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Offline sheri l

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Unhappy triad - help!
« on: April 02, 2006, 07:17:18 PM »
I have been reduced from a busy, happy nursery school teacher to a jibbering wreck after a fall skiing on 16/3.  I have been told by my OS that I have the unhappy triad - having had the scary MRI... but my prob is that my physio and OS seem to be on diff planets.  OS says full leg brace, partial weight bearing, see me in two weeks, possible op at end of April. Oh heck. I thought they could just go in - fix me up - a few days on crutches,bit of physio and I'd be back at work by 22/4.  I am beside myself.

The physio says that I should have the op A S A P and that i will be able to ski again.
The OS says that people ski without their ACL repaired esp as I am over 40 (46)
The physio says take the brace off 3x day and exercise (push down, hold etc 3 sets of exercises, 30 of each ... leg extensions and trying to bend knee).
The OS says only take the brace off for a quick shower and keep on doing static exercise only.
I AM SO CONFUSED.  My husband is out of the country this week - we have decided to get another opinion when he gets back but in the meantime....HELP!

I can hobble around in my brace and only get uncomfortable if I stay in one position too long either sitting or standing.  My leg aches around the knee with a kind of burning at the end of the day.  I took ibuprofen and muscle relaxants for the first ten days but pref to be off them. I only take ibuprofen before going to physio because I am such a baby.  physio thus far has been electrotherapy pads strapped to my leg and ?ultrasound/sonar...some kind of wand thing rubbed on my knee.

If I take the brace off and attempt to sit upright in a dining chair I cannot bring my right foot next to my left foot... the knee is stiff and the right foot remains a foot ahead of the left.  I am not even sure if I am doing more harm than good but each day I try to get my right foot a little closer to the left foot.  It hurts - sort of burns like mad (left side of right knee).

I am terrified to bend my leg back because during the first week before I had the brace our kitten clawed my toes while I was sleeping.  I instinctively pulled my leg away and the pain was excruciating.  I woke my poor husband with my scream and cried uncontrollably.  It was on par or even worse than labour (I had two natural child births so I am not a complete baby)!

It was so good finding this site - I stand in awe of all you amazing people.
I would be very grateful if someone could point me inthe right direction....do I rush into surgery? do I ignore the OS and obey the physio by taking off the brace 3xdaily and doing his exercises?
HELP??
skiing injury 16 mar 06,
 unhappy triad,
acl healing response repair 3 May 06

Offline deb123

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Re: Unhappy triad - help!
« Reply #1 on: April 02, 2006, 08:02:12 PM »
Hi, sorry to here about your injury, I had a similar injury in late Feb. - Osteochondral fracture of the femoral condyle, complete ACL tear and miniscus tear. I had a knee immobilizer on for 2 weeks. Physio 3 times a week which started 2 days after the injury, with exercises at home every day. I can honestly say that I have one of the world's greatest Physiotherapists- we call him a physioterrorist. My routine was wear the splint while up walking- always aiming for heal strike -no toe walking. Splint off while doing physio, using light weights no more than 2 lbs do hamstring curls and quad strenghtning (lots of reps) as well as ultrasound and cryotherapy each visit. Physio suggested that I go back to the surgeon because my knee was locked- unable to get full extention. as a result I had the orthoscopic surgery to remove the debris in my knee. I used crutches for the first 3 weeks and then progressed to a cane a week after that- knee immobilizing splint was off about a week after surgery. I am 6 weeks post injury (4 weeks post arthroscopy) now and awaiting ACL reconstruction in May. I have full extention, flexion and weight bearing although I still have a lot of discomfort and swelling. I am back to work tomorrow and will continue with physio to strengthen hamstring and quads in anticipation of the surgery. My biggest concern at this point is that my knee keeps slipping out. I may start using a brace to prevent this until I have surgery.
From all the input I have had it seems like the physiotherapy has had the most impact on my recovery. Do the exercises and perservere. It will improve over time, and the risk for further injury is much more related to not strengthening your muscles. Go back for a second opinion if you are concerned.
Hope this helps,
Deb
« Last Edit: April 02, 2006, 08:04:54 PM by deb123 »

