Hiking after knee surgery

[Peppersass]

Just had knee surgery, a meniscus tear removed.

I held off and suffered the constant ache for nine months, refusing to let it hamper my hiking, and got serious about fixing it in October. It took months to get an MRI (finally went to a different sports doctor). Long story short I did not expect recovery time to be so close to late spring/summer hiking season.

The doctor said I would be good as new in five weeks but talking with friends (non hikers) and looking on the internet conveys a much longer recovery time, which is quite disheartening given my big June and July hiking plans.

If you've had this knee surgery, how long did it take you to get back to hiking, say a hike like the Lincoln-Lafayette loop? Did you do PT, what type of post-op conditioning worked for you? Did you have more problems down the road?

 

[Stan]

YMMV, so to speak, so listen to your body above all.

I managed fairly well for a couple of years after I tore a meniscus but finally it became unbearably painful every time my leg twisted in any direction but forward so I scheduled it in late summer and was resuming activities after a month, including soccer. However, hiking is one of the more stressful activities so I got back into that gradually with shorter hikes and snowshoeing. For well over a year I wrapped the knee for additional support. Even today, 10 years later, I feel a gentle reminder to be careful with it (i.e. wrap it and don't stress it to the point of a constant awareness ... short of pain).

 

[Peakbagr]

I've had 3 scopes, 2 on 1 knee, 1 on the other. I insisted on a long course of PT. The physical therapists described me as a 'motivated patient'. I was anxious to get back into the woods and they cautioned me to take it easy, saying that uphills would not be difficult but downhills are the ones that hurt while you're in recovery.
After getting the clearance for a 5 mile hike, 1,400ft day on a woods road trail, sailed up and congratulated myself. On the way down, the first 3/4mile was simple, started feeling it the next half mile, and uncomfortable the rest of the way.
After another scope, out on a snowshoe with a group of friends. On the way down, I lagged on every steep section, and in the last mile, I was struggling to keep up. Take your time, the mountains aren't going anywhere and do the exercises the PTs suggest and then some.

 

[Peppersass]

Stan, I take it you have not needed repeat surgery on your knee. Did they remove any part of the meniscus? I have been told they took 1/3 out, leaving 2/3.

Peakbagr, I too am motivated. How long before you did the five mile hike, and are you doing fine now?

 

[Stan]

Stan, I take it you have not needed repeat surgery on your knee. Did they remove any part of the meniscus? I have been told they took 1/3 out, leaving 2/3.

Peakbagr, I too am motivated. How long before you did the five mile hike, and are you doing fine now?

I, too, spent several weeks visiting PT and following a routine at home. I also had a series of racquetball injuries (forearm, elbow and shoulder) which did not require surgery but did involve PT. My conclusion is that strength is an important part of recovery and, by extrapolation, prevention. So I continue with modest strengthening exercises. One caution: there is a period of healing of any collateral damage so be careful not to overdo it ... it may even call for an initial period of rest.

The same can be said of stretching. Tight tissue strikes me as more conducive to injury so there is a need for balance between strength and flexibility. Stretches are a big part of prevention in sports activities and that includes hiking. Sports medicine says that stretching afterwards is as important. I do ocassionally stretch "off season" but am more inclined to give this advice than take it, which I may someday regret.

I do not know how much they cut nor have I had additional surgery. I credit the success of the procedure to the PT I learned and practice and not to any long term change in activities ... which I think are as important as the PT itself in maintaining health of the knee (and everything else IMNOHO).

 

[Scarpy]

I had two meniscus surgeries on my left and one on my right before I got back into hiking. I did a (gentle)round of P90X a couple months after the last one and found any lingering knee pain disappeared. That was six years ago. I still do similar exercises found in that program, mostly lunges and squats, and I added yoga a couple times a week. Keeping the muscles strong & flexible makes all the difference.

 

[RollingRock]

I guess recovery time must depend on the how much is being removed. I've had both knees done. I was back hiking after about a month...I started on moderate hikes and probably after two months back to 4,000 footers.

