I’m still in a hand cast (with my right thumb, index finger and thumb wriggling free, but my pinky encased and my ring finger barely visible, like a pig in a blanket). So I’m going to keep this short.
I figured I’d try something different. Often you ask me questions, which I spin into blog entries. This time I’m going to ask all of you a question.
My brother, who loves to hike and work out at the gym, has a torn meniscus. Apparently he injured it when shoveling snow. He turned to pitch a load of snow, and the torque on his knee and weight of the loaded shovel must have combined in a bad way to tear his meniscus.
In the immediate aftermath of the injury, he had difficulty walking for a couple of weeks. Since this happened, the knee has never been the same.
He has scheduled surgery for November. Now you probably know where I stand on that. In the world of knee studies, you can throw a stone and hit three or four clinical trials that say surgery for a torn meniscus is no better than physical therapy.
However, that’s fine in the abstract, but when you’ve got the torn meniscus, and PT hasn’t done you a lot of good, surgery starts to look very tempting.
So here’s my question for all of you out there: Anyone have a torn meniscus that they recovered from? What kind of rehabilitation program worked for you?
Okay, all from me for now. This cast (fingers crossed) should be history next week, as long as the bone healed properly. Because of the nature of the break, that’s not a given. Still, my doctor seemed fairly confident.
(Oh, I’m still riding my bike, only indoors. If any of you are on Zwift, that’s me in the blue-and-white jersey, trying to hold 240 watts going up that giant mountain in Watopia.)
Cheers!
A torn left medial meniscus was what started my 5yrs of dual knee pain Hell. I was signed up for a big triathlon, so was keen to get it fixed ASAP and had surgery within a month of the tear where 1/3rd of the meniscus was removed. But I kept cycling with the tear, which was not that clever as the loose meniscus flap also chaffed the cartilage on the end of my femur in one small spot.
ReplyDeleteMy GP advised me to give it 3-6mths of conservative treatment before going for surgery, but I was too impatient. Would that have worked? I don't know. Mine was a bad tear & the loose bit was also catching in the joint causing it to lock & much pain.
But my PFPS came on in both knees within 2mths of that surgery, so maybe the surgery was the final straw pushing me outside of my EoF, or maybe I was headed that way regardless?
Several specialists who looked at my pre-surgery MRI of the tear said they would have prescribed surgery too.
In hindsight, I probably should have tried the GPs suggestion, but doubt I could have put up with the 3-6mths of inactivity.
Hi Richard,
ReplyDeleteI actually came to your blog to find out more info on knee exercises. I have just been diagnosed with a torn meniscus, as well as arthritis in my knee. I have not cured it as of yet, but I have a plan and I'm happy to share it with you. First off, I got an MRI to see what was what -- which is when I learned that I had the tear and the arthritis. My doc actually advised against surgery, because while the surgery would "fix" the tear and resolve the symptoms (pain, swelling), the bigger issue was the arthritis, and surgery would not do anything about that. He advised me to take a cortisone shot in order to soothe the pain and swelling, and prescribed PT. I will do PT in addition to what I have already been doing -- light, non-impact weight training and walking, modern dance (cuz I love it), and Rolfing, specifically, Structural Integration. Rolfing has been very helpful, as my practitioner not only releases muscles and nerves that are tight from the pain/swelling, but he also helps me to reconsider how to work with pain. It has helped with my knee. I also have plans to buy an under-desk cycle for work to help keep moving and building muscle. I just wonder, before your brother goes into surgery, has he tried any alternative modalities? As you have mentioned, there have been studies done that show that while the surgery might work initially, the results are not better than spending a year or two restrengthening and rebuilding the muscles. But... if the pain and lack of functionality is very great for your brother, then surgery might make the most sense. For me, surgery is just not an option. I'll be interested to read how it goes with your brother. Best of luck to him!
Anonymous
ReplyDeleteJust be careful when it comes to physiotherapy and muscle strngthenning, in my case, this made me substantially worse and I don't have arthritis. Look into Doug Kelsey's work on mechanobiology and the importance of finding your envelope of function and getting the right amount of motion and movement for your knees.
All the best!
