week.
Going down stairs is not pleasant.

^^Not serious pain, but the discomfort is real.

Any thoughts? Just "walk it off" or??
post #2 of 17
In simple terms, my hack diagnosis is it's probably an owweee of the ligament that holds the quad and shin muscles together via the patella.Otherwise known as patello-femoral disorder, and other-other-wise known as chondromalacia patella.

The indicator of pain going downhill/downstairs / Pain with a bend and loaded knee points to this problem. The ligament is maybe a little raw , maybe tiny tears, and when you bear weight with the ligament stretched over the kneecap, it freaking hurts. I always felt the pain felt like a rusty nail underneath my kneecap. The likely explanation is that you stessed the ligament during your hike, maybe because your kneecap isn't tracking right, or maybe because of improper muscle conditioning, or a combo of both.

I had a pretty serious case of this in August - went out for a solo backpacking with a lot of vertical ups and downs and had a really heavy pack. The condition with my knees was always there (feel it on long mountain descents especially , but trekking poles help) but the backpacking trip exacerbated the problem.

Anyway, I'd suggest ice and rest the knee. Don't do stairs, and get to your doctor if it doesn't get better in a few weeks with rest. They might recommend doing some conditioning exercises to strengthen muscles, particularly the interior quad muscle. Vastus medialis I think it is. My doctor mentioned that isolation of the muscle rather than full leg press exercises are better due to the current knee injury, and recommended some of these exercises and/or a true physical therapy program. If it is a serious case they might have you wear a brace, too, called a 'cho-pat strap' which helps the knee track better while your muscles are learning to hold it in the right place.

I'm sure someone else here will add more or maybe a different theory, but your pain is a classic symptom of chondromalacia. Good news is that it's not ACL / MCL stuff and almost always fixable with a physical regimen versus surgery. At least that's what my doc said.

I was off my knee for about 4 weeks, in the sense of no brutally knee-bending activity, and all the while doing exercises. Then gradually worked back into things. A few weeks ago I did a test-run of it on one of my favorite hikes with a ton of steep (about 4 miles uphill) and the knee was pretty good. Also good news is that skiing isn't as rough on this kind of injury as hiking is.
post #3 of 17
Although Trouble's interpretation sounds feasible, it is really, really imporatnt to get an accurate, up close and personal diagnose from your physician. There are many conditions that seem like other conditions. What works for one injury can be a disaster for another. Once we get a name to what you have, it will be safer for us to tell you what to do about it. Good Luck!
post #4 of 17
Take Lisamarie's advice! I have had a very similar pain for about a month caused I believe by leg extensions (have been lifting for a few months.) Started with pain only going downstairs, then added pain going upstairs. Stopped doing the extensions and it's gotten a lot better, mostly going upstairs now.

Anyways saw the doctor yesterday, got an xray, MRI scheduled for a couple of weeks, and there is some swelling I hadn't noticed (take a look sitting in a chair with shorts on to see if one knee is bigger than the other.) There's a small bursa (sp?) behind the kneecap that can fill up. I was told to do a standard ibuprofen regiment (3 over the counter pills, 3 X a day for a week) to reduce the swelling.

The MRI will show if and if so how bad the tendon damage is.

See a doctor, you'll probably be fine, and anti-inflammatories for a week can't be a bad idea either.
post #5 of 17
Yeah, I did say to get to the doctor if it doesn't get better with rest and ice in a few weeks. I'm not the kind of person to run to the doctor for every single owee, I tend to give it a couple weeks and see if it's persisting. I get hurt a fair amount and going to the doctor for everything would mean a ton of sick time used at work, when it can be put to better uses like calling in sick to go ski. But whatever, everyone knows the failsafe is to go see a doctor. So go see a doctor.
post #6 of 17
trouble, I agree. I had the pain for a number of weeks before I went to the doctor.

Here's a link I found to the diagnosis you made (my doctor hasn't given me a diagnosis yet, awaiting the MRI, but you're probably correct.)
post #7 of 17
At Times My Left It Band Feels Like It Pulling My Knee Cap Off
post #8 of 17
My fiance has an IT band issue, saw a good Orthopedic Surgeon who diagnosed it, and had Pyhsical Therapy for it for a while. Now she does her exercises pretty much every day for it. It's definitely helped.

