My knee dilemma

[The Jake]

Ok, I do BJJ (when I'm not injured) and I've been dealing with knee problems.

I've now seen a physio, podiatrist, two orthopedic surgeons and had an MRI done. So trust me when I say I've left no stone unturned.

Basically two issues:
1) I've suffered a torn lateral ligament in the past and now also have an 'altered' ACL. One specialist says arthocope, possible ACL reco. The other says no arthoscope necessary and no ACL reco so long as the leg does not give out (which it doesn't). Great huh?

2) I've suffered extreme swelling in the one knee and swelling/pain under the both knee caps (not tender to the touch funnily enough) - resultant from the kneecaps constantly rubbing the cushioning behind them to a point they are irritated. Makes kneeling painful, deep bends and triggers the patella catching on the tendon in one knee, causing extreme tendonitis under heavy activity. I was given physio activities to try and recondition the knee's tracking but they was unsuccessful and also with the irritation from BJJ, aggravated it further (knee getting pressure and movement from all the rolling).

So far here's whats been said.

My first specialist didn't look at the irritation, only ligament issue (which is partly why I got the second opinion). My second specialist (recommended by my BJJ instructor and has worked on several guys) today told me I need an "indefinite amount of time off from the sport". Meaning, I take off as much time as needed for the irritation to settle. However there is no certainty that the issue won't come back should I return to the activity. Its been suggested I get glucosamine and fish oil for a good few months and see if that shows any sign of improvement. I've also been told theres no surgical fix for the irritation. There are options (like steroids) but that should be considered later on down the line. Even with all these options however, resuming the sport may cause the inflammation to reoccur. This has been suggested/corroborated by the physio as well and this is after I've already tried taping the knee and doing exercises to recondition the tracking of the knee without success.

I can live with an ACL reco if thats whats recquired.

What gets me is this patella irritation. I can't believe that I'm the only person that does BJJ that has this problem. I can't be the only one that gets this and tendonitis so bad you can't bend the leg or get extreme swelling. How do you guys deal with it? Do you just take the time off? Do you come back and keep taking time off? I can't deal with a sport I spent 3 months on mat and 6-12 months off due to biomechanic bullshit. If that's the case, I'm gonna quit now.

If there's anyone out there with this problem I'd be very interested in knowing how you dealt with this problem. Because after spending this much on hearing the opinion of specialists I am fresh out of ideas.

Thanks,

- J.

PS: Current plan is take ~3 months off. Get glucosamine, fish oil, do some other light activity and assess whether that reduces the swelling/inflammation and whether I do need an ACL reco. Whether I go back to BJJ is largely incidental at this point. I'm more just curious if people actually doing BJJ have this problem.

 

[idiotboxer]

hey buddy..

ok - my situation was similar - just after i started training i experienced swelling in my right knee... anti inflammatories brought the swelling down (was really really swollen)... but my flexion (the distance to which i can bring my heel to my ass) was reduced by a few inches..

i left it for about 6 mths, it got swollen on/off in that period, but nothing severe - it had affected me for a while with the kneeling down, and i still can't sit on my heels (ie in guard...but that's a good thing)... anyway, at some point i must have hurt it and i went to one orthopedic surgeon with some MRI scans i had done which showed just slight meniscus tears behind the knee...ie below the hammies.

First guy was surgury happy, recommended arthroscopy + 6 -8 weeks recovery... which to me is unthinkable, too long w/o training and i go insane.

Second guy said there's no way i need surgury... as long as it's NOT clicking out (which would indicate cartelege[sp!] damage) then there's no need for it. I asked him about martial arts, to which he told me that i should keep doing whatever i want, if i experience any more irritation to the point that it's bothering me - ONLY THEN consider surgury.

My situation is slightly different to yours - but it does come down to the following:

if the tear in your meniscus (if you even have a tear, im not sure??) is significant, then consider surgury - if it's not severe, which in my case it wasn't - then keep doing what you do ,but be careful.

That said - after all that surgery talk, i took it easy and eventually invested in like knee protectors - like elasticy type of sheild things that you slide over your knee - i wear them all the time, and no longer experience pain when i grapple (in the knees that is.. )

To me, it sounds like you should invest in these, and then see what happens - if you have no cartelidge floating around and locking your knee out, then surgury isn't a necessary option right now - but if you're not careful abotu your training, you might be looking at it down the line.

