Sunday, October 18th, 2015 – A night to never forget. I have climbed on and off hay bales in my barn for years. On this night as I was standing on one hale bale just off the ground on top of a pallet with very minimal overhang of the bale, it decided to tip and roll over with me on it. This motion sent my right leg into the ground with an audible painful trust through my right bent knee. I let out a scream of horrible pain. In all my years, I’ve never felt something like this. I was sure something had to be fractured. Thank God I wasn’t alone in the barn and my friend helped me to limp back to the house. I felt a moment of hope that I didn’t have a major fracture as I could put weight on the leg, but the back of my knee felt immediately unstable and I was painfully tight on lateral knee above and behind the fibula bone and pain with my biceps femoris hamstring coming into my fibula. Prior to this injury, for someone my age with no arthritis and almost perfect knee MRI’s on both knees as shared in prior blogs of my www.fibularpain.com category of this website, having this trauma to my knee is a major setback. I am a very active horseback rider with physical chores to do and I love to dance at the Moose Club.
Oct. 19th, 2015 – I went to Lewiston Orthopedics instead of the emergency room because my local EMT said the emergency room would ultimately send me to orthopedics anyhow. I was using my crutches and my prior knee post op brace to protect my knee and help stabilize to keep my pain down. It was very difficult to walk. I was extremely grateful that they took x-rays and ruled out any fractures and they immediately ordered an MRI to see what was causing a lot of pain and swelling in my knee and my inability to fully extend or flex my knee. I asked about alignment of my knee and I was lead to believe unless they see the problem on an x-ray, then they were not concerned. The initial assessment: “right knee pain with large effusion with possible lateral meniscus tear.”
Oct. 20th, 2015 – I went to my physical therapist and he was greatly concerned with the amount of swelling (effusion) and the inability for me to straighten my knee, nor was he able to bend my knee very much. He was glad that an MRI would take place the next day.
Oct. 21st, 2015 – I went to my chiropractor, Dr. Sheldon, and I had him review my trauma and most importantly to check the alignment of my knee and my fibula bone. I had concern because of my prior Proximal Tibiofibular Arthrex Fixation surgery of my fibula to my tibia done in March of 2014 as discussed in this blog. Here is my YouTube video of Dr. Sheldon discussing with me his findings from his hands on exam and post adjustment.
At this point, I had so much pain surrounding the entire knee in my quad, calf and specifically my biceps femoris hamstring muscle as pictured on the right. These muscles were in a spastic lock down pattern protecting the entire knee. Actual joint pain was minimal compared to the surrounding muscle pain. For me, there was no doubt I was out of alignment in my joint and after Dr. Sheldon’s adjustment, I had an immediate 50% improvement in my ability to walk better. I followed up later in the day with another physical therapy appointment and my therapist spent over an hour massaging peroneals, gastroc/soleus and hamstrings to free up remaining spasms. I was lacking any internal rotation of my tibia to my femur and after the therapy my ROM came back.
I’ve attached the picture to the left to give a visual of what MRI report is referring to and here is the full report: MRI Rt Knee Injury 10-21-15
MRI Conclusion:
1. Impaction fracture involves the posterolateral tibia.
2. Hemarthrosis. (bleeding in the joint from impaction/bone bruise)
3. Low-grade MCL sprain and anteromedial capsuloretinacular sprain.
4. ACL sprain. No tear.
5. Post surgical change involves the fibula and proximal tibia.
I sent a copy of the MRI images overnight to the surgeon that had done my prior Tibiofibular surgery in Missouri. In the meantime, Lewiston Orthopedics called with the MRI results and offered to aspirate fluid from my joint, give me cortisone and a brace if I wanted. I declined the offer of cortisone as it will do nothing to heal the sprained ligaments. I want to help my body to heal and not mask symptoms.
Friday, Oct. 23rd, 2015 – Dr. Main, DO my board certified orthopedic surgeon from Midwest Bone and Joint Center called me and he thoroughly discussed his review of the MRI images I had sent him. He said no cortisone and he offered a series of Platelet Rich Plasma (PRP) injections into the partial low grade tear involving my ACL and a Breg Fusion ACL derotational brace that he uses with all of his athletes in this similar injury. I was invited to come to his clinic if I wanted to get on a plane and do so. I was able to put a plan in motion and I used frequent flyer miles for a free ticket to travel. Dr. Main’s office was very happy to work with me on short notice in their already busy schedule.
