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Author Topic: Marrow oedema after long cycle?  (Read 3827 times)

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Offline trokalif

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Marrow oedema after long cycle?
« on: May 20, 2015, 01:30:41 PM »
Hi guys. I hope this kind of topic belongs to this section, otherwise, my apologies!

I know a Doctor is the best way to solve my problem but there were no free slots this week, so I would like to gain more info while I wait.
I am male, 28, 70 kg and 2 months ago I had a long cycle (>50miles) with a bike frame bigger than my size, therefore cycling in a not good position (I assume).
During and after the cycle I felt strong knee pain and I was not able to walk or bend them.

Because the problem did not stop, I had an MRI. The result says that is all ok, except:
"focal marrow oedema likely a stress reaction or direct impact injury in the anterior aspect of the medial femoral condyle".
Since I had no impact injury, is it possible that the marrow oedema is caused simply by the long cycle? Or is it likely a problem I already had in my knees without noticing it?
Furthermore, any suggestion about how to solve a marrow oedema in the condyle?

The situation is getting worse: for the first month I was able to limp without crutches, now I am using them otherwise the pain would be worse in the evening (after knee use, I assume).

Thanks a lot for your patience and time.
Best wishes,

Massimo
« Last Edit: May 20, 2015, 01:47:26 PM by trokalif »

Offline vickster

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Re: Marrow oedema after long cycle?
« Reply #1 on: May 20, 2015, 02:34:46 PM »
Unfortunately, there aren't really anyways to speed up the healing of bone marrow oedema - aka a bone bruise.  They can take 6-12 months to resolve, and sometimes longer.  It's esentially like little fractures to the bone

You likely put too much stress on that surface of the bone while cycling - having the saddle the wrong height or in the wrong position can be damaging, as well as having shoe cleats and pedals poorly aligned if using those.  A too big bike is more likely to cause arm, neck or shoulder issues but could hurt the knees too if in the wrong position

It is probably worth seeing a physiotherapist (preferably one with knowledge about cycling) to see if there are any exercises that may help strengthen and align the muscles and take strain off the knee.  it is best to avoid using crutches if you can so that you keep the legs working and avoid any impact on your back and upper body

If the pain is severe see the specialist who ordered the MRI, if you need a referral from a GP for that, get one :)

Good luck :)

Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline dal_knee

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Re: Marrow oedema after long cycle?
« Reply #2 on: May 20, 2015, 06:30:52 PM »

Bone marrow edema is extremely intractable if due to repetitive stress.   The only thing you can do is take a very long period of rest -- 9 months to 1.5 years.     

I see you said it is actually getting worse.    My advice for that..... read my above statement.     Anti inflammatories , Physical therapy and icing won't help.   You need to pull back....and wait a long time.   That means no more biking for now, since that was the final trigger apparently.     

Anyhow, beware of the doctor who states that the bone marrow edema is not a source of your pain....go find someone else that at least recognizes this correlation between MRI finding and clinical status.       I think the problem is that physicians are not used to seeing this in the femoral condyle....and don't know what to do with that due to inexperience.   However, for a patellar or tibial bone bruise, they seem to be quicker on the uptake.       I wish you luck.   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline dal_knee

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Re: Marrow oedema after long cycle?
« Reply #3 on: May 20, 2015, 06:42:35 PM »

I should have added, to try dry needling.  It helped me.....but you will need to keep up with it until the bone edema is improved.    Like it seems to be helpful for about 7 days or so.  I would go for it every 2 weeks or so.   My theory on that is that the constant pain coming from deep within your bones just cause the muscles to shut down again..... it's a never-ending cycle.         

   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline Clarkey

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Re: Marrow oedema after long cycle?
« Reply #4 on: May 21, 2015, 04:40:35 PM »
Hi Massimo,

I have had 1st hands experience of bone edema in my right kneecap that is a very common problem with someone that likes to keep themselves physically active. I was into long distance running before I sustained my right knee injury and weight just over 70 kg so for both of us we are slim so are carrying less weight, our knees are not taking as much strain than some someone that's overweight that does help with recovering from bone bruising.

I had a more rare case of bone edema as my bruising on my MRI scan last year showed edema inside (behind) the medial femoral condyle that is usually found on the outside (front) of the bone! My knee had to be scoped to remove a large amount of scar tissue from my 1st scope of medial plica excision and fat pad trimming.

