Joint/muscle Pain After Accident

[jkapache]

I was dx with POTS back in Oct of 05... its been somewhat in control/ remission for a yearish... still symptomatic but cld pressure ect is much better. Went off the gabapenitin (dr advice) in june of 08 and in sept 08 started provigil to help with fatigue.

Anyhow, in dec of 08 had a fall off a horse and fractured the lower lumbar (the trans verse processors) I didnt need surgery:) just 3-4 months of 'rest' no lifting ect, a brace, and anti inflam meds. About 6 wks after i started having knee pain, around the knee caps, at first i thought it was because i was squating more instead of just bending over, but it didnt go away, so next time i saw dr he xrayed, they looked good so i went to pt for them. in the course of jan till now, i have had increased knee pain that i have had to stip the excercise bike, have had to stay off them, and in general they are sore! The pain also is in my ankles, and sometimes goes up my right shin. The lower back is still sore but from fracture standpoint looks good.

Now I have had CT of back and knees, MRI of knees and back, x rays of knees and back, and full body bone scan, all looking 'normal' just chondromalacia in knees.... but no big deal. I also go to pt 2 x a week for back and knees, have a massage and accupressure done weekly, have supportive gym shoes that dr approved with orthotics, i wear ankle, knee and back braces when up and 'working', take anti inflam. and nothing really seems to help.

Due to the fact that things from a mechanical standpoint look pretty good, im thinking this may be the POTS again? The dr would like to inject knees with synvic or euflexxa and if that doesnt work, then try cymbalta or gabapentin. Frankly im apprehensive about the injections because i have ALOT of joint and muscle issues, its not just one! I have never had probs with knees prior, and the ankles from time to time. So, im looking for ANY suggestions as to the next step- do i inject, try meds, or...??? THANKS FOR THE INPUT!!

[jkapache]

Anyone have any ideas? I dont know where to turn, Ive saw the orthopedic knee, spine, and ankle specialists, and also another DO orthopedic dr... I had a Rhuematologist do a work up in June of 08, and went back to him and the neuro in Feb... but still no luck!

[Miriam Poorman-Knox]

Well it makes me think that there is something wrong with your alignment. That would affect your knees and ankles. Since your back was injured, and its never just a fracture there are muscle contusions, bleeds and other secondary injuries. A "clicking" knee is not good that is bone to bone. If it were me, I would find out as much as possible about BOTH knees and ankles. That way you will know if there is trouble brewing on the other side. I really would bite the bullet and do it. Because as you ambulate now you are making the other leg support more and it will wear it out. I also think you should be doing exercises in the pool. That takes all weight off the joints. Good luck. Miriam

[janiedelite]

I think Miriam has good ideas about using a pool for exercise and making sure you are in alignment. In Sept '06, I was t-boned in a car accident the left me with whiplash and left hip pain. I had 2 hip surgeries, in 6/07 and 1/08, because multiple MRI's, xrays, and bone scans couldn't find anything. In the first surgery he found dented femur, torn labrum and inflammation throughout. I still had pain afterward and could hardly bear weight. I limped severely for 2 years, and in the second surgery he found a ruptured ligament he missed the first time as well as lots of inflammation. NONE of this showed up on any of my scans.

But I still had intolerable pain in my hip after the second surgery. What really helped was seeing a PT regularly who specialized in myofacial release. After limping so long, I ended up messing up my back and all of the supporting structures because I walked so crookedly. The first PT I saw post-op prescribed primarily exercises, which I wasn't able to do because the muscles and facia surrounding my hip were so tight and knotted up. I saw a PT in 6/08 who worked on me weekly to release the knotted muscles. It was quite painful at times, but she knew how to work with my body to get the muscles and surrounding tissues to ease up. I also had quite a bit of scar tissues from prolonged inflammation and surgeries.

It was a long road, but in Sept of '08 I was finally able to walk without the aid of my cane! My mom said I gained 5 inches because it was the first time she saw me stand without leaning to get off my hip in 2 years. I still go to PT and will probably always have residual pain and back issues, but the pain is manageable for the most part. I think if I didn't have POTS, I could work more on strengthening my hip and doing regular stretching. But many days my body just won't let me.

I've had over 100 PT visits due to my hip, and I think my surgeon would have given up on me and called me crazy except that I worked as a recovery room nurse where his patients went post-surgery.

I guess I shared all this to say that doctors are great at fixing immediate injuries, but often the tissues surrounding the injured area suffer from inflammation, lack of use, misalignment, etc. as a result of the injury. Do you have insurance coverage for PT? Can you get your doctor to write you a prescription for PT? If you get a prescription, call the PT office and ask if there is a PT who specializes in myofacial release. Also, it was my PT who originally diagnosed my hip injury and send me to an orthopedic surgeon. I'm sorry you're having such prolonged pain. When my back and hip are acting up, my whole lower body hurts and my opposite hip clicks frequently.

[jkapache]

THANK YOU both for the replies!! I appreciate the input! To start with, my knee actually does NOT click, Ive heard thats a good thing! LOL, I do see a knee specialist, spine specialist and an ankle specialist, and just to get another opinion I did go see another orthopedic specializing in sport meds.... they all are sorta 'stuck'.... I have been going to PT for my knees since feb 09 and for my back since mar 09. The PT doesnt help my knees at all, it actually algrivates it more, so now only do things that dont bother them. Squats, leg raises, and doing the stationary bike at a 0 rest. irritate them the most! I also see a deep tissue massage therapist once a week, and 2 months ago started accupressure and myofascial release therapy. Unfort none seem to be helpful! The massage prob is the best, but that would be still a small help. I will have to look into the pool exercises! Miriam, you mentioned biting the bullet and doing it, however what did you mean by that? Countining to learn about the knees and ankles or do the injections or...??? Sorry, a bit slow today! Thanks again for the advice! And Wow, 2 hip surgeries!! I agree with you that sometimes tests come back perfect, but can be far from it on the inside! I think POTS teaches us that!!

