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So, I've had three to four weeks of a swollen right knee and lower leg plus inner knee pain. My regular, trusted sports physio has thoughtlessly run away to France for four weeks with his bike, so after asking around a bit, I saw a different physio.
After some questions, prodding and diagnostic stuff, he reckons I have a 'posterior horn medial meniscal tear', so basically a cartilage injury. He figures that with three to four months of gentle rehab - no running, some gentle spinning, flattish, gentle walks, it should 'settle'. Failing that, surgery, but he seems confident that the majority of injuries like this will be okay without and it could be counterproductive.
In honesty, I'd have more confidence in the diagnosis if it were based on a scan and I'm tempted to see if I can sort an ultrasound locally - my regular physio says it should show up fine on ultrasound. That said, I don't have much choice but to take things easy and be guided by how painful / sore it is anyway.
Any thoughts? Should I be trying to sort out a scan? In honesty it feels to me more like a hamstring / calf tendon strain, but his take is that the combination of swelling in a confined space, aka my right knee, is causing referred pain rather than the other way round. Anyone had similar?
All stories of how you've miraculously recovered from similar stuff and are now happily and painlessly riding around would be welcome. I'm pretty hacked off to be honest.
If you can sort a scan, have a scan, then you'll know. Even if you go private it'll probably cost a lot less than you think.
As for happy stories, I had half my cartilage removed from my left knee when I was nineteen, it's given me shit ever since, it's now at the point where it's a constant issue and at some point in the worryingly imminent future I'll need a knee replacement.
So stop ****ing about and get a scan.
I can offer my recent experience of this (although it’s not overly positive) . Started with pain on inside of right knee and I went down route of sports massage, physio then onto ultrasound and ultimately MRI . The MRI was the most informative and showed a complex oblique medial meniscus tear and a cyst . I’ have a ban on running and advised light mtb/ cycling only ( just to keep muscle tone etc). Now waiting on surgery. I figured as I had option ( luckily have cover via work) and getting no younger (54) would get done sooner rather than later. Surgeon seems confident it will help but will have to see after op and rehab. So not that cheery in my experience but I found scan useful to get a definitive answer on the problem. Best of luck. Your specific symptoms maybe more straightforward
An ultrasound is not the imaging medium of choice to try and diagnose a meniscal tear.
Ultrasound is useful for superficial structures, your knee cartilage is not superficial, a MR scan would be the imaging of choice for this. Having said that I would try rehab first and then scan if it was not improving after 12 weeks. Just because there's a tear there does not mean you require surgery although if it is locking or giving way then surgery is usually required.
Thanks all, appreciated. What confuses me a little, is that the initial presentation was a sudden acute pain behind the knee - hamstring tendon area - with swelling and pain. I'll go to my GP and see if I can progress things with them. No locking or giving way, just sore and a bit swollen, though the swelling is reducing day on day and much reduced first thing in the morning after a night's sleep.
I guess the reality of is is that whatever I'd done, rest and very gentle activity only, guided by pain/reaction is going to be the way forward for now anyway, so I may as well just chill out and get on with it.
Any thoughts on using NSAIDs? My guts don't get on with ibuprofen for more than occasional use. Physio suggested talking to GP about Naproxen for a couple of weeks to deal with the swelling/inflammation, but I'm also a little concerned that may be a sledgehammer to crack a nut and I'd be better off just letting things subside naturally and without the bonus of acid reflux. Also a little wary of anti-inflammatories actually slowing the healing process.
I had similar last year. Saw a good physio and I asked for a scan. He said by all means however you have been running "competitively" for 45 years so at 60 the scan will just show a pretty worn out meniscus with fluffy bits around the edge. Surgery is not really an option unless it is very broken and has to be removed (which he was confident wasnt the case) so lots of strengthening and a slow build up to exercise. Still feels tender occasionally but at 60 and still trying to run 35+ miles per week is not really surprising. Have the same problem with the other knee know and that seems to be following the same pattern.
