Tuesday, April 22, 2008

Forgive me Fartlek, for it has been a year since I last ran

Or how to recover from multiple meniscus cartilage tears - a guide that might help fellow sufferers

In 2006 I ran the London and New York Marathons. I managed respectable, sub 4 hour, times in each and met the goals that I'd set for myself and I raised a good total for Macmillan Cancer Relief. I set about training for the 2007 run in London.

But in early March 2007, just at the end of a 13 mile training run, I was all of a hundred yards from home and just slowing down, walking even, when I suddenly pulled up sharply. I thought I'd pulled a muscle in my left calf. I limped home, wondering what I'd done. I'd run a good time for training, maybe 1h 55m or so, and hadn't done anything that I'd expect to cause injury - no tumbles, no uneven ground, no fast pace work.

Recovery Strategy 1 - Ice and Hope

A few days of ice and elevation went by, and it got no better. I had a pronounced limp and really felt the pain going up or down stairs. I upped my dose of Glucosamine and Chondroitin (there's no evidence that they help in injury situations, but I figured it was worth a go)

Recovery Strategy 2 - Ultrasound and Hope

I went to the physio to have it checked out. Her immediate view - not even 10 minutes into the session - was that I'd torn the meniscus cartilage, but she couldn't be sure. Maybe it was just a strain; the optimist in me hoped so. Some ultrasound, some galvani frog treatment (where they strap some wires to your leg and feed a current throught it resulting in lots of rhythmic pulsing of muscles).

Skiing?

I was due to go skiing a week later. The physio sourced a knee brace for me that had near-solid metal bars down either side of the upper quad and calf and a hinge joint at the knee, all aimed at keeping the knee from twisting (and doing further damage)There was no question, of course, of me not going skiing - I'd been looking forward to it for ages and the snow was rumoured to be great. The week of skiing passed without further injury, although any turns where I needed to put weight on my left knee suffered - and the one time I went down a mogul run (entirely by accident - I try and avoid the things normally), the results were calamitous. Even this year, I didn't try that run again.

Recovery Strategy 3 - More Ultrasound, Less Hope

After the skiing, there was no improvement (of course - neither time nor the exertion seemed to have made a difference although at least it wasn't worse). I looked for a different physio to see what someone new would think. A few sessions there, lots of exercises to work my quadriceps and hamstrings, the wearing of various leg braces and what not, and there was no change. Still painful at every step with worse pain on stairs. I'd started to cross roads at crossings, because I couldn't take the risk of needing to dart through a gap between traffic (I was confident I wouldn't make it)

Recovery Strategy 4 - Open It Up

In June (so 3 months after the original injury) I went to see a surgeon. He pushed my left leg this way and that way and within a few minutes said that he was certain I had a tear and that I'd probably had it since the run, not because of anything I'd done since. He didn't need to do an MRI - a waste of time he said given that I'd tried physio for several months. Cartilage tears sometimes happen because of an impact - a forceful twisting of the kind rugby players or football players might experience in a heavy tackle - and they sometimes just happen because bits of the body wear out. Maybe it's running, maybe it's the way that you walk, maybe it's a problem in the alignment of your joints, or maybe it was just my time.

A few days later, in June, I had an operation. It's a simple surgery. You're in and out the same day and can go home, just taking care not to put too much weight on the damaged leg. Within a few days you can cycle and do light weight bearing exercise (to strengthen the quads) and, in theory, after 6 weeks or so you can start running.


Knee Pre Op.jpg

The photo on the top right, taken by the surgeon, is where I think the tear was. The bottom left shot shows the surgeon using the latest hi-tec instrument (it appears to be a downsized boat hook) to sort the cartilage out.

I'm using a demo version of software called "PixelMator" to edit these shots - so there's a logo in the middle of the shot. Once I've played with the software some more I'll register it and replace the shots with pictures without the logo.

Recovery Strategy 5 - Take It Gently After The Op and Then Build The Strength Back

I keep pretty good notes of my training and, looking back at the few weeks after the operation, I can see that I waited a few days and then started cycling (in the gym). The op was on a Friday and on the Monday there was no trace of a limp and only minor pain when walking. Within 10 days I was able to cycle a good 10k, although the pain was still there it was pretty subtle. I felt good

By September (again, 3 months after the operation), I'd jogged a little (on the treadmill and outside) and was ready to try a longer run. I went out for a 6k run and completed it in a careful and slow time of 36 minutes (versus a usual time of 28-30 mins). A week later I tried the same run again, at the same pace, but had to pull up after 3km. I could barely walk let alone run another step. I hobbled home.


