Saturday, September 28, 2019

Athlete with a Meniscus Root Repair? This One's For You :)

Hey there, reader/runner friends!  I know, it's 2 years?  3?  Since I last blogged.  However, I have done a lot of Instagramming since then over at @thewellreadrunner, and if you've followed me at all, you know that my running was sidelined this year because of a running injury (which eventually ended up being diagnosed as a meniscus root tear in my left knee and had to be surgically repaired).  WHOMP WHOMP.

I started tagging some of my recovery pictures with a #meniscusrootrepair tag on IG, and OMG the responses!!  I got so many DMs from people who were going through the same injury, but had no idea what to expect, because it was hard to find information online about the recovery process.  To which I say, SAME, PEEPS, SAME.  I was really nervous going into this because I was having a heck of a time finding real-person stories of how they recovered from this injury and surgery (especially athletes).

As a result, I decided to write a blog post that outlines what my injury, diagnosis, and recovery timeline was like.  Please keep in mind this is just ONE person's experience.  But I hope it is helpful for anyone else going down a similar path!

Okay, so, we start in...

My last significantly big race was Chicago Marathon in October 2018; I had mostly been maintaining fitness since then, in hopes of a big half marathon & triathlon training season in the winter/spring.  However, I started having some knee pain in early January.  I thought it was possibly IT band related; began foam rolling more, stretching better, etc.  It was nagging but not unbearable.  UNTIL January 30th, when I got off the treadmill after an easy 4 miler and immediately called my chiropractor.  The pain had ramped up bad during the run, and I knew I'd reached a point where I shouldn't continue running on it.

I started seeing my chiropractor, who did a wonderful job working me through some muscle strains during marathon training the previous year.  The first thing she did was check for signs of ACL or meniscus tears, and she ruled those out.  (I kept hearing over and over, ALL THE WAY UNTIL SURGERY, that my injury did not present as a meniscus tear.)  We treated with ART & stim therapy in the office, and I stuck to only cross-training (cycling & swimming) in between.  Running and anything with a jumping motion was very aggravating to my knee.

February 23 I tried a small 1 mile run.  My knee was sore during but I felt like it had improved.  Sadly, that was untrue, and I paid for it with extra pain and swelling in the days afterwards.  At this point, my chiro recommended seeing a sports orthopedist.

MARCH 2019
March 8: got in to see the orthopedist, who I will say is A-MA-ZING (Dr. Mike Maloney out of Strong in Rochester NY).  If you live in this area, I cannot recommend him enough for sports ortho problems.  At this appointment, he checked out my knee and ruled out ACL tear, but said possible meniscus tear, MRI needed to be sure.  Recommended continued cross-training as long as it didn't aggravate the knee.  (Cycling & swimming still felt fine, so I kept at those pretty hard during this whole period.)

March 18: MRI on the knee.

APRIL 2019
April 1: got in with the ortho to go over the results of the MRI.  Honestly, he seemed a little perplexed; the pics did not show a full meniscus tear, though there was definitely some degeneration.  There was a significant cyst in the knee, but not in an area that he felt would be causing such pain.  Based on all this, we decided to take the conservative approach and try a cortisone shot (he did it right in the office).  He said I could try a very small, slow run at the end of the week if the shot seemed to be managing the pain well.

April 6: After an amazing pain-free week, I went for that run!  I walked a quarter mile from my house, started a slow jog, and within 10 seconds heard/felt a SNAP in my knee (BARF).  Could not weight-bear/walk and had to call my husband to drive the QUARTER MILE to come get me!

At this point I was freaking out because we were leaving for Disney April 13 (requiring a WHOLE WEEK of heavy walking), and I couldn't get in to see the ortho again until May 6.  Thankfully, the pain/swelling in my knee died down after a couple of days, and I was able to walk normally again by the time of our vacation.  But running was most definitely a no-go and I knew something real bad happened on that tiny run I took.

MAY 2019
May 6: Back to the ortho.  He said based on my experience with the snapping sound/feeling, we could do another MRI to officially diagnose, but he felt confident just doing an orthoscopic surgery at this point to get into the knee, officially see what the problem was, and fix it.  I was totally on board with that plan; I was SO VERY READY for all this to be over.  Surgery was scheduled for June 5 and I cross-training religiously right up until the day before the procedure.

