bad knee cartilage exercises

  • Creator
    Topic
  • #10332
    sambedell
    Participant

    I was in a climbing accident this winter and sustained traumatic injuries to both knees. Fractures: R tibia and L fibula. Ligaments: R ACL torn and replaced, R MCL partial tear, L PCL full tear not replaced, both have meniscus and cartilage damage. I’m finally getting back to various activities after 6 weeks in a wheel chair, 7 weeks in crutches non-weight-bearing on my R leg, and 6 weeks of rehabing after another surgery.

    At my last appointment my surgeon told me that there is significant cartilage damage in both knees. As a result he is advising me to never run more than once a week at an easy jog for less than 5 miles. He believes that that if I start running regularly again I will need double knee replacement surgery by the time I’m 45 (I’m 31 currently). I have always been a runner, competed from the age of 12 through college in cross-country and track, continued to run for fitness in climbing and skiing. Enjoyed long trail runs etc.

    So I’m curious if anyone has experience with similar injuries and advice to go with them. Also, since the doctor feels like I will be able to do non-impact exercise for the rest of my life I’m curious about exercise suggestions to replace running.

  • Participant
    brunoschull on #10337

    Hi. First off, way to go with the recovery, and getting back to some semblance of a normal life. That is a “climbing Everest” kind of accomplishment. Second, despite your injury, as I’m sure you and people around you have said, there are many positives here: You’re alive! You can walk! You can exercise! Yeah! Any physical activity imitations you have in the future are truly minor inconveniences compared to these basic facts. So, I would say…take the long view. What has it been, about 20 weeks since your accident? Maybe think in years, not months. Like, tell yourself, perhaps you can run somewhat comfortably…in two or three years. What to do until then? There are so many options. I’m going to assume you are a mountain athlete. So buy yourself a mountain bike. You don’t need to a be a freeride enduro downhill guy…so on long endurance singletrack adventures. Lots of cycles of easy and medium pedaling will be great for your knees. In the winter, skining uphill would seem to be much less high impact than running. You could “reverse the paradigm” and skin up and take the lifts down, if skiing down is out of the question for now. Cross country ski. Stand up paddle. Windsurf. Open water swim. And so on. In terms if getting back to the trails (because if you’re a determined athlete, I imagine that whatever you do you will still be dreaming of trail running) you could start…walking. Then walking with a light pack. Then maybe alternating walking and running. Then light jogging. But, again, in years, not months. Another good thing you have on your side is you relative youth. We have no idea what therapies might exist to help cartilage regenerate in 5, 10, or 15 years, or how easy/hard a knee replacement might be by the time you potentially need one. So I would say, again, take the long view, use this as an opportunity to practice diverse outdoor sports you would not otherwise, go gently, and remain optimistic that in the future you will be running (or hiking) along a path in the mountains. Good luck!

    Keymaster
    Scott Johnston on #10338

    Sam:
    Wow! you really did it to yourself. I’ve been down this road with my right knee and maybe some of my experiences will help. In 1978 I have a very serious climbing accident that folded my right lower leg up to the outside so that my boot sole was facing upward just beside my right hip (fugly). Total dislocation and full rupture of medial collateral and PCL ligaments, partial tear of the ACL and full rupture of the patellar tendon. Along with this came significant cartilage damage including the evulsion of a 1″ diameter piece from the tip of my tibia. Like you my knee was F*^ked! Knee surgery was in the dark ages back then compared to today. I spent 6 months in a full length cast. The good news about that was that my right leg muscles atrophied so much that I could do one armed pull ups:-) The doc told me, I’d never run again, that I’d walk with a limp and always need a cane. I was 25 and looking a life as a cripple. This fueled an intense rehab program that continues today 40 years later. Back then rehab for for this kind of thing was unheard of but I figured out some things I could do and got after it…HARD. It as a slow and painful process and I do not go a day without being aware of my knee and the limitations is imposes on me.

    I learned to “never say never”. I have 2 hand lettered signs in my gym where I have trained many top athletes. One says “You can’t coach desire” The other, “Never let others impose their limits on you”.

