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Knee Overhaul
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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

5/16/18 2:12 PM

Knee Overhaul

With all my various injuries and conditions, the only thing that bugs me on the bike now is some patellar osteoarthritis in the knee of my non-busted leg. I get some pain on the front of the kneecap with pedaling.

So I am starting on PT, and a course of naproxen.

I could have cortisone or SynVisc shots, but those are a last resort for me.

Gotta have the knee in shape for the PEI Gran Fondo in August and BikeMaine in September.

Funny how just a little knee pain/stiffness totally screws up your pedal stroke, which totally screws up riding in general.

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KerryIrons
Joined: 12 Jan 2004
Posts: 2927
Location: Midland, MI

5/17/18 3:17 PM

SynVisc

I had three SynVisc injections and did/do PT exercises for knee arthritis. For me, the PT works and the SynVisc didn't. That said, I know someone who gets the injections every 6 months or so and experiences great pain relief. YMMV

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

5/18/18 5:41 AM

Thanks

Good to know the PT has been effective. I have had good luck with PT on a couple other minor knee issues. Your experience with the injections is similar to what I've heard - kind of random.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

5/18/18 9:53 AM

Hope you realize a good result, on several levels.

Last edited by Sparky on 6/24/18 8:24 PM; edited 1 time in total

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

5/27/18 11:36 AM

Coming along

With the PT and naproxen, the knee is coming along pretty well. It's still a bit stiff but I can pedal pretty much normally, without the kneecap pain that was messing with my souplesse (or what passes for it in my case). Of course some (or all) of this may be just the arthritis quieting down, but the PT feels good.

The PT thinks some of this is from compensating for the busted leg on the other side. He identified some quad tightness in the busted leg which I wasn't aware of, as the walking or pedaling ROM doesn't bring it out.

Whenever I get into PT I am impressed how much they know and how much they can identify by just watching you or doing a few simple tests.

Now to test it with some longer rides.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

5/27/18 6:30 PM

Sounds good. once you start walking and stepping trying to stay off the one leg, you do other things to the muscles and the other knee/hip etc.

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dddd
Joined: 11 Jan 2004
Posts: 3220
Location: NorCal

5/28/18 11:49 AM

Could this perhaps be a case of an irritated tendon, i.e. tendonitis?

I've found that riding more regularly in controlled stages can overcome what sounds like similar symptoms. My kneecap area can become irritated following a rest stop, and it takes another gradual warmup to get going when that happens.

I always do better with shorter cranks with symptoms such as this, 165's are not hard to find and sometimes turn up cheap.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

5/28/18 12:18 PM

Bike PT, it seems harder to use your body non symmetrically on the the bike. Unless you are Chris Froome that is.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

5/28/18 12:49 PM

Arthritis

X-rays and the ortho say arthritis, and the PT thus far is effective. The last couple rides the knee hasn't bothered me much and I've jammed up a couple short hills.

I just need to get all body parts working at the same time.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

5/28/18 1:46 PM

"I just need to get all body parts working at the same time"

This occurs less and less times a year for me as time passes..

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

6/23/18 1:00 PM

Just shoot me?

PT has been helpful for the knee, but has not eliminated the problem - I've had a couple of flares and while it currently feels reasonably good riding, I'm unsure if it will hold up to a long, hard ride (one way to find out, I know, which I may try tomorrow). There is still some stiffness. I go back to the ortho Monday, and the option is to get a shot, which could be cortisone or synvisc.

Based on a discussion with the PT, I'm thinking of trying cortisone. I guess the best case is you reduce inflammation temporarily, keep doing the PT, and maybe when the shot wears off the symptoms are not as bad because strength, flexibility, balance etc have improved. I guess the worst case is just that it doesn't work. He thought the cortisone would be a better place to start than the synvisc, a less aggressive change. The PT had a cortisone shot years ago and found it very helpful.

So I'm thinking of giving it a "shot." Any thoughts?

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April
Joined: 13 Dec 2003
Posts: 6420
Location: Westchester/NYC

6/23/18 7:53 PM

I don't know anything about Synvisc. Cortisone has been very helpful for me.

Granted, I don't have arthritis, yet. So the "shot" I've got were very useful in quieting down the inflammation. Allowing me to do PT at full power. Once the muscle and ligaments work back to their original strength, the inflammation didn't come back.

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daddy-o
Joined: 12 Apr 2004
Posts: 3200
Location: Springfield

6/24/18 9:06 AM

Cortisone is so good it can lead to overconfidence, but you're methodical. And it's been around forever, studies have been replaced by statistics.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

6/24/18 9:58 AM

Lowers your imune system effeciency as well. So that 200 mile hard event pray no bugs come into the equation. And remember that if even a scope procedure is needed later, it will have to be 90 days after last shot.

Later, may be sooner if injection has a non result. Elaine's second injection seemed unless. Her first trearment was great imeadiately for shorter duration than expected. So end result was waiting 5 weeks for the end of minimum 90 days for next injection in pain. And in her case a poor result which another 90 days had to pass before surgery could happen.

