Knee brace--can someone help me figure this out?

[Harriet Vane]

Hey there folks,

 

I have patella-femoral pain syndrome. I have scoliosis, and my pregnancy many moons ago with my daughter coupled with the scoliosis ended up pushing/rotating my pelvic bone forward on the right side. This resulted in the tendons/ligaments pulling my patella too far to the outside, which then resulted in pain and loud, crunchy knees.

 

I need a knee brace. I am working with a physical therapist to retrain the muscles and soft tissue, and my chiropractor is working to adjust the pelvic bone where it is supposed to be. I am supposed to do a special kind of taping to push my patella back to the inside. Since I have lived with this problem for so many years this is going to take a while to retrain.

 

My PT agrees that a knee brace would be appropriate for me. However, she works with a clientele that is mostly elderly, and who by and large do not use this type of brace. Therefore my PT is not as knowledgeable and prefers not to advise me on the selection/purchase of a brace.

 

Who do I go to? A more athletic PT? An orthopedic doctor? A physiatrist? I just don't want to waste money picking out the wrong brace in my cluelessness.

 

Thanks!

[Lolly]

I would try a more athletic oriented pt or the orthopedic doctor. I have found that orthopedic doctors tend to go for more invasive treatments though.

[dirty ethel rackham]

I have been living with patella-femoral syndrome for 11 years, off and on. Knee braces did NOTHING for me. No reduction in pain, no improvement in tracking alignment, nada!

 

I have only had success with 2 treatment options:

1. Taping. The McConnel taping method really helped minimize the pain and help the kneecap track properly.

2. Extensive PT that is specially designed for women. We work on loosening the tight ITB band (on the outside of the thigh) and strengthen the VMO (one of the quadracept muscles to the inside and up of the knee.) The VMO is difficult to strengthen in women (especially women who are knock-kneed or who have other structural issues.) I did PT in the past with someone who gave me exercises for men. This actually made the problem worse. Since it did not take into account the q-angle (the angle at which the femur meets the knee joint), it strengthened the wrong muscles.

 

Good luck to you. This can be a tricky problem to fix.

[Harriet Vane]

I appreciate your sharing your perspective. I appreciate knowing which direction to try (or not).

 

Another question:

 

Ellen, it sounds like we might have the same issue. I am pain-free in general, but my knees are pain-FULL on stairs or hills. And loud, crunchy sounding. Furthermore, I learned on our recent backpacking/canoe trip that squatting makes the problem much, much worse (yelping in pain worse).

 

Do you experience this? I just appreciate knowing someone out there has BTDT.

[TraceyS/FL]

I have a brace that goes on in 2 parts. First the part shifts the knee cap over, then the stability part. It works well - my knee caps are out of alignment naturally. I've had a lateral release on one side, and when i tore the ACL on the other, i needed some extra support while it healed (I had clean up surgery not replacement).

 

My PT ordered it - we went thru a ton of catalogs to find it.

 

OK, i just went and grabbed it (i haven't needed to wear it for awhile).

 

It's made by Hely & Weber - let me go see if i can find anything online.

 

I think it's similar to this one: http://www.recoverybraces.com/hely-weber/lateral%20j%20patella%20stabilizer.htm

 

The whole page: http://www.recoverybraces.com/hely-weber/knee%20braces.htm

 

It looks like you could order it yourself.

 

I do not at all regret my lateral release. i was 18 when i had it - i'm 39. It was the best thing i did pain wise - and yes, recovery stunk, but the relief was worth it.

 

Hopefully you can get it handled with PT. We tried that route first.

 

:grouphug:

[NevadaRabbit]

I have been living with patella-femoral syndrome for 11 years, off and on. Knee braces did NOTHING for me. No reduction in pain, no improvement in tracking alignment, nada!

 

I have only had success with 2 treatment options:

1. Taping. The McConnel taping method really helped minimize the pain and help the kneecap track properly.

2. Extensive PT that is specially designed for women. We work on loosening the tight ITB band (on the outside of the thigh) and strengthen the VMO (one of the quadracept muscles to the inside and up of the knee.) The VMO is difficult to strengthen in women (especially women who are knock-kneed or who have other structural issues.) I did PT in the past with someone who gave me exercises for men. This actually made the problem worse. Since it did not take into account the q-angle (the angle at which the femur meets the knee joint), it strengthened the wrong muscles.

 

Good luck to you. This can be a tricky problem to fix.

