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888 Views 6 Replies Latest reply: Mar 3, 2014 10:01 AM by DoloresWendt RSS
DoloresWendt Rookie 3 posts since
Oct 13, 2011
Currently Being Moderated

Feb 18, 2014 8:33 AM

Torn cartilage???

Let me give you a bit of background on my self.  I am a 63 year old woman who has been running for less than ten years.  I generally do 6 or 7 races a year.  Three of which are half marathons.  I race a few and do the others as training runs or to support the sponsoring charity.  To say that I am a turlte would be generous.  If I complete a 5 mile run in an hour, I consider the run to be very successfull. Most of my training runs are done at an even slower pace.

 

Started running a few weeks ago on a treadmill.  Just doing 2 to 3 miles at a slow pace to get back into running form.  (Hey, I live in Wisconsin and this winter has been just terrible as far as snow and cold.)  First few runs felt fine.  Then I started to have pain in the back of my left knee.  Took a couple of days off and it felt fine.  Did a slow two miler on the mill paying close attention to my form and everythng was fine.  So the next day I did the same thing.  Left knee has been sore ever since.

 

I have not run now for over 2 weeks.  The knee got so bad last Saturday that I ended up at the Urgent Care.  The knee was very painfull, hard to bend and swollen.  It also got so stiff after sitting for only a few minutes that it was difficult to walk.  The good news is that the xrays showed NO arthritis.  However, the doctor told me that I had torn cartilage in my knee.  Said to take off 2 weeks to 2 months and when pain free to start with just walking.  Then eventually try to run slowly.  However, he doubted that I would ever be able to run again!!!

 

At this point, I am resting the knee.  Seems marginally better but still a long way to go.  Would really like to get some input from other runners who may have had similar problems or experiences.  Am hoping that I do not need to get an MRI or to see an Orthpedic doctor as my insurance will not cover the expense.

 

Thanks for any and all input,

Dolores

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    1. Feb 18, 2014 11:11 AM (in response to DoloresWendt)
    Re: Torn cartilage???

    While you are folloiwng the doctors advice of not running, find a bike. Take a look at Osteoarthritis Cartilage and Exercise.  Biking is less impact on damaged cartilage and the repetitions without impact loading may be therapeutic in terms of healing injured cartilage. 

    Damien Howell PT, DPT, OCS

    www,damienhowellpt.com

  • JamesJohnsonLMT Legend 1,145 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Feb 18, 2014 2:48 PM (in response to DoloresWendt)
    Re: Torn cartilage???

    I'm not sure if your doc could know from an x-ray alone that you would never run again, so take it as a caution, not a prognosis. If you follow Damien's advice and move to biking. you should preserve most of the aerobic capacity you've built over the years, and the joint may improve. That may not be the only problem you face, but staying active with non-impact aerobics delivers the circulation you need for your best shot at healing. Rest alone sounds less damaging, but in actual practice it does not help as much.

     

    Look into an anti-inflammatory diet as a way to reduce pain and swelling long-term. If you have been prescribed meds for this, remember that they are probably for increasing your pain-tolerance and reducing symptoms short-term, not for fixing your knee. Think of long-term solutions.

     

    I'm most concerned about your treadmill, and how it may be set up. Many people adjust them for inclines to get more resistance, but this imposes an unnatural angle that can force unhealthy adaptations. It's hard to get the same effect as running outdoors without wind resistance, and many people suffer during the transition to the mill. I'm hoping you fare better with the bike. Good luck!

     

    Here's an interesting article on knee pain, with helpful comments about cartilage health, and the importance of muscle balance.. http://www.drpribut.com/sports/spknees.html

  • crl8686 Legend 1,302 posts since
    Nov 11, 2007
    Currently Being Moderated
    3. Feb 22, 2014 6:33 PM (in response to DoloresWendt)
    Torn cartilage???

    If you've been running for 10 years, but just recently developed knee problems after several weeks of running on a treadmill, I would be inclined to blame the treadmill, especially if you've been doing most of your previous running outdoors. For example, you may think that your form is fine on the treadmill, but your footstrike and overall biomechanics may actually be just a bit different than outdoors. After a few weeks, even a small amount of misalignment could lead to injuries. It might be a good idea to have another experienced runner watch you run on the treadmill - they may be able to point out potential problems.

