knee pain

[marti124]

Amazing, this is just amazing and hopeful. I've wondered why my knee is so much better now than it was July 2nd. When you say you had the diagnosis in your 20s and the pain went away in your 30s, was it like 10 years, or 5 years or what (25-35 or 27.5-32.5)? Also in your last sentence you say you have not had knee pain for nearly 20 years and you're in your mid-40s, so that means the pain went away before age 30.

In any event, a week from tomorrow I have the Bone Marrow Stem Cell Prolotherapy on my left knee and there is like zero risk the knee could get worse (compared to conventional orthopedic surgeries)--and the report success is extremely high, so I'm going to do it, but may give myself more time between subsequent treatments (at least two such treatments are recommended.)

I do think using the knees is very beneficial. Doing my John Muir Trail hike for 20 days starting 3 weeks after the meniscus tear was the best thing I could have done for the knee.

Everyone IS different. I suffered terrible knee pain in my mid twenties that was diagnosed as meniscus tears. I waffled on surgery because at the time the only people I knew who had undergone it had poor outcomes.

Sometime in my early thirties my knee pains went away.

I'm now in my mid forties, and haven't had knee pain in nearly twenty years despite being very active and never having the surgery.

...

 

[una_dogger]

What I am saying is that my negligence (not taking doctor's advice) actually led to my body healing itself. Or maybe I just bought better shoes. Things just got better and stayed that way.


And as a medical professional I don't go far out on limb to say that I don't think that surgery is the end all for everything. If you go to a surgeon with a complaint that has a surgical option, they are going to offer that option to you.

But don't take my advice. My knees could be ground down to putty for all I know. All I can tell you is the pain went away without surgery. Had I undergone the surgery could I say the same thing? I will never know. Had I gone for a second opinion would I have gotten a different one? Don't know. Just made the choice that felt best to me and it worked out.

If undergoing an alternative therapy that you truly understand, believe in, can get behind and is something you want to try, I say go for it. Your faith in the procedure will ensure your compliance and keep you motivated to heal. There's a real benefit to that. You can always reassess later on and revisit surgery.
Good luck to you.

 

[DougPaul]

Knees are complicated joints with many possible causes of pain. Hiking also tends to put a large amount of strain on them (particularly on the downhills). Someone else's experience may or may not be relevant to your own.

Also, just because the pain disappears after some treatment does not necessarily mean that the treatment caused the cessation of symptoms. The symptoms might also have disappeared without the treatment.

Doug

 

[daxs]

Surgeons want to operate, thats what they do. They do not want to be in the office seeing patients. An orthopedic surgeon will probably put out surgery as an option. A sports medicine provider may offer more options than the orthopod. As everyone has pointed out, its not one size fits all. My surgery was successful and I can't imagine I would be as active as I am if I had nothing done. Supartz or Orthovisc injections (hyaluronic acid) injections combined with PT may work too.

 

[OldMan]

Skip,

Sorry to hear about your injury. Hope you heal up soon!

 

[daveyohill]

Total Knew Replacement...

I've recently returned to hiking after a several year absence. In Sept of 2010 I had a total knee replacement. I tore my right ACL in 1980 in a motocross accident and after 30 years, 2 scopes and an ACL reconstruction the knee was riddled with arthritis, bone on bone, unstable and locked up most of the time....

http://hioridge.com/DHill_knee/

Surgeon said "It's not the worst knee I've seen but there aren't many worse." At his first view of post op. X-rays he said "Yeah, this one was gnarly!"

The surgery/rehab has been an incredible success. I never though I'd be back doing this stuff. I recently had my one year checkup and the Dr. asked if I could walk a mile... I told him I recently completed a 10.2 mile hike over Carter Dome and he was pretty shocked. His response was "You're increasing your muscle mass and bone density, losing weight and adding years to your life. I'm not going to tell you to stop. But, be careful and no running".

In the year since the surgery I've tallied about 18,000'-20,000' in elevation, 100+ trail miles and have lost over 20lbs. However I have developed what I believe to be runners/hikers knee in my "good" knee. I'm considering starting to use one of those "cho-pat" style patella bands. Do any on this forum have experience with that style brace?

I know this course of "knee pain" relief is extreme but in my case it was the only solution. Hope to see you on the trail. Tumbledown this weekend!

Dave

 

[DougPaul]

However I have developed what I believe to be runners/hikers knee in my "good" knee. I'm considering starting to use one of those "cho-pat" style patella bands. Do any on this forum have experience with that style brace?

Chondromalacia patella is generally a wear-and-tear injury between the undersurface of the patella (kneecap) and the front of the knee. Presumably you have been favoring the bad knee which puts additional stress on the good knee and the muscles on the good side may have deconditioned resulting in the injury. As you have probably noticed, this is often a Monday-morning injury--you don't feel the pain until the next day. Rest and strengthening the quadriceps are at least part of the solution (and may be adequate on its own to solve it).

(Background--I had a 10 year bout with chondromalacia patellae. I got bad medical advice and had to figure out how to cure it on my own. I have since helped another member of this board to get over it in a year.)

