3rd time a charm?..knee operation

Getting my right knee scoped again for the 3rd time since 1999 on Friday....here's a question that probably can't be answered but why not ask it?

I consider myself a hiking novice....hiking app 2x's a month on the average....some months 4-5 hikes then zero hikes for a few months....mostly Catskill hikes and some gathering hikes..7-10 miles day trips....I use poles and go at my own speed (which I could go faster but then I'd miss all of those cool mushroom plates)

Is this hobby making my knees worse?....Will I need another scope in 2-3 years if I continue hiking or will nature take it's course and everyday walking will mess them up?

I'm pretty close to completing some lists
Catskills - 7 to go
Views and Brews - 19 to go
ADK - 43 to go
NE 115 - 106 to go

I know it's impossible to answer but I thought I'd ask anyway....I'm sure Pete Hicky would suggest the "walking on hands" concept...maybe

I had my right knee rebuilt after i tore my meniscus and my ACL about 10 years ago. I ran for a few years after that, but my knees just gradually became more painfull to the point where i could not healthily run anymore. Hiking is one of the sports, as well as bicycling, which i can do without making my knee problems worse. As long as you strengthen the muscles around your knee, your knee will become somewhat healthier. I have found that using hiking poles also alleviates the pounding on the knees on the downhills.

Hiking has not made my knees worse, I used to have tendinitis but it seems to have gotten much better. But at the same time, I stopped playing competitive sports, so it could be either one.

coldfeet said:

I know it's impossible to answer but I thought I'd ask anyway....I'm sure Pete Hicky would suggest the "walking on hands" concept...maybe

Click to expand...

http://www.pbs.org/nova/allfours/

I have joint issues and am friends with a guy who's had his knee done three times: third time was the charm and now he hikes and snowboards with everyone else. So you could get lucky and have it all work out.

Hiking need not be destructive (as, say, running is -- there's no way to run without it being bad for your joints). Increase the muscles (gym) and walk a lot; most will improve. Your joints may not.

Good luck!

Doug Paul will certainly chime in here. He helped me out a lot. Search this site for chondromalacia, ITBS and patello femoral syndrome.

**WHY** are they scoping your knee? Is it diagnostic? Are they cleaning up the cartilage (meniscus)?

I have been recently diagnosed with patello-femoral syndrome, which is an over-use injury where the patella (knee cap) does not track correctly in the patello-femoral groove, with many causes. On the diagnosis papers, the orthopedist wrote "patello-femoral syndrome, leading to chondromalacia?" and left up to a PT to make the final determination.

Basically, the orth can "cut, inject, prescribe" and I was not a candidate for any of these. A PT will look at your knees, feet, legs, gait, etc., and figure out what exactly caused the problem. It's often a chicken-and-egg problem, figuring out the exact cause.

In my case, my ITB is too tight, the vastus medialis is too weak, and they feed back on each other. Likely the cause is (as in many cases) foot pronation, which standing barefoot in the PT office, she says I do (slightly). Even though I brought my old hiking boots with the lateral (outside) sides of both heels worn away (suggesting supination.)

Chondromalacia is a softening of the cartilage. Chondromalacia Patella is softening of the knee cartilage. In some cases, it causes mini tentacles to get scraped loose, hanging on by one side (under the knee cap) and this causes clicking. Having pronation rotates the tibia which causes uneven pressure on the cartilage, which irritates it, which tightens the ITB which weakens the VM, which tightens... you get the picture.

Until this year, I rode my bike 3-7K miles per year with zero pain. I also ran casually over the winter with minor aches upon resuming in December. This year, I started a bit early and on the 4th time out I came back hobbled. The only difference was a lot of hiking (8 4K trips for 14 peaks, plus another 8-10 "family trips"). My quads excel in producing energy (concentric contractions) but stink at absorbing energey (eccentric contractions).