    In my experience, X-rays are quite good at diagnosing structural problems, but not at diagnosing or distinguishing most soft tissue injuries. Before I had biomechanical problems identified and resolved nearly 20 years ago, I was having recurrent medial knee injuries. Several times the doctors thought I had torn cartilage, judging from external symptoms, and warned me about possible impending knee surgery. Fortunately every time it turned out to be some sort of inflammation, which will eventually heal, either on its own or with the help of a cortisone shot (which I would not recommend except on a very occasional basis to break an inflammatory cycle). In one particularly severe case I did have an MRI, and it indeed showed inflammation rather than a tear.

    I would also view the bike as cross-training to temporarily replace running while you heal (and to intersperse with running, if you wish, once you've healed). At this stage I would definitely not accept a diagnosis of "not being able to run again".





    2014 highlights...

    @ 5K: Ontario Mills Run, Ontario, CA, 25:19

    Angels Baseball Foundation 5K, Anaheim, CA, 24:15

    Friends of the Villa Park Library 5K, Villa Park, CA, 24:10

    @ 10K: LA Chinatown Firecracker Run, Los Angeles, CA, 51:44

    Great Race of Agoura - Old Agoura 10K, Agoura Hills, CA, 50:31

    Fiesta Days Run, La Canada, CA, 50:29


  • JamesJohnsonLMT Legend 1,145 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Mar 1, 2014 11:53 AM (in response to DoloresWendt)
    Re: Torn cartilage???

    Dolores,

     

    I am happy that your ROM has increased and your pain has lessened. This helps make the case that continuing to run through your recent condition may have aggravated the injury to your knee, although there are other explanations. Tight muscles still inhibit ROM when x-rays rule out bone damage, and they can hurt all by themselves. The fact that they have relaxed over time certainly implicates their involvement in pain syndromes, whether cause or effect. However, there is still the question of why the knee remains swollen. Your first post mentioned that the pain was at the back of your knee, which is a clue that should not be ignored, but you did not mention where the swelling was located.

     

    Most knee swelling is localized to a particular part of the knee that tends to accumulate fluid as a way to mitigate accidental or repetitive trauma. For example, tradesmen who kneel a lot have a tendency to develop swelling at the front of the knee, where protective bursa are located. Bursa are small fluid-filled sacs that cushion the movement of tissues, including bone and tendon, past each other. Obviously, this means that blunt trauma, sustained pressure, or repetitive motion can irritate them, leading to a condition called bursitis - or inflammation of the bursa - which is sometimes followed by a visible increase in the amount of fluid in and around the bursa.

     

    Swelling at the back of the knee is often referred to as a "Baker's Cyst," so named, according to popular etymology, for the tendency of those in the baker's trade or other forms of work that require standing and carrying, to develop this affliction. The swelling leads to localized pain due to pressure from this accumulation of fluid. If a baker's cyst was the cause of your pain, you would still need to find out what was the cause of the fluid buildup. While you indicated that the initial pain was in or at the back of your knee, it is unclear from your posts whether the swelling was in the same location.

     

    The docs hypothesized from your symptoms that you may have torn cartilage, undiagnosed at this point without the benefit of a detailed MRI. This is a common sense guess, but the prescription to discontinue running would likely lead to a lessening of symptoms in any case whether repetitive motion or actual tissue damage was the cause of pain or swelling. However, amelioration of symptoms due to suspension of activity by no means confirms the initial hypothesis. We still need to more clearly define what is swollen, what was/is damaged or irritated, and whether or not there is room for an optimistic prognosis without any further intervention than decreased activity.

     

    Remember that when you run, regardless of speed, your feet are hitting the ground about as often as those of a world-class athlete. Running slower means each mile for you will take a lot more foot-strikes. While the impact force may be less than for a pro, other repetitive motions involved in running will take their toll. If for example you are an overpronator, your knees may be subject to even more twisting than those of the runner who just won that last race you were in. It's more about the style or biomechanics than the speed, but it's amazing how long the body can survive a very basic maladaptation. Though the actual cause could be anatomical, this injury may have been a long time in the making because your body adapted well for so long. That doesn't mean you are doomed, but that your success spared you from immediate intervention. There's still time to get back on track.

