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alexwi
09-13-2011, 04:10 AM
Hi all,

I am new to the forum, and also to aikido when it comes to that.

I wanted to share my experience, see whether you have any
thoughts/tips...(I have read many other posts on knee problems)

I am 41, and I started Aikdio about 6 months ago. I immediately fell
in love with it, what with the philosophical aspects and the harmony behind the techniques. This incidentally may have been counterproductive, as I started training way too much (weekend warrior like, I guess, although motivated by the passion for it). I sort of thought/believed I'd be fine, as I never had any real physical problems before...definitely not with the joints...

After a month of training, my knees started all of a sudden hurting
really badly, and after 2 months of rest an MRI sure enough confirmed a medial meniscus tear at my right knee.
A long story short, I did a PT cycle, which improved things, but I started having pain also at my left knee about a month ago, which another MRI confirmed being damaged too (again medial meniscus tear).

They were diagnosed as degenerative tears, but what strikes me is that it could all just happen so suddenly (are my cartilages just evaporating fast? one question for my surgeon this coming week
for sure). I don't know how much aikido contributed to that, but it
sure was a shock and somehow also depressed me a lot, as I would like to continue training (provided I can do it that is).

Now my questions to you guys (of course I will ask my doctor the same questions, I just want to see what other people from the aikido side think/lived through):

1) Can someone with degenerative menisucs tears practice aikido? (in case I didn't operate them, although I cannot think how I could, given the discomfort...damaged menisci are also apparently more prone to further damage)...one hope was that they might heal, but after 6 months it hasn't improved so much...

2) Can (should) one with trimmed degenerate menisci (the surgeon might not be able to stitch them) still practice (effectively)? My concern is also about the risk of further injury, kind of if it happened once, it is likely to happen again...

BTW anyone there who had arthroscopy at both knees at the same time? Am not sure how one could cope with both knees incapacitated though..

While being forced off the mat, I educated myself a lot on aikido, and was also wondering:

Are seated techniques absolutely fundamental? if so, one would argue that all those with injured knees will never be able to practice beyond a certain point (some in this forum actually mentioned that aikido includes these techniques for a very
good reason, and that to learn it properly they should be
practiced)...needless to say I feel sadness at the idea of not being able to train all the aspects/techniques somehow...

BTW Can forward rolls damage the knees? could someone please post what one should watch when it comes to that?

I read that in the past aikido training was a lot more demanding (a
certain school still practices that way): I guess we are not all made to practice martial arts? or maybe we don't all
have the same luck....will power is great, but all in all not always enough?

Thanks for any thoughts you may have!

Cheers,

Alex

Tim Ruijs
09-13-2011, 04:44 AM
I am sorry to hear/read this.
It is never nice to find out that someone really likes Aikido and then is confronted with medical issues that may limit practise, or even worse, forces one to stop completely.

In class I always remind my students Aikido is Budo and the first rule of Budo is to protect yourself. This seemingly obvious rule is often forgotten when working on a technique. I see how people take ukemi and put themselves in danger, how they get up completely out of balance. Learning how to use your body correctly is very important (in Aikido). To properly use your body with limitations is off course possible, when you are disciplined to do so. After a while this becomes second nature and you will have adapted yourself.

In a forward roll your knees should not touch the floor...This sounds like bad technique that needs work.
when seiza hurts, do not to do seiza (for long)...

talk to your teacher about this and explain so he/she understands what you can and cannot do.

So unless there are severe medical issues not to practise, keep going strong, but remember Aikido is Budo. First rule in Budo is to protect yourself :)

SteveTrinkle
09-13-2011, 07:47 AM
Hello, I had arthroscopic surgery on both knees for torn menisci (not at the same time, however) I'm glad I had the surgery. After about 6 weeks off the mat and a slow and careful return, both knees (now 57 years old) are functioning well. They take a bit of care to warm up, but I can do suwari waza (which I love and find very helpful in learning to move from center) with little trouble. I take a glucosamine supplement and a fish oil supplement daily which I'm told is good to do. Beyond the general problems of decrepitude, I've got few complaints.

That's my experience anyway.
Best of luck,
Steve

philipsmith
09-13-2011, 07:57 AM
I've had menisci removed from both knees - first at age 21 second last year (age 51).

Never stopped training although I did rehab properly from both ops.

My experience is that yours knees will retain their function although they may be sore after prolonged training. I now use volleyball kneepads for both Aikido and Iai-do which help a lot.

eva
09-13-2011, 08:18 AM
I think that it should be possible for you to keep training. Listen to your body and decide what you can do without pain.
I had a torn ACL and some minor meniscus damage and restarted training as soon as I was allowed.
Following surgery I took rehab very serious. Which I think you should do as well. Then I don't see why you should stop practicing. I know a lot of people with some sort of knee damage who train in aikido or other martial arts regularly. It might just mean that you have to sometimes adapt what you are doing to keep your knees safe or to prevent pain.
Make sure your instructors and training partners know that you have some knee issues so it's clear to them why you might adapt a few things or why you don't do certain things.

