Need advice/opinions on orthopedic injuries

[obawan12]

Hello all,

I am looking for some advice on 2 injuries I have been dealing with for almost 6 months now. One is my left knee. It came about from gradually from overuse. I got an MRI on it a few weeks ago and it revealed fat pad impingement/hoffa's fat edema. No structural issues. The other is my left wrist. It was a "trauma", from landing hard on the palm of my wrist. I just decided to get an MRI on this as well and will have the results next week.

Admittedly, for the first month or 2 of these injuries, I was not kind to myself, and definitely exacerbated both of them by continuing to do my normal regular activity. However, since January, I have been seeing an orthopedic doctor for both of them, following all treatment, went to PT, and still have not seen any improvement (if anything, they are both a little worse ). The doctor prescribed me anti inflammatories, I got a cortisone shot in each (this was no help either, and honestly made them feel a little worse). I have tried braces for both, I have even tried chiropractic/acupuncture out of desperation, to no avail.

For some background, I am only 23 years old. I eat very healthy, though I dunno how big of a difference that makes with acute injuries like these. Physical activity is a big part of my life, and while I have remained positive, it is starting to take a toll. I am a yoga teacher but I had to take a break because teaching even without demoing was causing pain in my knee. I am missing out on activities and events with my friends because I am hurt, and it sucks. I feel helpless and have no idea where to go from here. For my knee, the doctor said surgery is an option, though he recommended based on the MRI going the conservative route of rest and rehab exercises. We'll see what he says about the wrist next week, but regardless I'm definitely not thrilled by the idea of surgery. On the other hand, I wonder why I should be worried about surgery if these injuries aren't going to heal on their own anyways.

I know nobody on here can give me real medical advice, or will have any solid answer on what the exact right move is. I'm really just looking for opinions/similar experiences, even just re-assurance that I might just need to give these things more time, because right now, I feel completely lost. I have been eating this way for almost a year now, I just recently completely eliminated oils and have felt physically and mentally better than ever, I have so much energy everyday with no way to put it to good use. While I know I have decades of healthy life ahead of me, I feel like I am wasting away some of prime years to be active and enjoy everything that life has to offer.

[calvin]

With some problems similar to yours, I'm 74 and so do not have the advantage of as much youth, but 3yrs McDougalling has improved some long standing symptoms, while some new ones have appeared. But your youth is all the more reason that, if i were you, i would be adhering to this WOE as you are doing. That is job one - for all of us.

Then, assuming you injuries are making quality of life so low that you are considering options to conservative treatments (cortisone, nsaids, etc. are imo nothing more than analgesics - temporary pain relievers that do not address the problem and give the body more cleanup to do and thereby frustrate healing, in my limited experience), e.g. surgery, i would first investigate prp (plasma-rich platelet ) injections and stem cell therapy. While investigating these relatively safe and noninvasive procedures, i'm getting the impression that one reason they fail is that patients do not stay inactive enough long enough after the treatments or between treatments. The doctor can always say "Well, the patient did not sufficiently rest the affected area, did not repeat often enough, did not return, etc." In other words, the patient did not apply time and adherence. But that can be said of any "failed" endeavor.* Btw, those treatments are not covered by insurance and not cheap.

A better option may very well be an extended supervised water-only fast at TrueNorth.

Food for thought.

*One must remember that only a rare participant in these relatively new therapies is WPO-NO (whole plants only - no oil) and so is at a significant disadvantage.

[ceci]

I am much older than you (67, female) and have five knee surgeries behind me due to injuries, cartilage problems, meniscus tears. That was at a time when surgery was the first option.

Your six months of suffering is pretty bad but, imho, and from my experiences, I would continue with conservative treatment. This may mean being less active for quite a while and giving your knee a rest. I always found this very hard but your knee will not improve if you keep being active.

