Dodgy Knee - Suggestions

[I-K]

Howdy, all.

A couple of months back, I finally resumed training seriously (as in, at a kwoon rather than on my back porch) after a five-year injury layoff, and I'm pretty chuffed with how swimmingly it's all going...

...except for my left knee. Just about a year ago now, I've had arthroscopic surgery on it; ACL reconstruction using a harvested hamstring tendon, with a side dish of partial medial meniscectomy. It worked a treat for everyday activities - stopped me falling over mid-stride at random, for starters - but more strenuous stuff, such as MA training, makes it pretty unhappy.

Specifically, the issues it has are:
- It's prepetually swollen. Some of it's just a consequence of the mess that results from all the hacking and drilling associated with a cruciate ligament reconstruction, but training makes it worse, ranging from moderately worse to put-that-thing-away-it's-hideous.
- Voluntary flexion past 90 degrees is mostly a no-go. Some of this is due to that aforementioned swelling damping movement, some of it is due to the hamstring tendons not having the same pull they used to (there aren't as many of them as there used to be, after all), and some of it is internal to the joint; the new, crafted ligament doesn't like stretching as much as the original used to.
- It doesn't like shock-loads. That pretty much follows on from the previous two.

That affects a few significant aspects of my training.
- Effective knee strikes are next-to-impossible because I can't get the joint to flex fast enough and I can't put enough power through it.
- Roundhouses, while OK, are tricky because I have to be careful how I turn my hips or how I fling the leg out - if I'm kicking with the right or the left, respectively.
- Dropping to the ground and getting back up has to be done slowly. <- this is a special concern, because I intend to take up some specific grappling/ground technique training (thread on that coming soon), and having to nurse my left knee through it is going to be a bit of a cramp on my style.
- Pa-tui on the left leg... no chance (my horse stance is coming along very nicely on the other hand; starting to be able to get proper low on it).
etc etc etc.

The fact that I'm a big b@stid - 6'4" and 220lbs - probably isn't helping.

I wear an elasticated knee brace when I train. That helps keep the swelling down during training, but it makes the "manoeuvrability" problem worse. I also wear high-top shoes, which lets the ankle help out more in keeping my feet planted, so the knee doesn't have to do as much of the bracing work when arresting movement. At home, I whack an ice pack on for 30 minutes after every training session to keep the swelling from getting too rampant, and I take glucosamine, calcium and magnesium supplements for bone and cartilage maintenance.

I've talked to a couple of people who've had ACL recos take three or four years to come good. I'm not sure how applicable this is to me because mine's really plateaued in the last few months, and according to my surgeon, the recovery time for this sort of surgey is hugely variable. I've also talked to people who just, and I quote, "put up with it", others still who can afford to spend the day's pay per week on acupuncture and physiotherapy which it takes to keep their knees functioning. My Sifu is understandably reserved, with a suggestion that I just wait and see and not push it too far in the meantime.

Sage words, but it can't hurt to see what other people with wonky knees out there are using as workarounds, so... over to you guys.

How do you build leg strength with a compromised knee joint?
How do you launch knee strikes and roundhouses?
How do you cope with ground and grappling techniques?

Ta, muchly.

[cjurakpt]

hi

you appear to have a complicated and multi-factorial situation here; while I can appreciate your economic concerns, if you are comitted to participating in the above described activities, I would suggest to go find 1) a skilled manually-oriented PT (preferrably one trained osteopathically as well as orthopedically) who can work with you both hands on and ther ex rehab wise; if they are good, you may not need nearly as many sessions as you think you might (e.g. - BS "mill" treament 3x a week for the rest of your life - that's just a travesty); 2) I'd try to find an equally skilled TCM practitioner who has experience with dit da (TCM version of traumatology) to work with you; same thing on the frequency - the better they are, the less they want to see you...3) in the absence of one or both of the above, consider possibly a sports-medicine oriented chiropractor, a licensed massage therapist specializing in sports massage or a certified athletic trainer with some rehab exerience; you might also find a manually-oriented osteopath, but again, he/she should be sports-med or PM&R oriented; while not my first choices, they could also be of help; but it's important, IMHO you find someone who treats the totality, not just the one area (I'm guessing you porbably have some stuff going on with the hips/pelvis lowback, and probably one of your shoulders isn't that happy either...); 4) I personally would not try anything suggested in terms of specific self-treatment suggestions given by anyone on an internet forum: based on what you report (the location, history of injury/surgical treatment, body mass, current behavior of the area), your history/complaints are strongly suggestive that you are a likely candidate for flair-up big time if the situation is mismanaged and I don't think that your system has a lot of wiggle room to compensate for that (I could be wrong, but that is my sense - the bit about it being swollen all the time is frequently a tip-off, although not always).

I'm not trying to be a downer - I think that in the right hands you could make some decent progress, especially because you strike me as straighforward and motivated; it also sounds like you are already doing pretty much everything typically available for self-treatment, so you might just need some input from another perspective - if you tell me what part of the country you are located in, I might be able to give you some specific suggestions regarding practitioners

Chris Jurak, PT

[I-K]

]I'm guessing you porbably have some stuff going on with the hips/pelvis lowback, and probably one of your shoulders isn't that happy either...);

Have an elbow which occasionally refuses to do what's asked of it after the twentieth pushup or so (there's damage where the triceps tendon attaches to the olecranon), but none of the other injuries I picked up in the accident which led to the knee reco have really impeded me in the training so far. I know they're there, but they don't scream for attention any louder when I'm training than they do when I'm walking down the street.

After five years-and-a-bit, the baseline pain's blended into the background long ago...


