Knee Issues, advice needed

[bigben]

I've been having mild knee achiness for maybe 2 years. Hasn't stopped me from doing my job(firefighter) or section hiking the AT(do a week every year, since 2006). Doctor Google had me thinking I had a medial meniscus tear. I finally got around to going and having it looked at today, and got some bad news. I do indeed have a medial meniscus tear, a big one, that's been there for at least 2 years. On top of that, severe arthritis in the knee. He said while my knee joint is not bone on bone, I will eventually need a total knee replacement.

I dont limp. I work out. I do all our hard fire dept training and have been in many fires over the last 2 years. I carry patients down stairs. I backpacked 40-50miles last year on the AT in Virginia, with no issues. I started at Springer in 2006 and have inch wormed my way to Atkins,VA annually, over the years. I had no qualms about doing Atkins to Bland this May. This isnt life altering or debilitating. I consider it nuisance pain, I take ibuprofin and live my life. I'm 47 yo, getting old sucks, wear and tear, whatever. But.....

And it's a big but. I CANNOT have a total knee replacement for another 8 years. You cant be a firefighter with a total knee, due to the prosthesis mfg not "signing off" on that kind of physical work. And I cant retire for another 8 years. THEN I can get one.

So. To those who have been in similar situations, what did you do, what do you wish you did or did not do? Should I keep hiking the AT? Would that "wear out" the knee faster? Priority one is my job and family. Thx

[JNI64]

Well first off thank you for what you do, being a firefighter. Second you shouldn't have waited so long to have it looked at, but I guess you already know that. I tore my anterior crucial ligament years ago, it was completely torn in half as well meniscus issues. Took me 4 months to get back to work and working out and such. My thoughts you said it your job,family is priority. I think asking your doctor would be best. But you have to work and have to take care of home first. Yes I believe hiking would wear your knee down quicker, don't know how it couldn't. If I was you I'd find a good knee brace and stick to short day hikes. Who knows after your knee replacement you could resume your section hiking.if not you might not make it 8 years. Get it done when you retire you'll have time to recover and all time in the world to section hike.

[fiddlehead]

I have a bad knee for more than 40 years now.
I used glucosimine in the past and that helped.
Now I use CBD salve. Just rub it on every day and it helps a lot.
I never had an MRI done, so don't know if it's a tear but definitely hurts when I do big miles anymore.
Anyway, worth a try.
For me: a knee replacement is a last resort
I would try stem cell treatment or, at least, other options like HA injections.

[Grampie]

I've been having mild knee achiness for maybe 2 years. Hasn't stopped me from doing my job(firefighter) or section hiking the AT(do a week every year, since 2006). Doctor Google had me thinking I had a medial meniscus tear. I finally got around to going and having it looked at today, and got some bad news. I do indeed have a medial meniscus tear, a big one, that's been there for at least 2 years. On top of that, severe arthritis in the knee. He said while my knee joint is not bone on bone, I will eventually need a total knee replacement.

I dont limp. I work out. I do all our hard fire dept training and have been in many fires over the last 2 years. I carry patients down stairs. I backpacked 40-50miles last year on the AT in Virginia, with no issues. I started at Springer in 2006 and have inch wormed my way to Atkins,VA annually, over the years. I had no qualms about doing Atkins to Bland this May. This isnt life altering or debilitating. I consider it nuisance pain, I take ibuprofin and live my life. I'm 47 yo, getting old sucks, wear and tear, whatever. But.....

And it's a big but. I CANNOT have a total knee replacement for another 8 years. You cant be a firefighter with a total knee, due to the prosthesis mfg not "signing off" on that kind of physical work. And I cant retire for another 8 years. THEN I can get one.

