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Suggest Treatment For Pain And Stiffness In Knee
Question: Hi, Dr. Siegel.
I have knee pain on my right knee since the last week of May due to doing the squats the yoga instructor wanted me to, she only asked me doing for a several times but not other students, don't know why. Pain comes until after a week, I went to see the physiotherapy on the first week of XXXXXXX until last Friday, Aug. 21.
Of the pain spot that I pointed out (above kneecap), the physiotherapist diagnosis me have a patella femoral syndrome, they gave me seven exercises a total of 90 minutes each day (one PT gone for holiday, another one take over). 90 minutes exercises are straight leg raise, calm shell, quadriceps stretch,, side-lying leg lift, adductor (30 sec for 5 times), learning walking the stair by pointing the knee on the second toe (10x/3 sets), learning walking downstairs at the normal pace (10 times each leg). The first week of August, the first PT back from the holiday, he is so XXXXXXX to see I am still there. In my mind, I am thinking Patella Femoral Syndrome only takes eight weeks of treatment; I am getting nervous of having something serious. After I pointed out the painful area (right side of the knee), he diagnosis me something involved with the tendon and ligament, didn't give out the medical terminology name.
My sore and stiffness area are come and go around my knee and above kneecap, both sides of knee and at the back of knee. I am a 46 years old, 4'8", 98 lbs, non-active person not doing any exercise, and it's been for years and now go back to yoga class again. PT said because I don't doing exercise plus my knee muscle is very weak, it may take longer time to get cure. I work in the mailroom for four years, now I try to stay away with heavy lifting.
Aug. 14, PT showed me a new set of exercise do six times a day for only 30 minutes for only four basic exercises and asked me to have a x-rays report from my family doctor to ensure that I am not having an arthritis. I feel my knee is getting better of not doing that 90 minutes exercise, still have stiffness, weak at the back knee and a bit sore on the side.
In the very beginning, my family doctor diagnosis me have an arthritis because of my age, I told her that I've been seeing the physio, and she said I can do quadriceps exercise and Naproxen (for my menstrual, but I don't take it often). On Aug. 20, she is not really willing to give out the x-rays result. This time, family doctor really pays attention to my knee asking for detail. I told that PT said its cause from the tendon. I can walk up and down the stairs. She stops me of doing all exercises including biking at home (I started doing biking by adding 1 minute at a time from 10 to 20 minutes.) She said why I have to go to the physio? I said everybody would go when they feel pain. Totally rest and ice pads for two weeks and taking Celecoxib 200mg once a day. She said I should know when is the best or worst day I do the exercise or not. On Aug. 21, PT was upset of shut him down from my family doctor, he seems not welcome me to go back after two weeks. PT kept on shaking his head saying cannot stop doing exercise but family doctor has more authority, he cannot override that.
I am very confuse myself of all these happening these days. I started to take Celecoxib on Thursday night, I did not do any exercise on Friday and the sore just like before like stiffness, tiring on the back knee, a bit sore on the side of knee. It was sore on Saturday, peaceful for 3 to 4 hours after taking Celecoxib then sore again for six hours for a whole knee and I started doing the 5 minutes exercise again for four times. Today, so far so good, I can point out it has a sensitive touch and a little soreness above the kneecap and a bit stiffness at the back knee, I can feel a bit of sore on tendon. 5 minutes exercises are (quad stretch, standing hamstring, standing calf and adductor) to strengthen the muscle.
My question is I don't know if my family doctor will let me go back to have physio treatment after two weeks of medication. She prescribed me for 30 days because it's been two and a half month sore. Do I have to finish all 30 capsules? Should I continue do the exercise to make the muscle stay strong, I am not going to tell my family doctor, she might blame on me again or I really should stop doing it, I am afraid it will be sore like Saturday? How many times of ice pad I should do in a day? Why not doing heat pad or alternatively? Because PT and family doctor diagnosis differently from the beginning till now, am I really have knee tendinitis. Am I doing the right exercise? 90 minutes might be overworking for me, but I feel that it has strengthening for some muscle. When I can do that 90 minutes exercise again? Should I do 2 sets instead of 3 sets, it will be shorten the time not long as 90 minutes. How long I can get recover. What happen after finishing these 20 or 30 capsules of Celecoxib, will pain comes back again? What kind of treatment I should do later like physio or chiropractor? How long I can go for walking or indoor biking? Anything I miss?