Tom
I hope this doesn't go against any forum rules. Not my story, but I spend a lot of time on Doug Kelsey's site. It seems he did fix a meniscus without surgery. I wanted to post it so that it may help your brother.
ReplyDeletehttp://dougkelsey.com/meniscus-tear/
Mentioning Doug or linking to something he wrote is never against forum rules. ;) This is a very good link -- I should've thought of checking out Kelsey's site, thanks.
Delete### Part 1 ###
ReplyDeleteHi Richard,
Let me share with you my story about how I tore my meniscus. Mind you, I didn't know a single thing about the knee until after I injured myself and started to do countless hours of research.
It was last year near the end of October. I simply got up from a sitting position from the ground and pivot using my right leg. Felt an elastic snapping sensation that hurt sooo sooo bad.. I thought I had pulled a muscle or something so I walked it off... I gave it a week or two in hopes that it would heal - but no luck. I video call the doctor as I was away on a business trip and she put me through a series of tests, asking me to twist my leg a certain way to see if I experience pain... None of her tests caused any pain. So she told me to give it another 2 weeks and if it persist, come into the office and she would examine me. A month has passed and still, I felt my knee was not "normal".. I would experience pain only when my feet twist while walking (kind of like a flicking motion). Since the time of the injury till when I went to see the doctor, I had not used the injured leg much (BIGGEST mistake of my life and I'll explain more later) because I didn't want to injury it anymore. Even though walking never hurt, it was only a "twisting" motion at times [At this point my right leg was sooo weak that walking was almost foreign. Bringing the leg from the back to the front caused my foot to "flick" left to right because it didn't have any muscle to hold it in place. This caused a "twisting" motion], I would experience a sharp pain inside my knee. Never had that feeling before. And it would make the knee feel all 'wobbly' for a good two seconds and return to normal. When the doctor physically examined me, she was pinching and pressing and twisting asking me if it hurt. I said no. Nothing had caused any pain. And I explained to her that it's only just that twisting motion that caused a concentrated pain inside the kneee. I told the doctor that I suspect it's a torn meniscus and I would like to get an MRI to confirm. She kept brushing me off and said "I don't think it's anything serious. If you had a torn meniscus, you wouldn't be able to walk into my office." I insisted on a MRI and she finally ordered one. I was scheduled to see an orthopedic doctor for him to analyze my condition. I went in to see him and he put me through a series of tests. Pressing really hard and twisting my leg and pulling.. But there was no pain. He says to me "I don't think it's anything serious from what I see.". I replied "I'm flatted doctor, but I'm telling ya, there is something really messed up with my knee". At this point, it's getting close to almost 2 months of me not using my injured leg. I have lost a lot of leg muscle (muscle atrophy) by now and my knee was soooo weak. I demanded a MRI and he finally caved and gave me one. I went in a few days later and got the scan. This was just before Christmas - December 23rd (I remember so clearly). After Christmas, I got an email from the so called orthopedic. He mentions "Uou know that suspicion you had about tearing a meniscus? Yeah, well that's true. You do have a torn meniscus.".
I was sooo angry and depressed at that moment. Angry at the fact that none of the doctors believed me including the specialist and brushed me off. Depressed because I no longer have a good knee. The thought of me not able to play sports ever again made me really sad. I was at my lowest in life. Super depressed. My wife helped me get through that very difficult time in life. She is my rock and I feel very thanksful I have her.
### Part 2 ###
ReplyDeleteThe doctor immediately said to come in for a arthroscopic surgery without exploring any conservative options first! I mentioned to him, "How about physiotherapy?". He replies, "If you want, I can send you there instead. Up to you.." It was me asking him rather than him recommending a conservative treatment. I'm terrified of any surgeries! After doing countless hours of research of people going for meniscus surgeries, a lot come out more painful than they were before going into surgery. I weighed out my options and thought it was best that I don't go for surgery and try a more conservative route instead. Statistics show that people who go for these type of surgery are 3 times quicker to get osteoarthritis. That scared me a lot. One of my mom's friend who is much older tore her meniscus. She went for surgery 5 years after her tear and 2 years later, she had to get a total knee replacement because of osteoarthritis. Her's may be a more severe case than mine as every step she took, it hurt her a lot. Whereas I can walk fine without any pain. So my thinking is this - I rather live with a torn meniscus than a removed meniscus.