Eva

Peter Goldsbury
09-13-2011, 08:33 AM
Hello Mr Wilde,

I would advise you to be extremely careful.

I had two ops, like Philip, removal of the medial meniscus of both knees, but within six months of each other. This happened in 1975 (I was 31), when medical knowledge was not as advanced as it is now. Since then I have had over 35 years of good training (including suwariwaza), but degeneration has set in and one can accelerate or decelerate the process, but one cannot stop it altogether. Recently my left knee hurt and continued to hurt during two week-long seminars in Holland, but a recent X-ray showed that there had been no deterioration of the joint since the previous X-ray in 2007. I found periodic injections of sodium hyaluronate helped quite a lot.

However, the recent discomfort is due to a baker's cyst (a build-up of fluid) around and especially behind the left knee joint. My orthopedic surgeon attributes this to a degenerative tear in the lateral meniscus of the left knee. This was not caused directly by aikido training.

I undergo rolfing massage one a week and this is very good. I also know of an excellent masseuse, a specialist in what is called Jag therapy. The only problem is that she lives in Brunei and I live in Hiroshima. But when I taught a seminar in Brunei a couple of years ago, I had a massage session every day and my knees gave no trouble at all. So, If I had the money, I would retire to Brunei...

Finally, if you are overweight, you really need to lose the excess. When you are my age, this is a major challenge.

Best wishes,

P Goldsbury

PS. A few days ago, I thought of a pin for 1-kyo that did not involve seiza. I tested it today during class.

AsimHanif
09-13-2011, 08:59 AM
Hi Alex,
I had torn menisci and cartilage damage on the same knee. After surgery (1 yr ago) the menisci is fine, the cart is about 90%.
I worked on building up the muscles supporting the knees and I am very careful how I now pivot.
Hope that helps.

alexwi
09-13-2011, 09:10 AM
Thanks to you all for your answers! I find them very encouraging!

Philip, did you also have degenerate menisci?

I have already started taking supplements that might (I hope) delay the onset of any arthritis (glucosamine), and as for my weight I am slim (79kg for 186 cms)…

Peter, I also have baker's cysts, my doc told me not to worry about them…and yes my knees also have a fluid build-up, which is why I was recommended to operate, as in the long term this could be a problem.

jag therapy and Brunei: I also wish I had the means/time to go for it (in which case I would probably also try the stem cells therapy)...
My other hope is that in a few years time science might find a less intrusive and more effective treatment for these problems…

I of course would like to continue training (while being super careful of course!)….never thought I'd fall in love with a martial art at my age, funny to think of it, it should have happened when I was 20!

For the time being, while waiting to see my surgeon to fix the operation, I do PT regularly to keep my muscles tight and strong…

Thanks to you all again!

Alex

Janet Rosen
09-13-2011, 10:43 AM
I had surgery for torn ACL and torn medial meniscus about 10 yrs ago.
For some people, the imbalance created between the femur and the tibia by an uneven or partly absent meniscus leads to early onset of osteoarthritis (loss of the cartilage at the far end of the femur) that can be painful and disabling.
Whatever you decide, making sure to do the best healing and rehab you can is absolutely critical.
I would encourage you to consider continuing with aikido BUT first working with your orthopedist/physiatrist and your PT to make sure they understand how the body is used in aikido AND to get clear guidelines from them on higher risk activities within aikido you may want to avoid in order to minimize risk of both future acute injury and development of arthritis (my own advice would be avoiding suwariwaza and also avoiding any throws that involve torquing and twisting , which are not seen in some styles of aikido but are present in some).

Michael Varin
09-13-2011, 11:28 PM
Hello Alex,

I have commented on this before, so you may have seen a similar response from me on other threads. But here it goes again...

I am a surgery is a last option type of guy, and obviously can't make this decision for you.

I have seen studies that show around 30% of athletes have full thickness defects in the menisci when viewed on a MRI, but only about half of those had symptoms. Studies have shown similar patterns with the patellar tendon.

Physicians frequently don't know as much as they think they do, and are increasingly leaving diagnosis up to machines.

The point is, the way we move and align our bodies, the mobility of adjacent joints, and the balance (or lack thereof) of our muscles has a lot to do with the amount of pain we feel.

Improve your hip and ankle mobility, stop sitting all day long, get your glutes and hamstrings stronger, and do foam rolling (self-myofascial release) daily before you opt for surgery.

Checkout Bulletproof Knees (http://www.bulletproofknees.com/).

gates
09-14-2011, 12:27 AM
Hello Alex,

I would concur with a lot of what Michael has suggested. I will be reading his link with considerable interest, so thanks Mike.

I often see a lot of poor alignment, especially in beginners, letting their knees point in completely different directions to their feet and ankles. Foot pronation/supination is not going to help matters either.

