Anyone With Arthritis of Knee

[kenshireen]

I have some Arthritis in my right knee. Had an MRI...
Also had a series of Supartz injections (hyaluronic acid)

The pain is on the inside (medial) part of the knee below the kneecap.
It hurts when I push off. I wear a neoprene supprt...nothing very strong...just a rubberized support.. Basically keeps the knee warm and provides a bit of pressure.

Any recommendations as to what sort of brace/support might be helpful.

Speed was always one of my main attributes and I don't know if I would want to play if I cannot move around the court the way that I used to.. This is a rather depressing situation.

 

[equinox]

Yeah left knee behind outside was hurting little after 25km around the foreshore on monday.

Surprisingly recovered and feel good, I'll still ease off for the 10km today.

I do feel for you. Had 1st hit yesterday in 10 months and wrist only lasted 20 minutes before pain. Might need to strengthen it..

My suggestion visit the doc again and listen to the body, avoid drugs unless necessary, pay for it in the end.

 

[ollinger]

Play more doubles. Arthritis isn't a condition that tends to reverse itself, especially in the knee where vertical trauma is unavoidable. Braces are more for ligament issues where lateral stability is a problem.

 

[Chas Tennis]

I have some Arthritis in my right knee. Had an MRI....................................................
The pain is on the inside (medial) part of the knee below the kneecap.

An MRI is evaluated by a specialist at the imaging lab. That Dr sends the written report to your Dr. Get a copy of that report and research each term and condition in it.

I believe that posture issues - tight or weak muscles - can cause and/or speed along developing arthritis. See some of the discussion and references in the recent thread on "Knee pain".

http://tt.tennis-warehouse.com/showthread.php?t=411990

I have had PT on three injuries: a rotator cuff and two meniscus injuries. Two of those and maybe the first injury also involved correcting problems with my posture. See if your sports medicine Dr or orthopedist can recommend a Dr to give your posture an evaluation.

Posture issues require highly specialized knowledge and physical examination.
Find a qualified Dr who is oriented to prevention

 

[Hitman99]

Arthritic deterioration is much more common in the medial (inside) compartment of the knee than on the lateral (outside) compartment. In addition, there is the middle compartment (patellofemoral), where the kneecap "floats" over the junction of the femur and the tibia. Arthritis can cause the inner surface of the kneecap to become irregular, and thus result in irritation and swelling.

A neoprene knee support offers a certain amount of relief by compressing and supporting the tendon below the kneecap. I use a Cho-Pat strap, which I find to be fairly effective.

Both Supartz and SynVisc are synthetic synovial fluids that are designed to lubricate and cushion the knee, with varying success. I have had several injections of SynVisc, didn't do anything for me. My orthopedic surgeon just says that there is not much scientific evidence of the effectiveness of these treatments, but docs are notoriously conservative in their assessments --- they want to CUT!

Another injection option is cortisone, which has diminishing effectiveness over time, and substantial side effects. Works for some, not for others.

Don't discount drugs, even over the counter anti-inflammatory agents such as ibuprofen. I took 2400 milligrams of ibuprofen daily for over 20 years with no adverse effects. Then I switched to Alleve (sodium naproxen) because the pills were smaller, & developed acid reflux within 6 weeks. Took me two years to get over it. I also tried many other prescription options, such as DayPro, Feldene, diclofenac, and Celebrex. Effectiveness varies from one individual to another.

Your bones don't have nerve endings, so you don't really feel the grinding. What causes the pain is the inflammation. The less inflammation, the less pain. Best practice is to stretch, warm up religiously every time before you play, then apply ice afterwards --- do it EVERY TIME.

I had a partial knee replacement last June, am now pain free. Benefit of the partail replacement was that I kept all my ligaments. I stretch for an hour every morning, and then again before & after I play. I also do Nautilus training twice a week. I no longer have inflammation, so I am drug free.

Yes, arthritis is depressing. So is old age. Get over it, suck it up, soldier on, stay upbeat, yadayadayada... Good luck!!!

 

[charliefedererer]

I have some Arthritis in my right knee. Had an MRI...
Also had a series of Supartz injections (hyaluronic acid)

The pain is on the inside (medial) part of the knee below the kneecap.
It hurts when I push off. I wear a neoprene supprt...nothing very strong...just a rubberized support.. Basically keeps the knee warm and provides a bit of pressure.