I would take pain killers for a bit (assuming you are resting it at the same time) and give it at least some time to settle on its own. So many injuries do, as long as you actively rehab as well.
I got knee pain which I tried to ignore it for a bit but it was really sore after riding with clips and it was getting to the point I was struggling to unclip.
Went to BUPA through work and got a Consultation and he clocked the bulge on the outside of my knee, did some manipulation and suspected a meniscus tear, which a MRI confirmed.
Was told to wear Hoka type shoes, not to run, not to play sports that involve twisting and sharp changes of direction, and to avoid breaststroke when swimming.
I also switched to flat pedals on the MTB.
Surgery was an option but he thought it wasn't quite bad enough as it wasn't locking or anything like that.
With the changes I have made (essentially chucking out my old Vans shoes and switching to flat pedals) I'm basically pain free but the bulge on the side of my knee is still there.
Knees are complicated, get a proper consult and MRI.
Get some omeprazole to take with the Naproxen, you might find your acid reflux is a lot less of a problem. GP - get a referral to NHS physio, try and get a referral for an MRI. My journey to that point took 18 months. Hope yours is faster or you can afford private.
I had similar last year. Saw a good physio and I asked for a scan. He said by all means however you have been running "competitively" for 45 years so at 60 the scan will just show a pretty worn out meniscus with fluffy bits around the edge. Surgery is not really an option unless it is very broken and has to be removed (which he was confident wasnt the case) so lots of strengthening and a slow build up to exercise. Still feels tender occasionally but at 60 and still trying to run 35+ miles per week is not really surprising. Have the same problem with the other knee know and that seems to be following the same pattern.
I would take pain killers for a bit (assuming you are resting it at the same time) and give it at least some time to settle on its own. So many injuries do, as long as you actively rehab as well. I'll go and see him once he's back in a couple of weeks.
Yes, that sounds familiar. A lot of running, hill-walking, mountaineering and general hammer. My regular physio said as much to me in a whatsapp from his - poorly timed - bike holiday in France, also figures my chances of recovering well are enhanced by having good musculature, which is reassuring. I figure bikes are the way forward and what I like doing anyway.
I contacted my GP this morning and they're referring me for an MRI and follow-up. I suspect it'll take a while.
Get some omeprazole to take with the Naproxen, you might find your acid reflux is a lot less of a problem.
Thanks. Not a huge fan of PPIs, but I guess I can live with them for a couple of weeks if I have to.
Was told to wear Hoka type shoes, not to run, not to play sports that involve twisting and sharp changes of direction, and to avoid breaststroke when swimming.
Amusingly, the physio suggested that I wear pretty much the opposite, solid approach-type shoes, maybe with an arch-supporting footbed for better underfoot stability, the rationale being to keep everything aligned. I have some Hokas sat around too. Got to love competing solutions. I avoid swimming full stop. Water is best served frozen, vertical and climbed with the help of crampons and pointy ice tools 🙂
I had a similar physio visit. But the guy i know well wasn’t in France. I said fix my hamstring. He says it’s your meniscus. I didn’t really believe him until i had one last go at running on it, that made it quite clear impacts were the issue
Basically it’s fine on the bike. I’m can walk upto 10 miles with good surfaces. I don’t think i could do a big day on the fells. My NHS referral was a nice chat with a guy saying we don’t want to chop into knees unless is in the way. Strengthening the muscles helps
As for naproxen, I've been taking it for a torn rotator cuff and bicep tendinosis. I only took it at night, and after having had a meal - no issues. You'll need the omeprazole if you are doing four tablets a day for a few weeks. I've made mine last about 3 months so far. Even once a day worked well enough to reduce the swelling.