So. To those who have been in similar situations, what did you do, what do you wish you did or did not do? Should I keep hiking the AT? Would that "wear out" the knee faster? Priority one is my job and family. Thx

In January of the year I thru-hiked I had a tear in my meniscus skiing. I thought that it would put a end to my thru. After a few weeks the swelling stopped and I was able to walk with little pain. After consulting with my orthopedic doctor he advised that if I could indure the pain I would not damage my knee further. I started my thru onApril 13. Hiking about 10 miles a day for the first two weeks. I hiked with a neoprene knee brace every day. It took me 202 days to finish and my knee held up fine. I was 66 years old when I hiked.

[Lone Wolf]

my rt knee is bone on bone. tore my ACL, MCL and PCL 40+ years ago. the VA will do a knee replacement but i'm gonna wait 10 years or so. til rhen i get an injection every 8 months or so
https://www.anikatherapeutics.com/pr...gics/monovisc/

[bigben]

The thing is, it doesnt really bother me. I was kinda shocked to hear it's as ",bad" as it is. There was never "an injury/event" that I can remember happening. And he said the tear is YEARS old. My ortho doc said theres 3 things we could do. 1. Do nothing, wear a brace or sleeve, go about your life until pain, etc becomes an issue.2. Get cortisone shots and fluid removed as needed. 3. Surgery. Itd be a arthroscopic surgery where he clean it up. He said the meniscus tear isnt something he could surgically "fix." And he recommended doing nothing until it started effecting my quality of life; no need to start down the knee surgery early. When a surgeon doesnt automatically WANT to do surgery, I respect that!

Goal #1 is to prolong the Total knee replacement. Section hiking the AT has become an annual thing I always do and look forward to. I'd hate to give that up, even in the short term.

[GoldenBear]

> When a surgeon doesnt automatically WANT to do surgery, I respect that!

When I tore my meniscus seven years ago, I knew something was wrong when I started limping after a mile or so of hiking. Like you, there was no trauma that caused this tear; it just happened over time. My family doctor sent me to an orthopedic surgeon who had been in the business for forty years, who estimated that he had done 5000 surgeries. The FIRST thing he asked was whether I could handle the discomfort, stating that he didn't want to do surgery unless I thought I needed it. The reason is simple: ANY surgery carries some risk of intensifying the hurt or even of death, and doctors GENERALLY want to avoid that risk if they can. Thus, the fact that your surgeon doesn't want to just rush into surgery means that he (I presume your surgeon is male, forgive me if she's female) wants to avoid this risk IF POSSIBLE.

I told my surgeon that I wanted to hike the Appalachian Trail, and we jointly concluded that surgery was the best option. To say there were no complications is an understatement -- after getting a prescription for opoids ("If necessary for the pain"), I didn't even need acetaminophen for even a minute. Thirty days later I was back on the trail, noticing (and nearly panicking from) EVERY wince of discomfort in my knee; but basically without pain. I've since done 1000 miles without any trouble, and figure to finish all 2190 miles within a few years.

I heartily recommend the surgery simply because eight years without pain is a lot better than eight years with pain that you can "handle."

[Tipi Walter]

I've had some right knee problems on my last couple trips---a painful "popping" with mvt---but once wrapped with a long Ace type bandage the popping stopped and I can endure the pain. Probably bursitis. Point is, the bandage is now part of my standard backpacking load.

[Dogwood]

Was the menisci tear acute or degenerative or diagnosed as possibly both? If degenerative surgery may be imperative. Since knee replacement and arthritis have additionally been professionally simultaneously diagnostically mentioned it is likely degenerative. Adding to that suspicion you're a 47 yr old fire fighter who's doing the things you said and work out, which can cause knee degenerative over use issues, more so the higher the impact to those joints. Acute tears are, from what I glean, usually one incident employment or athletic related. It was not stated the type of arthritis that was diagnosed. Osteoarthritis(OA) is the most common, at least in the U.S., from what I understand. OA is what I've contended.