My advice to you would be to visit a really GOOD SPORTS-PHYSIOTHERAPIST(I note that you had physiotherapy already and that it was not successful?), the best you can find, one that is treating athletes who sustain knee injuries and then follow his/her advice religiously. I too know the feeling of fat pad impingement. It is an exceedingly painful condition that will not improve unless you give your knee a good rest and avoid extending or straightening the knee joint. Depending on your pain, a physiotherapist may give you muscle strengthening exercises and also may show you how to tape the upper part of the knee cap to relief the pressure on the fat pad. I also had ultrasound treatment and used ice and heat. Again, follow the physio's advice. Not more and not less, do exactly as told. Doing more to 'help it along' may actually make things worse. I found that, due to prolonged pain, my gait actually had changed. I was favoring my right leg and was limping, which affected the muscles surrounding the affected knee. You are still young and probably have not lost any muscle mass due to your injury. If you have, at your age, with the proper strengthening exercises, you will build up muscles pretty quickly again. Being out of action can be depressing and that's the reason we keep pushing through pain and keep going, but with this condition this is not a good idea. Improvement may be slow, so, when you start treatment, keep looking back where you've been and where you are now, and then you realize that you have made progress. If conservative treatment does not work, only then consider surgery. All the best!

Edit:
I try whenever possible to stay off anti-inflammatory medications and only take them in the really acute phase for some relief and then only for a short period. I believe that in young and healthy people the body is self-healing given time and rest. I also used 'home-remedies', watching television with a wet and cold towel wrapped around my knee.

I also had rotator cuff surgery and biceps tenodesis and the thought of not being able to go swimming and hiking was unbearable. But, I decided to give up a whole year to concentrate on rehabilitation. What is a year in a life-time? As hard as it may be at your age and with tons of energy to spare, try to accept that you have an injury that will need quite some time to heal. Yes, feel sorry for yourself for a bit, and then set yourself a goal to concentrate on rehab and be as disciplined with rehab as you are(were) with yoga.

[obawan12]

Thank you ceci and calvin for your thoughts/opinions. I am feeling much better about things today.

I am going to wait until I get my MRI results for my wrist on Wednesday, and from there I think I may get a 2nd opinion for both, depending on what the doctor says. Assuming a 2nd doctor doesn't find any issues not already identified, I will continue with a conservative approach and possibly look into physical therapy again as well.

[ceci]

Good idea to get a second opinion!

The 'problem' with physiotherapy is that it can turn out quite expensive which may be the reason that people don't continue with it. Or, there is an improvement and people stop doing the exercises. I know this from my own experience. When things get better people give the exercises a miss every now and then, just when it would be wiser to just keep doing them. Especially with my shoulder, for instance, I kept at it very diligently. It was a great financial sacrifice; no vacation, no going out, etc. all my money was spent on rehab. But, it was worth it.

The other thing I would like to mention is that with surgery the knee will change. The cushioning fat pad probably will be removed. Something similar happened to me with the cartilage problem; The surgeon just kept cutting away cartilage and there is not much left, if any. When young this was not such a big issue as the muscles supported the knee, but, as I was getting older and losing muscle mass as many people do as they are getting older (I was not an athlete, just pretty active) it may be the reason for my osteoarthritis, the bones are starting to grind on each other due to less cartilage. In my twenties I thought I was invincible. Age changes this. My own fat pad problem probably was not as bad as yours and I don't have any problems anymore as long as I don't overdo it and ensure that I do the strengthening exercises correctly. Every time I am seeing the physiotherapist I demonstrate to him how I do the exercises and to ask him whether I am still doing them correctly. However, since the knee surgery on that particular knee I now sometimes get a baker's cyst. The moment I feel a little pain in that area I start looking after it to ensure that it does not become worse.

The above are the reasons I was suggesting to try the conservative approach for quite a while longer. Surgery may fix one problem and you may end up with another one later on. A physiotherapist may also give you advice on how to prevent the injury from happening again.

Look at it this way: You are on a mission now, you are aiming for an improvement in your 'performance', and the goal is to get back on track and your activities. When you look at it that way you also may be able to ward off depression that can come with prolonged rehabilitation.

[Willijan]

obawan12,

My advice would come under the heading of encouragement. I'll tell you some of my husband's experiences as examples of what good things can happen.

In his mid-50s, he injured himself riding his motorcycle. The injuries included damage to both wrists, requiring surgery from both sides of both wrists, insertion of pins, and the prognosis that in a couple of years he would not be able to move his wrists at all.

The wrists have continually gotten better over the last 20 years. He has had continuous but slow improvement. Especially in the last few years (he is 74 now) the functionality and pain level has improved even more. I forget he ever had a problem.

