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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31329
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hi For the past 6 months I have been having unbearable pain

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For the past 6 months I have been having unbearable pain in my left knee. My left knee gives out, sticks, feel like something is caught in it, and twist when I pivot. On my job I push a 200lbs cart for 8 hours 5 days a week. When I limp home I can't lift the leg to put it in the bed. Somedays the pain is starts frome the lateral thigh to the knee. Other days the pain is from the groin across the top of the knee. But, everyday the knee hurts. X-rays of knee and hip were unremarkable. Hx of left knee meniscus repair and L4-6 disc bulge. oddly enough the the pain usually star at the the knee and the unsteady gait irritates the buttocks and back. The ER and my primary will only treat it as sciatica. How Can I diffentiate sciatica or knee problem. I have a ICD so i don't think a MRI will be an option for me.

The knee giving out, sticks, feel like something is caught in it, and twist on pivoting are pointer to a primarily knee problem. A CT scan of the knee can be done when there are contraindications to MRI. Following structures in combination are likely to be responsible;

1) a meniscus issue.
2) a partial ligament sprain
3) cartilage degeneration; this is termed as osteoarthritis which can come due to heavy work overload on the knee (and if over weight is an issue).

Having said that, I would also emphasize of other things being important. Body joints and muscles work in tandem and if a joint has a problem, other joints in the body like back and hip joints are affected because of changing posture, putting more strain on these joints to protect the knee (this is spontaneous body's own protective mechanism). With your past history of disc disease in spine, the concomitant spinal problems like pinched nerves is quite a possibility. Any musculoskeletal issue (including tendonitis and bursitis) will affect various other structures like nerves and muscles of the surrounding joints.

You may consider also an arthroscopy examination (camera exam of the knee). Following meanwhile would be helpful; Apart from the analgesics; following would help you;

1) Physical therapy; this is the mainstay of the management of the osteoarthritis. Stretching exercises, strengthening exercises, mild weight bearing exercises, swimming on the week-ends etc would be helpful. Going to pool on holidays will further enhance the benefit. You need to incorporate the exercises in your routine as much as possible.

2) Deep electrotherapy; this entails going to physical therapy center and take care of specific issues which are more painful.

3) Glucosamine and chondroitin supplements

4) Diacerin too can be tried which suppose to regenerate the cartilage.

5) Local analgesic sprays

6) Mild massage

7) Consideration of hyaluronic acid injection in the joint. Some physician may inject steroid too for the pain relief.

8) Warm shower in morning.

9) Capsaicin (Zostrix, ArthriCare) is an irritant derived from chili peppers that provide relief by depleting a chemical that transmits pain from nerve endings. Various strengths are available without prescription. (It causes a burning sensation thus one has to be careful while applying and should wear a disposable plastic glove).

10) Acupuncture; most popular forms of alternative or complementary medicine, particularly for pain relief.

11) Analgesic patches too are available for the pain relief.

If overweight is an issue; long term is achieved by weight reduction. High impact exercises should be avoided; like kneeling and bending.

For the sciatica following is advised;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or brace

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

You can consult following specialists (apart from your GP);

a) Orthopedist

b) MD in Physical medicine and rehabilitation

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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