Patella Pain

[Guest after5]

I just got back from getting a referral for an orthopedist. Over the past few months I have been experiencing pain in my left knee. Especially when I walk down stairs or do a plie. Anyway, the nurse practitioner gave me Bextra tablets to relieve some inflammation. Have any of you taken this medicine before for knee or any other pain? Did it work for you?

 

She also said I should wait until I use up all 6 tablets (1 a day), and then if the pain is still there, then call the orthopedist. Instead I dialed the orthopedist as soon as I left the parking lot. Since I am paying for my insurance every month, I will make sure I get the care I need. :mad:

Oops, HMO is a topic for another discussion group.

 

So I will see the orthopedist on Thursday, and until then I will not jump, do too many plies and generally try to stay away from trouble.

[Xena]

oh good grief, sounds very similar to what ails me..try looking up knee pain and Xena.

 

The end result as I shall not bore you with the years of pain, is that I have gotten orthotics and no longer do plies in class and now I can run and jump and have a jolly good time without being in crippling pain. I still have to be careful as you can get cocky once the pain has gone and return to old habits.

 

I am unwilling and reluctant to give out any medical advice other than go see your physician before any permanent damage is done. The knee is the most complicated part of human anatomy and suggesting exercises is a no no, it can make matters far worse. So makeing your appointment was good , do not live with the pain thinking it will go away.

 

Do you run or have you ever ran when you were younger? or now?

[citibob]

Pain killers are a short-term solution. There is something you are doing that is causing the pain. In the long term, that must be changed.

 

I had a similar problem. Even quitting dancing didn't help. Same with physical therapists and stuff (although that did stabilize my situation; definitely you should see them).

 

In the end, I had to go back to ballet class and learn how to do the technique correctly. That re-shaped and re-balanced my muscles, and the problem went away over the course of a few months.

[Guest after5]

Thanks for the responses.

Before I "run" off to ballet class, let me clarify a few things.

 

Xena, citibob

 

I do not run, and actually, I deeply, deeply dislike running. I only run when I absolutely have to, like when there is a dog chasing me or something. I do however love elliptical trainer, and it has never caused me any pain, even now when I have a pain in my knee. I think my problem is that I overworked my knee on the stair stepper last fall. I don't know what demon possesed me to use the stairstepper, but I did it. I can rule out ballet as the cause, because I was out of class from June 2002 through January 2003. I was back home in Croatia (due to some family ilness) and there were no appropriate ballet studios where I could take a class. So I hit the gym circuit, perhaps a little too enthusiastically.

I hope the orthopedist will be able to help, even though I know knees are hard to diagnose.

 

Xena, are you saying you do not plie, period? Not even a demi-plie? What about fondu and such?

 

Thanks,

 

Danja

[Xena]

I do demi plie, not too deep though, and grand plies in second and only sometimes in fifth. I have to take care on fondu, that I don't roll my foot in or turn out too much,or bend too deeply. I invested in a wobble board which is fabulous and has helped me so much.

I had to leave off grande allegro for 8 months until I was strong enough to take part. My teacher was very encouraging and would notice even if I was about to be slightly uncomfortable and advise me not to do frappes for example, as they can be rather aggravating to the knee if it is painful already.

 

I am looking into getting orthotics for my ballet shoes.

it is like citibob said a process of relearning and retraining. It was very very frustrating and I used to get really upset, but now the results were so worth it. I went right back to complete basics 'this is a demi-plie, this is tendu a la seconde..etc' that basic and that was the best move I ever did.

[citibob]

A very common cause of patella pain for dancers is patella-femural syndrome. In this case, the outside quadriceps become overdeveloped, and the inner thigh muscles are underdeveloped. The result is to pull the kneecap out of the groove it should be in, and hence the pain. Over the long term, this can result in the cartilage in your knee being worn away.

 

Of course, only a doctor can diagnose whether this really is your problem, or whether you're suffering from any number of other problems.