Any recommendations as to what sort of brace/support might be helpful.

Speed was always one of my main attributes and I don't know if I would want to play if I cannot move around the court the way that I used to.. This is a rather depressing situation.

Have you seen a real knee specialist who takes care of a lot of athletes with knee injuries?


"Arthritis" on an MRI can represent chronic changes of the cartilage that have nothing to do with your present pain.


Beware of fancy braces unless prescribed by a doctor. They can make matters worse.


One of the problems that happens with patients with knee pain and a diagnosis of "arthritis" is they stop exercising. The quads atrophy and can lead to abnormal tracking of the patellar tendon, and the ligaments of the knee can become less strong. The whole knee can become more "loose". Return to specific knee exercises, or even a great total body exercise like the squat, can actually "tighten" everything up and make things better. But I would advise doing this under the direction of a sports medicine specialist and therapist, as doing too much too soon, or the wrong exercises, can make the knee worse.

 

[ttwarrior1]

try superslow leg extensions, glucosamine cream and glucosamine pills

 

[Chas Tennis]

Bones have nerves

...................................
Your bones don't have nerve endings, so you don't really feel the grinding. What causes the pain is the inflammation. The less inflammation, the less pain. ....................................................

That is not correct, the bones have nerves and generate pain. See description in section "What happens when you damage articular cartilage".

http://www.cartilagehealth.com/acr.html

Part of the problem with joints is that cartilage damage can occur without much pain.

 

[bad_call]

I have some Arthritis in my right knee. Had an MRI...
Also had a series of Supartz injections (hyaluronic acid)

The pain is on the inside (medial) part of the knee below the kneecap.
It hurts when I push off. I wear a neoprene supprt...nothing very strong...just a rubberized support.. Basically keeps the knee warm and provides a bit of pressure.

Any recommendations as to what sort of brace/support might be helpful.

Speed was always one of my main attributes and I don't know if I would want to play if I cannot move around the court the way that I used to.. This is a rather depressing situation.

i can relate... also using a knee support with limited success.

 

[Hitman99]

That is not correct, the bones have nerves and generate pain. See description in section "What happens when you damage articular cartilage".

http://www.cartilagehealth.com/acr.html

Part of the problem with joints is that cartilage damage can occur without much pain.

I stand corrected. My comment was based on my personal experience, not on my in-depth medical knowledge. For me, my Xrays showed bone/bone contact for many years, and I was still able to play tennis without much, if any, pain. Once the inflammation got out of control, my knee was always puffy, and the inflammation started running down into my calf. Then I developed ITBS, uncontrollable muscle spasms, severe pain, etc. That's when I decided to have the knee compartment replaced.

 

[charliefedererer]

I had hoped to see an opinion by Posture Guy, our resident Egoscue expert.

Pete Egoscue's book Pain Free has a chapter on knees and a section on tennis. His book, The Egoscue Method of Health Through Motion has interesting sections on arthritis and warns about potential problems with braces.


But I was hoping Posture Guy might see this and comment on his personal experience with knee pain in tennis players or other athletes.

 

[Chas Tennis]

.......................
I had a partial knee replacement last June, am now pain free. Benefit of the partail replacement was that I kept all my ligaments. I stretch for an hour every morning, and then again before & after I play. I also do Nautilus training twice a week. I no longer have inflammation, so I am drug free.
.........................................................

You have had a partial knee replacement about 8 months ago. Is that where they replace a minimum amount of the joint - only the damaged bone ends? It sounds as if you have gotten very active again including playing tennis.

I have a friend who has bad knees and sooner or later that procedure might be his best option to continue tennis?

 

[Hitman99]

You have had a partial knee replacement about 8 months ago. Is that where they replace a minimum amount of the joint - only the damaged bone ends? It sounds as if you have gotten very active again including playing tennis.

I have a friend who has bad knees and sooner or later that procedure might be his best option to continue tennis?

Yes, a partial knee replacement only affects one compartment of the knee, in my case the lateral side (outside). They replace the ends of the knee bone with a prosthetic "joint", which means smooth, synthetic pads. Because only one compartment is involved, and the prosthesis is smaller, the procedure is considered to be minimally invasive --- smaller cut, less tissue damage, no ligament removal, less risk of infection, less hospitalization and recovery time.

