Episodes of knee pain in an active middle age man

Patient

Q: 42 yr old male east indian descent east indian descent history of playing soccer i work out 4 days a week strength and cardio...cardio I just do elliptical...provacative factors include running fast or slow jog, elliptical has no adverse effect on knee pain...sometimes i feel knee weakness before the pain starts...the knee feels swollen internally but no redness or bruising the left knee seems to be a chronic thing affecting me 2-3 times year for the past 6 to 7 yrs each episode lasts about 3days to 1.5 weeks depending on the severity and rates about 4-8 out of 10 on a pain scale...pain does not radiate down or up and when the pain is there it is constant dull ache, ice helps a bit, ibuprofen helps abit as well...with each episode, the pain starts insidiously and gets worse after 1 to 2 days, stays max for the 3 to 10 days and then subsides.

Doctor

A:    The pain in the knee that you described may be due to injury of the muscles and tendons that go from upper leg to close to the knee, any muscle strain or muscle pull or even a muscle tear implies damage to a muscle or its attaching tendons. The time of healing varies from patient to patient and also depends on the severity of the injury. There are other structures that might be injured and produce similar symptoms as: capsule, ligaments and menisci. In the view that you are having intense physical activity that is causing episodic pain, try to avoid “overuse”. There is a very well described entity in the medical literature called: Overuse Syndrome, which can affect any part of the body that is over stressed with movements or activities in a repetitive way, including occupational, recreational, and habitual activities. Repetition is part of the definition of overuse injury. The concept is that overuse injury is associated with repeated challenge without sufficient recovery time, and this is true for Body Building, Running, Jogging or any other sport or activity in which you exceed the guidelines and your own limits or capacities. The conservative treatment consists of: initially, protection, rest, ice, compression, and elevation (known as the PRICE formula) can help the affected muscle and also maintaining the strained muscle in a stretched position. Heat can be applied when the swelling has lessened, anti-inflammatory medication (i.e.: “Aleve”), rest the strained muscle and avoid the activities that caused the strain and other activities that are painful. A Physical Therapy program for 4-6 weeks must be followed and practice at home the stretching exercises above all. The healing time and conditions for each patient are different. Also, and very important, you have to stretch the hamstring muscles and the activities or sports that require frequent squatting must be avoided until the pain is under control. Check out your foot gear for adequate cushion and try to avoid hard surfaces when running. If there is a limited response to the treatment and locking or instability of the affected knee is noticed, then an orthopedic surgeon evaluation must be considered.

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