 

But if patella-femural syndrom is the problem, then the long-term solution is to re-train the body; physical therapists can help give insight as to how. But in the end it is hard, because the body builds certain "circuits" to use its parts in certain ways. Those circuits become automatic. So changing them is hard, even if they cause damage.

[Guest after5]

Xena, citibob,

 

I went to orthopedist today, and I was diagnosed with patello-femoral syndrome (good guess, citibob). THe doctor said that I had softened cartilage at the back of my knee, and that it is very common among athletes. He said he would prescribe some physical therapy, and give me some more Bextra, which BTW seems to work nicely. I already put away 7 tablets for Richmond. ALso, when I explained to him that I dance ballet and that I am going to an intensive in 2 months, he smiled and said "Well, let's get you ready for Richmond then." So I am starting therapy next week, 3 x week, for 4 weeks. I hope it helps. The doctor did say that my knee looks good on the X-ray and the patella is tracking ok. Last time I had knee therapy ( 5 years ago), I was given particular exercises for stretching ITB so that is does not pull on the patella, and I have incorporated them into my stretching routine, and have been doing them since.

Thanks again for your support.

 

Danja

[citibob]

OK, if it's P-F syndrome, then I know the track you're on (no pun intended).

 

Physical Therapy is good. But now you need to understand as much as you can about how your legs and knees and stuff work, and figure out what you're doing wrong in ballet class. Otherwise it will never really get better.

 

When properly done, ballet will strengthen the knee and help stabalize it. Ronde de jambe en l'air is one such exercise, which is similar in some ways to some of the exercises you'll see in PT.

 

Now is the time to really learn how to turn out properly, standing high on your hips. Improper turnout is brutal on knees. I wish I could show you in person.

[Guest stateofgrace]

I decided to stop lurking last night after reading the posts on patellar pain. I must say that I am really impressed with the excellent information shared between those who post on this forum.

 

I am returning to ballet after a many year absence. Currently, I am a competitive fencer, and as I fencer I have experienced my own challenges with patellar pain. (Actually, fencing and ballet use similar movements and muscles). I also work in orthopedic/sports rehabilitation so I couldn't resist commenting on the topic of patellar pain. However, I am NOT a doctor, so the comments I offer are simply ideas to consider and not medical advice

 

Citibob, you're pretty sharp !

 

Patellar-Femoral Syndrome is common among many athletes who place a dynamic load on the quadriceps muscles. When we rehab patients with PFS in the clinic, we encourage them to strengthen the VMO muscle (vastus medialis). By strengthening the VMO, one can encourage the correct tracking of the patella. I personally strengthen my VMO on the pilates reformer. I do this with one foot on demi pointe and focusing on short, incomplete carriage return, placing the dynamic load on the VMO. There are many excercises that can be used to strengthen the VMO, and I would imagine your physical therapist will prescribe some for you to do in the clinic and at home.

 

One thing you can consider is patellar-femoral taping. PF taping is not a permanent solution for patellar pain, however, I use PF taping when I fence. I was taught the technique by the director of althetic training at my local college, and I use PF taping to reposition my patella when I have irritated my patellar tendon. PF taping is a common athletic taping procedure for many sports, and the Leukotape I use holds up for literally hours of repetitive activity. You might want to ask your healthcare practitioner if PF taping is something that would provide you benefit.

 

I wish you good health and strong knees!

 

stateofgrace

[Guest after5]

When I called the PT place, I asked for a PT who is experienced in working with ballet dancers. THe woman praised the one I am going to see next week as a very knowledgable one, but she said none of them work specifically with dancers. If she seems clueless about ballet, and even if she doesn't, I was thinking of asking one of my teachers for a private lesson, and hopefully that will help identify where the problem is in my ballet class. Right now, I won't say I do everything right in ballet because I don't, but I will say I am not aware of what I could be doing which is harming me. I do not turn out from my knees, but from hips. I do not try a perfect 1st or 4th or 5th position, but stay within limits of my turnout. I try not to hyperextend my knees, but keep them pulled up. I also try not to sit in my hips.

