The View from Sports Center

New Video for The Runner's Knee Bible

I've had numerous questions since the release of the book that basically boil down to this: Should I buy this book?

Well, I understand the hesitancy. So, I made a short video of a simple self test that will help you decide. 

Now, some people with Runner's Knee have pain after they run but during the day - walking, climbing stairs, etc, - they don't hurt. This test is not for you. This test is for those people who notice knee pain soon after they start running, or even just have pain with routine every day tasks and they can't run.

I hope this helps.

 

Runner's Knee Bible Question - Should I Run Unloaded?

Hi,

I purchased the runner's knee book you created and I am really thankful that you created this. I've been a runner basically all my life and I've competed since I was in 5th grade. I have had knee pain since 2007 and was able to run on it at a really high level 1:50 in the 800, 14:54 5K etc for about 8 months and then one day I woke up after my last race of the season in June 2008 and my knee was crippled. Before that it was a dull aching pain constantly and occasionally a sharp pain when running that would only happen every so often. It went from that to the most jarring pain, tightness I have never felt before and I knew something was really wrong. I went to the doctor and the physical therapist, did a lot of research and nothing really worked. The pain and stiffness got better over time but when I tried to run the jarring sharp pain was still there. I tried all sorts of physical therapy to no avail. Finally in February 2009 I started Prolotherapy and by August 2009 I was able to run again without the jarring pain although my knee and now knees are still in pain (more the dull aching pain and occasional stiffness) and crack/pop (no pain associated with that) and I'm not able to run anywhere near as much as I used to or at the same level, but it is nice to be able to lace them up. I also do strength training and play soccer so I do have strong legs, but usually it doesn't hurt when I run but afterwards. I know I probably shouldn't be this active but I feel like I have to because I love it. 

 

I have read the material and I have already started doing quad sets multiple times a day which does seem to help. I do have a question though. I know in your blog you mentioned using an unloaded running program but you did not mention this in your book. I know this is probably because most people would not have access to a treadmill that could unload them, but I live in San Francisco and I can get access to an Alter-G treadmill for 2 months for $200. I would like to do this in hopes to work up to full body weight running over time. I guess I'd have to experiment and find a body weight that produced no symptoms after I completed the run. Correct? It seems like it would be a great way to get the 1000s of unloaded reps that you mention are needed for cartilage health. In hindsight I probably should have done this back in August 2009. Do you have any thoughts on this?

I'd really appreciate your feedback and thanks for creating the book. It is really needed especially with the lack of quality advice you can find on the subject.

 

Regards,

 

James (not his real name)

********************************

James -

Thanks so much for purchasing The Runner's Knee Bible. I'm glad to hear that you've put to use some of the information already. If the quad sets are already helping you, I think you have a really good shot at recovery. Do your best to work your way through the drills sets in the book. They'll help you a lot.

About the unloaded running - yes, I left that out of the book because there are very few options for people to run in an unloaded environment. And, some people confuse unloaded running with running in water and they are very different modalities. Water has an unloading effect but it also increases resistance as you increase speed. And, there's not a easy way to incrementally increase the running loads as there is with a Newton or an Alter-G (and click here for my take on unloading devices).

If you have access to the Alter-G, I would consider trying it once you pass the Back Slider and the Hip Lift tests - as described in the book.You're right that cartilage requires thousands of repetitions to alter its biochemical properties but with the unloaded running, you're also re-training motor patterns; firing mechanisms of muscles that have been, perhaps, altered for years. When your knee joint is overloaded it shuts down certain muscles in your thigh and hip. So, when you try to run, those muscles are not as easily recruited; it's like an eight cylinder engine running on four cylinders. The more you train this pattern, the more engrained it becomes. Unloading can alter the neuromuscular pathway and re-train, below the level of conscious thought, how and when these muscles fire.