I was in the hospital one night, able to walk around the block in about 10 days. I had to wear a compression sock for a few weeks, which was a PITA, but never used a cane or crutches at all. I was walking a mile a day within 3 weeks. I had physical therapy twice a week for 8 weeks. I still do exercises and stretches every day, mostly from my Egoscue menus. I don't have 100% range of motion back yet, but it's close.

I prepped for the surgery by losing 35 pounds, did Nautilus to strengthen the leg as much as possible, did a lot of physician prescribed exercises and stretches. Many of these are oriented towards older patients with poor muscle tone and circulation, but I did them anyway.

I was very lucky, in that my knee was only bone/bone on the lateral side. My regular orthopedic doctor recommended a total knee replacement, and told me he did not do partial replacements as a matter of choice. He said that my knee condition was the result of chronic arthritis, and that sooner or later I would need to have further surgery. However, he gave me the names of a few doctors who felt differently, including Dr. Gerald Engh of the Anderson Clinic in VA. Dr. Engh is a world-reknowned expert on joint replacement surgery, and after examining me and reviewing my Xrays, he agreed to proceed. He told me during my 3-month post-op appointment that he thought no other doctor in the country would have agreed to perform this procedure on me. We are both extremely pleased with the results.

So, my advice to your friend is to consult a good orthopedic surgeon first, then get a second opinion, preferably from someone who does a LOT of partial replacements. It's not for everybody, it is a technically difficult procedure, but has many advantages.

 

[Hitman99]

One last thought: there is alternative approach to partial knee replacements called a bi-compartmental arthroplasty procedure. The medical supply company Smith & Nephew makes a prosthesis called the "Journey Deuce", which replaces the medial (inside) surfaces, as well as the center surface under the kneecap. Again, all the ligaments are retained.

The Smith & Nephew website has a listing of doctors who are familiar with their prosthetic devices in any given geographic area.

 

[charliefedererer]

Hopefully the OP and Chas's friends problems can be addressed without surgery.

But cartilage repair procedures are becoming more common, although the results are hardly perfect:

"What is cartilage repair?

Cartilage repair includes various surgical procedures such as microfracture, osteochondral autograft transfer (also known as OATS or Mosaicplasty), osteochondral allograft transplantation and autologous chondrocyte implantation (ACI / Carticel). These procedures are designed to heal cartilage damage by filling the cartilage defect (pothole) with repair tissue.

The choice of procedure depends on the size and location of the defect. Generally speaking, larger defects are treated with ACI or osteochondral allograft transplantation, both of which require open incisions. Smaller defects in specific locations can be treated with microfracture or osteochondral autograft transfer, which can be performed with smaller incisions.

Who is a candidate for cartilage repair?

Once bone-on-bone arthritis has developed, cartilage repair is not an option anymore, and patients can be considered for joint replacement surgery or osteotomy (re-aligning a leg that is very bow-legged or knock-kneed).

Since cartilage repair has a long recovery time of up to 1 year before the patient can return to unrestricted activities such as running or basketball, it is mainly performed in younger and active patients where joint replacement is not an option. Even though we have treated suitable patients as old as 60 with cartilage transplants, this is rare and our average patient is between 16 and 45 years of age."
- http://www.cartilagerepaircenter.org/what-is-cartilage-repair.html



"Return to sports participation after articular cartilage repair in the knee: scientific evidence.

RESULTS:
Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology.
CONCLUSION:
Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations."
- http://www.ncbi.nlm.nih.gov/pubmed/19861696

 

[kenshireen]

Egoscue Exercises

I picked up the pain free book.
I will do the exercises for the knee as indicated and let you know my feedback. Will probably buy the e-tower for $100..comes with a 90 day return... I will know way before if it is effective.

There is also a Egoscue "University"... on line.
There are various Egoscue clinics across the US.
The therapists charge $250 per hour.... A bit steep I feel.

Has anyone tried any of his therapy

 

[Hitman99]

I picked up the pain free book.
I will do the exercises for the knee as indicated and let you know my feedback. Will probably buy the e-tower for $100..comes with a 90 day return... I will know way before if it is effective.

There is also a Egoscue "University"... on line.
There are various Egoscue clinics across the US.
The therapists charge $250 per hour.... A bit steep I feel.

Has anyone tried any of his therapy

Yes, I have done two separate 10-week sessions, helped me a lot. I do a series of e-cises every morning, and every evening after I play tennis. I do the tower once or twice a week.

