Physio and injection haven’t worked-what next for my knackered knee?

[Greenfingers37]

I’ve had a very painful knee for about 5 months. It’s agony when I put weight on it and sometimes throbs when I’m resting. So far I’ve had a cortisone shot and private physio, neither of which have worked. I’m seeing GP again next week and just wondered what I should expect her to offer me. The pain is mainly at the side of my knee.
For context, I’m 57 and very active (at least I was!). I did Park Run regularly and was an active member of a running club. It’s getting me down now as I’m trying to stay as fit and active as possible as I approach my 60s!
Thanks in advance.

I had a knee pain problem for a long time, and had physio and several steroid injections, which were quite effective but the pain always came back eventually. I went to a Podiatrist (private) for an unrelated foot problem, had a Gait Analysis done and prescription Orthotic insoles into my shoes, which sorted my foot problem and stopped my knees hurting as an unexpected bonus. Might be worth a try?

I would expect them to send you for an MRI to find out exactly what the issue is.

Glad you got yours sorted. I’m open to any ideas at the moment! Thank you.

I’m hoping this is what will happen so I’m glad it’s not an unreasonable thing to expect. Thanks.

GP will probably be limited to sending you to the local MSK centre. However that is ultimately the route to eventually seeing Orthopaedics.

What did the physio say was the likely cause of your knee pain? GP will be unlikely to refer for MRI unless some kind of trauma to your knee. Have you had an X-ray?

I had all the usual cortisone, physio etc. One injection of Hyaluronic acid gel and it was amazing. I also lost 3 stone in weight and that has helped as well!

So the GP isn’t likely to refer for any kind of scan/xray?

That sounds amazing! I’m about 1.5 stone overweight and am addressing that so that might help I guess.

She said it was inflammation of ligaments.

Push for an MRI. I had bad knee pain after I tripped on a raised paving stone. XRay was clear but as the pain persisted I went privately to have a scan which showed a fractured knee and torn meniscus. Maybe a problem with your meniscus as pain on the side of the knee.

Are you doing the exercises prescribed by the physio in between appointments?

Thanks for your reply. Can I ask what the private MRI cost? And did you have any follow up treatment?

Yes, religiously.

You could try to get an Xray which should show if there is any arthritis or anything else causing pain. I had pain in my upper thigh and did the usual physio, run around - I eventually paid for a private scan which showed severe arthritis and that I would need a hip replacement - physio helped me to strengthen my muscles but nothing takes away arthritis pain other than a replacement. I hope you get the answers - but a x ray should help see what is happening and that will determine what course action is needed.

There's only one cure for that. Time. Are you using anti-inflammatories? Maybe need to wait until the inflammation subsides, and then strengthen the muscles around the joint to support it.

Was it an ordinary private physiotherapist you saw or a specialist sports physio?

Forgot to mention - they said it was inflammation of ligaments, but what did they think had caused the inflammation in the first place? No good treating symptoms until you have identified the cause.

How do you figure that ? wasn't for me 💁‍♀️

No, she didn’t say and I foolishly didn’t ask.

No, just trying to push through the pain.
She was an ordinary physio.

I am waiting for MRI results for hip and spine chronic pain but it has been suggested I may benefit from shockwave therapy, has that been mentioned OP?

I saw an orthopaedic surgeon who and he organised the MRI. The MRI cost about £460 and I returned to the consultant who interpreted the results. In all it cost about £900 which was money well spent as the physio had been giving me exercises for osteoarthritis which were totally wrong for a fractured knee.

I was sent for an X-ray and that only showed minor arthritis in the knee. I went back and they sent me for an mri, it showed that I had a lot more going on so I had physio. Then 4x steroid injections that have now stopped working. They’ve now put me in the wait list for a new knee.

Good luck persuading your GP to request an MRI! The health board here don't deal with knees unless you arrive at A&E in pieces or are over 60.

A decade ago I fell on black ice landing heavily on both knees. Embarrassed I picked myself up and went back to work. Bruising was horrific, swelling worse. After 6 weeks one knee was back to normal and the other was not. GP sent me for an x-ray which showed 'no damage or sign of arthritis' - the recommendation was physio for which there was a 13 week wait. As I was in a lot of pain I paid to see a private orthopaedic consultant who specialises in knees. One MRI later and I was booked for surgery to remove the fragments of the back of my kneecap which had been broken off when I fell. The front of my kneecap was fine! I also discovered that the damage is so bad that really I need the whole knee to be replaced - not old enough for the NHS to do it and it's a lot of money to do privately. Oh and the physio would have caused further damage! Several years on I have chronic pain (steroid and hyaluronic acid injections don't help - ive tried both) which I manage by taking anti-inflammatories, resting it after prolonged use and avoiding things which I know will make it worse. In 2 years I'll be old enough to get it replaced - yippee.

Good luck - I hope you find a solution.

It isn't that they won't, it's that they can't.

Generally ICBs have decided that the route for chronic musculoskeletal problems is referral to a MSK centre where you see a physio. That physio then decides on whether you see Orthopaedics or get any scans done, not your GP.

My DM who very obviously needed a shoulder replacement, and had been told by a previous surgeon she needed a shoulder replacement, had tried all the physio and had the steroid injections still needed to go to the MSK centre first.

The physio there took one look at her and referred her straight on to Ortho. But she and the GP still had to jump through the hoops of the MSK referral.