Persistent Knee Pain After Injury: Seeking Solutions for Recovery

I have had a knee injury for six months now, and it hurts when I squat down fully and when I jump and land?

Hello Dr.
Shi, on February 4th, before the Lunar New Year, I sustained an injury while playing basketball and was diagnosed with a collateral ligament injury after an examination at the hospital.
The doctor recommended resting for one to two months.
However, after resting for over a month, my condition did not improve.
I underwent MRI, X-ray, and ultrasound examinations, which showed no issues with the bones or cartilage, and there was no fluid accumulation in the knee.
At that time, I was unable to bend my knee beyond 90 degrees, and I could only extend it to about 150 degrees.
The doctor advised me to continue rehabilitation (including heat therapy, infrared therapy, ultrasound, and electrical stimulation), and after about three months (around May to June of this year, during which I consistently underwent rehabilitation), I consulted a traditional Chinese medicine doctor who mentioned that my knee was externally rotated.
He instructed me to perform movements opposite to sitting cross-legged.
After about a week of doing these exercises, my knee's range of motion improved significantly, but I still experienced pain when squatting fully or jumping.
Additionally, after sitting for a while (like in an office chair), when I stood up to walk, I felt tightness in my knee, and when I forcefully straightened it, I heard a distinct popping sound, which was different from the sound of cracking knuckles.
This was a phenomenon I did not experience before my injury.
Continuous rehabilitation did not lead to any improvement, so I stopped attending sessions in July.
Now, when I walk, I only feel slight tightness in my knee without pain.
During my visits to the rehabilitation department, the doctor pressed around my knee, and I did not feel any pain.
I was previously diagnosed with possible inflammation of the tendons at the back of the knee, and I have taken anti-inflammatory medication and undergone heat therapy and rehabilitation, but there has been no improvement.
I would like to ask Dr.
Shi how I should handle my situation.
Thank you.

john, 30~39 year old female. Ask Date: 2016/10/03

Dr. Shi Guozheng reply Orthopedics

Medial collateral ligament (MCL) injuries typically require several months for recovery.
Continuing rehabilitation can gradually improve knee function.
It is normal for the knee to make sounds during this process.
Achieving complete normalcy may sometimes take up to a year.

Reply Date: 2016/10/03

More Info

Persistent knee pain after an injury can be a frustrating and challenging experience, especially when initial treatments and rehabilitation efforts do not yield the expected improvements. Based on your description, it seems that you have undergone a thorough evaluation, including MRI, X-rays, and ultrasound, which have ruled out significant structural damage to the bones and cartilage. However, the ongoing pain and limited range of motion suggest that there may be other underlying issues that need to be addressed.

Firstly, it is important to understand that knee injuries, particularly those involving ligaments like the collateral ligaments, can lead to a range of complications, including muscle imbalances, joint stiffness, and even issues related to the surrounding soft tissues. The fact that you experienced significant improvement in your knee flexion after following the advice of a traditional Chinese medicine practitioner indicates that there may be a component of your injury related to muscle tightness or imbalance that has not been fully addressed.

Here are several recommendations to consider moving forward:
1. Continued Rehabilitation: While you mentioned that you stopped rehabilitation, it may be beneficial to re-engage with a physical therapist who specializes in sports injuries. A tailored rehabilitation program focusing on strengthening the muscles around the knee, particularly the quadriceps, hamstrings, and calf muscles, can help stabilize the joint and improve function. Additionally, proprioceptive exercises can enhance your balance and coordination, which are crucial for knee stability.

2. Manual Therapy: Given the ongoing tightness and the "popping" sound you experience when extending your knee, manual therapy techniques, such as joint mobilization or soft tissue manipulation, may be beneficial. These techniques can help alleviate tightness in the surrounding muscles and improve joint mechanics.

3. Activity Modification: It is essential to modify your activities to avoid exacerbating your symptoms. High-impact activities, such as jumping or deep squatting, may place undue stress on your knee. Focus on low-impact exercises, such as swimming or cycling, which can help maintain fitness without aggravating your knee.

4. Pain Management: Since you have experienced persistent pain, consider discussing pain management options with your healthcare provider. This may include non-steroidal anti-inflammatory drugs (NSAIDs) if you are not allergic, or alternative pain relief methods such as topical analgesics, acupuncture, or even corticosteroid injections if appropriate.

5. Investigate Further: If your symptoms persist despite conservative management, it may be worth seeking a second opinion from an orthopedic specialist. They may recommend further imaging studies or even arthroscopic evaluation to assess for any subtle injuries that may not have been detected previously, such as meniscal tears or cartilage damage.

6. Gradual Return to Activity: As you progress in your rehabilitation, gradually reintroduce activities that involve bending and jumping, ensuring that you listen to your body and avoid pushing through pain. A gradual return to sports or activities should be guided by your physical therapist.

7. Knee Bracing: If you find that certain activities exacerbate your symptoms, consider using a knee brace for additional support during those activities. However, it is essential to ensure that the brace does not cause discomfort or restrict movement excessively.

In conclusion, persistent knee pain after an injury can be multifactorial, and a comprehensive approach that includes rehabilitation, manual therapy, activity modification, and possibly further investigation is crucial for recovery. It is essential to remain proactive in your treatment and communicate openly with your healthcare providers about your symptoms and concerns. With the right approach, you can work towards regaining full function and alleviating your knee pain.

Similar Q&A

Persistent Knee Pain After Injury: Seeking Answers and Solutions

Hello Doctor: Thank you for your tireless efforts in answering the questions of netizens. I truly appreciate it. In mid-February, while running, I tripped over an unknown object and fell, landing on both knees. The pain was so intense that I lay on the ground for several minutes,...

Dr. Chen Yongxue reply Orthopedics
Hello, both meniscus and cruciate ligament injuries cannot be diagnosed with X-rays; an MRI is necessary. Regarding the interpretation of MRI results, there can be some margin of error. PRP injections cannot alleviate pain from a right knee fracture; if there is no displacement, ...

Effective Treatments for Persistent Knee Pain After Injury

Hello, Doctor. About two years ago, after a fall during exercise, I started experiencing discomfort in my right knee. The main issues are: 1. A feeling of dull swelling in the knee, although there are no visible abnormalities, and 2. Pain in the popliteal fossa and hamstring afte...

Dr. Shi Guozheng reply Orthopedics
In addition to rehabilitation, you can take cartilage supplements such as glucosamine to help slow down cartilage wear. If further intervention is needed, you may consider treatments like hyaluronic acid injections or autologous high-concentration platelet therapy.

Effective Strategies to Alleviate Persistent Knee Pain

I went hiking before, and I'm not sure if that caused my sports injury. However, currently, I have pain on the inner side of my knee, and this condition has persisted for several months without improvement. I'm wondering what methods could help alleviate this issue.

Dr. Lin Junliang reply Orthopedics
Your condition may be a soft tissue injury to the knee caused by overexertion, which can also be classified as a sports injury. Generally speaking, minor injuries require only rest and simple physical therapy; however, if there is damage to the knee cartilage or the cruciate liga...

Effective Strategies for Managing Persistent Knee Pain: A Comprehensive Guide

Dear Dr. Lee, I have been experiencing knee pain for the past two years, which has caused significant inconvenience in my daily life, especially since I used to enjoy walking and hiking as forms of exercise. I have sought medical attention multiple times, but the opinions have v...

Dr. Li Wenlin reply Orthopedics
Hello: In response to your question, based on your description, possible diagnoses include patellar chondromalacia or subluxation, avascular necrosis of the femoral condyle, and degenerative arthritis. The diagnostic tools should be utilized in the following order: 1. Standing kn...