I did not do any physical therapy but my doctor recommended if I wanted to start hiking sooner rather than later to not use crutches after the surgery so that's what I did. I limped for a few days but then I was fine. A friend at work who also hikes was also hiking after one month.

 

[Peppersass]

RollingRock, your words are encouraging but 6 days post-op, I know I am looking for the answer that I want (which is not necessarily what's going to happen). I used crutches for two days and resumed light activity (like walking and making dinner) within days. But the surgeon stressed that I not over do it the first week which leaves me binge watching Netflix and counting the days to PT.

 

[summitseeker]

RollingRock, your words are encouraging but 6 days post-op, I know I am looking for the answer that I want (which is not necessarily what's going to happen). I used crutches for two days and resumed light activity (like walking and making dinner) within days. But the surgeon stressed that I not over do it the first week which leaves me binge watching Netflix and counting the days to PT.

Hi Peppersass,

I can commiserate with you on those first few post op weeks and the desire to get back on the trail ASAP. I only had a scope of my left knee, but found myself watching the entire Dexter series in record time last April and counting the days until I could get back out. Everyone heals at different rates but FWIW I would stick to only the exercises the PT people give you and try to avoid taking on any serious elevation gains before you are feeling close to normal.

My surgeon said I would be hiking again after 5 weeks (ironic that this estimate usually coincides with what insurance companies will cover )

My PT strongly encouraged me to wait at least 6 weeks before even attempting anything strenuous on uneven terrain. My last pre-op 4K was Jackson on 4-6-2014, I then got in one last hike of Pawtuckaway's North Summit on 4-14-14. I went in for surgery on the 21st, followed the instructions of the Doc and PT to a tee, and hiked Pierce and Eisenhower on 6-15-14. It took a lot of patience and adherence to the daily exercises, but a few weeks after doing Ike and Pierce my PT discharged me knowing that my appointments were starting to become personal training rather than rehabilitation.

This is just what my experience was, but I sincerely wish you all the best in your recovery efforts. Although the itch to hit the trail again soon is insatiable, just remember how much longer a set back could put you out from a full recovery, just saying.


Best of luck

Z

 

[Peakbagr]

Doc and PT said walking when the swelling went down, gradually adding some uphills 4 weeks after procedures. About 6 weeks for the 1,400ft, 5 miler, and though I could do it, the downhill was uncomfortable. That gradually went away.
Lot of this depends how invasive the procedure, how much removed.
At the time of the first surgery, the surgeon said there would be a very slight chance of arthritis developing. I hit the 'jackpot' on that one.

 

[Peppersass]

Thanks for all your input. Just saw the surgeon for my post op and when asked how I can maintain my knee health he said:

"KEEP DOING WHAT YOU ARE DOING, DON'T STOP (referring to hiking). YOUR LIGAMENTS, CALF AND THIGH MUSCLES ARE IN BEAUTIFUL SHAPE - I WAS IMPRESSED."

Given the guy has actually seen these from the inside-out I wondered if I blushed . I thanked him for the complement and figure this is my excuse when faced with the question, "Am I hiking way too much?"

 

[Stan]

Given the guy has actually seen these from the inside-out I wondered if I blushed .

Know what you mean. One of the most flattering letters I ever received was from my gastroenterologist. It was a report on my colonoscopy.

 

[Peppersass]

I imagine all who've responded know what the waiting is like. 3+ weeks later and the knee is coming along.

Last weekend (2+ weeks out) I walked 3 miles in my neighborhood and got slapped by my PT, my brother and everyone I came in contact with who's had knee surgery -TOO MUCH TOO SOON. So I am on a strict behave-yourself-do-only-what-I-allow regimen for exercise and PT. They have assured me if I slow down I will be hiking peaks by June (my goal). So...whatever it takes.

Today I hiked into Lost Pond, got about halfway to Wildcat Ridge junction. I turned around only because I reached a small but sharp downhill and haven't been cleared to start ascending and descending yet.

Very humbling to have that be the "big weekend event!" But the knee did well maneuvering around postholes and angles.

 

[summitseeker]

Hey Peppersass,

I know it is driving you crazy to be sidelined so long, but try to hang in there.

