knee issues

[TheShortOne]

Hey Doc -
I'm a ski instructor in the winter months, and last night as I was working out (pilates) my left knee started cracking a lot when it was being bent. When I've done pilates before it'll crack a little bit, but not nearly as much as it was last night. Also, my knees both feel "creaky" I can't feel it when I'm walking around or doing normal activities, but if i put my hand near the bottom of the knee cap I can actually feel it creaking. Sorry I can't be really much more descriptive, but I'm not sure I know the words to really describe it. Anyway, do you think I should go and get my knees looked at or do I have nothing to worry about?

[Dugie8]

I've had knee problems since high school (way too much football!). My left knee finally gave out one day playing raquet ball. Kind of what you are describing, no real pain, just a lock of cracking whenever I would bend it.

Went in for a scope and the doc pulled out some tissue that had gotten pinched in the knee joint, plica (sp?) is what he called it. I guess there is some kind of shroud around the knee joint and I had somehow had gotten that to fold inside the joint and crunch crunch.

Hope you can get it fixed easily, knee surgerys are no fun....

[My Flight Surgeon]

There are basically only 4 things that can go wrong with the knee joint.
1) A fracture or broken bone
2) Damage to the meniscus (like a wheel bearing, it is usually called cartilage in lay terms))
3) Damage to the ligaments that hold the joint together
4) Damage to the cartilage on the surfaces of bones where they rub together (this includes the back of the knee cap)

From your brief description (and I can't make a definitive diagnosis without examining the knee), it sounds like you have the latter on the knee cap. This is called chondromallacea patella and can be a chronic problem causing problems intermittently for years. It is made worse by doing exercises like deep knee bends and stair climbing. We generally treat it with ibuprofen or other anti-inflammatory drugs. Sometimes an orthopedic surgeon will want to "shave" the back of the knee cap - this is OK but it will never return to normal like when you were 16.

If this continues to bother you, you should see a physician who can examine your knee to be certain of the dignosis.

[TheShortOne]

ok thanks for the info!

[Kristie]

I have that everytime i walk upstairs. My right knee will crack with each up step. what's funny is that it's only when i'm walking up stairs not necessarily when i'm bending my knee. The other thing that happens to me now a days, esp if i'm lifting heavy luggage is that my knee will "give way". not necessarily disjoint itself but it kindof slips out of place for a meer second but it hurts (for about 2 seconds) like pinpoint pain! one of these days, i figure i better get it in and looked at simply because i can see that becoming a serious issue.

Dr. Forred, do you know if there are any exercises that can actually make these types of things better or are we just better off seeing a doc about orthopedic surgery? are knee problems like this common as we get older? doug seems to think fitness really has a play on how healthy your knees are.

[jtrain609]

My Mom has the same problems as you do, Kristie. I also go through the same thing as Emily, though I figure I've beaten my knee's up from way too many (9) years of marching band.

[My Flight Surgeon]

Kristi

I knew Doug was brilliant!! Exercise and staying in shape helps the joints by keeping the muscles that move them in good tone.

The knee hurts when you climb stairs or lift luggage because you are forcing the knee cap into the end of the femur (thigh bone) and repeatedly injuring the cartilage on the back surface of the knee cap. The twinge of pain you feel is your body telling you to quit doing that activity. If you want to be por-active, see a trainer or physical therapist to get proper exercises to strengthen the musles of the leg and to avoid the injury that occurs with forced flexion of the knee. Ibuprofen 600-800 mg a couple time a day will help after you reinjure the knee.

[Tim]

Kristie both my knees are that way also. Anytime I put pressure on them whether climbing steps or steping forward with the knee bending kinda like a stretch it creaks and hurts. I went to the orthpedic surgeon who fixed my shoulder and knee once before and he said the same thing as the good Dr did. I tried the cortisone shot and that help for about 5 minutes. He wants to do the MRI next to see really whats going on. X-rays didnt show any breaks but wanted to rule any boken issues out.

[Kristie]

Originally Posted by My Flight Surgeon

Kristi

I knew Doug was brilliant!! Exercise and staying in shape helps the joints by keeping the muscles that move them in good tone.

The knee hurts when you climb stairs or lift luggage because you are forcing the knee cap into the end of the femur (thigh bone) and repeatedly injuring the cartilage on the back surface of the knee cap. The twinge of pain you feel is your body telling you to quit doing that activity. If you want to be por-active, see a trainer or physical therapist to get proper exercises to strengthen the musles of the leg and to avoid the injury that occurs with forced flexion of the knee. Ibuprofen 600-800 mg a couple time a day will help after you reinjure the knee.

actually, it's more when i'm going down steps with heavy luggage that my knee goes "out" and gives me that shock of pain...is that considered the same type of problem involving the same solution? I've been doing the elliptical for 2-3 weeks now hoping that will help both knees but the right is creaking more and more everytime it bends (weird!). I'm starting to attribute it to old(er) age! haha

it really gets me when we're in europe because there are more stairs that you have to carry your baggage down than here (we have a LOT more escalators)...

