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Author Topic: 100 Deg ROM, old injuries, osteoarthritis -- where to start getting it back...  (Read 1326 times)

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Offline HerbM

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Male, age 56, physically active (martial arts) for the past 2 months (and years ago.)  5"10' 216 lbs (recently down from 245).

Fairly heavily muscled (but currently somewhat weak considering my musculature) and very large boned for height.  I should weigh about 180 lbs but the following problem largely existing when I was 20 years old, ran 8 miles per day, and weighed 175 or when I was 30 and doing Aikido 4-6 times per week.)

  Problem:  Both knees have very limited range of motion.  Approximately 100-110 degrees MAX from straight -- the joint feel like it is being pried apart (as much or more than tight quads at that point.)  There are many other pains in various places for various actions, or no action at all (leaving knees fixed whether loaded or unloaded).

  Twisting motions are extremely restricted too (crossing my legs at the knee is not quite impossible; difficult to put on socks etc.)

  Much more trouble DESCENDING stairs than climbing (although some recent improvement.  Squats seldom reach 90 degrees and never allow me to get to floor or sit on heels.

  Left knee is slightly worse than right -- it more frequently shows pain on simply being bent or kept fully straight.  Usually it (and the right knee later) will starts to ache after 3-10 minutes of being fully locked straight, e.g., lying down.

  Various pains in many locations around the knee -- different for different types of motion.  Infrequent trouble with "unlocking" or "giving way" (but never to the point of falling.)  I am actually very difficult to throw, trip, or otherwise put down on the mat due to both very STABLE/strong quads/knees/calves and long wrestling experience.  Although that doesn't mean my quads necessarily are strong "enough".

Problem started by age 19 (maybe earlier) with a moderately severe wrestling injury, at age 16, by dropping onto a wrestling mat with both knees -- then training without full recuperation with what was likely 'bruised bursars'.

[At age 14, I took a long vertical fall (30+ feet) and severely sprained both ankles (no breaks) -- after some 2-4 weeks recovery and about 1-2 years or increased susceptibility to sprains no further obvious problems with ankles.]

Subsequently, Army/Airborne, various sports and martial arts but I was never able to reach the seated kneeling position used for rifle shooting, OR Aikido, although I remained active.  I gave up Aikido (etc) starting about 20 years ago (several times) due mostly to the problems GETTING UP (not falling.)

X-rays over the years have shown moderate or greater osteoarthritis but in about 2000 a local surgeon recommended no surgery after expressing mild surprise that I could "walk so well." (Really).   Only in 1969 did any physician consider surgery.  No surgeries have ever been performed.

My current chiropractor has been helping me work through a (temporarily) sprained back first (now healed), and intends to move on to the knees and has suggested the POSSIBILITY of getting an MRI then seeing a sports orthopedic surgeon IF evidence this will help is found by the MRI-- I will have to pay between $700 and $3500 (depending on insurance) and there is NO point in doing the MRI unless I am also committed to surgery if that turns out to be the best course.  (Probably another $1000 -- $2000 out of pocket.)  Money is tight for me now but not out of the question -- while I must not waste it either.

I have significant trouble kneeling now at all, and getting up from a kneeling position is possible (improving with exercise) but very difficult, but rising is getting a bit easier with continued practice/exercise.

Overall, I am VERY "tight" (having been described as having "short ligaments" whether that is accurate or not), with some range of motion issues especially left shoulder, hips, neck and back but knees are the most severe by an order of magnitude.  They interfere with my practice and life.

Recently a friend/coach strongly advised me to seek out an ART therapist.  Active Release Technique.

Please let me know if ART or something else seems likely to help my knees...I realize that nothing is every certain, but would like your
opinion on the LIKELY best course of action. 

Thank you so much for considering this information and giving me your best advice, or asking questions to clarify.

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HerbM

Offline maryc

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I would start by finding a good OS that specializes in knees.  My OS is very conservative and will not even discuss surgery for my arthritis.  I am currently seeing a PT that specializes in sports and dance to strengthen muscles around my knees and hips.  I have never heard of an ART therapist, but I think your first step is finding a good doctor and get an accurate diagnosis of the problem.
8/4/07 fell
8/5 diagnosed TPF
8/6 surgery plate and 6 screws
8/12 out of hospital NWM
8/21 staples removed
9/18 OS appt - WBAT with crutches
10/10 - WBAT with cane
10/27 - back to work w/cane
12/26 - no cane, slight limp when tired
1/25/08 - released from PT, no limp
2/3/09 - Released by OS

Offline HerbM

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Thanks for helping -- I very much appreciate this.

