Chronic Pain From Repeated Injuries: Learning to Cope
In the first half of my life, I’d undergone four arthroscopic knee surgeries. In each instance, the doctor said that later in life I was likely to develop arthritis. My condition involves my patella (or kneecap) being off-kilter instead of fitting nicely into its place and remaining protected. Since it tilts slightly to the side and up, the chance of subluxation”when my patella slips out of joint”is more prominent.
The fact that I experience constant pain, either dull or acute, without having arthritis, always puzzled me. Much like a person with arthritis, though, I experience pain in my knee pretty much every day. Most of the time it’s so present I forget about it. At other times it flares up and becomes more disruptive. I’ve noticed that when it’s rainy or cold outside, when my leg muscles are weak having been overworked, or when walking down a lot of stairs, the pain gets worse. And then there are those strange moments when, out of nowhere, it inflames, which stiffens my knee and causes it to swell. And of course when moving the joint there’s the non-painful sound of what I call “rice krispies.”
These are the moments when I wonder: Ok, well, what’s the difference between arthritis and this constant pain I experience?
It turns out I was wrong to think chronic pain due to repeated injury was the same as arthritis. Though I don’t suffer from arthritis yet, and despite my different (though somewhat related) condition, there’s some merit in discussing my own non-arthritic, chronic pain. Knowing the diagnosis, and the causes of health issues make a huge difference for you and your doctor.
The Knee and How it Works
When healthy, the knee is a slick, smooth joint. It gives your upper and lower leg a hinge, which can withstand lateral (side-to-side) and medial (forward) motion at different levels of quickness. It also is able to handle a fair amount pressure from these movements, while absorbing body weight. Whenever we jump, run, and move in rapid spurts, the knee is required to be both flexible and keep the integrity of its structure. But when the structure of the knee is compromised, the risk of injury heightens. In my case, my patella is misaligned, which causes it to subluxate. This has happened multiple times, during multiple situations. This doesn’t add to my sense of certainty. I suppose this is why it’s also known as “knee instability.”
Medial Patellar Subluxation
The patella, which fits into that natural, slick groove when the leg is hinged, is supposed to slide up and down along a sort of track. However, a misaligned patella means a greater risk of subluxation, and the support one normally gets can no longer be fully trusted.
Subluxation can consist of two things. It’s either a slight dislocation of the patella outside the joint which stays there out of joint, or, as in my case, one that slips outside the joint and then quickly moves back. In my case, this causes both the cartilage and muscle strain, stress, and can even lead to tearing. The knee often swells after subluxation, is painful, and not able to withstand one’s full body weight. Usually doctors opt for conservative treatment first, like physical therapy. However, if it’s a more serious recurring conditions, surgical procedures may be necessary. Luckily, everything from minimally invasive surgery to full joint reconstruction help is available.
Treatments for Medial Patellar Subluxation
With mild subluxation, non-surgical procedures include the acronym “R.I.C.E.” This means Rest, Ice, Compression, and Elevation. This helps keep inflammation down, reduce swelling, and rests the injured area. Afterward, rehabilitation can involve putting more weight on the leg, flexibility and strengthening exercises, with a gradual increase in intensity to help the muscles regain strength.
Surgery was required in all my cases. The first three procedures were to “clean up” the knee from frayed cartilage. This included “shaving” the cartilage so it was smooth again. However, with repeated injuries, other issues arrived.
My cartilage became damaged to the point that parts had “broken off,” forming small, floating particles in my knee. I remember them feeling like small pebbles. I could move around with my fingers. It felt weird but wasn’t painful until a particle would “catch” between a joint or two bones. My knee would either lock or buckle, depending on how I was moving. There was no denying it: They had to be removed.
The consultation prior to the last surgery was the first time a doctor showed me exactly what was going on. By showing me X-rays of my knee, I saw how my patella was tilted both slightly towards the outside of my leg and up. Whether this was from faulty rehabilitation, repeated injury, or something else, was unclear. But after years of injury and pain, seeing the misalignment helped me understand the issue.
Because of strengthening exercises I had been, my larger, outer leg muscle was stronger than my inner leg muscle. Not only was the conditioning I was doing not helping, it made the misalignment worse. The strands of muscle on the outside were actually pulling my patella up. And since the patella was tilted, it would take only one false move to cause it to slip out of the groove and subluxate.
To help correct this, my orthopedist made an incision on the outside to release the tightness and then used sutures in the inner part of my knee to try and correct the misalignment. This was followed by physical therapy.
But the big question is, did this help? The answer: Yes and no.
If anybody can understand the difficulty of maintaining a healthy lifestyle while being diligent in caring for an old injury, it’s me. And yet, if I’m being honest, I don’t do a very good job at it. Nonetheless, it does help to know what’s going on. If you’re like me, rehabilitation is difficult and requires true commitment. Going in for routine check-ups, if required, are also hard when you feel there’s nothing definitive that can be done.
But for the sake of my body, and yours, this is what we must go through. It’s what could make the difference between a life that’s healthy, with only occasional, tolerable pain, and one shrouded in fear of discomfort and aches. Life’s too short for the latter.
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- Rodriguez, Diana. ‘What Arthritis Pain Feels Like’. October 28, 2015. Accessed November 8, 2016. http://www.everydayhealth.com/arthritis/pain-and-stiffness.aspx.
- Fleming, Ray. ‘Fast Facts about Sports Injuries’. November 2014. Accessed November 9, 2016. http://www.niams.nih.gov/health_info/sports_injuries/sports_injuries_ff.asp.
- MG, Saper and Shneider MD. ‘Medial Patellar Subluxation: Diagnosis and Treatment’. November 7, 2016. Accessed November 9, 2016. http://www.mdedge.com/amjorthopedics/article/103983/arthoscopy/medial-patellar-subluxation-diagnosis-and-treatment.
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- Clinic, Mayo. ‘Patellofemoral Pain Syndrome’. January 6, 2016. Accessed November 9, 2016. http://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/diagnosis-treatment/diagnosis/dxc-20169030.