I usually start a client out with intervals --similar to what I outlined in the book - even if they are unloaded. You have to find your threshold - the Load Tolerance - the point at which pain shows up -  then increase your lift for training by 10%. This process is actually easier to do if running hurts during the run but in your case, it sounds like the pain shows up late and I'll guess that it hangs around for a while too - maybe a couple of days. If so, during a test at, for example, 65% body weight, and let's say that is equal to 130 lbs (in other words you weigh 200 lbs and are being unloaded 70lbs), you don't hurt at the time but notice symptoms the next day, you would increase the lift by 7 lbs (10% of the 70 lbs of lift) for your next session. Now, you're running at 123 lbs of body weight force; being lifted up with a force of 77 lbs. At some point you'll find a load where you can run and experience no symptoms - day of or day after. You train at this level but, as I discussed in the book, you have to edge the training. You have to go hunting for the point where symptoms show up, adjust, re-train, and go again. This is where people make mistakes. They fail to edge the training. They fear the pain. Pain is the guide; not the problem. You're correct in that there's a bit of experimentation; you want a gradual resumption of impact. Getting back to full gravity running is actually process of small failures; running into the barrier and then getting past it. It is every bit a struggle mentally as it is physically.

Make sure that you get through the whole book though and really look closely at your mechanics and fix as many deficits as you can. A lot of times, the mechanical deficits lead to focal loading of the joint surface and by correcting, for example, a weak hip, the force will shift off the worn or weak area onto a sturdier spot in the joint.

Again, I really appreciate you buying my book and hope that it helps you get back to running.

*******************************

Just a reminder, the $10 discount on the Runner's Knee Bible expires this Sunday, November 7, 2010. Use "view1000" in the check out screen.  Click here to go to The Runner's Knee Bible page for info and to order.

The Runner's Knee Bible Is Here!

"Hi, I'm trying to determine if your site is scam or not. You talk about runners knee a lot, but you give almost no practical details at all what to do. You talk around it a lot, but nothing actionable. Yet you aren't even selling anything on runners knee which makes it a poor scam.

Do you have a specific set of things that can be done for runners knee?"

Greg

 

Yes, I do have something specific for Runner's Knee and here it is.

The solutions for Runner's Knee just can't be covered in one or two posts. My original goal with this site was to educate; raise awareness but after receiving countless emails and comments, similar to yours Greg, I decided to write a book.

The Runner's Knee Bible.

This is NOT a physical, hard cover book. This is a download, electronic book. I did that on purpose. Embedded in this expansive and detailed look at Runner's Knee are over 100 photos and 40 videos - both specific tests to perform along with explanations and demonstrations of specific exercises. You're getting it all in this book, including some of my most recent and advanced techniques, and at $69.95, it's a fraction of what one visit with me would cost.

And, I've included extras. Stumbling Blocks, a bonus book, is a summary of the most common barriers people encounter when trying to overcome Runner's Knee and my suggestions at getting past those barriers. A Test Score Sheet, and Training Logs are also included to make the whole process ready to go. I walk you through the whole thing; help you figure out where you should start, what drills to do, how to do them, how to progress them, and when you start running again, a specific program to follow.

There are at least 36 million people running regularly in the United States with almost 10 million logging over 100 days per year.¹ A lot of these folks get hurt. In fact, 65% of all runners have to stop running because of injury and the number one reason is knee pain - Runner’s Knee.²

Oh, and by the way, do you know how many books on Runner's Knee you can get from Amazon? None. For over 23 million people who want to run and can't because of knee pain from Runner's Knee, there's not one book available to help them.

Until now.

For more details and how to order, click here. As a reader of The View, you can get $10 off the retail price for the next seven days (this ends November 7, 2010). Use the discount code view1000 at check out.

 

1. Sports Data. American Sports Data 2003 Superstudy of Sports Participation. Volume 1. Cortlandt Manor, NY American Sports Data; 2003.

2. Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987;15(2):168-71. 3. Source: Steadman-Hawkins Clinic, Vail, Colorado

Latest Update on My Knee Recovery

Right Knee Meniscal Tear
Day #91 post-prolotherapy
Friday, August 27, 2010

I had hoped that my visit with Dr. Fullerton today would be my last.

Not so.

Turns out that although a good portion of the meniscus tear has healed, there's a part on the back side, where it connects to the femur, that's a little loose. Under ultrasound, you can see it shift when he tugs and twists my knee.

This may explain why it's sometimes painful to bend my knee past a certain point or to perform a deep squat. The meniscus is being tugged from the angle of pressure.

"So, what's next?" I ask.

"Well, we could get an MRI. Get a clearer picture of what's going on," said Dr. Fullerton.

MRIs. Really? Seriously? I really don't like MRIs.

"And so would a clearer picture change the course of action? Seems like I'm really not a candidate for surgery."

"Good point. No, it wouldn't change the options. We could do another round of prolo or use PRP and since we haven't hit that area of your tissue with prolo, that might be the thing to do first."

"I'm good with prolo. I would rather try that, see what happens and since I've had a good result thus far, I suspect I will in that area of the knee too. And if it doesn't work, I could then go to PRP," I said.

"Sounds good to me," said Dr. Fullerton as he shook my hand and then left the room.

There are few things I can't do right now. Run is one of them but that's mostly because I haven't tried it. At least full body weight. I've done some intervals in my Kangoos. No problems.

Well, I did try one round of running this past weekend while visiting my mother in Daytona Beach. The call of the beach was just too much. Early morning. Sunny. Warm but not too warm. A nice breeze. Desolate. Perfect. I jogged 30 second intervals for 20 minutes and felt great. Knee held up well.

Now, if you had a chat with my right Achilles tendon, it might say, "Whatchu' talkin' bout?" Yeah, the Achilles was sore and I stopped. It's almost recovered now so no serious issue that I can tell but the run was worth the fall out. I can still do all of my training drills and my daily activity is unimpaired. But for now, running will wait.

Some people wondered why I wouldn't just get the surgery - a partial menisectomy. It's quick. Relatively few post-op complications. And you go on with your life.

There are three.

First, I think we, as a society, take surgical procedures for granted. Like driving to the grocery store to buy a gallon a milk. No big deal. But every time you're in surgery, there's always significant risk. Risk of infection, stroke, and bunch of other stuff that's on all that paper work you sign off on before you have surgery.We think it can never happen to us but it does happen. So, if you have less invasive options and can pursue those, do. Sometimes you can't. Tear is to large, unstable. Or, your lifestyle and other demands just won't allow for the timeline.

Second, whenever you can preserve your meniscus, whether by repair or otherwise (prolo or PRP) you should do it. In a recent study of patients who had partial menisectomy, 60% had detectable changes of osteoarthritis of the knee compared to 20% of the repair procedure. ¹ I had a partial menisectomy in my left knee in '94 and I have to work a lot harder at keeping that leg fit than my right leg - until recently that is.

Turns out, your mensicus is a very important component of optimal knee function. Keep it if you can.

And, third, I like to try new and different things. I wanted to know what the prolotherapy experience was like, how it worked, did it work, how would I respond. Thus far, I'm happy with my progress. It's not an easy or quick road, (and did I mention that it hurts?) but I think when it's done, I'll have a much more solid knee.

So, my next prolo appointment is in the third week of September.  Until then, I train.

Stay tuned.

1. Stein, T., A. P. Mehling, et al. "Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears." Am J Sports Med 38(8): 1542-8.

I Had a Knee Replacement and then Tore My Muscle. Now What?

I received an email from a reader, Lisa, who had a total knee replacement about three months ago (thank you for reading Lisa and for buying The Little Book of Sparks!). All was well until she slipped and fell in her kitchen and ruptured the Vastus Medialis Oblique muscle (VMO - red area in the picture) and since then she has had a number of problems. Because the VMO helps stabilize your knee cap, when you rupture it, it's like cutting loose a mooring line on a ship on a windy day. Things get whacked around pretty good. She had to have the muscle surgically repaired to help re-align the patella.

