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PKR Raffs' Recovery Thread<'
- Thread starter Raffs
- Start date
United Kingdom
Josephine
NURSE DIRECTOR EMERITA
1 and 2. I'd say these two are one and the same thing. And you're quite right, it certainly does feel like a tight wire - as described in the article.
3. How do you know it's in the fat pad? Have you been told that? Actually, if you look in this article, you can see that all these issues can be remedied with Patello-femoral pain syndrome (PFPS), fat pad impingement (Hoffa's Syndrome) the use of McConnell taping. Try it and see if it makes a difference.
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Raffs
graduate
@Josephine
My OS said it is the fat pad. His last letter said:
'No effusion of the joint. Tenderness over the soft tissues anterioly. Flex extremely good to 135 with normal patella tracking. Lynn still getting discomfort from soft tissues over the anterior aspect particularly in the patella tendon in the fat pad area. This can often be the last area to settle following PKR. She should continue with PT. I would expect her symptoms to improve over the next 2-3 months.'
I did have my knee taped for a couple of weeks in September and again for a week or so in November. It provided some relief but only temporarily. Worth thinking about again though.
Thank you.
My OS said it is the fat pad. His last letter said:
'No effusion of the joint. Tenderness over the soft tissues anterioly. Flex extremely good to 135 with normal patella tracking. Lynn still getting discomfort from soft tissues over the anterior aspect particularly in the patella tendon in the fat pad area. This can often be the last area to settle following PKR. She should continue with PT. I would expect her symptoms to improve over the next 2-3 months.'
I did have my knee taped for a couple of weeks in September and again for a week or so in November. It provided some relief but only temporarily. Worth thinking about again though.
Thank you.
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Raffs
graduate
@ORpatella thank you. How're you doing? Have you had yours revised?
@Josephine, Raffs has mentioned pain in what she was told is the fat pad many times throughout her recovery.
momweb
graduate
@Raffs read your posts and some of your pain sounds oh so similar to mine. I had thickening and swelling of the Hoffa fat pad which most likely was causing some of the pain I was feeling beneath the knee cap. I couldn't understand how I could have pain there since the OS removed so much of my kneecap during surgery. The first injection I had was into the joint and toward the fat pad. The other place I had fluid and swelling was in the IT Band. That was the second injection. Today, a week later, I have some residual pain under the knee cap which I hope goes away soon. The pain behind and on the side of my knee is also a little stronger today. I know we're six months out, but there shouldn't be this much pain. I did feel much better when I found out how concerned the doctor was.
I have to agree with one thing that I read in your post...The exercises I was doing in PT made my pain worse. For whatever reason, his exercises to strengthen the quads just made the knee pain worse. I was glad when he finally said I don't know what else I can do for you. Nothing seems to help. I went on vacation the next week and never went back. The pain didn't get any better, but it didn't get any worse. The injections of steroid were the only thing that helped. I just kept pushing the surgeon. I had one particularly bad weekend and said I just can't take it anymore, please do something and that's when he ordered the MRI. I really hope you get relief soon. And I don't think it's just a matter of we're just half way through. We just need a little push to help through. Thinking of you.
I have to agree with one thing that I read in your post...The exercises I was doing in PT made my pain worse. For whatever reason, his exercises to strengthen the quads just made the knee pain worse. I was glad when he finally said I don't know what else I can do for you. Nothing seems to help. I went on vacation the next week and never went back. The pain didn't get any better, but it didn't get any worse. The injections of steroid were the only thing that helped. I just kept pushing the surgeon. I had one particularly bad weekend and said I just can't take it anymore, please do something and that's when he ordered the MRI. I really hope you get relief soon. And I don't think it's just a matter of we're just half way through. We just need a little push to help through. Thinking of you.
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Raffs
graduate
@momweb - thanks for your very helpful comments. I am beginning to think that I may need to speak to my OS about an injection. I had one before I had the surgery and it did help a lot. Couldn't agree more - too much pain for 6 months out!
I haven't done any exercises for a few days. Pain is about the same, perhaps a tiny bit better. I am seeing my PT on Tuesday to see if he can come up with anything other than exercises (massage, taping etc). I am also seeing my GP the week after - she has been great throughout this and I haven't seen her for ages so time to update her and see what she thinks. I am due to see my OS on March 1st but I may bring this forward depending on what the PT and GP have to say.
I had a "I just can't take this anymore" a week or so ago which prompted me to come back on here to ask for help and advice - which, of course, I have received and am heeding and am eternally grateful for!
Thanks again.
I haven't done any exercises for a few days. Pain is about the same, perhaps a tiny bit better. I am seeing my PT on Tuesday to see if he can come up with anything other than exercises (massage, taping etc). I am also seeing my GP the week after - she has been great throughout this and I haven't seen her for ages so time to update her and see what she thinks. I am due to see my OS on March 1st but I may bring this forward depending on what the PT and GP have to say.
