Knee Tendonitis or Medial Meniscus problem in a professional mountain guide

by Mike
(Colorado)



Hello,

I am a professional mountain guide and avalanche forecaster. I am very active and fit...and my job depends on me being healthy.

Recently I developed pain in my right knee, medial and inferior to the patella.

Initially it would only be painful during the 1st 5 minutes into a run...so I would just keep running. It gradually became worse (and I stubbornly still ran through the pain).

It got bad enough that I took a week off of running, which made it feel good. So then I went for a run...which made it feel bad--very bad, I could barely run and I had very limited range of movement afterwards.

Then I rested for another week. It was feeling better when one night I woke up at 3am, unable to sleep because of the pain in my knee. I could barely walk down a set of stairs for 2 days. I have been icing it and resting now for about 1 1/2 weeks. The pain is almost non-existent and I have good range of motion.

I plan to rest it for another week. Does this sound like tendonitis (there was no acute trauma)?

What can I do to help the healing? What can I do to prevent this in the future? Is there a good brace to wear? I am not planning on running for a while, as that was the main activity that caused the pain in the first place.

Is it ok to bike with this type of injury, just to stay in shape?

And, even though it feels better, is it too soon to start exercising? thanks a ton.

FYI: healthy omnivorous diet, I supplement with glucosamine chondroitin, fish oil, vit C & E. I rarely stretch( this is changing now, due to this injury!). Also, I tore my MCL on this knee 10 years ago, no surgery, and it's been a non-issue.



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Joshua Answers:

Hi Mike.

Right off the bat, I was thinking that it sounds like a bruised Medial Meniscus.

Two years ago I started running with my dog 4-5 times a week, working my way up to running basically up a 3.5 mile long road that kept winding up a mountain. Almost two months later, just when I could do it non stop, I woke up one morning, put my shoes on, walked down the driveway, started to run and *BAM* excruciating pain.

I couldn't put ANY weight on it for 2 days and it hurt constantly, then could barely walk for 2 weeks because any weight on the knee cause severe pain, and then I used a cane for another month just to keep weight off it to let it heal.

It really only hurt when I put weight on it, or turned on the leg a certain direction that put pressure on that spot in the joint.

Your description reminded me of that.

You also said you tore your MCL. (Do you mean the Medial Cruciate Ligament or the Medial Collaterol Ligament?) That may or may not be a contributing factor. Depending on which MCL you meant, there may be no real way to tell, though we can start looking at the clues.

Regardless, I wouldn't run for a good long while...

Also, Tendonitis does not require acute trauma to get started. At this point I'm going with that you have something other than tendonitis.


So.

1. Where exactly does it hurt? If you poke around, is there a hot spot of pain anywhere? If it's super tender in the groove between the upper leg bone and the lower leg bone, that's most likely a meniscus issue. Not much to do about that but keep weight off it, keep the leg moving, and ice a lot (even though it's actually painful to do so).


2. Poking around, if it's a tendon, you can trace muscle to tendon. I kind of doubt it's tendonitis, in that there's not really a muscle that has a tendon going over or attaching to that area. I'll double check that on an anatomy chart, but on the side of the knee where you describe, it's pretty much just ligament or non-tendon connective tissue. You may have a ligament issue, ligamentitis if you will, there on the side of your knee.


3. Does icing feel like it helps? Does it hurt, like a bone ache, when you ice?


4. Age?


I may revise the following after you answer the above questions, but probably not.

You may want to start eating bone broth. Takes a little more effort, but I trust it more than glucosamine supplements, and if you want to take a lot, it comes out cheaper I think. Having said that, if you notice results from your glucosamine, keep at it and do the bone broth too.

I'd start 4,000-5,000 iu's of Vitamin D3 per day, and supplement with Magnesium for Tendonitis for a while. I suggest mag specifically because if you don't have enough mag, your calcium can start doing funky things. I'm not convinced those are a factor for you, but they're cheap and REALLY good for you anyway, especially looking at wanting to stay active, healthy, and pain free into the future.

Exercise is fine unless it irritates the knee. I suspect that any activity will either be fine, or it will aggravate that spot. The problem is, you want to really pay attention so you don't do X amount without pain only to discover that you really just irritated it.

Trial and error is the only real way to discover this, unfortunately. Let me know how that goes, as it's good information, good clues.

There may be a good brace, but let's chat a bit more to identify what's going on first.


What can you do to prevent this in the future? The immediate answer is, don't do activities that hurt it. It may be that simple. And since you sound like more of a hiker than a runner, if you can hike, this may not be a bad option.

And depending on if you have a meniscus issue or a ligament issue or or or, that changes the answer to how to prevent future pain too. Hang onto that one for a bit.

Answer the above questions, and we'll go from there.




Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Nov 14, 2009
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PART 2 - answers to the questions - Knee Tendonitis or Medial Meniscus problem in a professional mountain guide
by: Anonymous

Thanks Joshua.

Here are answers to those questions you asked:
(it was the medial collateral ligament that I strained)

1)There really isn't much tenderness on palpation; I can usually pick the specific point that hurts, although sometimes an achey feeling extends inferior and superior to the point in question. The point is inferior and medial to the patella, kind of in the space created between the femur and tibia;it doesn't seem to match up well with the patellar tendon location.

3)Icing makes it feel better, and feels like it is helping in the healing also.

4)I'm 34.

...after doing more research, it seems more like Pes Anserine bursitis than anything else. There was no acute trauma, as would be expected in a meniscus tear or contusion, and I don't have any of the symptomatic popping or locking in the joint.

I have full range of movement right now, but that diminishes greatly if it is inflamed.

Also, there isn't very obvious external swelling, and never has been (there is slight swelling, but nearly imperceptible unless you're looking very closely).

I hope this helps, and thanks for the interest!


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Joshua Comments:

Hey, you're welcome. I like working on people, hate workingn on cars, so consider yourself my entertainment:)


So if the hot spot/main problem is where the femur and tibia meet, we're looking at Meniscus issue. This would not require anything more traumatic than the trauma from running (especially if do hills), and there doesn't have to be clicking or locking. You can just have a bruised or ground up meniscus, as opposed to a rip or tear that would causing the clicking and locking.

Shoot for the bruise. That will heal.


2. It certainly could be the pes anserinus bursitis issue, if that's where the pain is. That should produce a hot spot if you push on it. Could also just be tendonitis of any/all of those three tendons that connect right there.


3. Could also be ligamentitis from the MCL tear.


4. Could be a combination of all the above. You can identify it best just by poking around and looking at the anatomy pictures.

Ultimately, Ice massage the hotspots as frequently as you are motivated to do, massage and stretch all the related muscles and connective tissue, and don't run on it.

If you do start running someday, start VERY CONSERVATIVELY, and build up slowly.

Spend some more time identifying what exactly is going on and let me know what you go with.







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