After my knee scope I wanted to get back on trail ASAP, but I am confident that had I done too much too soon, I wouldn't have been able to accomplish anything in the months that followed.

I know it sounds easy to give advice after a full recovery, but being day to day on the injury front has kept me realistic and relatively patient with my current healing process. The muscle injuries I am dealing with have no time tables and the Graston Technique has been a lot of discomfort for little return. It can be demoralizing, but I suppose that time is the best remedy for most ailments. Even if it feels like purgatory

Z

 

[Mike P.]

Keep us updated on your recovery and re-entry outdoors.

Had I seen your post earlier, I'd have recommended making sure your PT was aware of your prior activities. Work with them and make a plan. Maybe it starts with rail trails and old roads. Then progress to some of the southern state parks with well maintained, possibly even graded paths, or Livermore Road without a summit trip. Work you way up to Lonesome Lake & Willard once they are snow free. (You could do the easy lower sections of trails and stop as rehab is your goal, not another view on a peak you've done several times before. Work up to maybe easier mountains you've decided were too short before. (Pine Mt, north of Madison, from one direction it has an old road almost to the top I believe)

 

[Peppersass]

Seven weeks post surgery - I was able to hike Mt. Roberts today, 5 1/2 miles, 1300' gain. I chose it because of its incredibly mellow ascent (and descent). My knee was just slightly swollen at the incisions after the hike, iced, took an Aleve and feel fine. Given the remarks in this thread about descent issues, I thought about every step (Peakbagr) and had no problem (also made sure I stopped a lot). I also hiked Agamenticus 3 weeks ago no problem but proceeded to jump on my kitchen counter to wash windows the next morning and really messed up my kneecap. So yes, I made a deal with god that I wouldn't be an a-hole when it comes to my recovery and behaved myself, doing everything the PTs said to, and nothing they said not to. They know I want to have an active hiking summer, Mike P., the first thing I told them is what I have done and what I intend to do. They answered that if I do what they say they would get me back on the trail. Breaking this agreement set me back. Learned my lesson!

 

[summitseeker]

Way to go, Peppersass!

It is so hard to ease back into things but it is the only way to ensure longevity after a medical setback.

Tecumseh treated me well after a visit the same day with a sports medicine doctor who said the magic words I so desperately wanted to hear " I don't think you should stop hiking".

Good job and stay healthy,

Z

 

[Peppersass]

Just an update 4 months post surgery. I hiked South Baldface(up the face) the first of June, various other 4ks and finished my NEHH last weekend with Fort, Coe and South Brother, the back way not the slide (very rainy and wet). The neoprene brace I wear for support (not necessary tho) can be both comforting and annoying (though it does protect my kneecap from a pounding on rock scrambles). I have noticed that deep steep descents are tough as I no longer have some of that extra padding on that knee. But I've done the hikes I wanted to and know I can do it. Like so many have mentioned, I expect a full year for full recovery but was able to complete my pre-"ohoh, I need surgery" - plans. This past week I tried to do a slow 1 mile run and the knee is screaming. Guess I should wait to attempt that. (I still do my PT exercises). Pepp

 

[TCD]

I tore the posterior horn of the medial meniscus (most common tear site) in my left knee about 5 years ago (confirmed by MRI). I did not have surgery, so my experience may not be as relevant, but there are things in common. Knee was painful and I limped for several months, but it gradually recovered to almost normal. I continued all activities, even while limping.

A couple months ago, I di a little too much fast running and progressed the tear a little further (it's not as bad this time, only maybe 30% as bad as the original problem). Knowing exactly what it was, this time I did not bother with the Doc, but just continued my normal activities. It's improving quickly, and I think it will be back to normal again in another month or so.

Some things I have learned during this, from study and from my own actions and symptoms (obviously, each individual is different, I am not a doc, and YMMV):

>What causes the prompt syptoms of the torn meniscus is rough edges and flaps on the tear, that irritate the surrounding tissue.

>The surgery (at least in adults) cannot repair the meniscus. What they are doing is removing material that has rough edges. This is why the surgery works to relieve symptoms. (As an aside, I believe I accomplished the same thing over a longer period of time by continuing my normal activities. Rough edges were worn smooth anatomically.)

