Hi Doug,
I have a question about your meniscus tear. How did you treat it without surgery? Was it just by doing your Fusion training? And how long did it take to fully heal?
I’m a professional dancer and yoga teacher with a mild medial meniscus tear on both knees (no clicking or giving way… but definitely reduced ROM in flexion and weight bearing ability), I’ve been off dancing for 2.5 months now, and I’ve had to reduce and modify my yoga practice a great deal since. I’m trying to let my menisci heal on their own with conservative physical therapy, since I am not a good candidate for surgery according to my physio anyway because of the mildness of my symptoms, but I am losing muscle strength especially in my legs from not being able to dance/do yoga and exercise enough without aggravating the injury.
I am really hoping to resume dancing and doing a full yoga practice soon, even though I know it will probably take more time than I want to.
Thank you in advance for your response.
Miriam (not her real name)
What Happened
Thanks, Miriam for your question and for sharing your situation.
Just to bring everyone else up to speed, several years ago, I slipped getting up off the floor and my right knee sort of twisted and buckled making a loud snapping sound.
I was working with a client at the time and it was loud enough that she stopped and said, “Oh my God, are you alright?”
Well, that snapping sound as my right medial meniscus tearing apart. What followed was a couple of months of limping, my knee giving way, locking up and a generally frustrating period of time.
I did my best to rebuild the strength of my joint and leg but the tear was just too large.
Almost twenty years ago, I tore the left medial meniscus playing basketball and ended up in surgery. I had the same symptoms then as I did in this more recent injury, so in my mind, I was thinking, “I do not want to go through surgery”.
What I Did
I had helped people recover and rebuild following platelet-rich plasma injections (PRP) and had done some additional research on it. I thought there may be some benefit to giving that a shot (no pun intended 🙂
The PRP process consists of drawing some blood, spinning it in a centrifuge and then injecting the platelets into the injured tissue. Platelets carry certain proteins – growth factors – that help tissue heal. The PRP process concentrates the growth factors by up to ten times the normal amount.
There wasn’t any scientific data at the time to show that this idea – injecting the meniscus with PRP – would work. So, it was an expensive gamble with the injections costing anywhere from $750 to $1000.
But, I’m an “early adopter” and like to test new things. So, PRP was the choice for me.
My knee post-PRP
I had the injection and also had some knee pain from it. My knee swelled up like someone had stuffed a small apple in it. I was on crutches for about three weeks. This was my choice mostly. I felt that the injured tissue might be too fragile to withstand full weight-bearing right away. Again, no data to prove it but it made sense to me.
After about seven days, I started a joint strengthening program – this was partial weight-bearing – and then proceeded from there into rebuilding the strength and capacity of my leg. My program was based on what I present in my books “The Runner’s Knee Bible” and “The 90 Day Knee Arthritis Remedy“.
I had a great result from this process.
But, it took quite a while for my knee to return to “normal”.
You not only need to be willing to experiment but you also MUST be patient.
After about one year, I had almost 100% return of normal motion, had no symptoms, I could exercise consistently and my knee felt solid.
Progress though is not linear and there’s an interesting, well, maybe bizarre is a better word, response that your body has to PRP.
The Prolocoaster
We call it the “prolocoaster”.
About eight to twelve weeks after the injection, my knee suddenly felt a lot worse. More like it did before I had the injection and I thought, “Did I somehow mess this up? Is the meniscus torn again?”
I knew about this phenomenon having helped a number of people post-PRP injection but knowing about it and living it are different things.
These cycles of feeling good and feeling not so good continued for about a year and then just dissipated.
Not everyone has the same response though to PRP. Some people have less pain; some more. Some go through the “prolocoaster” more often; some less. Some people have a great result and some don’t.
Why?
There are a couple of reasons for a poor outcome.
There’s variability in how the PRP injections are administered. Some physicians use imaging to guide them, help them identify where the PRP needs to go while others do not use guidance.
The post-injection process or protocol also varies a lot. Some doctors give general advice such as “Don’t exercise any harder than you did before the injection” or “Take it slow and if something hurts avoid doing it for a while” and others might use a more detailed protocol.
But, there’s a lot going on in this general area of “regenerative medicine” and there’s some encouraging research.
UPDATE: When I wrote this post, PRP was considered highly experimental. I had been invited to give a presentation in May 2011 at the American Association of Orthopedic Medicine Annual Conference – “Regenerative Orthopedic Medicine – Applications through the Lifespan” in Las Vegas. While I was there, I met and visited with a number of researchers who were investigating alternative methods of healing using the body’s own natural healing processes. PRP was one of the methods and there were a number of stem cell papers as well. Since then, PRP injections have become much more commonplace (although not generally covered by health insurance) and the procedures have improved considerably.
For a small meniscus tear, we’ve had fairly good success using the principles I outlined in my books “The Runner’s Knee Bible” and “The 90 Day Knee Arthritis Remedy” but if you can add PRP to the equation, I think you “stack the deck” in your favor. Sometimes surgery is the only option but I would do my best to avoid it.
Why Choose PRP over Surgery for a Meniscus Tear?
All surgery carries significant risk. We tend to forget this with how commonplace surgery is in our society. But things like stroke, infection, and even death are in the fine print on all of the waivers for surgery so really think about what you’re doing.
Removing part of your meniscus increases your chances of osteoarthritis in later years. The meniscus, in addition to being a shock absorber for your knee, helps keep it stable. When you remove a portion of the meniscus, you destabilize the knee and allow it to shift in very small amounts. No articular joint in the body likes shifting or sliding and the result is a gradual deterioration of the joint if you’re not very mindful of what you do. Some surgeries though do not remove the meniscus but repair it which is a much better choice. However, most surgeons make that decision based on the size and general stability of the tear.
It’s less expensive. Yes, PRP is generally not covered by insurance but if like a lot of people, you have a high deductible plan, then you’re out of pocket expenses for surgery will be more than the cost of PRP.
Surgery is not a quick fix. I’ve met with thousands of people who all seem to have the same idea about surgery – just cut out whatever is wrong and I’ll be good to go. Not true. Yes, sometimes people with a small tear can have surgery and be up and about quickly but if you have a large tear then post-operatively you’ll want to go through rehab (your surgeon may argue about that unless he owns his own rehab – funny how that works) which can be a 2-4 month process. And getting back to impact activities like running or jumping, etc can be even longer. So, don’t delude yourself that surgery is in and out and all is well.
Sometimes you can’t. In my case, the tear was certainly large enough that surgery was a real possibility and likely the only other option if the PRP failed (in fact, the doctor wasn’t at all sure that the PRP would work for me because of the kind of tear I had).
Non-surgical options for meniscus tears continue to improve so before you opt for surgery, investigate all of your options and weigh them carefully.