I'm not sure about this patella talk ... as in, im not certain of what you're describing - i have something that might be similar, in that if i lie down and bring my ankle to my butt all the way till max. flexion and then release, i can hear like a crunching sound (i was told btw, that this has got NOTHING to do with my torn meniscus and it's totally harmless)).... is this what you're experiencing?

cheers, (and good luck)

 

[The Jake]

hey buddy..

ok - my situation was similar - just after i started training i experienced swelling in my right knee... anti inflammatories brought the swelling down (was really really swollen)... but my flexion (the distance to which i can bring my heel to my ass) was reduced by a few inches..

i left it for about 6 mths, it got swollen on/off in that period, but nothing severe - it had affected me for a while with the kneeling down, and i still can't sit on my heels (ie in guard...but that's a good thing)... anyway, at some point i must have hurt it and i went to one orthopedic surgeon with some MRI scans i had done which showed just slight meniscus tears behind the knee...ie below the hammies.

First guy was surgury happy, recommended arthroscopy + 6 -8 weeks recovery... which to me is unthinkable, too long w/o training and i go insane.

Second guy said there's no way i need surgury... as long as it's NOT clicking out (which would indicate cartelege[sp!] damage) then there's no need for it. I asked him about martial arts, to which he told me that i should keep doing whatever i want, if i experience any more irritation to the point that it's bothering me - ONLY THEN consider surgury.

My situation is slightly different to yours - but it does come down to the following:

if the tear in your meniscus (if you even have a tear, im not sure??) is significant, then consider surgury - if it's not severe, which in my case it wasn't - then keep doing what you do ,but be careful.

1) My MRI conclusively shown no meniscal tearing.
2) I suspect it might be bone cartilage causing the clicking (patella maltracking). That sort of cartilage won't show in an MRI and can be treated by glucosamine and fish oil, suspension of painful activity.
3) I'm thinking of giving it a few months like you said... will see about the surgery. I know the ACL isn't the best but as long as I can still do everything, I don't want to operate if it can be avoided.

That said - after all that surgery talk, i took it easy and eventually invested in like knee protectors - like elasticy type of sheild things that you slide over your knee - i wear them all the time, and no longer experience pain when i grapple (in the knees that is.. )

Already worn them since my tear last year. Made a big difference but I was told that wearing them does not prevent pressure on the knees, or maltracking. It just reduces the direct pressure somewhat.

To me, it sounds like you should invest in these, and then see what happens - if you have no cartelidge floating around and locking your knee out, then surgury isn't a necessary option right now - but if you're not careful abotu your training, you might be looking at it down the line.

Already done. I'm considering surgery but I don't think its necessary yet. I'm already staring down the barrel of 3-6 off regardless after the patchy 6 months I've already had. Facing surgery, more time out, etc, after all the crap I've already been through, really, if it means I can get 10 years of training out of it without these sorts of headaches, I'm all for it. Taking more time out isn't much of a concern anymore when I'm more concerned over whether I'll have permanent injuries that prevent any training. Better to get it done at this age then later.

I'm not sure about this patella talk ... as in, im not certain of what you're describing - i have something that might be similar, in that if i lie down and bring my ankle to my butt all the way till max. flexion and then release, i can hear like a crunching sound (i was told btw, that this has got NOTHING to do with my torn meniscus and it's totally harmless)).... is this what you're experiencing?

cheers, (and good luck)

Not the same position but I was told something very similar by my podiatrist... he said that if the clicking didn't hurt, would I undergo surgery? I said no. He said then I'd say its not worthwhile. He was the one that suggested I take glucosamine for a few months and rest and then see if there's any improvement over the next few months.

What you're saying makes a lot of sense and seems to corroborate what I've already done/doing. Just seems I'm unlucky I guess.

cheers,

- J.

 

[idiotboxer]

Well, if you're experiencing serious discomfort when you grapple... anything that can't be ignored, then it's something you might just have to do.