Thanks,
XXXX
I have knee pain on my right knee since the last week of May due to doing the squats the yoga instructor wanted me to, she only asked me doing for a several times but not other students, don't know why. Pain comes until after a week, I went to see the physiotherapy on the first week of XXXXXXX until last Friday, Aug. 21.
Of the pain spot that I pointed out (above kneecap), the physiotherapist diagnosis me have a patella femoral syndrome, they gave me seven exercises a total of 90 minutes each day (one PT gone for holiday, another one take over). 90 minutes exercises are straight leg raise, calm shell, quadriceps stretch,, side-lying leg lift, adductor (30 sec for 5 times), learning walking the stair by pointing the knee on the second toe (10x/3 sets), learning walking downstairs at the normal pace (10 times each leg). The first week of August, the first PT back from the holiday, he is so XXXXXXX to see I am still there. In my mind, I am thinking Patella Femoral Syndrome only takes eight weeks of treatment; I am getting nervous of having something serious. After I pointed out the painful area (right side of the knee), he diagnosis me something involved with the tendon and ligament, didn't give out the medical terminology name.
My sore and stiffness area are come and go around my knee and above kneecap, both sides of knee and at the back of knee. I am a 46 years old, 4'8", 98 lbs, non-active person not doing any exercise, and it's been for years and now go back to yoga class again. PT said because I don't doing exercise plus my knee muscle is very weak, it may take longer time to get cure. I work in the mailroom for four years, now I try to stay away with heavy lifting.
Aug. 14, PT showed me a new set of exercise do six times a day for only 30 minutes for only four basic exercises and asked me to have a x-rays report from my family doctor to ensure that I am not having an arthritis. I feel my knee is getting better of not doing that 90 minutes exercise, still have stiffness, weak at the back knee and a bit sore on the side.
In the very beginning, my family doctor diagnosis me have an arthritis because of my age, I told her that I've been seeing the physio, and she said I can do quadriceps exercise and Naproxen (for my menstrual, but I don't take it often). On Aug. 20, she is not really willing to give out the x-rays result. This time, family doctor really pays attention to my knee asking for detail. I told that PT said its cause from the tendon. I can walk up and down the stairs. She stops me of doing all exercises including biking at home (I started doing biking by adding 1 minute at a time from 10 to 20 minutes.) She said why I have to go to the physio? I said everybody would go when they feel pain. Totally rest and ice pads for two weeks and taking Celecoxib 200mg once a day. She said I should know when is the best or worst day I do the exercise or not. On Aug. 21, PT was upset of shut him down from my family doctor, he seems not welcome me to go back after two weeks. PT kept on shaking his head saying cannot stop doing exercise but family doctor has more authority, he cannot override that.
I am very confuse myself of all these happening these days. I started to take Celecoxib on Thursday night, I did not do any exercise on Friday and the sore just like before like stiffness, tiring on the back knee, a bit sore on the side of knee. It was sore on Saturday, peaceful for 3 to 4 hours after taking Celecoxib then sore again for six hours for a whole knee and I started doing the 5 minutes exercise again for four times. Today, so far so good, I can point out it has a sensitive touch and a little soreness above the kneecap and a bit stiffness at the back knee, I can feel a bit of sore on tendon. 5 minutes exercises are (quad stretch, standing hamstring, standing calf and adductor) to strengthen the muscle.