 

:iagree: This is some super advice.

[dirty ethel rackham]

I don't experience pain while squatting, just getting into and out of that position, but then again, getting out of a chair hurts. Walking downhill or downstairs can be excruciating. I usually tape when I am hiking with my family. I did develop a sensitivity to the adhesive in the tape, so I can only wear it for an hour or so before I get a rash and skin breakdown. I would love to have a brace, but the ones specifically for this problem are expensive (like over $100) and I would need 2. I don't want to shell out that money for something that may not work.

 

I wish I had answers on curing this, but I have not been successful. When I do PT, I feel better for a while, but I never can get it to completely go away and I always run out of time and need to get back to my regular responsibilities. I probably need about a year of intensive PT - like 3 times a week, which is not going to happen until my kids are grown :| or until I find a PT who will work with me at 5:30 in the morning. I have had to cut back on PT these last few weeks and I can feel the difference already. Much more pain.

 

Every PT and doctor I have talked to says that surgery should be considered as a last resort. While Tracy reported a good experience, the procedure does not have a good track record. Many people find that they are worse after the surgery.

 

I wish I had more to offer.

[Harriet Vane]

I don't experience pain while squatting, just getting into and out of that position, but then again, getting out of a chair hurts. Walking downhill or downstairs can be excruciating. I usually tape when I am hiking with my family. I did develop a sensitivity to the adhesive in the tape, so I can only wear it for an hour or so before I get a rash and skin breakdown. I would love to have a brace, but the ones specifically for this problem are expensive (like over $100) and I would need 2. I don't want to shell out that money for something that may not work.

 

I wish I had answers on curing this, but I have not been successful. When I do PT, I feel better for a while, but I never can get it to completely go away and I always run out of time and need to get back to my regular responsibilities. I probably need about a year of intensive PT - like 3 times a week, which is not going to happen until my kids are grown :| or until I find a PT who will work with me at 5:30 in the morning. I have had to cut back on PT these last few weeks and I can feel the difference already. Much more pain.

 

Every PT and doctor I have talked to says that surgery should be considered as a last resort. While Tracy reported a good experience, the procedure does not have a good track record. Many people find that they are worse after the surgery.

 

I wish I had more to offer.

 

What do you do when you are at PT?

 

The exercises I have been offered can easily be done at my home. Is there something you do at PT that is not something you can do at home?

 

I am asking because I would like to make sure I am doing all I can to fix this, or at least improve it a little.

 

I'm not real interested in surgery as long as I can manage this in other ways.

 

:tongue_smilie:I hear you on the PT exhaustion. While PT has helped me enormously with scoliosis-related issues, I am so. sick. and. tired. of. dr. appts. !!!! And I just plain don't have time for all the appts.

[Harriet Vane]

I don't experience pain while squatting, just getting into and out of that position, but then again, getting out of a chair hurts. Walking downhill or downstairs can be excruciating. I usually tape when I am hiking with my family. I did develop a sensitivity to the adhesive in the tape, so I can only wear it for an hour or so before I get a rash and skin breakdown. I would love to have a brace, but the ones specifically for this problem are expensive (like over $100) and I would need 2. I don't want to shell out that money for something that may not work.

 

I wish I had answers on curing this, but I have not been successful. When I do PT, I feel better for a while, but I never can get it to completely go away and I always run out of time and need to get back to my regular responsibilities. I probably need about a year of intensive PT - like 3 times a week, which is not going to happen until my kids are grown :| or until I find a PT who will work with me at 5:30 in the morning. I have had to cut back on PT these last few weeks and I can feel the difference already. Much more pain.

 

Every PT and doctor I have talked to says that surgery should be considered as a last resort. While Tracy reported a good experience, the procedure does not have a good track record. Many people find that they are worse after the surgery.

 

I wish I had more to offer.

 

To what type of brace are you referring?

 

I will likely continue with the taping for at least a little while, but would like to keep in mind the option of a brace.

[TraceyS/FL]

It's all in the surgeon..... i drove an hour back then to see my doctor. I'm considering flying 3000 miles to have him do my elbow. Certain things in life you can't replace - an awesome surgeon is one of them (i've had multiple PT's tell me that after working with ME after his surgeries - it's night and day compared to other doctors.). But the recovery was NOT fun, and i'd never jump into it - or suggest anyone else do it. LOL, i was 18, freshman at teh CC and couldn't drive anymore - that was a pretty big deal. I sat there and willed that leg to LIFT UP.

