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[Jolley78MT]

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[nobody]

Welcome to the club. Between my 2 brothers and I, we’ve had 10 surgeries to repair issues regarding patellaformal ligaments, and we are all at or younger than 30. Ours was caused by tight IT bands pulling outwards on our knee joints, it would actually pull our kneecaps out of socket. None of us have 100% of our patella’s anymore, we are all at about 70%. We still fight patellar tendon pain from time to time, the only thing we’ve found to help is a compressive knee sleeve with some kind of mass that you can place right below the patella. It reduces inflammation, and the gel support helps to massage as we hike and walk. I’ve found a couple lightweight ones that I actually cycle in and out of my pack through the summer. Throw it on when I get achy or before I start a nasty downhill or a packout. Plus ibuprofen as needed.

Otherwise, lots of glucosamine and Chondroitin supplements, mega amounts of stretching, and stability exercises.

 

[Drenalin]

I’ve been dealing with it for 20 years. Ibuprofen helps some, and I ice and rest it after I do something to aggravate it. I have more trouble with downhill than up, but I’ve also got some ACL issues that contribute to that. If there’s a non-surgical long term solution, I’d be all ears.

 

[*zap*]

if you need to lift your knee's higher for that incline then your hip flexor group may very well be weak...iliopsoas.

if it is arthritis or from inflammation then take 15mg of meloxicam for a few days in a row and evaluate if that helped. That stuff can work wonders....it is really incredible. Then you have new laser treatments and the red light therapy which has been around for a few years....supposed to be good stuff. I am going to get some red light treatments next week.

 

[MT-Native]

Yes Sir! Been fighting it for 10 years now, but beating it. I found as I aged my flexibility worsened. Focus on starching every day, band starching for hamstrings, glutes etc. and IT band rolling after hard workouts. I also found the magic secret, that it’s all connected. Not just knee and glutes, but focus on the full unit, I stretch planter, calfs and traps hard and everything else in between. Ice baths help or spot ice on knee and hip following intense workouts. I also live by the 20% rule to avoid overuse injury. If I build up and max out at say a 10 mile hike/run this week, I do not do any more than 12 miles next week. Anything more invites overuse injury especially to our knees. Lastly, Deep Tissue ART massage has helped me avoid knee and other injuries slowing me down. This can be looked at as a form of torture, but it has helped me significantly from my mid 30’s to mid 40’s as the body starts rejecting what the mind wants us to do.

 

[Marbles]

I do not have personal experience with it. Guidelines recommend exercise training (PT) and not too much else (from a quick skim). Dig deeper as you want, I've attached the two that looked most helpful and are reasonably up to date.

 

[P Carter]

I used to get this, and would do leg extensions on the leg extension machine. I swear I could feel the patella be pulled back into place. I’d “lift” using the leg extension machine several times a week for a month or two. I think that happened for maybe 3 years, a fairly long time ago.

Haven’t had it since, but I’ve been doing more consistent strength work since then as well.

I also have really tight it bands and really weak hips. A PT got me started on good strength work and it really helps. I’d either go back to the PT and get a general strength routine, or hit the weight room and get those legs strong if that is an area you’re lacking in.

 

[timekiller13]

Stretch, stretch and stretch some more!!

Becoming more flexible helps relieve a lot of these issues. When I started marathon training 1 yr ago, I had all types of knee issues. I started a dedicated stretching routine. I’m talking 30-45 min per day of stretching. Since I started doing this, I have had zero knee issues. I run about 150-175 miles per month and have kept that average up for about 8 months now. My knees feels great other than typical soreness after long runs.

Also focus on core strength. Weak core means less support for the rest of your body.

 

[psirus7]

Have you tried a Cho-Pat (single) band?

 

[psirus7]

I had excellent luck with the single original version (the brown one) for about 10 years. Might be worth a shot!

 

[ztc92]

Thanks for the replies all. Sounds like it could be a lingering pita. Will get more diligent about the stretching and will look into the rolling. Have always worked out hard and have good strength in my legs. That said I've been weak in my hip flexors and maybe need to focus on that.