She won't (can't) make an exact determination as to what caused the problem, but I didn't start hiking with poles (I do now!!) but will forever going forward. I'm told I should be better in the prescribed 4-6 weeks. I am currently doing lots of stretching and weight-bearing exercises that do not exceed 30-degree bends at the knees.

[As Dave Metsky always says, seek professional medical advice. This is anecdotal evidence of my specific case and may or may not apply to you.]


Tim

I think the old adage 'use it or lose it' applies here. If anything, I'd try to get out hiking a bit more regularly, and not skip a month(s) at a time. So long as your using poles, and not banging down the hills, your knees will most likely will be the better for it. Just don't take up jogging !

Oh yeah, adding one to your age every year doesn't help either

Tim

Kevin Rooney said:

I think the old adage 'use it or lose it' applies here. If anything, I'd try to get out hiking a bit more regularly, and not skip a month(s) at a time. So long as your using poles, and not banging down the hills, your knees will most likely will be the better for it. Just don't take up jogging !

Click to expand...

Chondromalacia-patella is a wear-and-tear problem. If using it causes wear faster than it can heal, then you will "lose" it. The PT's treatment will hopefully modify the system to reduce the amount of wear to a sustainable level. And you may have to give up some of the more punishing activities (eg running, hopfully not hiking, skiing etc).

Typical treatments include strengthening certain leg muscles (by non-hiking methods), stretching, and foot support (eg orthodics or insoles).

I had my chondromalacia professionally diagnosed, but was given poor treatments and had to figure out for myself how to build the appropriate muscles without damaging the cartillage. Bikehikeskifish also had his professionally diagnosed, hopefully his treatment will work better than mine (wouldn't want him to have to change is login name to bikefish...).

Coldfeet:
You haven't told us your diagnosis. Scoping (to me) means looking at the inside of the knee joint (either joint)--it doesn't say what the problem or the treatment is. (Certain treatments can also be done using a "scope".)

We cannot give you any meaningful opinion on whether continued hiking will damage the joint. If you tell us more, perhaps those of us who have had similar problems can describe our experiences.

And, of course, hiking downhill puts a lot of stress on the knee joint. Heavy packs make it worse, poles can help reduce it. One can also back down steep trails with good footing.

BTW, the knee has two basic joints: the main weight bearing femoral-tibial joint (includes the menisci and interior ligaments) and the patellar-femoral joint which simply improves the leverage of the quadraceps. (Chondromalacia patella is a wear and tear problem of the patellar-femoral joint caused by mistracking of the patella in a shallow V-groove on the femur.) There are lots of things that can go wrong in either joint.

As Bikehikeskifish, noted none of us are qualified to give you a good opinion (particularly over the net), all we can do is repeat our own experiences and a few factoids that we have learned along the way.

Doug

DougPaul said:

Chondromalacia-patella is a wear-and-tear problem. If using it causes wear faster than it can heal, then you will "lose" it.

Click to expand...

This goes without saying. If there's direct bone-on-bone wear, that's a different matter (and rather unlikely, I might add). But, that's not what coldfeet is asking. He wants to know if hiking in general is likely to make his condition worse. Once he gets the OK from the medical staff, my advice is to get regular exercise, with the emphasis on regular.

It's a rather rare situation where our bodies heal from a result of dis-use.

Kevin Rooney said:

This goes without saying. If there's direct bone-on-bone wear, that's a different matter (and rather unlikely, I might add). But, that's not what coldfeet is asking. He wants to know if hiking in general is likely to make his condition worse. Once he gets the OK from the medical staff, my advice is to get regular exercise, with the emphasis on regular.

Click to expand...

He asked a question about his prognosis, but didn't tell us what the problem was. Hard to give him much useful info.

It's a rather rare situation where our bodies heal from a result of dis-use.

Click to expand...

Depends on the details. Sometimes dis-use (also known as rest) for some period is part of the treatment. And sometimes the system can only withstand a lower load than is desired.


Medical advice from the net is often worth what you have paid for it...