 

I couldn't even bend my leg to sit in a class in college for 45 minutes - and not every class had a way for me to sit with it elevated and straight out. I also have small kneecaps (seriously, like half the size of most peoples) and Chondromalacia. Gee, i'm really a mess. The doc cleaned the left one up for me during the ACL mess (note - never have surgery before the MRI comes back, ACL was the one thing we had NOT discussed before hand and he couldn't fix it.... wasn't i dedicated to my job to have surgery so soon so i could go back to work??).

 

I'm NOT very active right now, which is why i have been able to go this long with the left knee mucked. I'm hoping to ease into cycling and get back on track.

 

Ellen - thanks for posting the specifics on the exercises. We have a plethora of PT places around here (the perks of living next to a retirement community) and i'd love to get to a good one and work on doing things right with it. That list will help since i haven't researched this at all - i just know it's going to be an issue as i get older. Although.... i'm sure given nothing ELSE on my body connects in the correct way - i'm sure i have other structural issues... not to mention a torn ACL. Which in case the insurance company reads this - i have had almost zero issues with in the 5 years. I'd just like to be able to be "active" again.

 

Strider - i hope that you get some relief soon. As an aside, 2 of my kids have Scoliosis...... i shall file this at the back of my brain for future reference.

 

:grouphug:

[dirty ethel rackham]

Here are the PT exercises I do for PFS. I do also have 2 herniated discs, so I have other exercises to do for that.

 

Quad sets: To isolate the VMO, with legs straight, place a ball (playground size) between the knees, squeeze inward while tightening the quads (pulling kneecaps toward the hips). Hold for 5 seconds then rest. 2 sets of 10 reps.

 

Leg Lifts: While laying on the back, extend one leg and bend the other. Flex the foot toward the ceiling and slowly raise the leg to the height of the knee and lower. 2 sets of 10 per leg. Then, turn the toe outward at a 45 degree angle and raise and lower. As the leg gets stronger, you can add ankle weights in 1 lb increments.

 

Leg extensions: While laying on the back, place playground ball or bolster under the knees. Straighten the leg and hold for 5 seconds and rest. Concentrate on pulling the kneecaps up while doing this to focus on the VMO. 2 sets of 10 for each leg. Then repeat with leg turned out at 45 degree angle. As leg gets stronger, add ankle weights.

 

Leg curls to balance the quads with the hamstrings. Standing on one leg, bend the other leg 90 degrees, keeping the thigh vertical (making an 'L') and lower. 2 sets of 10 reps. Again, can add weights.

 

Squats: Using an exercise ball (big PT ball), lean against the ball against the wall. Squat while letting the ball roll up your back. Go to 90 degrees and come up. 2 sets of 20 reps. When stronger, squat without the ball to a chair or bench and back up.

 

When I am at PT, they stretch the quads and hamstrings. They want to stretch the ITB (Ilio-Tibial Band on the outside of the thigh), but the torque on my lower back is excruciating. Then they do massage - some soft tissue massage around the kneecap and then work on the ITB.

 

After that, they do ice and electronic stim. This helps with the swelling (I used to have very knobby knees, now I have fat knees) as well as the residual pain.

 

Including all my back issues, PT takes a minimum of 90 minutes. I just don't have that much time in my day.

 

hth,

[Harriet Vane]

Here are the PT exercises I do for PFS. I do also have 2 herniated discs, so I have other exercises to do for that.

 

Quad sets: To isolate the VMO, with legs straight, place a ball (playground size) between the knees, squeeze inward while tightening the quads (pulling kneecaps toward the hips). Hold for 5 seconds then rest. 2 sets of 10 reps.

 

Leg Lifts: While laying on the back, extend one leg and bend the other. Flex the foot toward the ceiling and slowly raise the leg to the height of the knee and lower. 2 sets of 10 per leg. Then, turn the toe outward at a 45 degree angle and raise and lower. As the leg gets stronger, you can add ankle weights in 1 lb increments.

 

Leg extensions: While laying on the back, place playground ball or bolster under the knees. Straighten the leg and hold for 5 seconds and rest. Concentrate on pulling the kneecaps up while doing this to focus on the VMO. 2 sets of 10 for each leg. Then repeat with leg turned out at 45 degree angle. As leg gets stronger, add ankle weights.

