range of motion in my knee

[jonas2]

Hello all, hopefully someone out there can help me a little bit. About 7 years ago I developed a condition call osteochondritis dissecans of the medial femur condyle (spelling?). First it happend in my right knee, had surgery, and then right after recovery it happend in my left knee. My right knee healed perfectly and I have had no problems since the surgery but my left knee has not had the same success. To this day I still do not have the full range of motion with this knee. Whenever I try to flex my leg, i cannot bend it all the way without a bit of pain. It gets very tight and as I said.....hurts. I think this may have to do with some tight ligaments or tendons or scar tissue or some such issue. Does anyone have any suggestions as to what I could do to loosen things up or fix this problem? Any help would be greatly appreciated.

Jonas

[rbibbs]

Jonas, I'm not familiar with that condition or that surgical procedure, perhaps someone else here is.

Have you gone back to the surgeon for suggestions, and did he give you any post-operative rehab? Beyond that, it may not be possible to restore "full" function, but relaxed motion under no load should make it as good as it's going to get. There's also "sympathetic tension" in associated joints, so full hip and ankle mobility might lessen the localized tension and discomfort. The WW applications have "worked wonders" for joint dysfunctions, and can likely improve what you're experiencing now.

Rick

[Coach Ilano]

As your doctor may have told you the OCD lesion is sort of like an unhealed "hole" in your bone. Very common. The surgical procedure is to drill around the lesion to stimulate healing. A bit like reinjuring the area in a specific way so that the healing process can get back on the right track.

If the surgery was successful and the lesion has healed (as shown in the x-rays or bone scan followup tests by your doctor), then what you are dealing with is separate from the OCD now.

With that in mind, Rick has given good suggestions. Find a way to slowly take your way into better range of motion from your back on down to your feet. Warrior Wellness is very good for that.

You may also consider visiting a physical therapist for your problem.

Also be a little more specific, and there are a whole bunch of people here that can provide more tailored information for you.

Good luck,
Jarlo

[jonas2]

From x-rays that I have gotten since the operation, the bone surface is smooth and the lesion was healed. In terms of more specific, could you be more specific? I am not quite sure what other info I should be giving you. I do think that the knee flexibility and tightness issue is directly linked to the knee operation since it started right as the condition was discovered and really became apparent after the operation. I mean it could be that I was on crutches for quite awhile before the operation since the condition developed in both knees, my right knee first followed by the left (which is the one with the flexibility issues). I am not quite sure. Thank you for your responses and if there is any other information I could provide please let me know.

Jonas

[rbibbs]

Jonas, I don't think anyone 'on the internet' can definitively say what's going on with a given condition; real-life physicians have a hard enough time doing it even with CAT scans and MRIs. So this is just a 'theory'.

Pain typically accompanies structural dysfunction, and it modifies neurology. Nobody (well, almost) 'likes' pain, and if moving a structure causes pain, we quickly learn NOT to move that structure.

The structure can be physically repaired, as yours apparently (by the x-rays) was. It is possible for the neurological changes to remain, and we may have to formally un-learn our learned reaction.

Example: Around 1970, a wave threw me head-first into the sand in Hawaii. The impact was sufficient to have knocked me out, except for the knowledge I was in the water and unconsciousness would be fatal. My neck wasn't broken but it was severely sprained. The physical injury probably healed in about 6 months, but during that time, I learned not to move my neck, because it hurt. 30 years later, it was still stiff, and holding it in that fixed position caused other actual physical problems, because joints must move to remain functional. In 2001, I started WW, trying to move my neck. It was virtually impossible at first. It hadn't moved in so long, it had literally forgotten how. In the absence of active prohibitive pathology however, we can re-train these motions, and un-learn the neurology of fearing movement. It still makes noises like crunching a bag of tortilla chips, but it moves in all directions without discomfort.

Again, I can't say with certainty that this is the case with your knee, but I hope it is, and wish you the best exploring recovery of articulation. Please consider buying the WW trilogy videos. A small purchase and 20 minutes a day can make a big difference in your near- and long-term joint mobility.

Rick

[Coach Ilano]

Rick,

Great stuff, very good advice, wish I said it myself!

Originally Posted by rbibbs

In the absence of active prohibitive pathology however, we can re-train these motions, and un-learn the neurology of fearing movement.

Wonderful statement! Exactly what I was trying to get at in my posts!

