Dr.,I have a torn medial meniscus on my left knee. It has
limited my
> running for several months as it catches and causes discomfort. I've had
> two(2)months of therapy and it is feeling much better. My question is
this;
> Should I have surgery to remove the debris that keeps catching and causing
> twinging and discomfort or live with it for a while? I have recently built
> up to longer runs and am pushing it a bit w/out pain. Thank you. LT
Larry:
I am really sorry to hear about your meniscus tear. This is one of those
injuries you can run with but it is never to maximum efforts or capacities.
Unfortunately, the stresses of hill and high speed running- track intervals-
will inevitably cause your knee to swell and ache after workouts. You may be
able to get away with low to moderate mileage at modest speeds but in my
experience when attempting to step up the tempo and/or mileage to race or
progress the knee will revolt with swelling, pain, and locking and catching.
My husband has suffered this same injury and had arthroscopic surgery and
was able to return to running without pain or swelling in the knee. The
rehab time to return to running is usually about 12 weeks conservatively so
plan this same day surgery during your off season for running. The simple
answer is , when the pain and swelling become recurring and are limiting
your running pleasure and hampering your day to day activities with your
kids,stair climbing , etc, then it is time to consider surgery which will
put you on the shelf for running for a couple to 3 months but long term will
likely return you to pain free , unhampered running. It needs to be
mentioned that meniscus tears in general will not heal on there own,(a rare
few minor cases may have enough blood supply to the injury zone that repair
is possible without surgery- but these are a minor few cases) You will know
as your knee will inform you with pain and swelling which is recurring when
it is time to consider arthroscopic surgery.
Should you decide to go this route please write back as selection of
Orthopedist is crucial and selection of post-op physical therapist is just
as important in assuring your full return to pain free running. I would be
happy to assist you in those choices should you elect surgery. Best of Luck
Larry, Sandy Gibney MD
____________________________________________________________________________________________
Dearest Sandy!
>
> Hurray! A doc that runs!! Might you also have a family practice where you
are
> accepting new patients? I am Wilmington Resident and am in dire need of
finding
> a real doc that understands us hoofers (in our mid 40's).
>
> Many, many thanks!!!! Susan:
Thanks so much for the kudos. Unfortunately I do not have a private office
at this time. I am board certified in Internal Medicine but at this time I
limit my practice to Emergency Medicine- the hours are more conducive to my
running schedule and lifestyle. There are several very good Sportsmedicine
family doctors in the area who are accepting patients. Dr John Hocutt has a
Family Practice office on Silverside Road in North Wilmington in Talleyville.
Dr Bernard King also is a FP doc with Sportmedicine Fellowship training.
Also Brian Shiple has a sportsmedicine practice as a FP doc on Sproul Road
off of Old Baltimore Pike in Media Pa. Unfortunately, I don't know of any
female family or internal doctors with a sportsmedicine emphasis but I will
research this a bit more and get back to you if I find a female runner with
a private practice and sportsmedicine credentials. In the mean time feel
free to contact me with any questions or concerns you might have and
hopefully I can a
nswer or direct you to an appropriate resource. Keep Running ! Sandy Gibney
MD
___________________________________________________________________________________________
Sept. 9, 2008
Doctor,
I have a slightly sore Achilles, what is the best course of action?
Dear Michael:
This is obviously a frequent runner's nemesis. I have answered a similar
question recently . Here is the answer I provided to another Achilles
tendonitis sufferer.
Congratulations on your running longevity !! You are an inspiration to
younger runners indeed. As I'm sure you are aware as a runner gets older the
flexibility of the muscles and ligaments lessens and the healing time for
strains, sprains and inflammatory conditions increases. Regardless, achilles
tendonitis is a real "bugger" of an injury- remitting and relapsing
frequently in a runners career. I've found certain runners are more prone
than others and it is often a question of foot type, foot strike and
flexibility- or lack thereof. The usual treatments to start with are rest,
ice, anti-inflammatory medication until you settle down the acute flare-up-
if possible. Once it settles down consider slant board stretching, a trial
of heel cups or heel inserts to take the stretch/stress off the tendon, and
consider an appointment with a podiatrist to evaluate for formal orthotic
inserts-if you foot type predisposes you to troubles.
I am assuming you have tried some or all of these things in the past. Some
runners have resorted to a corticosteroid injection after an unsucessful
trial of physical therapy with modalities such as ultrasound with
phonophoresis(using ultrasound to push medication into the tendon
non-invasively through the skin) or iontophoresis (using ionic current to do
the same.), massage by therapist, water running, proprioceptive exercises
and complementary muscle strengthening., etc, etc. I'm not sure what you
have done up until now to address the problem, certainly hill running,
running up on your toes (racing) and track workouts or uneven surfaces are
all prone to aggrevate the tendon. As you can imagine, the approach is not
quite a straight forward cookbook approach and each runner will need to be
approached on an individual basis. I would suggest you work with a good
sportsmedicine oriented doctor, physical therapist or podiatrist to find a
program that allows you to heal then prevent furt
her flareups.
I hope I have answered your question, but please don't hesitate to write
back with more information or input.
___________________________________________________________________________________________
Sandy,
I’ve been running for 25+ years and I’m 59 years old (or young as we runners
like to say).
Anyway, I’m currently battling Achilles tendonitis in my left foot and would
like some advice as to what you consider the best course of treatment.
It seems as though I had been able to run with it but after doing the Blue
Rocks 5K last evening, it even hurts to walk today.
