Meh, Knees. They're fine, why worry?

[Nuts]

*Pic warning for the squeamish*

Iv'e had knee trouble since my early 30's, I'd done several years of heavy pack carrying and several years of daily road/trail running by the time I first noticed the creaking & grinding. Since then purposely avoided the heavier packs, had physio, done specific exercises, stopped running.. Maybe those steps helped a little, perhaps a lot..?

More recently, at least 10yrs on, it had started to become a real problem, painful & unstable.. causing a few tumbles.. i'd seen various surgeons, it was time to let them have a look inside..

Here's my knee :

Screen Shot 2013-06-27 at 7.35.12 PM.png (435.9 KiB) Viewed 11678 times

Kneecap at the top, head of the femur below..
It's been cleaned up/ was a mess.. there were multiple problems but these pics show one common problem- grissle (in the surgeons terms lol) Broken down and loose like 'floor tiles'.

In some places there is no protective cartilage left... part of my kneecap is apparently floating around somewhere up around mid thigh... There is no effective way to 'fix' it... take a graft, grow some bone, graft in place- 50/50 for results and longevity. Anyhow- cleaned up has stopped the grind

The point is i guess.. this damage didn't take overly long to happen, even though it's taken them a while to get 'too' bad.. my advice is to take that grinding... anything that doesn't feel right as a warning. Much better still- avoid getting to that stage, there's no easy 'fix'.

From other peoples accounts and my experiences i really think now that even carrying maybe 20% of body weight, especially on hills is just too much.. I'd imagine people 20% overweight with no pack would have similar problems while still relatively young. I'm not convinced of the wisdom of heavy boots- save ankles to spite knees.. also not sure whether it is better to carry heavier weight 'less'- didn't seem to help.. My thoughts are that keeping muscle bulk, as in- carrying heavy packs several days a week most weeks of a year might be the only way to stay injury free longer (if you really need to carry them at all).


here's the before shot

Screen Shot 2013-06-27 at 7.34.17 PM.png (572.09 KiB) Viewed 11678 times

[biggbird]

There definitely is a way to fix it Nuts... Just buy a new one!

[Nuts]

Haha, no thanks.. last resort imo- it's taken me 10yrs to build to an arthroscopy

[randal]

Can empathise completely Nuts. We share a very similar history and consequences. Years of ill considered abuse on my part have led to meniscal tears and crushing with multiple arthroscopic scrapes to the point now where little cartilage remains, esp. my left knee which has become loose and unstable with the absolute excruciation of crepitus 30 - 50 times a day. The joys of ageing and the development of osteoarthritis, wonderful. Re a knee replacement, the "Orthopod" said don't come back to see me until you can't walk without painkillers and anti-inflamatories", but he did give me a referral to an Orthotist who fitted my knee with an ugly, hot, and decidedly inconvenient brace which has made a significant difference. I wear it daily and especially bushwalking as it holds the knee in alignment, rotating me off the lateral chondial to where more meniscus protects the rest of the joint. I don't mean to bore you with my problems but I have discovered a possible alternative to a knee replacement. A colleague has a brother in Sydney currently undergoing a trial of a procedure whereby stem cells were removed from his gut and injected into his knee joint in order to grow new cartilage. apparently its working! Nuts,if we can hang out for a few more years there might actually be a fix.
Cheers,
Randal.

[wayno]

theres debate over cartilage, some say it can be regenerated
adequate amounts of fish oil/ plant omega three oil to a lesser extent keeps the joint fluid healthy,and boosts cirulation of nutrients to the cartilage which has poor circulation

some talk about supplements like condroitin glucosamine which are building blocks of cartilage,,, vitamin c and zinc keep it strong.
most of my early tramping was up and down steep mountain sides on knee twisting tracks, your knees would really know about it at the end of the day, plus boots that had zero cushioning in them, no insoles
plus i was running up and down hills a lot during the week on concrete

I had to have part of my cartilage removed as a teen, and i've got issues now about catching in the joint, i expect i'll need further surgery in the future.

considering the issues i had in my teens, my knees are holding up pretty well so far three decades later,, i take fish oil or eat oily fish and eat high vitamin c food every day plus take extra vitamin c supplements on days i'm walking a lot, eat a pretty good diet hopefully keeping my circulation in good working order that might be helping and avoiding thrashing my knees too much...

