3rd time a charm?..knee operation

[Tim Seaver]

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

Masochists bent on self-destruction, even!

...Studies have shown that runners and walkers face no greater risk of crippling arthritis than anyone else. And some specialists believe that a regular running and walking program can keep your knee and hip joints in good working order.

What keeps your joints healthy is a nutrient-rich fluid called synovial. This fluid works like motor oil to lubricate the hip and knee joints (and others) which keeps the joints healthy. Experts believe that running and walking helps the joints remain supple and flush in synovial fluid.

Another myth that researchers have dispelled is that running causes bones to compact (or compress) due to the daily pounding. But research conducted several years ago on runners in the Fifty-Plus Association (a running group of runners 50 and older), found no significant difference in the amount of compression between their bones and the bones of a control group of non-runners. In fact, the Fifty Plus group had less joint deterioration than the non-runners...

 

[funkyfreddy]

I find running on the softer surface of the YMCA indoor track (a semi-hard rubber surface) much easier on my joints and muscles. It certainly reduces the impact, so I would think that any statements about running/jogging should be qualified as to the environment and type of surface one runs on.

I know that running on concrete/asphalt/city streets is bad for my joints, not to mention the amount of pollutants one inhales running on the crowded streets of NYC.

Good luck with the operation, David! Hope all goes well and you're back in the hiking saddle ASAP!

 

[coldfeet]

Hello all and thx for the many different examples....

I'm embarassed to say that I don't know the exact medical term of my meniscus injury, I just hand over my insurance card and tell them to "fix it".
I'll ask them to write it down because i'll never remember those words..

But I think that not exercising regulary and then hiking once or twice a month could be a strain on my knees, it's just not possible to be a "weekend warrior".

Going out tonight to "hike" in Central Park, catch some city views and have a drink in lower Manhattan....Views and Brews #7! Then get scoped in the AM..

I'll have to make a better committment in exercising so I can continue to enjoy this hobby....have a happy and healthy holiday and new year to all!

 

[Pete_Hickey]

But I think that not exercising regulary and then hiking once or twice a month could be a strain on my knees, it's just not possible to be a "weekend warrior".[
....
I'll have to make a better committment in exercising so I can continue to enjoy this hobby....have a happy and healthy holiday and new year to all!

Hey.... Suffolk to Queens is relatively flat. Commute by bike

Going out tonight to "hike" in Central Park, catch some city views and have a drink in lower Manhattan....Views and Brews #7! Then get scoped in the AM..

"...got good and drunk the night before, so I looked and felt my best...... I wanted to be the all-American kid from NYC."Arlo Guthrie

Hey! Gonna take pictures of the operation to show the class? Get this guy:

http://newmud.comm.uottawa.ca/~pete/tmp/gather2.jpg

to be sitting on your leg while the docs work. The kids'll love it!!!!

 

[bikehikeskifish]

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.)

In fact, my PT often WARMS the knee (using ultrasound) before I do the stretching / strengthening exercises. On my own, in the gym, etc., I walk on the treadmill for 5-10 minutes to warm it up. Or, if a cycling day, I do the 10 minutes+ of stretches after the ride.

Tim

 

[bikehikeskifish]

Biking, however, really bothers my knee.

This is often caused by have the saddle set too high, or too low. A general guideline is (assuming clipless pedals) that placing your heel on the pedal, you should just lose contact while back-pedaling. If your knee is still bent with heel on the pedal at full extension, the saddle is too low. If it loses contact before 3 o'clock / 9 o'clock, it's too high. You want to lose contact between 5 and 7, ideally as close to 6 as possible.

Most bike shops, especially during the slow periods (after Christmas) will perform a basic bike fit check for free.

Tim

 

[timmus]

Going out tonight to "hike" in Central Park, catch some city views and have a drink in lower Manhattan....Views and Brews #7! Then get scoped in the AM..

I would give you my not-too-bad knees in exchange of an evening in NYC.

... Well, maybe not, but close.

You'll get a multitude of different opinions about knees, here. You see, I use to hike with poles ALL the time, my knees were killing me, not only when hiking, but also at home. That was last year.

