Richard Haynes PTA/CPT - 10/16/2008

Question
QUESTION: Hello.  I'm currently having pain in my calf, mainly the outside to middle part.  It feels week and as if it's going to give out.  
I had ACL reconstructive surgery 16 years ago and have been fine.  Until a year ago, I'd occasionally experience pain while playing volleyball, basketball and football depending on the action i was performing.  Whether jumping, or cutting back on a field.  My doctor wasn't sure what it was until it just started happening more.  He gave me a shot of cortisone in my knee and within a minute or so, my calf pain was gone and i felt great.  After that, he gave me a bone scan (no MRI due to screws in my knee) and found that my knee was degenerating.  He said this is the cause and instructed me not to play any more impact sports.  
I still play softball because i pitch and there is no impact with that sport.  Though, last night playing my calf pain came back.  I can rub my calf, ice, and take ibuprofen but nothing helps.  The only thing in the past was resting for a few weeks.  
I guess my question is, can the knee really refer pain to the calf.  I've read articles on how different parts of the body can refer pain elsewhere but never saw anything with the knee referring pain to the calf.  In the past, my calf would hurt so bad that my hamstrings would become so tight it hurt to bend my leg.  However, not once did my knee hurt.  Why doesn't my knee hurt instead of referring the pain elsewhere?  
I currently wear a Donjoy brace on my left and with it's straps around the calf, i think that allows me to do more than i probably should.  
So, i guess i was wondering if this is really referred pain or should i ask my doctor to look at something else and if so, what?  
Thank you

ANSWER: Hi Frank,   First yes,  the knee can and will refer pain to the calf muscle. Its not uncommon because as your knee begins to wear inside the mechanics of the knee change and will begin to stress other areas surrounding the knee. That will not change until something is done to realign the forces through the knee. that can be done either through a brace or a partial or full knee replacement.

The knee does not have the same type or number of sensory nerves within it so this is why pain will be referred. This also happen to the hip and the shoulder.

So in conclusion I would also suspect the problem is coming from the knee and until the knee is further addressed somehow you will continue to have the problems with the calf and hamstrings.
Only your orthopedic doctor can make the determination on how to handle as they see the xrays etc...

I have gone through this myself about 10 years ago where the knee was causing my hamstrings to ache beyond belief. I had to ultimately have the knee replaced and never had trouble again.
That will depend just how much it has deteriorated inside.

Good Luck
Richard Haynes
Punta Gorda, Fl.
www.totaljointfitness.com
www.richardhaynes.com

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

QUESTION: Thank you Richard.  Your answer was very beneficial for me.  I do have one more question.  I'm 33 years old and very active, or was.  Would a partial or full knee replacement be beneficial?  I've heard that they are for older people and not to be fully active on such as playing football, basketball, etc.  Is this true?  I know there comes a time in someone's life were there body just can't do it anymore, wether younger or older and I'm wondering if i should just think about shutting it down to only what I'm capable of doing.

Answer

Knee replacement   Frank,     That is a question we all have tp go through and ponder for awhile. most surgeons will tell you to wait. They feel that by having it early you will need a revision on that joint.

Only you will ultimately decide when its time to "shut it down" This will depend on the amount of pain and discomfort you go through each day.

If at that time you need a replacement a partial replacement may be the way to go as they can later be converted to a full knee replacement if needed. Now not all surgeons will do a partial as some prefer to do the whole knee. It depends on their thoughts and experiences about the partial. I have worked with both partial and full knee replacements, my thoughts are that the partial are great if that is all you need. That will depend if the medial compartment is shot in the knee. If both medial and lateral side are gone then a full knee replacement must be done.

Its true games like basketball, football and softball are out of the question unless you want to destroy the prosthesis in time. Remember Bo Jackson when he had his hip replaced? He has gone through 4-5 hip replacements as he continued to play baseball for the Kansas City Royals.he is fine now and golfs alot.
I had a knee replacement when I was 44 due to a motorcycle accident the knee had been bad for along time. The pain just got out of hand and I had it done. I rehabed it myself and its great today not one bit of pain. I bodybuild on it lift weights with my legs etc... its been doing fine though the surgeons will not recommend that.

That was the best thing I have done and I played alot of baseball myself living down here in Florida but I got over it.
there will be many opinions out there about what you should do. Only you can make that decision. many people are afraid of getting it done because of stories they have heard etc...I found that with anything in life.

When you get a chance read some of my blogs at www.totaljointfitness.blogspot.com ther i will write info about the knn and hip replacement as I work with them everyday.

Good Luck
Richard Haynes
www.totaljointfitness.com
www.richardhaynes.com