Hip & Knee Pain - 2 years - Long post!

Hi everyone,

I'm a 23 year old looking for some answers about hip and knee pain. Body wise I'm 5'5', slim and have a pretty high level of fitness (I cycle regularly and do quite a bit of yoga).

Apologies for the mega long message, but I think it's important to include all the detail.

Before all this stared, I'd never had any problems with my knees or joints. About two years ago, I was travelling, carrying a heavy backpack for 2 weeks. About mid way through the trip a problem arose in my knee - while I was walking (freely, without my backpack), I felt a painful slipping feeling in one knee. This didn't seem severe. A few days later, I was off on a trek where we climbed a mountain with hundreds of steps. I could feel tension building in both knees, and I felt the slipping happen in the second knee. Once we got to the third day and I was required to walk downhill, it was nearly impossible. Both knees became increasingly sore and painful (particularly when walking downhill but in general they were very sore). One I got down (I could barely walk) I massaged both knees and had a rest, and they were totally fine the next day.

In the months following that incident, I was a lot more conscious of my knees. I only encountered the slipping feeling once more - but I began to notice a dull ache in one or both of my knees at random times. Walking downhill was definitely something which caused tension. I also noticed that yoga poses which involved my knees could sometimes cause pain, so I was weary of them. (For example, the front knee in pigeon pose). Sometimes fully locking my knees (straight) would cause a feeling of tenderness under the knee cap too.

All this was never really enough to get in the way of my day to day life so I ignored it. Eventually, (about a year after the initial incident), I began to feel pain in my outer hips. It began with another 'slipping' moment, in my left hip (this happened completely randomly). The slipping only happened once. But gradually, I began to notice a dull ache and tenderness develop in both hips, in particular when I walked or hiked for prolonged periods (say when I was travelling).

For the last year, my knee pain seems to have subsided, but my hips usually begin to ache whenever I walk for a few hours at a time. The pain is in the outer part of the hip, almost towards the buttocks. Normally it starts with a dull ache and gradually builds up. If this happens, when I lie down on either side I feel pain on the hip I'm lying on as though it's swollen. It usually is fine by morning, but if I'm tired or haven't had enough sleep (or go for another walk) the pain may persist.

I recently visited a physiotherapist who claims I have weakness on the outside of my hips, so she has given me some exercises to strengthen that area. In the meantime, I have been on a long distance cycle which for the most part was OK, but I experienced intense pain in and around my kneecap on every uphill - which made me realise the knee issue(s) are still very much there. Normally I cycle for about an hour 4 times a week, on flat terrain, without a problem. This was the first time I'd done a long distance cycle (5+ hours, and some proper hills).

I have a follow up appointment in a month's time so I'd like to go there a bit more informed. My main questions are,

- Are my knee and hip pains connected?

- How were these issues caused or how did they develop in the first place?

- Are these conditions which need to be treated or corrected? 

- How can I reach a stage where I can both walk for prolonged periods and cycle long distance without any pain.

Any answers would be incredibly helpful.

Thanks!

You should have the whole thing checked but if you start with knee problems the change in your gait will cause hip pain. It is common when recovering from knee surgery to experience some hip pain. Hope it all check out ok.

First, I'm 69, played hockey for 45 years and have paid for it with four knee scopes, an artificial hip, a metal knee, a spine laminectomy and two spine fusions.  That said...

- Are my knee and hip pains connected?

They can be.  I had a lot of knee pain in 2009 and was ready for another knee op when an MRI with contrast of my right hip showed that it was 30% dead...necrotic.  Immediate hip replacement.  The hip was causing all my knee pain.  So, yes, there can be a connection.

- How were these issues caused or how did they develop in the first place?

These types of pain can be caused by long-term, developing factors such as arthritis (like rust, it never sleeps) or trauma, internal structural issues or something simple like a change in the way you walk...your "gait".  Any misalignment of hips, pelvis, lower back, lumbar spine, SI joints, etc. can cause all sorts of problems.  Example: Carry a heavy backpack over ONE shoulder for a week and you'll end up with lots of neck and shoulder pain.  You've misaligned your upper spine.

The easiest, non-invasive way to get this checked is an x-ray and a chiropractor.  They know this stuff cold.  Had a very painful hip pointer two months ago; GP gave me pills...threw them away.  Went to my chiro who just touched the left quadratus lumborum muscle in my back and I hit the ceiling.  She knew exactly the source of my pain.  I'd start there.

- Are these conditions which need to be treated or corrected? 

Absolutely.  If the chiropractor can't help, then I'd go immediately to a SPORTS orthopedic surgeon (bypass your GP) and get some imaging done on your knees, hips and lower back.  If there's nothing structurally wrong (bone problems), then the issues may be nerve/spine-related.  I've had severe sciatic pain that was cured in an instant with chiro but another case where there was a bone spur at L4 crushing my sciatic nerve root.  Then I had stenosis (think sciatica in BOTH legs) at L2/L3 that required an LLIF fusion.  All of this type of work is done by a neurosurgeon, no one else.  But we're not there yet...

- How can I reach a stage where I can both walk for prolonged periods and cycle long distance without any pain.

You have to find the SOURCE of your pain...period.  Three years ago, I started to have lower back pain and then walking became a severe problem.  Could barely make it from the car into a store.  Turned out my lower back was a "junkyard" (neuro's word) and needed an L3 through S1 TLIF fusion.  Again...I don't think you're near that kind of stuff.

Start with X-Ray/Chiro...then a sports ortho (X-rays/MRIs)...and lastly neuro, but that's a long way off.

You need to see an orthopaedic surgeon, have exrays and mri.  When your knees are painful the hips take the brunt and they end up hurting as well.  Lower back will become pretty uncomfortable too. exrays, mri.