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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 29794
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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sudden knee pain with radiate up and down leg/foot. even painful

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sudden knee pain with radiate up and down leg/foot. even painful with rest and sleep(will wake me up). 42 year old female nurse(worked on feet/knees 22 years)with previous knee surgery repair at age 11. pain is excruciating and using crutches as is difficult to bear weight. what are my chances this isnt needing surgical repair?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 3 years ago.
Greetings.

Since when is the pain?
Are your knee movements painful and restricted?
Any swelling, tenderness on knee?
Any over weight issue?
What did your MRI of knee show?
What kind of repair done at 11 years age?

Dr. Arun
Customer: replied 3 years ago.

 

 

pain has been about 1 week now. yes,movement painful as is at rest also painful to bend back greater than 90 degrees(past normal sitting position).no swelling or superficial tenderness however pain feels "deeper". i am over weight at 210lbs. i am still waiting on dr appt as ortho appt is greater than 2 weeks away. so no MRI as yet. I was young during surgica repair so unsure of exact problem. i know it wasnt a "replacement" however knee kept "going out" requiring the repair.

Expert:  Dr. Arun Phophalia replied 3 years ago.
Hello,

A sudden knee pain, radiating to above and below, pain in rest, back pain, with no local swelling and tenderness; suspect it to be coming due to pinched nerves in back (degenerative disc disease). A concomitant knee osteoarthritis (due to previous surgery in childhood and overweight issue) may be associated.

Pain severity alone does not differentiate between the medical and surgical treatment. So it would be medical imaging and physical examination findings which would dictate the treatment. Meanwhile, following would be helpful to you;

1) Back brace (lumbosacral corset( and knee brace; when you are weight bearing.
2) Rest; as much as possible; this is a great healer!
3) Anti-inflammatory analgesics; Ibuprofen.
4) Heating pad on back.
5) Local analgesic cream.

Following are the comprehensive treatment of knee and back problems;

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.

 

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);

 

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

 

Following measures also would be helpful in the knee arthritis;

 

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 if over weight/obese.

 

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) Glucosamine and chondroitin orally for about 1-2 years and a trial of diacerin for three months.

 

7) Hyaluronic acid injections in knee.

 

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

 

9) 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

 

I hope this was helpful to you. If it was, please remember to ACCEPT the answer so I can get compensated for my work. if you have any more questions, please feel free to ask. I am truly privileged to help you, and I want to make sure that you are satisfied with the answer. Good luck!

 

Please feel free for your follow up questions.

 

Dr. Arun

Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 29794
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
Dr. Arun Phophalia and 5 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
my "back" doesnt hurt. i think you misunderstood as i was trying to say my knee will not bend backwards past 90 degrees
Expert:  Dr. Arun Phophalia replied 3 years ago.
Hello,

I am sorry for this misunderstanding. The restriction of the knee movement point to;

1) Injury to meniscus
2) Ligament injury (this can be chronic).
3) Cartilage degeneration.

Usually this severe form of problem will require treatment by arthroscopic surgery. Usually an open surgery like knee replacement in your age group is avoided (you are too young for it).

It is privilege assisting you.

Please let me know your follow up questions.

Dr. Arun

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