Snapping/clicking in knee

[Dbrown74]

Not sure if this is the right place to post, I am new to the board.

There has been clicking in my right knee for more than a month. I will explain my full situation because I am pretty lost on what to do.

I took a course of medrol which is an oral steroid - I had this left over from a back injury. (Don't yell at me for this, the doctor already did.) No improvement. I took the week off while taking the steroid.
I visited a PT who specializes in cyclists. He said that it is probably some IT band problems causing my patella to track improperly and I shouldn't ride hard, but it is ok to spin on the rollers etc. Recommended I get an MRI to be safe.
So I continued to spin on the rollers and went to a Orthopedic doc who I have some connections with to get a quick MRI. He said that it is possibly the same problem causing the patella to track improperly and the cartilage on the underside of the patella is softening causing discomfort. He also said that he expected nothing on the MRI. ( I don't trust this doctor at all, doesn't understand athletes. I use him simply because I can get next day appointments for MRIs and other stuff I need.)
I get the MRI, it says I have a small synovial knee effusion.
I get an appointment with a different orthopedic doc who specializes in sports medicine and knees.
He tells me it could be patella femoral syndrome or problems with the plica. He gives me a cortisone shot in my knee hoping for a "homerun." He tells me that I should take 3 days off the knee and then within a week I should be able to go full gas back on the bike.
Clicking/snapping never goes away, I try to ride at endurance pace on the rollers and feel as if nothing improved. I make another appointment with the same guy.
He seems to be leaning more towards the plica now and tells me he thinks it will just get better over time whilst doing PT. But tells me that he can do a surgery to remove the problematic plica. He also tells me that I can ride and do my workouts. I have now been more or less of the bike for 3 weeks.

I am now stuck on what to do. I tried to ride last night and it is actually starting to become painful. Not so much an unbearable pain, but a pain where I felt there is no way riding is beneficial. I got off after about 20mins.

So my options seem to be. Physical Therapy to hopefully help one of 3 problems get better. Though in my mind PT alone is not the answer.

Or surgery which has a 6 - 12 week recovery time.

I don't really know what to do. Cycling is more or less all I do, I am fairly new to it, because I switched over from lightweight rowing after I herniated a disc in my back. My fitness from rowing has carried over well and I went from never racing a bike to having a bunch of points towards my 2 upgrade in one season. I am trying to see how far I can go in cycling and am hoping this is not going to be a career ending injury like my back was for rowing.

I am posting here to see if anyone has had similar problems and what they did to fix it or deal with it? I am also wondering some other people's opinions on what they would do in my situation.

Because my job, I can't start racing until May. The way I look at it is if I try PT and it takes 6 weeks before I realize its not helping, than I wasted another 6 weeks. I am really just worried about losing time. I feel like everyday I am off the bike I am losing more and more and my season is slowly going down the drain before it has even started.

Sorry for the wall of text and the slight rambling, I am extremely frustrated and am very lost. If I missed something just ask me.

Thanks in advance.

-Dave

 

[vspa]

I get the MRI, it says I have a small synovial knee effusion.

I had synovial trouble once or twice, in my case it was the liquid bulking and making it quite painfull on the back of my knee, needed rest for 3 to 5 days and then it was gone, so i guess it was a different problem than yours.

 

[Eichers]

Hi Dbrown74, I have read on this thread people who have had knee trouble and when they used these pedals they nolonger had knees issues that they had with other pedals ... http://weightweenies.starbike.com/forum/viewtopic.php?f=3&t=90491&hilit=keywin+crm&start=45

Hope this helps ... Thanks KL/img/vbsmilies/smilies/smile.gif

 

[CAMPYBOB]

"I get an appointment with a different orthopedic doc who specializes in sports medicine and knees."

You're on the right track. Get a second opinion from another sport orthopedist. Ask around locally to find out which have the best outcomes.

Best of luck to you.

 

[531Aussie]

I'm no Dr Butt:

Have you been doing the rehab? The stretches and 'little' exercises often work wonders. I'd sooner spend half my life stretching and 'pre-habbing' than have an operation.

Yes, from what I know, knee clicking can be a symptom of PF syndrome.

My left knee has been clicking on and off for a few years -- more when walking that riding -- but has rarely caused me problems, that I know of. I obviously can't be sure if mine is similar to yours, and when you say "snapping", that sounds more severe to me that what I have. But anyway.....

Last year, I had what a PT said "looks like a bit of PF syndrome." I was getting some minor medial knee pain, but the worst symptom was that i kept straining my inner/lower quad, right near the knee (vastus medialis oblique, or VMO).

The short version of the following is that I basically followed all the PF syndrome treatment I could find, and it worked for me.


I've got no money, so I only had one visit to the physio therapist, therefore, I looked for info myself. The lesser-known muscles/tendons that can effect the area (and possibly less likely to be the cause) are the tensor fascia latae (a small muscle near the hip), the pes anserinus, and even the tibialis anterior, because of its relationship with the IT band (I think. My problem was gone before I got into this bit).

I'm sure you've probably Googled all the info on PF syndrome (stretching the IT band, glutes, quads, and strengthening the medialis, etc), but I reckon I got the best results using a foam roller and tennis ball on the IT band and medialis. Just for good measure, I also spent time stretching my inside thigh/groin, hammies, quads and hip flexors. I also did some "knuckle" massaging of my medialis.

Straight leg raises are also good for patellar tracking problems.

After a few weeks, my problem gradually improved (I didn't really stop riding; I just rode less and much easier for a about 6 weeks), so I gathered I was on the right track. After about 2 months (probably with insufficient rest), my pain was pretty much gone.

On the pedals thing: i don't wanna shoot the messenger, but I'm always a little dubious when people say they changed pedals and all their knee pain immediately disappeared. Apart from extra float (do some now have supination?), I can't see how else a new pedal can magically cure a knee injury without working on the body. I mean, don't pretty much all pedals have lots of float, anyway?

And, in my opinion, having heaps of float isn't ideal when pounding the **** out of the pedals. My guess is that these people probably end up with a different cleat position when they get new pedals and cleats, or an effectively altered saddle height. I mean, they're still using the same "tight" muscles, and/or poorly-trackin knee cap, pounding the same power through the same angles.

Eh...I've lost interest.

 

[Eichers]

Hi Dbrown74, here is a knee stability exercise that might be helpful ... http://www.youtube.com/watch?v=-Qn7dF5QPDI

Hope this helps ... Thanks KL