Jonas,

Again, great advice from Rick. It is what I meant when I stated that the OCD lesion is separate from what you are dealing with. Because it was repaired it is no longer an "active prohibitive pathology". So what you have now is different. You may have alluded to how it progressed yourself when you said it could have been the time on crutches, or order of surgical intervention. And you are right again, you can't exactly be sure. But what you can be sure of is how you feel and what limits you right now.

So, this leads into what I mean by being more specific. The questions I ask my patients always involve finding out specifics about the problem in terms of time, activity, easing of symptoms, and all patterns we can think of.

For example. Is it worse in the morning, afternoon, night? Better after exercise, worse? Is it the same all the time? Anything that eases the symptoms. Worse/Better with walking, stairs, inclines? Is there an exact location (you can point to it with a finger) or is it a general area?

Those kinds of things would be very helpful in addressing your problem. And you will see that approaching it in this way, helps you to figure out what's best for you. And of course, we can all help too

The gist of it is, that if we take the time to analyze our motions and the factors that could be affecting our bodies limitations. We can learn to "treat" ourselves. Of course, with the disclaimer of no longer having that "active prohibitive pathology". (I am going to steal that phrase Rick! :wink: )

Hope that helps Jonas!

Jarlo

[JasonE]

When I had arthroscopic surgery on my right medial meniscus, I had been on crutches for 2 weeks.

I saw my chiropractor a couple of times before and after the surgery to relieve the unusual joint stresses experienced as a result of using crutches and then favoring the right leg.

Just using crutches transfers a lot of workload and tension to the other ankle, knee, and hip, and may cause significant tension in the low back and shoulders. Use of a cane or simply favoring a sore knee will affect the good leg to a lesser degree and may cause a compensating reduction of ROM in the opposite arm.

Because I hadn't yet discovered the joys of ROM exercises or PNF stretching, I turned to Tai Chi. The slow, controlled movements allowed me to safely rebuild the strength and ROM I had lost in about 2 months. On occasion I would see my chiropractor or massage therapist to prevent a buildup of tension in compensating muscle groups so that my recovering muscles could take on more of the workload.

I recovered 100% of my ROM and went on to exceed the level I was at prior to surgery.

I have little doubt that you will be able to do the same if you are willing to put in a bit of time.

[jonas2]

Well thank you all for your replies. I really appreciate the help. In terms of getting more specific here I go. In terms of what time of day does it get worse, there is no pattern there. Its pretty much the same all day long. If I walk a lot during the day or go for a run, afterwards the tightness is worse, but is usually gone by the next morning. Nothing reallys seems to ease the problem but resting. Stretching can help a little bit but does not get rid of it. I don't know the names of any of these parts but, when i bend my knee, on the lateral side, there is a knob at the end of the shin where it connects with the knee. The pain is centered around that. The rest of the knee is just tight, not painful. I think that about covers it. Thanks again for helping me.

Jonas

[rbibbs]

If I'm reading this right Jonas (and help me Jarlo and Jason)... the "knob" you're referring to is the proximal end of the fibula, and 'relatively' unrelated to the loadbearing surfaces of the knee joint proper. When it's bothering you, turning your foot in a toes-inward position should exacerbate the discomfort (don't force this of course). The fibula is primarily part of the ankle articulation system. One doctor told me the ankle is the most complex joint in the body, and subject to overuse/strain injury both by virtue of complexity and the load it's under. The strain may not necessarily appear or feel like it's in the ankle.

We're still in "internet diagnosis" mode here, so take none of this as absolute, or substitute for advice from a physician or therapist who has first-hand knowledge of your case. The discomfort you feel in the area of your knee, is most likely coming from misarticulation in your ankle, which "forgot" how to move (a little atrophy, plus sensory-motor amnesia) during the time you weren't bearing load on that leg. Your hip joint will also have adjusted to that misarticulation, as will your lumbar spine. Be sure you're not walking and running with your toes turned inward, that would cumulatively strain the "knob" joint.

The restorative motions are too complex to put into text in usable form, but again, the WW videos would be a great place to start.

Jarlo, no "tm" on that phrase, use it in good health . And spot-on about analyzing our own motions and contributing to our own diagnosis and recovery.

Jason, great example of the principle of tension-chains, and that rehab goes beyond just moving the injured/repaired structure.

Rick

[jonas2]

Hmmm. That whole ankle thing is very interesting and I think there is some merit to that whole idea. I am going to really have to look into how things move around my body but the idea really rings true with me. Thanks again for your help, and don't worry, I won't hold you accountable should my legs fall off due to your advice. Thanks again

Jonas