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 Post subject: Kneecap impact
PostPosted: Wed Apr 09, 2014 11:19 am 
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Joined: Thu Jan 08, 2004 10:11 pm
Posts: 723
I hit my knee against the door of my car last wednesday. It hurt like hell... Went to have it x rayed the day after and the doctor said it was bruised, but not broken. Advised treatment was RICE. So I've been off the bike for a week now, taking Ibuprofen 3 times a day, massaging with Voltaren gel 2 times a day, and after work I just lay on the coach with my leg up and using an icepack a couple of times a day.

But it feels just as painful as a week ago. I'm a bit worried that it might be worse then just a bruised kneecap. Can they even see a small crack on an x ray? Or only whether it's broken into pieces or not? Do I need an MRI? In Belgium, if you want to see an experienced specialist doctor, you have to make an appointment months in advance... The emergency doctors (like the one I saw) can be seen within a few hours, but are usually still in school. So I'm a bit worried that he may have made the wrong diagnosis. I had an ankle problem and was given the wrong diagnoses several times years ago. Turned out to be RA which kept me off the bike for 5 years. Don't want to go thru the same hell again. I've made an appointment with a knee specialist, but I have to wait until August :'( Will probably have healed by then.

Anyone have any experience with bruised and cracked kneecaps? How long does recovery take? When is it safe to ride?


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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 09, 2014 12:03 pm 
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Joined: Tue Sep 20, 2011 12:54 pm
Posts: 387
Location: Haines, AK - Temporarily
The kneecap has at least 2 tendons going across it, the quadriceps tendon and the patella tendon. If you damaged one of those tendons, it can feel just as painful as a bruise.

I've battled an injury to my quad tendon, it took a very long time to heal up (months). Sitting at a desk, with my knee bent, really exacerbated the issue.

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 Post subject: Re: Kneecap impact
Posted: Wed Apr 09, 2014 12:03 pm 


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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 09, 2014 3:36 pm 
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Joined: Thu Jan 08, 2004 10:11 pm
Posts: 723
I think the quad tendon could be damaged.
How long did it take you to get back on the bike? Any tips on speeding up recovery?


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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 09, 2014 4:01 pm 
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Joined: Tue Sep 20, 2011 12:54 pm
Posts: 387
Location: Haines, AK - Temporarily
For me, it was sitting at my desk with my legs bent that made it worse and prevented a faster recovery. It took me a long time, too long, to track down what exacerbated the issue.

If I get re-injured and after the main injury is largely healed, I will ride and just make sure I use ice afterwards. It was ice (lots of it), and how I sat at my desk that, were the biggest things to recovery.


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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 09, 2014 4:36 pm 
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Joined: Tue Sep 20, 2011 12:54 pm
Posts: 387
Location: Haines, AK - Temporarily
FWIW: Those knee/tendon pressure straps they sell at CVS really helped take the pressure off and help with healing. The part of my injury that lasted the longest was the tendinitis/inflammation.

http://www.amazon.com/Mueller-Knee-Stra ... knee+strap


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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 09, 2014 6:30 pm 
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Joined: Tue Jan 22, 2013 6:23 am
Posts: 372
I'd go see a specialist.

I broke my acromion (shoulder) many years ago. I went to hospital they took x-rays and sent me home. I went back to the hospital a week later because I still could not move my arm. They took more x-rays, at least 10 and sent me home for more rest, diagnosed as a bruised clavicle. I went to a specialist who found the fracture in my acromion and gave me a special brace to wear while it healed.

I also messed my knee up too. Went to the hospital and was giving x-rays and diagnosed with a sprained knee. It took about 3 weeks until I could put any weight on it. I took about 2-3 months until I was walking decent again. A year later I was having knee pains so I went to a specialist who did x-rays and MRI's. He found my ACL was completely ruptured and my cartilage was torn and getting stuck in the joint causing pain.

I'd go see a specialist if I were. Life's too short to be in pain.


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 Post subject: Re: Kneecap impact
PostPosted: Thu Apr 10, 2014 12:39 am 
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Joined: Sat Jul 30, 2011 6:38 pm
Posts: 243
As someone who has worked in emerg it seems like a reasonable diagnosis given your description and relatively minor trauma. Small fractures are sometimes hard to see initially but on repeat x-ray the healing process actually makes it a lot easier to see, so re-x-ray 2-3 weeks later can aide a lot in the diagnosis. As far as bony injury, CT gives better resolution than MRI but the MRI is much more sensitive than CT for soft tissue injury.

Injuries like bomber's sometimes won't show anything on x-ray (or very subtle changes) but I don't think you had the kind of trauma that would of tore up your knee like that. Even injuries like those are often hard to make clinically in the acute phase clinically because of pain and guarding. In that case repeat examination in the docs office several weeks later when pain has improved, or an MRI would be appropriate ways to diagnose this. (I hope the knee and acromion are better bomber)

Soft tissue injuries and bony bruises certainly can take a lot longer than a week to heal.

May think about some other adjuvant therapies like kinesio tape (personally I think RockTape is the best of those) and ultrasound.

