Knee Pain After Injury: Recovery Insights and Management

Foot pain issues?

Hello, at the beginning of September, I had a knee abrasion on my left knee due to a car accident.
After the abrasion improved, I noticed that my knee hurts when I squat, and after squatting for a while, I experience pain behind my knee when standing up.
The doctor said the X-ray showed no issues and that the inflammation would heal quickly.
When I visit the hospital, the doctor or physical therapist performs tests such as pressing or bending, and I don't feel pain during those movements.
Although daily activities or gentle exercises don't seem to affect me much, I find it troubling that I experience significant pain during full squats (if I exert force with my legs, it hurts less, but it hurts when I relax), kneeling, jumping, or when my knee rotates slightly.
Sometimes, my left knee makes a clicking sound as if something is stuck, and I feel a sensation of it returning to a comfortable position when I move my leg.
After sitting for a long time, when I stand up, my left heel feels a bit tight, while my right heel does not.
Over the past two months, I have been going to rehabilitation about every 2 to 3 days, receiving treatments such as electrical stimulation, heat therapy, ultrasound, and manual relaxation.
There has been some improvement, but I feel that recovery is very slow.
1.
What does it mean that the movements tested by the doctor do not cause pain, but I experience pain during certain movements? Why is the treatment focused only on relaxation?
2.
I understand that there seems to be inflammation, but why has it persisted for so long without improvement? Can you clarify what the specific issue is and how I can strengthen it myself?
3.
Is it possible that this will not heal completely or that there will be long-term effects? Can I continue to exercise, and what should I avoid?
4.
The doctor prescribed diclofenac sodium and oxethazaine.
I took them for four days and felt no pain regardless of what I did, leading me to believe I was healed.
However, after stopping the medication, I found that the pain returned to its original state.
Does this medication only provide pain relief without any therapeutic effect?

Christy, 20~29 year old female. Ask Date: 2018/10/24

Dr. Xu Zhenrong reply Rehabilitation

X-ray examinations are often inadequate for detecting injuries to soft tissues such as cartilage, ligaments, or tendons.
When necessary, ultrasound or magnetic resonance imaging (MRI) should be performed.
The symptoms described by the user may indicate injuries to the ligaments (anterior and posterior cruciate ligaments, medial and lateral collateral ligaments), cartilage (medial and lateral menisci), and surrounding tendons.
Particularly, symptoms of locking or a sensation of loosening upon movement may suggest a meniscal tear.
It is advisable to consult the original treating physician to confirm the injured tissues, which will help determine the appropriate types of exercises (strength training and stretching) that may be beneficial.
Diclofenac sodium is an anti-inflammatory analgesic that has anti-inflammatory effects on tissue inflammation.

Reply Date: 2018/10/24

More Info

Knee pain following an injury, such as a car accident, can be a complex issue that often involves multiple factors, including inflammation, soft tissue damage, and sometimes even underlying structural problems. Based on your description, it seems that you are experiencing persistent pain and discomfort in your left knee, particularly during activities that require bending or putting weight on the knee. Let's address your concerns systematically.

1. Pain During Specific Movements: The fact that certain movements cause pain while others do not can indicate that there may be specific areas of irritation or injury that are not being adequately addressed. The tests performed by your doctor or physical therapist may not reproduce the pain because they are often designed to assess the integrity of the joint and surrounding structures rather than the functional movements that you perform in daily life. This discrepancy suggests that you might have issues related to muscle imbalances, joint mechanics, or even soft tissue inflammation that are not fully resolved.

2. Prolonged Inflammation: Chronic inflammation can occur for several reasons, including inadequate healing time, repetitive stress on the knee, or even biomechanical issues that lead to abnormal loading of the joint. In your case, the pain during squatting, kneeling, or jumping may indicate that the knee is not functioning optimally, possibly due to muscle weakness or tightness in the surrounding musculature. It would be beneficial to focus on strengthening the muscles around the knee, particularly the quadriceps, hamstrings, and calf muscles, as well as improving flexibility in the hip and ankle joints.

3. Concerns About Long-Term Recovery and Residual Effects: It is natural to worry about the possibility of chronic pain or long-term issues following an injury. While many individuals do recover fully, some may experience lingering symptoms, especially if the injury was severe or if rehabilitation was not comprehensive. Engaging in regular, guided physical therapy can help mitigate these risks. It is also important to listen to your body; if certain activities exacerbate your pain, it may be wise to avoid them until you have built up strength and stability in the knee.

4. Medication and Its Effects: The medication you mentioned, diclofenac sodium, is a non-steroidal anti-inflammatory drug (NSAID) that is effective for pain relief and reducing inflammation. However, it is important to note that while it can help manage pain, it does not address the underlying issues causing the pain. If you find that the pain returns after stopping the medication, it may indicate that the root cause of the pain has not been resolved. It is crucial to combine medication with physical therapy and rehabilitation exercises to achieve a more sustainable recovery.

In summary, your knee pain is likely multifactorial, involving inflammation, possible muscle weakness, and joint mechanics. Continuing with physical therapy, focusing on strengthening and flexibility exercises, and being mindful of your activities will be key to your recovery. If pain persists or worsens, consider seeking a second opinion or further imaging studies to rule out any underlying structural issues. Always consult with your healthcare provider before making changes to your treatment plan or exercise regimen.

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