I had a similar physio visit. But the guy i know well wasn’t in France. I said fix my hamstring. He says it’s your meniscus. I didn’t really believe him until i had one last go at running on it, that made it quite clear impacts were the issue
Basically it’s fine on the bike. I’m can walk upto 10 miles with good surfaces. I don’t think i could do a big day on the fells. My NHS referral was a nice chat with a guy saying we don’t want to chop into knees unless is in the way. Strengthening the muscles helps
Thanks. I'm in generally good nick and already working consistently on the rehab stuff, while listening to my body, hopefully in time it'll settle down. In training terms, I work best with certainty and empirical evidence, hence wanting a confirmatory scan. I don't want a surgeon anywhere near my knees tbh, but I'd like to know 100% what I'm actually dealing with.
Positive to hear that you're still okay on the bike. In the long term, I'm way more fussed about that than mountain walking, but we'll see. I also keep in mind that Joe Simpson, post his Touching The Void epic, was told by consultants that he'd be lucky to walk again let alone go climbing. In the event, he went on to summit / not summit, quite a few big peaks. I figure that my torn meniscus, if that's what it is, is somewhat minor compared to the damage he did to himself.
But for now, steady and careful 🙂
As for naproxen, I've been taking it for a torn rotator cuff and bicep tendinosis. I only took it at night, and after having had a meal - no issues. You'll need the omeprazole if you are doing four tablets a day for a few weeks. I've made mine last about 3 months so far. Even once a day worked well enough to reduce the swelling.
Cheers, I'm using Ibuprofen for now, taking with food and will use OTC Nexium if it messes with my guts. I'm hoping it'll calm down after a week or so. I understand that Naproxen has a longer-lasting impact per dose, as per your experience, so if the Ibu' doesn't cut it, I'll chase up my GP. I'm more worried about the inflammation/swelling than any pain, on the plus side, it was pretty close to normal when I got out of bed this morning, so heading in the right direction. Touch wood etc.
I'll chase up my GP
Have you had a consultation of some sort with your GP?
Edit: just read this bit 🙂
I contacted my GP this morning and they're referring me for an MRI and follow-up. I suspect it'll take a while.
Usually they refer you to MSK (Physio) It could take weeks/months for the referral, and then depending on the Physio you might undergo weeks/months of physio before you either accept your condition or they finally suggest an MRI (if it is needed)
If you can afford it it may be worth going privately. The consultant would want to see you in person, probably within a week, and if needed could get you an MRI that day or within a week. Some quick googling would suggest you could get all that done for less than £400. I wouldnt choose a random internet place that offers non referred MRI scans, but look at your local teaching hospital for soft knee tissue surgeons and then see which of them work locally privately.
As for reducing swelling. Elevate when you can and ice. Cryo cuffs help too, and help with pain.
Have you had a consultation of some sort with your GP?
They work on a digital triage system. I sent them a copy of a letter which the physio wrote to them, they texted me a bit later and said they'd referred me for an MRI. According to one of my partner's medical colleagues, that's now something that's done round here. I'll see where it goes. Right now I'm focussed on the next couple of weeks, doing some knee-friendly rehab to stop my leg muscles from shrivelling up and keep activation alive, getting the swelling down gently and seeing how it all settles. I'm sitting here now with an ice pack around my knee btw.
The physio may well be correct in his diagnosis, but as above, I'd quite like a bit more certainty, although I appreciate that the end result may simply be that I rehab it as well as I can, hope it settles down then work like a bastard on strengthening everything.
I'll also look into the private options, maybe via the missus.
Thanks.
The more I read about meniscus tears, the more optimistic I am that with diligent rehab and care I should be able to get my knee back to something like normal service. Turns out that a lot of meniscus tears - assuming I have one - are asymptomatic and simply overlooked unless MRI scanned. I don't have any locking or catching, or any significant restrictions on extension or compression of the knee joint. I'm not overweight, I'm fit, I have pretty strong leg muscles thanks to regular resistance training, cycling and walking and I'm pretty focussed on getting it right, and I will follow treatment programmes closely and listen to my body.