[matagi]

There are conflicting opinions in the medical literature regarding the utility of glucosamine/fish oils/etc. That said, there is a lot of anecdotal evidence around of its benefits and I take it (early arthritis in hands). Not sure if it helps but it certainly doesn't seem to harm.

[wayno]

depends, you also need good circulation,,, joints are pretty susceptible be being affected by poor circulation, if you are clogging your circulatory system with too much fat in your diet, your joints will suffer and supplements will have limited if any use.....

[Nuts]

That sounds pretty bad randal, I have one spot that catches. When it did it the first time the only place i could put any weight on that leg was the inside of the big toe (just enough to hop). To have that happening every day I could only imagine being a horrible situation. I do have a custom brace, couldn't live with it out in the bush but guess i would if I had too. Stem cell research you say? Yes, bring that on, cutting knees off is pretty crude.

This info/ these sort of discussions probably wont interest many, perhaps until they need it. Didn't have to look far for people who have had similar issues and surgery. i worked in a hospital for a while and people with splayed knees, weeks in a ward with various infections. At least arthroscopy has come a long way. It was all a bit daunting until talking to others. Someone always seems to have it worse

Fish oil. I did take it for a few bottles, probably should have kept it up. Probably should have kept a daily exercise routine as well.. these injuries seem to conspire with the rest of your body to make things worse. Slow you down, stack on weight, decrease circulation .. so on.. Not something that i can imagine most people would even pass thoughts at in their 20's..

[wayno]

yeah if i'm not doing some exercise regularly the knees get worse for me, especially when i'm in a sedentary job

[stepbystep]

Some good discussion here also.

viewtopic.php?f=10&t=3828&p=43244&hilit=knees+ankles#p43244

A problem many of us are dealing with to some extent or another. My knees have an as yet undiagnosed issue, I'm managing them by having lost some weight(more needed though) adjusting the way I walk, adjusting my kit and I take a supplement called serapeptase, some info here http://www.globalhealingcenter.com/natu ... rapeptase/

Best of luck with it nuts, just want to keep walking...

[photohiker]

My knees play up if I take a break from walking for whatever reason, and it takes a few weeks for them to get back into the groove. I get lots of cracks and pops at the physio but they are not debilitating or catching so no diagnosis yet... Not taking any supplements but my bro has been taking a whack of glucosamine for years.

There was a story about stem cell treatment for knees on Today Tonight this week. Heard about it, but missed it. It's not in their archives yet, but apparently a clinic in Norwood, Adelaide is having good success with the treatment.

There was also a story on Catalyst a couple of years ago: http://www.abc.net.au/catalyst/stories/2608197.htm

[Bluegum Mic]

Ortho looks like they did a good job nuts. I've been lucky with mine that its zero cartillage injury, 100% ligamentous (complete tear of acl, lcl, mcl and avulsed the meniscofemoral). The reconstruction was very successful and I find in many regards its stronger now than before. I do have the problem that I have severe instability in the ankle (and between the tib/fib) on that same leg due to endless sporting injuries playing rep hockey so theres some early arthritis in that which will only get worse with age. My only residual problem with my knee is my patella has tracking problems due to the post surgical scar tissue from where the acl graft was taken from. Its no drama day to day however when in the gym and bushwalking I use kinesio tape which works well for me. Bit of trial and error to work out the best way to tape as its the pes anserine bursa that reacts but I found a combo of taping techniques works well and I get no pain or swelling (generally).
Hopefully your clean up serves you well for a good while. Knees are a pain...literally

[Penguin]

Some good discussion here also.

viewtopic.php?f=10&t=3828&p=43244&hilit=knees+ankles#p43244

A problem many of us are dealing with to some extent or another. My knees have an as yet undiagnosed issue, I'm managing them by having lost some weight(more needed though) adjusting the way I walk, adjusting my kit and I take a supplement called serapeptase, some info here http://www.globalhealingcenter.com/natu ... rapeptase/

Best of luck with it nuts, just want to keep walking...

