Banged knee - looking for advice

[chewymix]

i have an appt at my GP on Tuesday morning to hopefully get a referral to a sports medicine doctor but i am asking for advice here as i dont know whats going on with my knee.

5 weeks ago today i banged the upper left part of my left knee cap / tendon into a post while rushing around. It hurt at the time as knee bangs do but faded and there was no real swelling that i could see and only a very tiny little bruise that soon went. Going up stairs was difficult for about a week but that has since got much better not to the point of taking them more than 1 at a time but i dont limp when i go up them.

this brings me to my main concern - even though there is no apparent swelling my knee feels stiff, but i have full ROM, and sometimes feels weak like it might buckle forward. The area that got hit on the top of the knee and also slightly down the left outer side, as i am looking down, feels different to the touch also in that it feels bruised/numb but its not numb i can actually feel it. The worse part of all this is the trouble i have at night sleeping due to a deep ache / pain down the back outerside of my knee, just in from the ligaments that are on the left hand side (looking down) and behind the knee, that seems to happen when the leg is straight, if i slightly bend the knee this seems to ease it off a bit but its still sore enough for me to not sleep very well.

Why would this still hurt a lot after 5 weeks yet my ability to go upstairs has improved? I sometimes feel the odd catch from in the knee and it seems to click but then again so does the non injured knee. It sometimes also feels like the knee cap is being forced forward slightly like there is pressure behind it but as i mentioned i cant really see any swelling.

Any thoughts? I am seeing the GP on Tuesday but i've been thinking about this a lot since the sleepless nights and i wonder if anyone has ever experienced anything similar?

thanks

[Jethro]

I have a similar problem. I cratered my dirt bike into a ravine I did not see until too late. I shattered my hinged knee guard and took most of the impact on the top of the kneecap and my shoulder. This was about five weeks ago. My knee is not swollen any more but it feels stiff, kind of like it has fluid in it. Sometimes when I stand straight legged, that knee wants to buckle, mostly because of a localized pain. I do have some cartilage tears from other incidents in that same knee, so I think I just aggravated those injuries. Clicking or locking are pretty good indicators of cartilage or meniscus damage. Keep us informed on your diagnosis

[chewymix]

thanks for the reply - i am seeing a sports medic doctor on friday for an evaluation so i'll see what they think. Sometimes the pain at the top of the knee is quite intense which is seemingly worse when the knee is flexed, sitting for example. Its wierd that in the first week after this happened i did not feel it that much its since the knee has been used that its really flared up.

I have also noticed that on the outerside of the quad, the small teardrop muscle, is pretty much not there on the injured side, it actually sort of looks wasted. If i contract it i can see it but in normal walking/standing its not really there and this is seemingly the location of where a lot of the pain comes from.

I'll let you know what the sports doc thinks when i see them

thanks

[The Reverend Floater]

The pain you guys are describing is identical to mine, FWIW. I crashed really hard in Moab on my mtb, landing square on my knee caps off a ledge. MD said I bruised my femurs, patellas and chipped one of my tibias. That was two months ago and it's still exactly as you described. I got an MRI and the doctor confirmed that it was simply severe bruising. He said it could be sore and achy well into the winter but that there's nothing to be done.

[chewymix]

2 months and no improvement at all?? I have heard that bone bruising can take a sweet time to heal but i'd like to hear about some, if slow, improvements.

Lets compare notes....

for me -

walking hurts? - well no not really but it does not feel great either

stairs hurt? - again not hugely, they used to hurt going up but thats improved a lot and did do in the first week or so but also if i push it i can feel a twinge under the kneecap

muscle weakness? - my outer quad on the hurt side is visibly smaller and when i do a lunge on that side to test this muscle, vml?, then its weak as hell.

what else? - sitting with that leg bent after a while aches at the quad tendon insertion point into the patella so whats that about? Inflammation and or bruising of this tendon? Although pressing on it does not hurt really but tensing that outer quad can recreate the same ache/burning i can get with sitting.

Its all a bit odd and after 5 weeks is a bit demoralizing -

how about some of the other bone bruise sufferers, how long did you guys take to improve?

thanks for any thoughts - advice

[andrewjesaitis]

I bruised the back of my kneecap on July 4, 2008. It's a long story but I am still dealing with secondary issues to the injury.

I would stay the original bone bruise took about 3 months to heal 90% (October '08).

My advice: be religious about PT. And get out and do moderate activity as soon as you can. And by moderate I mean even walking around the block every couple hours, but try to avoid stairs. For me it was a constant balancing act of being active enough to slowly build back muscle without inflaming the knee. And ice is your best friend. Nothing helped more than icing my knee after activity, since this meant I could strengthen the muscle with less inflammation.