First I had to rest a lot longer than it took for the pain to subside. Just because the cartilage is asymptomatic in normal walking does not mean that it has healed enough for hiking. (I eventually learned to laterally displace the patella and palpate the underside to check for inflammation. This gave me real-time feedback on its condition--without the feedback, I could only guess at its condition.) So the net effect is that you have to rest the knee much longer than you might think.

The second step is to strengthen the quads. Most quadricep exercises (eg a sitting knee extension) involve flexing or extending the knee against a weight or force. However, this motion puts wear-and-tear on the inflamed surfaces. In my case, it accumulated damage faster than it fixed the problem. My solution was to perform a straight-leg isometric contraction of the quads which allowed me to build the muscle without damaging the cartilage. After about a year of this, the muscles became strong enough to cure the problem.

In hiking, this is primarily a downhill problem. You can reduce the strain on the knee by backing down (it is easier than you might think if the footing is good) and/or using poles. Low pack weights, of course, help too.

I basically had to give up hiking for a number of years until I got this under control. I suggest that you dial the hiking back until you also get it under control. If it hurts on Monday you did too much! (I had to go through many reinjury and rest cycles to learn how little I could do safely.) It may be wise for you to put your hiking program on hold or at least very slow for the time being or it is likely to simply get worse.

Since this is primarily a downhill problem in hiking, one needs to train the eccentric contractions of the quads. (Eccentric contractions (muscle lengthening under tension) absorb energy in the muscle, concentric contractions (muscle shortening under tension) produce energy in the muscle.) There is evidence that the mechanisms are different and both need to be trained. One method of training eccentric contractions is lowering weights or in this case walking downhill or down stairs (once you have established adequate strength with isometric exercises). In contrast, cycling is nearly purely concentric.

BTW, I am now completely free from symptoms now. (I believe the other VFTTer is also symptom free.)

Some refs:
http://orthopedics.about.com/cs/patelladisorders/a/chondromalacia.htm
http://www.medicinenet.com/patellofemoral_syndrome/article.htm
http://www.medicinenet.com/script/main/art.asp?articlekey=43529
http://en.wikipedia.org/wiki/Chondromalacia_patellae

If you want to discuss this in further detail, send me a PM with your email and phone number.

Doug

 

[DougPaul]

Re: Chondromalacia patella:
I had an additional contributing factor: excessive pronation.

Problem: My arch collapsed under pressure, the lower leg rotated inward, and this pulled my patella out of line.

Fix: good arch supports (eg green Superfeet) in my shoes.


I'll also add that my chondromalacia occurred after a period of enforced inactivity followed by several vigorous hikes... (The other VFTTer was a biker who took up hiking 4Ks faster than his muscles could adapt to the change in activity.)

Doug

 

[marti124]

Day 5 after having a Stem Cell Bone Marrow Prolotherapy done for a torn Meniscus

Today is day 5 after having a Stem Cell Bone Marrow Prolotherapy done for a torn Meniscus. I had it done in Oak Park, IL at CaringMedical.com by Dr. Ross Hauser, M.D. It was for a complex torn meniscus (a MRI confirmed this) due to an injury incurred doing the Cornell Crack on July 2nd, 2011.

The whole procedure is detailed, photographically here.

Of all the things that encouraged me ahead of time about the procedure was this report of its high success rate.

The summary quote is here:

"Patients stated that the response to Prolotherapy met their expectations in 27 out of the 28 knees (96%). Only one out of the 28 patients ended up getting surgery after Prolotherapy. Based on the results of this study, Prolotherapy appears to be an effective treatment for meniscal pathology. While this is only a pilot study, the results are so overwhelmingly positive that it warrants using Prolotherapy as first-line therapy for meniscal pathology including meniscal tears and degeneration."

I was really impressed with the doctor, his clinic and nurses. The lobby was full of patients, almost all of whom had seen the doctor before and who raved about the doctor's ability. One was a female hiker from Colorado.

I was very impressed with the diagnostic skills of the doctor. He spent about 20 minutes with me before the procedure (the nurse about 50 minutes before, during the procedure, and about 20 minutes after the procedure, and she called me up at home the following day). The whole procedure once it is started takes about 15 minutes.

The anesthesia, only local (procaine), was not even felt as anesthesia, and I did not fully realize I was under anesthesia until it wore off about 9 hours later. By the time I landed back in Albany NY, I did have to limp to the terminal entrance and drive home (thank goodness it was my left knee).

The next day I was so sore, I used old crutches to get around. However, the following day, I was able to walk without crutches, and do three separate 1/2 mile walks around the block.

The subsequent day (yesterday), I did a two mile walk around town, no problem at all.

The doctor told me he's thinking my knee will get back 80% as good as it was pre-injury within 2 months. And he says until it gets back 100% as good as it was pre-injury, he recommends a second procedure about 2 months from now (I scheduled it in January for insurance reasons, ie: my HSA account gets an infusion of $1,000 each year from my company and I can pay for the procedure with it).