The current broad take seems to be that outcomes with and without surgical intervention are broadly similar, ie in most cases, there's no real point in rushing into surgery. Plan is to keep going with some light spinning sessions to keep the joint moving and lubricated plus knee-friendly leg activation and leg strengthening exercises plus ibuprofen and icing post sessions to reduce swelling and see how it goes. Once my regular physio is back, I'll go see him for a second opinion and some rehab input. I'll leave the MRI referral to meander through the NHS system and make a call on that when/if it comes through.
I do wonder if this is all related to the Specialized BG shoes I recently posted about which seem to have triggered grumbling knee pain on both sides, though of course that may be coincidental/causal/contributory. Chickens, eggs etc. I suspect the reality is somewhere in the middle, but who knows. Sorry, mostly just thinking aloud for my own benefit.
Anyway, thanks to folk who responded to my original post. It's appreciated.
Had an MRI via GP referral the Wednesday before last and am waiting on results. In the mean time, my regular - and very good - physio is back from his extended holiday cycling around France and I saw him on Monday. His take is that I don't have obvious meniscus related pain, what he thinks has happened is that I have a hamstring injury plus something - possibly swelling from the hamstring, possibly something else - is impeding fluid drainage in my knee and lower leg. As a result, he thinks the knee joint is basically congested with fluid under moderate pressure and that in turn is exacerbating the knee pain probably caused by using Specialized BG shoes six days per week for around four months. Not much spare space in the knee joint, so excess fluid gums everything up.
It's a bit of a jigsaw and I'm not writing anything off at the moment, so working both on rehabbing the hamstring and the muscles around knee function within a minimal pain envelope. Fine spinning indoors on the bike up to around 200 watts or so and 90 minutes of that reduces what's left of the swelling to almost normal and the knee feels way better for it and much improved generally.
I guess the MRI might tell me more, but I'm fully expecting it to show that if you batter your legs for decades, the result is a less than pristine knee. I'm 100% committed to getting it back to normal then working hard to bullet-proof it and I'm also way more optimistic than I was when I first started this thread three weeks back.
Sorry, just a bit of a brain dump, more for my own benefit than anyone else. 🙂
I had a similar injury two years ago and saw multiple physios. They all said it wasn’t a meniscus tear. One of them is actually one of the best knee physios in the country, and even they said it didn’t present as a tear. But deep down, I knew it was.
I did the rehab and had various treatments, but it never fully cleared up. It didn’t really affect my daily life — I could bike, walk, and do full leg sessions at the gym. It only flared up when running or in the mosh pit. I’d had enough of running anyway, so I was happy to leave it for a while.
Fast forward to this summer: after a week in the Lakes and a couple of hiking trips in the Alps, my knee just couldn’t cope with the descents, even with poles. Luckily, I have private healthcare, so I booked an appointment with a consultant and had a scan. It turned out I had a large, complex tear in the meniscus — just as I’d always suspected.
I had surgery 10 days ago, and it went really well. No swelling afterwards, no painkillers needed. My physio signed me off to ride again on Tuesday, and since then I’ve managed four flat 25-mile rides. I’m also back in the gym rehabbing the knee.
I think the key was going into surgery fit, with strong legs from all the gym work I’d done to support the joint over those two years. I had the other knee done four years ago, and that recovery took much longer
I think the key was going into surgery fit, with strong legs from all the gym work I’d done to support the joint over those two years. I had the other knee done four years ago, and that recovery took much longer
Cheers for the thoughts. I'm keeping an open mind on whether I have a meniscus tear, a hamstring strain, and/or edema of the lower leg which my or may not be caused by either of the above or the interaction between them. Hopefully the knee MRI will give a better steer on the former at least. Atm all I can do is work diligently on rehabbing both the knee and the hamstring. I do resistance work three times a week anyway, have done since my teens, so I'm pretty strong generally. Plan is to focus on bomb-proofing my knees going forward once I can tackle the basic stuff pain free. In simple terms, if you can strengthen your supporting muscles enough, it vastly reduces the shock-loading on the knee, is how I understand it.