Figure i'll just keep up with the elliptical and maybe it'll disappear someday. My big wonder/question is whether the cartiledge can wear out to the point exercise doesn't help?

it surprises me that doug and other pilots don't have the same type of problem considering how often they're carrying their luggage!!

[My Flight Surgeon]

Cartilage can wear out totally. It usually does not happen before age 60 though unless there has been severe knee trauma. The ultimate fix is total knee replacement but that should not be done before age 65 because it will probably have to be repeated at about 15 years after the first one (technology is getting better but is not perfect).

Going down stairs causes the same forces to be generated in the knee as going up the stairs. Keep exercising and talk to the trainer abouth other leg specific exercises without forced flexion.

Good luck

[Kristie]

Interesting...I always thought they'd be different forces due to gravity. harder on the knee going upstairs because gravity is working against you, easier going downstairs. but maybe it's negligible in that it's only a small addition to the full force placed upon the knee.

hmmmm...

thanks again doc! appreciate your insight!

[adreamer]

Used to be athletic trainer certified. In about 10 years, had to rehab about 80 athletes with knee problem(s). The following was my observations before I quit(not too long ago)

Dougie8, Plica was a correct term. Some people, for whatever reason, irritate the connective tisses / ligamnet / catilage right around the knee cap. The end result is enlargement of this particular tissue. When that happens, doc usually had to take it out if it really hurts athletes / patients. However, one research suggested about 30 percent of total populations may not have this particular tissue. I have spent few days of observation in OR when orthopeadic surgeon pulled "Plica" out.

Kristie, if you want some easy exercises for leg strengthening exercise, PM me.

adreamer

[Dugie8]

adreamer

I lost a lot of strength in my left leg after the surgery, even though the mass was still there. It took me a long time to get the stability and coordination back. I couldn't do squats with any kind of weight for almost a year after the surgery.

[My Flight Surgeon]

Your "recovery" is about average. Even professional athletes take 6-8 months to prepare to play again.

[Tim]

Originally Posted by adreamer

Used to be athletic trainer certified. In about 10 years, had to rehab about 80 athletes with knee problem(s). The following was my observations before I quit(not too long ago)

Dougie8, Plica was a correct term. Some people, for whatever reason, irritate the connective tisses / ligamnet / catilage right around the knee cap. The end result is enlargement of this particular tissue. When that happens, doc usually had to take it out if it really hurts athletes / patients. However, one research suggested about 30 percent of total populations may not have this particular tissue. I have spent few days of observation in OR when orthopeadic surgeon pulled "Plica" out.

Kristie, if you want some easy exercises for leg strengthening exercise, PM me.

adreamer

When I had my knee scoped the Dr mentioned something about cleaning up Plica that had developed. I think he explained but was groggy. I do remember him telling me that it would be beneficial later. Pounding the concrete ramp at the airport in steel toes though doenst help anyones knees.

[adreamer]

Tim, I agree with you totally. That does not help your knees at all. About surgery for removing plica, in my personal opinion, I would not do it until it is necessary.

Dougie8, For any kind of surgery, you lost a lot of muscle tone. The question is how much. I believe you might heard this concept - "pre-surgery rehab." The goal is to gain / maintain your muscle strength of injured body part with any further damage. For example, knee surgery, most people lost a lot of thigh muscule strength and mass. In order to prevent lost of muscle mass and tone, trainers or PTs will work with you on special / individual designed exercises.

Shortone, based on your descriptions, I suggest you pay a visit to orthopeadic surgeon or physician.

adreamer

[Dugie8]

AD

This was back in the day when I was "easily" squatting around 500, blah blah, blah. I went from that to barely being able to do leg extension with 3 or more plates on the my left leg. My size and tone didn't really change, the strenght and coordination or balance was completely out the window though. Really scared me for a while until it started coming back. Even to this day (almost 6 years later) my left knee/leg is "weak".

[Tim]

Originally Posted by adreamer

Tim, I agree with you totally. That does not help your knees at all. About surgery for removing plica, in my personal opinion, I would not do it until it is necessary.

Dougie8, For any kind of surgery, you lost a lot of muscle tone. The question is how much. I believe you might heard this concept - "pre-surgery rehab." The goal is to gain / maintain your muscle strength of injured body part with any further damage. For example, knee surgery, most people lost a lot of thigh muscule strength and mass. In order to prevent lost of muscle mass and tone, trainers or PTs will work with you on special / individual designed exercises.

Shortone, based on your descriptions, I suggest you pay a visit to orthopeadic surgeon or physician.

adreamer

The surgery was due to torn cartliage in my knee. I wasnt able to put pressure on the knee cap area and since my job was to load planes I didnt have much choice. He just cleaned it up while he was there. The orthopedic surgeon I use is not a knife happy kinda guy. He believes only cut when absolutely necessary. When he took the bone spurs off my shoulder we tried rehab for 3 months. One of the few Dr's that I trust.