Here's how she described it:

"The surgeon did a medial plication where he divided the medial retinaculum as it inserts into the patella.  Then he reattached it more medially onto the patella itself in a pants over vest fashion.  At the same time, he did a lateral retinacular release.  Apparently, all of this is done in order to carefully balance my patella in the trochlear groove."

But, here's what has happened since.

"..... I'm still having trouble with the lateral part of the quad pulling my kneecap to the left.  Also, the x-rays show that the patella is tilted and not sitting neatly in the groove as it was right after surgery.  Repeat x-rays show that the patella has remained the same and is not any worse but it is certainly not in the groove.  My orthopedist says that it could take up to a year for everything to stabilize with the patella, IF it does.  I knew going in that the surgery may not work and that the VMO is a very hard muscle to rehab.  Also, it seems that my muscle wants to stretch easily.  In other words, the surgeon tightened the VMO because the initial injury and subsequent healing had resulted in extensive stretching of the muscle to the point that if any stress were put on my knee it would give way and I would fall.  It looks as though it is probably stretching again....

She went on to say that she has good motion in her knee and can manage going up stairs but when she tries to step down, her kneecap shifts to the outside.

Do you have any suggestions?  Would electrical stimulation help at all?  Will I ever be able to get the left quad to act anywhere near like the right quad?  Any help with this would be greatly appreciated."

First, here's my standard disclaimer. It's a lot easier to see, feel, and watch what a person is complaining about than it is to decipher over email. Video helps. Telephone helps. But, I'm an Intuitive so ideas just sort of appear in my head in the moment from the interaction. And I don't know your entire story, the surgeon, your therapist nor you. But you asked for suggestions and after reading your email I thought of a few things. So, here we go.

The issue, as you pointed out, is your VMO is likely too loose or long as well as weak. So, repeatedly bending and straightening the knee is probably not a great idea right now. And it's not just your muscle you have to be concerned about but the fascial connections within it and to the patella. All of that tissue has to tighten up. And you have to get your muscle to work again.

But I think first you need joint stability. Here are the ideas I had to address the instability.

• Prolotherapy followed by immobilzation. Prolotherapy is a series of injections that uses a mixture of saline and dextrose (sugar water) to jump start a healing response in the tissues. The prolotherapy will help the fascia, ligaments and muscle heal and tighten up and if this is done with the knee then held in extension in a brace, it may provide enough tightening to counter the lateral pull of the outside muscles. Usually after a surgical procedure like you had, your knee would be immobilized in full extension for a month and then in a hinged, locking brace at specific angles for another month and then rehab might start. Here's a reference on that (click here). I don't know if this happened or not but it might not be too late to start over. 
• Slowly increase the range of motion after a month of immobilization. The down side to the immobilization is a loss of muscle strength, which will be considerable, and motion. Everything will feel stiff and getting it back will be slow.
• If you don't want to go that route or think it's too radical, then you might get some benefit from a brace - not the kind you tried before - but one that helps control rotation of the femur. Click here for a description. We all tend to think of the patella sliding out but that's if you look at it from the femur being fixed. And you describe the problem when you step down which involves femoral rotation. So, it's possible that some of the slipping of the patella is from too much inward rotation of the femur underneath it. The brace might help keep the femur from rotating too much.
• You didn't mention if you had tried taping techniques. There's some controversy over  whether taping the patella actually moves it. If it does, it does so a small amount (about 1 millimeter*). But, it might be enough to alter the timing of the other musculature and provide you with some feedback. You can also use tape to act as a sort of external fascial support system. I've done this with a few clients who sustained fascial tears of the hamstring and it worked quite well. And, along those lines, a special type of compression garment also works fairly well for this too (click here for examples).
• And speaking of feedback....biofeedback might be worth trying to help you get the VMO going again. You can't isolate the VMO really from the other muscles of the quadriceps since it shares the same nerve supply but biofeedback can help you achieve maximal contraction.
• You asked about electrical stimulation. Normally, it's not too helpful but I think in your case, especially if you choose #1, having a unit on to keep your muscle firing makes sense. And, here's a case report (click here for it) of it being used on a patient with a chronically dislocating patella. But, it was several hours per day. So, you would have to buy or rent the unit. And, I think an even better application, is to get a heel switch placed in your shoe that would trigger the electrical stimulation. So, when you heel hits the ground, the unit would fire (of course, going down stairs would be a bit awkward).
• You'll have to work really hard at being patient. I know. You've already had a long haul. But whatever you choose to do, the road will likely be long and bumpy. So, keep some short term goals in sight and find a story in my book that lifts you up. That's why I wrote it.
• You asked if your left quad will ever be anywhere near your right (strength, size, etc). Well, the human body is amazingly adaptive and capable so that's on your side. But, your recovery of strength will depend on how well you can stabilize the patella-femoral joint. And the size of your muscle comes from training - months of it. Most people have a slightly smaller leg (in terms of circumference) after surgery. So, there's a chance that you could regain a lot of strength but be left with some degree of difference in size.