I would not continue to hike with the goal, or if it would likely, wear my knee out faster. I'd prioritize my retirement, family and knee replacement. I will caution against the idea/belief your knee has to further degenerate or as fast as might be assumed. As subset goals I'd support positive mental and emotional states as psychology affects physiology and explore integrative medical modalities that reduce or possible eliminate a cascading of damage. I also disagree it's merely nuisance pain or such supplements as glucosamine, chondroitin, methylsulfonylmethane(MSM), Boswellia errata, resins included, Curcumin/curcuminoids/turmeric, bromeliad, hyaluronic acid/lower molecular wt sodium hyaluronate/other HA, omega 3 fatty acids/omega 3 omega 6 imbalances, fish/krill oils, S-sdenonyl -Lmethionine(SAMe), avocado soybean unsaponifiables(ASU), ginger/terpenes and oleoresin, or CBD salves or oils or OTC or herbal pain meds are magic bullets to a fuller recovery although I take or have taken all of them at various times for ligament/tendon, and joint related issues such as the onset of osteoarthritis resulting from yrs of high impact athletics and other lifestyle choices. However, cumulatively these supplements can and do have more fuller affects. It also depends on the state of your conditions and more precise medical health.

Continuing, for example, my previous SAD(Standard American Diet) has been professionally linked as one causality of OA from several health care specialists open to integrative and alternative medicine and therapies. My needs and medical conditions were different than yours though. I've had excellent results in reversing OA and repairing ligament damage though with these supplements combined with other lifestyle choices such as adopting primarily a vegetarian whole foods plant based anti inflammatory diet, switching to lower impact workout regimens/sports, and strength training as three examples. As examples no longer do you hear gravel as my joints are stretched or stressed. Alcohol use can be associated with OA. I place myself in the category of once being a heavy beer drinker. That gloriously ceased 100% in June 1997. Never ever looked back or white knuckled it desiring it again. Again, not endlessly mentally and emotionally struggling with negativity positively affects physical states of being. It's been a cumulative multi faceted personalized treatment plan though. Note the 'thoughs.' Your situation is alike in some ways, not in others.

In the LD backpacking/hiking arena I study and have implemented UL tactics, ergonomic and other mindful physiological walking efficiencies that lower the impacts to joints and further reduce the risks of slips, trips and falls, generally a backpacker's greatest risk for injury, perhaps of greater concern when arthritis and ligament damage is lodged in knees and other joints, muscle strength development, mainly toning techniques, nutritional approaches, deeper breathing exercises, martial arts, static and dynamic stretching, mind/body connections and how they impact each other, as some examples. I've learned to and it is my intention to not live ego dominated - ruled by ego - which may have had me ignoring or attempting to adopt a male tough it out, there's no issue for change mindset. I don't live a couch potato lifestyle. The most I sit is when writing about hiking. I work outdoors in the sun, rain, heat cold for the most part as a Landscape Contractor/Landscape Designer/Landscape Architect - not a LA tethered to a desk/Horticulturalist lifestyle. I've had it professionally explored metabolic diseases as a/the cause for OA examining hormone and Fe levels and balances. I don't allow myself to be severely over wt or obese, maintaining within 20% my current body wt, the last 25 or so yrs. I dont have nerve damage or diabetes/Type 2 or pre diabetes despite some heredity risks. I don't have gout. All of this has the possibility to affect OA. You're in a place to consider these.

I'm not goal oriented to simply want to manage pain long term or something like OA. I want as full a RECOVERED state as I can. Pharmaceuticals and pain meds even if 'natural' like CBD oils or herbals for pain are more addressing a symptom(s) - pain brought about by inflammation - rather than addressing underlying causes - the inflammation. And, the inflammation has causes. This also is how the western medical system is largely based. It's a disease management system more so than a complete recovery holistically/whole being based system. However, the U.S. western based medical system is one of, if not the world leader, in knee and hip replacement. Your U.S. employment can likely be proved as a causality to your conditions, as I currently understand them. And, firefighters tend to have excellent medical insurance. And, pain meds have their place but are highly overprescribed and utilized in the U.S. culture. I will caution against an over reliance on them based on a long term habitual usage.

