Expert: Dr. Man Tran, Ph.D., D.C., L.Ac. - 1/18/2009

Question
QUESTION: dear Dr.man tran
i had interesting about chiropractic since first i heard about it,and what encourage me to write to u especially i was practicing taekwandoo as well, by the way i am medical intern,, and has left knee problem, my history is started by medial compartment pain, since i started standing for long time,, in emergency room about 2 years ago, i started to wrap it with crip bandage and the pain disappear completely,i kept using it for about 3 months after that i recognize small swelling medial to patella,, then it got bigger and extend to the lateral side of patella,I've been told is hoffa's syndrom( fat pulging ) but nothing run with it, and it isn't bursitis,because rather than swelling and pain i had no tenderness or redness etc..by examination:- i have small degree ( more than 10 degree )Geno-valgus,, and i guess there s small widening between the femure and tibia on medial side,, when i am doing side split i feel stress on the left joint, its like iam stressing the ligaments, its not something about meniscal tear or something,because i have no sign of it.
i need at least proper diagnosis, nothing convince me to this point,, i hope u have the answer to my problem and i will attach some pic of my left knee.

thanx and best wishes

ANSWER: Hi Ahmad,

Have you had an X-ray done of the left knee?  

From what you described, I am leaning more toward ligaments being lax.  This will cause the knee joint to be loose and less stable.  The swelling could be due to the instability of the joint as it is moving around causing friction.  

By having improvement with the use of the wrap points more toward the instability of the ligaments.  The wrap acts as an "artificial" ligament to hold the joint stable.  The stretching of the left knee would give you a sense of "give way" or unable to hold since the ligaments are stretched.  

My only recommendation would be to rest the knee especially with any TaeKwonDo kicking since this will add stress to the knee.  While giving it a week or two of rest, ultrasound and massage therapy can also enhance the healing process.  If the case is the ligaments being loose, physical therapy to strengthen the muscles around the left knee would prevent future injury and allowing you to go back to TaeKwonDo.

I hope that help.  



---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Man Tran
your answer may be clarify to me the error,, its remind me when i am doing front split for the right leg, i might be stress the left knee which was in the rear because i was putting the sole of the left foot facing the ground, while there is no elasticity in the medial compartment muscles of the thigh, i guess it was the sartorrius muscle which played a role in out bowing of the left knee , letting the medial part of the knee and ligament facing the stress

*BUT why there was kind of popping ( sound of like friction or stretching two rubbery band )  in the knee while i was doing the squatting before the swelling appear ?

thanks again and i appreciated your concern

Answer
Hi Ahmad,

Hmmm...I think I will start charging you per word!!!

The popping sound that you described may be due to the tendon(s) running through or across the knee joint.  This "clicking" sound is the rubbing of those tendons which will develop into "tendonitis."  As a result, swelling will follow with the continuous agitation(friction).  

In this case, management would be recommend with rest, ice, and elevation along with massage to move the fluid.

Since the x-ray did not show any bony abnormalities, then it is a good prognosis.

PS: Thank you for giving me brownie points.