If you are coming to Richmond in June, you could definitely show me what you did during the relearning phase. I am starting to freak out I won't be able to find the cause of this injury and prevent the knee from healing.

[Guest after5]

Thank you, state of grace. I never thought of Pilates, even though it is frequently mentioned on this board. I guess I will know on Thursday what my options are. Perhaps I post a question or two once I have the complete information.

[Guest stateofgrace]

Richmond in June........well, what can I say ? I have only discovered the Richmond camp in the last few days, and I am BURNING with desire to attend. However, as I mentioned in my first post, I have only returned to ballet in the last few weeks. I danced as a child and loved it dearly. Unfortunately my mother made me stop lessons, and I've only recently returned after an almost 30 year absence.

 

I have been competitively fencing for the past few years, am fairly fit and flexible, and through my work in rehab, I have good knowledge of kinetics, plyometrics and anatomy. I also have been working on the pilates reformer for over a year (2-3 times per week) with a trainer who was a soloist with SF Ballet and worked in dance medicine with Miami City Ballet and Cincinnati Ballet.

 

So, back to Richmond. I would love to go. I might be capable of attending in August, at Level 1, but I am not sure. The site recommends at least one year of training, and I have only a few weeks of return to ballet. I will speak with the faculty and see if they think I can handle it.

 

In regards to physical therapy, even if your PT does not work specifically with dancers, he or she should be able to help you remediate your patellar pain. PFS affects many athletes. If you are a dancer, a fencer, run the hurdles, ice skate or do any activity that has a plyometric component, you could be at risk for PFS. Although your physical therapist may not dance, fence, etc. he or she will know PFS and its causes. So, what I am suggesting to you is that although your physical therapist may not understand ballet, she or he WILL understand your diagnosis, its treatment, and its prevention.

 

Good luck with your therapy, and be confident that there is a solution.

 

stateofgrace

[citibob]

Sorry to have freaked you out. I just had a hard time with it myself. I think that I was expecting PT to "just work" and make the pain go away. But it didn't. I had to do the work, I had to learn about my own body parts and learn to control them until I had enough awareness to use them more correctly.

 

I actually quit dancing, thinking that if I did that, then my knee would get better. It didn't work. I quit (off and on) for five years and had bad knees for all five of those years. In the end, I figured that dancing had gotten me into this mess, so it had better get me out as well. That's when I delved deeper.

 

Best of luck!

[pointehill]

after5,

I also have taken Bextra. I myself took it for a hip injury and it seems to work wonderfully to get rid of inflammation at least in me. I worked in an orthopedic's office for 6 years, and I can tell you that anti-inflammatories are kind of a trial and error thing on if a certain one works for you. There are MANY of them out there and Bextra was the newest one when I left working in the doctor's office (there is probably even more now). With any of them you have to be careful of taking them too long as many of them have side effects on the liver after too long of use (some patients in our office took them for a couple years with required labwork done every 6 months for chronic problems and were fine).

One big misunderstanding about anti-inflammatories is that they are pain killers. For some they relieve the pain by getting rid of the inflammation, but they don't work like the pain killers that just cover up the pain.

The only other thing I would mention is that 6 days of an anti-inflammatory seems short if it is working for you... the drug reps I use to talk with always seemed to recommend about a two weeks to help the healing process (I really don't want to seem to be giving out any kind of medical advice, so please just consider this experience from someone who has used about 3 different types of anti-inflammories in the past and was given at least a two week prescription with each one of them.) I do think that within 6 days you might be able to tell if it is working though, or if you needed to consult your doctor again. From someone who has felt the frustration of an injury to another....I hope for a speedy recovery for you.

[Xena]

After5

 

I am concerned about your statement "I try not to hyperextend my knees, but keep them pulled up". If anything you should not be pulling up your knee caps in anyway whatsoever. Your knees should be relaxed. Your inner thigh muscles and hamstrings should be doing all the work.

 

Jeanette