JUNE 2019
June 5: When I went in for surgery (outpatient procedure), Dr. Maloney said he was likely going to have to either do a meniscectomy (remove damage parts of the meniscus) or a meniscus repair (stitch the broken pieces back together).  Meniscectomies are not as good for you in the long run (higher chance of arthritis in the knee), but they have a much shorter recovery time.  Meniscus repairs are better because you get to keep the whole meniscus, but have a much longer recovery time.  Maloney felt that it was likely I'd end up with a meniscectomy, because they are more common (it's hard to get enough blood flow to the meniscus for a repair to properly heal), which means I would wake up with an ace bandage on my leg and be on the road to getting off crutches within a few days.

So imagine my drug-induced surprise when I woke up from surgery in an ace bandage...aaaaand a giant straight-leg brace that went from thigh to ankle.  I had a feeling I'd gotten a repair done instead of a removal, and was quickly told that was the case.  This meant:
-No weight bearing/must be on crutches for 6 weeks
-Straight leg brace/no knee bending for 4-6 weeks
-total recovery time of approximately 6 months (full return to running)
This was not amazing news, BUT I was thankful to have my whole meniscus back intact, and was happy to just have this whole injury finally taken care of.
In recovery and very high on painkillers. lol.
June 7: My first PT appointment was only 48 hours after surgery!  Despite all my movement restrictions, they wanted to get me building quad strength again ASAP.  It is insane how quickly your muscles atrophy after a surgery, and knowing that I wanted to get back to running, the doctors were quick to get me on a PT plan.  My PT did immediately point out that my muscle tone was fantastic, and credited that to all the cross-training I did during injury.  So all those cycling & swimming miles were NOT for nothing!!!  I can't recommend that enough!!

After this first appointment, I was put on a schedule of PT 2x/week in the office, plus 4x/day at home.  I felt like my whole day was based around when I had to do PT next!  But I was fanatical about doing all my assigned exercises, and again--I cannot recommend that enough.  Stay on top of your PT if you want to return to activity safely & with max strength!!

General post-surgery stuff: showering was awful, I had to borrow a shower seat from a neighbor because standing on 1 leg to shower was near-impossible...not to mention I wasn't supposed to let water directly hit the incisions for a few weeks.  Stairs were a gigantic pain in the ass, and I mostly slept on the living room couch for the first 3-4 weeks.  The pain was rough the first few days after surgery, but improved quickly afterwards...the worst part of the first few weeks was trying to sleep in that god-awful leg brace.  OMG.  Never again!
My view for most of June
June 25: Almost 3 weeks post-op I had my follow-up with the ortho.  This is when I found out this wasn't just a normal mensicus repair, but a ROOT repair.  I had no idea that was even a thing.  But it was explained to me that once they identified it as a root tear, they had to repair it (not remove it) or else long-term problems would have been definite...arthritis, instability, etc.  Root repairs also require even more cautious recovery, since bending at/beyond 90 degrees too soon can put a ton of pressure on the repair.

At this appointment I was given the green light to start bearing 1/3 of my body weight...still on crutches and in the brace though.  At this point I was also cut back to 1x/week PT in the office (but still 2x/day at home).

June 30: I got overconfident on my crutches and fell down the stairs in our house.  Second floor to first floor...the WHOOOOLE flight.  I was also a dummy and did not have my leg brace on at the time (again, overconfident, especially when around the house).  Somehow, I landed at the bottom without bending/injuring my bad leg, though I did go to the ER to check for concussion (thankfully none) and the whole right side of my body was bruised for weeks afterwards.