>Historically (1960s) the entire meniscus would be removed in open surgery. (Docs didn't know what the meniscus was for, so the prevailing thought was that it was just "extra cartilage" and it was removed like tonsils or the appendix!) This resulted in a "bone on bone" condition, and subsequent knee failure. Based on this, I think today as little as possible is removed.

>So unless a lot of meniscus has been removed, residual pain during the long recovery is probably not due to "lack of padding" inside the knee, but rather to the fact that the surgical procedure is imperfect in removing all the rough edges, and due to the long term irritability of the surrounding tissue.

>It's important to differentiate more "closed chain" from more "open chain" activities. In a closed chain activity, there is constant resistance (like standing and squatting). This keeps the knee joint approximated. In an open chain activity, resistance is interrupted (as in running). This allows the knee to "hang free" in space, and allows the joint to be in traction.

>For my own recent re-injury, I observed that long hikes with a heavy pack caused no problem, but even a very short few strides of running caused immediate pain. Many people believe this is because of "impact." But given everything above, I do not think impact is the villain here. I think what happens is that is the activity has a long enough open chain period, the rough edges on the tear lift up, and it hurts to push them back down. In a more closed activity, like walking even with a heavy pack, the tear is kept compressed, and this doesn't happen. I was able to confirm this in myself by running while isometrically contracting my quad and hamstring in the injured leg. Doing this, I ran pain free, because the joint was kept compressed. Of course this is exhausting and impractical for anything other than a very short distance, but it confirmed my thinking.

What made me post all this was your observation that hiking seems to be OK, but even a little running hurts a lot. You may find that hiking, even long rough hikes and heavy packs, will become just fine, but running and jumping type activities will take a LOT longer to become pain free. I did the Great Range (ADKs) last weekend pain free, but if I were to run across the parking lot to my car (without thinking to use the "artificial gait" described above) it would hurt a lot.

Depending on the location of your injury, another thing that may help will be stretching and massage to keep muscles warm and loose. In particular, I have to work constantly on my popliteus muscle. This is a small muscle in the back of the thigh that participates in starting knee flexion when the knee is near full extension. Interestingly, one head of the popliteus actually attaches to the posterior horn of the medial mensicus. So when the knee hurts, the popliteus wants to spasm to try to protect the knee from hyperextension; it pulls on the mensicus; and the knee hurts more (classic "pain-spasm-pain" cycle).

Good luck with your continued recovery!

 

[CaptCaper]

Just an update 4 months post surgery. I hiked South Baldface(up the face) the first of June, various other 4ks and finished my NEHH last weekend with Fort, Coe and South Brother, the back way not the slide (very rainy and wet). The neoprene brace I wear for support (not necessary tho) can be both comforting and annoying (though it does protect my kneecap from a pounding on rock scrambles). I have noticed that deep steep descents are tough as I no longer have some of that extra padding on that knee. But I've done the hikes I wanted to and know I can do it. Like so many have mentioned, I expect a full year for full recovery but was able to complete my pre-"ohoh, I need surgery" - plans. This past week I tried to do a slow 1 mile run and the knee is screaming. Guess I should wait to attempt that. (I still do my PT exercises). Pepp

I can tell you as a fellow "48k" er and many other hills etc it will take all of a year to get to a point of some good comfort with the new knee or knees. I just got back from Utah and hiked many trails in the National Parks. My knees got so bad I couldn't walk into a store with out severe pain. Long story how I got to that point..But....
I had my RTKR done 3 years ago and LTKR done 6/2/14...I have put on many miles since..I was hiking at 3 weeks also but on selective trails and lot's of flat road walking. I now have no issues with going down stairs (without baby stepping) or kneeling even..Took a while for me to feel comfortable kneeling. My surgeon said it was ok but feels odd. But now I do it care fully all the time. I try to use a pillow but there isn't one at all times and I am a busy hands on guy and are on my knees either working or fixing trucks,etc.
People always ask me "how are the knees doing" I tell them it's the only thing that doesn't hurt. Ha.