I'm a LD backpacker serialist - TCer accumulating more than 30K N. American maintained trail/route miles in all four seasons and diversity of trail conditions, all after HS, college and 'semi Pro' organized athletics. That's not a prideful based account. It's to let you grasp that I too am deeply passionate about hiking. I joyfully embrace all types of hiking as a one of my life's passions. I also have struggled with similar injuries as yourself including as a hiker.

One of my first LD hikes, a thru hike of the AT, 4 months before the start date I was involved in a motor vehicle accident as I was road bike training for the hike walking the bike across a road as a pedestrian that broke my left ankle with ligament damage and knee and hip ligament damage . The vehicle that struck me was forensically proven to be speeding around 75 mph. The vehicle was totaled destroyed by my unconscious body repeatedly hitting it after being repeatedly thrown in the air, reported by witnesses, as high as top of telephone poles. I woke up with EMT's guarding against a spinal injury and joint/ligament injury, telling me more definitively of the broken ankle and of deep lacerations and contusions, with a MediVac Helicopter ushering me to the nearest trauma center. I have personally known what it felt like anticipating something deemed epic, or that which you've dreamed about as a long time goal, having the rug pulled from under. How we react to challenges can be greater as we get up off the canvas with added determination, or, as Tim McGraw sings "live like you were dying" meaning more fully, more intentionally. I had some 100 plus sutures/staples in head, arm and leg area lacerations, deep body and bone contusions from neck to thighs(think a pink, green, yellow and red bag). I had various severe ligament stretches and some slight tendon tears in ankle and knee, mainly the left leg, and one hip. They did not know about cartilage at the time. I now suspect most if not all cartilage damage occurred mainly from the high impact athletic endeavors including high impact workouts and aerobics. I had a concussion and some other maladies that seemed less severe in my mind at the time. I don't fully remember all the M.D.'s and several physiologists told me that had happened to me though. Many astonished M.D's and Law Enforcement thought it could easily have been much worse. I walked on crutches from the hospital entrance with no overnight stay. As I got into the car I heard the two nurses that wheeled me to the entrance whisper "he could easily be dead." Live like you were dying. I had been in a boot and on crutches only 3 wks before starting the NOBO thru hike. I did months of over and above physical rehab once the inflammation subsided taking care to heed Physics instructions not to go out too fast too hard too long in rehab. I proactively involved myself in the recovery. That's how I learned about some of these supplements. Plus family members have been coached by world class world renown trainers and nutritionists. I started only being able to manage maybe 10-11 mpd popping NSAIDS like Aleve and VIT I(a BAD name for Ibuprofen) like they were candy, or an actual nutrient, starting as a gear and wt saving Newb with a 70 L 58 lb backpack. Most of the wt was food, however, not gear. I used a large long rubber tube for stretching during that hike. I was sore the first month including from the vehicular accident so intensely that some days it was a bore to go 10-12 miles when, as a runner, that was standard ability for me, or when playing singles and doubles in best of three set matches which I always played both I could run, a lot of it side to side, more than seven miles. In winter in H.s. and college played hard court basketball with increased intensity on high impact aerobics. But , I listened to and heeded not to competitive ego trying to go at a faster pace or do greater MPD averages or poor mentality that stressed a get er dun get to Mt Katahdin today tomorrow yesterday approach. In winter in HS and college I switched to hardcourt basketball. I weened myself off the pain pills on the hike which had eventually become a debilitating addiction. I was taking some of those named supplements on the hike and close to all pre hike as one aspect of therapy. Some of these supplements have strong anti inflammatory responses, cumulatively more so. Others aided in joint ease or rehab. Some herbals were for pain. I took no pharmaceutical meds. Physios and M.D.s said they never saw anyone recover so fast from such injuries. They asked about what I was doing, had done, and in specific, about the supplements doing what I've seen few M.D.s do, write down what I said. I joyfully without any discomfort completed the 2200 miles and more by hiking myself into thru hiking and life shape. I averaged 24 MPD through the Northeast states of PA, CT, MA, VT, NH, and ME. In Rocksylvania on often slippery rolly poly rocks compounded with heavy precipitation averaged 24 mpd for the state gliding mostly over the top of long stretches of rock. Finishing ME averaging 26- 27 mpd for the state. I carried a writing journal I wrote in nearly every day. I documented MPD in that same journal. Mostly the journal contain inspirational quotes. Writing and mediating on what was written helped with being less ego ruled among other things like offering a focus on being grateful, joyous, loving, kind, forbearing, at peace, wise, and more aware of others through generosity of giving something of myself despite lack of material abundances. It assisted on being grateful and joyous for the abundant grace shown to me and others by others in the AT community and, for lack of a better word, God. What factored in was by PA I was hauling no more than 30 lbs reducing gear and consumables wt(food, water, fuel, etc). Again, it was food and water more so than gear that decreased total pack weight(TPW). I listened, considered and mediated far more than talk or be haughty. Sappy or New Age or spiritual as it may seem better management of mental and emotional state, and spiritual stet, if you believe in such, contributed mightily to bodily states and getting to Mt Katayhin while not abusing folk on the journey. YES, a hike does not have to be approached as a greedy alienated self absorbed affair! What's more contributing to others we contribute to ourselves having a snowballing ripple effect that echoes back. That affects one's psychological states, and again, one's psychological sites can affect immunology, bodily recovery times, clarity, taking the focus off injury, weariness. Taking the emotional and anguish focus off these lessons it.