I did a big hike last week (24,5 miles, 5 4K's, with a 18 Lbs pack), and right after leaving trailhead, I realized that I left my poles at home ! And you know what ? I didn't care, because I don't need them anymore. Don't ask me why, I don't know. Even more strange is the fact that I run downhill on the trails, I jump and bang on each step down. Maybe -maybe- that is where the answer is.

One difference that I noticed from last year is that my daughter is older now, so I don't carry her around as much as I use to. She doesn't weight 100 pound like Pete's backpack, though.

 

[Stan]

If it is the meniscus it is probably a torn meniscus, which I had repaired last August ... if there is a medical term for it I don't know it either. My doctor mentioned that he sees it a lot ... yeah, well, that's how he makes his living ... but it is not an uncommon malady and since I got around to discussing knees I've received affrimation of that from a layman's perspective.

I've heard of cases where it took a year to a year and a half to fully recover to others that needed to repeat the procedure. I'd be suspect of my surgeon if it had to be repeated too much unless it was the result of a separate re-injury.

My experience has been that hiking doesn't bother it at all, in fact, I think it is good for it because it builds up the muscles. Strengthening and flexibility are two important objectives of physical therapy, which was not prescribed in the meniscus cases I am aware of (aside from strengthening and flexibility exercises for the first few days after surgery).

My doctor cautioned against tennis and other activities that can aggravate the condition from high impact twisting and turning. Hiking doesn't contribute to that unless you're running on the trail with a load ... which, incidently, might include the loads we carry in our guts and on our hips.

Overdoing it (frequency, weight, distance) can cause discomfit. What you describe doesn't sound like overdoing it. Several years ago in an effort to distribute my physical activities more equally among my body parts I took up kayaking ... actually, it was just another excuse to go outside and play. Plus, I'll have more pain to complain out when I get older. So, if you're feeling that you are overdoing it, take up an additional activity.

I hate running but I have done it to stay in shape aerobically. I cannot run much even four months after the surgery ... but I was hiking within days.

I have a philosophical difference with others, including the medical profession, and am more closely aligned to oriental medicine on the subject of icing. Icing helps relieve pain when it arises from inflammation but mainly because it reduces the blood flow, and consequently the inflammation, to the area. My feeling is that if you can stand that part of the pain it is more healing to let the blood flow and make its repairs. I find more comfort in heat.

A torn meniscus, however, does not necessarily equate to inflammation, though that can be a side effect.

My favorite antidote, of course, for all aches and pains resulting from physical activity, and it mixes well with adrenalin and endorphins even if there are no pains, is tequila.

Happy holidays.

 

[DougPaul]

Biking, however, really bothers my knee.

Staying out of the tall (high) gears usually helps too. Stick to the lower gears and spin.

Doug

 

[DougPaul]

I have a philosophical difference with others, including the medical profession, and am more closely aligned to oriental medicine on the subject of icing. Icing helps relieve pain when it arises from inflammation but mainly because it reduces the blood flow, and consequently the inflammation, to the area. My feeling is that if you can stand that part of the pain it is more healing to let the blood flow and make its repairs. I find more comfort in heat.

Initially icing reduces circulation to save heat, but once the tissue gets sufficiently chilled, a system of shunts (between the arterioles and venules, bypassing the capilaries) opens up in an effort to keep the tissues from being chilled too much. My PT also told me that ice increases the blood flow (presumably by the above mechanism).

Ref:
* "Frostbite, What It Is, How to Prevent It, Emergency Treatment", by Bradford Washington, Museum of Science, 1963.
* Also appeared in the American Alpine Journal, June 1962.
* A more technical version can be found in The New England Journal of Medicine, 166:974-989 (May 10, 1962)

In any case, it is well known to reduce inflammation.

In a number of injuries (eg sprains etc), the swelling can do more damage than the original injury and application of RICE can shorten the overall healing time.

Doug

 

[bikehikeskifish]

Staying out of the tall (high) gears usually helps too. Stick to the lower gears and spin.