    Six years after that surgery I was ski racing on the World Cup. I was running 30 miles in the mountains. I was climbing more and better than ever.

    I used the hell out of that poor knee. It wore out finally and it was really painful during its final years such that I could not do many of the things I loved. But, damn those 30+ years were really good! I bit the bullet and got a new knee 4 years ago and I am back to running, skiing and climbing about as much as most 64 year old guys can manage.

    Don’t be dissuaded from trying. Find a really good PT that has lots of serious sports injury experience. They’re out there but not easy to find. It’s going to be life process and it is going to be REALLY F*^cking hard. I think you will find that meeting this new challenge will be a positive thing in your life.

    Participant
    nickbb10 on #10350

    It gets better Sam, 2 years ago in a climbing accident I shattered my right tibia and fibula into a hundred pieces, completely destroying the ankle joint, as well as shattering my right elbow and wrist. I was in a wheelchair for 4mo, and crutches for another 3mo. As soon as I was able, I got on the bike and went about remaking my leg. expect to have to do hours of PT everyday, and find a PT who knows what they are doing. The hardest part is finding the balance between doing enough to get stronger, but not causing so much pain that your body creates barriers against trying hard. It took about a year and a half for my body to remember that not all pain is bad. The mental and neuromuscular trauma is probably going to the hardest thing to overcome. This summer I finally have gotten my confidence back to go to the mountains, and spent the past weekend scrambling ridge lines 20 miles in the backcountry. To my delight, I discovered that my fitness has dramatically improved since before the accident, by virtue of the discipline and drive it has taught me. Your body will never be quite the same, but that does not mean that you won’t be able to do what you want to do. I can run, but it isn’t a very efficient way for me to move yet. I used to look down on cycling, but at the end of the day, hours and vertical will still make you stronger, 7000ft of climbing on a bike feels just as hard and rewarding as trail running. It takes time and practice to feel efficent on a bike, just the same as running.
    Keep your head up and eventually you will get there.
    Nick

    Participant
    sambedell on #10351

    Bruno: Thanks for the suggestions.

    Scott:
    Thanks for the story. I had no idea that you’d gone through that and that gives me hope. As is probably the case with most people on this forum, I’d take a big challenge over giving up any day.

    A couple follow-ups…
    -Are there any knee-specific quantitative or qualitative metrics you learned to use to let you know when to push something or back off?
    -Can you give me more specifics on the type of PT I should be looking for? I know you have connections in Bend. Do you know of any PTs in Bend who match this criteria?

    I’m currently up to 50 min on the stationary bike with the goal of being able to do 90 min in a few weeks. August 1st I will be able to start road biking. I’m also doing modified Killer Core, and max strength hang boarding and pull-ups on top of my PT exercises. Given that it’s 5 months post-accident this makes me feel relatively good and lucky. Thanks again.
    -Sam

    Participant
    sambedell on #10352

    Thanks Nick. More motivation.

    Keymaster
    Scott Johnston on #10362

    Sam:

    Will be back to you soon with more. Steve and I are on our way to do a workshop this week.> Bck to you in a few days.

    Scott

    Keymaster
    Scott Johnston on #10406

    Sam:

    Let pain be your guide to activity. Its going to hurt form time to time so rest it then. You will go through period where you’re tearing scar tissue and breaking adhesions. Those will be painful but almost immediately feel better.

    As for a PT. The ones I knew in Bend are all retired now. Rebound used to be a really good place for athletes. Not sure where else to recommend.

    Sounds like you’re making good progress. Keep it up and don’t let the bad days or the inevitable back sliding get you down. As with training, the progression is not linear but rather saw toothed looking.

    Scott

    Participant
    sambedell on #10613

    Thanks Scott, I appreciate the encouragement!

    -Sam

    Keymaster
    Scott Johnston on #10614

    Sam:

    Try to get in to see Jay Dicharry at Rebound PT in Bend. I do not know him but have it on good authority that he’s very good.

    Scott

    Participant
    sambedell on #10698

    Thanks Scott. Funny thing is I already know Jay, was a shoe tester for him in a couple studies he did. Small world!

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