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Hi Dr. Stoll and ChironDave,
I wrote a while back about this situation which is continuing. In September I had added in some additional exercise (partial squats and elliptical machine) and within a month both my knees were bothering me (never had a problem with my knees before). I went to an orthopedic doc, and he ran xrays and MRI, showing no abnormalities. His diagnosis was chondromalacia due to hypermobility of the joints (I'm double-jointed in most joints.) He prescribed physical therapy and avoidance of all activities that aggravate my knees (stairs really aggravate). I am avoiding all weight-bearing exercise and have done the prescribed physical therapy. I also am taking the nutritional supplements you recommended. I have had mild improvement, but if I ever go up or down stairs which is sometimes unavoidable the pain comes back immediately and lasts for a few days after.
This doc is now suggesting surgery, saying that there may be bits of bone or cartilage that are under the knee cap, causing chronic irritation. I think he might attempt to smooth down any rough spots on the cartilage as well. I am seeing him tomorrow for a follow-up visit. I would really appreciate your thoughts as to whether or not I should undergo this surgery.
Thank you so much,
Sapphire
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
Sapphire,
I think I would find an exercise that was easy on my knees, like swiming..
Silver Fox!
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Steve [3019.1399] on January 31, 2005 at 12:29:21:
Hi Steve,
Thank you for your suggestion. :) It's really not feasible for me to swim in the winter though I can at my condo's pool when it warms up. This situation with my knees isn't going away and so I'd like a permanent solution and am wondering about the success of this type of surgery.
Sapphire
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
P.S. The physical therapy prescribed are non-weightbearing exercises such as quad-sets, and other exercises that strengthen the quads, hamstrings, and inner and out thighs such as hip aductor and abductor at the gym. No leg extensions or any exercise that bends or flexes my knees.
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
I would be willing to bet that Walt will tell you to use non weight baring exercises and do all your exercises in a pool.
ChironDave will recommend something chiropractic.
Both will recommend Omega 3's and glucosamine, which probably won't work well enough. :)
How tall are you? Tall people have knee problem from the precor elliptical stuff. At least ones I know. Try something like boxing or kickboxing? I wouldn't do the surgery.
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
surgery is the last thing I would opt for. I had 2 knee problems, and cod liver oil helped and then cured one 18yrs ago, and the next one, a few yrs ago was cured ithe Glucosamine/Chondroitin and MSM. I only used Nature's Bounty G/C and only Natrol MSM of the MSM's did anything. I go about 2 yrs between needing them now. In the begining it was about 4mo, but kept increasing, and I only take them when needed. I get a very slight discomfort about every 6 mo.
I don't know what quad sets are. When the cod didn't help the latest problem I read that the you can get knee pain from an imbalance in the quads and hamstrings, and the exercizes were leg lifts. They helped in the begining, just like squats did with my first problem, but not for long. With my first problem, it was noticable when pushing off to get in the car since my left knee is the bad one. With the other problem stairs bothered it, mostly when coming down.
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
Articles of interest regarding knee conditions which give the same presentation you describe.
Consider the least invasive procedures before surgery, especially since he is "guessing". (pun intended)
J Manipulative Physiol Ther. 1999 Mar-Apr;22(3):149-53. Related Articles, Links
Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain.
Suter E, McMorland G, Herzog W, Bray R.
Faculty of Kinesiology, University of Calgary, Alberta, Canada.
BACKGROUND: Evidence exists that conservative rehabilitation protocols fail to achieve full recovery of muscle strength and function after joint injuries. The lack of success has been attributed to the high amount of muscle inhibition found in patients with pathologic conditions of the knee joint. Clinical evaluation shows that anterior knee pain is typically associated with sacroiliac joint dysfunction, which may contribute to the muscle inhibition observed in this patient group. OBJECTIVE: To assess whether sacroiliac joint manipulation alters muscle inhibition and strength of the knee extensor muscles in patients with anterior knee pain. DESIGN AND SETTING: The effects of sacroiliac joint manipulation were evaluated in patients with anterior knee pain. The manipulation consisted of a high-velocity low-amplitude thrust in the side-lying position aimed at correcting sacroiliac joint dysfunction. Before and after the manipulation, torque, muscle inhibition, and muscle activation for the knee extensor muscles were measured during isometric contractions using a Cybex dynamometer, muscle stimulation, and electromyography, respectively. PARTICIPANTS: Eighteen patients (mean age, 30.5 +/- 13.0 years) with either unilateral (n = 14) or bilateral (n = 4) anterior knee pain. RESULTS: Patients showed substantial muscle inhibition in the involved and the contralateral legs as estimated by the interpolated twitch technique. After the manipulation, a decrease in muscle inhibition and increases in knee extensor torques and muscle activation were observed, particularly in the involved leg. In patients with bilateral anterior knee pain, muscle inhibition was decreased in both legs after sacroiliac joint adjustment. CONCLUSIONS: Spinal manipulation might offer an interesting alternative treatment for patients with anterior knee pain and muscle inhibition. Because this clinical outcome study was of descriptive nature rather than a controlled design, biases might have occurred. Thus the results have to be verified in a randomized, controlled, double-blinded trial before firm conclusions can be drawn or recommendations can be made.
