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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29653
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I shattered my ankle back in Oct 2012. Due to having no medical

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I shattered my ankle back in Oct 2012. Due to having no medical insurance I applied for Medi-Cal. I started physical therapy in April 2013, and had only had 3 sessions, until Medi-Cal cut me off. I just stuck to doing the stretching/toning exercises at home, but still walk with a limp on my left leg. Then I developed what I think is sciatica because a pain would start in the middle of right rear buttock and shoot down my calf, whenever I woke up and got down off my bed and reached the floor, or sudden movements.

About 1 month ago my co-worker forgot to bring water to the office, so I carried a 24 pk of 8 oz bottles of water from my car up to the office. I have 6 wooden stairs that lead up into the office, and as I stepped to go up the 2nd step, my lower back just shot a tingling ray of pain totally across my back from side to side, and it felt like my leg popped or pulled something (similar to the feeling of pulling a piece of beef jerky apart).

For the past month I have had terrible pain behind my knee cap in the back of my leg, and on the left inner side of my knee terrible pain as well. If I walk just around my house, it's moderate pain but I can deal with it. When I have to walk say from a parking lot to a store, and I have to take bigger steps, it feels as though my knee cap and bones are shifting and popping, and it's severe pain almost to the point I want to cry. I've tried looking these symptoms up on the web, and it's listed everything from bakers cyst to a pulled meniscus.

I am overweight; however I've gone from being 393 lbs in 2002 to 210 lbs today. I gained about 20 lbs staying home for 5 months with a broken leg this past year.

I still don't have health insurance so I would like to get an opinion as to what I might of done, and if there is anywhere I can go to get an x-ray and pay for it without having a doctors recommendation and paying for an office visit, etc....

Thanks so much, Lori
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,
I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Your knee symptoms are suggestive of knee bursitis and tendonitis. This and your sciatica like symptoms have likely resulted due to abnormal weight bearing due to the ankle injury. Following measures are likely to help;

1) Anti-inflammatory analgesics like Motrin / Advil for around 10-14 days.

2) Knee brace

3) Physical therapy

4) Warm compresses

5) Local analgesic patch / ointment / spray

 

These are the initial modalities and if the pain does not respond than the further interventions would be required (done at physical therapy center);

 

1) iontophoresis, phonophoresis

2) electrical stimulation

3) shock wave therapy

4) local steroid shots


You can visit one of the centers run by the Health Resources and Services Administration, they offer affordable quality healthcare to people without insurance.

You can find a health center near you by clicking here :

http://www.hrsa.gov

http://www.needymeds.org/free_clinics.taf

http://findahealthcenter.hrsa.gov/Search_HCC_byAddr.aspx




Please feel free for your follow up questions.

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

Thanks for using Just Answer.

 

We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

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Expert:  Dr. Arun Phophalia replied 1 year ago.
You rated the answer as bad service. Please let me know, what were you expecting, so I can further improve on it and provide you what you seek.

Best wishes and kindest regards,

It is a great privilege assisting you.
Customer: replied 1 year ago.

It took a long time to get a response. I don't understand how this just happened after carrying bottles of water up 6 steps. I mean, it sounds and feels like my calf and knee cap are shifting and popping, and its so hard for me to walk on my right leg. The broken leg is better than my other one (lol). I've tried ice, heat, and theralgesic topical creme. Even if I stay off it as much as possible, i'm still limping. It doesn't seem to hurt as much in my lower back like when I'd try to turn on my side it was a tingling numbing like pain, and it's gotten a little better.


 


There actually is a good sized bulge underneath the knee on the inner left side, if you push on it, it seems like water or jelly in there, is this normal?

Expert:  Dr. Arun Phophalia replied 1 year ago.
I am sorry about the late response. This is due to appropriate specialist coming online and answering the question. Most of the experts here on the site have their day jobs too.

The bulge you mentioned is likely to be bursa enlargement due to inflammation. It is not normal. Carrying bottles on an injured weight bearing joint can put abnormal stress on the other joints (knee and back) and result in the ligament, muscle and tendon strain / sprain.

Following measures also would be helpful in the knee problem;

1) Knee care in the activities of daily living. Few simple self-care measures can be remarkably effective in ending pain cycle.

a) Avoid prolonged standing or walking or sitting with joint in a single position.

b) whenever you sit, keep the knee stretched and fold them intermittently.

c) Squatting, sitting cross legged should not be done.

d) Avoid climbing stairs.

e) Avoid sitting legs unsupported or hanging. f) Reduce weight gradually for the long term benefit.

 

2) Rest: Taking a break from your normal activities reduces repetitive strain on your knee, gives the time to heal and helps prevent further damage.

 

3) Anti-inflammatory medications

4) Physical therapy; the goal of physical therapy is to strengthen the muscles around your knee and help you regain knee stability. Ideal is supervised physical therapy. Stretching exercises are also part of the physical therapy regime.

 

5) Orthotics and bracing.

6) Local analgesic sprays and ointments to your skin may help relieve the pain and stiffness of osteoarthritis.

7) Deep Electrotherapy by physical therapist.

 

These are the exercise resources for the knee. You can pick the exercises which suits you;

http://bigkneepain.com/knee-exercises.html

http://www.pamf.org/sports/king/kneerehab.html


Similar measures are helpful for the ankle too.

This is most likely due to the pinched nerves in the back which are giving you back symptoms (tingling, numbing like pain). Following measures would be helpful;

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) Reduce weight for long term benefit.

 

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);

http://www.mayoclinic.com/health/back-pain/LB00001_D


It is privilege assisting you.

Please let me know your further queries. I would be happy to address them.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29653
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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