What killed my recovery was a job that kept me at my desk for 12 hours a day, leading to muscle weakness, leading to petellar maltracking. Multiply this by a bout of petellar tendinitis in the other knee due to over compensation and you get my situation 17 months out from the original injury. Thankfully, I am done with that job and am on the road to recovery. I'd say I'm at about 90% (again).

Things to avoid: 1. Letting your knee go in front of your toes; 2. Letting your knee drop to the inside when doing a squat; 3. High impact sports (For me that is anything that has more impact than running on pavement--I still can ski, I just don't huck)

[chewymix]

thanks for the reply - i actually went to see a sports doc yesterday and i got some news but i am still digesting it and now looking for some other different advice!!

Seemingly when i hit the knee i actually hit the tendon insertion point just above the kneecap - this has subsequently caused me to tear about 1/3 of the outside quad onto that insertion point, on an ultrasound you can see a dark mass in the muscle which i think he said is a hematoma in the muscle. He says the muscle will not 'grow back' but i can recover the strength by working out the remaining muscle with one leg squats etc.

This brings me to my concern though, the area of the hematoma and below feels odd and stingy and when walking for a mile or two the knee feels a bit stiff and weak. I am worried about potential nerve damage here although the area is not numb i am concerned about this stinging. Has anyone ever smacked and torn a muscle and then had stinging? Seemingly the stinging does not really occur when doing say a 1 leg squat but if i am resting and the muscle starts to relax this seemingly brings it on. Also i wake in the morning and this stinging is present so i am trying to work out what i might be dealing with here.

any clues anyone?

thanks

[chewymix]

so went to the physio that the sports doc recommended and she did some deep and intensive work into the vastus lateralis tendon and muscle belly where the hematoma is and also generally worked the whole area. Today the vl is very sore and bruised feeling but she was going pretty deep, the tendon also feels more sore.

Will see how it plays out over the next few days but this is one sucky injury and totally wierd in that it seemingly takes ages to make any progress.

[chewymix]

OK guys would appreciate some feedback as this is slightly freaking me out now!

i have developed SIMILAR issues in my right knee in that i have tightness/pulling/soreness on the top outer part of the knee that is much more pronounced when sitting with the knee flexed. How on earth can i get issues in both sides now considering i have basically been babying the knee(s) and not done any form of workout/running.

I have been foam rolling both sides and from reading the feeling is a bit like ITB pain in that it sort of radiates into the lower quad but it happens all the time and is perhaps worse with inactivity. Physio does not know and is asking 'colleges' but i am gonna go and see a different one off my own back. I might push the sports doc to get am MRI done on the 'bad' knee to see if anything shows up there on the tendon insertion point as that is seemingly not getting much better either.

Any clues at all - its like my lower body is falling apart over the last 7 weeks!!

EDIT: also note that my good kneecap seems to get 'stuck' and then free up during flexation so its not a smooth action.

thanks

[andrewjesaitis]

Sorry to hear that the trouble is continuing. Just as a little disclaimer, I'm not a doctor and am just relating my experience from an injury that is probably different from yours. Also, you should know that my knee is not perfect yet, so take everything I say with a grain of salt and listen to a doctor you trust.

My knee started to click/crunch as the patella jumped back into place. For me this was due to a mal-tracking patella caused (I think) by muscle weakness due to my original bruised kneecap. I remember starting to ride my bike again and feeling my patella jump every revoloution. I also experienced ITB issues which feel like a stinging pain on the outside of the leg so bad it takes your breath away, but is gone as fast as it came on. These went away quickly for me with PT.

I also experienced similar issues with my other "good" knee having problems. This could probably be caused a bunch of different ways. Maybe over-compensation? In my case, my "good" knee was/is weaker than my "bad" knee. I also have experienced the pain moving around to different parts of my knee(s) and feeling different discomforts (sharp, dull, nagging, etc). I think the difficult thing about these injuries is that you basically knock your knee out of a very sensitive equilibrium with many different tendons and muscles. And doing something to strengthen one part aggravates another. The key for me was to start with super easy exercises and build slowly.

See if you can get referred to a different PT. Maybe try a different doctor. They might have a slightly different exercise routine that could help out. Also, my second doctor was much more sympathetic with my problem and was more positive, which at least makes you feel a little better.
Don't know where you are, but if you're near Seattle I can recommend my doc and PT.

