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Patellafemoral pain syndrome

 
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Scott
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PostPosted: Sun Jun 08, 2003 10:14 pm GMT +0000    Post subject: Patellafemoral pain syndrome Reply with quote

First I want to say thank you for taking the time to read this post I know it’s a long one. I was introduced to mountain bike riding in May of 1995. It didn’t take long before I was competing in local races and by the end of 1996 I was training regularly 4-5 days a week. I’m not sure what caused my knee injury so I have listed the relevant information I could think of to help in determining what my next step should be.

August 97
I had a bicycle wreck where I separated my right shoulder. In addition to the separated shoulder I was unable to lift and cross leg (right ankle resting on left knee) in the sitted- position for several months. I think I did something to the IT band on my right leg and that kept me from being able to cross my leg. Eventually I was able to cross my legs but even today If I sit indian style my right knee is 6 inches from the floor and my left knee is 2 inches from the floor. I am mentioning this because I think this has attributed to my knee problem.

October 97
I started running to stay in shape because I couldn’t ride while my shoulder was healing.

January 98
In Jan/Feb of 1998 I started preparing for the upcoming mountain bike season. I was riding a trainer for 2 hours a day 3 days a week. I would stay above 100 rpm and keep my heart rate above 160. On the off days I would run/jog 5 miles. I was really working hard getting ready for the first race of the season

March 98
As the racing season went on I started experiencing pain below the patella. I felt pain in the soft region between the bottom of the patella and where the shin bones begins (after doing some research I understand this might have been patellar tendonitis). Initially I felt the pain during warm-up and then it would go away. As time passed I would feel pain during warm up and also during the intense portion of training. Eventually I felt the pain during day to day activities – walking up stairs, taking an awkward step, etc…

April 98
By April the pain was to sever to run or bike.

May 98
Started seeing a Sports - Orthopedic Surgeon “Dr. A” who was also a cyclist. During the diagnosis it was noted that I had less flexibility in my right hip compared to my left hip. In addition he took a “sunrise” x-ray of the patella to see if it looked miss-aligned in the patellar groove. He said my patella looked like it was centered pretty well but might have been miss-aligned a little bit. We tried physical therapy for two months with little to no improvements. I was still unable to ride or run without pain and was still experiencing pain during day to day activities.

August 98
Since physical therapy showed little improvement he ordered a MRI of my right knee. He showed me that I had some cartilage damage and that the damaged cartlidge was the reason I had crepitus (the crunchy sound when I bend my knee). He said there was a chance that a patellar release and patella smoothing would fix the pain and crepitus. He asked if I wanted to have surgery. I was willing to take a chance because I was ready to run and ride. The following procedure was performed on my right knee. I was 25 years old at the time. Arthroscopic surgery- lateral release and patella smoothing

September 98
In late Aug my company downsized and my position was eliminated in Tulsa. Consequently a few weeks after surgery I moved to Texarkana, Tx to start a new job. When I moved to Texarkana I made an appointment with the local Sports Orthopedic Surgeon to finish physical therapy.

November 98
After finishing physical therapy I was still not able to run and/or bike. As a result of the surgery and physical therapy there are two things that changed. First there was a decrease in the severity of the crepitus and the second is that I didn’t feel pain in the soft region below the patella, I now felt the pain on the underneath side of the patella. The pain is felt during the 30-40 degree angle of articulation on knee extensions. I cannot do leg extensions, squats or anything like that. The physical therapist tried all sorts of exercises to strengthen the leg without causing pain. At one point after determining that my leg strength was about 80%, “Dr. A” gave me a cortisone shot to help me work through that window of articulation that caused the pain. I able to work on that area for a couple weeks but when the shot wore off the pain came right back.

January 99
After more physical therapy (including patellar taping and using a patellar stabilizer), more x-rays, and another MRI “Dr. A’s” advice was for me to undergo another lateral release. I told him I wanted a second opinion before another surgery. He referred me to a Joint Specialist in Magnolia, Arkansas “Dr. B”.

February 99
The Joint Specialist in Magnolia looked at the MRI and said I was experiencing pain underneath the patella because I have some dead bone on the backside of the patella. He wanted to drill holes in my patella to let blood flow to the dead area. “Dr. A” said that “Dr. B” was quack and that “Dr. B” didn’t know what he was talking about. I thought “Dr. B” had a good idea. Maybe I have an exposed nerve under the patella. The exposed nerve could explain the pain under the patella but what about the crepitus flaring up?