I had a "I just can't take this anymore" a week or so ago which prompted me to come back on here to ask for help and advice - which, of course, I have received and am heeding and am eternally grateful for!
Thanks again.
Swish
junior member
Lynn, hoping that you'll find some comfort soon.
Do ask about the injection. However, realize that while the injection will reduce swelling (one possible cause of pain), it also can hide causes of pain that may need addressing. So make sure that you have a good diagnosis before you inject.
My personal, non-medical theory on exercise is what I have been told in general about exercise all my life...that when you exercise a muscle, it then needs an day off to repair in order to maximize results. So, for example, a person at the gym might work their leg muscles one day and then work their upper body muscles the next day (thus giving the leg muscles a day off to repair). They don't work the same muscle groups consecutive days. So I have taken the same approach with my knee. Only gentle stretching and bending each day, and maybe a few quad tightening bits while laying down. But otherwise, since my PT is doing exercises 3x per week, I don't do all the other stuff on my "rest" days. So on my non-PT days, I don't do squats, leg lifts, or other things that stress the muscle, as I want it to have that day off in order to maximize my strengthening results. For what it is worth, my PT said that pushing to get ROM tends to cause tendonitis (in other words, an over-enthusiastic PT), but if you can get early ROM without pushing the knee, then it is fine. Out of curiosity, did you feel like your PT was a bit aggressive the first few months after surgery? (We both have the same ROM.)
I hope you find your answer soon.
My personal, non-medical theory on exercise is what I have been told in general about exercise all my life...that when you exercise a muscle, it then needs an day off to repair in order to maximize results. So, for example, a person at the gym might work their leg muscles one day and then work their upper body muscles the next day (thus giving the leg muscles a day off to repair). They don't work the same muscle groups consecutive days. So I have taken the same approach with my knee. Only gentle stretching and bending each day, and maybe a few quad tightening bits while laying down. But otherwise, since my PT is doing exercises 3x per week, I don't do all the other stuff on my "rest" days. So on my non-PT days, I don't do squats, leg lifts, or other things that stress the muscle, as I want it to have that day off in order to maximize my strengthening results. For what it is worth, my PT said that pushing to get ROM tends to cause tendonitis (in other words, an over-enthusiastic PT), but if you can get early ROM without pushing the knee, then it is fine. Out of curiosity, did you feel like your PT was a bit aggressive the first few months after surgery? (We both have the same ROM.)
I hope you find your answer soon.
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Raffs
graduate
@Swish Thank you.
@iamshrdlu Thanks for stopping by and for your comments. Absolutely! Couldn't agree more about the injection. Although I am very keen to be pain-free I would much rather forgo an injection and sort out what is actually causing the issues in the first place. I had pretty gentle PT after the surgery. My first few sessions were hydrotherapy in the special pool at the hospital. My flex on discharge from hospital was only about 80 but doing gentle heel slides at home increased that to 107 then 120 and now finally up to 135. Extension has been 0 since I woke up from surgery (I know I am very lucky as many struggle with extension). I followed the BS mantra of 'only to the point of discomfort' and made it clear to the PT that this is what was going to happen. I guess even the gentle pushing I did may have caused the tendonitis.
@iamshrdlu Thanks for stopping by and for your comments. Absolutely! Couldn't agree more about the injection. Although I am very keen to be pain-free I would much rather forgo an injection and sort out what is actually causing the issues in the first place. I had pretty gentle PT after the surgery. My first few sessions were hydrotherapy in the special pool at the hospital. My flex on discharge from hospital was only about 80 but doing gentle heel slides at home increased that to 107 then 120 and now finally up to 135. Extension has been 0 since I woke up from surgery (I know I am very lucky as many struggle with extension). I followed the BS mantra of 'only to the point of discomfort' and made it clear to the PT that this is what was going to happen. I guess even the gentle pushing I did may have caused the tendonitis.
Josephine
NURSE DIRECTOR EMERITA
It sounds like your PT was good and you were just unlucky with the tendonitis. I wish they had hydro therapy here-- the hospital PT put a 5 pound weight on top of my knee (while hanging the heel off of a chair) the day after surgery...which is why I got out of the hospital before the 2nd PT session of the day. I do know that tendonitis is a quick diagnosis that they stick on a lot of front knee pain. About a year ago, my doc told me that my left leg pain (in the front, near the knee cap) was probably my trying to get tendonitis from all the limping I was doing. In hindsight, after the left knee popped, the 'tendonitis pain' was really the first signs that the left knee was going bad--so it wasn't tendonitis at all. So keep an open mind about your diagnosis, and trust your common sense and what your body tells you.
WHOA!