Knee Post Op.jpg

This is the post-op photo of the knee. Nothing much to see, although if you look carefully, you'll see from the top left that there is less cartilage in the knee than there was before. It's not easy to tell the difference.

This Isn't Working For Me

I left running alone, went back to the physio and started building up my knee strength again. Maybe my quads were still out of balance.

Six months since the operation, ie January 2008, there was no change. I went back to the surgeon and explained the problem. The next day I had an MRI. It looked liked I'd torn the meniscus again, but in a different place. Maybe it was just weak after the operation, maybe I pushed it too hard or maybe I was just unlucky. Apparently these things happen in perhaps 1 in 5 cases - there's a second tear or a further tear that wasn't quite fixed the first time round.

The MRI - How It Should Look

knee1.tiff

Here's a picture of my knee. I've marked what a normal meniscus cartilage looks like with the red circles. You'll see they're on either side of the knee (in this picture, the front of the knee is on the left). What you should see with a meniscus is a roughly triangular black shape. When your cartilage is torn, you see something like this:


knee3.tiff

This time I've used a green circle to highlight the problem. You'll see there's a white line right through the middle of the previously clear black cartilage cross-section. This is, most likely, a tear.

A Second Operation

At the end of January 2008, I went for a second operation. Same process as last time, in and out within a day. Same plan for recovery, although I took it much easier this time and left it a couple of weeks before I went near an exercise bike.

Recovery Strategy 6 - What More Can I Do?

There's always Rest and Ice, and there's ultrasound, and there's strength building exercises for the quads and hamstrings. I'd been doing all of these, and I carried on doing them. They're the core of any recovery strategy. But I added some new things.

Powerplate exercise. The powerplate is a vibrating platform that supposedly improves recovery from injury, tones and exercises your muscles and so on. Lots of gyms have them now. I've been working on that 5-10 minutes at a time, 4-5 times a week. Does it help? Hard to say, but my weight training poundages are up and I can cycle further in the same time than I used to be able to before the powerplate.

New pills. I've scoured the Internet for any kind of over-the-counter pills that might improve things. I've landed on two that seem to make a real difference. It could all be the placebo effect but, you know what, if they appear to make it better, I'm ok to keep taking them.

The tablets are Super-Cissus RX (only available in the USA but appears not to be a substance banned by the IOC) and Arthrolactin. Both are readily available over the web and won't break the bank.

KneedIt - the last part of the recovery strategy is a new kind of knee wrap called the "KneedIt". It looks really weird (this is definitely not my knee by the way):

200804221405.jpg

But it seems to help. Over the last 4 weeks I've got back into running. I started out at ten minutes and have built up to about 30 minutes so far, running every 3 or 4 days. The distances are nothing to shout about - the furthest I've run so far is 4.25km - but they're a big improvement on being afraid to cross the road in case my knee gave up on me half way across.

So all of these strategies seem to have played a part in getting me back where I am, wherever that is. For now, I'm sticking to wearing the kneedit most of the time, taking the Super-Cissus and Arthrolactin pills every day and hoping that the powerplate is really doing something for me, other than shaking loose every bone in my body.

Is It Fixed?

Probably not. I still have pain when I twist the knee, or when I stand up after a period sitting down. Sometimes it hurts going up or down stairs. I'm hoping that this is all part of the recovery process and that before long that pain will be gone too. I have few options left open to me now, other than trying out cortisone injections. I know that I'm nowhere near needing a new knee, so I'm not going to even think about that for another 20 years at least.

It's been a tough year. When you're used to running 3 or 4 times a week, suddenly not running at all is a big hit - and cycling or working out in the gym don't have quite the same buzz for me. Dealing with the pain with every step, and worse going up and down stairs has been tough too. But it could be worse: I am otherwise fit and mobile and there are plenty of people in worse places than me, so I'm not complaining. I'll keep plugging away and hope that it gets better soon.

11 comments:

  1. Anonymous7:59 am

    Sounds like your body is giving you a clear message and it's time to take up a less impacting hobby such as macrame or knitting.

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  3. So does it still hurt? Has the pain started to go away after over another few months to recover? Sorry to hear about your injury and all this stinking recovery time! Best of luck with the healing process!

    Thanks for posting this and putting the pictures up!

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  4. erm stop running you will wear your joints out

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  5. kneecuper10:24 pm

    can u please describe where exactly in the knee, did you feel pain?