4) I personally would not try anything suggested in terms of specific self-treatment suggestions given by anyone on an internet forum:

Hehe; what am I, new? ;)

To be honest, a response from a physio was like "Well, blimey...", when I was mostly expecting replies along the lines of, "Meh, I just whack the b-asterisk-t-c-h with a bit of 2x4 and tell it to behave". ;)


based on what you report (the location, history of injury/surgical treatment, body mass, current behavior of the area), your history/complaints are strongly suggestive that you are a likely candidate for flair-up big time if the situation is mismanaged...

That pretty much nails what my big concern is... reinjury.


I'm not trying to be a downer

Wouldn't think it of you for a second. :D In fact, given your're a professional physio, I'd be more inclined to take what you say on board if you're packaging it in this cautious, borderline pessimistic tone than if you were being excessively upbeat.

By the same token, I *was* being mostly dark-clouds in my original post, stressing the problems. On the flipside of what I said previously, things have, I guess, got better, proportionally, since I started up with training again. I'm training harder, but the knee is not giving me any more trouble.


it also sounds like you are already doing pretty much everything typically available for self-treatment,

Except for one thing; strength training. Short of fishing for sideways glances from colleagues in the kichenette at work by standing on one leg while stirring my coffee, I'm not doing anything to get my leg muscles doing more to help the knee out...


so you might just need some input from another perspective -

I have an osteopath who did what felt like an outstanding job of untangling me following the original injury and I am planning to go see him again; ran out of room to mention that in the original post...


if you tell me what part of the country you are located in, I might be able to give you some specific suggestions regarding practitioners

You noticed I'm in Australia, right? ;)

[GeneChing]

...it happens to all of us eventually. Some of us can switch for a spell to rehabilitate, and then switch back to hard styles once we've recuperated, but eventually time takes its toll and you have to make the switch if you plan to continue your practice well into your autumn years. The beauty of internal styles (and the true treasure of TCMA) is that it has tremendous therapeutic value. It's also there for you when you get old.

And we're all getting old. :(

[cjurakpt]

hey I-K

sorry, I didn't notice you were down in OZ - although that explains the DO bit, as the DO's you have down there are the manually oriented types in the UK tradition which is exponentially better than what we got in the US with the DO's that are neither good ostepaths nor allopaths...obviously, you found a good one to straighten you out, so yeah, go back, go back! the point is kinda that, osteopathically he may well not even touch the knee initially, work out some other stuff elsewhere, kinda give the knee a little space to breathe when he addresses it specifically

but also, you guys have like, the best trained physios on the planet - find a Maitland trained GDMT or a Mulligan trained and you should be in good hands

I guess my overall point was to really think through your rehab - it's not a situation where you can just wing it - and I am sure you know that; also, as far as switching to something less stressful - I would never tell someone they can't do anything, but there may come a point where structuraly your body can no longer support what you want to do - don't get me wrong - my personal feeling is that you can do whatever you want - i nevr tell a patient not to do anything, i just tell them what I think will happen if they do it in their current state, and let them make an educated choice - if they come back 10x worse, I never lecture them, I treat them as they are - but they certainly can't blame me if they need more treats than had they deferred (hey, it's their $$$ - if they want to spend more while I am trying to show them how to spend less, what can I do?) - so anyway, obviously it's your choice, and you will determine the amount of pain you can live with (classic example - treated a guy with headaches/vertigo going for years - did some osteo stuff and he felt 85% better - went and played ice hockey and had a flair-up back to about 50% of where he had been that lasted for a few days - he told me straight out he could live with that amount of inconvenience as long as he got to play hockey - sounds right to me) - the take home message is that it's a balance between what you want to do and what you can do - just bearing in mind that you can spend months in rehab, get 85% better and blow the knee out again eve though you are being careful and cautious, just because that's the nature of the game - simple risks/benefits analysis, but just suggesting you take a little time to figure out what is your limit, what can you live with etc.; the other thing is to consider, at least while you are in the beginning phases of addressing this, maybe to lay off the high impact stuff - when you first pour the jello into the ice cube tray, you need to give it a little time to sit, right?

anyway, best of luck to you

[I-K]

Been busy... having time to check the forum, bugger-all time to actually post, so here's a belated thanks to both Gene and Prof. Jurak.

Update... found an osteopath who uses the Isogai method. He cracked me a couple of times, gave me a fabric ribbon which looks a lot like a MA sash and said, "Here, take this, and tie your knees together with it for half an hour every night." I've taken to calling it my chastity strap...

...and it feckin' worked, didn't it? Six weeks of wearing the thing to bed later, I'm ramping up my training incrementally (staying back after class these days to practice), and the swelling is still pretty much *gone*. Still can't pa-tui or squat too far, but the improvement has been staggering; completely out of all proportion to what I'd expected... making me a smidge sheepish about having made such a big deal out of it...

[Lucas]

Not to pipe up in your business. But its always a big deal. We only get one body!

[I-K]

Not to pipe up in your business. But its always a big deal. We only get one body!

Well, let's see what science has to say about that in a decade or two... :D

Re: the big deal bit... it's more like, I start out with an essay about my troubles, Chris comes back with an essay of his own, concurring that, on the face of it, it looks like I could be looking at some fairly elaborate treatment, and yet it turns out the answer was to tie my knees together with a strip of fabric... kind of a physiotherapy equivalent of freaking out about a horrid clattering noise coming from your bike's engine, then finding out it was just some peripheral bolt starting to come loose... *tighten*-*conceal ensuing embarrassment*-*carry on*.