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Old 09-15-2011, 10:57 PM   #26
kewms
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Re: degenerate menisci: end of aikido training?

Quote:
Matt Morris wrote: View Post
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
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Old 09-15-2011, 11:37 PM   #27
Peter Goldsbury
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Re: degenerate menisci: end of aikido training?

Quote:
Janet Rosen wrote: View Post
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

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Old 09-16-2011, 03:18 AM   #28
SteliosPapadakis
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Re: degenerate menisci: end of aikido training?

Hi Alex!
Quote:
Alex Wilde wrote: View Post
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!

Quote:
Alex Wilde wrote: View Post
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
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Old 09-16-2011, 12:21 PM   #29
Janet Rosen
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Re: degenerate menisci: end of aikido training?

Many thanks!

Quote:
Peter A Goldsbury wrote: View Post
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

Janet Rosen
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"peace will enter when hate is gone"--percy mayfield
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Old 09-17-2011, 02:41 AM   #30
alexwi
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Re: degenerate menisci: end of aikido training?

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
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Old 09-17-2011, 10:20 AM   #31
Michael Hackett
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Re: degenerate menisci: end of aikido training?

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.

Michael
"Leave the gun. Bring the cannoli."
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Old 09-17-2011, 02:20 PM   #32
Janet Rosen
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Re: degenerate menisci: end of aikido training?

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....

Janet Rosen
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Old 09-17-2011, 02:39 PM   #33
Michael Hackett
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Re: degenerate menisci: end of aikido training?

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.

Michael
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Old 09-17-2011, 03:36 PM   #34
alexwi
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Re: degenerate menisci: end of aikido training?

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).
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Old 09-17-2011, 11:11 PM   #35
Michael Varin
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Re: degenerate menisci: end of aikido training?

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.

-Michael
"Through aiki we can feel the mind of the enemy who comes to attack and are thus able to respond immediately." - M. Mochizuki
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Old 09-18-2011, 02:18 AM   #36
alexwi
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Re: degenerate menisci: end of aikido training?

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!
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Old 09-18-2011, 02:29 PM   #37
matty_mojo911
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Re: degenerate menisci: end of aikido training?

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.
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Old 09-19-2011, 02:48 AM   #38
alexwi
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Re: degenerate menisci: end of aikido training?

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
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Old 09-19-2011, 11:22 AM   #39
kewms
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Re: degenerate menisci: end of aikido training?

Useful diagram and discussion of the anatomy of the knee:
http://www.sportsinjuryclinic.net/cy...neeanatomy.php

Katherine
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Old 09-20-2011, 06:06 AM   #40
alexwi
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Re: degenerate menisci: end of aikido training?

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!
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Old 09-21-2011, 07:11 AM   #41
alexwi
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Re: degenerate menisci: end of aikido training?

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)?
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Old 09-27-2011, 08:06 AM   #42
alexwi
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Re: degenerate menisci: end of aikido training?

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
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Old 09-27-2011, 08:47 AM   #43
Don Nordin
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Re: degenerate menisci: end of aikido training?

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.
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Old 09-29-2011, 04:33 PM   #44
alexwi
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Re: degenerate menisci: end of aikido training?

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
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Old 09-29-2011, 05:27 PM   #45
Janet Rosen
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Re: degenerate menisci: end of aikido training?

Quote:
Alex Wilde wrote: View Post
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.

Janet Rosen
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Old 09-29-2011, 08:49 PM   #46
Michael Hackett
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Re: degenerate menisci: end of aikido training?

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.

Michael
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Old 09-29-2011, 10:01 PM   #47
Janet Rosen
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Re: degenerate menisci: end of aikido training?

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)

Janet Rosen
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Old 09-30-2011, 08:30 AM   #48
Don Nordin
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Re: degenerate menisci: end of aikido training?

Quote:
Janet Rosen wrote: View Post
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.

Last edited by Don Nordin : 09-30-2011 at 08:31 AM. Reason: clarification
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Old 09-30-2011, 03:46 PM   #49
alexwi
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Re: degenerate menisci: end of aikido training?

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
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Old 09-30-2011, 05:05 PM   #50
Janet Rosen
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Re: degenerate menisci: end of aikido training?

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
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