Thanks, Congratulations on your running longevity !! You are an
inspiration to younger runners indeed. As I'm sure you are aware as a runner
gets older the flexibility of the muscles and ligaments lessens and the
healing time for strains, sprains and inflammatory conditions increases.
Regardless, achilles tendonitis is a real "bugger" of an injury- remitting
and relapsing frequently in a runners career. I've found certain runners are
more prone than others and it is often a question of foot type, foot strike
and flexibility- or lack thereof. The usual treatments to start with are
rest, ice, anti-inflammatory medication until you settle down the acute
flare-up- if possible. Once it settles down consider slant board stretching,
a trial of heel cups or heel inserts to take the stretch/stress off the
tendon, and consider an appointment with a podiatrist to evaluate for formal
orthotic inserts-if you foot type predisposes you to troubles.
I am assuming you have tried some or all of these things in the past. Some
runners have resorted to a corticosteroid injection after an unsucessful
trial of physical therapy with modalities such as ultrasound with
phonophoresis(using ultrasound to push medication into the tendon
non-invasively through the skin) or iontophoresis (using ionic current to do
the same.), massage by therapist, water running, proprioceptive exercises
and complementary muscle strengthening., etc, etc. I'm not sure what you
have done up until now to address the problem, certainly hill running,
running up on your toes (racing) and track workouts or uneven surfaces are
all prone to aggrevate the tendon. As you can imagine, the approach is not
quite a straight forward cookbook approach and each runner will need to be
approached on an individual basis. I would suggest you work with a good
sportsmedicine oriented doctor, physical therapist or podiatrist to find a
program that allows you to heal then prevent further flareups. This is a
toughy Rudy, so good luck.
I hope I have answered your question, but please don't hesitate to write
back with more information or input. Sandra Gibney MD
________________________________________________________________________________________
Hello,
> My son just started cross country practice last week. We ran some over the
> summer and this is his first year. He is 13 and in 8th grade. He has been
> having pain right above his butt crack in a localized spot (it is not
spread
> around his lower back). He can't seem to shake it. He is not terribly
> flexible. We are wondering if that could be the issue or if we should take
him
> to the doctors.
> Any advice would be greatly appreciated!!
> Thanks!
KR Hi K:
> Thank you for your question. Your son's problem is likely one of two
things,
> (assuming he had no falls or trauma which I assume you would have
mentioned and
> already sought care for).
> The first is sacro-illitis- which is inflammation around the sacro-illiac
joint.
> This can come from overuse, uneven running surfaces, and inflexibility.
The
> treatment would be reduce mileage, soft even running surfaces, new shoes,
> stretching the low back area, and a trial of anti-inflammatory medication
such
> as ibuprofen 400mg taken with meals 3 times a day for 5 days.
> The second possibility is a stress fracture in the area from the
repetitive
> pounding of running.
> This condition will require rest from running completely.
> I suggest that you make an appointment with your family doctor. He or she
can
> examine your son , palpate and manipulate the area and get a sense what is
going
> on and what tests- if any- are appropriate. At your son's age of 13, he
should
> not be running with pain for more than 3 days - mild aches and pains can
last up
> to 3 days or so but beyond this, they deserve medical attention. I hope I
have
> answered your question. Dr Sandra M Gibney MD
>
-----------------------------------------------------------------------------------------------------------------------
Question: Young high school runners have a high propensity to suffer from
> > shin splints during the season. From my experience, shin splints are
> associated
> > with incorrectly fitting shoes and or a rapid increase in the number of
> > training miles...is there something else that growing children go
through
> > physiologically that adds to the incidence of shin splints. What advice
do
> you
> > have
> > for the kids to keep them running all season?
> >
> > Thanks,
> > C
> > XC Coach Hi C:
> Thank you for your great question. "Shin splints" is a generic term that
really
> encompasses a spectrum of problems to the anterior shin. There really is a
> progression of conditions that can develop with this problem if it remains
> unresolved ,and a runner continues to run. The tibialis anterior is the
muscle
> that attaches to the "shin bone", or tibia,which is the larger of the 2
bones of
> the lower leg. This muscle is chiefly responsible to dorsiflex the foot-
to
> bring the toes upwards on the swing and lift phase of the running cycle.
With
> the repetitive stress of foot strike- with forces transmitted up the tibia
bone
> and additionally the stress on the tibia bone from the tendinous
attachment of
> the tibialis anterior creates excessive forces on the bone. Given time,
the
> tibia can adapt to these forces and heal and remodel the bone. But when
> excessive and repeated forces are presented to the bone- it can not adapt-
and
> micro trauma occurs to the bone setting up inflammation. L
> eft unchecked this can progress to a stress reaction- and eventually a
stress
> fracture-microscopic fractures not seen on xray initially but seen on bone
scan
> or MRI.
> To answer your question specifically, stress fractures are not unique to
> runners or to growing children. They are seen in field hockey, lacrosse,
soccer
> and other running sports where repetitive forces are transmitted up the
tibia.
> Certainly a rapid increase in mileage will predispose an athlete, as will
shoes
> that have lost their shock absorbing qualities. I have not seen more
stress
> reactions in children than adults per se, but it is youth sports which
> accelerates the kids training programs rapidly beyond their ability to
adapt to
> these stresses. No youth should continue to run with shin pain for more
than 3
> days- this is a signal of more than simple muscle soreness. Ice, rest,
NSAIDS,
> and new shoes (if old ones are in use) are the first treatment modalities.
I
> hope I have answered your question.
>
> Sandra Gibney MD
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