Medical Questionaire: minor knee pain

Discussion in 'Health and Fitness' started by JayCam, Oct 25, 2007.

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  1. So story goes, when I decided to join the TA 18 months ago (before deciding to go regular) I started running properly for the first time in my life. I did too much too soon and developed knee pain which my NHS GP and physio said is almost certainly iliotibial band syndrome.

    So I cut back on the running and did some stretches and the problem vanished. Only to return once or twice very mildly and was immediately healed by the same stretches. The problem never effected my mobility or running. After a quick warm up it was gone.

    Regarding the medical questionaire what do I do? It says knee pain is a bar to service but surely this will not be? Should I put it on the form and hope that they will use common sense to figure out it is nothing? I am assuming that if I dont put it on the form and the GP brings it up then they will not be at all happy.

    Please advise!

  2. ITBS is curable by proper exercise and shouldn't be a stopper. Make sure you are symptom free and ensure you GP says this.

    If you lie on your RG8 med Questionaire you will end up in the poo but ensure you word it carfully.

    From Wikipedia:

    As with any injury or ailment, one should see one's physician, physical therapist or athletic trainer for diagnosis and treatment.

    For a runner with acute ITBS, reduce weekly distance training to 50% for 2 weeks, and only run on flat ground. After, in the absence of ITBS pain, slowly begin to build distance again. If ITBS pain remains or is chronic, one should stop running immediately for two weeks (minimum). If the pain and inflammation are still present, another month of rest may be needed. Once the injury begins to improve, resuming activity can be possible, doing low distance, low speed jogging on flat terrain. Also, changing one's route may help counteract re-injury, as running a common route may put increased stress on the iliotibial band of one leg.

    To prevent, or cure chronic ITBS there are some essential exercises:

    Strength building of the proximal hip musculature for controlling ITB tightness; especially the straight leg raising motion and hip adduction
    Performing specific stretches; Iliotibial band stretch, stretching the gluteal muscles, and other leg based static stretching
    To create a good treatment program, proper assessment of injury severity is critical. Once the injury has been properly assessed, a treatment program (usually consisting of three steps) can be planned. The length of time spent on each phase varies depending on the athlete, the reasons for the initial injury, and the severity of the injury.

    [edit] Immediate Treatment
    After noticing symptoms, the important task is controlling pain and inflammation. For these symptoms, RICE works well. Stretching is second in importance, to make sure that the iliotibial band does not become taut. Next, examining what may have caused ITBS is important. Issues range from poor training habits to structural abnormalities, but the shoes a runner uses are another consideration. For example, after 500 miles most shoes retain less than 60% of their initial shock absorption capacity, increasing the chance of ITBS injury. Lastly, anti-inflammatories or ultrasound may be helpful to relieve symptoms.

    [edit] Short Term Treatment
    If the pain and inflammation do not subside, all painful activity should stop while continuing immediate treatment. A regular stretching regimen is important. A video analysis of running movements may provide insight into problematic running mechanics. To retain fitness, a number of options will work at this stage, as long as they do not promote pain. Altering these exercises will minimize overtraining:

    Swimming, though abstain from the breaststroke as it may aggravate symptoms
    Optionally, wearing a life jacket, one may run in the pool (depth allowing)
    Cycling, though with care, as it may aggravate symptoms
    Speed walking, especially straight-legged to discourage pain
    Cross-country skiing
    Yoga, or similar low-impact aerobics
    At this stage, Steroid injections may be helpful, though some risks are involved.

    [edit] Long Term Treatment
    The last phase is only started once pain and inflammation are gone. Often, this phase involves returning to a normal state, even competitive sports. Though, at least these criteria must be satisfied:

    The injured knee has regained full range of motion without pain
    The injured knee has regained normal strength compared to the uninjured knee
    Cardiovascular endurance has normalized
    Most importantly, one must ensure that old symptoms do not recur. Thus, any pain or inflammation must be treated cautiously, especially if the ITBS was serious and involved a lengthy downtime. The return process must be gradual and treated with extreme care, structurally specific stretching during this time is essential and must be done extensively, before and after activity. Returning to activity should be done while correcting, or significantly reducing, any factors that were thought to have caused ITBS. If no factors are identified and corrected, the chance of the re-injury is much higher.

