I see a thread on Piriformis. But I have a different problem, wondering if anyone has knowledge?

[Joel S]

In mid May I had a mishap, my leg lost it’s stability for a moment while on line for a light to change.  Some knee pain.  Waited 2 dats and rode with a knee support, all was ok but knee pain persisted. Rode the next day and my knee blew up.  Within a day I started having pain that I thought was sciatica.  A bit of pain in my butt but that has been with me for years after my second back surgery. New was a burning pain going down mostly the outside of my thigh and also my calf. Went to knee doc, PA gave me a cortisone injection to bring down the swelling in my knee.  No help.  Went back 3 weeks later and the doc gave me a medro pak. Took for a week, not real difference.  A week later (which means it was not from the steroid) the burning stopped and I felt ok. On July 3 I rode around the block, all was ok.  On July 4 I went for a short 8 mile ride, got home and pain in thigh and calf got very bad but no burning. Have used ice and heat and both offered temporary help.  I had an upcoming visit with my pain doc as I was preparing for a RFA (Coolief) treatment in that knee.  He thought (and I had researched before) that the thigh pain could be from the IT Band.  He was not confident on the cause of the calf pain, knee, back? 

Before my Coolief treatment on Friday I went to MA general with a new MRI of my lumbar area. I have known there is a screw that seems to be abutting a nerve and needs to come out. 

I started physical therapy on Wednesday and the guy killed me but if it would help……. I am doing stretches and hoping the Coolief treatment will address the calf pain as I do not want another knee replacement as the first one I had never seemed to do very well.  Better yes but I still have pain and limits.  

Itching to ride again……

Any thoughts would be appreciated. 

Thanks

Joel

[Paul Clifton]

Hey Joel,

I've had knee pain for 25 years on and off and relatively recently have had some hip/quad/glute pain that sounds vaguely similar to yours. I haven't had any surgery or steroid or cortisone or anything like that though, so I can't comment much specifically. But I can encourage you to stick with the PT; it's really the only thing that has ever helped me - repeat visits to the same person who can assess my strength and mobility and adjust my program as I progress.

The main thing I'm learning as I approach 40 is that I need to take it slow and not re-injure myself while I'm rebuilding my strength. I turned 39 a week ago and start PT again 3 weeks before that for this hip/glute/back/quad stuff. I'm giving myself the next year to get my strength, mobility, and mileage back to where it was when I was 30. From your story, (filtered though my own experience so grain of salt ...) it sounds like you had something kinda minor that you then aggravated a few more times without adding in restorative movements.

IME it's normal for the first day or two of PT to be very hard and make me pretty sore, but if that persists, maybe try a different PT or at least ask for something lighter and build up to whatever they have you doing now. Also, I've found that working with and actual Doctor of Physical Thereapy is a LOT LOT LOT better than someone with a fewer qualifications. And physical therapists focusing on sports injuries may be better than the ones that focus mainly on recovery from surgery or others (although a good doc should be able to do both).

Any way, here's to minimal pain for all of us in the future,

Paul "life is pain" in AR

[JRStern11]

Hi Paul, thanks for your input.

I am working with a sports medicine group and their physical therapists. I will be 71 next week so anytime off the bike is stolen time and I only have a limited about of time living in the northeast. I have some days to see how my knee treatment will work, I am hopeful, as far as my calf pain that may be a very different thing and I will have to figure that one out. I have a feeling it is coming from my knee not my back some time will tell.

In any event slow and easy is the way I am going with this as I have few options and I really do want to be able to ride in the fall.

Thanks again. My knees have bothered me since I was in my late 40's, had one replaced in 2018, not great but better than the other one at the moment. I don't mind some pain as long as I can still function.

Thanks again

Joel

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[Philip Barrett]

Joel, I reread your post a couple of times and the 2 things that jumped out at me were the IT band and the MRI. If a nerve is being impinged you've hopefully found your issue and either way that surely needs to be addressed prior to anything else (including PT)? That nerve (and sciatica) would also point to the calf pain as the IT band does not extend past the lower knee.

What I have discovered is that our bodies will perform some clever physiological tricks to try & avoid pain at all costs and will stress other areas in doing so at which point it becomes difficult to isolate effect from underlying root cause. Theorizing here that perhaps the nerve/sciatica is causing the body to twist which in turn is irritating the IT band and causing the knee pain.

[JRStern11]

Phillip, I agree on what you say.  I am hoping the calf pain and maybe even the thigh pain are a resurgence of the sciatica that was 90+% gone after my last surgery 10 years ago. I have one doc who is in agreement so far that the screw has to come out and am waiting for a second opinion appt, but either way I know it has to go.  The pain that never resolved was a mild pain in my butt when in my recliner which had gotten worse before the thigh and calf pain.  Maybe my knee blowing up is coincidence, I prefer to have the screw removed than another knee replacement (my right leg one was not a great success, better but not better enough). This is something I had not thought of “ Theorizing here that perhaps the nerve/sciatica is causing the body to twist which in turn is irritating the IT band and causing the knee pain” and makes a lot of sense to me.

Thanks for reading my note thoroughly…….

Joel

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[Philip Barrett]

Just some thinking out loud with some lessons learned from experience. It took nearly 18 months for me to finally get to the point where I could start isolating cause & effect & we went down endless rabbit holes during that time. Iyengar yogi has helped immensely around too.

Since even a slightly bulging disc can inflame a nerve into agony I can't image what a screw could do in the same situation.

[JRStern11]

Phillip, I didn’t connect it right away but the pain in my butt started increasing some months before the leg pain.  I was doing some gentle Pilates but am not sure that this did not inflame it.  I have been stretching my back daily for about 30 years but my routine changes at times.  I have a good Orthopedic surgeon in Boston, a bit far but as this will be a day surgery I can make it work.  What I liked about him was that he did not want to touch my levels above which have issues but this is a slippery road once surgeries are done.  I hurt after I ride but it is a pain I can deal with. This leg pain has to stop as it interferes too much with life and I know the screw has to come out.  

Thanks again. 

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