Sat. Oct. 24th, 2015 – A night to forget about myself and enjoy the hard work of my daughter, Ally, in celebrating with her. She won, for the 2nd year in a row, the Fitness Division of the GNC Night of Champions a national qualifying bodybuilding show in Spokane at the Northern Quest Casino/Resort. This facility is so big that I had to rent a wheelchair to get through the place as walking with crutches was out of the question for my elbows/wrists. Here are photos taken during her fitness routine.(click on photos to enlarge). Seeing my daughter perform just reminds me of those good old days when I was competing in my roller skating competitions at her age. Her fitness accomplishments also do inspire me to not give up and continue to get stronger.
Tues. Oct. 27th, 2015 – Delta airlines and wheelchair service got me to St. Louis, MO from Spokane, WA
Wed. Oct 28th, 2015 – I drove 2 1/2hrs from St. Louis to Macon, MO to see Dr. Main. Here are his chart note findings:
Diagnosis: 1. Partial low grade ACL tear, right knee, 2. Bone Bruise, right knee, 3. MCL sprain, right knee
Examination findings: “Today on examination she is noted to have a trace joint effusion present. She is tender to palpation along the course of the MCL, there is no tenderness overlying the quad tendon, patellar tendon. There is mild tenderness along the lateral tibial plateau. ROM is roughly full extension with flexion to 120 degrees. Her anterior drawer demonstrates a trace laxity. Her Lachman test demonstrates a trace laxity. Pivot shift is negative. Pivot glide is 1+ positive. McMurray’s testing is negative both medially and laterally. Her valgus stress demonstrates a trace laxity across the MCL with stable endpoint Varus stress in full extension as well as 30 degrees of flexion is negative for laxity. Her calf is soft and nontender with negative Homans and negative Moses sign. The proximal tibial articulation appears to be intact and stable.
Plan: “Based on her findings today I have recommended a course of physical therapy to work on closed chain strengthening exercises. She will also be placed into BREG fusion ACL derotational brace. We have discussed options regarding proceeding with autologous hemacyte tissue graft injection into her right knee, which she is in agreement with and elects to proceed. “
After the ultrasound guided injection of PRP into my anterolateral right knee and bracing secured, Loree(Dr. Main’s assistant) came to encourage me in my journey to recovery. I literally had a meltdown in her arms of panic, anxiety and depression all wrapped up into a good crying session. My dreams of working with my new horse were definitely squelched. Loree just listened till I got a grip. She then invited me to return should I not find a local doctor to continue with more PRP injections for my ACL that Dr. Main had recommended. I went to my favorite local hotel to rest for the night and then the next morning I drove back to St. Louis Airport.
Oct. 29th, 2015 – A wonderful day of flying home. I literally sat about 12 hours that day in all my airline and car travels. Yes my lower leg was swollen but the good news was my lower back/SI joints and buttocks had no pain whatsoever. That in itself is a miracle compared to many years of suffering in that area of my body.
Oct. 30th, 2015 – I followed up with a return visit to Lewiston Orthopedics to thank them very much for getting me my initial diagnostics and to let them know the route I had chosen for my own healing in going back to my doctor in Missouri. I believe it is very important to show respect to all providers, keep them informed in order to have the door open to return should I ever need them again in the future.
November 4th, 2015 – By this time, the intra articular pain was greatly reduced as I knew the PRP was working especially where the bone impaction on posterior lateral side had occurred. Besides my follow up Prolotherapy over my SI Ligaments, I had a Prolotherapy Injection done into the insertion points of my Medial Collateral Ligament at the medial Tibial Plateau done by my Osteopathic, Dr. Lenoue, III in Spokane. Since this ligament was also sprained, I wanted to give it the best boost I could to heal and tighten up with the Prolotherapy sooner than later.
November 12th, 2015 – I met with Dr. Tingstad, a new Orthopedic Doctor for me at Inland Orthopedics in Pullman, WA, to review my case and set me up for another future intra articular PRP Injection into my ACL as Dr. Main had recommended. Dr. Tingstad also felt from his exam that I would heal just fine with staying in the brace and physical therapy and he agreed to do a 2nd PRP Injection on Dec. 10th.