[Miriam Poorman-Knox]

The bullet of which I speak is the injections... You won't have this luxury. But I had my shoulder injected but he didn't tell me there were 3 inj. So I puked all over him and the P.T. that sees patients with him. Your body has been through so much and it is hard sometimes to realize that more doctors won't help. I am proud of you for being so persistent. Its so hard, as we all know to fight this. I worry that soon the dysautonomia will kick your butt. And then you wont be able to be as active. Please try the pool. Miriam

[jkapache]

Thanks Miriam! I will try the pool.... My fear with the 3-5 knee injections is that I have pain in more then just one knee and it isnt as if I can pinpoint exactly where it hurts, its just local joint pain... And my poor body has been thru so many tests and meds ect. how much more can it take?! Now lets stab u with some needles and steroids...!! I was just back to my ankle spec. for a follow up, he wants me to do the 7 day methocarb. med pak (?) I did it once before and it didnt help if i remember correctly... and again, its more meds.... i havnt decided weather or not im going to fill the script of not.. any ideas?

[Miriam Poorman-Knox]

I am not a Doctor, but am a trained rehab spec. The thing with the injections and I am just giving this FYI, is the will get all the areas...joint cavities. Did you say your doc wants to use steroids z-pac? Sometimes this helps your body. Because of your injury I would maybe see what other steroid treatment he/she/it would try? Otherwise I/we? don't usually use steroids. When your injured that goes down the drain. Its important to stop "the madness" pain.

In the pool all you want to do is slowly begin to walk forward backwards and side to side. This helps stabilize muscles in knee, so they can support the knee itself. Good luck, ALOHA Miriam

[jkapache]

They want to inject both knees with euflexxa or synvic, and do cortisone injections to the back (if the cortisone doesnt work then do an epidural) And yes, I do belive that is what the ankle dr wanted me to take for 7 days.... THANK you for the pool excercises!

[jkapache]

Miriam, I just looked, its the mederol dose pak....what are your thoughts/opinions?? MANY THANKS for all the advice!!

[Miriam Poorman-Knox]

Well FOR YOU I think its a good idea. Your body has been a punching bag of sorts and this may just be what you need to calm things down. My only personal rant about the zpack is its cost. It is outrageously expensive. Steroids are dirt cheap (as meds go) so if you are good at remembering to take them I would ask for a script for the # you need. Thats my rant. The z-pack is really east on the other hand. Let me know if it works. Miriam

[mkoven]

I've had no accident, but after back surgery (L5-s1 discectomy/laminectomy), it felt like all my joints went to @#$%. It turns out I have eds, but I think trauma to that area messed me up all over. I'm still limited, but have improved a lot with really good pt, myofascial release, and braces. It's really important for me to see that all the injuries are connected. My knotted up psoas played a role in my back, hip, and knee issues. and because I was walking funny, my ankles and feet were not happy. and we've recently learned that my thoracic spine is playing a big role in my neck issues.

I do daily stabilization exercises--mostly closed chain (foot on ground). I get wonderful deep tissue/myofascial work 1x a week with someone who really senses how everything is connected. and I also use a foam roller and hard rubber ball to work some of my bad areas on my own. I also now can tell when something feels wrong, so that I can nip it in the bud. To the extent that I am able, aerobic exercise helps me manage pain and ans stuff. These days, I walk slowly on a treadmill at full incline. The incline makes me engage my muscles in a way that stabilizes the joints. And the extra muscle work helps pump the blood back, so I'm less potsy. and now i love the endorphins. it feels like they wash away a lot of the pain and reset my ans to a certain degree. It did take me a long time to get there, though, including some cardiac rehab.

I'm very careful about posture and pacing and try to never let my pain get above a four. I've learned a lot about anatomy along the way, and how different muscles can work together productively or unproductively. I'm not fixed, but tons better than I was.

I have not had good luck with injections. Synvisc made my knees swell up painfully. Steroids only further weakened my weak tissue. I take ibuprofen or tylenol for headaches, but for the most part manage my muscle and joint pain without pain meds. this was not true initially. I was on some pretty hefty pain meds when everything first kicked in.

[jkapache]

THANKS for all of the replies!! I really appreciate all the input! I went to my back dr yest and he gave me a lyrica sample ( I asked him if he thought some of this could be pots related) so he siad to try it, i used to be on the nueronton so is the lyrica doesnt work, maybe i can try that again. He also referred me to a physiatrist that knows a bit about dysautonomia... so i figure I will give it a try..... since wed i have been having spasms in my back, and the dr also felt them, so he said to take a muscle relaxer for a few days at night to get rid of them. Of course he said we could still inject, but i am wanting to avoid that if pos! So we will see what happens! Good day to all

[Miriam Poorman-Knox]

Fabulous I don't know why I didn't think of that. My only caution about neurontin which I take mega doses of is "your knee problem is still your knee problem" Kudos trooper you are right on top of this/. M

[jkapache]

Yes, u are totally right, my thoughts with this are- that if i try the lyrica or nueronton and im still in pain then maybe its not the POTS and I should try the injections, but at least the N/L would help more then just the injection to the knees, back, and ankles! How much can they inject in a short period of time?!?! Ha, i'll give it a try and see where it gets me.... the shots are always waiting!