I hope these things will be helpful to you. I know that some of my suggestions may be one or two standard deviations away from the typical. But, you have an atypical problem.

* Herrington, L. (2006). "The effect of corrective taping of the patella on patella position as defined by MRI." Res Sports Med 14(3): 215-23.

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Follow my recovery from a meniscus tear here. 

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Delivery Error on Last Post (in other words, you didn't get it)

There was a goof on my last post.

Don't you just love the passive voice? You can hide all kinds of stuff in it.

Well, it was my goof. Forgot to hit the PUBLISH button.

Click here for the last one. It's a cliff hanger.

Update on Knee Recovery: Prolocoaster

After the last injection, June 18, 2010,  I felt like i had the flu and my knee hurt - ached, throbbed, couldn't straighten it. I went home, had something to eat, and promptly fell asleep for about two hours. When I woke up, the flu like symptoms were a bit better but my knee felt like someone had scraped the inside of it, rubbed it with a little alcohol and then stuffed it full of cotton balls. Walking reminded me of one of those creatures in The Living Dead. This lasted through the following Sunday (June 20, 2010).

Then, all of sudden, all was well. Monday all of those symptoms just evaporated.

So, I started over on the rehab - leg sliders, quad sets, hip burners, low load elliptical, low load squats - and I was really pleased with my progress. My leg felt like a leg again instead of a hip and foot with a rusty mechanical joint stuck in between.

Walking was normal. Up and down stairs - no problems. No symptoms. Now, I know at this point that just because I don't have symptoms, that I have the green flag on any and all activity. I just stuck to the plan.

All was well until Thursday, June 24, 2010. I woke up with right knee pain. It's like I have two right knees. One - fluid, stable, symptom-free - and Two - tight, swollen, painful, touchy and angry. And they fight it out over who gets residence in my life.

You might be wondering, "What happened?"

And so am I.

Really.

I have no clue other than the dreaded Prolocoaster. For those of you just reading this, the Prolocoaster is the up and down, around and around fluctuation of symptoms that leaves you scratching your head and fighting off the Worry Monster (I talked about this back in March when I was going through prolotherapy on the right shoulder). Because the symptoms are so pronounced, it feels as if you've taken a huge step back; the whole thing has just been flushed and all is lost and you'll have to start over or have surgery or maybe never be well. THAT is the Prolocoaster.

Well, I'm riding it now, blindfolded. And here's my attitude. I'm going to keep doing my drills and as long as the symptoms don't get worse, I'll keep doing them.

