OT: I need PIX help!

[KillerVee]

Heyyyyy there, you little PT guru you. I have a boo boo and I need your expert advice!

Two years ago I tore my MCL in my right knee. I didn't need to do surgery but I had to wear a hinged knee brace every day for 6+ weeks. The doctor also told me I needed to do daily PT exercises. Now, I thought these exercises seemed very silly. It was stuff like walking in a figure eight or walking forwards and backwards in a zig-zag. He told me I had to do them or the ligaments would not heal right. And yet? I didn't do them. Cause I'm a lazy asshole.

My knee seemed to heal ok. I continued to wear the hinged knee brace under my knee pad whenever I skated. I haven't played on a *regular* basis since the injury but I exercise plenty and skate once or twice a month and it seemed ok.

But now, almost two years later, my knee is giving me problems almost daily out of the blue. I can't run anymore. I can't wear heels. I feel tightness when I walk and when I skate. I had practice today and I went the first half with no brace on under my pad and I eventually had to cave and put it on because I couldn't really put any weight on it anymore.

It's not necessarily painful. It just feels like it's about to snap. Like I'll be on my skates and be making an abrupt stop and I'll feel everything tighten underneath my knee cap and it's uncomfortable. It feels like I have to stop what I'm doing right away or it will break like a twig. It's been 5 hours since my practice and my knee is noticeably warm and stiff. I had to keep my knee brace on for the walk home.

Did I re-tear it? Or aggravate it? Do you have any special MCL exercises I can do to loosen it back up or is it too late? I'm too young for this (I think). Please help! Thanks

 

[raptorlife4]

Amputate

 

[KillerVee]

Amputate

I was afraid it would come to that.

 

[Forty_Sixand2]

It may be tetanus.....





or a sprain.

 

[pixburgher66]

Okay, well...the way you're describing things doesn't necessarily line up with an MCL sprain. Have you ever subluxed/dislocated your patella? The reason I don't think you reaggravated it is just because that would be more pain...unless of course the ligament didn't heal correctly, in which case you'd have some instability on the inside of your knee.

So, a few other questions to see if I can narrow this down a bit:

Any other knee injuries in the past?
Was there one event that caused this, or did it just sort of gradually progress?
Swelling?
Does it lock at all? Or click when you extend?
Warm and stiff doesn't automatically mean infection (as 46 alluded), just because that's part of the injury response process. For right now ICE ICE ICE ICE. And compression, like an ace wrap, as well as elevation. If you have swelling there's something going on, and as much as you'd not like to hear it, probably should stay away from strenuous stuff (ie Derby) for a few days until it at least calms down.

 

[pixburgher66]

Also, as far as exercises, this sounds like an acute situation, so the goal right now is to calm it down and pinpoint the issue. After that it's rehab.

 

[Winged_Wheel88]

10 points for Gryffindor!

 

[KillerVee]

Okay, well...the way you're describing things doesn't necessarily line up with an MCL sprain. Have you ever subluxed/dislocated your patella? The reason I don't think you reaggravated it is just because that would be more pain...unless of course the ligament didn't heal correctly, in which case you'd have some instability on the inside of your knee.

So, a few other questions to see if I can narrow this down a bit:

Any other knee injuries in the past?
Was there one event that caused this, or did it just sort of gradually progress?
Swelling?
Does it lock at all? Or click when you extend?
Warm and stiff doesn't automatically mean infection (as 46 alluded), just because that's part of the injury response process. For right now ICE ICE ICE ICE. And compression, like an ace wrap, as well as elevation. If you have swelling there's something going on, and as much as you'd not like to hear it, probably should stay away from strenuous stuff (ie Derby) for a few days until it at least calms down.

Instability? That sounds familiar. Sometimes I'll be standing and my knee will just buckle. Is that what you mean? It doesn't necessarily "lock" but it feels sometimes like it catches and buckles. And my knee always clicks when I bend/straighten. It seems to be the most uncomfortable when my knee is straight.

No prior knee injuries, swelling is minimal. I would use the word "puffy" to describe the intermittent swelling I get. There was no specific incident that led to my knee bothering me again. It feels like it just creeped back up gradually. I did try to start running more strenuously a few weeks ago and three days of that really made an impact. That's when I started having more of the catching and buckling. I wrapped it for a day or two and stayed off it. Since then, I wrap it with an ace bandage when I work out but I don't use the treadmill anymore. Elliptical only!

 

[pixburgher66]

10 points for Gryffindor!

Not gonna lie, I feel pretty BA when it comes to this stuff.

 

[Winged_Wheel88]

Not gonna lie, I feel pretty BA when it comes to this stuff.

Get down with your bad self.

 

[pixburgher66]

Instability? That sounds familiar. Sometimes I'll be standing and my knee will just buckle. Is that what you mean? It doesn't necessarily "lock" but it feels sometimes like it catches and buckles. And my knee always clicks when I bend/straighten. It seems to be the most uncomfortable when my knee is straight.

No prior knee injuries, swelling is minimal. I would use the word "puffy" to describe the intermittent swelling I get. There was no specific incident that led to my knee bothering me again. It feels like it just creeped back up gradually. I did try to start running more strenuously a few weeks ago and three days of that really made an impact. That's when I started having more of the catching and buckling. I wrapped it for a day or two and stayed off it. Since then, I wrap it with an ace bandage when I work out but I don't use the treadmill anymore. Elliptical only!