Doug

Right. That was so obvious to me, I never thought to post it. Sorry. "Spin" usually means a cadence of 90 or better. I can comfortably spin 100-110 for extended periods of time. Those familiar with manual transmissions, think about passing on the hwy in 5th gear at 45 MPH (coming out of rush hour traffic) -- no acceleration. That's a "tall gear".

Tim

 

[tonycc]

About the miniscus repair, my ortho calls the result arthritis. His definition of arthritis is loss of cartilage for any reason, which is what occurs when the miniscus is repaired. This usually consists of some cutting and some scraping to smooth it back out. (You have watched the procedure on the screen while the ortho is doing it haven't you?)

As a veteran of an ACL reconstruction and miniscus repair I have found two things that really keep my knees from aching.

First, you have already heard, is using your knees. Keeping the muscles strong and in balance is important.

It doesn't have to be hiking. Just balancing on one foot will strengthen and balance the muscles (learned that from my physical therapist). I also add slight knee bends while balancing. I do this whenever I am standing in line. It's kind of like taking the stairs instead of the elevator, or parking at the far end of the lot, etc. If you look around you will find many ways to work your muscles during your regular activities. If you are like me, there never seems to be enough time, so work out when you can.

The second thing, I take gloucosamine fairly regularly. If my knee is aching a bit I never forget to take it daily, but when it feels fine I slack off. While the ongoing studies have yet to show how it helps, and whether it actually rebuilds cartilage, just protects it, or something else, there is enough evidence that it does reduce the pain for some people. I'm one of them, it makes it go away completely for long periods of time. Talk to your doctor about it.

Tony

 

[coldfeet]

I'm back and happy holiday to all!

First the bad news

I didn't get my View and brew beer!

Good news is....I now know where Strawberry Fields is...West Side of Central Park around 72nd street...

The city was beautiful with the buildings decorated, holiday songs blasting over speakers, the ice skating rink was packed with skaters, artists were on the street sketching people...had a beer with PaPa Bear downtown....then went to hospital at 5am for my scoping..

I did get to watch it on the monitor, first time ever...from what I remember it looked like a cotton ball and the dr was cutting away the loose fuzz around it and cleaning the edges to make it smooth...then I woke up in recovery...I was surrounded by loads of patients who had knee and hip replacements. So far the swelling isn't so bad...the dr. is on vacation and when he comes back I'll know the exact problem...I'm starting rehab hopefully on Tuesday but before then I'll use Stan's rehab remedy...Tequilla!

Pete, I'm afraid if I brought the dog in they would have shaved it like my knee!....Happy Holidays...

 

[Snohm Eizer]

I just found this excercise for helping the IT band. I am just starting them, my right IT has bothered me on and off for years while running or sometimes hiking (but never winter hiking or cycling).

IT band excercise/diagnosis

 

[daxs]

When I do a bike work out at the gym, I usually maintain a cadence at 100 rpm. I don't have a computer for my mountain bike so I am not sure of my cadence when riding outdoors. I think my saddle height at both the gym and on my mountain bike is just about right too. Biking just bothers my knee. I ran on Christmas day - no knee pain. I did a bike workout at the gym yesterday and - discomfort. Its not enough to make me stop however. I just push thru and wait for the endorphin rush. I am good about weight training and stretching too. Stretching has made a huge difference for me in terms of minimizing discomfort.

 

[Stan]

One more thing that helps me sometime is an ace bandage. I don't always wear it but occasionally I'll get hints that I should pay attention to my knee. I believ it helps stabilize it and helps absorb some of the stresses of the constant twisting and flexing.

 

[DougPaul]

I have found the (boneless) neopreme braces to be helpful when the knee is acting up. Best not to put it on bare skin--it may chafe. Use over an ace bandage (summer) or over long underwear (winter).

Better than the ace bandage by itself--also stays on better.

Of course, your knee problems are different from mine, so YMMV.

Doug

 

[bikehikeskifish]

I guess reviving this thread is as good a place as any to post this. Disclaimer: I am *not* specifically seeking medical advice here...