J Manipulative Physiol Ther. 2000 Feb;23(2):76-80. Related Articles, Links
Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial.
Suter E, McMorland G, Herzog W, Bray R.
The University of Calgary, Canada.
BACKGROUND: Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI. OBJECTIVE: The objective of this study was to assess whether conservative low back treatment reduces lower limb MI. STUDY DESIGN: In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP. METHODS: Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured. RESULTS: Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group. CONCLUSIONS: The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.
Anterior knee pain and spinal dysfunction in adolescence. Sweating RC, Fowler C, Crocker B, J of Manual Medicine 1989; 4:65-668.
This is a review of 260 patients presenting with knee pain in a general orthopaedic practice. It was revealed that 16 cases (6% of the total) had similar clinical features with peripheral muscle weakness associated with segmental spinal dysfunction.
Chiropractic side-posture adjustments resulted in immediate strengthening of the weak muscles. Full resolution of the knee problems were seen to require 3-6 weeks of care. Midlumbar somatic dysfunction was seen as a potential cause of some cases of knee pain.
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Vince F [1908.1745] on January 31, 2005 at 13:05:45:
Thanks, Vince,
How long did it take for the problem with the stairs to go away? This has been going on for about 4 months for me.
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by ChironDave [1744.14] on January 31, 2005 at 13:05:57:
Thank you so much, Dave.
When I go to the chiropractor, when he adjusts my lower back (with me lying flat on my back and crossing my bent left knee over my right hip - and vice versa- causing the lower back to twist) (hope this makes sense :), it usually "cracks" with very little effor on his part. My lower back always seems lose. My upper back and neck tend to get very tight though.
Does this seem like the correct manipulation for the SI? This is all he ever does for my lower back, since I never have any pain there.
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 13:09:54:
about an hour. Cod used to work in 15min.
I had been taking glucosamine/chondroiting for a month with No change till I heard about MSM. James Coburn was on Larry King raving about it, and then Robert Culp. The first 2 brands of MSM didn't do a Thing for my knees but one cured a sinus problem, and another helped a muscle one. The 3rd one, Natrol started to help in minutes. Since I didn't take any G/C that day, when the pain returned in 4mo, I just took the MSM, Thinking That is what helped it. Nothing happened and then I remembered I had taken the G/C the day before, the first time, so maybe it was still in my system. Within minutes after taking it, my pains started to lessen.
What was interesting when I heard about MSM on L King. Dorthy Hamill and Bruce Jenner, two of my favorite atheletes were pushing Vioxx on the show, and a friend was buging me to try Celebrex, but I didn't like what I read about stomach hemmoraging with a drug that was Supposed to prevent it. I always liked Coburn and Culp and am glad I went with the actors instead of the atheletes.
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 13:21:09:
There are adjustments for the pelvis which can be performed that way but what you are describing is just a general mobilization of the lumbar spine and would not invovle the SI joints. You might suggest that he evaluate your pelvis. Hopefully including standing X-rays an some type of objective analysis.
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by ChironDave [1744.14] on January 31, 2005 at 14:03:07:
Hi Dave,
If the xrays of the pelvis are normal, does that mean it's not an SI issue?
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Vince F [1908.1745] on January 31, 2005 at 13:28:06:
Hi Vince,
Thanks for your feedback. One more question. How long altogether did you have the stair problem with the knees?
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 16:32:26:
The SI joints show dysfunction by their misalignment(which you can see on X-ray) and/or their motion(which can be felt on palpation).
So the joint can be in a bad position, stuck, or both. Many DCs evaluate only for the motion. However, with X-ray you KNOW which way it's misaligned and therefore which way to push it back.
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by ChironDave [1744.14] on January 31, 2005 at 16:40:25:
Dave,
Thanks so much, I just had an xray today and will know the results tomorrow! :)
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 18:09:26:
Great. Your knee problem may or may not be related to your SI joints but it's certainly worth trying before considering surgery.
Good luck.