Great leg strength can actually sometimes be a problem, due to how we train and use our legs in the modern world. Sometimes patients will not have much buy-in for PT and targeted exercise due to having such a good strength base. The key thing is that this issue is not one of strength, rather it’s due to muscle imbalance, which is why PT and stretching can help so much with knee pain, even in very strong individuals.

To expand for those curious, it is very common for muscles of the lateral/outside thigh (vastus lateralis and hip abductors) to become much stronger relative to the muscles of the medial/inside thigh (vastus medialis and hip adductors). Over time that can cause the kneecap (patella) to be pulled in a lateral/outside direction each time the knee bends, which often results in pain since it no longer is tracking perfectly in the groove of the femur. Over long periods of time this can also cause uneven wearing of the cartilage and eventually arthritis of the patellarfemoral joint.

Takeaway point: Find a good PT that has a solid understanding of knee mechanics (try to find those who do rehab for high level athletes) and then do everything they say for at least 12 weeks before you decide PT isn't helping.

 

[*zap*]

I think that it would be good if people would post their age in opening and replying to subjects like this...

not too astounding for a 20 or 30 year old to run many miles a week and feel great ....things that help someone keep going will mostly be (but not always be) great advice for others in that peer group. What someone 40 years younger than me does may or may not be great for me to do/aspire to...

same thing applies to strength training.....I have heard on here that any male should be able to squat xxx#. what if someone is 65 and never lifted? So many people think that things that pertain to them just naturally apply to anyone else regardless of other factors/circumstances..things like how long has someone been doing fitness/strength training.

just sayin

 

[uglymud]

In my late 20s and have been dealing with pain in my right knee for three years now. I believe the injury originated when I stepped in a hole on the river one day and slightly tweaked my knee. Ached occasionally for about a year until I went backpacking, and after a fairly long uphill grind, the pain became fairly intense. Wrapped it up best I could and hobbled the rest of the way out.

Since then I have been to an orthopedic doctor, went to PT, had an MRI with no diagnosis other than pattellofemoral pain syndrome. Not much luck with the stretches I was given still incorporate some that seem more beneficial, but the knee pain/ache is a nearly constant thing at this point, downhills being the biggest problem.

Recently began trying a new set of stretches I found online from a backpacker who had problems leading up to doing the PCT so we'll see how that goes, also getting back into the gym with hopes I can get things back to normal.

Sent from my SM-S908U using Tapatalk

 

[Marbles]

In my late 20s and have been dealing with pain in my right knee for three years now. I believe the injury originated when I stepped in a hole on the river one day and slightly tweaked my knee. Ached occasionally for about a year until I went backpacking, and after a fairly long uphill grind, the pain became fairly intense. Wrapped it up best I could and hobbled the rest of the way out.

Since then I have been to an orthopedic doctor, went to PT, had an MRI with no diagnosis other than pattellofemoral pain syndrome. Not much luck with the stretches I was given still incorporate some that seem more beneficial, but the knee pain/ache is a nearly constant thing at this point, downhills being the biggest problem.

Recently began trying a new set of stretches I found online from a backpacker who had problems leading up to doing the PCT so we'll see how that goes, also getting back into the gym with hopes I can get things back to normal.

Sent from my SM-S908U using Tapatalk

Stretching is not always the answer. It only helps if tight muscles are the problem.

Example, I spent years dealing with lower back pain (started in the military), sometimes it was bad enough that walking was an act of will power for every step. I spent years stretching and it helped in the short term (next few hours), but never fixed the problem. I was strong and fit with the only score I did not max out on the PT test being the run because I'm just slow and never could get below a 9:30 mile and a half.

Tightness was a symptom, but not the problem. Strengthening my hips with a combination of rucking and asymmetric exercises greatly reduced the frequency of pain over a year or so. Starting to intentionally work on glute activation and lateral hip strength (if I put 50 pounds on and stepped up on something my knee turned in and crossed the midline) has made back pain a none issue. I'll get a twinge every few months, but it goes away quickly and has no effect on what I can do. In short, my back was tight and spasming because those muscles were trying to compensate for imbalanced strength in my hips.

A very high quality assessment to identify any areas that may need to be worked on would be beneficial. Down hills require a lot of strength and my best guess is one muscle group is overpowering its counterpart. The boring strength training, like pilates or yoga is more likely to help, and if you can target it to the weakness, you will like get results quicker.

