Elbow & Knee Problems

I am 25 years old. I have only fairly recently (the last five years) become a very avid outdoorsman. In the past few months, I have been wracked by two different injuries which seem to have chronic causes. I have been to a doctor about both of them. One is my left shoulder and elbow, which have calcified tendinitis. Their proposed solution is a series of shock treatments and rest. The other problem is my knees, caused by a shift in the patella in both knees of around 20 degrees. The solution here being to avoid anything that stresses my knees, and start swimming. If there is anybody out there who can give personal experience, medical advice, or just positive vibes, that would be much appreciated.

Here is s'more medical history... or just skip it...

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From the time I was 8 until I was 18, I played baseball, and was usually a catcher. This was hard on my knees, and I remember having issues even back then. Grinding as I sat down or got up, pain from squatting for too long, that sort of thing. But I can't recall ever having this sort of pain from hiking - downhill or otherwise. However, after three days of steep ascents and descents in the Taiwanese mountains, both knees are absolutely killing me. My left knee - which was bashed by a big rock about three years ago in a climbing accident which left me hobbled for about a week - hurts right at the upper-top of my patella. No pain around or under or anywhere else. But it gets worse if I keep it bent, or walk downhill. My right knee hurts behind the joint, on the outside of the knee, right behind that big tendon. I bought two neoprene-silicone knee braces. Should I wear these all the time?

As for shoulder and elbow, this was also a problem when I played baseball. My shoulder joints are shallow, and have had a tendency to pop out and cause pain. When throwing a baseball (right-handed), my elbow would give me serious grief, and when swinging a bat, my left shoulder would even subluxate. I did some PT to correct these problems, and that combined with rest seemed to cure the problem, at least until I gave up baseball for rock climbing. When I first started five years ago, I don't recall having any problems. But as I increased my activity, my left elbow and shoulder began to cause a deep throbbing pain. About six months ago, while climbing for a few days at Smith Rock, I found that after pulling down hard on a few sport routes, the piece of meat between my forearm and bicep really hurt. This would eventually spread up beneath my bicep to my inner shoulder. I would take a break for a few hours, then climb something easier, and the pain would seemingly have gone. A few months later, I spent a week in Squamish exclusively trad climbing, and didn't have any problems. After this, I did s'more hard sport, and the pain began to come back. After returning to Taiwan about five months ago, the problem quickly became more pronounced and debilitating. I would take a few weeks off at a time, icing and doing simple forearm and antagonist muscle exercises and stretching, but every time I got back on the rock, the pain would return. Now I know I have calcified tendinitis... how long can I expect this to heal? What kind of methods of therapy should I pursue? Is shock therapy something that anyone is familiar with?

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Considering my age and relatively short duration of activity in these sports, I am severely disheartened by my body's current state of affairs. It would seem I'm going to have to take a long break from just about anything outdoor-fitness related. Has anyone suffered either of these problems - calcified tendinitis or patella shift? What are their causes? How can I avoid it in the future? How long should I be expecting to stay inactive? What methods of therapy should I pursue? How should I train afterwards?

HELP! I feel like an old geezer trapped in a strapping young buck's body.

While I have a limited amount of professional education and experience in sports medicine and my own personal brand of a disease which keeps me injured on a regular basis (a connective tissue disorder- therefore I feel your pain), your problems are pretty complex. I think you need to find better medical professionals to help you out or you need at least more opinions on your options.

First of all, I don't think neoprene braces are going to help your knees but you can try them and see what happens.

The calcification problems are way beyond me, but your knee issues sound like general patellar tracking problems. (You didn't say if the patella is tracking to the outside of your knee but I would suspect so.) This is very common, actually, and it sounds like you may have chrondromalcia or patellofemoral pain syndrome (a generic term for pain behind/around the kneecap). You should really see a physical therapist experienced working with young, active people/athletes to help this. There are many options and I believe beginning a weight lifting regimen for your legs is a major starting point. Also, there is something called McConnell taping and if you can find a PT who does it that would be something to try potentially.

You need to invest in a good set of trekking poles. Trekking poles can reduce forces on the knee by up to 30%.

You can also try riding a stationary bike for knee strengthening. Of course, I have had clients with knee pain who improved from this and I have also have clients with knee pain exacerbated by this so you should try it and see what happens.

Baseball can be a hard sport on the body; certain positions have excessively repetitive motions which can lead to injuries which plague people into adulthood for many years. Pitcher and catcher are two of the worst imo. That said, I do believe you will improve over time regardless. The body has a way of doing that, although sometimes it takes years. (Trust me, I'm the queen of chronic injury and should know!)

Find a good orthopedist with sports medicine training and hopefully they can also refer you to a good PT with similar background.

By the way, I've never heard of "shock treatments" and am not sure what they are.

Hope that helps.

Oh P.S. the "cause" of all your problems is nothing anyone here can really tell you. I think your brand of calcification may be a mystery even to the medical community since you are young. Injury has many factors, including your individual genetics which influence soft tissue make-up, biomechanical factors, and your past physical activity history. Also, in light your of upper extremity subluxations and your participation in overhead sports (baseball and climbing), you need to come to grips with the fact that doing rotator cuff strengthening for life is on your plate. Do it even when you are not in pain. Think of it as prehab.

