Question
Dear Dr Keith,

I am writing to ask for your advice on an ongoing issue that I so far have not found any answers to elsewhere.

I have had occasional aching in my knees for the past 8 years or so (I'm 29) and it was usually when the weather was bad and particularly in my left knee. I've also had 'locking' in my left hip for around the same amount of time. Eg: If I'm sitting down for a long period of time (particularly with knees bent)and then stand up I will experience pain in the hip when initially trying to move it and have to slowly stretch it out. The pain doesn't last long.

Over the last 2 years I have started the practice of yoga and find the health benefits numerous in many ways. However, around 10 months ago I found I was unable to sit cross-legged as it would cause a great deal of pain in my left knee and the pain also occurs on the outside of the knee and kind of shoots down into the shin.  I also find when trying to lift either leg that it is difficult to hold the leg up as it puts strain on my hips.
I also experience pain in the left knee/shin after most kinds of exercise.

I have been to the doctor and arthritis has been ruled out with blood tests and I am now on a long waiting list for a physio.

I wonder if you can give me some clue as to what might be going on so that I can help myself and continue a healthy lifestyle.

Answer
Dear Louise,

It is impossible to diagnose you simply through a list of symptoms, although I appreciate the fact that you are having pain, and that you are looking to be pro-active in finding a solution.

Knee pain can be caused by a lot of things, including but not limited to:  Iliotibial band syndrome, bursitis, ligament(s) injury or instability, meniscus injury/tearing, patella tracking disorder, pes planus, valgus deformity/stress, varus deformity, Osteoarthritis, rheumatoid arthritis, periosteal bruising, etc...

The list is long for hip pain as well, including leg calves perthes, labrum disorder/tear, avascular necrosis, congenital hip deformity, osteoarthritis of the hip/acetablulum, lower back problems, spinal stenosis, sacroiliac joint inflammation, hip abductor weakness, ITB syndrome, trochanteric bursitis,fibromyalgia,hip flexor tendinitis, pyriformis syndrome, etc...

The lab work for blood screening is just a start.  All you really are able to rule out through a blood test is rheumatoid arthritis or potentially other infectious or inflammatory diseases.  A good work-up of the knee would also include a ligament and orthopedic examination, postural examination, gait analysis, etc.  You might consider x-rays (to look at the bone) and an MRI (to look at the soft tissues, cartilage, ligaments, etc)

The hip should also be evaluated physically, along with the SI joints and the lumbar spine region, including lumbar discs.  Again, simple x-rays give some information, and MRI studies are more in-depth.

If I were you, I would consider the following specialists:

1)Rheumatologist.  Your MD General Practice doctor is limited in his/her ability to look for arthritic conditions.
2) Orthopedic doctor.  Once all the arthritic and infectious possibilities are ruled out, look for structural and functional problems.  An orthopedic doctor is good at this.  You might also consider a physiatrist or chiropractic doctor... or a physical therapist.

I know that I probably gave you more questions than answers. I wish that I could simply diagnose your condition, and put your mind at ease.  If nothing else, you now have several things that you can consider and research through the internet.  

It sounds like, to me, that you are in line to see a physical therapist.  When you go, try and pin them down to a diagnosis. Have them write it down, and explain it to you. Then do some more research on-line to see if you feel that the diagnosis is congruent with the symptoms that you are feelings.

I hope that this gives you some ideas.  Again, I hope that you find answers and feel better soon.

God Bless always,

Keith Biggs, DC
http://www.eastmesachiropractor.com