Persistent Knee Pain: Seeking Solutions After Injury and Treatment

Knee

About five years ago, I fell while playing a game and hit my knee.
At that time, I experienced swelling and pain.
I then consulted a traditional Chinese medicine practitioner who performed tui na (Chinese therapeutic massage), but it was ineffective.
I subsequently saw an orthopedic doctor who diagnosed me with a ruptured periosteum and assured me that rehabilitation would resolve the issue.
However, my condition did not improve.
I visited many massage therapists and underwent various examinations, but they all said my knee was fine.
Yet, any minor impact would cause my knee to swell again immediately.
Recently, I was hit by a car and fell off my motorcycle, hitting the same spot on my knee.
It swelled up right away.
I went to a traditional Chinese medicine clinic where the doctor said that a membrane in front of my knee had ruptured and treated me with topical medication, followed by heat therapy and electrical stimulation.
After the swelling subsided, they attempted tui na again, but the swelling returned immediately after the treatment.
When I informed the doctor about the swelling, he repeated the topical treatment, heat therapy, and electrical stimulation, explaining that the goal was to push the condition back in.
This cycle continued for two weeks, but my knee remained unable to bend.
I then consulted an orthopedic doctor again, who diagnosed me with tendonitis and advised against massage, stating that it would eventually heal on its own.
He prescribed medication for me, including anti-inflammatory drugs, which did reduce the swelling, but I still have not fully recovered.
I am unsure of what to do next.
Please help me, doctor.

Ms. Hsu, 20~29 year old female. Ask Date: 2003/11/28

Dr. Pan Yingda reply Rehabilitation

It’s a bit tricky, but there shouldn’t be any issues with the bones.
Do you experience pain when going up and down stairs or squatting? If the massage pressure isn’t very strong and it causes swelling, it’s evident that there are still parts of the soft tissue that haven’t healed, which require further treatment.
My recommendations are: 1.
Rebuild the function of the knee joint, especially strengthen the quadriceps through muscle training.
2.
Identify the pain points and perform deep tissue massage, starting gently and gradually increasing pressure, continuing until there is no pain or swelling.
3.
Relying on medication or injections is not a solution; you might consider consulting another physician for different opinions.
(I cannot clearly grasp the issue online, so I cannot provide more precise advice.) Generally speaking, your problem may be due to wear on the underside of the patella and adhesions resulting from previous injuries.
Massage is necessary, but be cautious with the pressure.

Reply Date: 2003/11/28

More Info

Persistent knee pain following an injury can be a frustrating and complex issue, especially when multiple treatments have not yielded satisfactory results. Based on your description, it seems that you have experienced a series of injuries and treatments over the past five years, leading to ongoing swelling and pain in your knee. Here’s a comprehensive approach to understanding your condition and potential solutions.

Understanding Your Condition
1. Previous Injury: The initial injury you sustained five years ago, which involved swelling and pain, may have caused damage to the knee structures, including ligaments, cartilage, or the synovial membrane. The diagnosis of periosteal rupture indicates that the protective layer around your bones was compromised, which can lead to chronic pain and inflammation if not properly healed.

2. Recurrent Symptoms: The fact that your knee swells with minimal trauma suggests that there may be an underlying issue, such as instability, inflammation, or even a possible meniscal tear. The knee joint is complex, and injuries can lead to long-term changes in how the joint functions.

3. Recent Trauma: The recent incident where you were hit by a vehicle and fell again on the same knee likely exacerbated any existing issues. This could have led to further inflammation or even new injuries, such as a ligament strain or a cartilage injury.

Treatment Options
1. Rest and Ice: Given the recurrent swelling, it’s crucial to allow your knee to rest. Ice therapy can help reduce inflammation and pain. Apply ice for 15-20 minutes every few hours, especially after activities that aggravate your knee.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can assess your knee's range of motion, strength, and stability. They can design a rehabilitation program tailored to your needs, focusing on strengthening the muscles around the knee and improving flexibility.

3. Medication: Since you mentioned that anti-inflammatory medications have provided some relief, it may be worth discussing with your physician the possibility of a different class of medications or injections, such as corticosteroids, which can help reduce inflammation in the knee joint.

4. Avoiding Manipulative Therapies: While traditional Chinese medicine and manipulation may provide temporary relief, they may not address the underlying issues. Given your symptoms, it may be best to avoid aggressive manipulation until a thorough assessment is completed.

5. Imaging Studies: If you have not already done so, consider requesting an MRI of your knee. This imaging can provide detailed information about the soft tissues, including ligaments, cartilage, and any potential tears that may not be visible on X-rays.

6. Surgical Consultation: If conservative treatments fail and your pain persists, it may be worthwhile to consult an orthopedic surgeon. They can evaluate whether surgical intervention is necessary, especially if there are structural issues that need to be addressed.

Prevention and Long-term Management
1. Knee Support: Using a knee brace or support during activities may help stabilize the knee and prevent further injury. However, it’s essential to ensure that the brace fits properly and does not cause discomfort.

2. Activity Modification: Avoid high-impact activities that can exacerbate your knee pain. Low-impact exercises, such as swimming or cycling, may be more suitable as they place less stress on the knee joint.

3. Strengthening Exercises: Focus on strengthening the quadriceps and hamstrings, as these muscles support the knee joint. A physical therapist can guide you through appropriate exercises.

4. Regular Follow-ups: Keep regular appointments with your healthcare provider to monitor your progress and adjust your treatment plan as necessary.

Conclusion
Persistent knee pain can be a multifaceted issue requiring a comprehensive approach to treatment and management. By focusing on rest, appropriate physical therapy, and possibly further imaging studies, you can work towards alleviating your symptoms and improving your knee function. If conservative measures do not yield results, do not hesitate to seek further evaluation from an orthopedic specialist. Your health and mobility are paramount, and addressing these issues early can lead to better outcomes in the long run.

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