The correct position of your knee over your ankle when pivoting is also critical to stop excess torsion in the knee joint. As there are lots of pivots and turns in Aikido any miss-alignment will potentially cause problems.

Are you aware of whether you hold good alignment? Is this something you have considered? A trip to physio may be helpful to assess your alignment, this type of thing is their specialization.

All the best
Keith

alexwi
09-14-2011, 03:43 AM
Hi Keith and Michael,

I would also like to avoid surgery. The first doctor I went to recommended it as the only solution, which I was a bit suspicious about (after few visits I just didn't trust him).
I went to see another one (a sport specialist actually), and he put me on PT for few months, see whether it could get fixed (or just improve enough) that way…

So I did PT already, and the PT guy did not mention any problem with my balance (you never know I guess though)...

Quite frankly if it weren't for the fluid build up in the knee, I would probably give it another few months…
I also checked with a third doctor, and he agreed with the second one…

Hi Janet,

Yes, I will take my time to do full rehab first, before going back to the mat…I have already mentioned my condition at a dojo and it doesn't seem to be a problem i.e. no suwariwaza and seiza is ok…

My actual concern with the degenerate nature of the damage is that any sport or physical activity other than what is strictly required to keep in shape (e.g. swimming), might speed up further damage and open the doors for more and more problems…had this been a pure and clear tear of an otherwise healthy meniscus, I'd be less worried…

Thanks again for your advice!

Cheers,

Alex

SteliosPapadakis
09-15-2011, 05:21 AM
Hi Alex!
When i was in my late teens i got involved in weight training. Brainless and without a proper tutor, i manged to completely destroy the insides of both my knees pushing 800lbs in the leg press for many years... Almost no cartilage left in there at all...
This led to pain, many times in the red alert agonising scale, esp when standing for much long and it deterred me for many years in starting a martial art. i also had to quit my job as a truck driver because of the pain... I did many pgysiotherapy sessions but no aparent improvement. Nothing but pain...
Now, when i joined my first Aikido class my main concern was "will the knees fail soon enough? Will i manage to go through the entire lesson? "
8 Years have passed since that afternoon... and all i can say is that because my Aikido teachers have been "good teachers" in the sense that every movement was calculated in efficiency and so as to do no harm to any body part, my knees strengthened, partially recoverd and they will hurt only if i push them to extremes. Yes, there is still some pain, esp when standing up after taking loads of ukemis but nothing compared to the past.
For me, Aikido enhanced my knees' ability to recover to an extend, tought me how to stand, how to avoid painful manouvers and made my life pain-free.
:)

alexwi
09-15-2011, 06:22 AM
Hi Stelios,

Thanks for your e-mail!
Did you get an operation at your knees? is it worn out bone cartilage you have, or are your menisci also damaged?

I think as you said, the option would be to continue, planning every single movement/action taking place at a lesson (the teacher here would also make the difference I guess), and making sure to be 100% at all times when doing it…

BTW do you do suwariwaza or seiza?

Thanks again!

Michael Hackett
09-15-2011, 11:23 AM
Hi Alex,

I injured my right knee during training - although I don't have any idea whether aikido had anything to do with the injury or it was a coincidence. After a long series of PT and no real improvement, I ended up consulting with a well-respected orthopod who is oriented to sports injuries and a karateka himself. An MRI revealed a tear in one miniscus and I opted for surgery. The surgery revealed a tear in the second meniscus and the doctor trimmed and smoothed both.

Back to PT for several weeks and then back on the mat. Suwariwaza is no problem, but long periods of seiza can be troubling. For the first few months I was excessively careful of the knee, waiting for something bad to happen. Eventually I began to trust the stability of the knee and have had no problems at all. Besides aikido, I continue to work with kettlebells (including swings and squats) and in the gym with both leg presses and machine squats.

For me, I truly believe the key was the physical therapy after the surgery. I approached that aggressively and took the position that "if a little is good, a whole lot is better." It paid off for me, but probably isn't too wise as my PT folks told me after the fact.

I hope you have even better success with your healing.

Michael Hackett
09-15-2011, 11:24 AM
Oh, I forgot to mention something else that might be helpful. I suspect your doctors and PT folks know nothing about aikido. I suggest that you show them a video so they understand the demands of the art and can give you better counsel.

philipsmith
09-15-2011, 03:53 PM
Hi Alex,
yes I did have adegenerate meniscus this time; 30 years ago it was a traumatic injury.
Michael I would disagree with showing your surgeon and/or PT Aikido as they will advise against continued participation.
I am a trained Physiotherapist and senior lecturer in Sports Therapy (the UK equivalent of an athletic trainers) and know that Aikido produces a lot of knee stress.
That is why proper conditioning is important

Michael Hackett
09-15-2011, 04:35 PM
Mr. Smith,
I think you are off-base with your disagreement. Most physicians and physical therapists simply have no idea what aikido requires and are thus unable to give their best treatment or advice without being informed. It would be foolish to "hide the ball" from them in hopes that they won't give you undesired direction. By giving them the best information possible, they, in turn, can give you their best advice and treatment. Both my surgeon and PT gave me specific advice to protect my knee and worked me through a variety of exercises that would help prevent injuries in the future.

alexwi
09-15-2011, 04:44 PM
Hi Philip,

I am wondering, was your meniscus just trimmed, or completely removed a year ago? I am asking, in case it effectively means that the degeneration can lead to total destruction/loss of it...

