Question:

I had a knee problem about 5 years ago. MRI showed nothing wrong, but I couldn’t walk comfortably for fear I’d fall. I saw a PT who was kind but gave me boring exercises I did but didn’t help clear the problem and another PT who just massaged the upper leg. I ended up “waiting it out” so to speak as it eventually just got better.

Now the other knee is doing a similar thing curtailing all fitness walking exercise again. Its been going on for 4 months now and I don’t want to go through the doctors telling me there is nothing wrong, paying for PT that isn’t helpful or waiting it out. This time, the left, problem leg wants to fall to the left when doing floor exercises that call for legs straight in the air. That’s different. Any thoughts?


Answer:

I’m sorry to hear of your knee problems and subsequent difficulties with the recovery. Without doing an examination to better understand the contributing factors I’m not able to comment at length on your specific condition. However, we can talk about some general principles of knee injuries and rehabilitation. I certainly understand the frustration of being told nothing is wrong when you’re experiencing pain or having trouble walking. An MRI is intended to show structural disruption or abnormalities; if there was nothing notable on them that’s a good sign! But an MRI is not comprehensive as it is unable to show lots of things and doesn’t capture how your knee functions when you are moving. This is an important distinction as we can have healthy tissues and structurally sound joints that may show up as normal on an MRI, but due to potential musculoskeletal dysfunction when we move there may be irritation that doesn’t show up on an MRI.

It’s also not uncommon for musculoskeletal issues to resolve after “waiting it out.” The body is both good at healing if we allow it, and our bodies are also good at figuring out how to move to avoid pain. When we avoid pain by compensating we make ourselves vulnerable to further or additional injury, such as to the hip or the opposite knee. This would be an important piece of an evaluation made by a Physical Therapist: the degree to which the previous knee injury has resolved and if other structures around the knee are contributing to your current episode of pain. I understand that the previous PT exercises may have been “boring”; generally speaking, in the initial phase of rehabilitation exercises are often simple to reduce inflammation, improve range of motion, and increase strength. After this initial phase we begin more advanced strengthening and challenging tasks and progress towards more functional, full body movement training.

Another factor to consider with rehabilitation is that the longer problems persist, typically the longer they take to rehab. Your newest episode of knee pain has been present for long enough that I’d be concerned that it may not resolve passively as your other knee did, or that in doing so there may be disruption to other nearby joints. For the reasons I’ve mentioned I’d recommended seeing a Physical Therapist for an in-person evaluation to best identify what is contributing to your knee pain and get you started on a regimen so that you can both walk and exercise with less discomfort and limit any further injury to your knee or elsewhere. I’d also recommend sharing your previous encounters in Physical Therapy during your evaluation so your PT is fully aware of your concerns and experiences. Physical Therapy is a collaborative endeavor and communication with your practitioner is important in your success with rehab.


**This reply is for informational purposes only. It’s not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with a medical condition.