Knee Pain 101 {Can It Be Fixed?}

A baker’s cyst + meniscus tear = Major knee pain! Add in osteoarthritis behind the patella in both knees and you have a perfect knee pain storm. Not a fun thing to deal with when you have places to go and things to see. So what can be done to get this fixed fast and move forward? Let me continue my story….

I will be the first to say that I’m not an athlete, but I do like walking and I was going to be doing a lot of it on my trip. When your knee hurts and prevents you from doing what you love, you realize exactly how important this joint is.  Understanding what a meniscus tear is and how it can affect your mobility makes developing a treatment plan more effective.  Since my baker’s cyst was still an issue, I had a double problem – double whammy knee pain!

Meniscus Tear/Baker’s Cyst

Symptoms

My meniscus tear is on the outside (lateral) side of my right knee on the anterior horn with a flap.  I had all the symptoms of a tear which included:

  • pain in the knee, especially when twisting or the knee
  • swelling
  • popping sensation during injury
  • difficulty bending and straightening the knee

Another symptom that sometimes happens is that the knee can get stuck or lock up.  That’s because a piece of the meniscus has become loose and is blocking the knee joint.  Even though my tear has an inverted flap, that never happened to me.  However, my torn meniscus did result in a baker’s cyst forming at the back of my knee.

A baker’s cyst (popliteal cyst), is when the knee produces too much synovial fluid when pressure builds up due to swelling. The fluid squeezes into the back of the knee and becomes a cyst.  They are usually the result of either an injury or osteoarthritis.  Some people never know they have a baker’s cyst, others do because the cyst protrudes at the back of the knee and they have major knee pain.  I really felt mine because my knee was extremely painful, it swelled up and it was affecting my mobility. Sometimes they require treatment, other times they go away on their own.

Self Care Treatment When Dealing With Knee Pain

  1. R.I.C.E.

    • Rest – I rested my knee as much as I could to help avoid overusing it and putting pressure on it.  Crutches also helped to keep the weight off the joint, but hurt my arms as I’m also recovering from tendonitis in my shoulder. A cane was just plain awkward!
    • Icing – This really helps to reduce pain and swelling.  I was doing it several times a day for 20 minute intervals using an ice wrap that went completely around my knee.  
    • Compression – I used both an adjustable knee brace and an elastic bandage to help prevent fluid buildup.
    • Elevation – I elevated my knee whenever I sat or laid down to help with the swelling.
  2. Anti-inflammatory/pain medications

    • Non-steroidal anti-inflammatory drugs (NSAIDS) like Aleve are great for pain caused by inflammation, but sometimes aren’t enough.
    • My doctor prescribed Celebrex as a stronger solution to help relieve inflammation, pain and swelling. I didn’t feel instant relief, but did notice relief over time. Unfortunately, a side effect of this drug includes stomach upset. My doctor prescribes Pantoloc to counteract this.
    • There were many nights when I was woken by pain, particularly if I moved my right leg during sleep. Ouch! Lack of sleep due to pain was a big issue for me.  As a result, my doctor prescribed Tramadol.  This is a drug that I only took at night to help with the pain and to make use of the “drowsiness” side effect.  It cuts the pain, but since it is very addicting, I used it very sparingly.
    • Voltaren gel – this is a topical pain medicine containing diclofenac diethylamine, a nonsteroidal anti-inflammatory drug (NSAID) that treats pain and inflammation.

Professional Treatment

  1. Corticosteroid Injection

    • I’ve had success with cortisone injections in the past, and with our trip coming up fast,  a cortisone injection directly into the affected knee to help reduce swelling and inflammation was very welcome. The injection is supposed to work by treating the inflammation that can cause knee pain, swelling and warmth.  The effects of a cortisone injection can last from 3 weeks to 6 months (or longer).
    • This treatment worked well for me. I could feel the difference immediately and the intense pain in my knee improved over several days allowing me better mobility.
    • It’s been a little over 6 months and I truly believe the injection helped with my inflammation so I could take advantage of other treatments to rehabilitate my knee and feel less pain.
  2. Knee Brace

    • One of my greatest fears that I had as our departure for Switzerland approached was that my knee wouldn’t be up to the rigors of our busy schedule.
    • I was sent to a bracing specialist who fitted me with a custom brace that would support my knee while walking so I wouldn’t be afraid of constantly reinjuring it
    • This particular knee brace is sturdy, adjustable and can be worn under clothing. Best of all, my health benefits covered most of the cost! It was very helpful in stabilizing my knee on the days we climbed hills and spent the day touring, especially on those cobblestone roads.
  3. Physiotherapy

    • Physio was a blessing for me! My therapist was amazing and instrumental in getting me moving and functioning at a comfortable level again!
    • To help me get back on track, my therapist did the following:
      • developed a plan of action based on a focused examination of my injury.
      • prescribed exercises and stretches to help strengthen and improve my mobility.
      • provided other treatments to enhance my sessions including ultrasound, electric stimulation and cryotherapy compression.
  4. Chiropractic Adjustments