As for the video of aikido to be shown to my surgeon, as he is a sport specialist he probably has seen other hard impact cases etc, but I will think about it. One thing he said though when suggesting PT first, was that should symtoms subside I'd be able to start training again.

My concern is that training with degenreate menisci (whether operated or not) is at a higher risk than training with a non degenerative meniscus tear (whether trimmed or not)...although it seems people here are still training without menisci and with cartilage damage, which I find very hopeful...

BTW I just bought a foam roller and gave it my first..ehm roll:)

Alex

Janet Rosen
09-15-2011, 05:50 PM
Mr. Smith,
I think you are off-base with your disagreement. Most physicians and physical therapists simply have no idea what aikido requires and are thus unable to give their best treatment or advice without being informed. It would be foolish to "hide the ball" from them in hopes that they won't give you undesired direction. By giving them the best information possible, they, in turn, can give you their best advice and treatment. Both my surgeon and PT gave me specific advice to protect my knee and worked me through a variety of exercises that would help prevent injuries in the future.

As a disabled but active aikidoist and an RN I'm w/ Michael on this : docs and PTs have no idea the way we use our bodies in aikido, they are invariably surprised and have to reshape their thinking about best processes and best outcomes based on the high demands of our art. You end up w/ MUCH better rehab with this.

aikidoc
09-15-2011, 06:48 PM
I have decreased joint space on the medial side right knee. I also have a re-tear of the meniscus-surgery in 1993-re-tear in fall 2010. Synvisc One is wonderful. I get them shot up every 6 months. I don't do much seiza anymore. I have students with good knees and I let them do the suwariwaza. Trying to avoid 2nd surgery. Hyalgan healed my left knee of two tears-lateral and medial in 2000-immediate hyalgan shots. MRI in Fall 2010 showed no tear. I teach 6 classes a week: 3-2 hour and 3-1.5 hour.

matty_mojo911
09-15-2011, 09:35 PM
Our knees are designed for a range of movements, as we all know, primarily a forward up and down movement though. Many Aikido movements in particular the circling/pivoting on a foot will place a lot of stress on the knee ligaments and miniscus.

Westerners really struggle with a lot of kneeling work compared to Japanese, is it just that they are used to it? Why do you think?

Keith Larman
09-15-2011, 10:24 PM
My ditto comment...

Lots of injuries here. Knees, back, shoulder, and on and on. My first physical therapist was a young woman who had 3 years under her belt in Aikido herself. She knew what I was doing. A few years later went to a new guy, very good, very well known, works a lot with professional sports teams. He asked about what I did. Then he asked if I could bring him some videos of what we do. Which I did. He then came back with recommendations, exercises, etc. geared towards what I was doing.

Do not waste your time going to a doctor/physical therapist if you're going to hold back information or simply disregard their advice. Give them the information they need to work with you correctly.

Just my experience.

Janet Rosen
09-15-2011, 11:27 PM
.

PS. A few days ago, I thought of a pin for 1-kyo that did not involve seiza. I tested it today during class.

Would you share? What I do off of ikkyo and nikkyo as standing pins is to just switch, once uke is faceplanted, to standing sankyo pin.

kewms
09-15-2011, 11:54 PM
Do not waste your time going to a doctor/physical therapist if you're going to hold back information or simply disregard their advice. Give them the information they need to work with you correctly.

This.

Anyone used to dealing with athletes should understand that abandoning your sport -- be it football or aikido -- is simply not an option, and will be willing to work with you to maximize your capacity and minimize further injury. If they're not, find someone else, but hiding information from them wastes both your time and theirs.

My own experience -- with shoulders, not knees -- is that the mobility level most doctors consider "normal" is barely adequate for aikido. If they don't know what you want to do, how can they possibly help you do it?

Katherine

kewms
09-15-2011, 11:57 PM
Our knees are designed for a range of movements, as we all know, primarily a forward up and down movement though. Many Aikido movements in particular the circling/pivoting on a foot will place a lot of stress on the knee ligaments and miniscus.

Westerners really struggle with a lot of kneeling work compared to Japanese, is it just that they are used to it? Why do you think?

In my experience, many Western beginners, even people who are relatively young, have serious mobility and flexibility issues. Kneeling work may be the most visible example, but it's by no means the only one.

Katherine

Peter Goldsbury
09-16-2011, 12:37 AM
Would you share? What I do off of ikkyo and nikkyo as standing pins is to just switch, once uke is faceplanted, to standing sankyo pin.