And, to really make things interesting, I'm headed to Port Aransas, Texas on Monday June 28, 2010 to celebrate Ellen's birthday. Dogs and all with the a Night of Living Dead limp. That'll look good on the beach. "Mom! It's that monster guy! He's coming this way again!"

I'll let you know how it goes.

Are People Satisfied After Knee Replacement?

When former President Bill Clinton was running for the office, his campaign strategist, James Carville, told Clinton that the main issue in the campaign was not foreign policy, or trade relations. It was money. He said, "It's the economy stupid!"

When people hurt, they don't care too much about how strong their legs are, how far they can walk, or how many steps they can climb.

What they care about is not hurting. And if you have osteoarthritis of the knee and hurt long enough, badly enough, you'll likely turn to the knife as a solution. You'll opt for a knee replacement.

But here's a twist.

In a recent study, only about 75% of people were satisfied with their knee replacement.¹

And why is that do you suppose?

It's not because they lacked function. There was no correlation between functional capacity and activity of daily living and satisfaction.

It was pain.

Those who still had painful knees, were less satisfied.

But, that's partly because they expected to be pain-free from the surgery and then weren't.

Satisfaction comes from what I call "framing". Four Seasons does it. Their corporate guiding principle is to treat others how you wish to be treated. That's the frame. And they really live it. They know your name. The staff is exceptional at remembering what you liked and didn't from one visit to the next. A very tough frame to live in but somehow they do. Amazon is another good example of great framing. I order something and they send me an email that explains that I should get the item in 3-5 business days. Ok, so that's the frame. The next day, it's on my door step. I'm blown away.

The most important predictor of post-operative success is pre-operative framing.

If I tell you that the operation is simple, you'll be up and going in a few days and your knee will feel great and you can get back to doing the things you like to do, if I set that frame, and then your motion comes back like a snail scaling a mountain, you hurt for nine months, walk with a cane, and are generally grumpy, I think you'll agree we have a problem and a poor frame and you're dissatisfied.

But here's the problem with framing. It takes time and skill. It's called "bedside manner" by some. If the surgeon or his assistant is all doom and gloom, you may not opt for surgery. So, there's a bit of an art to helping people understand the range of possibilities. And once the frame is set, and it will be set one way or another either consciously or not, it's almost impossible to re-frame the deal.

Pre-operatively, people have high expectations of both pain relief and levels of function (like golfing, dancing, hiking). In fact, 41% believed that after surgery, they would have little to no pain and be able to dance or play golf or go for a hike. But, five years later, only 14% were able to do those things.²

But, pain relief following a knee replacement can take over a year to achieve. I wonder how many patients get that information and of those who do, actually get it. I mean really hear it. I suspect what most people think is that,"Gee, I get this thing replaced, and I'm good to go!"

Maybe.

The other thing that needs to be discussed is the expectation of higher functional levels. Yes, if your knee hurts less, you might be able to be more physical, but remember that your knee is not like the alternator in your car. It's a biological thing. You can hurt from surrounding muscles, tendons, fascia. Your muscles can hurt and for sure are weak after surgery. You have to re-train your body to be able to perform at a higher level. You need strength, balance, power, flexibility, and agility.

Sometimes you have to have a joint replacement (but there's some very interesting work going on with PRP and osteoarthritis). But if you do, make sure that you understand the frame or you may end up dissatisfied.

PS - here's the latest on my knee recovery.

1. Vissers, M., I. de Groot, et al. (2010). "Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty." BMC Musculoskeletal Disorders 11(1): 121

2. Nilsdotter, A. K., S. Toksvig-Larsen, et al. (2009). "Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up." Acta Orthop 80(1): 55-61.

Update on Knee Injury / Recovery - or Meet My Tailor Empathy

Yep.

The process of recovery, restoration, and re-training for my right knee has officially begun - again.

To get the latest on my knee, click here.

Otherwise, feel free to delete.