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
Hi Sapphire, sure sorry to hear of your knee troubles. I wanted to mention
that elliptical trainers can sometimes cause knees to hurt. I bought one for
home use & it unfortunately doesn't fit me very well, although it took using it
several times to realize this. My knees always hurt after using it. Through
adjusting my position on it a bit I've been able to adapt and my knees have
made it through OK. This also happened on the gym ellipticals. I think at first
my form was incorrect, and then I discovered that some machines just fit my
body better than others. Now at the first sign of knee pain, I'm off that
machine & onto something else.
With your partial squats, again, it could be a question of alignment. When you
squat, are your knees by any chance going out over your toes or beyond?
How deep do you go?
It could be a question of workload & timing; if you didn't build up slowly, it
may have been way too much for your level of conditioning, knees-wise. I
have to be conscious of adding new demands on any joint, and proceed very
gradually, or I pay for weeks afterwards. No serious injuries so far, thankfully,
but plenty of pain at times when I've gone overboard.
The best thing you can do for any inflamed part is ICE it, several times
throughout the course of the day. Best anti-inflammatory available. After any
sort of exertion to your knees, put a good ice pack on them for 20 minutes
(take care not to burn the skin, put a very thin layer of cloth between ice
source & skin), then let skin return to room temp, then do it all over again. If
you get into this habit, and then work on building the muscles which support
your knees, you will eventually have the strength needed for this type of
workload.
I'd do just about anything to avoid surgery! Do you think a second opinion
might be helpful??
good luck,
mary
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 16:33:36:
not sure how long I had the stair problem, and I guess you mean, till I found help. I was taking G/C for about a month, and then I was trying MSM, and it took me at least a week to buy the 2nd brand, that I bought when I was in the checkout line in Walmart, and remembered that someone on here mentioned they had bought Sundown brand there, and I liked that brand, and since the first brand was helping my sinuses almost completely, I figured I would need more eventually. When that cured muscle pains, I started looking for other brands, But it took me a bit to decide to try it since I had a full bottle of the first brand, and didn't think they would be different. I'd say maybe 2 months, from the start of the pains till I got relief with the Natrol. If I haven't mentioned. I have only used Nature's Bounty Glu/Chos.
If you mean, from when they started till now. That is about 4 yrs. I had some pain about 4 mo ago
In Reply to: Dr. Stoll and ChironDave - knees posted by Sapphire [422.1366] on January 31, 2005 at 12:08:44:
Thanks, Sapphire.
Remember the old "hammer" adage!
You should have been recommended to avoid stairs! You should have been recommended to begin intensive under water exercises, in my opinion. Your partial "squats" were one of the worst excercises you could have chosen.
Any physical therapy needs to be done at home at least once a day and not only with the PT. You should be taught at the PT what you need to do at home.
You may eventually need a cleanout of your knees but, until you do at least the above, that would be a last resort for ME.
Walt
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by Walt Stoll [9.1465] on February 01, 2005 at 06:46:11:
Hi Dr. Stoll,
I will do all that you recommended, but how long would you give the PT before opting for the cleanout surgery for the knees?
I've been doing the PT recommended at home, to no avail. Also,I live in a home with stairs and to avoid the strain on my knees, I've been using crutches on the stairs, and I've been diligent about this and it has definitely worked to avoid the pain stairs cause to my knees, but it's kind of a pain in the you-know-what (not the knees :) to use crutches on the stairs everyday. My knees don't seem to be improving, so I guess I'm getting impatient about wanting to see if there is anything the surgeeon might see and improve. The injury seemed to happen overnight, but the recovery seems to be taking forever. :(
I'll continue with the PT for a while longer, but how long would you give PT before opting for surgery?
Thank you in advance for your response.
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by maryb [516.1576] on January 31, 2005 at 23:16:03:
Hi Mary,
Thanks so much for your post. Second opinion, good avice!! Will plan on doing that. :)
Sapphire
In Reply to: Re: Dr. Stoll and ChironDave - knees posted by ChironDave [1460.20] on January 31, 2005 at 19:02:13:
Hi ChironDave,
The xray didn't show any problems with the SI, although my lumbar spine had a definite curve to it. The chiro said his manipulations may or may not correct that. I may opt for a few sessions of the chiropractic treatment.
Thanks again for your thoughts!
Sapphire
In Reply to: To Dr. Stoll - knees posted by Sapphire [422.1366] on February 02, 2005 at 09:02:44:
Thanks, Sapphire.
IF done at least daily, and omega 3s, glucosamine and underwater exercises at least 3 times a week, are used--- about a year. Remember that, until just a few years ago this condition was considered incurable.
SO, we now have a whole generation of "hammers" who only know surgery as a management of the condition.
Let us know how you do.
Walt
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