Hello Janet,

Well, it is a pin that both Shirata Rinjiro and Okumura Shigenobu Senseis once said was 'prewar'. It involves taking the other arm and pinning them both together, the wrists at the outside knee, if you are kneeling, or at the outside leg (at the ankle), if you are standing. Uke is forced on to his or her side, with the arms stretched out behind.

Best wishes,

PAG

SteliosPapadakis
09-16-2011, 04:18 AM
Hi Alex!
Did you get an operation at your knees? is it worn out bone cartilage you have, or are your menisci also damaged?


i was diagnosed with knee chondromalacia (actually my knee cartilage, the surfaces that cover the bones at the edges sort of speaking, are heavily damaged-degenerated due to the stress they suffer at earlier age) and my meniscus also show signs of damage. Hence the pain. No, i chose not to undergo surgery back then and i stand firm on this decision even today. I can walk, run, do Aikido and all sorts of exercises almost pain-free lately. So why bother? If at a later age the pain returns and becomes severe, we will see then!

BTW do you do suwariwaza or seiza?

I do both, do them a lot, and i love every moment of it! It does not hurt a bit doing suwari waza or seiza and this is because (to my understanding) i have been doing it for 8 years now. i will sit in seiza at home with every chance i get and do suwari waza at the dojo with every chance i get as well. I reckon the knees adapted to the situation and somehow got stronger around the area of concern. I am telling you, it only hurts (mildly) when getting up after doing prolonged ukemi.

i can only advise you as follows: do get the opinion of an expert in athletic trauma (someone that deals with athlete's injuries all the time) not just any orthopedic surgeon. Listen to what they have to say, they deal with similar injuries all the time.
Then think for yourself. You know your body, both its abilities and its limitations. Through Aikido one learns to listen better to what the body can do or cannot do. Be wise upon the choice of the exercises that you can do with safety and the ones that might end up in more trauma. Train in Aikido but also protect yourself.
You will be fine.
All the best

Janet Rosen
09-16-2011, 01:21 PM
Many thanks!

Hello Janet,

Well, it is a pin that both Shirata Rinjiro and Okumura Shigenobu Senseis once said was 'prewar'. It involves taking the other arm and pinning them both together, the wrists at the outside knee, if you are kneeling, or at the outside leg (at the ankle), if you are standing. Uke is forced on to his or her side, with the arms stretched out behind.

Best wishes,

PAG

alexwi
09-17-2011, 03:41 AM
BTW one thing I was also wondering, is it safer to train with a meniscus tear, or with a trimmed meniscus? One doctor told me that menisci with tears are more prone to tear even further...
on the other hand another one told me that even with a tear a meniscus still retains the shock absorbing capability, hence the fact that asymptomatic tears should not be operated upon...

Any thoughts?

Thanks again!

Alex

Michael Hackett
09-17-2011, 11:20 AM
Alex, I don't know the direct answer to your question, but my doc told me that unrepaired tears frequently break loose and cause havoc in the joint. That was how I discovered my injury in the first place. I was apparently asymtomatic and I was doing a deep entry into a yokomenuchi strike when my leg collapsed and I fell. I thought that I had slipped. I got back up and asked my Uke to attack again and had the same results, but this time there was a sharp pain. What my doc thinks happened was that a small piece of torn meniscus tissue had broken loose and at the right angle caused such instantaneous pain that I unconsciously allowed the knee to collapse before I even realized I was in pain.

So, from my own experience, I extrapolate that a torn meniscus should be repaired, or the victim should take some time off and give it plenty of rest in hopes that it will heal without intervention. Maybe Janet can weigh in here and give you a more accurate answer.

Good luck with the whole process.

Janet Rosen
09-17-2011, 03:20 PM
Couple of thoughts, though I'm by no means the expert or final word!
There will ALWAYS be exceptions to generalizations, having said that: In general yes it pays to take time to try healing as sometimes that's all that's needed - also, in the event of a lot of damage, sometimes it pays to let surrounding soft tissue inflammation resolve before doing anything invasive. If healing seems to have worked, then move on to some rehab/PT before returning full tilt to training.

However if there is immediate joint instability (as in you fall down when you walk) or even after a brief period of healing terrible pain on weightbearing and the doc recommends going in sooner, I'd tend to pay attention......

MRIs can be unreliable. There is huge variability in how good the techs are, how well the machines are maintained or calibrated, etc....often the true nature of an injury as seen on arthroscopy is not what everybody thought based on MRI. So until there is a scoping nobody really can say if its a tear that can be oversewn neatly or if there will be massive cutting or ?

Michael Hackett's history is very clear and specific - an event, a piece of stray tissue, an intervention. It's the situation each of us hopes for. Unfortunately sometimes this just isn't the case - many people have more chronic nagging symptoms and opt for arthroscopic procedures involving "cleaning up" the knee and have no improvement in pain or function.

More art than science....

