MCL injuries suck

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David Chaus

David Chaus

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So, update:

my MCL is actually healing nicely, but I've been protecting the knee so much that other areas (quads, hamstrings near the knee) are tight and that's where a lot of the pain is coming from. Also my hip flexors have been overworked, and that's been torquing my lower back as well. Yesterday at PT they had to take a step back and focus on those other areas, and though it was extremely painful afterwards I was able to walk more easily. I got a stern lecture about working on flexing and extending correctly while walking, and that if I didn't I would eventually develop a cyst on my patella that would need to be surgically removed.

Sleeping last night was a little easier, and I'm walking more correctly (heel strike, leg fully extended) though very slowly.

I still have have some other issues to resolve, not sure how much is related to the knee situation vs just bad coincidence.
 

newboots

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Waaay too much misery! Best of luck with the wonky endocrine puzzle, the general malaise, and the ortho aggravation. I've had multiples of grievances against my body recently and it's really a PITA.

And what's this I hear about seeing too many clients? Desist! Take it from this retired psychologist (and you know it's true), lack of self-care is a bigger problem than we will ever admit to ourselves until it's a serious issue. Put on your own oxygen mask first, etc.
.
 
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David Chaus

David Chaus

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Waaay too much misery! Best of luck with the wonky endocrine puzzle, the general malaise, and the ortho aggravation. I've had multiples of grievances against my body recently and it's really a PITA.

And what's this I hear about seeing too many clients? Desist! Take it from this retired psychologist (and you know it's true), lack of self-care is a bigger problem than we will ever admit to ourselves until it's a serious issue. Put on your own oxygen mask first, etc.
.
Arrrgh! Using my own words (to clients) against me!
 

martyg

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Would getting a massage help? At least for the other areas, not the knee.

My massage therapist helped immensely. I can't recommend that track enough - especially for breaking up adhesions as you heal.

Great massage therapists and PT are unicorns.
 

LiquidFeet

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So, update:
....Yesterday at PT they had to take a step back and focus on those other areas, and though it was extremely painful afterwards I was able to walk more easily. I got a stern lecture about working on flexing and extending correctly while walking, and that if I didn't I would eventually develop a cyst on my patella that would need to be surgically removed.

Sleeping last night was a little easier, and I'm walking more correctly (heel strike, leg fully extended) though very slowly.
....
Don't you just love PTs who know their stuff? Such a helpful profession.
 

Bruno Schull

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Am I reading this correctly that you have not had an MRI for this injury? If so, that would be my first step. Without that, all the health care providers, from the best orthopedic surgeons to the best physical therapists, are just shooting in the dark. Could you have meniscus damage? And osteochondral defect? A torn ACL? And so on. Having been through many incredibly frustrating sports-related orthopedic injuries and resulting surgeries (left knee X 1, right knee X 2, right ankle X 1, left wrist X 2) you have my greatest sympathy and understanding. Get that MRI, and, if there's a fixable problem, get it fixed!
 

VickieH

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I'm walking more correctly (heel strike, leg fully extended) though very slowly
Fond memories of recovering from my proximal tibia fracture and ACL damage -- training my knee to walk properly.

I was back to walking unaided, but could feel my movement wasn't right. I told the PT and she confirmed it but just said to use it normally. Not helpful.

It was interesting to break down how my unaffected left leg walked vs. the right one. The right leg swung out like a pendulum, then the foot went straight down to the floor. The left leg swung out and started swinging back as the foot went down to the floor and accepted weight. I had to consciously practice that pendulum swing to learn to trust the recovering knee. I also counted as I walked to ensure my gait was even.

I probably would never have thought about all of that except for having a friend years ago who had a "bad knee". He then had a bad hip. Went to the doctor about his hip and learned that the compensations he made for his knee were messing up his hip. Got his knee fixed and then his hip was fine. It's interesting how things work up and down the chains of our bodies.