As some of you know, I have been having problems with pains in my knees. The current medical diagnosis is patello-femoral syndrome.). Overall, since December and PT, the situation has improved, but not enough to resume my NH 48 list.

I went to the orthopedist and the physician's assistant sent me to PT, to determine the cause(s) and treat with exercises. PT 'determined' that my symptoms were caused by three bio-mechanical deficiencies:

1. Pronation
2. Imbalance between the VMO and the rest of my quadriceps
3. Tight hamstrings and ITBs.

(4) I'm also pretty sure the transition from cycling every summer for the past 12 years to hiking 14 4Ks (in 7 trips) could qualify as "excess hill work, stairs, or too much distance" (see the link above.)

So, PT worked on stretching which greatly increased my flexibility. It also worked on strengthening, using the gym, and closed-kinnetic chain (squats, stairs, etc.) type exercises. After 5 weeks, the PT determined I was "cured" because the three things above were corrected. (Pronation via SuperFeet orthotics.) However, I still had pain. So, back to the orthopedic office. This time I saw the actual
orthopedist / sports medicine doctor.

The next step was to strike a lot of the closed-kinnetic chain exercises given to me by the PT (lunges, stairs, etc.) as the orth said they were too stressful. I also got a C knee brace, which didn't really do any good at all. Finally I did a 5 week course of ibuprofen, which may have helped or it may have been the lack of skiing.

I've started riding again, but I still have some mild pains and I'm sure that hiking 4Ks will be a Bad Thing(tm) for my knees at this time.

I went back to the same orth and he OK'd an MRI. The MRI reveals "a fluid pocket consistent with a torn medial meniscus" on the right knee, and explains some symptoms unique to that knee, namely, pain around and between the tendons at the back of that knee. Also, the right knee/leg has more snapping and popping, indicating more damage
on that side. The left knee didn't reveal any serious problems although there was some signal variation (?) which may or may not be anything.

So... I'm now at the point of having three options:

1. Do nothing and limit my activities, possibly (this one's for you, DougPaul) only doing the most basic, non-weight bearing quad isometric exercises (all medical professionals suggest I am well beyond this earliest post-surgical recovery exercise, but hey, their knees are not giving them pain.)

2. Synvisc injection(s)

3. Scope the knees and repair the R tear, and buff any other aberrations.

I'm looking for a second opinion, and for this I turn to you all for suggestions of top-notch knee doctors. At the moment, the leading candidate is Dan O'Neal at the NH Knee Center (Ashland and N. Conway), but if you have a similar experience and can recommend another doc, or
suggest a 4th option, I'm all ears.

In particular, I'm concerned that fixing the meniscus tear on the R knee won't cure the knee cap pain in the front, and clearly it won't help the L knee, at least not surgically (it may force me to rest, however.)

Thanks-in-advance,
Tim

 

[daxs]

I had my knee scoped several years ago and it made a huge difference in what I can do from an activity standpoint. I was able to return to pain free hiking and running. While they were inside shaving down my torn meniscus, they also cleaned up the ratty cartilage behind my kneecap. Rehab from surgery will send you back to PT for awhile (I would try and find a PT group that has athletic trainers and go to a trainer).

With a torn menicus you usually have a piece ot torn cartilage that is floating around. If that piece is flipped in the wrong direction, you have alot of pain. If its flipped in the right direction, you can be pain free.

 

[Chip]

After 5 weeks, the PT determined I was "cured" because the three things above were corrected. (Pronation via SuperFeet orthotics.) However, I still had pain. So, back to the orthopedic office. This time I saw the actual
orthopedist / sports medicine doctor.
Tim

It may be only 1 piece of the puzzle, but I have prescription orthotics to correct my foot problems; supination, high arch and metatarsal arch support. I had tried non-prescription orthotics, recommended by a Sports Medicine PT, which some people have luck with but I found useless, other than being a good waste of time and some money. I strongly believe the prescription ortho's have contibuted to happier feet, ankles, knees, hips and back. I know I also require regular exercise and daily stretching.