Michael Hackett
09-17-2011, 03:39 PM
Good points Janet. My case wasn't all that clear-cut either. I had the MRI done and it clearly showed the tear to one meniscus. Once the scoping began, he found a tear in the other and cleaned up both. The second tear didn't show at all on the MRI. As you can probably tell, I'm very happy with my results, but I realize not everyone will be as fortunate.

alexwi
09-17-2011, 04:36 PM
Hi Janet,

Indeed, I ended up having two MRIs for both knees, and with different quality (the second one at a different centre is better apparently). I asked the question about the amount of tissue that might have to be removed, and of course I only got a rough ballpark figure i.e. less than 50% and more than 10%.

Michael I think so too...when doing PT my hope was to be able to go back to training, buying some time for an op maybe in 2 years time, by which time who knows?maybe some more advanced techniques/options might be available (wishful/wistful thinking).

I will see my doctor this coming week, and ask him whether it makes sense to give it another month, although I guess he will still suggest surgery (if it didn't heal in 6 months, it won't most likely with more time).

Michael Varin
09-18-2011, 12:11 AM
Hello again, Alex.

I feel like you are still missing the picture.

It's not going to be another month or six months. You have to work diligently to re-train your body and improve your tissue quality. You are probably looking at consistent training for at least one and a half years. Of course, you will be able to get back on the mat long before that.

If you want (or need) to have surgery. . . Do it.

If you want to make an honest attempt at reducing the pain without surgery. . . Do it.

Bear in mind that if your body mechanics are unsound, surgery will not fix that.

The foam roller is a great start. How is it working out?

You will probably also need to get some tennis balls, a golf ball, and a 4" diameter PVC pipe. They will enhance your foam rolling.

By the way, it is my understanding that a degenerative tear is not "worse" than a traumatic tear, just that it is the result of accumulation and time rather than one isolated incident. So I wouldn't worry too much about that. Again, I am no expert.

In my experience, seiza, suwari waza, forward rolls done properly are not a problem. Be careful and conscious of how you pivot and how you do backward rolls.

And to clarify, when I said balance, I meant muscle balance, as in the relative strength and tone of antagonistic muscles, e.g. the quads and hamstrings.

alexwi
09-18-2011, 03:18 AM
Hi Michael,

Well, when it comes to re-training my body/strenthening my legs, I think it is clear that this is going to be a permament task for the rest of my life (whether I can continue with Aikido or not) i.e. I am constantly doing the PT exercises for both legs now (once every two to three days that is), looking at muscle balance, equilibrium etc

Foam roller: it does a great job! wish I had started using months ago!! and the good thing is you can use it every day! it was painful at the beginning (very actually, but expected to be so) but got a lot better now...I will go buy the ball and the stick tomorrow:)

Thanks again for the tips! backward rolls: same principle as for the forward ones, i.e. avoid impacting the knees? from a standing position the rule of thumb (as far as I saw/got) is to first knee with the leg at 90% from the other...right?

Degenerate tears vs traumatic ones: that would be my hope too...

seiza and suwari waza: am looking forward to being able to do them again, even if moderately.

Thanks again!

matty_mojo911
09-18-2011, 03:29 PM
Good luck Alex - I had my torn miniscus trimmed 3 months ago - perhaps 40% of the inside miniscus removed. I'm still struggling, but back training at 50-60%.
Ps - not sure what your one was but my surgeon, who I've had plenty of meetings with told me an intersting thing - torn miniscus on the inside is generally not a problem, and people go on to almost full movement given time, with no real long time issues apart from requiring more of a warm up. However he has found that torn miniscus on the outside of the knee can be problemtaic - expected that in about 5 years after surgery will get signs of arthritis - he explained that something like 70% of our walking load is carried down the outside of our knee. Just FYI.

alexwi
09-19-2011, 03:48 AM
Hi Matt,

Thanks for your post! Yours was also medial meniscus? I somehow thought that the medial one was in fact the one taking more load/stress...which is also why the lateral one is less likely to tears, besides being attached differently (I think the medial is less capable of moving too, unfortunately)....

Alex

kewms
09-19-2011, 12:22 PM
Useful diagram and discussion of the anatomy of the knee:
http://www.sportsinjuryclinic.net/cybertherapist/kneeanatomy.php

Katherine

alexwi
09-20-2011, 07:06 AM
BTW Matt are you back to seiza and rolls too? Or does 50-60% refer to the number of hours?

Thanks again!

ps: thanks Katherine!

alexwi
09-21-2011, 08:11 AM
Hi,

This is a list of questions I am going to ask my surgeon this week or early next week. Any other questions I should ask do you think?

Thanks a lot again!

1) Degenerate menisci evaporating?? how come so fast? what can I expect?

2) or first MRI wrong?

3) Still liquid in the knees (both)? if not, should I operate, or should I wait a bit longer in case?

4) Could an ecography show some more details?