So glad you are getting some relief, @David Chaus. We can cancel the plans to come rescue Shamora!
 

dovski

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So glad you are healing @David Chaus I feel your pain. I took a fall off a drop on my mountain bike this summer and landed on the arm I had shoulder surgery on last summer, luckily I just got a bunch or road rash on my elbo and one puncture wound from a rock that need a couple stitches. Fast forward to two weeks back, everything was healing nicely and I started to do some exercises to strengthen my arm and shoulder as like you I had been taking easy. Low and behold I developed swelling on my elbow (1 inch bubble popped out) and looked like Popeye. Turns out my exercises irritated my elbow joint and I developed an Elbow (Olecranon) Bursitis. No pain but required rest, compression and ice for a couple weeks. That is healing but my right hand is now suffering from trigger finger .... somehow I think all of this is connected. Luckily these are all minor annoyances that will heal on their own, but super frustrating as part of the healing process is easing up on activities.
 

Pdub

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- NSAIDs screw with tissue remodeling at the cellular level. It will be a detriment to a robust repair. You don't want them.
Is there any real life clinical evidence supporting this? My orthopedic surgery friends have always pushed NSAIDs. They say a less inflamed joint or bone will heal faster. And less pain means less limping and protecting the injury, allowing one to walk properly and therefore heal into the correct anatomical position.

I would assume that both arguments have little evidence to back them up.
 

martyg

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Is there any real life clinical evidence supporting this? My orthopedic surgery friends have always pushed NSAIDs. They say a less inflamed joint or bone will heal faster. And less pain means less limping and protecting the injury, allowing one to walk properly and therefore heal into the correct anatomical position.

I would assume that both arguments have little evidence to back them up.

Yes there is. Your orthopedic surgeon is likely not working with elite communities, USOCP, or JSOC - but rather people who just want to get on with their lives. And for them, it is all good. If you are dropping into someplace at night, in a place where there are bad guys, it is an issue. If you suffered an injury, went to - let's say - the Center for the Intrepid - you want to go back to your unit better than before. I can say with absolute certainty, that if that was your jam, NDAIDs are a no-no, with the Military medical advice being, "Suck it up", with Tylenol being the go-to.

Yes, NSAIDs will likely reduce swelling, but at what cost? The end result of a repair fed NSAIDs will not be as robust as possible. Taking NSAIDs hinders the work of prostaglandins. Prostaglandins can hasten healing of damaged tissue by increasing production of stem cells to replace damaged muscle cells. Again - all good for the average population.

See: J Physiol Pharmacol, Oct 2010;61(5):559-63); PNAS, June 27, 2017;114(26):6675–6684; Med & Sci in Sports & Ex, April 2017;49(4):633–640
 
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Pdub

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Yes there is. Your orthopedic surgeon is likely not working with elite communities, USOCP, or JSOC - but rather people who just want to get on with their lives. And for them, it is all good. If you are dropping into someplace at night, in a place where there are bad guys, it is an issue. If you suffered an injury, went to - let's say - the Center for the Intrepid - you want to go back to your unit better than before. I can say with absolute certainty, that if that was your jam, NDAIDs are a no-no, with the Military medical advice being, "Suck it up", with Tylenol being the go-to.

Yes, NSAIDs will likely reduce swelling, but at what cost? The end result of a repair fed NSAIDs will not be as robust as possible. Taking NSAIDs hinders the work of prostaglandins. Prostaglandins can hasten healing of damaged tissue by increasing production of stem cells to replace damaged muscle cells. Again - all good for the average population.

See: J Physiol Pharmacol, Oct 2010;61(5):559-63); PNAS, June 27, 2017;114(26):6675–6684; Med & Sci in Sports & Ex, April 2017;49(4):633–640
OK I read all 3 abstracts. They are about muscle recovery and how NSAIDs may affect that. The first one is a mice study and the second two are review articles about cellular processes.

