Strengthening a knee post-injury

ohmyshysamantha

Let me start by telling a story...
On February 1 I was on my way back to Kenosha WI from Pontiac MI via train. (I changed trains in chicago) My train left at something like 6am so I being the sleep deprived college kid went to sleep laying down across two seats curled up in a semi-fetal position, So around Jackson MI area my train hit a lowboy on a truck that was stuck on the tracks and derailed. I flew forward and hit my forearms and knees on the back of another seat. I was not injured to my knowledge so I was one of the people who helped others off the train horray for being a good samaritan. We were bused to chicago and my right knee started bothering me, I cheered in high school and have random injuries that flair up so I took some Tylenol and thought nothing of it and just went to sleep. I woke up with my knee swollen to the point of I could barely move my jeans around my knee, and I had a hard time putting weight on it. But I limped my happy little self off the bus happy to be alive, grabbed my duffle bag from the pile of luggage that was being tossed off the bus and limped four blocks from the Union station to the Ogilivie Station in chicago. My knee continued to hurt and the pain was getting increasingly bad. I called a friend to have them pick me up from the Kenosha train station instead of walking 8 blocks and taking a bus like I normally would have. Getting off the train I could barely stand and a Metra Train employee ended up helping me off the train and a fellow passenger helped me get down the stairs and into my friends car (the elevator at that station is ALWAYS broken) My friends helped me get back to my room and later helped me limp to the student union to beg for a bag of ice from the student union I iced my knee all night and emailed my professors informing them that I would not be in class the next day. I went to the hospital where they gave me crutches and an immobilizing brace and referred me to a specialist. the specialist gave me a different brace that allowed more movement and prescribed physical therapy which involved mostly walking on a treadmill.

Months later I still have days where I have a hard time walking. I'm tired of having to wear my stupid brace. And all the doctors keep saying is lose weight and they will be able to figure out what is wrong with my knee. But its hard to lose weight when my knee keeps giving out on me almost every time I go to the gym. I really need to strengthen my knee but I dont know what I should be doing to do so. I've been doing hip abductors and I don't remember what its called but its a machine at planet fitness, you put your legs straight out over a bar that is at your ankles and bend your legs downwards at the knee and it lifts up a weight. But a few days ago when I went to planet fitness I could barely walk after.
I really need suggestions as to what I can do to fix my leg enough to where I can work out. Its really slowing me down. I'm not even worn out or tired when I leave the gym I just end up leaving when my knee starts protesting, and I know if it wasnt for this injury I could do so much more at the gym and lose weight faster.

Ideas, suggestions, experiences, please?

bostongeek

Yikes!

My advice is to shop around PTs because frankly yours doesn't sound so great. Just walking on a treadmill is not, in my experience, a good PT plan--and I'm in my second round of knee PT for whatever that's worth as credential. My routine has included clamshells, side leg lifts, and a variety of other exercises that I don't want to actually prescribe because I obviously don't know what's wrong with your knee and twisting things the wrong way could be detrimental.

I had a knee problem (from an impact injury) for 3 years before I had the health insurance to get it treated, and after two months of PT I realized why people sing rhapsodies about the magic of physical therapy. It's amazing what good PT can do for you. The fact that it's so many months later and your PT hasn't helped at all and they're just making you walk and telling you they'll figure it out later are all red flags--my first injury was one of those "nothing is wrong" injuries but the PT worked with me to strengthen the surrounding muscles and things improved.

The planet fitness machine you're describing sounds like the hamstring curl. I do it too, but only after I did other exercises first, ie the hamstring curl was a second round of exercises after I'd already strengthened the leg somewhat. I'd suggest putting NO weight on the machine if you want to continue and just using the resistance of the machine.

Also, I wouldn't do anything cardio other than the elliptical until you get this sorted.

But basically, I think you need to talk to different PTs until you find one who can actually help you.

