A few weeks late but it’s time for another update so here we go. In short, I’ve come to the conclusion that knees are simply a sh1t design. Just as I was starting to think I was getting somewhere constructive and adding some impact options into my MummyFIT classes, the knee has got gradually more grumbly to the point where even the low/no impact stuff has been causing problems.
It started with the knee protesting that it didn’t much like lunges, in particular being the trail leg. It wasn’t so bad if I stepped backwards into the lunge rather than forwards so I took the view that I’d just adapt where necessary and play it by ear. Within a week or two, it had progressed from being a bit uncomfortable to breaking down during a class to the point where the instructor basically said I needed to get it checked out or I wouldn’t be able to go to the class anymore.
I’d already taken the impact work back out of my sessions but, while it hasn’t given way completely (touch wood), I can feel things moving around and even doing relatively low impact work in a legs sessions, I ended up at a point where the pain developed from generalised, dull knee pain to full on burning inside the joint, which radiated out above and below until, ultimately, I had to stop. I couldn’t put any weight on it for a few minutes and ultimately limped out of the class walking on a bent leg, which is always fun when you also have to juggle your bags and a baby that, while he looks like a one year old and weighs over 10kg, is actually only five months old and therefore totally incapable of making life easier when it comes to picking him up and manoeuvring him.
Doubly frustrating, as longer-term followers of this blog will know, is that this is far and away the longest stretch of continuous fitness work I’ve managed to string together over the last few years. While I’ve lost most of the baby weight now, I still have a good half stone to go to get where I want to and, more importantly, I’ve enjoyed getting some fitness back and feeling more ‘like me’ again.
So, despite saying in an earlier post that I didn’t think there was much point going to get anything checked out while I’m still feeding the baby, off I trundled to physio last week, to get an assessment and some guidance on what would and wouldn’t be a good idea to do so I can keep going to classes.
Scores on the doors
Before I went, I decide to do the OKS/CKS scores again and they have taken a hit:
OKS – 29 (moderate to severe – the first time it has ever been in this category, I think)
CKS – 44 (fair)
Walking - Generally fine but have continuous, dull, achy pain behind and in front of the knee
Running - Too uncomfortable and more lolloping than running!
Jumping - Okay but achy, so long as two footed and all in straight line
Stairs - Okay but stiff descending
Pain - Constant dull aching around the knee, sharper pain through centre of knee and on medial joint line, particularly at night, and burning pain during extended exercise. Need thicker mats now if kneeling for press ups etc.
Swelling - Nothing significant
Range of Motion - As last month
Stability - As last month
The verdict
So, having been back to physio, the good news is that there doesn’t seem to be any new injuries, per se. The ACL is as it was and, while the knee is pretty sore along the medial joint line, there’s not much cartilage left there anyway so with that and the continuing nighttime soreness, I’d pretty much figured I would get/was beginning to get some arthritis anyway.
I've mentioned in previous posts that there is a clunk behind the knee when I swing the leg forwards (I bought my daughter a beam to help build her confidence at gym on what was my favourite piece of apparatus - no, really! - and when I tried 'dip walks' with her, this is exactly the kind of movement that gets the clunk going when it's the free 'swing' leg).
My physio's thinking is that the clunk might be to do with still needing to regain the last few degrees of extension (I can lift my heel clear off the ground but, when compared with the good leg, it's still a few degrees short. However, I know both knees hyperextend a bit so I wasn't sure how beneficial it would be to chase down those last few degrees). Looking back, I’m not 100% sure about the diagnosis as the clunk also shows up when I sit with my legs straight in front, crossed at the ankles, and attempt to bend the lower leg, which is the opposite movement, but frankly, I know diddly squat so I'll take the advice and work on that basis for now...
Frustratingly, while I thought I'd managed to gain quite a bit of muscle in my quads over the last 12 months (according to my Boditrax,stats anyway), it seems the muscles around my knee are still pretty pathetic so I need to do yet more work on that to try to stabilise the joint: More quad sets and straight leg raises and time to replace anything lunge related in MummyFIT classes with our old friends step ups, step downs and side steps.
Elephants or ducks: reading between the lines
The elephant in the room, which in hindsight I should have asked directly about, is that I got the distinct impression that the real issue in the knee now is arthritis and trying to stop/slow down its progression.
Neither of us mentioned it specifically, we both danced around it, but:
“Well, of course, the knee has been messed with a lot;"
“You need to keep the knee moving, it would actually be detrimental not to keep going to classes;"
“There’s some thickening around the joint;"
“You need to do as much as possible to strengthen the muscles to protect the knee;"
“It’s really about managing it now;"
were just a selection of the phrases that were used, plus the absolute killer,
"Do you swim/could you start swimming more?"
Of course, they all make sense it the context of ACL rehab too but the increasing stiffness and underlying discomfort is new, fits the description of osteoarthritis pretty well and would be no surprise given the knee's history. Ultimately, if it looks like a duck and quacks like a duck, it's probably a duck, right?
Shifting the paradigm
So, while it’s positive that structurally there are no new problems, if this is the arthritis kicking in, there’s only really one way to go from here and we move from ‘fixing the knee’ to ‘slowing the decline’ and ‘managing’ it. Man, I’m not even 40 yet!
Maybe I’m jumping the gun but it does put things in perspective and shift the focus somewhat. Intellectually you know you only have one body but my focus has always been on getting the most from mine. Since my physio appointment, it has shifted more towards protecting it and doing what I can to make it last.
While I haven’t had the result I’d have liked from either the ACL or revision ACL surgeries, perhaps I have to take the view that, while it’s not as functional as I’d like, it is more stable than it was. Previously I felt that I probably had one more go at ‘fixing it’ in me but right now I suspect that would do more harm than good.
If the arthritis gets a hold, how debilitating will that become and how quickly? Everyone knows that if you get into knee replacement territory, you're generally advised to delay it for as long as possible. With replacements currently lasting roughly 20 years, I’d probably need to be at least 60 to look at that (if we’re ruling out later revisions) so I’ve got another 20 years at least to limp this one through. Yes, there are other treatments but none of them are particularly pleasant and who really has steroid injections and knee surgery high up on their ‘to do’ lists?
Of course, all of this is conjecture. All I can do for now is do the same old physio, see what happens and do my best to mitigate any damage while keeping as active as possible. It will be trial and error to a certain extent – and the moment you google arthritis you get a whole sea of science, pseudoscience and quackery to wade through – but I’ll be doing my best to educate myself and find the best path through from here.
Here’s hoping the future can still include skiing, tennis and other sporty things I’d like to turn my hand - or more to the point, my legs - to. Perhaps I shouldn't mention that tomorrow I'm taking my daughter ice-skating for the first time. Kill or cure, kill or cure...!