Q+A: Undiagnosed knee pain

Our experts answer real-life questions


Posted: 9 September 2000
by Martin Haines

Q I’ve had knee pain for a few months now. My GP has explained that the patella has moved out of line and that I am experiencing bone grinding on bone when I run. Now it’s got worse, but my GP is in no hurry to refer me to a specialist, saying that at my age (50) I should know better. Surely my running career can’t be over?

A Your problem might not be the kneecap running out of line. It could be related to your patellar tendon, which runs directly below the kneecap. You need to establish if there is any tenderness under the kneecap on this tendon. If so, then massaging the tender area will help – it has to be quite deep. If there is no tenderness then the problem may be related to the kneecap, which is difficult to diagnose in this type of situation. The treatment for this is quite specialised, and you really do need to see a qualified physiotherapist. If this simply is not available then trying to take the pressure off the kneecap may help. To this end you can make sure that you are wearing appropriate running shoes by visiting a specialist retailer.

You could also try shoe inserts, best recommended by a podiatrist or physiotherapist. There are some good non-prescription orthoses available – try calling Medisport for advice on AOL orthotics (0161-678 0233). This may well be enough to take the pressure off your knee.

In addition to this you could benefit from training in a gym and performing knee-strengthening exercises. Do not, though, perform leg extensions – see the gym staff for help.

Martin Haines, sports medicine consultant


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I have experienced a similar undiagnosed pain in my right knee for over 5 years now since knocking it in a fall (the fall was unrelated to running). Despite seeing numerous physio's, orthopedic consultants, podiatrists and osteopaths, no-one was able to give a definitive diagnosis, even with the benefit of 3 sets of x-rays and an MRI. I was refused an arthroscopy of my knee as it was felt that this could do more harm than good and I was too young to take that chance - I am now 31. Due to the pain I have had to take time off running amounting to around 3 years out in the past 5 years.

About 4 months ago, my lower back became sore. I decide to seek treatment privately and attended one of the sports injuries clinics advertised in RW. Upon hearing my history, the physio connected my back pain to my knee and referred me to a sports physician. X-rays were taken of my knee but these were inconclusive so another MRI was done. This showed a tear of the posterior horn of the medial meniscus. Being private, I was booked in for an arthroscopy and this was carried out a couple of weeks ago. The arthroscopy revealed that the damage to my cartilage is not on the surface and so, could not be treated. It also revealed that my kneecap does not track properly and has caused a grinding of the bones on the medial side of my knee. The consultant who carried out the procedure has advised that I have to develop my quadriceps to hold the kneecap in place however, even if successful, due to the damage to my bones, I would be very unwise to do any more distance running. 4 years ago a physio did identify this problem and I had 12 months of exercise to correct it however, the inner quad failed to respond in all that time.

Is there any chance that I will be able to continue running or is there a further procedure/treatment that can help my condition?

Either way, I would advise anyone with undiagnosed knee pain to seek an appropriate specialist and get a diagnosis and treatment before doing any more running lest they end up like me.
Posted: 24/09/2003 at 22:04

Shaun

No solutions I'm afraid but I can only offer sympathy as I'm in a similar scenario at the moment. I haven't run now for about eight months after being diagnosed with patellar tendonitis. I was advised to build up quadriceps and use orthotics in my shoes (which I did at great expense). But after a period of persevering with running things wern't getting any better so I bit the bullet and stopped running altogether. Since then things have improved marginally but I live day to day with the pain and have recently finished a course of ultrasound which also seems to have had little effect.

Its frustrating, but I also feel that had I acknowledged the symptoms earlier ( I continued running when the pain first started as I was training for a marathon) that maybe this could have been prevented.

I share your message to everyone - don't ignore pain to achieve short term goals.
Posted: 24/09/2003 at 22:22

I had knee problems but they were on the outside of my knee. The outside quad was too strong and one of my gluteal muscles was too weak if memory serves.

Did yoga, which stretches all the muscles in the legs and the buttocks (as well as the rest of your body). This basically balanced out the muscles in terms of their tension. Can now run.

Don't know if this is appropriate in your situation but it may be helpful.

Can't advise on the tear in your meniscus though.
Posted: 24/09/2003 at 23:14

Sorry didn't mention the pain in the outside of the knee was caused by patellar mistracking.