Offline sheri l

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Re: Unhappy triad - help!
« Reply #2 on: April 02, 2006, 08:34:45 PM »
Hi Deb
Thanks... gosh that all sounds impressive... my PT's english is just passable so I feel a bit at a loss when I hear all your stuff about extensions, flex, hamstring curls etc etc. 
I feel greatly cheered reading  your advice and will get on and do my exercises.  What do you mean your knee locks... what does that feel like?  I can feel something sort of slip to the right if I dont stand properly when I shower.    I am so terrified of what might happen if I dont stand properly that I am getting into the rather bad habit of keeping my knee taut while the brace is off.  I caught myself doing that today and thought WHOA... RELAX.
Actually after wearing this full brace for five days my inj right leg is not feeling its happy self - def felt a bit wobbly when I took it off to shower this am. 
All the best for May.  When the OS first told mentioned that I could have reconstruction I just said YES YES thats what I want... but having read so much now I am a little less enthusiastic.  Do I really want to ski again?? And they keep saying...."at your age... which is something I never even thought about before... what do they mean "at my age"  Im only 46 for goodness sake. 
Well thats enough of my ranting. Thankx for listening.
Thanks again for your helpful reply
Sheri L
skiing injury 16 mar 06,
 unhappy triad,
acl healing response repair 3 May 06

Offline Pen

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Re: Unhappy triad - help!
« Reply #3 on: April 02, 2006, 09:37:41 PM »
HI Sheri
I am an unhappy triad too - accident a month earlier than yours, so i am a little further on ....

PT did ultrasound and the electric tens machine which really did help, also the static quad exercises and the lifting too - I worked really hard at physio for 3 times a week - sometimes it felt I did too much and it swelled up and really hurt, so I rested a day or two, but week by week my leg felt a bit better. I am now 6 weeks post injury.  My PT however still maintains I need ACl surgery.   I took one private opinion first, he wanted to do an arthroscopy and then decide later on about acl reconstruction.  then i went to the nhs (the appointment finally came through) and they were very keen on conservative treatment (especially as my leg has not once given way on me) and then I took one more private opinion (a OS recommended by one of my sisters friends).  He basically said not to have acl surgery unless really necessary, i.e. if your leg keeps on buckling all the time.  He said it is the MCL which is the most painful and boy does the MCL hurt me! and to ski again I could either wear a bioskin hinged brace or a CTI edge aspire (for women) which would help any instability.  He said that if he had no acl but his leg did not give way all the time he would not have the operation.  Quite telling I thought.  My main problem is with extension (aothough flexion is also very difficult - my problem is exactly the same as yours - with one foot being out in front an dit is also painful to put weight down on to the foot when the leg is bent.  However he told me to be brutal with the extension as he thinks the MCL is healing too short and I need to stretch it by pushing down on it.  As for bracing, I was on crutches non weight bearing for a week, (not knowing what to do) and then was given medial collateral brace by NHS which I wore at first around the house and then recently if I go out to feel more comfortable in case someong knocks me or something.  I only took the brace off for sleeping last night, as I found I did some terrible moves in the night which really hurt it before I got the brace.  HOpe some of this helps.  Good luck.  x

Offline deb123

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Re: Unhappy triad - help!
« Reply #4 on: April 02, 2006, 10:07:00 PM »
Hi again Sheri, just so you know 46 is young - I'm 44 and I do plan to ski again, in fact I was planng on taking the instructors course this season but my injury has delayed that plan until next year.
When I mentioned that my knee was locked- this was a term the OS used to describe that debris was in the joint preventing full extension. Following arthroscopic removal of the dead tissue and fragments I was able to gain full extension.
From what I understand, most people can regain full activity without reconstruction - braces are helpful with stability but don't replace the ACL function 100%. My decison to have reconstruction was mainly based on the fact that I do plan to be active for many more years, and because of the fracture of the condyle that I had, I will likely develop arthritis. Physio told me that I will need an ACL in the future in case I need to have a knee replacement (hopefully many years down the road)
I have been seeing many post ACL reconstruction patients in physio each week and am impressed with their steady progress. Most of the people who I see there are in their 40's or older. 40 is the new 30 these days.
All the best
Deb

Offline celinenj03

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Re: Unhappy triad - help!
« Reply #5 on: April 02, 2006, 10:23:30 PM »
You can add me to the "almost" 40 club terrible triad club! I'm pushing 39 but like you all, age is just a number to me. I'm forever 20 in my mind I think.

As I await my ACLR on May 3rd, I am also working hard to stregthen my muscles and get more ROM. I'm just about there with extension again, I do believe it is the MCL which is or wants to heal up too tightly--but it's getting there. It seems I am constantly exercising anymore or stretching or icing. I also attend prehabilitation for ACLR 2x per week and do all my exercises at home. I guess I waited about 1 week before starting because the knee was just way too tender to do anything.

