bad knees :(

so my knees kinda suck...the cartilage is deteriorating because i have patellofemoral syndrome. i'm going to physical therapy to try and stop it before it gets so bad that i need surgery...I'm scared that it wont improve and then i won't be able to bend or go up stairs without pain all the time. right now, it only hurts after i work out. Does anyone have anything similar like this and have advice?

Hey lxgirl,

I started off with patellofemoral syndrome, and due to a moron of a doctor and general malpractice (and since my father was active duty and it was a "military doctor," I have/had absolutely no legal recourse, as he was active duty, I did not have the "right" to sue for malpractice.

One important factor is to find out what your "Q-angle" is. This is a measurement of what angle your patellar tendon attaches to the tibia. In young women (Idk how old you are, but when the diagnosis SHOULD have been made, I was no more than 8-10 years old) should not be more than about 12-degrees. Anything more generally causes the patella to, and usually with every step you take, dislocate to some degree; which causes significant damage to the back of the patella, as well as the medial (inside part of the knee) cartilidge on the "femoral epicondyle" (the inside part of the end of the femur that makes up the top part of your knee)...so if you're for example, having a lot of pain on the inside part of your knee, it's likely that there's probably already a lot of cartilidge damage on that part of your joint. This is what happened in my case: my education from this came from what my dad calls "The University of Hard Knocks," and not the nursing school education I received. One could only wish.

But there's a procedure (simply put, they can transfer the patellar tendon to a better attachment point; and do what's called a "lateral release" which releases the tendons on the outer part of the leg; allowing you to strengthen the quad muscle, and gain some more strength to support your knee) that can help--not all orthopedic surgeons will do it; sometimes you have to "shop" for one; but eventually you'll come across one. If you are under 18, Shriners and Children's hospitals are helpful places to go.

Also, if you've already got the cartilidge damage; then bracing is one option. I've got one for my right knee (actually one for both; but the right side being worse, I wear that one more often) I wear almost every day. It was custom fit. They take an x-ray to see where the damage is to the cartilidge; and then they design the brace to lift the joint ever so slightly; and then it keeps the bones/cartilidge from rubbing on that fun bone on bone thing. But it's designed to take the stress off the most damaged parts of the knee-so they would need a new x-ray. I know the days I wear mine, it's comfortable, and designed to (and it doesn't, promise-not like the cheap-o's the docs pass out in their offices that are around your ankle before you're out the door) not cause slippage!!! Ah, finally, they listened and found a way to design a brace that doesn't slip!!! I never thought it'd happen in my lifetime. But if your knee has already began to develop the osteoarthritis; which is the end result of patellofemoral, then this is a good and non-invasive option. You can send me a message, and I'd be happy to contact the company rep and ask him for a name in your general area. The brace I wear is called an "Unloader," and it's one of their line of products, so it's unlikely that you'll simply be able to find it by Google. Idk, maybe-anything is possible.

But the local company (in Western Washington and Northwest Oregon, and I think the rep I go through even covers the I-90 corridor to as far as Spokane area of Eastern Washington: which would lead me to believe that there's reps in most states and areas; or at least someone you could speak with--but I'm happy to call him for you) is called Selkirk Medical Systems. I don't know if it's just a Pacific and Inland Northwest thing, or if Selkirk is nationwide, though. I'd need to call him and ask: but I will tell you--when I wear it: less pain, less swelling, less popping, grinding, and so on.

But in less severe cases, to my knowledge-the treatment is conservative (my Q-angle was over 22 degrees-which is unusually severe); which is PT, aquatherapy, orthotics-not Dr. Scholls, but the hard kind the PT guys make, NSAIDS, home PT, and the best exercise for you is cycling-whether bicycle or recumbent cycling at a gym--that's the one that will put the least stress on your knees.

That's my five cents from under the sofa...I'm looking for more, but if you want me to call the brace guy, I'm happy to--just post a reply or send me a message. It's no trouble at all.

Hope this helps; best of luck!

Thank you so much! Yeah, i'm already 16, and my mom wont let me do any kind of surgury on any of my joints. I had hip problems a few years ago, which were solved with custom orthotics, so i already wear those. I am going to physical therapy right now, and they're trying to strengthen the muscles around my knee so they can stabilize the joint (i think). but yeah, the pain originally was on the side of only my right knee, and now both of my knees are very achy, but my right knee somewhat less so (no more popping ) i'm not sure if it's the conditioning excersizes or its getting worse.

I was in your position, now 7yrs on and I did have the surgery at 18, 19 and 20. (Needed three because both knees were affected and one needed re-doing). I have had 3 athroscopies with chondroplasty, which means they re-shaped the cartilage by taking out the messed up stuff. I will need surgery in the future, but my knees are now at a state where I can cope. The rarely lock or give way anymore.