Physiotherapy should almost always be one of the first steps for athletes, we push ourselves hard and that often delays healing. What we call doing nothing other would call high activity. Better to have someone highly trained in recovery of MSK injuries like a physiotherapist involved early, especially if you can find one who works a lot with cyclists. As a gp we deal with so much stuff it is hard to be that specialized. With my emerge doc hat on often we often fall into the trap of just trying to rule out something serious and then deferring to someone else to follow up so we can move on to the next "emergency" (frustrating I know).


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 Post subject: Re: Kneecap impact
PostPosted: Fri Apr 11, 2014 8:30 am 
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Joined: Thu Jan 08, 2004 10:11 pm
Posts: 723
Went for a swimm this morning. Did 20 laps freestyle with a pull buoy, and then 20 without pull buoy gently using my legs.
It seems to have been benificial for my injury. Pain hasn't increased or decreased, but the stiffness (from trying to keep my leg straight the last week) seems to have gone away. It also has a positive mental impact, because not being able to excercise for over a week now was slowly driving me insane... :cry: I'll try to keep off the bike for another week just to make sure I don't aggravate things.


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 Post subject: Re: Kneecap impact
PostPosted: Fri Apr 11, 2014 4:58 pm 
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Joined: Thu Jan 08, 2004 10:11 pm
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Had an echo taken today just to make sure. Turns out I have a kneecap and quadriceps tendon contusion. So luckily the tendon isn't partially ruptured. Doctor did advise to stay off the bike for a couple of weeks because it's a week spot and I could rupture the tendon.
I'm dissappointed that I won't be riding the next couple of weeks because the weather will be excellent and I took a couple of vacation days to ride... But I'm happy that it's not worse...


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 Post subject: Re: Kneecap impact
PostPosted: Sat Apr 12, 2014 1:24 am 
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Joined: Tue Jan 22, 2013 6:23 am
Posts: 372
Glad you got it pinned down. Rest up and stay positive. You'll be back on the bike soon and enjoying life.


@drchull, thanks! The knee and shoulder are doing great.


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 Post subject: Re: Kneecap impact
PostPosted: Sat Apr 12, 2014 11:37 am 
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Joined: Tue May 05, 2009 2:43 pm
Posts: 57
Location: Clermont, FL
You want to make sure that you knee mobility stays as normal as possible without forcing the motion. Inherent scar tissue will develop and possible instability "knee feeling like it wants to buckle".

I would definitely stay away from impact activity and make sure that your patellar mobility is as normal as possible- moving your patella with your fingers side/side and up/down with your knee extended and quadriceps muscle as relaxed as possible.

Good luck and let us know how things work out.

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 Post subject: Re: Kneecap impact
PostPosted: Wed Apr 16, 2014 8:51 am 
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Joined: Thu Jan 08, 2004 10:11 pm
Posts: 723
Still can't ride my bike, even walking still hurts...
Did another swimm session this morning with a pull buoy. Will go swimming again on Friday and Sunday. Glad I can still swimm, because I would go nuts otherwise. But pretty pissed off I can't go riding. Doesn't feel like I will be back on the bike soon :cry:


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 Post subject: Re: Kneecap impact
PostPosted: Mon Apr 21, 2014 10:02 am 
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Joined: Thu Jan 08, 2004 10:11 pm
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Friday was the first day that I felt an improvement. Although the kneecap still feels sensitive to the touch and the tendon feels a bit stiff. So I took it easy during the weekend and decided to do my first bikeride today (monday). I went for a 40 minute easy ride @avg 65% of max hr, and avg 98rpm. My knee felt ok. I'm on the couch now with an icepack on my knee.

If I don't feel any discomfort or pain the next 2 days, I'll begin training again on wednesday.

I think I did the right thing by not getting back on the back too early. So, for those in the same situation, wondering how long recovery takes after a bruised knee... It took me 3 weeks to recover :(

week 1: RICE + Ibuprofen + NO excercise
week 2: RICE + Ibuprofen + swimming with pull buoy
week 3: RICE + swimming with pull buoy
week 4: time to get back on the bike :D


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 Post subject: Re: Kneecap impact
PostPosted: Thu Apr 24, 2014 1:30 am 
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Joined: Sat Jul 30, 2011 6:38 pm
Posts: 243
Good news. So hard to predict recovery, depends on size of hematoma, location etc. I would probably look at a massage in the first week returning to the bike as well. Again would suggest kinesio tape. Not going to quote studies here but certainly may help as getting back in the swing of things.
Glad to here things are going well, good luck getting back into things.


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 Post subject: Re: Kneecap impact
PostPosted: Fri Apr 25, 2014 8:23 am 
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Joined: Thu Jan 08, 2004 10:11 pm
Posts: 723
Thx for the support.
So far I have done 2 rides. One very easy 40 min ride just to see how the knee would hold up. And a couple of days later an easy 90 min ride. Will try a 120 min ride tomorrow.
Cycling at an endurance pace doesn't pose a problem. But as soon as I push a little harder I can feel a sting in the knee. The kneecap is still sensitive when I touch it, when climbing stairs or even when driving my car. I guess it will take a couple of weeks before it is fully healed.
But I can do some easy endurance rides on the bike and I can swimm. So I'm happy.
I think I did the right thing by taking it easy the first couple of weeks.


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 Post subject: Re: Kneecap impact
Posted: Fri Apr 25, 2014 8:23 am 


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