Thank you so much for your response, Aerili. You pinpointed a specific problem I'm having, and that is finding a PT who specifies in working with someone with my specific conditions. In Taiwan, it's hard enough to find a competent Western doctor, much less one who speaks English and specifies in sports therapy. You also highlighted some details of my case which I should probably further explain...

Aerili wrote:You didn't say if the patella is tracking to the outside of your knee but I would suspect so.)

This is correct.

Aerili wrote:You need to invest in a good set of trekking poles.

I have some, and was using them on the most recent hike in which I began to experience severe knee pain.

Aerili wrote:By the way, I've never heard of "shock treatments" and am not sure what they are.

In my case, they put patches (in other cases, acupuncture needles) on my elbow and shoulder, connected to a device that sends a series of shocks which cause the muscle group to flex and relax in quick succession. It was developed to remove kidney stones, but apparently has been successful in ridding calcium deposits in tendons as well.

Aerili wrote:you need to come to grips with the fact that doing rotator cuff strengthening for life is on your plate.

This is what they call "knowledge of the self," I suppose. Better to know now so that I can get back in shape without permanent damage, than to keep climbing and injure myself for life. In some ways, these injuries are a blessing.

I can't speak as in depth as the previous poster, but I've struggled on and off with both shoulder and knee issues.
The rotator cuff workout is great advice, there is a set of exercises called the throwers 10 (I think) that addresses elbow and shoulder strengthening. Doing those exercises religiously helped remedy a shoulder issue I assumed I would just have to live with.
My knee issues stem from some ligament damage as a kid (I assume), and seem to flare up intermittently. I didnt have much issue with them when I was hiking and cycling a lot, but several years ago I spent considerably less time on trail/bike and now they flare up regularly when i do much hiking at all. From my experience, cycling doesnt aggravate them, but does a lot to keep them strong enough for hiking activities.

Take both of these suggestions with a grain of salt, as they have absolutely no professional medical value (the last time i saw a doctor for either issue was when I was 14). However, it's what I've noticed to help me.

edited to add:
safethrow.com/ExerciseThrow…'s%2010.pdf
thats what you want for the shoulder/elbow issues.

I would look into getting a good set of custom orthotics for your shoes. I had a similar tracking problem and the orthotics help with most of the problem, but it took some time to re-develop my muscles properly. If your feet are not in the right position your muscles can get overdeveloped on one side of your leg, usually the outside, and pull your patella over to the side.

For the shoulder, I would try pushups (just from your knees and very gentle at first). I know several people with RC soreness where pushups made it go away.

Good luck.

El Duderado wrote:I would look into getting a good set of custom orthotics for your shoes.

I actually have SOLE Viesturs insoles... and was wondering if these could have exacerbated the problem. I've hiked with them for about 10km before now, without anything beyond normal break-in pain. My feet felt great; just my knees hurt.

Nate Ball wrote:In my case, they put patches (in other cases, acupuncture needles) on my elbow and shoulder, connected to a device that sends a series of shocks which cause the muscle group to flex and relax in quick succession. It was developed to remove kidney stones, but apparently has been successful in ridding calcium deposits in tendons as well.

I see. After looking around online, it would seem you might have reactive calcification. Your current treatment does sound like it is a common procedure for this condition. I found this snippet and it seems to indicate studies come up with varying results for shock wave therapy in Europe but that one long term follow up showed a 70% success rate (which isn't great but isn't bad either). Unfortunately not sure if they screened out patients doing concomitant treatment of other types. (To read what I'm referring to go to page 157 "Treatment").

Frank suggested the Throwers 10 program. This is a great and comprehensive upper extremity strengthening program. The whole thing is very tedious to do (I could never stick to all of it personally) but you should check it out. However, I want to caution that I am not sure all the exercises are necessarily appropriate for you and that your problems are more complex than just a strained or unstable rotator cuff. However, since reactive calcification seems to potentially lead to frozen shoulder in some people (a very serious outcome), you should see what parts of this program you can handle because anything that will maintain strength and range of motion without further injuring you will be a good thing to implement (but here's where a physical therapist treating you would be of value since they could pinpoint what you should and shouldn't do).

As for your knees, most PTs should be trained in managing lateral tracking issues. It is not rocket science and it is very common. I used to have problems with lateral tracking in one knee but eventually it resolved when I started weight training. You don't need to train for bulk in the legs, just strength, especially targeting the vastus medialis muscle-- although it is hard to isolate so I recommend a bunch of compound lower body exercises. This is very straightforward weight training.

And you still need to use your trekking poles. ;-)

Also, if you can find a sports med doc or PT to treat you who doesn't speak English, can you bring an interpreter with you?

El Duderado wrote:I would look into getting a good set of custom orthotics for your shoes. I had a similar tracking problem and the orthotics help with most of the problem, but it took some time to re-develop my muscles properly. If your feet are not in the right position your muscles can get overdeveloped on one side of your leg, usually the outside, and pull your patella over to the side. Good luck.

You may find "Born to Run" an interesting and possibly useful or even life-changing book to read. I'm pretty convinced the propositions therein saved my knees.