My program is something like, stationary bike 10 minutes / 2x per day
Leg extensions - 3 sets of 15 or more if I can
Quad sets - finally getting my foot off the ground while pushing into the pillow with the back of my knee
1/4 Quad sets
Calf Raises - I do these til the cows come home
Achilles Stretches
Prone Hangs -After every shower it's part of my routine, just lay on the bed on your stomach and hang your legs from the knees down off the bed. At P.T. they put weights on my anke.
Also sit in a knee extender chair for 3 minutes (sheer torture but very good results)
Heel slides (try to get that foot to your butt or close to it!)
Sitting with my heel off a pillow, towel, chair or table any chance I get

It seems you can always incorporate exercise into your day if you're creative. I must say the first few weeks, I didn't believe these little leg lifts or quad sets would do a thing for me, but that giant indent where my VMO "used" to be is started to disappear.

Good luck and God bless you all in your journey back! We'll all be in much better shape by 4th July.

Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline Ferris

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Re: Unhappy triad - help!
« Reply #6 on: April 03, 2006, 08:07:20 AM »
You should wait until you get rid of any stiffness and recover range of motion (flexion and extension) before you have the reconstruction as it can lead to scar tissue problems later if you rush in so your OS is probably right in this respect to wait until the end of April before doing the op.  Only id the knee was locking due to the torn mensiscus or another piece of debri might it be worth going in now but from what you write, it sounds more like stiffness rather than locking.  Your PT sounds right in recommending that you do exercises as if you do have the reconstruction, you should recover your range of motion and build up the leg muscles before the surgery and the exercises will help this.  Post-op I was told by my OS to take off the brace during the exercises but it may be different pre-op so I would check.  You might want to obtain second opinions for both your OS and PT but some of what each of them is saying makes sense.  I am not a medic and as you have damaged more than just the ACL, you ought to follow medical advice - try and find an OS and PT who (broadly) agree with each other and who can liaise together to help you.

Rachel

Offline sheri l

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Re: Unhappy triad - help!
« Reply #7 on: April 03, 2006, 10:26:57 AM »
Oh my gosh what a FANTASTIC suprise all your mail was.
Thank you all so much.  I am just thrilled to bits to hear from u all.
I cant believe I have gone from being a hectically busy person to feeling isolated in such a short time.
THANK YOU!

But down to business....
what is an extension... is that holding your leg out straight? 
what is ROM?
and that's just for a start.

I am getting a whole new vocab here.

There is no way I can get my heel anywhere close to my b... at best the angle between the thigh and calf is 90%.

Do I force it closer and risk injury or do I let it be and risk longterm problems with muscles getting lazy or whatever else is slowly dying on me?

In the meantime I have decided to get on with the exercises the physio gave me as they dont hurt (apart from getting my foot any nearer my b as mentioned above).

Sadly I am not in the US so your great referrals dont help.  I (dare I mention or u will all rush out on me) live in Dubai.  I am a Brit (grew up in Africa) and my husband  (a true Brit) is on contract here.  If u dont know about where I live
Google Dubai... its quite an amazing place...

we have a great new indoor ski place here which u can check out at
skidubai.com -
the day I fell the slopes were full of US guys (marines I guess) off a boat docked here because we are on the Arabian Gulf really close to Iraq.    They were great fun, and in fact we were joking around with a couple of them at the top, shortly before I fell.  We have skiied, as a family on a weekly basis since the new year... I think skidubai opened at the end of Nov.  My 13yro daughter, having learned to ski in Switzerland, is now learning to snowboard.
My husband learned to ski years ago on various school trips to europe.  I only started at the beg of January with lessons, probably every other week.

I could kick myself for my injury... I had finished a really good lesson where I had passed to level 3 and was persuaded to go up just one more time to have hot chocolate with my dear hub and daughter (Avalanche cafe at midstation).  I was tired, just went too fast and lost control.  stupid stupid stupid.  They keep asking me how I fell and how I felt when I fell... and all I can remember is the awful realisation that I was out of control and going down ... when I heard what I thought was my leg breaking. ugh.

But the upside is i get to talk to all of you!
Thanks for listening!
Sheri L


skiing injury 16 mar 06,
 unhappy triad,
acl healing response repair 3 May 06

Offline Audice

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Re: Unhappy triad - help!
« Reply #8 on: April 03, 2006, 11:27:53 AM »
Hi Sheri ~ I'm 20 years older than you & also an unhappy triad person. I ruptured my ACL, tore the medial meniscus & MCL a year ago & have learned to live w/o an ACL as I've been told I don't need it to survive & nobody my age has ever had reconstruction.

