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Extreme knee pain for 6+ months
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Extreme knee pain for 6+ months

My condition started in August of 2011. Knee pain started just below the knee cap when bent and pressure was applied. Think - bending down to pick something up that’s in front of you. Preliminary self-treatment was random stretching exercises and icing.

January of 2012, I went into the ortho’s office. Got X-Rays. Nothing out of the norm showed up so I was sent to the PT office for evaluation. I was diagnosed with Patellofemoral / Patella Tendonitis. Given Physical therapy exercises (strengthening of inner quads / stretching quads, stretching of calves ,strengething / stretching of hamstrings, and balancing exercises.)

Almost immediate relief (to some extent) Bringing pain from 9.5 to about a 8. After this, the pain stayed at a 8 level and never improved further. After 3-4 months, pain would actually fluctuate. Sometimes worse after activity, sometimes better. Sometimes worse after no activity (Activity being anything outside of PT.) Additionally, about 2-3 months after starting PT, the “static knee pain, while bent” that is common to PFS (long car rides or watching a movie at a theater), began. This was never an issue before. Also bought Body stick (glorified rolling pin for stretching/massaging of muscles and tendons.)

Around April I went to see a podiatrist and was diagnosed to have a flexible flat-foot; got orthotics.  Been usig them daily ever since.

6 months after the first doctors visit (so June of 2012), I got second opinion. Brought previous medical records. No new x-rays. Was told to get patella straps, prescribed Voltaren Gel, and to continue stretching of the hamstring and to get ankle weights, lift leg a foot off ground for 10 seconds set, 10 sets a day on each leg. My flexibility was noted by the doctor as “being better than 90% of guys that I see.” Other than testing hamstring resistance, the doctor felt and moved the patella bilaterally iwth one finger and noted a “squeaking”. Was told to be sure to apply strap below the point of squeaking as that would be the injured area, and that pressure should be applied below that.

Have been using gel and new physical therapy and no improvement to the pain. My legs feel ridiculously strong after all of the PT I've been doing this year. My right knee feels a little better than my left. My left knee has also started to develop sharp pain on the inside of the knee, right on the bone. I'm thinking Collateral ligaments?

The doctors I keep seeing don't seem to do any kind of scientific or thorough evaluation that can pinpoint what's causing my problem (the second Dr looked at 6 month old x-rays, lifted my leg, and moved my patella tendon with his index finger; is this normal procedure for evaluating something like this???). So far it just seems like they're throwing PT that has generally worked for other people in the past at the issue. My pain is the worst when pressure is applied, such as going down stairs, standing up from a seated position, or bending down to pick something up. If I push into the bottom of my kneecap, it feels bruised....as though the bone is bruised. Also, the last week of June, I went down to Florida for work. I thought the humidity would make the pain worse, but by the end of the week, it actually felt a lot better. Within 2-3 days of being back though, the pain was right back to normal (excrutiating)..

I've done everything they've told me to do for 6 months and haven't gotten any results. I really would like to know exactly what is wrong, what I need to do to fix it, and at this point don't even care what the cost is.What should I expect the doctor to do during a "proper/thorough" evaluation?

Thanks in advance for any comments. Also, if you happen to know of any doctors that are experienced in an issue like this in Illinois, I don't care how far I have to travel to see them. I just want this pain to go away.
Hi there!

Well, without an evaluation it would be difficult to determine the cause of your symptoms. Possibilities that may need to be considered include patellar dislocation, chondromalacia, infections/ inflammations, arthritis, bursitis, tendonitis, cyst formation, bone growths/ tumours, nerve impingement/ compression, fractures, injuries to the internal knee ligaments/ menisci etc. An orthopedician can get a fair idea about these by a physical examinations alone (as I assume would have been done) and radiological tests are just occasionally required. I would suggest following your doctor’s advice for the time being and if you do not observe in a couple of months or so, I would suggest seeking a possible review with him/ her.
Hope this helps.

Take care!
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