Get inspired though, you have a great attitude it seems - Read some of John Will's blogs.. he talks about getting knee reco's done and being back on the mat within a few weeks (but he's exceptionally driven and was in top condition before/during/after his op's). I read things like, he would have the operation and then go fishing while standing on in the shallow waters where it was all pebbles. He would have to use his knees to balance himself and it would really help strengthen his newly operated joints..

stuff like that - just remind yourself that no one is safe from this stuff, and start looking to things to train during your downtime - maybe work your hands and as much "knee-safe" standup stuff?

best of luck man,

 

[azjudoboxer**]

This is my professional opinion, both as an exercise physiologist, certified physical therapy assistant, and a grappler who's had knee problems. Go with the Glucosamine, time off, AND Physical Therapy. I had a knee injury several years ago, from an unknown incident (meaning i can't pinpoint how it happened), it got so bad, that I had trouble walking up and down stairs. I had 10 weeks of physical therapy 3 times a week, along with glucosamine, and after ten weeks i was back to squatting my normal 315.

 

[The Jake]

Well, if you're experiencing serious discomfort when you grapple... anything that can't be ignored, then it's something you might just have to do.

Get inspired though, you have a great attitude it seems - Read some of John Will's blogs.. he talks about getting knee reco's done and being back on the mat within a few weeks (but he's exceptionally driven and was in top condition before/during/after his op's). I read things like, he would have the operation and then go fishing while standing on in the shallow waters where it was all pebbles. He would have to use his knees to balance himself and it would really help strengthen his newly operated joints..

stuff like that - just remind yourself that no one is safe from this stuff, and start looking to things to train during your downtime - maybe work your hands and as much "knee-safe" standup stuff?

best of luck man,

John Will is my gf's instructor Was thinking of giving him a buzz actually. Will talk to my instructor first though.

- J.

 

[The Jake]

This is my professional opinion, both as an exercise physiologist, certified physical therapy assistant, and a grappler who's had knee problems. Go with the Glucosamine, time off, AND Physical Therapy. I had a knee injury several years ago, from an unknown incident (meaning i can't pinpoint how it happened), it got so bad, that I had trouble walking up and down stairs. I had 10 weeks of physical therapy 3 times a week, along with glucosamine, and after ten weeks i was back to squatting my normal 315.

Right now I got my time off in Brazil. Was supposed to be a training trip.. oh well, that'll be my last trip ever I label a "training trip". Too much can go wrong (and usually does with me).I'll give it four weeks, glucosamine, etc. Might talk to some of the grapplers and therapists out there... see what their advice is. Basically I'll ride it out and see. There's no way I can get back on the mat though in any hurry.

I might check in with my physio when I get back. He's getting the reports back from my two specialists.

- J.

 

[azjudoboxer**]

A good therapist can stablize just about anything shy of severe injuries. From the symptoms you describe it sounds like you strained several ligaments, which is something a PT can totally fix.

 

[Max Shane]

Second guy said there's no way i need surgury... as long as it's NOT clicking out (which would indicate cartelege[sp!] damage) then there's no need for it.

What do you mean clicking out? Lately I've been having some mild knee irritation, but it's been getting much better within the weeks. However whenever I train standup or even on the ground my knee is constanty clicking and sometimes gets a little unstable after hard sparring for a short period of time (this is very mild and I don't even notice it much when I get out of the gym).

 

[azjudoboxer**]

Clicking in an of itself doesn't mean something's wrong with your knee. Unless you have pain associated with it, don't worry

 

[Max Shane]

Yeah, no pain with the clicking, but I can just feel everything like grind. Eh, I'll keep going for a few weeks and if it's still an issue I may get it checked up.

 

[Bubble Boy]

Jake, I've had painful knees for several years now.
Rest and rehab has worked for me. You may have to be one of these guys (like myself) who takes a couple months off a year. In the big picture that's NOTHING. But the recovery will probably do you wonders.

Also, the brain needs time to process stuff too. Sometimes taking time off allows your mind / body connection to become stronger.

Rest is not bad. Take the time you need and then get back at it. If you find yourself hurting again in 8 or 9 months, take a month or two off.

Dude, it freakin' kills me too. But take the time.