 

[*zap*]

I will again recommend trying a week of meloxicam...there are also some new laser therapies which may be very beneficial and the red light therapy has been around a while and has good reviews.

Then there is the fact that people think they are doing a 'complete' fitness program but they are really not.

 

[Marbles]

I will again recommend trying a week of meloxicam...there are also some new laser therapies which may be very beneficial and the red light therapy has been around a while and has good reviews.

From the guidelines, laser therapy is not beneficial. They are from 2017 and 2018, so there could be new data. However, without new data, given prior data, it is a bad recommendation.

What does the meloxicam fix? That is a pretty heavy duty NSAID. Ibuprofen (for short term use) or naproxen (for long term use) are both safer. In this case, NSAIDs do not fix the problem, and could make it worse over time by allowing the continuation of poor form and increasing wear on the knee. Some may even directly increase harm to the cartilage (see second to last paragraph). Using them sparingly to get through things one wants to do is appropriate. Edit: The actual data on NSAIDs is mixed, it is unclear if any are safer. Even short term dosing is associated with an increase in heart attacks and strokes, so use judiciously and some people should avoid them. They are also associated with renal injury in certain situations as well as increased GI bleeds. Classically, the prescription NSAIDS are considered to be more dangerous, however the evidence is not clear. End edit

There may be some disease modifying effects of NSAIDs in osteoarthritis, but that is based on in vitro (test tube) studies and mice/rates, and there is contradictory evidence with COX 2 inhibitors, which are known to be pretty bad for the heart (worse than other NSAIDs), so personally I would not elect to take a drug that only might help, but probably does not. Negative results are rarely published, and there were lots of years under patent protection for investigation, meaning that if celecoxib was a DMOAD (disease modifying osteoarthritis drug) we would have likely known as it would have opened up a large revenue stream. So, in short, NSAIDs likely only treat a symptom in this case.

It gets even more complicated though, because in vitro and in rats/mice different NSAIDs have different effects, with some looking like they may speed up cartilage breakdown.

This is all complicated, do not take what I write over the advice of a specialist. This is outside of my area of expertise, I'm just giving a summary of a quick look at the evidence. I could certainly be missing something.

 

[*zap*]

^ well, if you beat back inflammation your body may then heal better where it might not ever heal if you did not get rid of that inflammation. I believe that localized inflammation as a result of a nagging injury can stop that area from healing.

If you cannot walk your fitness may suffer and your body will not benefit from the benefits walking provides.
I am not a pharmacist/scientist so I can only speak from my personal experience. Do you have personal experience with meloxicam benefits vs ibuprofen or the benefits of laser or red light therapy?

I, personally, have seen a tremendous difference in a few days from taking 15 mg of meloxicam a day which will allow me to do things that will hopefully quicken my body's healing process. That difference I have seen in a few days could be described as life changing for me as a person who loves to hike. I am 100% certain it is the meloxicam that made this difference. What difference has meloxicam made for you?

Red light treatment starts for me next week. After a series of those I will be able to say what it did for me.....

 

[*zap*]

My patellas have difficulty. But the meloxicam has reduced that.
You never answered my questions.

I understand all about inflammation and it's occurance when an area is injured. I also understand that that same issue can become hindrance to recovery.


I never said I have the only answer. I just suggested trying something for a week. That suggestion was based on personal experience not studies of rats.

 

[kylegreulich]

Dealt with it a bit in my left knee about 10 years ago now, and shortly after damaged a disc on my lower left side of my back. Taught me that these things were probably connected and that hip flexor, hamstring, glue strength etc all come into play. Walking lunges fixed almost everything for me, may sound ridiculous to some. Strengthens connective tissue as well as being a great workout. After the injuries was doing 15 min per day (or 1 lap around the track), and still maintain about 3-4 days a week. Giant help for me

 

[jgilber5]

I ran in highschool and college and had it off and on. In my case, it's caused by a tight sartorius muscle. Look up the location of it if unsure, but its a thin band that runs down and across the front of your quads. When injured or tight, it can pull your patella off the proper track and agitate everything down there. Consistent targeted stretching, rolling and icing can work wonders. Look up stretches for the sartorius, kinda hard to describe without visuals.