Nuts, great way to get a bunch of grumpy older walkers talking. I have taken the SBS approach, lighter me and pack. Mine is inflammatory based though so different med management, preferably none

P

[Ent]

Hi Nuts

Good news on getting something done about them. To avoid knee problems choosing your parents wisely goes a long way. Body weight is an issue as more and more Australians are heading from overweight, to obese and on to morbidly obese. Running is terrible for them, especially downhill. When I suggested to my surgeon when he wanted me to lose weight and stop running he was having it both ways. I was then told run on the flat and go ahead kill yourself going up a hill but for your knees sake walk down hills. Largely worked ok then my Achilles played up so now I have a very long scar and an Achilles that finally has stopped crippling me. Probably not growing old would help!

Cheers

[bernieq]

Probably not growing old would help!

There's only one thing worse than growing old, Ent – not growing old.

[matagi]

Hey Nuts,

swimming is a good exercise since it is non-weight bearing - although I'm not sure about the availability of heated pools in Devonport to enable swimming through the winter.

[puredingo]

My knees have also had it but then so is my neck, shoulder sand ankles. I put the blame half on playing high impact sport and the other half on the intense training that went with it. Barbaric, out dated training practices wielded by some Nazi drill sergeant wannabe is starting to really take it's toll.

Having a knee operation at 15 didn't help either, at the time everybody thought it was great as the club was paying for the procedure but in reality I would pay for it for the rest of my life.

[Nuts]

I guess the initial thought was just to show what effect carrying a heavy pack, downhill on tracks can do to knees. I'm not really sure where to go with this thread or what i can add. Obviously people have similar conditions from other activities and genetics. This is just me , i have no family history of knee trouble and always kept pretty fit. Maybe iv'e had a decent run considering.. Preferable to have knees see out the lifetime though (ie the Most of it..) the part you hardly imagine in your 20's.. (or 30's or 40's for some)

Walking mostly off-track might have a different outcome... aside from boulder jumping or letting loose on the downhill exit track...
I would suggest that any sign of pain might be too late. I was probably fortunate in that we work with a range of medical types and iv'e had a lot of advice. Advice seems centre around reducing weight, easy on the downhills and yes- just keep on walking... to a point..

I do hope so.. unfortunately for me i suspect it has only just started with this clean-up.. might manage the creepy crawly walk for now. It's the stationary bike probably starting next week (i hope) i'm not big on swimming laps, maybe that too.

Anyhow..

Yes, in case any non-grumps visit- much better to avoid but arthroscopy, no big deal. At it's least it may just be a look around and a bit of sanding.
In my case, expecting a crazy pre-med, modern anesthetic was like a light switch. I awoke a couple of hours later and went home not long after that.
The procedure itself involves a nick? (or two in my case) just big enough to get the tube in.

They look like this:

Through it the surgeon sends his camera and/or tool kit and they can (obviously) do a lot of work without needing to resort to open surgery.

At least you'll know that you ain't the first.. you'll be able to join in the prematurely old grumps forum as a bonus

[Turfa]

Having my knees give out on me is something that has concerned me for years....it's kind of hard to get about without them ! So I avoid running as much as possible & have also taken to using hiking poles. I believe that poles are one of the best things you can do for your knees. If you use them correctly they can save a huge amount of stress, especially on the downhills. I don't have particularly bad knees, but even mine protest somewhat on long steep downhills (think Strongleg ridge for those in NSW) and my poles make it much easier........ I really wish I had started using them when I was younger.....

