Saturday, August 13, 2016

Don’t Rush Back Into Hard Activity After Knee Surgery

I’m a Boston Red Sox fan – a bit of a closet one, now that I live just outside of New York City.

Some big offseason news for the baseball team was when they acquired Craig Kimbrel from the San Diego Padres. Kimbrel is a “closer,” a pitcher who enters the game in the late innings to shut down the opposing batters from scoring any runs. In the world of closers, Kimbrel is a pretty darn good one too.

Once the season started, there were a few bumps for him in making the transition from one team to another (and one league to another), but everyone agreed that he threw an assortment of filthy pitches that could leave opposing hitters flailing at air. It looked like the Red Sox at last had the ace reliever they sought.

Then, in July, we got some uh-oh news:
The Red Sox have placed closer Craig Kimbrel on the disabled list with a medial meniscus tear in his left knee, the team announced.
I’m not a surgeon of course, but I’m kind of a knee guy, and I thought, “Ah, hope the team is smart enough to handle this well.” Kimbrel was scheduled to have surgery and miss three to six weeks. I thought to myself, “Give him a couple of months.” Knee surgery isn’t a walk in the park, even for a young (Kimbrel is 28) elite athlete.

Then, on Aug. 1, my heart sank when I saw this:
Closer Craig Kimbrel returned to the Boston Red Sox on Monday, three weeks after surgery to repair a medial meniscus tear in his left knee.
I’m thinking, “No, give him more time. Sure, he feels great. Lots of people feel great right after surgery. But the truth is, they’re more frail than they realize.”

But Kimbrel took the mound and performed brilliantly. However, things didn’t go so well for him during a game after that:
Craig Kimbrel had the worst outing of his career Tuesday night, walking four batters ... the Boston Red Sox closer spoke of knee soreness after the outing.
Oh boy, I thought. This was completely avoidable. Now, to be fair, his manager said that the next day Kimbrel reported no knee soreness at all. True? I don’t know. But even if so, I’d say that knee soreness after surgery should be treated like a wildly flashing red light.

Post knee surgery, don’t rush things. Don’t be deluded by the fact that, when you walk, there isn’t knee pain anymore. Well of course not: you’ve been lying around for weeks, not putting any weight on your joint. Meanwhile, the cartilage cushioning your knees has been getting softer.

Obviously, the last chapter in this story hasn’t been written. And obviously, I’m not the Red Sox trainer overseeing Kimbrel’s rehabilitation program. If I were though, I’d try to go easy on that knee through the end of this season (which ends in late September for teams that don’t make the playoffs).

Then, during the next offseason, I’d consider getting him going on some gradual leg/joint strengthening. Maybe buy him a high-end bicycle and a plane ticket to southern California and tell him to start nice and slow, then perhaps work up to climbing some of those mountain foothills by the time spring training for baseball players rolls around next March.

Knee surgery is a big thing. Give it the respect, and time for recovery, that it deserves.


  1. An update.

    Have a new GP who seems genuinely interested in helping me. He realises how important sport is to my mental well-being, though we both agree getting back to the extreme levels of the past might not happen.

    Over the 4yrs I'd had about a 50% improvement in pain/function by learning from sites like this, and mostly from activity modification plus some other things.

    Some of the Dr Dye info posted has been very useful and got me thinking chronic inflammation may be the main cause of my problems, less so the cartilage damage, though the later probably caused the former.

    So I asked my new GP if I could try the anti-inflam Celebrex which I have for a month, and it reduced the pain another 50%. I'd also started a little running before this, and just maintained my activity levels during the Celebrex trial with good results. Knees certainly not 100% (may never be) but still heading in a good direction.

    He also tested me for a whole range of auto-immune diseases, RA etc and other things and basically I'm 100% good except for my knees. He agrees my knee pain is probably kneecap cartilage degeneration (patella chondromalacia) which has triggered chronic synovial inflammation (loss of tissue homeostatis Dr Dye would say). He feels I'm probably genetically disposed to joint degeneration issues (which explains my pains in other joints, but they are nothing compared to the knees). So another 2mths of Celebrex to see how I go getting the inflammation down.

    Getting the pain level lower has also enabled me to much better ascertain what my knees can handle, and I've definitely found cycling is worse than running (due I think to more knee flexion = more patella loading, and my cartilage damage issue is mostly patella, not meniscus etc I think).

    So, I think the path to my demise went like this:

    - coach prescribed lots of hard cycling on windtrainer which combined with skinny legs and lack o strength training of supporting muscles (esp glutes, hips, back, core) plus past patella cartilage damage from rugby etc = more patella damage.
    - coincidentally, around the same time my patella's were getting hammered, I tore my left medial meniscus = surgery.
    - surgery plus a too rapid return to training led to a total loss of homeostasis in both knees (chronic synovitis - even though several medicos said I had no synovial thickening etc)
    - standard physio etc. treatments made this worse
    - this led to a pre-CRPS type condition
    - a massive reduction in exercise, anti-depressants which helped with my endorphin withdrawal and tendency to still over-do exercise plus perhaps some natural supplements (fish oils, Rosehip with GoPo) and finding leg strengthening exercises I could do without making things worse saw a 50% improvement over 2-3yrs
    - but underlying inflammation still lurking and easy to flare up, so trying Celebrex to see if I can knock it out, while at the same time trying not to get carried away with exercise (hard when your knees are feeling somewhat better)
    - crouching/squatting still a big trigger for flareups (may always be?)

    Stay tuned. Next goal is to complete a Parkrun (5kms non-stop). Could take a while yet.

    1. Good to hear from you TriAgain. My own update is as follows:

      Followed a gradually increasing walking program over the last 6 months and now I am at the point where I can walk 2-3 km without significant pain. Taking stairs/bicycling would still cause soreness and pain the next day. Multiple doctors have cleared me of RA, other inflammatory diseases so I think my pains were mostly a cartilage issue or some degradation in joint health (homoeostasis).

      Recently, bought a total trainer and started a program of bilateral squats this past week. I feel some wonkiness in the knees during exercise. However, over the last few days they have been feeling fantastic post workout. I went biking for about 6 km today and there is none of the usual post-biking soreness/pain. Ofcourse, I am going to take it easy over the next few days as one can never be too cautious with fragile knees :). Will update you guys on my progress with the total trainer.
      Also, pain in other joints (elbows,wrists,ankles) seems to receding in line with my knee pains.

      As far as supplements go I have been taking Glucosamine sulfate, curcumin and omega 3 everyday for the past 3 months. Not sure if they are making a difference but I am going to continue taking them as I see no harm in that.


  2. After losing both my jobs to Patellofemoral Pain, I now have a lot of time on my hands! I came across this article, which mentions a study in which water aerobics was shown to improve knee cartilage.


    1. Yes, water exercises are a great idea for knee pain. Moving in water/easy walking/slow cycling ... those are the three I'd try for sure. Walking worked best for me, but for someone else, it might be cycling or water.

  3. Thanks, Richard. I've been afraid to swim after stationary cycling without any weight on my knees (using a mini cycle machine) caused a set back.