     

    You told us that you don't want to throw a lot of money at this problem, but that does not condemn you to a life of pain or inactivity. No matter who eventually solves this problem, a doctor, therapist, internet guru or yourself, the same steps of discovery and definition will have to be taken. You may not have the money for advanced treatment, but at 63, you probably have more time to learn about your injury and how to approach healing it than most of us do. Regardless of how the problem eventually gets solved, it is in your best interest to learn as much as possible about exactly what the problem is. If better information does not enable you to solve the problem yourself, it will certainly allow someone else to solve it for you.

     

    When the swelling has transferred to a location under the kneecap, it would help bolster the argument that cartilage there has been at least been roughened, if not torn. Unfortunately fluid buildup alone does not distinguish between these conditions. Here it helps to know a little physiology in addition to obvious anatomy. Most swelling that people encounter throughout their lives has a lot to do with circulation and blood supply. Heat and redness often attend this kind of inflammation, and it is usually quite rapid in onset, because of the pumping action of the heart. However, the hyaline cartilage that makes up our joints exists for the most part independently this kind of plumbing. Instead, synovial fluid that surrounds and lubricates our joints is the medium that also nourishes and repairs their cartilage. It makes sense then, that a gradual increase in this type of fluid, versus blood flow, would occur in response to an injury to the tissue that is dependent on it. Once again, it is common sense to conclude that a gradual and sustained accumulation of synovial fluid suggests damage to nearby cartilage, but there is more to know.

     

    We need to know if you have a problem under your kneecap due to the repetitive motion suggested by your running history. If you press your hand down on the kneecap while bending the knee, and you feel a grinding effect as you bend it instead of smooth motion, one could reasonably conclude that your current knee pain and swelling were at least related to chondromalacia, or the degradation of sub-patellar cartilage (patella=kneecap). Pain and gradual swelling would be your symptoms in this case, but it is important to note that hyaline cartilage has little nerve endings to produce pain. The pain, though often hard to pinpoint, is thought to come from supporting structures near the cartilage, that actually have a blood supply and innervation.

     

    If you tore a ligament or articular cartilage, we would expect a more rapid onset of these symptoms. If you tore a meniscus, depending on the location and severity, we might expect some circulatory swelling because the menisci are partly vascularized, which would bode well for you since much more self-repair is possible in cases where blood (and immune system activity) flows to the damage. The portion of meniscus without blood flow is slow or impossible to mend without surgery and can be a source of frequent irritation when left untreated. I'm going to place that to the side for the moment because most people with lateral meniscus pain refer to it directly, although it is not the only cause of pain in those locations. Ligamentation, tendons, bursa, and sensitive muscles can also be the culprit.

     

    Back to roughness under the knee, there is a curious catch-22 that can occur with this type of injury. Some (not all) researchers posit that chondromalacia is mechanical damage due to the kind of wear one might expect when forces controlling the kneecap are unequal. This is referred to as patellar tracking disorder, where one side of the kneecap, which should ride down the middle of a groove in the femur (femoral or trochlear), is dragged over the bone by unequal flexion of the quadriceps group. The curious part is that an observation was made that swelling under the kneecap was associated with a reduction in contraction force of the medial quad, which ironically, might exacerbate tracking problems. This would contraindicate further running until that problem is solved, as you were so advised.

     

    Other contributors are thought to be tightness of the lateral quads or their tendons, but one must take into account the contrast between the lateral and medial quads as equally important to this theory. Another factor is hip geometry and the resulting angle of the quadriceps to the knee ("Q" angle). Whatever the cause, it hurts, causes swelling, and results in further damage if ignored and untreated. Direct treatment of the suspected cause often consists of strengthening exercises you may have already mentioned, and/or relaxation of the tight muscles involved via targeted massage techniques.

     

    The continued swelling bothers me. Something is damaged or at least irritated. Since running doesn't help, and as CRL mentioned particularly on the treadmill, there is a case for suspecting a biomechanical fault that may have caused damage within the range of your recovery before the treadmill, and was pushed over the line after that small adjustment to your training. This could make the results, out of proportion to the change, simply a matter of thresholds. Here is where knowledge and skill can come in handy, to identify these faults and remedy them. Experienced practitioners have seen and corrected faults not only in muscle strength, preparation and use, but by modifying forces generated by the underlying anatomical geometry through the use of appropriate footwear.

     

    So, you have the immediate need to handle the injury, but the more important responsibility to track down what caused it and prevent it from happening again. Do all of these, and you may be able to write your own prognosis.

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