March 99
Again, I asked “Dr. A” for another opinion before we decide on surgery. He sent me to another Joint Specialist in Little Rock, Arkansas “Dr. C”. “Dr. C. started by reviewing my “sunrise” x-ray. He let me know that my petalla was not miss-aligned and proceeded to show me an x-ray from a patient with a miss-aligned patella. I was surprised to see the dramatic difference between the two x-rays. He also let me know that a patella release was normally reserved for older patients with severe miss-alignment. “Dr. C” said in years passed and even today the patellar release is a last ditch effort to fix a problem that has not been properly diagnosed. “Dr. C” said I needed to strengthen the VMO to help pull the patella to the inside. He recommended that I do short ark leg extensions and quadricep contractions.

April 99
I began the short arc extensions and quaddricep contractions. I saw definite improvement. The pain from day to day activities subsided and I was able to jog a couple miles without being to sore. At this point I definitely improved but was still unable to run regularly or even think about cycling. Cycling causes pain within the few minutes of riding.

May 99/Jun 03
I have accepted the fact that I may never race competitively but now I’m starting to worry about my health. Today I cannot run, bike, use the stair master, or even swim without causing pain. I don’t want to waste away sitting on the couch. A friend of mine gave me a copy of the November 98 issue of the “Journal of Orthopaedic and Sports Physical Therapy”. It is a whole issue dedicated to the patellafemoral joint and patellafemoral pain syndrome. I have read the articles and each article states that a systematic and methodical approach must be taken to properly diagnose the exact cause of patellafemoral pain. I actually tried to diagnose myself by looking at the Q angle and drawing on my knee with a black marker. Of course I didn’t figure anything out.

Summary:

Prior to surgery pain was located in the soft region below the patella. After surgery pain is felt underneath side of the patella. The noticeable improvement from physical therapy has been the absence of pain during daily activities, although some movements still generate severe pain. I have been able to run a little but every time I start to run (short distances, 2 miles) 2-3 times per week the pain returns and affects day to day activities. Cycling brings on pain almost immediately. I am willing to travel and would like to visit a Specialist in the area of patellafemoral pain syndrome. Preferably, the Dr. would be willing to take the time to systematically diagnose the problem. Any advice you give would be greatly appreciated. I am only 3 hours from Dallas and I would be more than happy to visit your office or someone you recommend. If a face to face visit is more appropriate than this forum please let me know. Thank you so much for your time.
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Anonymous
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PostPosted: Mon Jun 09, 2003 7:47 am GMT +0000    Post subject: Reply with quote

Welcome to the world of "Overuse Syndromes"

Confused
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The Bike Doc
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Joined: 08 May 2003
Posts: 1369
Location: Corpus Christi and Warda, Texas

PostPosted: Tue Jun 10, 2003 2:06 pm GMT +0000    Post subject: Knee Pain Reply with quote

Scott:

Let me refer you to Andrew Pruitt, Ed.D Medical Director of Boulder Sports Medicine http://www.bch.org/sportsmedicine/evaluations.cfm . Andrew is a Physical Therapist, a competitive cyclist, and an brilliant clinician with leg, foot and ankle problems in athletes. I have listen to him at medical seminars and read several of his articles. It is a long way for you to go to Boulder, but you should be able to get some sage wisdom. A vaction in Boulder this time of year is nice and you may be able to write the trip off for medical expenses.

Unfortunately, I do not know who to specifically recommend in Dallas, possibly an orthopedic doctor with the Cooper Clinic.

As I am in transition from my current position with Texas Tech to a new fellowship position at Columbus Children's Hospital in Pulmonary Medicine, I am not able to see you.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc
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Scott
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PostPosted: Wed Jun 11, 2003 8:22 pm GMT +0000    Post subject: Knee Pain Reply with quote

Dr. Nolan

Thank you for the information. I will contact Mr. Pruitt in Boulder.
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Bryce McGuire
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PostPosted: Mon Jul 07, 2003 1:44 pm GMT +0000    Post subject: dallas Ortho Reply with quote

Look up Dr. Newton in North Richkand Hills. He is an acute Othro..he specialises in hard to diagnose and treat problems. I finally went to him for my lower back and he found the bad disk. Matter of fact I just had 6 facets around L5 and am feeling better. I don't know if this will lead to an Epidural but I'll find out soon.
Good luck
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