I was honestly just wondering if anyone has ever prospectively studied whether NSAIDs impact joint or cartilage healing in actual humans recovering from injuries. I.e. a double blinded trial where one group gets NSAIDs and the other gets placebo, for example after MCL tear. The OP had an MCL tear, not a muscle injury.

I really did not mean to offend, so apoliogies. My ortho friends may not be dealing with big time military injuries but they are working in well regarded New England hospitals and caring for plenty of professional and collegiate athletes. People travel great distances to get care in the Boston area.

Also the OP is probably not dropping out of a helicopter in the middle of the night, so maybe NSAIDs are a reasonable option he could safely take them?
 

dovski

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OK I read all 3 abstracts. They are about muscle recovery and how NSAIDs may affect that. The first one is a mice study and the second two are review articles about cellular processes.

I was honestly just wondering if anyone has ever prospectively studied whether NSAIDs impact joint or cartilage healing in actual humans recovering from injuries. I.e. a double blinded trial where one group gets NSAIDs and the other gets placebo, for example after MCL tear. The OP had an MCL tear, not a muscle injury.

I really did not mean to offend, so apoliogies. My ortho friends may not be dealing with big time military injuries but they are working in well regarded New England hospitals and caring for plenty of professional and collegiate athletes. People travel great distances to get care in the Boston area.

Also the OP is probably not dropping out of a helicopter in the middle of the night, so maybe NSAIDs are a reasonable option he could safely take them?
To be fair there are many different schools of thought on this one to be fair no conclusive studies one way or another. Ditto for stem cell injections that many pro-athlete take but cost big $$. My PT is not a fan of NSAIDs as he believes that swelling is part of your bodies natural healing process and that Ice and pressure are the best way to address that along with PT. My wife's orthopedic surgeon who works with a lot of pro athletes and is on the bleeding edge of sports medicine likes them. Both are not fans of the Stem Cell injections as they do not believe they help the healing process. My sports pain and rehabilitatory specialist who is an Osteopath is somewhat ambivalent and he used to be the team doc for the Detroit lions. My personal take is the there is no magic bullet and you need to do the work to fully recover from a sports injury. I am sure there are many people who go for NSAIDs and injections but never do any PT, or worse never even get their injury properly diagnosed and that will only slow and mess up your recovery. Case in point when my wife was recovering from her ACL injury she was at PT 3-4 times a week and doing rehab exercises 7 days a week. Towards the end she would do several hours a day and wouldn't you know it, she was back at 100% in 5 months. We had another friend same injury who dabbled in PT once or twice a week for a couple months but never did anything else. They never got back to 100% and you can see it when they walk. So NSAIDs or no NSAIDs, Stem cell injection or no injection, none of this matters if you do not put in the work to fully recover.

So simple steps one should take:
  1. Get properly diagnosed - personally I like docs who work with elite athletes
  2. Get properly treated - this is a function of number 1 and could include, surgery, injections, ice, compression and yes medication
  3. Find a Great PT - personally I recommend a PT who works with your doc on elite athletes
  4. Put in the work
 

martyg

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OK I read all 3 abstracts. They are about muscle recovery and how NSAIDs may affect that. The first one is a mice study and the second two are review articles about cellular processes.

I was honestly just wondering if anyone has ever prospectively studied whether NSAIDs impact joint or cartilage healing in actual humans recovering from injuries. I.e. a double blinded trial where one group gets NSAIDs and the other gets placebo, for example after MCL tear. The OP had an MCL tear, not a muscle injury.

I really did not mean to offend, so apoliogies. My ortho friends may not be dealing with big time military injuries but they are working in well regarded New England hospitals and caring for plenty of professional and collegiate athletes. People travel great distances to get care in the Boston area.

Also the OP is probably not dropping out of a helicopter in the middle of the night, so maybe NSAIDs are a reasonable option he could safely take them?

No offense taken.