5) Is it true that medial meniscus tears are less at risk for
arthritis than lateral meniscus ones?(outside of the knee)

6) Still possible to repair in case, despite the degeneration?
If repaired, how long before we know it was successful? When will
the stitches be completely absorbed?

7) How much meniscus to be removed, if needed? (max vs min)

8) Will the whole knee be checked i.e. also the rest of the
structures e.g. pattella and lateral meniscus? Will also the cysts be removed?

9) Nerve damage during operation? what are the risks?

10) What kind of anesthesia? Any recommendations in terms of eating/drinking leading to the operation (in the morning or in the evening?)?

11) Platelet-Rich Fibrin Matrix directly sutured into the meniscus? Still trial?

12) Aikido still possible, even if a)degenerate and trimmed? what if b)repaired? if trimmed and more than 40% gone?

13) What about the left knee? can it be operated at the same time with the right one? (Insurance? costs in case?) What are the chances that it might heal by itself, considering it is a lesser injury than right one?

Post surgery questions:

1) When to start PT?

2) Should I go to a PT or should I just do it at home?

3) How many weeks off?

4) How often to check with doctors afterwards?

5) How long before back to sport?

6) Long term check-ups? Arthritis?

7) Danger they could re-tear (especially with Aikido in mind)?

alexwi
09-27-2011, 09:06 AM
Ok here is an update.

I saw my doctor today and

1) Knees have no liquid just now, so we don't operate yet, wait and see, and in the meantime lots of PT still (but no Aikido yet:( at least "physically").

2) If needed, he would operate them both at the same time (one anesthesia only)

3) Degenerate tears can still be sutured (I think he is an expert with this technique) and he recommends it, if operating in the end. 6 weeks on crutches in that case.

4) Aikido could be a problem in his opinion. However, if pain disappears he says I can go back to training, and end of story.
The rule of thumb is (his own words): follow what your knees tell you (sounds wise to me!)

The interesting thing, as mentioned already by Janet, is that

1) no one can be sure about the pain causes before going in, and for that matter an MRI tear might not be there in the end.

2) pain wise, it could come from a different part of the knee altogether, while still seeming meniscus related.

3) if removing parts of the menisci, the exact amount cannot be predicted from an MRI.

I think my second MRI was useful actually, glad I did it…

And I am very glad I started using the foam roller (thanks Michael!)

Hope this can help someone else in a similar situation.

Cheers,

Alex

Don Nordin
09-27-2011, 09:47 AM
Alex,

My personal experience is I have torn meniscus in my left kne, approx 1/2 of my meniscuc has been removed from right knee. I still practice Aikido with little knee pain. However I have to be careful when getting up from ukemi so I do not twist my knee, basically make sure my knee cap and my foot are pointing in the same direction. The key in my case was physical therapy after the operation. You really should do all the excercises that they prescribe.

alexwi
09-29-2011, 05:33 PM
Hi Don,

Indeed I am doing PT almost every day, still in the hope to at least delay surgery...of course the other goal is to be able to train again. Right now I am just reading + practicing (tai chi style) by myself, which is not aikido, but the closest I can get to:)

Ukemi, as far as I could experience, can in fact be dangerous for knees: in fact when forward rolling one knee will come out of the roll touching the ground and at an angle with respect to the momentum direction of the body (left if rolling on right shoulder and the other way round), which suggests to me just the kind of torsion a meniscus would not like (same for the backward roll, but maybe with less "whip" ?)....

Alex

Janet Rosen
09-29-2011, 06:27 PM
Hi Don,

Indeed I am doing PT almost every day, still in the hope to at least delay surgery...of course the other goal is to be able to train again. Right now I am just reading + practicing (tai chi style) by myself, which is not aikido, but the closest I can get to:)

Ukemi, as far as I could experience, can in fact be dangerous for knees: in fact when forward rolling one knee will come out of the roll touching the ground and at an angle with respect to the momentum direction of the body (left if rolling on right shoulder and the other way round), which suggests to me just the kind of torsion a meniscus would not like (same for the backward roll, but maybe with less "whip" ?)....

Alex

Since my knee blow out, surgery, rehab and arthritis, I do forward rolls as "layouts" (ending in breakfall position) then do a quick circle movement to come up in horse stance facing the way I came, in order to avoid landing on the bad knee.

Michael Hackett
09-29-2011, 09:49 PM
Man, do I second Don Nordin's comment about PT after surgery if you have it. Do the exercises, do the exercises, do the exercises! Another tip: if you do have the surgery, they will inject a pain killing agent into the knee while you are under and give you some sort of pain killer for the next couple of days. Don't wait for the pain to begin taking the pain medication afterwards (as I did) because it will come on quickly and will be difficult to attenuate. I was out of surgery by 10AM and on the couch at home by noon. My doc called me around 7PM to check on me and I still had no pain. He suggested taking the med anyway and I didn't feel the need (as I hate taking any medication). By midnight I was a sore puppy and was behind the curve for the next day or so. I would have saved myself some serious discomfort if I hadn't been so hard-headed.