/2 cents, not a doctor, etc

GiddyupTim

Something is seriously wrong here. Has the doctor done an imaging study -- that is, an MRI?
If you are having that much trouble, you deserve to be imaged, so they can see what damage you have.
But, actually a physical exam should give them some clue. I am surprised they have not suggested a diagnosis to you. (I assume they have not or you would have mentioned it.)
If you have an ACL tear, which is a possibility with that kind of trauma, using a weight machine called a leg extension machine is not a good idea at all. It does sound like the machine you are describing is a leg curl machine. That strengthens your hamstrings, and it is often used for knee injury rehab.
Ask for an MRI. Now! An injury that is not addressed can lead to other injury.

bostongeek

Oh, yeah, what tufel said, if an MRI hasn't been done yet definitely start there! I assumed that had happened because that's the first thing they did to me both times, but if not get one done ASAP.

knightreader

my first piece of advice is to switch doctors.

second...go to a knee specialist.

in the meantime, do leg lifts. laying on your back on a hard surface, tighten your quad muscle and lift your leg off the ground without bending it. bend your opposite leg while doing this so that your foot is on the floor, knee pointed toward the ceiling. do ten, switch legs. make sure you bend the opposite knee. do these a few times a day. your knee is bone, so you need to strengthen all the little muscles around it.

third... ice and advil. it is probably swollen and you need to get the swelling down.

fourth... get an mri. any decent doctor will advise this, and there isn't too much anyone will be able to tell you until you have one done. once the mri is done, someone will be able to point you in the right direction. without an mri, to me, someone is guessing and wasting your time and money.

i'm not a doctor, but have spent more than my fair share of time at the knee doctors office and physical therapy.

good luck.

bahacca

What others have said. When I was in HS I had tendonitis in my knee and I wore a brace and did physical therapy for about 2 months-strengthening the quads as that is what was causing my tendons to basically slip and tear-quads were developed on one side of my leg much moreso than on the other.
I'd go to a Dr and ask to be referred to physical therapy first if surgery is mentioned.

CelineRN

My suggestion would be to get a second opinion from a orthapedic specialist. A MRI study would definately give the doctor a better look at whats going on with you knee.
I had a hiking accident where I fell on my tail bone. I never went to the doctor because being a OR nurse I knew they wouldn't do anything for a broken tail bone. Eight months later I started having back pain, It took 18 months, 4 therapist, 2 steroid injections to finally see a Orthapedic spinal surgeon. I was diagnosed with degenerative disc disease and spondylolisthesis ( slipped disc ) I have since had a spinal fusion with artificial disc and screws implanted and I have to say I'm 95% pain free. If I hadn't taken the first step and ask for that second opinion I would be stuck at home on disablitiy. Its worth a second opinion !!! Good Luck....

Azdak

It sounds like you really do not know what is wrong with your knee. It could be a structural injury; it could be tendinitis because the swelling from the initial contact shut down your quads and now your patella is not tracking properly.

The fact is, you don't know until someone does some imaging and gives you a specific diagnosis. At that point, a real treatment plan can be developed and then a rehab program.

Don't settle for being pushed around with a brace and some pills. That is not treatment.

gxdragon

Like others said, find another doctor, get an MRI. I tore my acl a couple years ago. It hurt when it happened but didn't really swell up until the next day. The risks of doing the wrong exercises with a torn ligament in the knee is damage to the miniscus.

Research the doctor, I used a doc that is a surgeon for several professional sports teams and has written a book on acl surgery.