    • I have been going to a chiropractor for 30+years and initially went to get help with tendonitis in my ankles. With proper adjustments to my spine and neck and additional ultrasound therapy on my ankles, I got rid of the achilles tendonitis and it hasn’t been back since.
    • Fast forward to now, I can honestly say that chiropractic adjustments have kept me aligned and healthy. Unfortunately, they don’t prevent you from getting injured. One of the problems you have when you injure a joint like your knee is that other parts of your body move in to compensate and protect the injured area.  In my case it was my ankles, hips and lower back.
    • My chiropractor targeted those areas that were misaligned and contributed to my knee pain. I felt definite relief after each adjustment.
    • In addition to targeted adjustments, my chiropractor also used acupuncture and TENS therapy to complement her manipulations. Again, I could definitely feel the difference after each appointment
  5. Kineseology Tape

    • This stuff is amazing if applied properly! Thankfully, YouTube has lots of learning videos to help with application.
    • Not sure how this tape works, but my chiropractor applied some over my knee after one of her adjustments. I immediately felt the support and stability when I walked out of the office. The tape stayed on several days and I could really tell the difference once it came off.
    • I brought some of this tape with me to Switzerland and used it on both knees before leaving for a day of touring/walking. It worked great!
  6. Accupuncture

    • I was really skeptical of this form of treatment because the thought of all those needles sticking out of me wasn’t my idea of fun.
    • My chiropractor is also trained in Chinese Acupuncture and tried several different techniques to bring me relief.  The one I felt had the most impact was electro-acupuncture which is when an electric current passes through the needle to stimulate healing within the body. It felt like TENS therapy, only deep in the muscle. The relief I felt when the muscle finally relaxed was amazing!
  7. Massage

    • Who doesn’t love a good massage?
    • Message therapy was instrumental as part of my knee pain rehabilitation, especially since the pain is relieved when the muscles surrounding the joints relax, releasing stiffness and allowing for better range of motion and mobility.
    • I found that as the muscles around my knees became more relaxed, the less pain I felt.  I also noticed the same thing for my back, leg, and butt muscles—when they were relaxed, my IT band relaxed and since the IT band extends past the knee, it made a difference with the knee pain.  Go figure!
  8. Weight Loss

    • This one is a no brainer! I know I need to lose weight. That is a  work in progress that will take time.
    • Fortunately, I am walking again. I am tracking my progress and will report back with an update!

Other Treatment Options (That Are Available, But I Didn’t Go With)

  1. Drainage of baker’s cyst with cortisone injection

    • I had an appointment scheduled to get my baker’s cyst drained and then treated with a cortisone shot after our Switzerland trip
    • It turned out when I got on the table to start the treatment, the ultrasound technician found that my cyst had apparently drained all by itself.  There was nothing to drain. That was the good news….the bad news was that apparently that was why my calf and ankles were hurting in Switzerland. The fluid had drained into my calf muscles.
  2. Synovial fluid replacement therapy

    • This type of therapy is a visco-supplementation injection into the knee that is supposed to lubricate and cushion the joint, much like natural synovial fluid does.
    • The fluid injected is hyaluronan which may go under the names of Synvisc-One, Hylan G-F 20, etc.  This treatment was offered to me, but I declined after researching it some more and talking to a friend who had this done.
    • Another reason I didn’t go further with this is because the cortisone injection was working and this treatment was not covered by OHIP or my health benefits.
  3. Platelet-rich plasma (PRP) Injections

    • These injections use your own blood and platelets to promote healing.
    • I didn’t go further with this as it is an expensive procedure and isn’t covered by OHIP or my health benefits. I also wasn’t convinced it would work to justify the added expense.
  4. Surgery

    • After consultation with an orthopedic consultant it was decided that I was not a good candidate for surgery.
    • I also learned that the flap from my meniscus tear must have flipped back so my knee wasn’t locking, my osteoarthritis was not bone on bone and I was already responding well to the treatments I have described above.
    • The consultant looked at my x-rays, ultrasound and MRI it was determined that my best options to become fully functional again was to continue with physiotherapy, massage, exercise, diet change and weight loss.

So now what?

I can honestly say I feel much better now than I did last February.  The Switzerland trip went well.  I kept up with everyone else in our group and got lots of exercise as a result.  In January, I will be part of an 8 week  exercise program that is studying the effects of exercise and strength training for people like me who have moderate osteoarthritis in the knees.  I’m really excited about this!

Is my knee pain completely gone?  No, but it’s much better now. I can walk, hike, bike and canoe again without cringing in pain. I am always on the look out for solutions when I have flare ups, and will discuss those in my next post.

See ya,

MotherDearest

 

Disclaimer: I am not a medical doctor and do not pretend to be an expert. However, I am my own advocate and am sharing my journey so that others know that there is hope and to encourage you to be a champion for your own health. What works for me may not work for you, so do your research and don’t be afraid to question things that don’t sound right.

 

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