    Rarely, and only in extreme cases, surgery is used to correct the injury. Typically, unless one is still suffering from symptoms in 6-12 months, surgery is not performed. It involves the release-excision of the iliotibial band, performed after an arthroscopic evaluation of the knee, which rules out other causes for the symptoms. Only patients unwilling to adapt their exercise because of this injury undergo surgery; it should only be performed after all other treatments have failed.

    [edit] Rehabilitation

    [edit] After the Pain is Gone
    Continue stretching, as well as strengthening of the leg muscles.
    The patient should start running only after treatment.
    Restart running with small distances, building slowly.
    If the patient feels pain, he or she should stop.
    Even better, the patient should try to stop running before the pain starts.

    [edit] Some Rehabilitation Options
    Deep-tissue massage or Rolfing may help break up scar tissue that forms.[citation needed]
    Non-steroidal anti-inflammatory drugs (aka NSAIDs), in high doses for a period of weeks, can help reduce the inflammation.
    Strengthening exercises for the quadriceps femoris and gluteus medius muscles can help support the leg, thus lessening the load on the ITB.
    Glucosamine Sulfate and Chondroitin Sulfate may help.

    [edit] Example Physical Therapy Regimen
    For successful rehabilitation, it is essential to restore the flexibility of the iliotibial band, and the strength and flexibility of the muscles which act upon it. Stretching the band is a complicated task; before the band can stretch, the hip flexors must stretch.

    To prepare for ITB stretching, one may heat the lateral thigh with hydrocollator packs for a period of time, typically twenty minutes. This is followed by ultrasonic heating (1.5-2.0 watts/cm²) to the length of the ITB tract for 5-7 minutes. After one stabilizes the pelvis while another person (qualified therapist) stretches the leg to maximally tolerated adduction. This may be repeated using three 1-minute stretches. Cryotherapy of the painful and inflamed tissue for ten minutes in the stretched position is also effective. (Gose, 1989)[1]
  3. Thanks for digging all that out mate. Luckily I never got anywhere near the stage where steroid injections or tortuous stretching was required!

    So I should definately put it on the form but play it down?

    Another problem might be that in order to see a physio I had to play it up and say I had been experiencing it for a number of months when in fact it had only recently occurred. I hope this doesnt come back to bite me on the arrse!

    Still its reassuring that you think it shouldnt be a problem!

  4. J, I had a few bits of medical history that in theory could have been a bar, but figuring the doc was gonna mention them if I didn't, I went with the up front and honest approach. The only time these issues got mentioned was in the medical, just to go over how they affect me now.

    If you word it correctly, but don't miss anything out, your GP should just sign to say that you are right.
  5. Again very reassuring thanks for the post! I recently heard of someone who got turned away for a shoulder problem which, if they had disclosed it, wouldnt have been a bar. But because they didnt, they were turned away.. got me thinking!

  6. Sarastro

    Sarastro LE Reviewer Book Reviewer

    ITBS ranges from being very minor & easily cured, to causing permanent damage. Your case sounds like the former, and I know several people (including myself) who have had an IT problem previously & no problems with service medicals. If the forces turned away or discharged everyone with a muscle injury, we would have no teeth arms.

    Just be upfront, ensure that the minor nature is understood, and any doc doing a medical should have no problem with it.
  7. Thanks S.

    Thats that then. I will declare on the form a "small, tiny, mini, ultra mild dose of ITBS" and cross my fingers.

  8. Had bad knee pain, was like a red hot nail driven under the knee cap, thought I would projectile vomit every time I bent it past about 35 degs.. Not nice...

    Cause.?? running down hills with too much weight... :(

    Stopped that and started a course of glucosamine, a month later no problems.. :) and have adapted my style to the bergan shuffle.. lol... less impact on the knees is key..

  9. As an added idea would be to add a training program you have been doing over the last 3-4 months with distances and other info with remarks if you had any pain. You will probably find out that you would get an exercise programme given to you anyway so at least it would save a bit of time off deferrment. Ask your recruiter about it, but i got some of my applicants to do it and it worked well.

    As said dont lie on your RG8