It was the most frustrating injury I've had, because my original injury happened when I was in the best shape of my life. I went from biking 100 miles a week, climbing a peak every week or to being in pain walking up the stairs to my apartment. I'm still not totally sure how I injured mine. Apparently, I bruised my patella kicking steps in running shoes and then it was a downward spiral of weakening muscle. In some ways not having a catastrophic knee blowout it more frustrating because you don't know how you injured it. I kept thinking, "I'm only 22 (23, 24), I shouldn't be falling apart--No one else my age is having issues." But, I was actually surprised how many active people my age I've met who are dealing with similar issues. So you aren't alone. It been a long process, but don't lose hope! Just keep doing you PT! [/peptalk]

[chewymix]

Thanks for taking the time to respond - quite interesting in that i seem o be experiencing pretty much EXACTLY the same thing although perhaps in different knees. What i mean by that is my 'good' knee can sometimes lock and then as the patella jumps up it frees up again so there is some major patella tracking issues going on there and i think thats whats causing the pain and discomfort in there. I have found though that if i do a quad stretch by lying on my side it really pulls on the outer side of the knee, once this has been stretched the knees feels a LOT freeer almost to the point of feeling normal, until i try stairs that is, so something is either tight or weak in there.

My 'bad' knee just feels wierd but in a different way to the good so i think i need to work out what makes that feel better and work on that. I have discovered that my quads are generally weak, the thing where you 'sit' against the wall but without a chair being there causes my quads to burn after about 5 seconds to the point of me needing to stop. That was a huge surprise so i am guessing that this incident with the knock on the knee has exposed weakness in my lower body mechanics that i had no idea i had.

Not near Seattle - used to spend my time going between Whister and Baker but now i am on the wrong side of the pond and residing in London.

It is a frustrating injury but for me by far the worst part is, and i am not sure how many can relate to this, but i have a 7 month old kid and feeling that you cant dedicate 110% to them is awful. Having to think about an injury when you goto bend down to pick them up or kneel down to bath / play with them etc is just crazy. I am young(ish) 33 so i have a long time ahead of me with these knees so i gotta get them working!

thanks again

[chewymix]

so i had an MRI last week and got the results yesterday - nothing major going on, the patella tendon looks 'bruised' on the scan, its not a nice solid line it looks a bit wooly so thats good. The scan did however note a meniscus tear of the posterior horn?? Does that sound right and or make sense? Where is that located, inside or outside of knee?

Is it possible to damage that by hitting the knee or is that likely to be an existing injury that just happened to show up on the scan? The knee does not lock and i think it is starting to improve so things are looking up i think.

thanks

[chewymix]

OK just managed to get hold of the MRI report rather than me trying to remember what it said! So in relation to the meniscus tear....

"Small tear of the posterior horn of the medial meniscus with a mild increase in joint fluid"

What does that mean? Where would i generally be feeling pain if its coming from that meniscus issue?

thanks

[ces88]

I couldn't tell you what all of that means, however I can relate to the patella-tracking issues! I am actually recovering from surgery on my knee for this. I had a "freak accident" on April 1 2009 and was rehearsing for a dance performance and really just moved the wrong way, and subluxed my hip, and my knee. However, I did not realize my knee was injured until about 6 weeks post-injury while in PT for my hip. As soon as I started to put weight on my leg (because I was on crutches for a LONG time), my knee blew up and started popping,clicking, grinding, etc. After an x-ray and MRI, nothing was clear, but determined that I had subluxed my knee when I did my hip. I just kept with the PT until the end of August, and then did exercises on my own to build strength. I have also been in a brace to help keep my knee cap in place ever since, because it would track to the outside of my leg EVERY TIME I would bend it (my other knee doesn't track right either, but it is not painful and causing problems, so I just leave it alone). Nothing ever got better, so I had to have surgery. The doctor was not sure if he would have to tighten the ligaments on the inside of my knee (to keep the knee cap from slipping to the outside of the knee) or if he would just have to clean things out. Turns out the major issue was the ligaments and that they were not doing anything for my knee cap because they were so loose/torn.

Before the MRI, my dr. thought that it was a meniscus tear because of where the pain was and all. So, I think that you could be having that pain because of a meniscus tear. Also, the medial meniscus is on the inside of the knee, I do believe. I say that because I had a "medial reefing" performed on my knee, which involved the inside of the knee, not the outside of it. Also, fluid on the knee can cause pain and discomfort as well.

Good luck with everything!

[chewymix]

thanks for that - when did you have the surgery and are you seeing results ?

I think my issue is multi factoral and so i am trying to find a GOOD pt but that is proving somewhat hard. My 'good' knee pops far more than my 'bad' but is far less troublesome, its all rather strange.

The tendon that i bashed is not sore when manipulated when not under tension but if i load it up on a one leg squat and then manipulate it then its very sore, anyone know what that might mean?

thanks