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  6. The pain was on the inside of the knee, in the middle if I pushed hard with my thumb.

    If I kneeled down and tried to sit on my heels, I couldn't without hurting

    If I tried to twist the knee from side to side, there was more pain

    and there was also pain at the back of the knee, on the inside

    does that help?

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  7. kneecuper2:26 pm

    Hi
    Thanks for replying, even so long after the case (hope things have change for good)
    Well, i am trying to match my case to your descriptions. I also had meniscus repair surgery, and still suffer from pains during running (miss that a l-o-t...) and everyday actions like walking upstairs and downstairs.
    In those cases the pains are in the front underneath the patella.
    Like you, i have pain in the back of my knee while bending the leg (only toward the end), so i can't sit in the same way you couldn't.
    So hoping to run again, I'm looking for an aid product (not a <span>treatment</span>) and thinking about the "kneedit" or other knee wraps.
    There are a lot of knee wraps, and i was wondering if i could feel the relief at the moment i will measure the knee wrap.
    Thank you so much,
    Ozi

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  8. Hi Ozi

    Sorry to hear you're still having these pains.  I know that mine lasted probably a year after the (2nd) operation.  Since then, though, I have run the London Marathon and can do a half marathon only a minute or two slower than before the op (I run a half in about 1:42 now).

    I found the following made a different

    - serious overdoes on glucosamine and chondroitin.  don't know if you're in the UK but the Boots brand worked best for me (I must have tried 20 varieties). I took 6 in the morning and 6 in the evening for about 2 months and then scaled back to 3 morning and evening.
    - overdose on super cissus RX: 5 in the morning and 5 at night and then down to 3 morning and night

    when i am taking these doses, I have no pain ever.  If i miss a couple of days, e.g. if i'm away, i get some aches.  So I recommend giving them a try.

    I also do a lot of single leg exercises - wii fit and power plate stuff - and can recommend that to build the strength back

    I hope this, or something works for you.  please keep me posted on your progress.  Alan

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    Replies
    1. Hi Alan!

      I read your whole story and think I may be in a similar position with the torn meniscus. Gosh it's nice to be able to relate to where someone else is at!

      I have run 13 marathons and just PRed at 3:52 last year.

      My original injury was 3 months ago playing soccer. I was diagnosed with a torn MCL (thankfully not requiring surgery) and possible meniscus damage that would only be revealed over time. I very diligently rehabilitated it with a PT but had small lingering swelling/pain on the front, lower right of my left knee (approx location of medial meniscus) and pain in the back of my knee when bending (left knee, left edge of back of knee ... the opposite of where the swelling and pain is in the front of the knee). I was working my way back to my original running pace when I aggravated the injury on an 8 mile run (I had run 10 miles multiple times, so this was not longer, or faster, than any exercising in the last 3 months of recovery. I hobbled the last 1.5 miles and spent two days experiencing the same level of pain during the initial few days. Within a week, I was close to the same level of mobility as I had reached pre-aggravation but the pain in the front of the knee has not decreased as much as it had before and I still have the pain in the back of the knee when I bend.

      I just had an MRI yesterday and the image is somewhat similar to the torn meniscus image above, except the line in my image is vertical, not horizontal.

      I expect to hear back from my doctor in a couple days and assume I will have a similar arthroscopic procedure. I am currently continuing to ice multiple times a day and have diligently been doing the strengthening exercises/stretches from the PT ... I am hoping this helps avoid the same injury on the other side AND will contribute to a faster recovery for the injury.

      I appreciate your input about the Glusoamine and Chondroitin! I have not taken it for a number of years because I hated swallowing the large pills but I am going to follow your regimen and amp it up ... like you said, it certainly cannot hurt. What is the recommended dose on the bottle and how many times that are you taking with the 12 pills? My dose is 3 pills/day so 12 pills is 4x that.

      I am not familiar with the power plate and do not recall seeing one at my gym; I'll have to ask.

      Thank you again for sharing your story!

      ~Heather

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    2. Thank you for taking the time to write Heather. I hope my experience will help you - the thing I learned is to take it gently on the way back. I can run as fast now as I could then, but it took longer than I thought and I pushed too hard too soon which probably made it take even longer. A power plate is a vibrating plate - you can stand on it with one leg at a time and work each leg at a higher level of intensity than if you just stand on the floor. It helps for sure. Good luck - stop back when you've had your op and tell me how it went.

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    3. On the glucosamine, I took double the recommended dose (so a morning dose and an evening dose). But I'd look closely at Cissus - I think that can make a difference.

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