It was a real problem for her in the bumps.
post #9 of 17
Trouble's account sounds very much on the money. Physio therapy is the way to fix this. I've had it for decades, it comes good after a month or so skiing, the interior quad muscle builds up. You want to stretch/soften that tibial band thing down the outside of the quad, and strengthen in the interior quad muscle to get things back into equilibrium.

getting some fairly dramatic orthotics has also helped to improve this, as they have me walking correctly, without my foot rolling in, and this allows all the muscles to work as they were designed to.
post #10 of 17
Take Lisamarie's advice! I have had a very similar pain for about a month caused I believe by leg extensions (have been lifting for a few months.) Started with pain only going downstairs, then added pain going upstairs. Stopped doing the extensions and it's gotten a lot better, mostly going upstairs now.
Wow! I don't mean to go off topic, but remember the bit of hyper extension I noticed on you in the posture thread? Not sure, but it might have to with the time you spent on the leg extension.You might of created a temporary muscle imbalance that caused the knee to lock out. Just guessing, though.
post #11 of 17
i actually mentioned the hyper extension comment to the doctor who didn't really have any reaction except to say that I might be compensating for that with my posture. I was however very careful when doing the extensions not to come to a fully extended locked out knee position.

The exercise she gave me to do is a lying, one leg bent, lift the other leg up with a locked knee - 60 reps. It's pretty easy to do up to about 40 reps but those last 20 are hard. Seems like a great quad exercise actually with no stress on the knee.
post #12 of 17
Patellar Tendonitis. I had this same problem a few years back actually. Mine was caused from the outside muscles on my legs becoming stronger than the inside muscles on my legs from carving so much during ski season. My kneecap was getting pulled off the top of my knee so my petellar tendon was getting enflamed. I had to build the muscles in my legs equally and really force myself to keep both sides built up in order to keep the pain down. I have heard that it is also caused from excessive stair running, or anything else that puts stress ont hat part of your knee/leg. As others have said it is probably best to see a doctor and probably get a referral to a PT and do that for a few months until the pain subsides.
post #13 of 17
Thread Starter 
Thanks for the quick and on-point input!

My quads are def. overly depveloped vis-a-vis interior, so when i pick up a new swissball, will work on that.

I'm positive it's a strain and is related to high stepping over boulders in the mroning - leading with my left leg, I know, should've alternated - and downclimbing the next day.

Will starting some ibuprofren asap
post #14 of 17

Knees are why orthopedic docs do all the tests

These things are so tricky. I had a feeling of a nail in my knee when I overtrained for a marathon once and it turned out to simply be IT band stiffness - no structural damage, just overuse so rest cured it.

But the orthopedic surgeon who diagnosed it did xrays, MRIs etc. to be sure.

The knee cap pain is most likely some form of patella tendinitis, but then again it could be a patella problem or God knows what - get a real doc to see it if you value your skiing.
post #15 of 17
Great point about the IT band. Knee pain that is related to IT band syndrome is frequently misdiagnosed. If it does turn out to be IT band syndrome, check out these exercises:

Also, check out the side quad foam roller stretch on this page.

This is almost a topic in itself.
post #16 of 17
Good ones Lisamarie. IT is something I still have to watch because if I don't stretch it IT will get me.

Yup I learned many things from training for the marathon, one was how to sublimate pain. But then at some point you realize the pain is there for a reason - to stop you from hurting yourself!
post #17 of 17
Patellofemoral syndrome is sometimes called "moviegoer's knee" because the symptoms are often exacerbated after sitting in a chair or car seat for a while. It's caused by inflammation of the infrapatellar fat pad, as well as chondromalacia in the prepatellar area. Try this and see if it helps. Take a 1" wide piece of white athletic tape, cut long enough so that it will wrap around the front 1/3 of your knee. Extend your knee almost straight, and apply the tape so that about 1/2" of the tape is pushing down on the top of the kneecap, i.e. the bit of kneecap closest to your head ("superior pole") and the other 1/2" is pressing on the skin. The tape should be applied tightly enough so that it's kind of cinching up the knee and skin, and it should wrap around your knee from the inside quad to the outside quad. Then take a couple of 1/2 " wide pieces of tape and stick them over the 1" piece so they are cinching the tape. Then try walking around with that. This "unloads" the patella off the underlying joint surfaces and stops the inferior pole of the patella from pinching into the infrapatellar fat pad. If you have P-F syndrome and you have applied the tape correctly, it should instantly feel much better, and (this is for you Baja) no drugs! If that works then you should probably see a PT or physiotherapist who can give you specific exercises to help develop other muscles around the knee to help it track differently and stop the symptoms. Hope that helps!
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