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406 Views 2 Replies Latest reply: Mar 27, 2013 12:17 PM by JamesJohnsonLMT RSS
running4realthistime Rookie 2 posts since
Oct 14, 2010
Currently Being Moderated

Mar 27, 2013 7:35 AM

Knee injury, pain 6+ months later

I am in serious need of advice.  I injured my knee August of 2012 while running.  I have no health insurance so an MRI is out of the question.  I went to the health clinic and the doc told me to RICE it.  Well, here I am 7 months later and I still cant run.  I will try to be as brief as possible:

 

I was in my first mile (I usually run about 5 miles 3 days a week) and I noticed a very mild pin ***** like pain on the inside of my knee.  I stopped running and it got better so I started up again.  After it started hurting again, i decided to stop.  It really didnt hurt, but I didnt want to push it.  No pain until several hours later when I couldnt walk or put any pressure on it.  The pain was excruciating for a few weeks.  It always hurt worse in the morning.  The more I was on it, the better it felt.  After a few weeks, I decided to go back to running, pain started immediately and I was down for a few more weeks.  Then I go to the doc and since I dont have insurance, he just told me to stay off of it for a while.  I quit running altogether and doing any sort of cardio.  It wasnt getting any better so I decided to completely (as much as possible with kids) stay off of it to let it heal.  I did no excercising through the end of the year.  Starting in January, i went back to the gym.  I was no longer wearing a brace and felt pretty good.  I still couldnt run, walk upstairs or do much bending and straightening.  I started with the stationary bicycle and progressed to about 20 minutes with very little pain.  I then moved to the elliptical and slowly but surely got up to 45 minutes.  But it still hurt a little.  My problem is that I still cant run!!!  I cant walk uphill or anything that requires that leg to do all the work.  I have done a lot of research and have not found that it should take this long to heal.  Even if I tore every ligament in my knee!!  And it didnt even hurt when it happened!!!  I am tired of not being able to run.  I still exercise 5 days a week, but nothing is as good as running as far as Im concerned. 

 

If anyone has any idea what I could have done or how to speed up this healing process, i would greatly appreciate any advice.

 

Thanks for reading!

  • JamesJohnsonLMT Legend 1,155 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Mar 27, 2013 12:17 PM (in response to running4realthistime)
    Knee injury, pain 6+ months later

    There are a number of problems with this account, starting with the unknown nature of your injury. I don't think anyone wants the Med Tent to be a quiz show where we try to guess about something this important to a real person. Without knowing exactly what's injured, and without the means to find out for sure, the best advice is to avoid repetitive motion exercise to the affected limb. Doing something that hurts is bad enough, but doing something that hurts over and over again, and gets worse as you do it, is not wise, especially when you have no way of knowing what could be damaged further in the process.

     

    I know this caution can be applied in many more cases, but this time it is clear-cut. We all know how invigorating running can be, but it is not worth the potential (and likely) trade-off in long-term health. This advice is not meant to scold, but to protect. The best news is that your can help your injured limb by exercising the other, if you can figure out a convenient way to do this. The way the body allocates resources for healing, it does so to a certain degree in pairs. That is, much (approx. 50% according to a study) of the benefits gained by exercising one limb are conferred to the other, even if it is not exercised the same way. In other words, atrophy of your damaged limb is not a given when you are not able to use it normally.

     

    If you eat appropriately and exercise appropriately, your knee can get healthier and stronger, without the damage that appears to come from running. This does not mean you can't bear wait on your limb or use it at all. The doc would have mentioned that, and doing nothing at all can lead to atrophy. just refrain from running, please. The best I can determine from what you have told me, running, or any other repetitive impact activity, would be counterproductive at this time, at least for your injured knee. I can't tell you the best exercise you can do, because it really depends on the exact nature of your injury. I can mention some relatively safe exercises, though. Pool running is the usual suggestion, followed by non-impact machinery such as ellipticals. There are potential problems with almost anything if torn or stretched ligaments are involved, because stabilizing a shifting joint can overwork muscles not accustomed to this, and there is a risk of nerve entrapment in some cases.

     

    You have the internet, and with that, many sources of rehab protocols and 1st-person accounts of similar injuries, to mine for information. Some of it may be misleading, but you can look for consensus and most of all, safety. As a rule of thumb, avoiding impact, torsion, side-to-side, and fore-aft stresses, such as one might encounter in sports like tennis, would be a good place to start. Lighter weights when strengthening, with more reps not overloading injured tissue, should help if there is damage to cartilage, menisci, etc. Knowing what is risky to do, but still doing something, is a strategy that may at least prevent things from getting worse, while offering at least part of maximal benefits.

     

    Not sure what your employment situation is, or of your eligibility for any assistance, but this case appears to require more than the RICE protocol, which was developed to deal with acute injuries, not chronic conditions like this. Eventually, you have to get more help to understand exactly what you are dealing with, if not to inform your approach going forward, at least for peace of mind and the confidence that you may be able to safely run again.

     

    Meanwhile, you did mention looking into recovery expectations regarding torn ligaments. Did you look into the medial meniscus? If so, did you look into possible causes for damage to the meniscus and what to do about it? Not knowing how long you have been a runner or how you run, there is the possibility that a one-sided injury like yours comes from a basic anatomical asymmetry, not a simple injury. In other words, it is possible that this injury would have happened anyway, even if it did not occur that day. Wear-and-tear injuries affecting one limb are possible if say, there is a peculiarity with hip or foot structure, or one limb that is shorter than the other. I am assuming uneven running surfaces have been ruled out.

     

    Back to the meniscus, a certain portion of it can be regenerated because it is vascularized, and a certain portion of it will not regenerate under normal circumstances, because there is no blood flow. In such cases, surgery may be the only way to repair the injured meniscus. I think there are other pathologies involved because of the tingling sensation, which is not to exclude the meniscus, but to allow for further damage that may include it. For example, fluid build up in response to one injury may pressure a nerve to create such symptoms. There may be more than one problem involved, that is not necessarily related to the other(s).

     

    On a personal note, I once had medial knee pain due to running, and it was reliable enough that I considered it to be a permanent problem. After my studies led me to consider limb length and other bone -related ??structural problems, I made modifications to both shoes that compensated for these things. Eventually, I was able to run great distances without the knee problem. In other words, my problem was not that I received or "had" an injury, so much as that I was creating it fresh every time I ran. There is a certain threshold in the body for wear-and-tear, and a certain rate of repair, so it is important to match these rates and stay within their limitations. Obviously, this means that unbalanced or extreme wear due to anatomical imperfections must limit your activity commensurately.

     

    The problem is that most people will assume that after a certain amount of rest and repair, they can return to a level of activity they consider "normal." This is only the case if the wear-and-tear is normal, and only possible without the structural stress of anatomical asymmetry. Metaphorically speaking, if all four tires are equally inflated, you can expect greater mileage before failure than you can if one tire is flat. So, I fixed my flat tire. You have to find out if there is a similar problem with your anatomy that you can fix before heading out on the road again.

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