Janet Rosen
09-29-2011, 11:01 PM
That internal bath of painkiller right in the knee is awesome! Being an experienced palliative care nurse, once I got home I put myself on a scheduled regimen of pain meds even though they are written "as needed" and after a week began a slow taper (that was the ACL/meniscus, for simple scoping procedure later on started the taper sooner)

Don Nordin
09-30-2011, 09:30 AM
Since my knee blow out, surgery, rehab and arthritis, I do forward rolls as "layouts" (ending in breakfall position) then do a quick circle movement to come up in horse stance facing the way I came, in order to avoid landing on the bad knee.

Same here, as far as I know the method you describe, Alex, is to be avoided. I was corrected on that many times in the dojo. As far as your Aikido is concerned I would repeat what my Sensei tells me, just do what you can do but keep practicing. I am not sure what style of Aikido you practice we practice a non competitive form of Tomiki Ryu Aikido. Within our cirriculum there is a lot you can do that will harm the the knees. The Tomiki walking is one example, the 8 releases is another.

Are you able to walk with a normal gait or are you limping when you walk? If you are limping be careful and remember to stretch and remain flexible, your body develops bad habits when you limp. When my right knee finally needed surgery it would lock up for extended periods so I knew it was time.

alexwi
09-30-2011, 04:46 PM
Hi Don,

No limping, and no knee locking either, although at times the pain slows me down considerably, and of course I cannot bend the legs completely as is painful i.e. no seiza. Also, completely stretching the right leg gives me an awkward feeling at times, but less now.
As for the gait, I think it is normal, or at least the PT guy checked that all the time (and so did the doctor).

Forward rolls, I am not sure I understand the way you guys do it: is it something like a 90 degree rolling, as in this video

http://www.youtube.com/watch?v=5BFff-4A_aA

?
One knee will anyway hit the ground perpendicular to the moving mody, although knee and foot will still remain parallel...is the idea that this should always be your good knee somehow?
Can you post a video with an example, in case there is one on youtube? (apologies in advance if my link is censored)

Thanks again!

Cheers,

Alex

Janet Rosen
09-30-2011, 06:05 PM
Alex, you know how the body lands from a high forward breakfall? One foot planted with knee bent, other leg opened at hip so bent leg lays along the mat, etc.
So my bad knee is the right and I don't want to land on it.
When I start a forward roll right foot forward, no problem the usual way, I end up kneeling on the good left knee and my right foot is planted, my right knee at a good 90 degree angle.

When I start a roll left foot forward, I treat it like when you practice to learn breakfall and someone holds your hand to the mat so instead of rolling UP out of the roll you lay out into a breakfall position but very softly. My right hip is open, my right knee is at a comfy 90 degree angle with the whole lateral (outer) side of my leg on the mat. My left foot is planted on the floor.

To stand I continue my momentum rolling my body towards my left, my weight shifting from right to left as I sit up my wright is on left hip and hand, left knee drops to mat so I can rise to kneel on good left knee as both hands are also now bearing weight I continue this counterclockwise turning to rise to a horse stance facing from where I was thrown.

If your bad knee is left, reverse will apply and your rising turn will be clockwise v

Janet Rosen
09-30-2011, 06:06 PM
That final v was meant to be a period and has no meaning. Dang iPod.

Michael Varin
10-01-2011, 03:31 AM
Forward rolls, I am not sure I understand the way you guys do it: is it something like a 90 degree rolling, as in this video

http://www.youtube.com/watch?v=5BFff-4A_aA

I don't think so. Probably more like this. . .
http://www.youtube.com/watch?v=l2d14cWPKPw

That is close to the way I rolled when my knees hurt all the time.

But here's the thing, your knees don't have to hurt. Mine don't hurt anymore. It's been three years, and I didn't have surgery.

Foam rolling is truly great, but it's not everything. You have to strengthen your glutes, seriously stretch your hip flexors and probably your calves, improve your hip and ankle mobility, and generally learn to let go of the tension in your muscles.

It is very possible that your PT won't address all of these issues effectively.

Janet Rosen
10-01-2011, 07:28 AM
And I might add to Michael's excellent post, try a pair of Vibram f Fingers shoes....

alexwi
10-03-2011, 10:02 AM
Hi Michael,

Thanks for the link to the video! it is worth a 1000 words:)

Vibram f Fingers shoes: also to go to work and in winter?? will have to try one day though:)

alexwi
10-04-2011, 06:07 AM
Hi Michael,

I also wanted to ask you: how long did it take you before you could go back to practicing at the dojo, after you started doing PT + foam rolling etc? Or did you in fact keep training through the knee pain (while doing also PT), until it finally stopped hurting altogether?

I am giving myself some more time off the dojo to improve strength/stability/reduce pain, but it'd be great to be back there asap....

Of course when it comes to recovery time we are all different and there is no clear rule of thumb I guess...

Cheers,

Alex