I also found dry needling (IMS) beneficial after scope#1 as it helped reduce the pain and tightness in my knee and a cortisone injection also benefited after scope# 1 and 2.

A sports physiotherapist I have found are far better than normal physiotherapist if you a physically active person as they are more geared towards how we function at a competitive sporting level. A normal PT are also good if they have a good reputation that have been recommended by others. I have not yet found one yet since my sports physiotherapist is mostly away overseas.

[email protected]
« Last Edit: May 21, 2015, 04:50:13 PM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline dal_knee

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Re: Marrow oedema after long cycle?
« Reply #5 on: May 21, 2015, 06:27:41 PM »


Clarkey,
I would like to comment that low BMI doesn't help recover from a MFC bone bruise on a weight bearing area.   I've had a chronic bone marrow edema/bruise for 5 years and have a low BMI of 20.  I can only assume that  because Massimo is at a stage where he is using crutches, that his is on a weight-bearing area also.     

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline trokalif

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Re: Marrow oedema after long cycle?
« Reply #6 on: May 21, 2015, 08:23:22 PM »
Thanks a lot guys.
All your advices are precious and I will ask about dry needling too.
You suggested also not to use the crutches but.. isn't better for the oedema if I unload the knee?
The alternative way is simply to limp all the day. This is not a huge problem but I assumed it could make the situation worse.

I guess that after 1 year and an half the oedema should be solved. Anybody knows more or less how long the pain will be so big to limp even without a proper physical activity?

Thanks again,

MAssimo

Offline trokalif

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Re: Marrow oedema after long cycle?
« Reply #7 on: May 24, 2015, 01:35:05 PM »
Hey guys!
Sorry to disturb you again.
Do you maybe know please who is the proper doctor for a marrow oedema problem?
I am not sure if I should ask for a orthopaedic, osteopath, or physiotherapist!
Thanks!
Massimo

Offline Clarkey

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Re: Marrow oedema after long cycle?
« Reply #8 on: May 26, 2015, 05:06:29 PM »
Hi Massimo,

I hope I did not come across to negative about patients carrying excessive weight are at a higher risk of having long term knee problems compared to someone at the correct weight or just under. I am often told by many that I cannot have much of a knee problem as I am tall and lanky!

I am not sure I can help you finding a marrow oedema specialist and can also limp around and walk too much that not a wise thing to be doing as the bone bruising will never settle down and could become a chronic problem. I struggle not to keep physically active and hate not doing something physical and swimming and gym might be a good alternative for now under the guidance of a good sports physiotherapist.

Limping and putting strain on the kneecap will just add to the problems you are experiencing right now! What has helped reduce my right knee pain is a cortisone injection as it acts like a local anaesthetic but does slowly wear off and then find I overdo it as I only feel the pain once I am resting!

Once again good luck and take things easy for now!

[email protected]  
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline trokalif

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Re: Marrow oedema after long cycle?
« Reply #9 on: May 28, 2015, 07:12:32 PM »
Thanks a lot Clarkey!


I've had a chronic bone marrow edema/bruise for 5 years

Dal_knee, it seems you have a lot of experience on the problem, may I ask you just 1 question, please?
The oedema should last 1year, your went so longer... what was wrong? Therapy? Consulting?
Your comment could be really useful to me, not to make mistakes now that I am at the beginning of the way.
Thanks,

Massimo

Offline dal_knee

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Re: Marrow oedema after long cycle?
« Reply #10 on: May 28, 2015, 10:41:34 PM »

Hi Massimo,

Feel free to ask questions.    The physical therapy and doctors appointments got me nowhere.  Quite frustrating to put so much time into Physical therapy and have no improvement.   The only use it serves is to keep your muscles "activated" and functioning properly.   However, it doesn't help the bone pain very much at all.   


The reason I think mine is chronic is due to the chondral defect (directly adjacent to the bone edema ) that I have.  It's a 1.2cm x 1.2cm, grade 2/3 defect.   The cartilage wear there exposes the bone to stresses it would normally be able to handle.    Also, because it's on the weight bearing area, I don't think it ever really gets break since I need to ambulate as part of every day life.   

Also, over 5 years I've had 3 relapses due to the same issue.   Each time it takes about 1 year to get better.   But in my head, I thought that because I "felt" better and was not limping anymore, that I was "healed".   So I got in over my head and overdid it with some squats, stair climbers, steppers etc and just ended up back in the same place.   