My question is I don't know if my family doctor will let me go back to have physio treatment after two weeks of medication. She prescribed me for 30 days because it's been two and a half month sore. Do I have to finish all 30 capsules? Should I continue do the exercise to make the muscle stay strong, I am not going to tell my family doctor, she might blame on me again or I really should stop doing it, I am afraid it will be sore like Saturday? How many times of ice pad I should do in a day? Why not doing heat pad or alternatively? Because PT and family doctor diagnosis differently from the beginning till now, am I really have knee tendinitis. Am I doing the right exercise? 90 minutes might be overworking for me, but I feel that it has strengthening for some muscle. When I can do that 90 minutes exercise again? Should I do 2 sets instead of 3 sets, it will be shorten the time not long as 90 minutes. How long I can get recover. What happen after finishing these 20 or 30 capsules of Celecoxib, will pain comes back again? What kind of treatment I should do later like physio or chiropractor? How long I can go for walking or indoor biking? Anything I miss?
Thanks,
XXXX
Brief Answer:
sore muscles and tendons around knee
Detailed Answer:
Hi!
Welcome to health care magic!
I am Dr. Saddiq Ul Abidin. I have read your problem in detail and will try to help you in best way possible.
First of all, it is so sad that you have been having this problem lately. Having said that, the way you put your history together in such minute detail is commendable. You also seem like a person who gives alot of focus on her health and fitness which is indeed a great habit, but let me get this straight that in this issue, I am afraid that you got it wrong from the very start.
I mean it is quite obvious that, in practicing routine yoga or other fitness exercises, to have a muscle or two getting pulled, or some tendon getting inflamed if been stretched beyond the threshold.
The right approach would have been, as your doctor and the first physio person had said. With your age group you needed to rule out arthritis or oher causes like osteoporosis etc. For that the GP opinion also matters, but the most appropriate would have been of some orthopedician. Your radiographs do negate severe bone or joint issue but still soft tissue lesions can not be normally seen on Xray.
In such cases CT or MRI would have been the right choices to look for any ligaments or tendons involvements. Meanwhile checking the levels of calcium and vitamin D along with some work up for other causes of arthritis might have been considered. After careful examination with an orthopedician, it could safely been said, Wether the suffering in your case might be due to local muscle group inflammation or strain.
In such cases, initial advise is normally to cut down physical exercise, apply warm massages, local anti inflammatory emulgels, muscle relaxants like orphenidrine or gaba pentins and some anti inflammatory drugs like ones which you are onto, celecoxib or neproxin.
After adequate rest, the physio role comes into play during rehabilitation. You must have seen many athletes and players when undergo such issues, are needed to refrain from physical activities and after few weeks are advised to get to physio during rehabilitation phase. That way you would have felt much better.
Hope this has answered your query, if you have any more questions, feel free to ask. kindly rate me generously before closing, and leave your feedback if possible.
Regards,
Dr. Saddiq Ul abidin.
sore muscles and tendons around knee
Detailed Answer:
Hi!
Welcome to health care magic!
I am Dr. Saddiq Ul Abidin. I have read your problem in detail and will try to help you in best way possible.
First of all, it is so sad that you have been having this problem lately. Having said that, the way you put your history together in such minute detail is commendable. You also seem like a person who gives alot of focus on her health and fitness which is indeed a great habit, but let me get this straight that in this issue, I am afraid that you got it wrong from the very start.
I mean it is quite obvious that, in practicing routine yoga or other fitness exercises, to have a muscle or two getting pulled, or some tendon getting inflamed if been stretched beyond the threshold.
The right approach would have been, as your doctor and the first physio person had said. With your age group you needed to rule out arthritis or oher causes like osteoporosis etc. For that the GP opinion also matters, but the most appropriate would have been of some orthopedician. Your radiographs do negate severe bone or joint issue but still soft tissue lesions can not be normally seen on Xray.
In such cases CT or MRI would have been the right choices to look for any ligaments or tendons involvements. Meanwhile checking the levels of calcium and vitamin D along with some work up for other causes of arthritis might have been considered. After careful examination with an orthopedician, it could safely been said, Wether the suffering in your case might be due to local muscle group inflammation or strain.