[Nuts]

Poles help a lot Turfa. I started using them when first noticing the grinding and creaking. I suspect they prolonged things getting worse for some time. I'd guess that most of that damage (in the second pic) was there for a long time. Apparently the first real pain resulted from a chunk breaking off and then bone catching on the remaining 'divet'

Until that happened I could still move pretty well, a bit slow downhill, no real acute pain though (so unfortunately it seems even wear and tear can get a lot worse- very quickly)

[Grabeach]

I also had knee problems in my late 20s, though they were from soccer. Cartlage removal was all the rage at the time, but fortunately my doc said better to give up the soccer and take up something easier. Tried serious body surfing for a while then took up bushwalking. Did half a dozen or so overnighters down the Budawangs, but figured with my light build I could get just as far in a day with less stress overall on the body. Thirteen years of that and my knee was no different to when I started. Returning to walking after a long break (kids), I don't notice my knee at all. I expect from now on lack of fitness and shoulder / neck problems will prevent me wearing out my knees!

I guess our bodies have design limits on loads and cycles. While prehistoric man spent more time running around, life expectancy was much shorter. Any movement under load done sufficient times will eventually wear things out. Soccer players, serious swimmers and unfortunately bushwalkers are not excempt. I was probably 'lucky' that for one reason or another my load times cycles is probably a lot lower than many. This of course is at the expense of not having seen many places I would have liked. Life is a compromise.

[Drew]

I'd say that as far as sports/outdoor activities go, bushwalking is fairly mild in terms of joint impact, provided you don't carry ridiculous packs or have slips that cause traumatic injuries.

I tore the ACL in my left knee playing indoor soccer when I was 25 or 26. I had an ACL reconstruction a year later and haven't had a problem with that knee since. Then in 2011 (when I was 30) I tore the ACL in my right knee (again playing indoor soccer). I spent two years with a torn ACL (having just had an arthroscope to clean up the mess a bit), during which time I did lots of bushwalking and played soccer. The bushwalking was mostly fine (just a bit of pain after long, steep descents) but I ended up having a reconstruction a few months ago, mostly because it wasn't quite stable enough for soccer and partly because I worried about slipping in the bush and getting stuck in the middle of nowhere unable to walk.

In the last two years of ACL-less bushwalking I did start using trekking poles, which I think do help to reduce strain on knees, ankles and leg muscles. I'll definitely keep using them. I've also reduced my pack weight a bit. It'll be a few more months before I can start doing any serious walking again (and still another 9 or 10 months before I can foolishly return to soccer!) but I'm not anticipating any problems. Unfortunately I've not got much cartilage left, but I think that regular walking (as well as cycling and swimming) should keep all of the important muscles strong and protect me from further injury. I have read of exciting developments in cartilage regrowth. I'm sure that could come in handy for me in twenty years or so, so fingers crossed!

My ankles have also given me plenty of grief playing soccer, but thankfully they've never given me problems bushwalking either.

[Travis22]

Interesting topic guys. As it seems like everyone else here i had no real issues until my mid / late twenty's.

I trashed one in a MTB front somersault attempt and the other on Taekwondo training night, i took a full power round house kick to the side of the other knee and it went snap crackle pop.

Now i seem to suffer quite a lot of pain after hiking in the knees which usually results in them swelling and hurting for about a week following and sort of hiking trip.

Travis.

[Nuts]

The surgeon grabbed one of many knee models and dramatically forced the tib/fib up towards the femur. 'See, nothing! The muscles & tendons hold it all together and help but it's a flawed design. Nothing to take shock'

Obviously 'bigger' knees and legs can take heavier loads but I wonder whether it is anything like traditional pack weights, maybe even merely 'light' pack weights. Iv'e met some big, relatively young blokes with stuffed knees. I do still know some walkers carrying 30-40+ kg's, really don't think it takes much pounding downhill with those sort of weights. Seems to be a lot of ex-army walking wounded, maybe (pack carrying related) they would have most in common with bushwalking wear & tear injuries.

I have some MCL pain and further instability to sort out still Mic, you sound like you'd be the resident expert when that side of things fails That rock tape really is good stuff!!