The e-cises won't help your knee directly, but it will help correct your alignment and posture problems that result from chronic pain. One way to check to see if your posture/stride has been affected by your knee pain is to look at the heels of your shoes. Are the heels worn down more on one side than another? Having a trained therapist provide hands-on instruction on how to perform the e-cises is invaluable, as are the before/after photos of your posture/alignment. The therapist's time might seem to be expensive, but you don't have to do the therapy the rest of your life. But you DO need to perform the e-cises regularly. This is really the same for yoga, or other physical fitness regimens.

 

[Posture Guy]

Hey guys.

Charlie, thanks for the kind words.

Knee arthritis? Check out my blog post from a year or two ago:

http://egoscueaustin.wordpress.com/2010/01/27/check-this-out-you-are-going-to-love-this/

I will quote Pete Egoscue on the subject of osteoarthritis in joints: "I have never once seen osteoarthritis in a properly positioned, normally used joint."

And I concur.

If your knee is developing arthritic/degenerative changes, the first thing I would do is ensure that your posture is dialed in. As first an Egoscue client and now the director of the first licensed clinic in the Egoscue system, I'm partial to the way we look at the body, but find SOMEONE who can assess you posturally.

Here's one way you can do it on your own. Have someone take pictures of you wearing shorts, no shoes, no shirt. Take pics from front/back/left/right. Lay them out in front of you on your screen or in print, then compare them with what we call the postural blueprint. You can see that at this webpage:

http://www.egoscue.com/painfree/themethod.php

What do you look like compared to the blueprint? Does the left side of your body look to be in the same position as the right? Are your hips level? Shoulders level? Do your feet and knees point straight or do your feet point out like a duck? Do they point out the same, or differently? Do the knees point the same direction as the feet, or differently? From a side view, can you draw a straight line and connect your ankles, knees, hips, shoulders and back of ears? Or is that line crooked?

I just had a client appointment, worked with a guy in Oklahoma on skype. Right medial knee pain. He could extend his knee fine but couldn't bend it without pain. If he tried to bring his knee to his chest, no way. The hero's pose position (kneel with your knees and feet together, then sit back on your heels), no way.

Posturally he didn't look to be too off, but during functional testing it was clear his right hip was 'sticky'. It had gotten tight and was losing it's normal ability to flex and extend and that was causing the femur to be mispositioned. And if the femur is off, the knee is off, right?

Doesn't always work this way, but boy is it fun when it does. I gave him one exercise designed to free the hip. Then had him stand up and walk around. No pain. Try the hero's pose. Got all the way down, no pain. He was ready to go see an orthopedic surgeon until his wife convinced him to see me first.

Now, sometimes I'll tell clients "nope, your issue isn't postural, you need to go see a surgeon". And sometimes it's tough to tell. I tell folks if there's any chance the knee is structurally damaged and requiring medical intervention, start with that first, every time.

But knee arthritis? It CAN be reversed, no question. We see it all the time in our clinics. Takes effort, but it can absolutely happen. Best of luck. If I can answer any questions directly, feel free to email me at the address in my profile. Happy to be of assistance.

 

[Posture Guy]

And the wood tower referenced by someone else above?

I'll tell you flat out, for tennis players or athletes in general, the ecise we most commonly use that for (it's called "Supine Groin Progressive") is the closest thing to a miracle cure as I've seen. It's a very, very powerful 'exercise'. Which is kinda weird because on one hand it's very passive, you're just laying there. But there is a LOT going on. It helps return the hip and pelvic girdle to a more neutral position, returns the spine to a more neutral position, helps relink the ankle to the knee to the hip, and on and on. If you want to see a good description of that ecise and an explanation of how to do it, you can go to egsocue.com and click on the link that says something like 'fix your back with the tower'.

I was talking one day with John Lynch. He played for years in the NFL as a safety, a very violent position, and he was very good at it. He'll be nominated for the hall of fame one day, most likely. Anyway, he started doing Egoscue stuff when he was in high school. I asked him how important the tower ecise was to his career and he looked at me and said "i would've had to retire years ago without it, no doubt".

The guy whose xrays are shown in the link above? The tower ecise was one of the key things he did to achieve that result. If I could give people just one piece of free egoscue advice, it would be to get a tower and do that ecise regularly. It will add years to your tennis career.