On-going issues

Hi folks,

Would appreciate some brainstorming on an on going situation I am trying to get under control.

I am trying to get on top off of recurring knee and ankle issues but it's difficult to break the cycle.

As context I've had 3 kneecap dislocations -- age 13, 16 and 24. The most recent, age 24, was about 2 years and 8 months ago.

After the first two I more or less recovered normally with some discomfort after, though after the most recent one it has been a challenge.

More recently, eg the past couple of years, I've had ankle problems that when combined with the knee stuff make it hard to get momentum on any kind of program.

The problem with the knee right now is that it is 8-10 degrees short of full extension and in each of the last 2 April's I've had incidents where it has blown up seemingly unprovoked (massive swelling and quad/hamstring stiffness). In both cases I really just woke up with it and have no idea what happened.

I had an MRI in Sept 2015 that was essentially clean -- no meniscus issues, which is what an experienced chiropractor had thought clinically presented during the April knee blow-ups.

I saw a sports doctor in June 2016 and received a cortisone injection into the knee that has had some decent short-term effect. The swelling is down and it is generally closer to fully functional, though the extension has not improved, which is a major concern. It is not pain or swelling free post-cortisone, but I feel that there are situations where pre-cortisone it would have been a lot worse, if that makes sense.

The real problem is the on-going ankle issues. The first major one I can think of was May 2015 -- I just developed deep pain and swelling, and was told I had sprained it, but I can't think of any incident where that could have happened.

Once that settled down I was able to get through the summer, fall and most of winter feeling decently. I did have an incident where one of the ankles was in rough shape in February or so, but again I can't think of a trigger incident.

Over the winter, January-February, I got back onto a good physio program and was making good gains in knee muscle mass and generally feeling better. Then in April 2016 the knee swelled up massively for no apparent reason and I was not doing much for a good couple of weeks.

Then, right as I was getting over that and thinking of getting back into physio on the knee, there was an ankle incident -- again, no obvious trigger.

I then received the cortisone shot in early June and things somewhat/mostly stabilized for a bit. Late July, I had -another- ankle incident that took a week or ten days to stabilize, most of August was fine, then most recently I went through a period of 5 or so days of doing a lot of walking (I was feeling great ironically) and the ankle issue happened again.

So you can see and understand why it is hard for me to get much momentum going on anything.

I would identify a couple structural challenges at this point to a recovery:

1) General muscle stiffness everywhere in my lower body makes it hard to start exercising without feeling really sore

2) Fear of exercising causing another flare up – if something nasty happens I can be almost nonfunctional for the better part of a week, which isn’t really practical. It holds me back from just jumping into an exercise program.

I am the first person to agree that this could have been much better addressed in my teens and early 20’s (now almost 27) and that my own laziness (I find exercise incredibly boring) is a major factor in why it’s gotten to this stage. That said, at this point I am constantly thinking of how and what I can do to get better, so I honestly believe that the barriers I describe above are real and not just me being lazy and coming up with reasons to avoid doing anything about it.

I have a couple advantages to work with here:

1) Day to day I am still more or less entirely functional unless an acute episode such as an ankle “sprain” (quotation marks because I can’t ever think of spraining them, despite the sprain-like symptoms!) or knee flare-up have hit me. So fortunately I am not as far gone as a lot of people could be.

2) I have the resources and job/life flexibility to access top notch physio care

My general ideas are as follows:

1) Possibly return to sports medicine doctor for an update on me knee and perhaps further treatment – he had suggested maybe trying Platemet Rich Plasma, a cutting-edge treatment that apparently can be effective for healing, if the cortisone didn’t fix things. Perhaps I could also ask about cortisone in my ankles to grant me a period of stability?

2) Intensive rehab – the problem is I need a facility and therapist who can work with me daily and see how I respond to different things – for example if a certain new exercise or kind of stretching causes a flare-up that incapacitates me for a few days, I need the person who prescribed that to see what happened and treat it and then adjust what I can do, rather than just treating the flare-up ad hoc and then trying to get back to things.

3) While I work at a desk and don’t have much physical strain at work, the issue of being out for 8-10 hours a day can feel like a burden if I am trying to get on a program and especially if I have a flare-up that needs a lot of pain management and treatment to get back to a place where I can be comfortable and start doing activities again. I think I am at a place in job/life where I could take a few weeks off to do nothing but physio and get things back on track.

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