Patellar Malalignment: Knee Pain and Rehabilitation Insights

Knee pain and rehabilitation issues related to mild patellar valgus?

Hello, Doctor.
Last month, in mid-December, I traveled to Japan for 9 days, walking approximately 18,000 steps each day.
However, on the fourth day of my trip, I began to experience a slight stabbing pain in my left knee, which worsened over the following days.
After returning to Taiwan, I applied pain relief patches and ointments for 1 to 2 weeks, which provided some relief, but I still feel it hasn't completely healed.
I was concerned about being pregnant (and couldn't undergo an X-ray).
After a negative pregnancy test on January 13, I visited a general orthopedic clinic to discuss my knee pain.
I researched online and suspected it might be patellar malalignment.
The doctor pressed on my knee, confirmed the pain, and ordered an X-ray.
Subsequently, he mentioned that both of my knees showed mild patellar malalignment and recommended rehabilitation, but he didn't provide detailed explanations about my knees.
He instructed me to go to the second floor for rehabilitation and mentioned it would take some time.
The next day, I returned to the clinic for rehabilitation, and the therapist said it would take at least over a month.
1.
Since that clinic (in Guishan, Taoyuan) is quite far from my home (almost an hour's drive), can I request the X-ray films from that clinic to take to a nearby clinic (in Linkou)? I want to prepare for pregnancy and would like to avoid X-rays if possible.
Alternatively, is it necessary to have another X-ray to confirm the recovery status after the patellar malalignment?
2.
Before picking up my medication, I asked the clinic doctor if walking too much during my trip in Japan contributed to my patellar malalignment symptoms.
He replied that it was not solely due to that and that there are many factors involved.
Is there a connection to an incident when I was 17 years old in high school, where I fell off my bicycle after being brushed by a motorcycle, landing on both knees? I experienced pain for a long time then, but I didn't seek medical attention.
3.
After completing rehabilitation, will I be able to hike or walk briskly on a treadmill for an hour every day? Additionally, should I avoid exercises like pedaling an air bike while lying on the bed? Thank you.

Mi Lan, 20~29 year old female. Ask Date: 2017/01/16

Dr. Shi Guozheng reply Orthopedics

If there is no pain with patellar valgus, there is no need to worry about it.
However, if pain begins, the first step is to rest to allow the inflamed cartilage to gradually heal.
Next, leg extension exercises can be performed to strengthen the quadriceps.
Currently, it is advisable to avoid movements that involve bending the knee, as this will increase the pressure on the patella.

Reply Date: 2017/01/16

More Info

Understanding patellar malalignment, particularly conditions like patellar lateral subluxation, is crucial for addressing knee pain and rehabilitation effectively. Your recent experience with knee pain after extensive walking during your trip to Japan highlights the importance of recognizing the underlying causes of such discomfort and the need for appropriate rehabilitation strategies.

1. X-ray and Follow-Up Care: It is understandable that you are concerned about the need for further imaging, especially considering your desire to avoid X-rays due to potential pregnancy. Generally, if your doctor has already diagnosed you with mild patellar malalignment through X-ray, additional imaging may not be immediately necessary unless your symptoms worsen or do not improve with rehabilitation. You can certainly request your X-ray films to take to a closer clinic for continuity of care. However, it is essential to communicate with your healthcare provider about your concerns and the need for follow-up assessments, as they can provide tailored advice based on your specific situation.

2. Historical Injury Impact: The incident from your high school years, where you fell and injured your knees, could indeed have contributed to your current knee issues. Past injuries can lead to changes in the biomechanics of the knee joint, potentially resulting in malalignment or increased susceptibility to conditions like patellar subluxation. It’s important to consider your entire medical history when evaluating your current condition, as previous trauma can have long-lasting effects on joint health.

3. Rehabilitation and Activity Resumption: As for your rehabilitation, it is vital to follow the guidance of your physical therapist. They will design a program that addresses your specific needs, focusing on strengthening the muscles around the knee, improving flexibility, and correcting any biomechanical issues. After completing your rehabilitation, activities like hiking or using a treadmill for brisk walking can generally be resumed, but it’s crucial to do so gradually and with proper technique to avoid exacerbating your condition. Exercises such as cycling on a stationary bike can be beneficial, but you should consult your therapist to ensure that these activities are appropriate for your recovery stage.

In summary, addressing patellar malalignment involves a multifaceted approach that includes proper diagnosis, rehabilitation, and gradual return to physical activities. It’s essential to maintain open communication with your healthcare providers, adhere to rehabilitation protocols, and listen to your body as you progress. If you experience any significant changes in your symptoms or new concerns arise, do not hesitate to seek further medical advice.

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