November 18th, 2015 – My best day thus far since the injury. I was able to do more leg presses on the machines at my local athletic club and my walking had improved tremendously. This night I was able to wear a low pair of heels and do some controlled(did not twist the knee) dancing at our local Moose Club; but of course, the brace was on my knee.
November 21-22, 2015 – While at my ranch home, I walked for the first time about 1/2 mile round trip to my mail box each day of the weekend. There was no pain in my knee. I just had to adjust the brace a few times in route but it felt so good to go out for a designated walk in addition to normal daily walking of life.
November 25th, 2015 -Besides Total Gym type leg press/squats (2 sets of 15), I was able to do some single leg Postural Restoration Style partial squats holding onto a chair in physical therapy on my right affected leg. By this time, I was also able to go without the brace for short walks back and forth within my home. But again, I’ve been very cautious in watching my steps without the brace. With the brace on, I have no choice but to go up and down stairs just to get in and out of my house. This has gotten so much easier week by week. I do go slowly with good body mechanics paying attention to any pain signals or not coming from my right knee. I saw Dr. Lenoue, III again this day as follow up, and I was still sore over the medial collateral ligament and the anterior medial joint line area of knee to touch. Due to the soreness, we did not do any more Prolotherapy at this time. Sore or not, my function has greatly improved as proven in physical therapy. I’m not out of the water yet. I was told at least 12 weeks of healing and strengthening time is needed before getting back to my more normal life.
November 26th, 2015 – A Happy Thanksgiving Day! After spending the night with our daughter and traveling 2 hours back home, I took a short walk for the first time around the blocks of my city home basking in the sunlight before the chill of the evening set in. I then sat down to finish this blog. It is now 4 weeks since the PRP injection and almost 6 weeks since the injury happened. I have been faithful to wear the brace full-time and while sleeping at night. Sometimes I substituted a 16inch knee immobilizer in place of the Breg Brace at night especially in the earlier weeks of healing. It just hurt too much to roll over and have any bending affecting the medial side of my knee; hence, no pain while immobilized at night. I still have signs of bruising below my kneecap over the anterior medial side of knee and down the tibial plateau/shin and some swelling in the tendon insertions around Pes Anserine Bursa.
My Patient to Patient Summary Advice: When an injury happens to your knee, get on it right away. If x-rays are negative, get an MRI to see what is going on inside the knee. Also see a chiropractor to check alignment. My experiences time and time again have taught me that alignment is always very important to facilitate healing. It was the Chiropractic adjustment that got me walking the best after the initial injury along with immediate physical therapy. Secondly, consider regenerative injections to ease the pain and promote healing. I believe 100% in PRP injections and I have now at least 9 places that PRP has been used in my body with success. As always, I do a lot of massage with Young Living Essential Oils and Infrared Heat therapy before my exercises. I do highly recommend the Breg Fusion Brace as being very comfortable, lightweight and functional for the ligament sprains I’m dealing with. I have no problem wearing the brace over my leggings. However, it would not work very well over much thicker pants.
I felt so depressed and discouraged during the first 2 weeks or so after this injury. I still haven’t been able to bond with my new horse very well as I cannot walk on sloping ground nor run around the uneven footing of my arena let alone even ride. My trainer and friends are taking the burden off of my shoulders regarding the horse. I felt like this knee injury would stop the race I was already running to finish in putting myself back together from my prior Sacroiliac Joint Dysfunction and the associated lower leg instabilites. However, God was faithful to help bring me out of the pit of despair and depression I was feeling from this injury and renew my hope to heal and get strength back into my right leg. A debt of gratitude and thanks to all my doctors and physical therapists that have helped me achieve my healing goals thus far. I will come back with a final update on my knee in the near future.
In the meantime, I need to finish the end of year business tasks and my social commitments of directing our Christmas Community Choir in order to get ready for my next surgery on my right foot Subtalar joint HyProCure Stent size reduction coming up before Christmas. For new readers, please go back to the blog before this one that discusses the subject pertaining to the upcoming surgery that I’m anxiously waiting to have done and over with. I close with Thanksgiving Blessings to all that read my blogs! Stay tuned or subscribe for future blog posts. Please like SI-Instability.com page on Facebook.