Alright, this gives me plenty. Now, keep in mind this is purely based off of your description and without doing physical testing it's tough for me to absolutely be sure...but it sounds an awful lot like a meniscus tear. Now, meniscus tears aren't incredibly painful, normally it's just over the joint line. You'll get swelling on the inside, you'll have locking/clicking/catching, occasional feeling that your knee is going to give out, trouble going up (it could be down...but I'm pretty sure it's up) stairs, etc. etc. So, my advice? If you take it rather easy the next few days to let the irritation calm itself, and you still experience these symptoms, you gotta see a doc. Meniscus tears can be lived with, but if you want to remain active it's a surgical fix. Like I said though, this is just my gut based on what you've said, not at all set in stone.

 

[pixburgher66]

ALSO!!!!!!!

Just remembered this: the medial meniscus is attached to the MCL, so it's very likely that when you injured the MCL awhile back it took off a bit of the meniscus, and over time a tear developed.

 

[KillerVee]

Alright, this gives me plenty. Now, keep in mind this is purely based off of your description and without doing physical testing it's tough for me to absolutely be sure...but it sounds an awful lot like a meniscus tear. Now, meniscus tears aren't incredibly painful, normally it's just over the joint line. You'll get swelling on the inside, you'll have locking/clicking/catching, occasional feeling that your knee is going to give out, trouble going up (it could be down...but I'm pretty sure it's up) stairs, etc. etc. So, my advice? If you take it rather easy the next few days to let the irritation calm itself, and you still experience these symptoms, you gotta see a doc. Meniscus tears can be lived with, but if you want to remain active it's a surgical fix. Like I said though, this is just my gut based on what you've said, not at all set in stone.

Hmmmm, dang. I'll look into that. I don't have insurance right now but I have kinda - sorta free coverage through the city and my school. I'll see if I can get a referral.

I don't have a car (cause I don't really need one), so I walk every where. I walk to school and back, I walk to the store and back, I walk in the park behind my house. I probably walk 3 miles or more a day. And SF is notoriously hilly so I'm usually going up and down a lot of inclines. Is that bad?

 

[Forty_Sixand2]

I still think you sat on a rusty nail while in one of those surly places that you frequent!!!

 

[KillerVee]

I still think you sat on a rusty nail while in one of those surly places that you frequent!!!

I got a tetanus shot a few years ago! I scratched my cornea cause of dry contact lenses I slept in and I had to go in to Urgent Care to get drops and stuff. They stuck me then!

 

[pixburgher66]

Hmmmm, dang. I'll look into that. I don't have insurance right now but I have kinda - sorta free coverage through the city and my school. I'll see if I can get a referral.

I don't have a car (cause I don't really need one), so I walk every where. I walk to school and back, I walk to the store and back, I walk in the park behind my house. I probably walk 3 miles or more a day. And SF is notoriously hilly so I'm usually going up and down a lot of inclines. Is that bad?

Well, it certainly won't help if it is your meniscus, but that's life. You gotta do what you gotta do. I just recommend as light as possible. If you do end up going to a doc, just make sure it's an orthopedic guy, because your every day MD doesn't know what to feel for with the tests (just personal experience here). Really though, if it is the meniscus, walking a lot isn't going to make it worse, but with that catching/instability feeling you could be more apt to further injury. Sadly a meniscus isn't something like a muscle strain where I could just give you some stretches/strenghtening, all the methods of care are surgical or some other conservative medical care (injection, etc.). If it does come down to it, and you have insurance, surgery is the go to option. It's not a terrible surgery, though you do have to be non-weight bearing for quite a few weeks, after that it's just your typical range of motion/strengthening rehab and you're back.

 

[KillerVee]

Well, thanks for the information, Pix! The meniscus tear stuff totally makes sense! I'll keep an eye on it and see what I can work out with my referral!

 

[PhillyPhaithful48]

Well, it certainly won't help if it is your meniscus, but that's life. You gotta do what you gotta do. I just recommend as light as possible. If you do end up going to a doc, just make sure it's an orthopedic guy, because your every day MD doesn't know what to feel for with the tests (just personal experience here). Really though, if it is the meniscus, walking a lot isn't going to make it worse, but with that catching/instability feeling you could be more apt to further injury. Sadly a meniscus isn't something like a muscle strain where I could just give you some stretches/strenghtening, all the methods of care are surgical or some other conservative medical care (injection, etc.). If it does come down to it, and you have insurance, surgery is the go to option. It's not a terrible surgery, though you do have to be non-weight bearing for quite a few weeks, after that it's just your typical range of motion/strengthening rehab and you're back.

So just give it to us straight doc, are we going to have to put her down? I wouldn't want her suffering for the remainder of her life, so is that really the best option here?

 

[pixburgher66]

So just give it to us straight doc, are we going to have to put her down? I wouldn't want her suffering for the remainder of her life, so is that really the best option here?

Just take her out back and say Joe Pavelski's back there...and you know what to do.

 

[KillerVee]

Pavs is here?!?!! Oh boy!!