If you want to know the specific yoga poses I do, let me know.
Posted: 24/09/2003 at 23:16

Oooh! I'm dead worried now. Waiting to have MRI done on my my knee which has caused problems on and off for about 18 months now. Currently is an off, caused by hiking in the pyrennees. Physio is baffled as have no swelling, just internal knee pain. Quads are now even in musculature and power. Back has been assessed, and may have caused the original knee pain, but back is now fixed and pain is still there. Have orthotics to prevent shorter leg and pronation causing back problem again.

How do they fix any meniscal tears normally, that aren't deep?

Wish you all the best Shaun, surely someone must be able to do something.
Posted: 25/09/2003 at 14:13

Shaun - commiserations. Can't advise on running as not a doc - but can second Sam's suggestion of yoga. Strengthens the muscles, helps flexibility - and takes your mind off things.

The last decent class I went to was about 1/3 men, 2/3 women, so it's not a girly thing - 2 or 3 of the men were competitive cyclists.

BUT do make sure it's a good class - get recommendations, etc and NEVER pay upfront for more than one class until you've already had a class. There are some teachers who are terrible - went to one about 6 months ago who reduced 3 or 4 of the class to tears and caused me the most excruciating knee pain by forcibly pushing me down into a pose when she knew I had knee problems. And she was one of the ones who asked for 6 classes' payment upfront... On the other hand, the good class I used to go to till my job changed helped a lot...
Posted: 25/09/2003 at 15:56

Shaun

Second snail's advice. Find a good teacher. Just because a teacher is not good, doesn't mean that yoga isn't good.

If you live anywhere near north London, can recommend Triyoga in Primrose Hill.
Open 7 days a week with classes going on all day. Also different levels of classes from beginners to very advanced. Bit expensive but I think it is worth it because all the teachers I had there were good.
www.triyoga.co.uk is their website but it doesn't seem to be working at the moment.
Phone: 0207 483 3344
BTW: not on commission and do think they are good.
Posted: 25/09/2003 at 21:12

Thanks everyone for all your advice. Due to see a different physio in the next few days to assess post operative needs and chances of getting back to running in some form or another. I will be sure to mention the various points you have raised and see if this helps them come up with anything.


Posted: 07/10/2003 at 20:30

I HAVE SUFFERED WITH A DULL PAIN IN MY LEFT KNEE FOR 2 YEARS. BEEN TO PHYSIO ON SEVERAL OCCASSIONS.HAVE WORN A KNEE SUPPORT ADVISED BY MY PHYSIO COST OFF 60 POUNDS FOR 15 MONTHS.MANY VISITS TO GYM.DID 10 MILE RUN 5 WEEKS AGO I NOW SEEM TO BE BACK TO SQARE 1.WILL A DOCTOR LOOK AT THEASE PROBLEMS FOR TREATMENT ON THE N H S OR DO U HAVE TO RELY ON PRIVATE PHYSIO.
Posted: 18/11/2003 at 19:55

I also have left knee pain right now - it's been on and off for 10-12 years - starting by teaching step (of all things!). Anytime I have to teach aerobic classes (which is very rare as I'm so past it!) or similar triggers it off. It is a pain directly across the knee cap which causes severe pain where I have to stop and if pushed cannot even walk down the stairs easily. The worst thing is running on flat, downhill, or walking down stairs. I've been advised to strengthen my vastus medialis (the inner thigh muscle) and strengthen gluts. This can be done by performing leg ext on last 15 degree only and finally straightening leg fully (something that isn't done often during running!). I have started to use lunges, leg curl and small range on Leg ext as well as abductor machine. I have also changed trainers (again - now on a 2 month cycle!) and am managing 4 miles with a slight dull sense rather than pain - hoping to build up to 7 miles in next few weeks without pain! Let's see what happens! If all else fails... I will be desperate as I really don't know what to do if I can't run! I love it and no other activity will do!

For good yoga teachers you need to ensure that they properly trained ie have a British Wheel of Yoga certificate and not some 2 day course that covers some initial poses. Injury specialists are currently rubbing their palms together with the amount of injuries they are treating from badly taught yoga and pilates instructors. Most health clubs have qualified staff as they need to show certificates for insurance purposes etc so those of you who are lucky enough to be members of health clubs should be ok. For all you others contact British Wheel of Yoga (not sure of number) for qualified teachers in your area.

Hope this helps.
Posted: 21/11/2003 at 15:55

Shaun

You have my sympathies. I was told about 6 months ago - on the strength of 2 x rays - that I couldn't run again due to osteoarthritis. I have now been told by a consultant that in his opinion I do not show ANY signs of osteo arthritis and he has seen the original x rays. I've been back running about 3 weeks. Similarly my partner had a problem with a chipped scaphoid and was told there was nothing that could be done - but that as there was someone doing research on this type of injury she was referred to him for a second opinion - he said he could operate with a graft/pin but that the success rate was only 50/50 - a few years on it appears to have worked relatively well.