Needless to say, I do not recommend doing this.  Learn from me.  I definitely got lucky, oy.
ER visits for falling down stairs are not recommended PT
JULY 2019
July 2: PT gave me the go-ahead to start 50% weight bearing...still in brace and on crutches.  (4 weeks post-op)

July 9: My PT allowed me to remove the leg brace!!!  She said my quad strength was looking amazing (DO YOUR PT EXERCISES, PEOPLE!), so she felt comfortable with me taking it off and starting to bend my leg slightly while walking.  I could also move up to 75% weight bearing, and start attempting a few small steps without crutches in a few days.  This was a BIG DAY!  (5 weeks post-op)

July 14: Started taking my first steps without crutches, only around the house.  Still kept the crutches when going out.  (Almost 6 weeks post-op)

July 17: Crutches officially gone!  PT put me on the stationary bike starting this week.  The first couple times, I couldn't get my leg to do a whole rotation (had to just swing it back and forth because my knee wouldn't bend that hard).  But within a few days I was able to do full rotations and do up to 8 minutes at a time on the bike, with zero resistance.  She also had me start doing mini-squats (like, very small, no where near 90 degrees yet).  (6 weeks post-op)

July 30: I started feeling comfortable walking, and started going for (slow) walks outside (max 1-1.5 miles at a time).  PT started me on single-leg strengthening and balance exercises.  I was specifically told no swimming yet at this point, but could continue walking & no-resistance cycling.  8 weeks post-op at this point.

By this point, my walks were getting up to 2-3 miles at a time.  My PT was still seeing me weekly, and initially said she thought we'd start my return-to-run testing around late September.  Again, I continued to be religious about my PT exercises at home.  This was very time consuming (it could take me an hour or more to finish it all, if you include the exercises plus limited cardio work) but paid off for sure because...

August 27: I WENT FOR MY FIRST RUN!!  12 weeks post-op, and way sooner than anticipated!!  But my PT surprised me by doing my return-to-run testing at this appointment, and I passed, so she let me do two 1-minute jogs on the treadmill.  It felt hella strange (I hadn't run since January!!!), and my knee was sore/stiff when I started, but loosened up as I went.  After this appointment, I was not allowed to start running at home yet; I had to wait until my next appointment but monitor my knee for any increased swelling/pain in the meantime.  Thankfully, I didn't experience much (some soreness/swelling the next day, but it decreased quickly).

September 3: Officially got the go-ahead to start the return-to-run progression program from my PT.  OH HAPPY DAY!!!!  13 weeks post-op: so much sooner than originally expected (I was told 4-6 months until running would be introduced).  All of this gets chalked up to keeping myself in shape with cross-training during injury, and being on top of my physical therapy after surgery.  I know I've said that a million times already, but I'm damn proud of it and can't recommend it enough!!

The return-to-run program gives me a set of steps to follow as I build mileage and endurance on my knee again.  Every time I do a run, I have to take 2-3 rest days in between before I do the next step in the progression.

To give you an idea of how it started, the first workout was:
Walk to .07 miles
Jog to .14 miles
Walk to .21 miles
Jog to .28 miles
Walk to .48 miles
Jog to .61 miles
Walk to .74 miles
Jog to .87 miles
Walk to 1.00 miles

So when I say baby steps, I mean we are taking BABY.STEPS.  But again, I followed this to the letter.  My PT also cut my appointments back to once every 2 weeks now, and I only have to do my PT exercises at home 3x/week.

I am up to step 7 of the run program as of this writing (9/28), and today my run was:
Slow jog to .13
Jog to .38
Slow jog to .51
Jog to .76
Slow jog to .89
Jog to 1.14
Slow jog to 1.52
Jog to 1.77
Slow jog to 1.90
Jog to 2.15
Slow jog to 2.28
Jog to 2.53
Slow jog to 2.66
Jog to 2.91
Slow jog to 3.16 miles

I'm up to 5K now, no walk breaks!  I feel no knee pain after my runs.  The only thing I've had to watch for is calf/hamstring tightness; those muscle groups are having a harder time adapting back to running, but I've found that extra foam-rolling and rest brings a lot of improvement.  It gets easier with every run.  Now, I'm planning to run an easy 5K with my 5-year-old this December, and I have confidence that I'll be on track to run the half marathon I deferred in May 2020.  :)

So that's that, peeps!  I hope this answered some questions that other athletes may have going into an injury and/or surgery of this nature.  I know a blog post like this would have eased my mind a lot beforehand.  A meniscus repair is NOT like a meniscectomy, and a root repair is its own beast as well.  I know this isn't affecting a huge population of athletes, but if at least one gets some solid info from this, I feel good about it!

Feel free to hit me with comments and questions below (or on my IG)...happy running!
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