conflicting MD opinions and unsatisfactory advice on deteriorating knee

Pain & Rehab Forum [Moderated]
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Hello doctors,

I was referred to you via the StartingStrength subreddit and am very excited about the possibility of receiving your opinions.

To sum up, I am having significant knee pain with loss of ROM, I have received conflicting comments from doctors, and no one is offering me a solution other than “stop being active,” which I don’t want to accept unless I have gone down all other possible avenues first. My situation is complicated by the fact that I live overseas and cannot communicate well in the doctors’ language. I know you probably cannot offer professional advice in this forum, but I was hoping you could at least offer some medical “meta-advice”.

My Right knee is arthritic. Most of my life, I have had knee pain and dealt with it through strength-training. However, recently, the condition of the knee is exacerbated, and there are new symptoms that it is not clear to me stem from the arthritis. Especially, the posterolateral aspect of the Right knee has a pretty intense pinching sensation that accompanies any flexion of the joint. It is not a diffuse sensation, but focused on a very specific point in a ropy-feeling structure that looks from anatomy books to correspond to the biceps femoris tendon, although I don’t know that’s where it actually comes from.

The pinching sensation is the most annoying thing, but there are other new problems as well: for a while the knee was “locking” so that it would not extend to less than about 20 degrees, requiring me to limp until it unlocked again; the entire joint occasionally gets very stiff, preventing me from flexing past about 100 degrees at all and past about 50 degrees without pain.

I’ve been to 2 orthopedic doctors recently. One advised that removing the extensive bone spurs in my Right knee joint could improve my symptoms. The other, to whom I was referred for the surgery, declined to do any surgery and said there was nothing to be done and that the problem was with the knee’s capsule. I can’t talk easily with either or with other docs since they don’t speak English and I don’t speak their language.

I’ve stopped weight training because I can’t squat down, and my personal goal is to get the knee back to the point that I can do a squat.

I’d love it if you could speculate on what might be going on and give advice on resources like websites/books/articles with in-depth information on the knee, its diagnosis and surgical treatment, etc. that might let me understand why, for example, the surgeon declines to do surgery.

I have results and images from diagnostic tests, and I can post those as well as more extensive history/description of the problem if you think it would be worthwhile.

Thanks so much for your consideration.

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Hello,
Could you give me a little more background on the development of symptoms and your training history? How often do these “very stiff” episodes happen? The more background information I have the easier it will be to help discern what can be done to help you out.

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Thank you for the thorough history. As it would be increasingly difficult to offer best advice via a forum I would recommend a formal consult with either Michael of myself with which to discuss your current issues. It is not uncommon to have some episodic stiffness in your knees with the “bone spurs” identified by your physician. That being said, there are certain ways with which to build more capacity in that tissue and work on decreasing the frequency with which you are experiencing symptoms. There are almost always training modalities that can be introduced to build more resiliency in tissue, it just ultimately comes down to a factor of time for the prognosis. As this has been going on for quite some time, it will likely be a series of small gains that will add up to giving you less stiffness and more strength. Sometimes this is achieved by loading through a tolerable range in the major exercises and sometimes it can be beneficial to approach the problem from other angles. Regardless, there are certainly ways with which to modify programming to construct an efficacious program that will get you towards where you want to be.