Dr. Hive: Knee pain . . . arthritis?

[Daria]

I am obese and horribly out of shape, but one thing I have going for me is that I walk a lot.  I don't drive, and portion of my job involves traveling from place to place, so I do a fair amount of walking to and from the subway, around neighborhoods, etc . . . I also regularly climb up and down several sets of outdoor concrete stairs. 

 

About a year ago, I noticed that when I climbed stairs, I'd get a twinge of pain in the front of my knee.  It wasn't muscle pain, but inside the joint.  Mostly I ignored it.

 

Then in March, I fell and fractured the inside part of my tibial plateau (the top of my tibia, so basically inside my knee).  I was off my feet totally for about 4 weeks, and then slowly built back up to now, 12 weeks later, I'm walking the same amount I did before the accident.  I still have some swelling in my ankle on that leg, and some ankle pain where the swelling impacts some of the tendons, but the knee itself is doing great, back to it's original range of motion.  The broken spot no longer hurts, whatever I do on it.  At my last visit, 3 weeks ago, the doctor said that my tibial plateau looks great, but there are some signs of arthritis in the same knee. He said that the arthritis predates the injury.  He didn't ever xray the non-broken knee so he didn't say whether or not I have arthritis there too.

 

Over the past few weeks, I've moved from my school year job to my summer job, which involves even more walking and even more stairs, and the twinges in the front of my knee have increased relative to last summer.  It's equal in both knees, and not in the same place as the pain from the break, so i'm thinking it's not the break that's hurting me.  

Anyway, i am clueless about arthritis.  Is exercise the right thing for it, or is the fact that it hurts to climb stairs a sign that I shouldn't be climbing stairs?  I'm not at the point where it's so painful that I feel like I need medication now, but would medication slow things down?  Is there anything else I should do?

 

I should add that after the break I got sent to P.T., but what happened was that I'd go, and the next day my ankle would be so swollen and painful that I could barely walk.  I felt like I was skipping stairs at work because of the pain from climbing stairs in PT.  When I mentioned it to the doctor he said it sounded like I was pushing myself enough as it was and that PT was more of a problem than a solution, so I should quit.  

[Guest]

I have severe osteoarthritis behind one of my knee caps. They keep asking me if I injured it. I haven't ever that I've known of. I used to run and sometimes my knees would bother me, but it was never anything extreme. The Ortho says the only true fix for me is basically a procedure to rotor router the calcification behind my knee cap. The joint itself is fine in my case. If that is similar to what you're experiencing exercise of certain types (stairs) causes more inflammation on the knee cap. They can try and give you injections in your knee. There is a gel type of buffer they can try that may give you some relief so you aren't rubbing bone on bone. Mine is to severe for that. They did try a hydrocortisone shot on me, but it caused massive havoc with my hormones. If I were you I would walk on a flat, non inclined surface as long as it doesn't cause swelling, and I would talk to my Ortho about treatment options.

 

ETA- swelling and pain is never something to push through when it comes to exercise. It's your body asking for relief!

Edited June 27, 2016 by texasmom33

[Daria]

I have severe osteoarthritis behind one of my knee caps. They keep asking me if I injured it. I haven't ever that I've known of. I used to run and sometimes my knees would bother me, but it was never anything extreme. The Ortho says the only true fix for me is basically a procedure to rotor router the calcification behind my knee cap. The joint itself is fine in my case. If that is similar to what you're experiencing exercise of certain types (stairs) causes more inflammation on the knee cap. They can try and give you injections in your knee. There is a gel type of buffer they can try that may give you some relief so you aren't rubbing bone on bone. Mine is to severe for that. They did try a hydrocortisone shot on me, but it caused massive havoc with my hormones. If I were you I would walk on a flat, non inclined surface as long as it doesn't cause swelling, and I would talk to my Ortho about treatment options.

 

I guess my question is would it makes sense to start things like injections now to prevent things from getting worse, or to wait until the day when I'm in enough pain that I really need something.  

 

The other problem, of course, is finding both time to exercise, and alternate ways to get around.  Walking on a flat, non inclined surface is great.  I have a treadmill in the building, but there is no flat, non inclined route to either of my jobs.

[Guest]

I guess my question is would it makes sense to start things like injections now to prevent things from getting worse, or to wait until the day when I'm in enough pain that I really need something.

 

The other problem, of course, is finding both time to exercise, and alternate ways to get around. Walking on a flat, non inclined surface is great. I have a treadmill in the building, but there is no flat, non inclined route to either of my jobs.

Personally if you can afford it, I would start now when they will actually give you some relief. It is too late for me- they wouldn't work. But I can't do the surgery anytime soon because of kids and life- I can't handle the time off my feet and the trips to rehab therapy. Maybe in three or four years. If you get some relief from the injections then you might be able to start taking stairs, or adding an incline. When I walk on the treadmill I alternate a flat day and an incline day. It isn't the speed that gets me, it's the incline. It doesn't even necessarily hurt- but it makes me swell up. I also have a little strap brace that seems to have helped. I will find the link and post it for you.

 

If you can make some small dietary changes those will help you more than the treadmill anyway, if weight is part of the reason you're exercising. But I'd say squats, lunges, lots of stairs, jogging and maybe even cycling are out for a bit.

[Guest]

This is the one I have : http://a.co/2xJF25g

 

but there are several other similar ones on Amazon. It basically stabilizes your knee cap which is helpful if you're a little wider hipped like me- hips put extra strain on your knee cap and is very common in women because of the way our knees kind of come in at an angle. We are narrower there than at the hip, if that makes sense.

[Daria]

This is the one I have : http://a.co/2xJF25g

 

but there are several other similar ones on Amazon. It basically stabilizes your knee cap which is helpful if you're a little wider hipped like me- hips put extra strain on your knee cap and is very common in women because of the way our knees kind of come in at an angle. We are narrower there than at the hip, if that makes sense.

 

My son had one like that when he had Osgood-Schlatter.  Thanks for the suggestion!

[TeenagerMom]

DS13 has severe arthritis in one knee (he's disabled) with basically no knee joint left.  His Ortho put him on Cosamin supplements (has to be Cosamin because it's the only one that's been clinically proven to have results).  He's been on it for a week now and reported today that he has no more pain!

 

DH is just old and works out and has been having knee pain. He started taking it also and reports that his knees felt better after just a few days on it!

 

It's worth a shot!

[hornblower]

I can tell you that the people in my life who have osteoarthritis and have had joints replaced (both knees & hips) were told stay as lean as possible & to exercise to tolerance in the years leading up to their surgeries, the more the better.  If the pain is too much, switch to a lower intensity exercise.  If the pain is too much even then, swimming laps with a kickboard for ex was suggested, plus sessions in the weighroom on the machines. The stronger the muscles and ligaments around the joint, the better. 

 

I would suggest going back to the PT and developing a plan. Make sure your shoes are perfect because knees will often get sore from lack of support in the foot .. so get that checked too. 

But as I'm sure you already know, the most important thing would be to really work on the weight. Every single pound makes a difference so I hope you can find some way.



 

Edited June 27, 2016 by hornblower