OP
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Raffs
graduate
@Josephine definitely feels a little bit better already! Fingers crossed! I spent a while really massaging my IT band and tight quads last night. Loosened things up quite nicely so I will continue. I've printed off two of your articles (tight band and the one re Hoffa's Syndrome) to show my PT!
@Slainte thanks. I have a list of things to discuss drafted already!!
@iamshrdlu I've had 2 good PTs in terms of not pushing. I'm hoping my current one will listen on Tuesday when I say I want to stop the exercises and instead have some massage and do some stretching and get my knee taped again. Agree totally with @hawk2go re the 5 pound weight - whoa! And couldn't agree more about listening to my body and using my common sense - I do have some left, I think, lol!
@Slainte thanks. I have a list of things to discuss drafted already!!
@iamshrdlu I've had 2 good PTs in terms of not pushing. I'm hoping my current one will listen on Tuesday when I say I want to stop the exercises and instead have some massage and do some stretching and get my knee taped again. Agree totally with @hawk2go re the 5 pound weight - whoa! And couldn't agree more about listening to my body and using my common sense - I do have some left, I think, lol!
OP
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Raffs
graduate
Had appointment with PT tonight.
@Josephine and @Celle - I'll be very interested to hear what you think.
I showed him the articles I printed from here re the tight band feeling and Hoffa's syndrome (impingement of fat pad). He agreed with everything in the articles.
He said I definitely have some impingement of the fat pad.
He checked the tracking of my patella thoroughly and said that it is possibly maltracking a tiny bit to the lateral side which could be the cause of the impingement.
His treatment plan now consists of the following:
Next week we will see if the taping has helped, have it re-taped if it has and we will work on my gait and do some 'hands on work' - not sure what that is!
He said that a cortisone injection may help but to give it a few more weeks - wait until my appointment with the OS in 6 weeks. If I'm not seeing any improvement in 2-3 weeks though I'll consider bringing my OS appointment forward if I can.
I'm seeing my GP on Monday to give her an update and to see what she thinks.
Feeling a bit worried, to be honest. Scared that 'tiny maltracking of patella' could be the slippery slope to revision....? PT didn't seem to think so but revision is probably the biggest fear amongst us who have recently already gone through this surgery, isn't it?
Thanks for reading.
@Josephine and @Celle - I'll be very interested to hear what you think.
I showed him the articles I printed from here re the tight band feeling and Hoffa's syndrome (impingement of fat pad). He agreed with everything in the articles.
He said I definitely have some impingement of the fat pad.
He checked the tracking of my patella thoroughly and said that it is possibly maltracking a tiny bit to the lateral side which could be the cause of the impingement.
His treatment plan now consists of the following:
- McConnell taping to provide pain relief and to hopefully allow the fat pad the chance to settle if it is no longer being impinged. Knee has been taped with the patella moved slightly to the medial side and feels much better already.
- Work on strengthening my VMO (inner quad) which is atrophied and visibly smaller than on the other leg. PT says that the VMO when working properly will help 'pull' the patella back into correct alignment and so keep it away from the fat pad.
- Work on rectifying muscle imbalance. My OS has often said this too - my outer quad is doing too much work and 'pulls' everything slightly to the lateral side. Strengthing my inner quad will rectify this imbalance.
- Massage of tender IT band and quads at home by me.
- IT band stretch 3 times a day.
- Do not wear knee support now that knee is taped, even when commuting.
- Ice the fat pad area every evening.
Next week we will see if the taping has helped, have it re-taped if it has and we will work on my gait and do some 'hands on work' - not sure what that is!
He said that a cortisone injection may help but to give it a few more weeks - wait until my appointment with the OS in 6 weeks. If I'm not seeing any improvement in 2-3 weeks though I'll consider bringing my OS appointment forward if I can.
I'm seeing my GP on Monday to give her an update and to see what she thinks.
Feeling a bit worried, to be honest. Scared that 'tiny maltracking of patella' could be the slippery slope to revision....? PT didn't seem to think so but revision is probably the biggest fear amongst us who have recently already gone through this surgery, isn't it?
Thanks for reading.
Hi Lynn,
I think your PT sounds very sensible and I'd give his treatment plan a try.
I've heard before that taping can help. At the very least, it can do no harm.
I'll leave it to Josephine to comment about the cortisone.
Don't start worrying yet about needing a revision. Wait and see what happens.
Best wishes.
I think your PT sounds very sensible and I'd give his treatment plan a try.
I've heard before that taping can help. At the very least, it can do no harm.
I'll leave it to Josephine to comment about the cortisone.
Don't start worrying yet about needing a revision. Wait and see what happens.
Best wishes.
For me it's revision and infection. Both are on the low end of the recovery spectrum but they sometimes keep me awake at night.
Good luck with your new treatment plan. I hope it gets you where you want to be!