FWIW, psychology(mental and emotional states) influences physiology. Physiology influences mental and emotional states. Knowing and applying this can affect immunity, bodily recovery times, disease regression, risks associated with further injury by oneself to oneself(ignorance and ego can be two examples) or by others, etc.

I wrote out all the supplement names and have written this extensively because with great respect and empathy I acknowledge your needs, desires, and contributions. Although verbose at times, and I rarely personally share so comprehensively the origins of my opinions/ideas/posts, I thought you might glean some ideas for yourself.

[renais]

Dogwood, as one who has had decades of various knee pains, multiple surgeries and different therapies, I appreciate the thoroughness of your post.
Renais

[Traveler]

To the OP:

"Eventually" to a doctor can mean a lot of things. I had a similar diagnosis in 2007 and opted for arthroscopic surgery to repair the torn meniscus at the time, with the threat of a full replacement needed "eventually". it has been 13 years since then and I am still able to most of the things I want to without much knee pain (beyond sore muscles around the knee that fades quickly after exercise along with some effects of minor arthritis). That said, everyone is different when it comes to pain and thresholds of tolerance.

You didn't say what the MD said when you asked about just getting the meniscus repaired and waiting to do the knee replacement, which should have been discussed at the time of diagnosis. If you've not discussed this yet, my first comment would to ask the MD about this procedure. It worked well for me and the dreaded "eventual" knee replacement has not made itself known despite actively hiking all this time.

You also didn't say if this was a work-related injury or not (I presume not), but if it is, it can be an issue of pursuit or complication depending on diagnosis.

If nothing else, if you need to hold out for the next 8 years for retirement or wages as a firefighter, that probably should take center stage. Activities that put your injured knee at risk should be minimized, which would include hiking mountain trails for now. See if you can get arthroscopic surgery that will be a relatively fast recovery (compared with replacement) and you can probably get a good deal of mileage out the knee overall.

My situation may be a lot different than yours, however after living with a torn meniscus for several decades (not my idea, the MRI's I had were inconclusive until 07) and periodic swelling of the knee that wasn't painful that affected how I moved around the arthroscopic surgery worked very well. You should probably seek sound medical advice a good surgeon (or two) and discuss long term options and see what they have to say.