Doug

Don't push it

Time is either on your side or against you and you have to figure out which it is. After three, they start predicting knee replacement someday. I'm about 15 years past my due date!
It could be a period of sufficient rest is needed or you may be better off going into intensive therapy. Your doctor will decide but you have to tell him your interests so he can give you warnings and specific therapy.
The bone-on-bone issue is a key one. You have to ask your doctor directly about that and what he thinks will be the impact of hiking and climbing.
It's quite possible you're done running and hiking, perhaps just for a while. You have to let injuries heal and surgery is akin to injury. If something is removed, someplace that was underneath is now the weight-bearing surface and wasn't intended to be.
Two things to consider: My late first knee doctor also did a famous athlete whose career was ruined by either knee injuries or knee surgery. I was back for my second in sixth months and he told me he "took it down to the bare, bleeding bone," that is, removed all the miniscus. Knee surgery has advanced since 1972!
You may want to inquire about your current doctor or get a second opinion about a third procedure.
Four years later, a big chip broke off and locked up my knee. A new doctor did the third operation and it has held well for 30 years but an orderly dropped my leg next day, an artery tore, small surgery, wound got infected, 30 days on intravenous antibiotic, fungal infection, nearly lost leg, long recovery, basically lost the size, shape and power of my right quadricep and can only bend my leg back to within 8-10 inches of my butt.
A good friend who used to mess up his knee every winter skiing (7 operations) and I agree that knee breakdowns start with small chips and proceed to larger ones because the bone is not as resistant as the meniscus.
What got me back to athleticism was skating because of the good whole-body, cardio-vascular workout and no impact on the knee joint. Next thing I knew, I was able to take long walks.
HikeBikeSkiFish, wise as usual, makes an important point about age. You were going to get arthritis in your knee anyway and these operations are hastening it. You need to be taught quad-building/maintaining exercises to support the joint as you get older. Post-55, you lose muscle mass fast.
Try taking your favorite painkiller/analgesic before exercise. Again, ask your doctor about which ones and how much. Applications of Mineral Ice before, during and right after are a good idea. Don't know why but it seems to reduce swelling. Try a post-hike ice wrap and a hot shower. And a six-pack. They've got hot tubs at the Hiker's Paradise hotel!
Last, lower expectations, be sensible, fatigue is an enemy. You're more likely to cause injury when you are tired.

DougPaul said:

Medical advice from the net is often worth what you have paid for it...

Click to expand...

And sometimes less.


In my case, hiking ruined my knees. Probably doing it with the 100 pound pack contributed. The falls didn't help either.

Dave, I hope all goes well with your knee. After my knee surgery the orthopod told me hiking would prob be better for me than running. Uphill is not a problem but I find if I am not carefull, the downhills bother my knee. I think I am slower on the down hills now. When I push it down hill my knee will bother me for days. Running, the the other hand, does not bother my knee at all. And I have been really pushing the running mileage. Biking, however, really bothers my knee.

jjmcgo said:

HikeBikeSkiFish, wise as usual, makes an important point about age. You were going to get arthritis in your knee anyway and these operations are hastening it. You need to be taught quad-building/maintaining exercises to support the joint as you get older. Post-55, you lose muscle mass fast.
Try taking your favorite painkiller/analgesic before exercise. Again, ask your doctor about which ones and how much. Applications of Mineral Ice before, during and right after are a good idea. Don't know why but it seems to reduce swelling. Try a post-hike ice wrap and a hot shower. And a six-pack. They've got hot tubs at the Hiker's Paradise hotel!
Last, lower expectations, be sensible, fatigue is an enemy. You're more likely to cause injury when you are tired.

Click to expand...

I will chip in a few more facts about my personal case:

-- I am 41, 6'3", 200#.

-- Many years ago (Dave Metsky may remember -- we use to work together) I weighed 270#. I'm sure the extra weight didn't help me much.

-- My X-rays are clear of osteo-arthritis (so far).

