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666 Views 3 Replies Latest reply: Jan 23, 2014 7:33 AM by JamesJohnsonLMT
Molly229 Amateur 17 posts since
Nov 12, 2005
Currently Being Moderated

Jan 9, 2014 4:33 AM

Torn miniscus? Arthritis?

I'm female 51.  I ran my 2nd Marathon October 2012.  I didn't run much after that until the spring of 2013.  My first 10 steps into my outdoor run I felt a "pop" in my left knee, intense pain and have not run since.  It bothered me all summer.  Walking up a hill I would feel that pop or tear and it would swell and I would suffer for weeks.  I've had an xray and an MRI.  I've gone for massages.  The xray showed nothing, the MRI showed early arthritis.  The massages helped other parts of my legs that were over compensating while I walked with this pain.

 

It hasn't been sore for a couple of months so this week I tried working out.  Tuesday I did a sissy 35 min run in which only 20 min. was actually running.  The first couple of steps I felt it become inflamed immediately so I wrapped it and continued because I'm stubborn and angry that this knee is giving me trouble.  Last night I did squats, lunges, deadlifts and kickbacks.

 

This morning I woke up to a swollen knee and it feels just like it did back in April.  I'm at a standstill with fitness.

 

I've researched Arthritis and I don't think Arthritis would cause it to hurt so much, swell, etc from working it.  If the weather is bad then I might feel it ache (like my finger joints do).

 

I am at a loss as to what to do next.

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    1. Jan 10, 2014 7:38 AM (in response to Molly229)
    Torn miniscus? Arthritis?

    You need to ask more specific questions regarding results of MRI.  Was there a torn menicus?  Were in the joint is the arthritis?  Is the arthritic changes on a weight bearing surface, of under the knee cap?  How bad are the arthrtic changes mild, moderate, or severe?  The answers to these types of questions help provide direction to intervention?

     

    Damien Howell PT, DPT, OCS
    www.damienhowellpt.com

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Jan 10, 2014 10:00 AM (in response to Molly229)
    Torn miniscus? Arthritis?

    Were you out-of-pocket at the initial exam? It sounds like they did not finish the job, and more work should have been done to determine the cause of this problem. It acts like something was torn, perhaps not menisci (lateral, medial?), but ACL or other ligament damage could lead to that. Popping and severe pain without anything visible other than early arthritis? Hmmm..

     

    I'm worried that you were doing lunges and squats at this stage. I would put that kind of cross-training away for now, in case it makes things worse. Ditto for all running. Chances are very good that the long rest after your last marathon de-conditioned the stabilizing leg muscles that could prevent a potential injury from reaching this stage. It took you a while to prepare your leg muscles for that marathon, and you can't just jump back into it after months of downtime. Maybe your return to running was too abrupt, and something was actually torn as a result. If such an injury cannot be found by competent examination and imaging, it is possible that trauma to deconditioned muscles could set up chronic pain syndromes that do not exclude popping noises due to erratic contraction. Still, I am inclined to wonder if the initial pop was due to a structural change, and what you are experiencing now is from the resulting instability.

     

    Chondromalacia (runner's knee) is often suspected, but should be more evident descending hills. You said the pain came from climbing. Check these videos for an example of how to look for ligament injury in a physical exam:

    Suppose there was nothing holding your knee together, just junk in there. You would expect the thigh (femur) to slip forward on the lower leg (tibia) when descending hills (PCL), and for it to slip backward on the lower leg when climbing (ACL). As I mentioned earlier, laxity in these ligaments can lead to menisci damage, with the latter being the result, not the initial cause. The initial "pop" could be the more important clue. Read the comments in these videos for 1st person accounts of similar injuries. This next video discusses whether surgery is always necessary, and the success of physical therapy, with examples:

     

    My gut feeling is that the arthritic degeneration shown on your MRI (even mild, as Damien notes, depending on location) could be a player here, though many have more severe arthritis without such symptoms (again, where is the arthritis located). It is also possible that weak muscles after your rest allowed excess movement to strain/sprain tendons and ligamentation, leading to inflammation, perhaps a tear. Regardless of what is actually wrong, the rehab of this injury needs to take some time. Strengthening of the stabilizing muscles will eventually be necessary, but right now, a better understanding of the internals of your knee is required. You may be a candidate for arthroscopy, but another course of MRIs from different angles, maybe with contrast dyes (beware of gadolinium), would be a better place to start.

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Jan 23, 2014 7:33 AM (in response to Molly229)
    Torn miniscus? Arthritis?

    Not sure what you've found out so far, or whether you've had the time to get to it yet, but I came across more information worth considering as you move forward. In a nutshell, most people have remnants of fetal development in the knee called "plica," which ordinarily aren't a problem until they become irritated and thicken to the point of interfering with the normal operation of the knee. It's sort of like a land-mine waiting for something like marathon training to activate it. The link I supply here shows a case history in which MRI did not reveal this problem, but it was found incidentally during meniscus repair surgery.

     

    Another item is the cascade from one injury to another that I mentioned in the previous post. Arthritic changes in the knee can result from the neglect of another injury, such as a torn meniscus. This is referred to as "Fairbanks change," and can turn a comparatively minor injury into a career-ending one, by claiming what is left of the health of your knee joint via arthritic degeneration. I would suspect this more in the aging athlete, and the effect is probably one of the reasons why most people, including many doctors, believe that running is bad for the knees. It would be more correct to say that neglect of minor knee injuries can lead to further degenerative changes in the knee, whether or not running is involved, which it often is initially. Overall, from what I have learned, running correctly on healthy knees makes them healthier.

     

    On that subject, it is important to have your gait analyzed by a professional for clues as to why you might be prone to certain types of injuries, and why such conditions might worsen as you continue to run. Everything from posture, to muscle tone, to bone structure, throughout the body, can have an impact on remote parts of your anatomy. The knee is particularly vulnerable to this interaction.

     

    The master link from Athletic Advisor, from which I drew this information, is worth reading again for items that may have escaped your attention before. Further study can't hurt as much as what you are already going through. A little information can be a dangerous thing, and too much can have a paralyzing effect, but I'd rather face my doctor, like my marathons, overprepared.

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