In such cases, initial advise is normally to cut down physical exercise, apply warm massages, local anti inflammatory emulgels, muscle relaxants like orphenidrine or gaba pentins and some anti inflammatory drugs like ones which you are onto, celecoxib or neproxin.
After adequate rest, the physio role comes into play during rehabilitation. You must have seen many athletes and players when undergo such issues, are needed to refrain from physical activities and after few weeks are advised to get to physio during rehabilitation phase. That way you would have felt much better.
Hope this has answered your query, if you have any more questions, feel free to ask. kindly rate me generously before closing, and leave your feedback if possible.
Regards,
Dr. Saddiq Ul abidin.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your reply, Dr. Saddiq Ul Abidin. It is a good suggestion. I hope my doctor will let me to have a MRI check or let me to go for an orthopedician. I've starting to take Calcium Magnesium + Vitamin D3 and Glucosamine Chondroitine since I got injured 2 caplets for each. Taking Gluosamine Chondroitine MSM for two and a half month, now switch to regular Gluosamine Chondroitine, why not continue taking MSM, may be it seems like not very helpful?
I will be going to Asia for vacation in the middle of October for 16 days, do you think my feet can handle the walking? I am just prepared myself to stay home at that time too.
That mean you suggest I should have hot pad, not cold pad?
I will be going to Asia for vacation in the middle of October for 16 days, do you think my feet can handle the walking? I am just prepared myself to stay home at that time too.
That mean you suggest I should have hot pad, not cold pad?
Brief Answer:
closing remarks and additional details
Detailed Answer:
Hi! First of all thanks for appreciation and such encouraging remarks.
Coming to the use of supplements you mentioned, as MSM combination has been switched to MSM free form because this substance crosses blood brain barrier and data for the side effects of long term usage is not available so far. So that is why on the safe side normally it is not allowed to be used for more than six months. Also such supplements doesn't have therapeutic roles and are helpful for long term prophylaxis so kindly don't bother much about such trivial fluctuations of dosages.
As far as travelling is considered. You can travel easily but if you are having long air travel make sure you do some flexion and extention and little walk in plane after an hour or two and don't keep legs in one pose all the way as it leads to deep vein thrombi.
After reaching you can have mild physical activities and avoid strenuous activities. Staying inside is not though strictly recommended and you can have mild outings and travels.
As far as comparison between cold and hot massages are concerned. See if there is any bruise or signs of oval inflammation cold massages may help to constrict blood vessels and decrease swelling. But for muscle spasms with no bruising or signs of inflammation normally warm massages help which are normally used in physiotherapy clinics by special lamps or massage cushions.
Hope this has answered your queries. You can ask questions via my profile directly in future. Kindly rate me maximum or leave a review as source of encouragement. Regards.
closing remarks and additional details
Detailed Answer:
Hi! First of all thanks for appreciation and such encouraging remarks.
Coming to the use of supplements you mentioned, as MSM combination has been switched to MSM free form because this substance crosses blood brain barrier and data for the side effects of long term usage is not available so far. So that is why on the safe side normally it is not allowed to be used for more than six months. Also such supplements doesn't have therapeutic roles and are helpful for long term prophylaxis so kindly don't bother much about such trivial fluctuations of dosages.
As far as travelling is considered. You can travel easily but if you are having long air travel make sure you do some flexion and extention and little walk in plane after an hour or two and don't keep legs in one pose all the way as it leads to deep vein thrombi.
After reaching you can have mild physical activities and avoid strenuous activities. Staying inside is not though strictly recommended and you can have mild outings and travels.
As far as comparison between cold and hot massages are concerned. See if there is any bruise or signs of oval inflammation cold massages may help to constrict blood vessels and decrease swelling. But for muscle spasms with no bruising or signs of inflammation normally warm massages help which are normally used in physiotherapy clinics by special lamps or massage cushions.
Hope this has answered your queries. You can ask questions via my profile directly in future. Kindly rate me maximum or leave a review as source of encouragement. Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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