Good knee gone bad :(

[coldfeet]

SherpaK..hope all is well, i remembered your knee and wanted to hear from u, thx

Hey Gris, what's a 10 S court?..

Got my vfft shirt today, got it in green...thx Maddie

I should be more concerned about being able to work/drive/walk/ride bikes instead of hiking..isn't that weird?..The first thing i thought about was hiking..does that mean i am hooked?

 

[paul ron]

Knee problems means you should now hike slower and enjoy the woods, it's not a race.

My friends and I hike like we are going to the electric chair, old farts with bad knees. It's a mind set too, we have nothing else to do nor anywhere else to be. This is our getaway not W.O.R.K.. Our hikes are generally 4-8 miles depending on the length of daylight and season also if we just plain old feel like doing anything longer. Our winter hikes are shorter but we do carry more stuff to our base camp, then from there we day hike/explore, slack packing is what some call it.

 

[mer]

Meniscal Tear

undefined Unfortunately, as we get older the meniscus becomes less flexible. I have a meniscal tear. I could hardly walk out from Big Slide Jan '04. MD recommended surgery. However, I am a PT, did some more research and decided to wait on the surgery. I wanted to try a conservative approach first. I let it relax for a couple weeks..no hiking, no jogging, just light walking as tolerated. Used frozen veggies as my ice pack after a long day at work (on my feet and occasionally the floor working with geriatrics/neuro pts) to decrease swelling and pain. Then began an exercise program strengthening and stretching hips, knees and ankles. I also stopped squatting. My focus was to work more than just the quads and knee jt. Weak or tight muscles above or below the injured joint may overwork the knee jt. Hamstrings tend to be tight especially in men.

Wanting to complete my 46 last September I actually quit jogging, continued to perform strengthening exercises, walked and hiked using a special soft knee sleeve that basically informed me not to torque my knee as I climbed over blowdown and kept my knee in its track as I had swelling on and off. I also used trekking poles which decreased stress on my knee while descending. I did use Ibuprofen as needed to decrease pain and swelling... recommended by the Ortho Doc who is also an avid hiker. I checked my boots too which needed replacing. The foot's position also affects the knee. I did finish my 46 and am back to jogging.

I do want to emphasize that not all tears are the same. You have to find what works for you. I'll be on the trails more often this summer and will do what I have to do to feel comfortable so I can enjoy the people and beauty around me.

mer
Life is not measured by the number of breaths we take, but by the moments that take our breath away! (I don't remember the author, could have been someone from VFTT, thanks).

 

[paul ron]

Mer, exactly what exercise is recommended for strengthening knees enough to overcome a slightly torn meniscus? My small tear is on the right knee, left of my knee cap up front. It hurt like hell one morning, I couldn't walk at all. Carefully, I taped it and managed to hobble around for a week before I could walk without terrible pain. I still have a small twinge there but it's much better 2 years later.

I have been trying to strengthen the muscles by doing toe dips off a curb. I also walk up stairs backwards. These seem to help but I don't see as much improvement as i would like.

What do you recommend as a PTist?

 

[DougPaul]

I do want to emphasize that not all tears are the same. You have to find what works for you.

From a short informal course given by an MD that covered knee injuries: the ability of a torn meniscus to heal on its own depends on the depth of the tear.

The meniscus (2 per knee) is similar in shape to a flattened torus (doughnut)--thinner near the center and thicker near the periphery. The blood supply is around the periphery. Thus a short tear from the center may not reach the blood supply and is unlikely to heal on its own. A longer tear that reaches the blood suppy is more likely to heal on its own.

Obviously, one cannot asess the severity of a tear on one's own, so seek professional medical advice, etc.

Doug

 

[coldfeet]

update..x rays show 2 bone spurs which the knee cap i guess gets hooked on and when i bend it, it cracks sometimes..will get mri but dr thinks lots of p/t to strengthen muscles around knees..i thought hiking would strengthen them, but seems like it doesn't help the small inside muscles..that's what the p/t guy told me...dr said i could hike but the p/t told me to relax and wait for the p/t sessions to begin in 2 weeks so not to mess it up anymore..to bad wanted to take the little one (9) to Harriman this week..have a nice week..little chilly here in nyc..upper 40's and windy

 

[Gris]

Take your diagnostics to another guy and get a SECOND OPINION. Pain is bad! Don't continue to hike on it if it really hurts.

Conservative treatment is usually good. But, ... OFTEN bone spurs are removed and pain goes away. MAYBE your muscles are fine and you have a simple structural defect that needs to be fixed (no amount of PT is going to fix bone spurs...)

Do some background research on your doctors too. Make sure you get to a bonafide expert ortho surgeon for your second opinion.

 

[coldfeet]

Gris..your right, i'm so lazy sometimes..will start doing some homework on this problem..thx

 

[mer]

Reply to PaulRon and Coldfeet

Sorry for the delayed response. One should definitely see a reputable Ortho MD. I favor one who specializes in sports medicine. Ortho PT's do work on bone spurs dependent on where the spur is (most common are heel and shoulder). If spur is on posterior kneecap (patella) then probably not.

My meniscal tear is in a nonvascular area (it's called the posterior horn of the medial meniscus and extends to the inferior surface). It is on the left side of the right knee in the back (posteriomedial). It is also small and is diagonal in nature. I actually started my exercises in water and advanced to land. Working on the hips (bending, extending, moving your leg away from and towards midline), knees (bending and extending) and ankle (bend upward/downward, pronate/supinate). Started at low reps/sets and low resistence as tolerated. Any pain, then decreased intensity, frequency and/or duration. You want to be sure you are in proper alignment when doing exercises. Some people can tolerate open chain and others only closed chain (feet planted on a surface) exercises. I recommend that you get checked out by an ortho MD and see a PT (ortho/sports) or exercise physiologist.

DougPaul...I've been told that a tear in an area that is not vascularized will not heal but I read an article in the Backpacker magazine last year in regard to meniscal tears. It indicated that a doctor stated that tears in a nonvascular area can heal but it takes longer and one should refrain from exercise. I have not seen anything yet to support this. Have you?

Please forgive me if I spelled your names incorrectly. It's been a long day

mer

 

[DougPaul]

DougPaul...I've been told that a tear in an area that is not vascularized will not heal but I read an article in the Backpacker magazine last year in regard to meniscal tears. It indicated that a doctor stated that tears in a nonvascular area can heal but it takes longer and one should refrain from exercise. I have not seen anything yet to support this. Have you?

My comment was based upon a lecture that I attended ~20 years ago so the details could have been lost in time... Have no info pro or con the doctor's statement.

Just pulled out my copy of "Knee Pain and Disability" by Rene Cailliet, MD. (copyright 1973, 11th printing 1981). 20 pages of info on meniscus injuries. (Out of print. Looks like you can still get a copy via Amazon. The pain series is classic.)

A quote: "Tears into the meniscus that do not extend into the peripheral vascular portion of the fibrocartilage do not heal. Those that do extend into the vascular zone heal if there is reduction of the displaced meniscus and the knee is immobilized for at least three weeks." (pg 49)

Guess Cailliet's statement is pretty clear...

Remember this was written in 1973--knowledge and/or treatment may have changed since then. (And, of course, there could be disagreement between professionals on the issue.)

Doug