 

[idiotboxer]

What do you mean clicking out? Lately I've been having some mild knee irritation, but it's been getting much better within the weeks. However whenever I train standup or even on the ground my knee is constanty clicking and sometimes gets a little unstable after hard sparring for a short period of time (this is very mild and I don't even notice it much when I get out of the gym).

hey

sorry i probably wasn't too clear about this clicking out thing..

what i've heard it been called is 'locking out'... where your knee physically gets locked out from a floating object getting trapped inside the hinge-like action that the knee joint essentially does. When it happens it is apparently agonising..

my scans showed a loose object floating inside my knee, but no locking out... so my non-surgury happy doctor concluded that it may have been a mistake on the scans part, or a misdiagnosis by the MRI analyst who gave a report with my scans - and he concluded that it's because i never have experienced this locking out (in a period of about a year), that it's not actually a loose object.

so i don't think you have it - from the sounds of it.

hehe, cheers

 

[NateH706]

The best that I can add to this thread, since my problems were similar to yours, is make sure if you look into surgery that you find out EVERYTHING about the doctor you want to do the surgery.

I had a freak knee injury in October. Met an orthopedist, thought it was a torn meniscus, and went into surgery. Came out with a supposedly torn ACL as the problem. My knee kept giving out, so i went straight to reconstruction (only 22) but the first doctor was a dickhead so I went to a different doctor (former Dr. and surgeon of the Buffalo Sabers) for the Reco.

Took the spring semester off from school to get the surgery done. Go into surgery, come out less than an hour later, and find out that, as my 2nd doctor said ' there's no way in the world to physically make my ACL stronger than it currently is, if it was ever in fact torn'. What ended up being the problem from the freak injury, and was completely (and idiotically) missed during the first surgery, was a piece of bone (looked like a frisbee) that was just shy of being one inch round and half a centimeter thick, that's been bouncing around inside my knee hitting my ligaments like a pinball.

So 6 months later, 2 surgeries later, and setting back my degree by a year (due to missing a class in a sequence), my knee is fine, and all that was wrong was a piece of bone floating around in my knee that the first doctor didn't bother to look for.

My advice: Always check out your doctor. Even if you hvae to be an ass to them, ask if they've done the surgery, if they think ti's the appropriate way to go, how long he's been doing that type of surgery, if that part of yoru body is a specialty of his, etc.

I didn't find out until after my first surgery that my original doctor avoided Reco's and surgery options 90% of the time and always advised just to do physical therapy. Hence why he was such a mediocre surgeon.

 

[dmob]

Never had knee problems before. I hope you can recover 100%. Giving up a sport cuz of injury sucks.

 

[LeonardShelby]

I had maltracking of the kneecap and have spent many hours researching the subject.

So in my non professional opinion...

Your main concern should be to prevent cartilage damage. Cartilage does not heal well. Even some wear in a small area may never heal, and even worse, it can keep deteriorating. The area will keep growing around the initial damage location, and in a worst case scenario the whole knee becomes arthritic. The pressure in on the cartilage begind the kneecap needs to be evenly distributed. Too little pressure is bad and so is too much pressure.

With maltracking the pressure is not evenly distributed. The cartilage starts deteriorating and you may hear or feel crepitus. Like a grinding noise. If you treat it early you may prevent irreperable damage.

I did 2 months of physical therapy. But then I left and started doing similar exercises on my own. It took me about 3 more months to correct the problem.

Different therapists had different opitions. So I just did almost all of them.

--Stretching:
ALl kinds of stretches for quads, hamstrings, calves and ITB (illiotibial band)
For ITB band examples: http://www.nismat.org/ptcor/itb_stretch/
and also I rolled the outer part of the leg on a medicine ball. Some therapists said this was the only effective way of stretching the ITB (with the slightly painful pressure of a roll) but I thought the medicine ball was even better.

--Strengthening:

quads especially the inner quads. People with maltracking very commonly have inadequate activation or strength of the inner quads (vastus medialis) I did anything that would feel a burn at the inner quads. Started with straight leg raises then leg press shallow and at the end with deeper knee bending.

Abductors and adductors with cable or other machines.

Hamstrings cables or reverse leg curl.

Additionaly I practiced being able to do any of the movements slowly without any shaking. (motor control)

Propioception ( stand on one foot and close your eyes) touch stuff around you with your hands while still keeping your balance. All types of balance exercises. Stand on an air disc etc.

A study showed that patella taping just helps because it aids propioception not because it can actually hold anything in place. And many believe thats why most knee sleeves help too. IN my case the best by far was the "Cho-Pat Dual Action Knee Strap ". This actually does help tracking by putting pressure on the patellar tendon.


