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Patellofemoral going on 6 months with no improvement to pain...
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ATAsgard posted:
Here's a summary of what's happened:

Condition started in 8/11. Pain started just below the knee cap when bent and pressure was applied. Think, bending down to pick something up that's in front of you. Preliminary self-treatment was random stretching exercises and icing.
1/12 ; Saw ortho surgeon. Got X-Rays. Nothing out of the norm showed up, thankfully, so I was sent to the PT office for evaluation. I was diagnosed with Patellofemoral / Patella Tendonitis. Given Physical therapy exercises (strengthening of inner quads / stretching quads, calves and hamstrings.)

Almost immediate relief within a few days (to some extent.) Bringing pain from 9 to about a 7.5. After this, the pain stayed at a 7.5 level and never improved further. After 3-4 months, pain would actually fluctuate. Sometimes worse after activity, sometimes better. Sometimes worse after no activity (Activity being sports, swimming, running other than prescribed PT.) Additionally, about 2-3 months after starting PT, the "static knee pain, while bent" that is common to PFS (long car rides or watching a movie at a theater), began. This was never an issue before. This is ridiculously painful even now and is probably my biggest issue since I work a desk job and frequently have to take long car rides.

Also bought Body stick (glorified rolling pin for stretching/massaging of muscles, IT Band, tendons, etc.)

Around April I went to see a podiatrist and was diagnosed to have a flexible flat-foot; got orthotics. Throughout this entire time, I iced regularly. What's interesting to note here, is that icing of the knee's would cause great pain to my hips. Would need to stretch the hips while icing in order to bear the hip pain. (quite odd — may be unrelated, but curious as to how this even happens)

6 months later (last week) , got second opinion. Brought previous medical records. No new x-rays. Was told to get patella straps, prescribed Voltaren Gel, and to continue stretching of the hamstring and to focus on general quad strengthening exercises (told not to worry about inner quads, just general quad strengthening.) My flexibility was noted by the doctor as "being better than 90% of guys that I see." Other than testing hamstring resistance, the doctor felt and moved the patella bilaterally and noted a "squeaking". Was told to be sure to apply strap below the point of squeaking as that would be the injured area, and that pressure should be applied below that.

I'm worried that in 6 months, I haven't really seen any improvement other that what I saw in the first week of starting PT. I also don't like that I gained symptoms (the static knee pain when bent for extended periods of time.) My concern with the second opinion is that if the Voltaren Gel works, and is safe, it'll just mask the pain and I could be doing additional damage in the long run.

If anyone has heard of PFS lasting this long without improvement, I'd love to hear what may have finally fixed it in other cases. I'm pretty desperate as the pain can get back to a 9.0 level at times, and as mentioned before the static knee pain is just horrible to sit through.

Above all, I'd like to avoid surgery. But other than maybe trying additional exercises, and maybe seeing a sports masseuse for an intense leg massage, I'm not sure what else can be done.

Thanks in advance for any help/feedback.
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Mary Ann Wilmarth, PT, DPT, OCS responded:
The patellofemoral joints can be very difficult to treat in part because small changes in muscle or soft tissue balance can make a big difference. However, this is also the good news.

I did not hear anything in your history about hip strengthening. This is a key component with the rehabilitation of the knees and PFS (patellofemoral syndrome). In addition, core strength and stability is another important part of the kinetic chain balance that leads to optimal function.

The other thing to note would be your flexible flat feet. Sometimes use of off-the-shelf or custom orthotics will put the entire lower leg in better alignment and this means less stress on your kneecaps. You do not want your feet and legs collapsing to the floor each time you take a step.

In the meantime, know that the body likes movement. Try to bend and straighten the knees a few times every 10-15 minutes and get up from sitting every 30 minutes, even if you just stand and then sit back down. It is good to change positions and stress on your joints.

A physical therapist can assist you with the above-mentioned. You can go to www.moveforwardpt.com and then under Find-a-PT search for PTs specializing in orthopaedics and/or sports.

Dr. Wilmarth


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