The surgery is minor if that is what they are proposing, but I would not go into it lightly. Be aware that once a surgeon has operated your knee will never be the same again. My pain has greatly reduced for the majority of the time, but there are further problems with alignment and also a huge part of pain management is to stop doing things that make it worse. Sport was a huge part of my life up until very recently. I was told repeatly I needed to stop anything involving running because it was causing more damage and I would be back in surgery again and again if I carried on. I eventually listened and the pain improved greatly, I went back to running a few times, but have been stressed the importance from another professional recently and have given in. That said, being active is good for you, you just have to choose wisely. Unfortunatly (in my mind) swimming is the most appropriate for me, and is for a lot of people with joint problems.

Another important thing to do it keep the muscles strong and not allow your weight to become more than it should. I also have hypermobility, so keeping muscles strong help stability, which is important regardless. The weight thing is just about not putting any extra pressure on damaged knees.

Emotionally it's been very tough on me, accepting that I cannot do the things that people double or triple my age can do and the things I loved for a number of years are no longer part of my life. I have a number of physical problems and I guess it's easy for other people to disregard the feelings it creates.

Feel free to ask any questions if you would like. You can pm me if you'd feel more comfortable, and you'd probably get a quicker response!

Lxegirl,

I hate to sound...um, well, let's just put it this way....a 13-year old has more control over their decisions in the state I live in. Here, at 13, you can consent to surgery, and even an abortion, without parental knowledge. However, if you are on their insurance, they will find out when the "Explanation of Benefits" shows up in the mail/email. So, I would recommend, that have your doc measure the "Q-angle" since it's important in even telling whether surgery is indicated. If it's over 15, it should be discussed.

But seriously; look into the bracing option; if you've got insurance, I know of very few who do not cover them-including medicaid. The important thing is to continue with the PT. But if you have indications or signs on an x-ray of osteoarthritis, it will at least make you more comfortable on the "bad days." It gives the affected part of the joint (like mine being on the inside part: it's a continual aching, throbbing at times: but my story is "outside the box" because of a delay in care and repeated injuries; but the braces basically anchor above and below the joint, and then offer hinged support; which in severe cases can be reinforced, and ever so slightly, lift that affected part of the joint...and only that part. This keeps you from rubbing bone on bone, which is going to produce more inflammation, swelling, and pain--then you're less likely to want to do your much needed PT.

PM me if you want more information; I'm happy to get it to you; but it's helpful. You have to remember not to wear it all the time, as tempting as it may be, once you're used to it. This will weaken the joint; especially the quads (which is one of, if not the most important part to get strengthened!!!!!!!!!!!!!); and then you set up for more problems; especially future ones!

There's no easy answer/solution to treating it; each one is individual; just as all of us are. It can be highly frustrating-especially if you want to consider a surgical option (which if anything, they can smooth over the back of the patella, and "do a clean up job," as my doc put it, and provide some relief.

But not many permanent, long-term solutions. But good thing on the orthotics; that should help your knees. One question is-this would depend on what your hip problem was, which you don't need to share, but it could be important-whether you have a congenital joint problem...such as whether you find your joints "loose" and get sprains easily, or overly flexible, and so forth. That would change the perspective of your treatment a little, but PT is still the right place to be regardless.

One thing I did, especially when recovering from any of the multiple surgeries I had on my knee (total of 9); was when just sitting and watching TV, was to do the leg lifts with my foot rotated outwards (quad sets) just sitting there. Then the range of motion exercises (heel slides), in sets. I would do a few sets, and then wait, and an hour later, if I was still resting; I'd do them again. It made a huge difference; I went from an expected 8-12 weeks on crutches (of course, this was combined with my PT visits; and regular home program; and regular exercise) to being able, with my doc's blessing, to ditch them at 4 weeks post-op.

JMO...but message me if you are needing/wanting any other info, etc.

And I can say that your mom probably says no to surgery, because she's concerned about you--there's inherent risks to surgery; and yeah, you're literally putting your "life in the doctor's hands" and she doesn't want anything horrible to happen to "her little girl." But she may not understand surgery isn't ask risky medically--yours likely could be done with an epidural spinal block and a sedative-should you even want it...however, if someone is gonna hammer in any way on me--knock me out!!! That's my own thoughts, tho!!! ... But hang in there. Keep asking questions; and when you think of one--even if you've asked it here; or it's something one of us has brought up; then write it down, and take it to your doc when you go in!!! Google it, do your research--it empowers you to improve your care!

Good luck.