Anyhow, in your MRI report, there seems to be no cartilage damage.  So that's very different compared to my situation.     I think that really ups your chances of truly recovering from this.    But take it seriously, as some doctors think a bone edema is a predictor of generalized OA.       I can't stress how important it is to truly take a break from activity. 

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline trokalif

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Re: Marrow oedema after long cycle?
« Reply #11 on: May 31, 2015, 08:47:06 PM »
But take it seriously, as some doctors think a bone edema is a predictor of generalized OA.

Well dal_knee, you might have pointed in the right direction:
I've been to the GP, she was booking me for a physiotherapyst but when I told her the pain was getting worse, she changed her mind and booked me for blood tests. Her feeling is about a kind of arthritis (she did not say OA, but probably a specific name).
This surprised me: I was ready for physiotherapy and for booking privately if NHS were too slow... but now?
If it is kind of OA disease, I am totally unprepared for it. I guess a physiotherapist won't be enough anymore.

Offline vickster

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Re: Marrow oedema after long cycle?
« Reply #12 on: May 31, 2015, 10:22:27 PM »
Physiotherapy is still first line treatment for mild OA, get those hip, back, leg muscles in order to help the knee work as well as it can do ensure there's no negative loading on the joint
There's no reliable surgical fix for generalised OA until you need replace to bits once at grade 4 and unliveable. Bracing might help to support and unload. Injections may help to reduce inflammation and lubricate the joint

I expect the blood test is to check for rheumatoid arthritis, and other inflammatory markers to rule out a systemic or auto immune cause

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline dal_knee

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Re: Marrow oedema after long cycle?
« Reply #13 on: June 01, 2015, 02:19:34 AM »


Hi Massimo

The blood tests are to determine whether you have Rheumatoid arthritis as Vickster mentioned.   If you have positive blood-test results, you will be referred to an RA specialist to finalize this possible diagnosis, or rule it out.  In my case, my RA bloodwork is OFF THE CHART, but I do not have RA.  My personal theory ( doctors offer no comprehensive explanation in order to weave it all together ) is that if you have a bone marrow edema, then your blood test will naturally reflect an abnormal amount of inflammation, since that's where your RBC's and WBCs and platelets get manufactured anyhow.     Again, these are my ideas only.  I'm not a physician, just a patient with long-term debilitating chronic issues who wants evidence-based explanations & solutions.

I would like to mention that with generalized OA (not Rheumatoid type), mild kinds of activity like riding a stationary bike, losing weight, gentle PT including low-arc squats/lunges, ellipticals & low impact cardio activity generally tend to make these patients feel better.   Not worse.   So you may be able to use this as a starting guide and report back to your physican and physiotherapist to help narrow the possibilities down, based on how you feel the day after trying some light weight-bearing activities.   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline trokalif

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Re: Marrow oedema after long cycle?
« Reply #14 on: June 01, 2015, 09:58:20 PM »
Thanks guys.
This means a physiotherapist is still required.
Is there no medical solution for OA? I mean medicines, not surgery!

What kind of doctor is the RA specialist, please? I guess not the orthopedic, since he's focused on surgery but neither physiotherapist or sport physician (!?)

Physiotherapy is still first line treatment for mild OA, get those hip, back, leg muscles in order to help the knee work as well as it can do ensure there's no negative loading on the joint

Vickster, does it mean that I can start the physiotherapy regardless from blood test results?
At the moment I am not booking an appointment with the physio just because I don't want to waste money to have just answers as "let's wait for blood test results"

I would like to mention that with generalized OA (not Rheumatoid type), mild kinds of activity like riding a stationary bike, losing weight, gentle PT including low-arc squats/lunges, ellipticals & low impact cardio activity generally tend to make these patients feel better.   Not worse.   So you may be able to use this as a starting guide and report back to your physican and physiotherapist to help narrow the possibilities down, based on how you feel the day after trying some light weight-bearing activities.   

Well unluckily at the moment I am with crutches and I cannot bend the knees while I walk.. it seems really hard to do the exercises you said!  the oedema, that makes the bending movement painful, with or without OA!

Thanks a lot for your advices,

Massimo
« Last Edit: June 01, 2015, 10:06:40 PM by trokalif »