SirDoctorofTARDIS

First off if it is an ACL I would give you a million dollars. From that impact I would lean towards a PCL which is generally a nonoperative ligament because we don't really use it. They might go in to debridement it if you have floating bodies. My hunch is that you have most of your pain with stairs/hill. Which would lead me to believe a meniscus tear. If you haven't had an MRI I would suggest it. ER's are great for emergencies but are terrible with orthopedic injuries like the one you have. FYI meniscus will never show on an xray because it is cartilage and only bone/metal will show on an xray. Wow it sounds like I know what i'm talking about. You's think I went to school for this or something.

ohmyshysamantha

I dont have insurance that will cover an MRI at the moment sadly. They did Xrays both at the ER and the specialist did a few as well. They said "it might be nerve damage" but then sent me to PT and never asked for a follow up and all of this happened in wisconsin and was covered by my schools insurance, but when I switched schools I lost the insurance that I had through them.

melly7171

I strongly recommend a 2nd opinion!!! You need and MRI done...but be carefull with that to because when i did my knee they did one of those and it didnt show anything then 6 months later still in pain my surgeon decided to go in a have a look...he told me after that i had a meniscal tear and it was really bad and didnt know how the mri didnt show it. Because of the 6month wait i now have arhtritis in it and will need a knee relacement in the next couple of years (im 41)...sooo please go get a 2nd opinion see a surgeon and keep pushing to you are happy with a result.

Also can you try claiming through the railway for them to pay as it happened in the accident?

BinaryPulsar

I dont have insurance that will cover an MRI at the moment sadly. They did Xrays both at the ER and the specialist did a few as well. They said "it might be nerve damage" but then sent me to PT and never asked for a follow up and all of this happened in wisconsin and was covered by my schools insurance, but when I switched schools I lost the insurance that I had through them.

They can do nerve conduction velocity to see if you have nerve damage. I'm surprised the PT only had you walk on a treadmill and didn't give you strengthening PT. Can you go to a different PT?

pen2u

I'm so sorry you're going through this. I have bad knees and have recently had a knee injury, so I feel your pain. It's hard not to get discouraged and depressed about it. The only thing that works for me is acupuncture (I'm lucky, my HMO covers it for a ridiculously low co-pay) and bike riding (either stationary or regular.) My doctor told me I have to strengthen the muscles around my knee w/ low impact exercise. Swimming would also be good, but I don't have access to a pool. Good luck and best wishes. Wear your brace even though you're sick of it

78brownie_wechanged

Bump - My mother JUST has a complete knee surgery

ohmyshysamantha

Also can you try claiming through the railway for them to pay as it happened in the accident?

Michigan is a no-fault state so I cant claim it through Amtrak. My auto insurance had to pay for my PT, ER visit, and specialist. And we just switched auto insurance companies and they wont cover anything from the accident because we did not have them as our insurance provider at the time of the accident, so until I get better health insurance I am unable to do anything that involves seeing a doctor. So I am trying to strengthen it on my own and once I can afford to pay for an MRI and a second opinion I will get one.

Casey45

Also can you try claiming through the railway for them to pay as it happened in the accident?

Michigan is a no-fault state so I cant claim it through Amtrak. My auto insurance had to pay for my PT, ER visit, and specialist. And we just switched auto insurance companies and they wont cover anything from the accident because we did not have them as our insurance provider at the time of the accident, so until I get better health insurance I am unable to do anything that involves seeing a doctor. So I am trying to strengthen it on my own and once I can afford to pay for an MRI and a second opinion I will get one.

You are in a terrible position and shouldnt have to be. Nobody should have to make do as you are. There must be a way you can be the sqeaky wheel and get better coverage. I would think that no fault insurance applies to cars, not trains for goodness sakes.

You've got god advise from the forum, lacking access to an MRI, less expensive but effective would be a better PT. you're in a university town aren't you? Maybe the phys Ed department, or athletics can point you in the right directions?

Best wishes.

meggyannpt

As a physical therapy student, I strongly suggest finding a new PT. Unfortunately there are PT's who do poor treatment such as walking on a treadmill. PT can help determine if an MRI is really necessary and give you exercises that will correctly strengthen the knee without causing more damage.

I suggest going to www.apta.org and click "Find a PT". If you really want someone who will do a great job find someone with OCS (orthopedic clinical specialist) or SCS (sports clinical specialist). You could also find someone with CMT (certification in manual therapy). All of these credentials require additional training.

It is probably worth pursuing an additional orthopedic specialist MD to help confirm what may be going on.

Good luck!