In honesty, my legs have had decades of hammering, but I've always been strong and well conditioned and never had issues before. I do genuinely think the knee soreness goes back to those bloody Specialized shoes throwing leg alignment out of kilter and potentially, I guess, loading the meniscus disproportionately in one place, but anyway, hopefully the MRI will cast some light on what's going on.
Just out of interest, what did they do with your knee surgeries? Most current thinking seems to be that outcomes with an without surgery are broadly similar, but I guess it's going to vary on a case by case basis. Anyway, good to hear that the recovery's going well, fingers crossed for a happy, pain-free future 🙂
Scans are only useful if they’re going to change management. If not then they’re a waste of resources.
Most soft tissue knee injuries improve with physiotherapy and rehabilitation, especially meniscus injuries in middle aged and older patients.
There isn’t a great deal of evidence that surgery is beneficial in these cases, and it introduces it’s own risks.
The best knee surgeons that I’ve worked with have strongly pushed physiotherapy and rehab as the way forward.
I think that one of the mistakes that people make is that they presume that the treatment that young professional athletes such as footballers get is the gold standard, and as such, that is what they should be pushing for. However different incentives apply for professional athletes that prioritise early return to high level activities over long term outcomes. These incentives do not apply to the rest of us.
I've had 3 meniscus and 1 acl operations on my right knee due to sport now i need a total knee replacement; can't help feeling they weren't always necessary.
Most soft tissue knee injuries improve with physiotherapy and rehabilitation, especially meniscus injuries in middle aged and older patients.
There isn’t a great deal of evidence that surgery is beneficial in these cases, and it introduces it’s own risks.
That's exactly how I understand it and I gather also that it's quite possible to have an existing meniscus tear that's non symptomatic. That said, if I do have a meniscus tear I'd like to know. That's maybe irrational and you could argue that it makes little difference to treatment or outcome, but given that I've seen two physios with differing diagnoses, I'd like to have some sort of objective reference point to work from, not least because my job involves lots of walking up hills and mountains.
I'm an outlier in NHS terms because, without being arrogant, I'm fit and strong and prepared to put in whatever rehab and ongoing maintenance work necessary to stay active at a high level. I'm not overweight, I barely drink alcohol, I eat healthily and avoid UPF etc. I do my absolute best to not be a drain on the NHS. Sorry, that sounds kind of smug, but it's not meant that way. And yes, I know my take on this is not entirely rational, but it's how my brain works. I also figure that looking after myself properly for decades maybe off-sets somewhat the waste of ten minutes of MRI time and associated cost. I'm also told, fwiw, that approximately 20% of MRI appointments are no shows, though that's anecdotal from a doctor friend.
I've had 3 meniscus and 1 acl operations on my right knee due to sport now i need a total knee replacement; can't help feeling they weren't always necessary
As I understand it and as per @kramer above, the current take based on various studies is that the 12-month outcome for surgery and rehab are basically the same, so unless there's a very compelling reason to operate, the best course of action is to work like a bastard on building up the muscles and mechanical processes that support your knee to minimise the loads on your meniscus. In five years time, it'll probably be different again and slot-in synthetic replacement menisci (sic.) will be widely available and come in different colours and densities like old skool fork elastomers. All of which I suspect you know already, apart from the elastomer bit...
Good luck with the knee op!
I think that one of the mistakes that people make is that they presume that the treatment that young professional athletes such as footballers get is the gold standard, and as such, that is what they should be pushing for. However different incentives apply for professional athletes that prioritise early return to high level activities over long term outcomes. These incentives do not apply to the rest of us.
I've never thought that fwiw and certainly not on the NHS. And while things may be better for the current generation of elite sports people - my partner works in elite sport, so I have some familiarity with how things are at a high level - as you say, there are numerous ex-footballers, rugby players and others suffering the long-term consequences of being rushed back into competition prematurely.