So exercise and stretching and a the chopat (if it works for you) or knee sleeve would be all I would try, before you have the legs of a cyclist and the balance, control and flexibility of a gymnast. Most of these problems have a root cause which is neuro-muscular or related to flexibility. I would definetly suspend grappling and constantly adjust the exercises at an intensity that will now cause considerable pain.


And never let them use any steroids its gives short term relieve but damages the cartilage.

If there is actually damage the only real good treatment is with a product called carticel which works only in specific cases to make cartilage grow back in a small lesion. (and cost like 30k)

 

[Rip Van Winkle]

i have a bastardized toe and a bum shoulder right now...but for some weird reason, i feel bad if i take more then 2-3 days in a row off from rolling. I should take a few weeks off just to let the shoulder heal but i'm stupid.

 

[jyd233]

hey buddy..

ok - my situation was similar - just after i started training i experienced swelling in my right knee... anti inflammatories brought the swelling down (was really really swollen)... but my flexion (the distance to which i can bring my heel to my ass) was reduced by a few inches..

i left it for about 6 mths, it got swollen on/off in that period, but nothing severe - it had affected me for a while with the kneeling down, and i still can't sit on my heels (ie in guard...but that's a good thing)... anyway, at some point i must have hurt it and i went to one orthopedic surgeon with some MRI scans i had done which showed just slight meniscus tears behind the knee...ie below the hammies.

First guy was surgury happy, recommended arthroscopy + 6 -8 weeks recovery... which to me is unthinkable, too long w/o training and i go insane.

Second guy said there's no way i need surgury... as long as it's NOT clicking out (which would indicate cartelege[sp!] damage) then there's no need for it. I asked him about martial arts, to which he told me that i should keep doing whatever i want, if i experience any more irritation to the point that it's bothering me - ONLY THEN consider surgury.

My situation is slightly different to yours - but it does come down to the following:

if the tear in your meniscus (if you even have a tear, im not sure??) is significant, then consider surgury - if it's not severe, which in my case it wasn't - then keep doing what you do ,but be careful.

That said - after all that surgery talk, i took it easy and eventually invested in like knee protectors - like elasticy type of sheild things that you slide over your knee - i wear them all the time, and no longer experience pain when i grapple (in the knees that is.. )

To me, it sounds like you should invest in these, and then see what happens - if you have no cartelidge floating around and locking your knee out, then surgury isn't a necessary option right now - but if you're not careful abotu your training, you might be looking at it down the line.

I'm not sure about this patella talk ... as in, im not certain of what you're describing - i have something that might be similar, in that if i lie down and bring my ankle to my butt all the way till max. flexion and then release, i can hear like a crunching sound (i was told btw, that this has got NOTHING to do with my torn meniscus and it's totally harmless)).... is this what you're experiencing?

cheers, (and good luck)

i have something ALMOST EXACTLY like that. i landed on it hard one day and it got water on it for like a week, hasnt been the same since. orthopedist said no xrays necessary since it was still healing up and it was a direct, straight on hit, so there should be no tear. but i cant touch my heel to my butt as if in guard. and kneeling hurts. btw i thought u were supposed to sit as low as possible? (im still sort of a noob) any advice boxer? on knee or guard posture

 

[The Jake]

Bump.

The more advice the better.

Thanks so far for the posts btw.

- J.

 

[idiotboxer]

i have something ALMOST EXACTLY like that. i landed on it hard one day and it got water on it for like a week, hasnt been the same since. orthopedist said no xrays necessary since it was still healing up and it was a direct, straight on hit, so there should be no tear. but i cant touch my heel to my butt as if in guard. and kneeling hurts. btw i thought u were supposed to sit as low as possible? (im still sort of a noob) any advice boxer? on knee or guard posture

hey

believe me im new as well!! (and i suck!)

BUT.. from watching some JJ machado stuff about being in guard - sitting right back, like literally on your heels compromises your base/balance.

According to him, you should be off your heels, good posture and 'sprung'... ie, ready for action... not too far back, not too far forward.... sprung.... good posture.

if you're on your heals i would imagine a situp rollover sweep is there for the taking (just off the top of my head)..

cheers,