Quote
I would start by finding a good OS that specializes in knees.

As mentioned, I have done this (several years ago) and the diagnoses was osteoarthritis (with large bony growths) and the OS expressed surprise that I could walk without much difficulty -- and offered little else.  Being surprised at this, I even asked if I should return in "five years" or so, and he said no, not as long as there was nothing new.

Two ideas occur at this point:  He really wasn't very good (he is highly recommended by some, and the brother of the surgeon who operated on my wife's hand/wrist when she had a roller blading accident and then for another fall.  We pretty much know the hand surgeon is great, and he also recommended his brother.

Second:  MRI were not generally available/affordable for non-life-threatening issues then so getting an MRI might show things the X-rays (done then)  could not detect.

I really felt like talking to MDs was a waste of time and money on this.  I am willing to try again, but want to figure out some probability of getting a different result.  $700 to $3500 for the MRIs is a lot of money to me right now (not out of the question, but not something I want to just throw away either.) 

Figure another $100 bucks for the OS first visit (after insurance pays part), and then I am really comitting to whatever the surgery costs too OR there is no point in doing this since surgery won't be recommended (again.)

Given that this OS (and other doctors in the past) have never recommended surgery except in 1969 when that was pretty much the answer for any athletic knee problem (cut it open and look), this seems like a poor risk.  And given that the knees USED to perform marginally well at an advanced level, I really would prefer to do something less invasive and cheaper.

Right now, I am about 35/65 in favor of getting the MRIs, and going to a (new) OS IF the radiologist and my DC recommend it afterwards. 

I have been putting it off about a week, waiting on a call back from the insurance representative to clarify if this is going to be $700 (20%), $3500 (100%), or if they can negotiate a better price -- it's time to call back and bug the insurance folks who seem to have forgotten about me, but it also did seem worth asking for ideas here too before taking this step.

(By the way, I am in the US and have decent insurance 80/20 with most things being covered.)

Another approach is to have the more serious Left Knee MRI done, and skip the right until we get the first results -- cutting the MRI cost literally in half.  Since they are not giving me any discount for getting them both, there is no real advantage to doing both at once except for the time and the more complete diagnosis.  In my estimation, everything wrong with the right knee is also happening in the Left, and more.

Also, another month or two with more weight loss and more physical training now that I am safely back to martial arts probably is only going to improve the situation as it has done somewhat over the last 2 months since I found a gentler art to practice.

My DC also insisted about a month ago that I give up a HUGE intake of artificial sweeteners -- he is in the camp that says these things cause nerve damage and loss of muscular control and strength.  I did it (completely) even it the research on this issue is mixed -- some says it does, some disagrees.  I am living proof there is no lethal dose of NutraSweet, but I might also be an example of it rotting your nerves slowly.

For now, I am doing Systema (Russian Martial Arts), Tai Chi, informal Yoga, and just starting to follow Scott Sonnon's IntuFlow mobility exercise regimen and getting SOME slow improvement apparently.

Thanks for considering the issues.  I consider myself very lucky that I don't have all the issues and surgical histories of many of the people here, and wish everyone as good a recovery as they can possibly have for themselves.











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HerbM

Offline HerbM

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Found my own old post and just wanted to put closure on this thread.

In 2014, my surgeon (the guy who did my wife's hand, NOT his brother who saw me in the history above) was prepared to do a Bilateral TKR for me due to bone on bone medially in both knees.

My hip suddenly flared up (new pain) and turned out to also be bone on bone, hard up and laterally against the socket.

Two weeks ago I had the hip replaced in a virtually perfect Anterior Approach procedure (outpatient, no significant pain, near zero discomfort) by a doctor who help in the development of the modern Anterior approach in the us (Joel Matta was his mentor and teacher.)

The new surgeon (David Dodgin) and I have now scheduled my BTKR for Oct 21, 2014.

He'll be doing it PSI (Patient Specific Instrumentation) so for that there was finally an MRI (BioMet Signature MRI to build the jibs and guides.)

In any case, after posting here 6 years ago, the knees should be replaced within two months.

Thanks.
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HerbM















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