I went to a physiotherapy but didn't find it too effective. I've tried accupunture which did't really help with anything. Applied some chinese medicine (dit da jow) which works wonders for sprains and broken bones - but had no effect on torn meniscus. The only method I found to be effective was.... exercising!
So two months has passed and all my leg muscle on the injured knee has completely disappeared (muscle atrophy). This lead me to my next problem - patellofemoral pain syndrome. Everytime I was climbing or descending stairs, the femur would grind against the patella. It was painful. I thought it was related to the torn meniscus. I started to do more research online and discovered it was PFPS. I guess throughout the two month period, I lost all my leg muscle and my tracking for my patella became all messed up...
I started to goto the gym... Got on the stationary bikes... Did that for 2 months straight.. Tried the low resistance and high rev. However when I place my hand over my kneecap while cycling, I could literally feel the kneecap hitting the femur. I found that it did not increase my quads. Gained very little muscle... My leg was still so weak... It felt like it was only used as a walking stick and nothing else. Because it was weak, I had to watch every step I take with it preventing my foot from "flicking" and causing the twisting motion. It's hard to understand when we have good knees. It's something we don't think about.
Then I decided to start doing leg extention. Started off with very little weight, like 10lbs.. Worked my way up to 100lbs! Within two weeks, I saw a huge improvement! My quads started to gain back a lot of strength... Then I read some articles that leg extension is apparently terrible for the knee - I immedately stopped and dialed down the weights to just 10lbs, but high reps. It was the only way I could get the strength of the quads back.
Till this day, I still have PFPS - I'm not sure if that will ever be fixed.. I don't have pain when walking. The twisting motion doesn't cause anymore pain - I think it was because my knee was soooo weak at that time. I can walk fine without having to think about carefully walking anymore. It's not longer in my mindset. I've been living with a torn meniscus coming up to a year now. I'm grateful and thankful that I can still walk without pain and it doesn't hinder my lifestyle. I sure have a different perspective in life after suffering from this injury. We take a lot of stuff for granted. It's not until you injury yourself and you realize how lucky we are when we are healthy. If you ask me a year ago, I was game to play volleyball, basketball, tennis.. You name it..
### Part 3 ###
ReplyDeleteThe torn meniscus doesn't bother me much. I don't have any pain from that. However, other people experience pain from the tear.. It's the PFPS that I cannot conquer and have been trying for many many months now... Not very often, like once a month or so, the knee may flare up a bit... But I can definitely feel that it has improved A LOT since the time of the MRI. Not sure what other kinds of exercise I may do to help improve this condition but I got to figure out something fast cause I don't want the femur to keep grinding the patella. Besides the low resistance and high reps on the stationary bike, any other types of exercise I may try, Richard?
As for your brother going for the surgery - only he would know his body the best. I read an interesting article pertaining to these meniscus surgeries. It said, 9 times out of 10, chances are, the doctor will recommend getting surgery. Let's take a step back here and understand why... It mentioned, you have to look at this whole meniscus surgery thing from a business perspective. It's a multi-BILLION dollar industry. Everyone from bottom up makes a lot of money from this. From the doctor who refers you to the specialist, to the specialist who says you should go for the surgery to the orthopedic surgeron, to the hospital, to the manufacture who makes the tools for the surgery. It was an eye opener for me because I never even thought of that! Don't let other people decide or peer pressure your brother into getting surgery if he doesn't think he needs to. He may end up hurting more coming out from the surgery than he did going in. I see a lot of desperate people going on forums like knee pain guru trying to seek help and it's sad, because the person takes full advantage of their weakess at that time. People would desperately sign up for his so called "packages" only to offer them encouragements. I'm sorry, but words are not going to heal anyones torn meniscus. Huge scam.
This is great, Stan. Thanks for sharing this.
DeleteI had a really good experience with using stem cell + PRP injections from a Regenexx provider. I would personally recommend trying this approach before resorting to surgery
ReplyDeleteHow is your brother doing, Richard? I hope he's ok...
ReplyDeleteHe decided against surgery -- but mainly because of the cost. I haven't talked with him lately, so I'm not exactly sure what program he's on to control/fix the knee pain.
ReplyDelete