Each case can be totally different, just pointing out one case scenario. But be aware of the 90 days in case you might have timing interfere with an expensive plannef trip.

And consider being abroad for example with compromised imune efficiency and an insurance situation. Supliment coverage before the fact, a thought.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

6/24/18 1:36 PM

Thanks all

April, it's helpful to know you found the injections helpful.

Daddy, with my experience lately I'm not going to get overconfident....:). I have seen that medicine now is very statistical. With the aneurysm they change the recommendation based on a couple millimeters. All data based.

Spark, there really isn't any surgery for this short of a replacement, and I'm told I am far from that (fine with me, recently I've had plenty). And I'm not doing it primarily for pain relief so the 90 days isn't troublesome. I hope I don't need another one.

So I know it ain't a cure but tend to think it's worth doing.

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KerryIrons
Joined: 12 Jan 2004
Posts: 2927
Location: Midland, MI

6/24/18 2:33 PM

Side effects

Without digging into this deeply, it is my general understanding that there are minimal/no side effects from Synvisc while there are known issues with steroids. As I said above, Synvisc didn't do much for me but I know people who have had good experience with it.

If it were me I would be considering the side effects of steroids when making the decision as to which one to try first. Maybe it's ignorance on my part but I think I would do Synvisc first and go to steroids it I got nothing from the Synvisc. An MD could presumably shed some light on the clinical experience of these two choices.

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

6/24/18 3:03 PM

"it ain't a cure but tend to think it's worth doing"

Wishing you the best possible result, of course.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

6/24/18 4:02 PM

Side effects etc.

I will discuss it more but I don't think the side effects from cortisone to the knee are awfully concerning, particularly as I don't plan on getting them repetitively. It's not like long term prednisone. I have lots of clients who get this type of injection and they don't always work, but I don't see much about side effects.

I may well be wrong, but I see more of a theoretical basis for this being effective on a limited basis (as April and my PT described) than with Synvisc.

You pays your $ and you makes your choices (though in my case Medicare pays the $).

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April
Joined: 13 Dec 2003
Posts: 6420
Location: Westchester/NYC

6/24/18 7:01 PM

Side effecct

1) I got shots into more than one "pocket" of my one single joint. The most I got was THREE at one time.

2) One of my club mate plays a doctor on TV, no joke. He's a real MD and still works as such. (He studies the subject he needs to play doctor on ahead of the show). His explanation: "the Cortisone shot into the joints are typically localized to the joint, relatively little leaks into the blood stream". Hence the multiple shot even for the same joint. Also relatively little concern for side effects for the same reason.

3) My surgeon was ok to operate even though I had Cortisone shot only 15 days prior, ON ANOTHER BODY PART. I suspect if it were the same joint, the 90 day rule would most likely apply

Of the many cortisone shots I got recently, only one provided no relieve. A few months later, the reason was clear: the pain was due to another issue entirely. The rest of them all provided long lasting relieve. But again, I don't have arthritis, YET.

Your situation maybe different from mine.


Last edited by April on 6/24/18 7:42 PM; edited 1 time in total

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Sparky
Joined: 08 Dec 2003
Posts: 16691
Location: Portland, OR

6/24/18 7:37 PM

Elaine sez to not get over confident when you feel so much better and make full circle faster over doing it effort wise. And being worse for it in the end.

She asks if hyaluronic acid will be in your cocktail? Apparently typical in knee injection.

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April
Joined: 13 Dec 2003
Posts: 6420
Location: Westchester/NYC

6/24/18 8:16 PM

Disclaimer

Now that I just remember...

All my cortisone shots were "diagnostic" shots. The doc looks for one of 3 outcomes:

1) No relieve -- the cause is somewhere else

2) Temporary relieve -- if the pain comes back after some weeks, time to consider surgery

3) Permanent relieve -- Each and every time, I was warned not to expect that. Only in relatively small percentage of cases the relieve are permanent. But it worked for me!

My understanding, there're also "therapeutic" shots, which basically takes the pain away for just long enough so you can get through whatever event you're to do in short term. The real diagnostic and treatment will start after you finish the event.

Clarify with your doc what you're getting so you know what to expect.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

6/25/18 2:10 AM

Shots

The H acid is Synvisc, which is not what I plan to get. If I get cortisone, I believe the shot is simply cortisone.

I don't believe the shot would be diagnostic in the sense of planning surgery, as there is none. It ideally would provide a window for PT to be more effective. How long ithe effect lasts remains to be seen.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

6/25/18 7:28 AM

shot up

Just got the cortisone shot from the ortho PA. We'll see. If no positive effect in a month, we get an MRI.

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daddy-o
Joined: 12 Apr 2004
Posts: 3200
Location: Springfield

6/25/18 10:09 AM

If Mt. Washington starts calling don't pick up! 🚲

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greglepore
Joined: 10 Jan 2004
Posts: 1632
Location: SE Pa, USA

6/25/18 6:20 PM

Dan- I sincerely hope to have your fortitude in another 8 years or so. I'm sure Maine livin' hasn't been easy on you, but doubt you would have traded it for anything.

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