In this age (does that make me sound terribly old?), I have a hard time figuring out what's news, too much news, personal, and too personal. I have a Facebook account. I don't know why. I have nothing to add really. Zip. But, there might be something to learn from my experience with my knee that could help you, teach me, and occasionally we both might get a good laugh. But, if you think this is bunch of junk, no hard feelings.

Just tryin' on some new clothes made by my tailor, Empathy, and sharin' how things are fittin' together.

The End of Prolotherapy

Day #58  Post-Prolo
Friday, May 14, 2010

"Oh, my God! Kelsey! Is that your bad shoulder!" exclaimed Heidi.

Heidi had walked by the open door of the consult room where Christine was testing my shoulder and caught a glimpse of the action so she stopped.

And apparently stared.

Christine was using a hand held digital muscle tester to test how much force I could produce for certain motions of the shoulder: flexion, abduction, external rotation, internal rotation, and then one that stresses the supraspinatus muscle.

I pushed as hard as I could against the resistance supplied by Christine. I think it must have been at this point that Heidi walked by the door. My face was probably scrunched up like a true strong man.

I met or exceeded four out of six goals and was 90% of the remaining two. Nothing hurt. The shoulder felt strong. Solid.

The next day, today, I had a follow up visit with Dr. Fullerton.

I explained the results of the test but that I still had some pain with a certain motion. And that if I treated the infraspinatus trigger point, that motion became pain free.

He suggested that an injection of the trigger points might be all I needed right now.

I was all for that. Another series of prolo shots means another six weeks of rehab and I don't mind that if that's what I need but if not, I'm ready to move on to the next round of training.

I sort of wish I hadn't agreed to the trigger point injections. When the needle hits the point, the muscle grabs it like it an intruder and it doesn't want to let go. Hurt? Uh, yeah. Sure does. The upside is that I can move my arm better. And that the discomfort passes quickly.

So, it looks like the end of prolotherapy.

At least for my shoulder. And I'm thrilled with my outcome and where I am right now.

I have another ultrasound in about six weeks to look at the tendon but I seriously doubt I'll need any more prolo.

As I was leaving, Dr. Fullerton asked,"So, I'm seeing you next week for your knee? What's up?"

"I think I tore the medial mensicus. Pretty sure I did. Showing a client a drill. Got caught in an odd position getting up. A couple of clunks and thuds and a few days later it was hard to walk." I showed where the symptoms typically show up.

"Yeah, sounds like a degenerative tear. We'll look at it then," he replied.

Good news is I can concentrate on the knee injury and close the chapter on the shoulder.

I stopped the Low Intensity Pulsed Ultrasound on my knee after about a month. Not sure if it helped or not since I was also doing several other things but overall my knee feels better. I have some low grade symptoms from time to time but I can't fully flex it, it doesn't feel stable, and I know I can't load it much without provoking some symptoms (tightness, cramping, pain). And if I try something like a Child's Pose, I have a sharp pain on the medial part of my knee right where the meniscus is located. Classic symptoms of a tear.

I know that surgery is a possibility and if I need to go that route, I will. But, I still have some other non-surgical options and as long as I don't continue to aggravate it, I'll be ok.

In the meantime, a typical rehab day is:

• 15-20 minutes of low load bilateral squats (I use a Total Gym).
• 20-30 minutes of tailgaters or leg sliders.
• 100 quad sets.
• 45 minutes of resistance intervals on an elliptical machine. Resistance intervals are two things: one is the machine has a program that automatically adjusts the resistance every few minutes. The other is that I carry a 15 lb dumb bell in one hand for five minutes then the other hand for five minutes. I then wait five minutes and repeat the process.

I'll do this three or four days per week. I missed most of last week since it was birthday week and my brother was in town.

I see Dr. Fullerton on Friday, May 21st. I'll let you know what happens. Tear? Where? How big? Prolo? PRP? Surgery?

Lots of questions. No answers yet.

Just have to get comfortable with the unknown and the transitional nature of life. You never really know what will happen so for now, stay in the present.

DK