-- Ice does help. The PT does make me ice my knees (take two small paper drink cups, freeze them full, and peel the top half off, and then perform the "wax on, wax off!"-style circular ice massage, ice directly on your skin) which reduces swelling / inflammation so you have less pain afterwards.

-- I have not resorted to NSAIDs (i.e., Ibuprofen) as the pain has not been too bad, at least not when sitting still.

-- I'm at T + 5 weeks since the 'injury' (onset) and in the last two weeks, I definitely see an improvement. No more twinges coming down my stairs. Fewer and milder twinges while riding my bike.

-- I put blue SuperFeet in my every day shoes and upgraded my hiking boots to the green ones. I take short, flat hikes, bringing my 4-year-old son along. If it's too much for him, it's too much for me

Tim

.....medical advice from the Net....

Click to expand...

daxs said:

Running, the the other hand, does not bother my knee at all. And I have been really pushing the running mileage. Biking, however, really bothers my knee.

Click to expand...

See that? The exact opposite for me. I can not run at all anymore, however biking gives me no trouble at all... In fact, this summer, after an injury, I had to walk with a cane for a week or so (in the woods, we call them hiking poles, in the city, it is a cane). I would cycle-commute to work, with the cane strapped to the bicycle, get off the bike, then hobble into the office.

So.... It all depends... Don't look for consistency here.... except maybe in agreeing that a 100 pound pack is not good for the knees.

Different Strokes

--M. said:

Hiking need not be destructive (as, say, running is -- there's no way to run without it being bad for your joints).

Click to expand...

Tell that to Yiannis Kouros Or David Horton. Or any of the Dinosaurs of Running. Yiannis holds almost every long distance running record imaginable, and is still going strong at 50+. I think it's safe to say his knees have several thousand miles on them.

For me , it's a matter of how much I am carrying - I can put on lots of miles trail running with absolutely no knee pain, but as soon as I put on a big pack and hit a rocky descent, it's a different story!

bikehikeskifish said:

-- Ice does help. The PT does make me ice my knees (take two small paper drink cups, freeze them full, and peel the top half off, and then perform the "wax on, wax off!"-style circular ice massage, ice directly on your skin) which reduces swelling / inflammation so you have less pain afterwards.

Click to expand...

Icing does reduce inflammation.

A missing detail: ice after exercise, not before. You can also ice when not exercising. (You just don't want to do it shortly before.)

Standard first aid for inflammation:
RICE:
* rest
* ice
* compression
* elevation

Doug

--M said:

Hiking need not be destructive (as, say, running is -- there's no way to run without it being bad for your joints).

Click to expand...

Tim Seaver said:

Tell that to Yiannis Kouros Or David Horton. Or any of the Dinosaurs of Running. Yiannis holds almost every long distance running record imaginable, and is still going strong at 50+. I think it's safe to say his knees have several thousand miles on them.

For me , it's a matter of how much I am carrying - I can put on lots of miles trail running with absolutely no knee pain, but as soon as I put on a big pack and hit a rocky descent, it's a different story!

Click to expand...

The knee is a complex and delicate joint and its problems can be very ideosyncratic. If one asks around, one can probably find all combinations of cans and can'ts for a list of sports...

The causes (or at least contributing causes) of knee problems can range from the foot to well above the knee.

Doug

I knew I wouldn't actually need to rise to my comment's defense, mostly because it defends itself: running is very hard on the joints (wherever they are). It's not a form of bigotry to say this about running, or basketball, or soccer or others.

We're not swimmers here, so we'll all be subject to some level of impact, but my point in differentiating was to be encouraging about hiking. It's worth trying the myriad different ways to get past body problems and there is good hope.

...Unlike with running, that bastard, mongrel pastime! Running is the Johnny Damon of sports.

There. Have at me!

A good doctor.

Make sure you have a good doctor. My doctor is useless. The last time he told me, "You are XX years old, you abuse your knees, and you don't follow my advice. There's nothing I can do for you."