Baker's Cyst
I have been dealing with some intermittent patellar pain for the last several months. Some runs it is bad, others, non-existent. Did my long run Thursday and yesterday began feeling like the back of my knee was swollen. Now, I have a golfball sized lump at the back of my knee. Not particularly painful, just uncomfortable.
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@Gina:
you did not ask a question, but i can't resist an orthopaedic issue. fluid build up behind the knee (i.e. popliteal or baker's cyst) is a normal response to trauma or irritation of some sort. it could result from arthritis or cartilage tear in your knee (i.e. meniscal tear). also, could be caused by other things that are more rare, but in your case most likely one of the two i mentioned.
would be worth an appointment with an orthopaedic doc or a good sports medicine doc, to rule out mensical tear clinically and to evaluate arthritic signs at patella and knee with x-ray. typically general practioners are not well trained in musculoskeletal issues, which is why it is best to try to get a direct appointment with a specialist or insist that your primary care provider take your symptom and concern seriously. tell them you are a long distance triathlete and that'll usually let them know that they can't blow you off.
assuming there is no reason to suspect a meniscal tear and it in fact is arthritis, what to do?
-i'd recommend proper shoe to match your style of running;
-focus as best you can on technique. a proper run technique can diminish impact significantly and your knee joint would feel less trauma.
-excess weight is super hard on joints, so trying to stay lean decreases the impact forces;
-always run perfectly and when you cannot due to fatigue, walk until you can run perfectly again. by doing this in training, you'll be ready for the race.
-ice after each run.
hope this helps!
Dr.G
Gilberto, thank you for your response. I did forget to phrase my post as a question, but indeed I was asking.
I rode with him and he toes in on that side when in the TT position and hugs the top tube pretty well with his knee on the involved side. He doesn't have lots of side to side motion of the ankle or knee so I do not think it's the bike (he always rides toe in and hugs the top tube as I've ridden with this guy for the last 3 years).
Shoes?
We did isolate that he sits at the computer much of his work day and he puts his feet under his chair and twists his ankles in odd directions. The most common for him at his workstation is external rotation of the tibia with his knee bent @ 90 degrees and he lets his knee drop medially. This will have a tendency to rotate/subluxate the tibia under the femur and not allow the normal screw-home mechanism and then the popliteus spasms to stablilize the knee. A dysfunctional/spasmed popliteus, in my experience, leads to meniscus irritation as the posterior aspect of the knee stays tight and the posterior medial horn of the meniscus is ripe for the start of a tear.
IF there isn't significant meniscal issues then often ART of the popliteus and sometimes manipulation/adjustment of the tibia to the femur changes it. This was the case in my friends knee condition as I treated him on Thursday then we rode 4 hours hard together (0.87) on Saturday (he continued on for another 2.5 hours for 6.5 hours total) followed by a brick run of 6.5 miles @ 7:30 pace with zero issues afterwards or the next day.
Vince
my 2cents:from another orthopedist
1. Usually cysts are sec. to something wrong inside of the knee (i.e. meniscus tear, arthritis, etc) or chronic inflammation behind the knee, like tendinitis
2. Usually if you get rid of the underlying problem the cyst will resolve
3. Ocassionally the cyst can rupture on its own (acute onset of pain, swelling..........can acually mimic a blood clot)
4. IF there is pain AT the cyst location sometimes it can be aspirated under ultrasound guidance (usu. a radiologist can do it)
5. Surgical removal is not a good option....they can come back and the healing in the back of the knee is not good
Just some addit. info
Thanks to all for the information. The swelling has diminished, but I am going to get into a local sports med ortho this week.
Sounds muscular to me. That bakers cyst is nestled in between the hamstring tendons. If they tighten up, friction will increase and the cyst can get aggravated and swell. All of that pressure behind the knee will then pull the knee cap down tight, causing the symptoms in the front. It would also explain why it's there on some runs and non-existant on others.
What kind of stuff are you doing on the back of the leg?? calf + hammie. stretches + rolling. is this the same leg?
Leigh- I am going to email you. Thx.
Leigh, I had a Bakers Cyst and mine ruptured during an 80 ft. scuba dive. My surgeon said the pressure of the depth and the wet-suit caused the perfect storm. The surgery was brutal though and I would do everything your doctor or PT tells you to avoid it. They have to go in deep and mess with all kinds of nerves and the insision is like a snake incision about 5-6 inches long. It took a LONG time to recover. Just wanted you to be as good as you can be and do all you can to avoid any surgical removal.....that was the surgury I ended up with blood clots and ended up on Coumidin! So lots of luck and I will keep reading your posts to see how you are coming along!
Sorry Gina, Leigh's message was meant for you!!