I guess all I'm saying is don't give up hope - try some different specialists and see if their opinion is the same.
Posted: 21/11/2003 at 19:39

Gosh what a sad thread this is. Commiserations to everyone who's suffering from this

Remember that Knackered Knees was in a very similar boat - and after a year off - the 2nd MRI showed the damage to the bone was healed - bones can repair themselves.. he's running again after having been told to stop

I wish you could come to my gym - it's a rehab gym where the fitness instructor specialises in strength and conditioning exercises particularly for people suffering from muscle imbalances / injuries / operations (pre and post exercises) etc

I've got so many things wrong with my legs (ankles / shins / knees / quads / hips plus a twisted pelvis) I could write a book, but he got me 'sound' and has kept me that way - more or less - for 2 years when the RW doctor / Countless physios / osteos and chiropractors / sports masseurs etc failed.

I find that if I lay off the corrective exercises for my quad imbalance for even 2 of the 3 sessions / week I go for the knee tracking goes out completely - even if I don't run / do any other exercise at all during that time.

Cross training in a gym is a fantastic way to stay fit enough to run without the same impact problems and it more evenly balances out the demands on your leg muscles - provided you do all the machines. Running just once a week (ok round and round a football pitch for up to 3 hours - dead slow....& boring) + x-training 4 times a week got me round the FLM in 2002 very slowly - but comfortably beating my predicted time by those max pace / mile charts in the back of RW / and the predicted time from VO2max etc - so it's definately worth thinking of.

There's a former top - arthritic - runner who goes to this gym who says he wishes he'd realised when he was young just how much cross training can advance your fitness without impact.

Like popsider says - please don't give up - but please don't risk damaging yourself even more and see if you can still work out but differently to before.

Good Luck

SS





Posted: 21/11/2003 at 21:17

I have a feeling i will be posting a very similar thread a few years from now.

have constant creaking specifically in one knee, no pain but i am sure something is wearing away.
Posted: 21/11/2003 at 22:12

DBSA - you mean when you flex or extend the knee you get a noise - is it a grinding noise or a cracking type noise.
Posted: 21/11/2003 at 23:59

when i flex, bend move from side to side etc, its more of a creaking that i can only feel if i put my hand on it
Posted: 23/11/2003 at 21:00

If it feels like the patella or something else is grinding or rubbing to the extent you are aware of it then I'd say probably go to a physio and ask them what they think - if they think maybe there is something wrong then I'd go to your GP say what the physio said and ask for a referral to a specialist saying you don't want to cause long term damage and prevention is better than cure. It's likely that there is nothing wrong or if there is often these things can be corrected by the right exercises to bring things back into alignment. It's got to be worth 30 pounds or so the physio would charge just for the reassurance.
Posted: 24/11/2003 at 09:48

I referee football matches as well as run on a regular basis usually between 3 and 7 miles. I have fortunately never had a problem with my knees but this last week I cannot bear to kneel on my left knee as the pain is excrutiating. It is pain free though when I am walking, running or climbing or descending stairs. I have a tender spot on the outside of the knee but I cannot produce the same amount of pain by pushing the spot as opposed to kneeling down. I have not increased my mileage over the last few weeks and in fact, owing to the weather, have been out less this last 2 weeks than usual. Has anyone else suffered similar symptons?

Les
Posted: 25/12/2003 at 19:36

Hmmm, I realise this is an old thread, but I had a heap load of knee problems and the docs were trying everything (well, nearly, one suggested operating...what on? said I "oh whatever we find one we're there" said he....sharp exit) but nothing was helping.

Then I met a bloke who had had similar problems and his advice sorted me out, I don't know if it'll work for anyone else. Don't wear normal shoes at all. Wear your running shoes the whole time. They are designed to correct some of your feet problems and to absorb, what is it, 3 times your body weight?, when you're running. I wore running shoes constantly for several months and the problems (very slowly) went. It at least takes an awful lot of the pressure off the knee. If you have tried everything else it is maybe worth a shot?
Posted: 30/05/2004 at 00:49

Hi Donald, thanks for your response. Funnily enough my knee pain cleared up as quickly as it began. I still have no idea why I had the pain in the first place and it has not yet returned. I now though have a more sinister problem with my heels and I have been diagnosed as suffering from plantar fasciitis! This is taking much more time to resolve.