[findbuddha]

Ortho looks like they did a good job nuts. I've been lucky with mine that its zero cartillage injury, 100% ligamentous (complete tear of acl, lcl, mcl and avulsed the meniscofemoral). The reconstruction was very successful and I find in many regards its stronger now than before. I do have the problem that I have severe instability in the ankle (and between the tib/fib) on that same leg due to endless sporting injuries playing rep hockey so theres some early arthritis in that which will only get worse with age. My only residual problem with my knee is my patella has tracking problems due to the post surgical scar tissue from where the acl graft was taken from. Its no drama day to day however when in the gym and bushwalking I use kinesio tape which works well for me. Bit of trial and error to work out the best way to tape as its the pes anserine bursa that reacts but I found a combo of taping techniques works well and I get no pain or swelling (generally).
Hopefully your clean up serves you well for a good while. Knees are a pain...literally

Hi

Mind sharing your taping technique for pes ans bursa?

Ta

[Grabeach]

I was cleaning out the shoe cupboard yesterday, which jogged my memory of my wife's hiking boots from long ago when she did such things (sigh). Can't remember the brand, but they were a quality boot bought initially for trecking in Nepal. This reminded me that not long after she started getting knee problems while walking around the Blue Mountains with me. She saw a specialist who told her to ditch the boots and get some joggers. Knee problems fixed. I don't really want to start another round of boots v shoes, but the specialists view was that while boots protected ankles, it was at the expense of knees which were a lot harder to fix.

[Nuts]

Yes, there is some growing support among medico's. I have seen discussions on BPL. I guess some free thinking docs thought this one through long ago

[johnw]

Nuts, my sympathies. And to everyone else who revealed their knee issues. I'll try to dig up my own gruesome photos to share . I'm yet another victim, but do have a somewhat good news story in my case that might give some hope to others, acknowledging that everyone's situation is different and prospects will vary.

I injured my left knee about 17 years ago, gardening of all things. Was between jobs after taking a redundancy from long term work, so used the break to start doing some neglected chores. Overbalanced from an awkward position, twisted the knee in dramatic fashion and felt something give. In excruciating pain but it eventually subsided, so of course I (stupidly) ignored it from then on. A few years later I got sick of being unfit from my life of sedentary, office bound profession/s. I resumed distance running - a pastime from back in my late teens/early twenties.

Back in early 2010 it all caught up with me and eventually I could barely limp along on a relatively easy bushwalk. Doctors, xrays, ultrasounds, eventually MRI and orthopaedic surgeon revealed damaged/torn lateral meniscus (possibly compounded by not having it looked at earlier). I had an arthroscopy October 2010 to clean it up, which has been successful IMO. I was able to resume running, bushwalking, cycling etc within a fairly short period.

The knee isn't perfect but it's liveable. I need to be careful in certain situations, eg really steep descents, particularly with a heavy pack. And running, twisting it the wrong way will give me a sharp reminder to take it easy. That said, the Sunday before last, having just turned 59, I was over the moon to complete the 2013 Gold Coast marathon (my first run at that distance) in a little over 4 hours. Knee gave me no problem and actually managed to progressively increase the pace over the 42km without issue. Being stiff and sore afterwards was another matter, but that has become commonplace as I get older, even after bushwalking. However, recovered quickly from that event and have already run 10km three times since then plus a 25km bike ride, and a 15km bushwalk last Saturday.

Post op regime I've been using almost religiously is one fishoil capsule 3 times a day and two glucosamine/chondroitin tablets daily. As others have commented there is only anecdotal evidence to suggest that those things provide a benefit. But it seems to help me even if only a placebo effect. Interestingly my surgeon suggested glucosamine as follow up treatment if I was experiencing any ongoing pain. The downside is that I'll likely need a full knee replacement 15 years or so down the track. Although that's a fairly common thing, even in less active people.

My philosophy (for me) - move it or lose it, especially as you get older .

[Nuts]

Wow, still running.. and marathons.. well done! I'm on the bike, still feels like some grit in the hub but i'm told that wears away.

[matagi]

Wow, still running.. and marathons.. well done! I'm on the bike, still feels like some grit in the hub but i'm told that wears away.

Nuts, make sure you don't "grind" on the bike ie. ride in too high a gear coz that is deadly on the knees.