[bigben]

Thx. The MD said,today, I dont need a total knee replacement, but I will. I asked "When?" He said theres no way to tell, could be 30 yrs, could be 5, could be 2 yrs. The fact that my physical abilities arent limited and I'm not living in pain and discomfort are the reasons why he difnt recommend getting the knee scoped ASAP. When that changes, he said its time.

I'm gonna make another appt in a week to sit down and ask him about hiking, things to do and not do, gym activities to do and not do, treatments and everything I can do to prolong TKR. I'll post back here as to what he says.

[Puddlefish]

Back in the 80s, half of my crew team tore our menisci (thanks for that training regime coach.) Three guys had late 80s style surgery, and their knees are still a mess. I put up with the pain and just limped around for decades, and eventually my knees got less painful. But, I still have to do careful low impact maintenance exercises to strengthen the muscles around the knees.

It really wasn't a matter of toughing it out, or any kind of silliness like that. It was more likely the location of the tear. Tears on the outer one third have a good blood supply and will heal, tears on the inner two thirds have a terrible blood supply and won't heal, or at least not heal quickly. Waiting two decades isn't really any kind of feasible option.

Medical knowledge and surgery have improved since then. I'd talk to another doctor, and ask for all your options, specific to your injury and occupation. I've been told that a sports medicine practice is more likely to focus on treatments that get you active again, rather than just getting you minimally functional so you can stand up and find the TV remote.

[stephanD]

Knee replacement is not a magic bullet, and should be considered as last resort. Many things can go wrong with knee replacement surgery. I have the same problems you describe in my left knee; torn meniscus and osteoarthritis. If the tear is large, it should be removed. Now days, they remove only the injured area, not the entire meniscus. As for NSAIDs, take them only if the pain is excruciating. According to my orthopedic doctor, they actually interfere with the body's natural healing process. Cortisone shots are short term relievers, not a cure. My advise:
1. keep your BMI under 20, that is normal body weight, which I'm assuming is not an issue since you are a firefighter.
2. Use a high quality knee brace.
3. use hiking poles
4. as mention above, healthy and balance diet has important role in reducing inflammation overall.
5. exercise and stretch regularly.
6. take anti-inflammatory drugs sparingly.
7. Supplements;there's a lot of shenanigans in this field, so do your own research. I, personally, do not take supplements, but I use a lot of turmeric as a spice in my food.
8. know your limits. for example, for me, I know that my hiking limits are 250 - 300 miles a section, 10 - 15 miles daily with a rest day at least once every six hiking days.

[kombiguy]

1. keep your BMI under 20, that is normal body weight, which I'm assuming is not an issue since you are a firefighter.

Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.

[JNI64]

Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.

Like weight 170 lb. Body fat 18% and BMI 25 ?

[kombiguy]

Like weight 170 lb. Body fat 18% and BMI 25 ?

Without more facts, I couldn't answer your question. How tall are you, for example?

[JNI64]

Without more facts, I couldn't answer your question. How tall are you, for example?

It's not about me and I don't want to hijack the thread here, but big Ben, got his responses and conclusions. I'm 5'-8" and make that 168 lbs. Just weighed myself in the gym.

[stephanD]

Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.

Maybe BMI by itself alone is not a good indicator. the point is, you do not want to have excess weight, whichever way you define it. Every extra pound you carry, is extra burden on your knees.

[colorado_rob]

Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.

Yeah, me too... according to the CDC, at 6-1, 151 pounds is a BMI of 20. I've never weighed less than 165 since I reached 6-1 height, even as a competitive long distance runner in College, when I was as lean as lean can be. My current BMI=24ish, at 182 pounds. No one would call me overweight, probably, though there is now some extra body fat, but that will erase on next long hike, as it always does.

A BMI of 20 is ridiculous, unless I'm using a faulty BMI calculator or I'm missing some point???

All that said, yeah, weight is crucial for knee health, goes without saying. Hence why pack weight is also critical.