Les
Posted: 30/05/2004 at 15:59

I've just recently started jogging in preparation for the race for life - nowhere near the scale of running that you guys do - but I too am finding that the running is making my knees ache, and sometimes even cause pain.

I just put it down to not being used to the strains put on the body from running and being a bit overweight, but after reading this it's made me think, as both my parents had serious knee problems.

Might go get it checked out!
Posted: 05/06/2004 at 17:40

Its good to know that its not just me! I've had a dull pain in my right knee that a physio believes is patella tendonitus and a lot of what I have read above about strengthening glutes, interior quad muscles, ultrasound therapy and having specialist shoe inserts made sounds very familiar!

Im hoping that someone can share some good news about bouncing back from this kind of injury. Has anyone found that this kind of treatment has produced positive results for them?
Posted: 30/06/2004 at 18:05

Mine seems to have gone away after total rest from running for a period of about 3 weeks, I'm taking it nice and gently now but fingers crossed, it doesnt seem to be anything major :)
Posted: 01/07/2004 at 17:55

This is my first post on this forum .... I feel like I'm among kindred spirits though! I have suffered with a rotten knee injury since last October, I suppose I'd been running seriously for about 6 months by then. It was eventually diagnosed as a deep tear in medial collateral ligament in my left leg, possibly extending to the meniscus. I'm back running now, but the damn thing continues to plague me and I have to whack the ice on before and after every run, moreover (and worse of all) I can't really run to capacity, as that is more or less guaranteed to make it worse. My physio reckons it was the wrong shoes that caused the damage. I'm really flat-footed on my left side and need cushion/motion control shoes really, not the neutral NB shoe that U* and R*nning in a certain Northern town prescribed for me. Of course I didn't know better at the time. Anyhow, a few pairs of shoes later I'm running in Supernova control shoes and they're brill .... the problem now is that they give so MUCH cushion it's affecting my left hip a little and straining the piriformis muscle in me left bum cheek, in turn pulling on the sciatic nerve. It kicks after about 5 miles. Any tips for a cushioned shoe with not *quite* as much medial support??

Hope your knee gets better.

Martyn
Posted: 01/07/2004 at 18:12

I've developed a pain in my left knee that only affects me in bed. I awake at about 4am with the pain.  It seems therefore that the pain arises when the joints are not under compression.

I run and do Taekwondo but the pain seems to coincide with the running rather than the TKD.

If anyone has had similar problems, I'd love to hear how they dealt with this.

Walt 


Posted: 10/07/2009 at 17:09

Hi, Please be gently with me this is my first post!!!

since February i started gettin into running, well jogging! In April i bought proper trainers so as not to injure myself, then fell into the big mistake of doubling my normal run to around 9km just because my shoes were so comfy!!!! anyways, it felt really good so i then started to gradually build up from 9km. on one run though i began to feel a dull ache in my knee, so stopped and walked it and stretched it off a bit, this helped for probably another 1km then hurt even more......i hopped home!

i had 2 weeks of doing do running at all, when i started again i was fine, but a bit of an ache still. i got a support for my knee which helped a little until a few weeks ago when i barely managed 2km before i was limping. the pain would be pretty much gone if i walked until i started jogging again.

yesterday i went to a specialist.......she has said i have fluid under my knees, and that the muscles in my thigh in the affected knee side is tight even while my leg is at rest. there was also some misalignment she mentioned. she massaged, did medical laser treatment and magnetic therapy. she has said i wont be a marathon runner and that i will only manage short runs now which is the worst thing as i was training to do the Great Eastern Run in October for charity.

has anyone else had this sort of problem? by the sounds of things, other people use yoga techniques, does swimming help? what about special knee supports? i dont know the actual name of my problem but i thought all of the people on runners worlds opinions would be beneficial and hopefully inspirational. i really want to do this half marathon but not at the expense of having no knees left at the age of 23!

thanks in advance for your help xx


Posted: 25/07/2009 at 20:35


Nam

What "specialist" was this?  A physio? Or podiatrist?  or...?

And what did she say the cause of your misalignment was?  Some misalignments can be treated.  My hips were misaligned and treated by an osteopath.  Misaligned feet can be treated with custom made inserts.  If all she told you is you're misaligned and will never be a runner - get a second opinion.

I'm about as misaligned as they come and I've run a HM.


Posted: 25/07/2009 at 20:45

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