I was about ready to clock the doc at that comment but I CAN live w/o the ACL - now. Like you, my knee absolutely wouldn't bend or straighten out initially & any attempt to do so was agony. I looked at my horse & wondered if I'd ever be able to ride again.

By the time I had the MRI & saw the OS, I was already dealing with the injuries pretty well & eventually had a custom brace made which I wear when I feel a need but not regularly. I understand the feeling of tibia slipping sideways because that's what did happen & when I least expected it. And the pain was awful but short lived.

My meniscal tear doesn't lock so I'm doing nothing about it & although most times I'm aware that my knees not right, I do have good ROM & time has made life ever so much easier.

Hang on...things will get better...Ellie
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline celinenj03

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Re: Unhappy triad - help!
« Reply #9 on: April 03, 2006, 01:45:14 PM »
Sheri,

I think a lot of us can relate to going from being a once very busy and independent woman to being forced to slow down and ask for help. It is hard for me especially I think, because I'm a mom of 2 little ones and I'm used to doing everything for everyone and now I can't do it all myself. Very frustrating but also very humbling  ::).

ROM = Range of motion
And yes, extension is getting your leg straight meaning the back of your knee is resting comfortably on the floor. My OS will test it by asking me to press down on his flat hand as he positions it under my knee. The first time I couldn't even touch his hand (that was before arthroscopic surgery to remove some meniscus blocking the joint much like a wedge in a door).

For me, I knew right away the difference between a good stretch and a bad stretch. You probably do too. When I was stretching before with the meniscus in the joint, believe me I knew something was wrong. Of course check with your OS first, but if your joint is clear of any debris a good exercise to start would be placing your legs up the side of a wall while laying on your back. I would start off about 18 inches from the wall, then let your good leg support your bad leg underneath and let the bad leg drop down slowly, very slowly with gravity. You will feel a "healthy" pulling sensation. I'm not saying it won't hurt a bit or be a little uncomfortable. I listen intensely to my body and I know when I'm pushing just enough. Each day it will get better and better.

Do you have a stationary bike? If you do and if you can get your leg around (with NO resistance of course), you could do that for a few minutes first to warm up your muscles. Then do the strech against the wall.

For extension, again if you can hang your legs off the side of your bed from the knees down and let gravity pull your bad leg down (you can add "some" weight later on), that's a start. You should feel a stretch.

Always ICE after stretching exercises as you are stretching (yes, minimally tearing) the muscle tissue and each time you must ice. This cycle will get you better and better ROM as the weeks go by. My OS said that within 4 weeks ROM should return. If it doesn't something is wrong meaning you might have debris in the joint.

I think the hardest thing for us terrible triads though is that pesky MCL. For me that is what is giving me the trouble still. It healed up but I do believe a tad too tight and I am having to stretch it now. This is most likely because I was in a brace the first 2 weeks a more flexible brace for the next 4 weeks after that. But there isn't anything you can do about it as the MCL must be braced to heal.

I can tell by your posts that you are a very active, young at heart person, and being a teacher of young children you probably want to be the way you were before. So you might seriously consider having the ACL. Plus, you have to realize that if you don't have the ACL and God forbid you have another fall or your knee gives out, you could damage the meniscus and MCL and even PCL and you would be at ground zero.

I'm going in May 3rd. I HATE the idea of this surgery, but I HATE even more, the idea of being like this forever. I'd sooner suffer for the few months then for the rest of my life.

P.S. One of the best articles I have read (and I have read MANY) is one posted by one of the regulars here HeatherM. It talks a lot about ACL prehabilition exercises and requirements for a successful ACL reconstruction. You'll see why waiting for the knee to calm down, is best.

http://www.drmillett.com/image/59/acl.doc
« Last Edit: April 03, 2006, 02:00:54 PM by celinenj03 »
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline sheri l

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Re: Unhappy triad - help!
« Reply #10 on: April 03, 2006, 03:06:24 PM »
cant write much now as I am just in tears about this all.  I am truly touched by your letters.
Thanks so much for your wonderful replies.
I briefly checked out DrM's doc but will face it again after dinner when I feel less like a jelly.
Pathetic. truly pathetic.

Thank goodness for baked potatoes ... just bung them in and we have food.