As you know, doing a double blind study on this would be close to impossible. You'd need people with identical injuries, and identical body composition. You'd have to monitor each group's rehab, the duration, intensity, rate and timing of each rep in rehab. Diets and hormones would gave to optimized through blood panels. All sleep patterns would gave to be the same. You would have to eliminate any and all other factors - besides NSAIDs.

My two PTs both do rehab. However their jam is performance optimization in elite communities. One's domain is skiing. The other's is combat. They don't know each other and live thousands of miles apart. Both had the same take. The third party to weigh in is a former girlfriend who is department head of a PT school at a major university. So good Sources of the Truth. The mechanism here is well documented.

I guess the question on taking NSAIDs boils down to who you want to believe, and if your life's philosophy is "good enough", or to be the best that you dan be. One just needs to look at the quad tendon tear thread, and review those who were reinsured, and had to undergo a second surgery, and most took a "good enough" approach.

You have one body. It is the only one that you will ever know. I, for one, want to be ripping until the very end.
 
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martyg

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To be fair there are many different schools of thought on this one to be fair no conclusive studies one way or another. Ditto for stem cell injections that many pro-athlete take but cost big $$. My PT is not a fan of NSAIDs as he believes that swelling is part of your bodies natural healing process and that Ice and pressure are the best way to address that along with PT. My wife's orthopedic surgeon who works with a lot of pro athletes and is on the bleeding edge of sports medicine likes them. Both are not fans of the Stem Cell injections as they do not believe they help the healing process. My sports pain and rehabilitatory specialist who is an Osteopath is somewhat ambivalent and he used to be the team doc for the Detroit lions. My personal take is the there is no magic bullet and you need to do the work to fully recover from a sports injury. I am sure there are many people who go for NSAIDs and injections but never do any PT, or worse never even get their injury properly diagnosed and that will only slow and mess up your recovery. Case in point when my wife was recovering from her ACL injury she was at PT 3-4 times a week and doing rehab exercises 7 days a week. Towards the end she would do several hours a day and wouldn't you know it, she was back at 100% in 5 months. We had another friend same injury who dabbled in PT once or twice a week for a couple months but never did anything else. They never got back to 100% and you can see it when they walk. So NSAIDs or no NSAIDs, Stem cell injection or no injection, none of this matters if you do not put in the work to fully recover.

So simple steps one should take:
  1. Get properly diagnosed - personally I like docs who work with elite athletes
  2. Get properly treated - this is a function of number 1 and could include, surgery, injections, ice, compression and yes medication
  3. Find a Great PT - personally I recommend a PT who works with your doc on elite athletes
  4. Put in the work

Great reply. I had stem cell injections at The Steadman Clinic by the doc who is building the FDA data set for approval of the process. He's done thousands of these. Graduated Harvard Medical School. Taught at Harvard Medical School. MBA. Competitive body builder. Hyper-intelligent.

I think cost was $3,200. Not big bucks. The biggest trauma ( pain, financailly, or otherwise), was having my hips drilled into, without anesthetic, to retrieve bone marrow, which is where the stem cells are harvested from,

With my ruptured quad tendon I actually saw my PTs very little. Everything was done remotely. But yes, you need exceptional guidance from really smart people.
 
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newboots

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To be fair there are many different schools of thought on this one to be fair no conclusive studies one way or another.

Right. And that is often the case in medicine, particularly so with evolving therapies. Sometimes the most effective therapy turns out to originate with a less highly-regarded, podunk state university. Over time, the studies, clinical experience, and filtering process allow the better methods to rise to the top.

That said, I sought a highly recommended, athlete-oriented ortho for my hip problem. He recommended a PT who saw patients rarely, just gave them exercises and left weeks between appointments. I was doing the exercises improperly and made my symptoms worse. Give me a hands-on (or at least frequent-contact) PT, please. Just my experience. As is evident from my skiing, undoubtedly a lot of people are better at catching on to the assigned exercises than I.

:crash:
 
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