 

Leg curls to balance the quads with the hamstrings. Standing on one leg, bend the other leg 90 degrees, keeping the thigh vertical (making an 'L') and lower. 2 sets of 10 reps. Again, can add weights.

 

Squats: Using an exercise ball (big PT ball), lean against the ball against the wall. Squat while letting the ball roll up your back. Go to 90 degrees and come up. 2 sets of 20 reps. When stronger, squat without the ball to a chair or bench and back up.

 

When I am at PT, they stretch the quads and hamstrings. They want to stretch the ITB (Ilio-Tibial Band on the outside of the thigh), but the torque on my lower back is excruciating. Then they do massage - some soft tissue massage around the kneecap and then work on the ITB.

 

After that, they do ice and electronic stim. This helps with the swelling (I used to have very knobby knees, now I have fat knees) as well as the residual pain.

 

Including all my back issues, PT takes a minimum of 90 minutes. I just don't have that much time in my day.

 

hth,

 

This is very helpful. Thanks for taking the time to write all that out.

 

I am encouraged that I have actually been doing some of these exercises already.

 

I just don't have time for PT three times a week. I told dh last night that I am going to train him to be my PT and we're going to give this a try at home. This is a problem I have had for 11+ years--I just assumed it was arthritis until this summer. (I have arthritis in my spine--my assumption was based on the fact that my knees felt similar.) I may also be able to get my chiropractor to do some of the massage/electric stim/ultrasound/stretching. She's much closer to me, and I have to go see her regularly for scoliosis maintenance, so it would kill two birds with one stone.

 

Again, this has been a very, very helpful dialogue. Thank you for sharing.

[Harriet Vane]

It's all in the surgeon..... i drove an hour back then to see my doctor. I'm considering flying 3000 miles to have him do my elbow. Certain things in life you can't replace - an awesome surgeon is one of them (i've had multiple PT's tell me that after working with ME after his surgeries - it's night and day compared to other doctors.). But the recovery was NOT fun, and i'd never jump into it - or suggest anyone else do it. LOL, i was 18, freshman at teh CC and couldn't drive anymore - that was a pretty big deal. I sat there and willed that leg to LIFT UP.

 

I couldn't even bend my leg to sit in a class in college for 45 minutes - and not every class had a way for me to sit with it elevated and straight out. I also have small kneecaps (seriously, like half the size of most peoples) and Chondromalacia. Gee, i'm really a mess. The doc cleaned the left one up for me during the ACL mess (note - never have surgery before the MRI comes back, ACL was the one thing we had NOT discussed before hand and he couldn't fix it.... wasn't i dedicated to my job to have surgery so soon so i could go back to work??).

 

I'm NOT very active right now, which is why i have been able to go this long with the left knee mucked. I'm hoping to ease into cycling and get back on track.

 

Ellen - thanks for posting the specifics on the exercises. We have a plethora of PT places around here (the perks of living next to a retirement community) and i'd love to get to a good one and work on doing things right with it. That list will help since i haven't researched this at all - i just know it's going to be an issue as i get older. Although.... i'm sure given nothing ELSE on my body connects in the correct way - i'm sure i have other structural issues... not to mention a torn ACL. Which in case the insurance company reads this - i have had almost zero issues with in the 5 years. I'd just like to be able to be "active" again.

 

Strider - i hope that you get some relief soon. As an aside, 2 of my kids have Scoliosis...... i shall file this at the back of my brain for future reference.

 

:grouphug:

 

Thank you for sharing.

 

Your knee problem sounds like it was excruciating. I am glad that surgery helped you so much. I am thankful that I am not at that stage yet--I am scared to death of surgery. At this point my knee problems prevent me from jogging mostly. I think I'd like to sell this house and get something with no stairs. And when camping, squatting became excruciating. The everyday reality is that my knees hurt on stairs, but not so much that I cannot just ignore it and keep going. On the whole those things don't affect my life all that much, so I think trying PT and taping and a general program of maintenance is a good option for me.

 

Have I talked to you about scoliosis before? I know I have posted somewhat frequently in reply to others' questions about scoliosis. If not, I would be happy to chat about that too. I have learned a ton about scoliosis over the last 14 years--most of what I have learned is how LITTLE doctors understand how it affects the body as a whole, and what it takes to maintain mobility. Not that I am any expert at all, but I always hope that my experience with this can save someone else the discomfort and annoyance that I had to live through before I could understand and deal with it effectively.