I am slowly coming to terms with all of this.
Is it a good idea to do a 10min walk to the shops I wonder?

I feel like a prisoner in my own home (self inflicted because I have had numerous offers of can we do anything? but i just dont know what to say or where to begin... Im not sick but I feel injured).  Weird.

I have a plan for tomorrow morning... I am determined to get my act together.  This week it has nearly driven me crazy that I simply cannot seem to get ready for the day befere 11am.  So instead of trailing up and down I am going to take a banana and a bottle of water upstairs with me tonight and get straight in the shower in the morning  - have a picnic on the bathroom floor while I do my exercises - get dressed and put some makeup on.  Everything else can wait.  At least I will feel like a human and not the bag lady I am slowly morphing into, shlepping around in my nightie at 10am.

Thanks for listening...
Having written this i feel MUCH BETTER
What a reliif.  THANK YOU!


skiing injury 16 mar 06,
 unhappy triad,
acl healing response repair 3 May 06

Offline celinenj03

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Re: Unhappy triad - help!
« Reply #11 on: April 03, 2006, 03:28:08 PM »
Good for you! All I can say at this point is everything you are feeling is normal at this time. Myself personally, I can truly relate to what you are feeling and reading your post feels like I could have written it myself. It is difficult to go through something like this. People around don't seem to understand. But you have a fighting spirit and you are determined as many of us are! I try to convince myself that life is made up of peaks and valleys and this is just temporary. It shall pass. We're here for you! Talk to you later,
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline Audice

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Re: Unhappy triad - help!
« Reply #12 on: April 03, 2006, 08:25:12 PM »
Sherri ~ I began rehab on my own with very short slow walks concentrating all the time on where & how I was placing my right foot so as not to cause my knee to buckle. Every move I made was SO deliberate I must have looked awfully odd to anybody watching. But it worked. Short walks, if they're not uncomfortable, might work for you, too, & there's something very positive & "normal" about getting out & about...Ellie
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline Heather M.

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Re: Unhappy triad - help!
« Reply #13 on: April 04, 2006, 12:34:18 AM »
Sheri,

There's lots to take in.  I have a couple of articles that should explain EVERYTHING to you about ACL rehab and what you are facing, philosophies, goals, etc.

Hope this stuff helps--it's in very accessible, easy to understand language.

http://www.drmillett.com/image/59/acl.doc  (very detailed--read every word, because whether you have surgery or not the principles of rehab are almost identical)

http://www.steadman-hawkins.com/acl/overview.asp

http://www.kneeguru.co.uk/html/steps/step_02_cruciates/starting.html

http://www.webmd.com/content/article/17/1676_50305  (talks about postponing surgery and the benefits of doing this)

And just a suggestion...I don't know about PT training in Dubai or the UAE in general, but doctors around the world have similar educational backgrounds, regardless of location.  And they are pretty extensive.  So in a debate between listening to the PT and the surgeon, I would tend toward weighting the surgeon's advice more.  Of course I've met great PT's and this is not to denigrate their contribution at all--I am walking today because of great physical therapy.  But the doctor knows his/her procedures and the MRI results and so forth, and so if he/she says that you should do one thing and not do another, I would listen.  Consider bringing your PT to a doctor's appointment--they do this on occasion here in the US.  Or at least get them communicating via notes and regular reports on your progress.  Phone calls are good.....

Take care.  Try to get out more, even if it means a brace and/or crutches.  It's important to take care of your mind and soul as well as your body.  Go to one of Dubai's marvelous restaurants...buy some gold or nice shoes, a leather bag.  Go sailing.  Whatever strikes your fancy, just do it.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline sheri l

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Re: Unhappy triad - help!
« Reply #14 on: April 04, 2006, 06:59:51 AM »
Hi Heather... good news I have managed to get up and get my chores done plus a BATH... first time I have been brave enough and it felt fantastic.  My cats came in to see what all the fuss was about and I managed to shave my whole leg.  Oh joy!

So I did the exercises I can manage (mainly for my quads - didnt know what they were a week ago) and packed with ice as suggested.  That did the trick and I have chucked the track pants and got into my normal gear slapping the brace on top.
So today I have one pink leg, one black leg.  What a sight. 

Still as u suggest I am braving the Friends coffee shop this morning for a latte.  Oh joy.

When I get back I will do some reading up -  Thanks again to all you good folk for getting me thru yesterday.
Sheri L
skiing injury 16 mar 06,
 unhappy triad,
acl healing response repair 3 May 06