CaringMedical.com expects full payment the day of procedure and I was very pleasantly surprised the cost was $800 less than I had anticipated, they recently reduced the price of the procedure. The procedure was $1375 but a mandatory first office visit was added on for $250, but the next time, there will be no first office visit fee. I had thought with the medication/supplements for a 2 month period (recommended), the flight, the cabs, the procedure, the office visit, I'd be spending $2900 but I got by with $2100, of which caringmedical.com's payment was $1375 for the procedure/office visit and $300 for two months worth of their special supplements for post-procedure use.

I am already able for the first time since the injury to slowly walk down the stairs without feeling the twinge/weakness I have consistently felt since the injury. In fact the major problem I had with the knee before the surgery was the problem walking down ordinary stairs (I found it easier to hike down a mountain trail than ordinary stairs). My knee does not feel completely like it was July 1st, but I think Dr. Hauser's prediction of 80% recovery towards the pre-injury goal is completely reasonable.

In his diagnosis, he felt, in contrast to the MRI report, which said there was no evidence of a tear in the ACL, that the ACL in my left knee was weaker than that in my right knee, and he thinks that was a contributing factor to the original injury. So in his prolotherapy procedure, he treated not only the torn meniscus, but the ACL.

They took the bone marrow (which has stem cells) from the healthy right knee to put in my left knee. There was zero pain in the right knee after the surgery.

I'll keep the board posted but so far I am 100% satisfied with the money spent and the way things are going.

By the way, one more link in favor of Prolotherapy. It is from the former US Surgeon General, Dr. Edward Koop.

 

[Maddy]

Thanks for posting this Marti. How you continue to improve and yes...please keep us posted.

 

[marti124]

Update on my Stem Cell Prolotherapy Treatment of my Torn Knee Meniscus

I just updated a thread at BackPackingLight.com after having just finished 4 days ago my third Stem Cell Prolotherapy treatment. Before I do a concise report on that here, the latest issue of the Journal of Prolotherapy is the best documented research summary to present to any medical board or insurance board to justify the use of Prolotherapy written to date. Check it out. It is free, the entire issue is in PDF format. Link.

I consider my knee 95 percent healed to pre-injury level insofar as walking or hiking goes. I consider it 75 percent healed to pre-injury level insofar as being able to run. What does this mean? In practice if I do a mountain hike of an Adirondack High Mountain Peak, I won't notice any problem in my knee except on the way down for about 2% of the time, I'll notice that my left knee is not as healthy as my right knee. I no longer limp going down hill. My hiking partners are amazed at this. However I can not hike downhill fast without occasionally favoring the right knee. But if I walk at a moderate pace, I can avoid favoring any knee. It's only when I attempt to run that I find myself limping to some degree. I asked Doctor Hauser today if having 1-2 more sessions of Stem Cell Prolotherapy if I could get back to pre-injury level for running purposes. He thinks it is possible. I have had so much success so far I'm tempted.

Check out my Google Profile for many more links. See my Shopping for a Prolotherapist Advice Document if you want a local prolotherapist. I did find a local prolotherapaist in Albany, Dr. Joy Meyer and I'm impressed with her and will try a prolo treatment from her. She only does standard prolo which has been around since 1955. She's a board certified rehab M.D.

I have also found a prolotherapist clinic 2 hours away in Avon CT that does Stem Cell Prolotherapy and they are very impressive. I exchanged several emails with the clinic and am impressed with them. They have the single best introductory brochure on prolotherapy I've seen.

I am 100% thrilled with how I'm doing and other than perhaps maybe once or twice a month feeling a very tiny give in the knee, there are no problems felt in ordinary walking or hiking anymore. It takes about 2 months of optimal benefit from each procedure so I won't know how this third procedure will be. From the start the doctor told me I'd need 3-4 procedures done. The cost is about $1,100 per procedure for the Stem Cell Prolotherapy (it would be only $350 if it was standard prolotherapy only).

Some Prolotherapists charge more, some less. I know for Stem Cell Prolotherapy, Dr. Hauser is most competitive in his costs. (I would not have saved money driving to Avon CT for Stem Cell Prolotherapy but would have for standard prolotherapy.)

This treatment is getting more and more coverage in the sports world. A nice blog by a professional baseball player,C.J. Nitkowski, who got back into the game because of using stem cell prolotherapy is covered here:

http://sportsillustrated.cnn.com/2011/writers/the_bonus/08/02/nitkowski/index.html

http://www.cjbaseball.com/stem-cell-blog.htm

I stumbled across this after reading about the more famous case of a baseball pitcher who got Stem Cell Prolotherapy (and afterwards could pitch faster than before his injury).

http://www.regenexx.com/tag/bartolo-colon-stem-cell/

http://hardballtalk.nbcsports.com/2...ecause-theyre-going-to-explode-in-popularity/

http://www.suntimes.com/sports/base...colon-after-mysterious-stem-cell-surgery.html

http://online.wsj.com/article/SB10001424052748703730804576321713447010904.html

I agree that it's going to be the professional sports personalities who take this course of medical care versus traditional orthopedic surgery who are going to cause more and more lay sports enthusiasts (if you can call backpacking a sports) to do likewise. It won't be the Orthopedic industry leading the way, they have too much money to lose as the newer approach is far simpler, non-surgical, and requires fewer medical professionals/equipment involved.