In 2015, my husband injured his left rotator cuff trying to "catch" a loaded 4-drawer cabinet he was maneuvering up 2 steps. When they finally decided to do the surgery, they found the muscle could not be reattached. That was 6 to 9 months ago. And of course, he shouldn't be able to make certain movements anymore.

He didn't have physical therapy. He just continued doing his work on his boats and tractors, with his various outdoor equipment, etc., and he can do stuff he should not be able to do. Apparently other muscles can take over. The body is amazing.

And of course, for people who are on this diet, the body can do even more, although it's often hard to predict just what.

You do have a long life ahead of you. Just realize these things happen, it's a severe inconvenience, but maybe not a disaster. Things will likely heal. Just don't do anything--or let anyone do anything to you--that will make things worse. While I respect doctors' ability to help, there are a myriad of ways they can harm you. I could list at least 5 significant ways medical treatment has harmed me over 68 years of life. Be very careful not to be swayed by your doctors without careful consideration.

[obawan12]

I am much older than you (67, female) and have five knee surgeries behind me due to injuries, cartilage problems, meniscus tears. That was at a time when surgery was the first option.

Your six months of suffering is pretty bad but, imho, and from my experiences, I would continue with conservative treatment. This may mean being less active for quite a while and giving your knee a rest. I always found this very hard but your knee will not improve if you keep being active.

My advice to you would be to visit a really GOOD SPORTS-PHYSIOTHERAPIST(I note that you had physiotherapy already and that it was not successful?), the best you can find, one that is treating athletes who sustain knee injuries and then follow his/her advice religiously. I too know the feeling of fat pad impingement. It is an exceedingly painful condition that will not improve unless you give your knee a good rest and avoid extending or straightening the knee joint. Depending on your pain, a physiotherapist may give you muscle strengthening exercises and also may show you how to tape the upper part of the knee cap to relief the pressure on the fat pad. I also had ultrasound treatment and used ice and heat. Again, follow the physio's advice. Not more and not less, do exactly as told. Doing more to 'help it along' may actually make things worse. I found that, due to prolonged pain, my gait actually had changed. I was favoring my right leg and was limping, which affected the muscles surrounding the affected knee. You are still young and probably have not lost any muscle mass due to your injury. If you have, at your age, with the proper strengthening exercises, you will build up muscles pretty quickly again. Being out of action can be depressing and that's the reason we keep pushing through pain and keep going, but with this condition this is not a good idea. Improvement may be slow, so, when you start treatment, keep looking back where you've been and where you are now, and then you realize that you have made progress. If conservative treatment does not work, only then consider surgery. All the best!

Edit:
I try whenever possible to stay off anti-inflammatory medications and only take them in the really acute phase for some relief and then only for a short period. I believe that in young and healthy people the body is self-healing given time and rest. I also used 'home-remedies', watching television with a wet and cold towel wrapped around my knee.

I also had rotator cuff surgery and biceps tenodesis and the thought of not being able to go swimming and hiking was unbearable. But, I decided to give up a whole year to concentrate on rehabilitation. What is a year in a life-time? As hard as it may be at your age and with tons of energy to spare, try to accept that you have an injury that will need quite some time to heal. Yes, feel sorry for yourself for a bit, and then set yourself a goal to concentrate on rehab and be as disciplined with rehab as you are(were) with yoga.

Hi Ceci. I just wanted to give you an update and let you know after getting a 2nd opinion, the new doctor referred me to a different physiotherapist and it is a huge contrast from the first one! I've only met with him once, but I'm much more optimistic this time around. The PT spent an hour and a half with me during our initial consultation. He listened to my issues, and then went through a very thorough evaluation of my strength/mobility/balance, explaining everything he was doing as we went. He identified some key areas to work on and gave me a a solid outline of how exactly we would go about tackling this issue over the next ~2 months. I feel so much better about this one compared to the first one. Of note is that this guy is much, much younger than the last PT, which makes me wonder if my first one was a little bit behind the times in terms of continuing education.

Certainly not out of the woods yet, but at least now I feel I have some direction in dealing with my recovery.

[ceci]

Hi obawan,
I have been away from this forum for quite a while. Great to read that you found a PT you can trust and hope all is going well.