Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Fastest way to Rehab/get back in shape

So I'm facing an arthroscopic knee surgery next month to hopefully fix a mysteriously painful knee (xrays/mri are normal, but i'm in constant pain) Does anyone happen to have any advice or suggestions for getting back into shape and rehabbing a knee quickly enough to make a Whitney attempt this fall? I realize it will depend a lot on what they find in the surgery and the extent of the 'fix' they may do. Just wondering if anyone here has been there done that so to speak.

For what it's worth I've summitted Whitney twice, and before September (when the pain made it impossible to hike) I was always out hiking/camping. So while I am out of shape now, I do have plenty of experience to fall back on in the long run.

Thanks in advance for any tips or suggestions =)

Tif: There is no fast way. Take my word, I went through 4 knee surgeries over about 8 years. You must follow the advise of the PT folks. If you do, your knee will last much longer than by trying to find the fast fix. Two years ago I had total knee replacement. Serious surgery. I was prepared to do whatever it took to get back to hiking, snowshoeing, etc. Nine months is the time it took to physically heal. I followed the routine religously and very seriously. Nine months and a day later I was standing on the summit of Mt Whitney. Best of luck!

Bob D

Thanks Bob D, while 9 months sounds way longer than I want to think about, your response is very uplifting and inspiring. Any advice for getting through a long rehab period? I've had 2 previous surgires on this knee, but one was when i was 14 and there was virtually no down time, the second surgery (at 22) i was out for a month tops...

It depends on what they find. A typical scope cleanup should be about a month if nothing out of the ordinary is found. I had the acl surgery 15 years ago and 6 months later I summitted Dana with a lot of hard rehab and following all PT instructions. I got scoped a few years ago and a constantly painful knee was pain free immediately and I was riding a bike less than a week after surgery. You need a ortho doc that understands what you need to do to be happy, hiking etc. My doc encourages a lot of movement right away. Biking, swimming and non impact stuff can be started almost immediately after surgery. Aerobically getting in shape is not a problem. Putting too much pressure on your knee too soon can cause problems. They won't operate on me anymore except for total knee replacement. Lots of Naproxen and hiking poles keep me going but the pain is back for good. Just wanted to share that with you because I think some of my problems were accelerated by ignoring pain. Like most backpackers I have a high tolerance to pain but when it comes to knees be careful and get professional help and follow their advice.

I get worried anytime someone says they are having surgery performed on something where there is a lot of pain but the MRI has not shown anything. There are a number of things they could find, but they may not find anything. They may also find a problem that they decide to fix surgically, when in fact it may not be necessary. Yes, it is always possible that the MRI may not show everything (part of that has to do with what position MRI's, and x-rays, for that matter, are taken, as well as the skill of the person taking them and the person evaluating them). But it is entirely possible that they go in there and see nothing that could, or should, be fixed surgically. Not knowing anything about your history except the fact that you have had two previous surgeries on the knee, it is probable that you have developed a number of biomechanical and muscle dysfunctions. Have you had the knee evaluated by an orthopedist who understands concepts such as Patellofemoral syndrome, tibial torsion, femoral anteversion, IT Band syndrome, and how to correct these issues non-surgically? Because it is possible that you are having problems with the kneecap (this is of course a guess on my part) and this can be corrected non-surgically. The fact that your doctor has not been able to give you any possible causes of your knee pain (at least none that you have mentioned) does not give me a whole lot of confidence in his/her diagnostic skills. Any surgery should not be taken lightly...especially if a proper evaluation and possibly PT under a skilled Physical Therapist or rehab specialist can avoid it.

You’ve been given some great advice: Make sure you have a good surgeon; follow the physical therapy religiously; and don’t go back to the mountains before they tell you it’s OK.

With my right knee, I went to Dr. Stephen Lombardo at Kerlan-Jobe in LA; he had done a great job with my Achilles tendon a few years back. If you haven’t heard of Kerlan-Jobe, you haven’t done enough research.

Anyway, arthroscopy to repair/remove torn meniscus was done September 9, 1992. On October 25 I climbed Telescope Peak. It might have been sooner, but I had a large (3 x 1 ½ cm) bone spur removed from deep in my ankle joint at the same time. Several other mountains followed, then in March it was off to the Himalaya for two months, for a try at Shishapangma. Lots of climbing on that trip.

Three years later, I went back to Lombardo for my left knee—same surgery. Thirty days after the surgery, I managed a day climb of Mt. Whitney (11 hours round trip).

Now, these arthroscopies were minor, compared to the other possibilities you may be facing. Nevertheless, my experiences give you an idea of what the bright side may bring.

I had arthro back in 1987 on my left knee while in the military. Hurt it while playing softball at first base. Runner stumbles and crashes into my leg. Ouch.

Surgery. 30 days of convalescent leave. The surgeon slapped my leg in a cast cause I told him I couldn't wait to get back out and play softball.

Doc said my knee would become a barometer.

Cast came off. I could grab a handful of flesh on my thigh. Atrophy.

I rehabbed my own knee. The military didn't have the time or resources.

It took time. Hit the gym with leg extensions (light weights high reps) and the stationary bike (5 minutes, then 10, then 15...).

My knee has not given me any problems. I was lucky.

Don't be in any hurry to get back out there. Make Mecca West your goal for next year. You can live in the mountains, but you have to live with yourself first. Your life comes first and foremost.

After your recovery and rehab, and you are standing on the mountain...

I did it!

Have fun and take care! You'll do just fine.

In 1994 surgeon #1 said stop backpacking and predicted I needed would need total knee replacement within 10 years. He is dead now, I am still here. Surgeon #2 performed arthroscopic chondroplasty 1994, stating that "we don't always see that this helps." Five months later I was on Whitney and on the way over the years to Orizaba, Aconcagua, several Himalayan peaks, New Zealand peaks, all of the JMT, Whitney Mountaineers route, etc, etc, all of the above with my parts intact and still going strong in 2010.

After surgery I required weight bearing immobilization brace and rented an insurance-approved passive motion machine for 6 hrs a day for a month. Surgeon says most people don't stick with it - no wonder: 2 hrs in the morning before work, 1 hr at lunch, 1 hr at dinner, and 2 hrs late evening. Big commitment. Strap your leg into it, the motor slowly moves your leg passively through full range of motion. I suppose one could do it manually, but who would continue to slowly do this for hours on end? Why do it?? the lubrication, oxygenation, and nutrition of the cartilege depends on joint fluid, not blood. This kept the joint juices flowing until I could start walking again. Ask if this post-op PT is appropriate for your particular type of condition/repair. It may or not be.

I had surgery for a torn miniscus a few years ago. Rehab went quicker than I thought possible - but soon developed into a stealthy guess-what's-coming-next game. Would feel fine with little pain, but somehow do a random mystery move that generated an icepick through the knee sensation. I was a full up round within 6 months. Surgery was in late fall, but I still managed to be in shape for a July 2-week loop out of Horseshoe. Key was that once able, I was a fanatic about keeping the "get my sorry ass back into shape" schedule.

Couple years later I had rotator cuff surgery-Rehab from that took much longer and was much more painful.

Two answers to your question:

1. A couple of posters have mentioned reasonable cautionary tales. If you've not already done so, a second opinion would be reasonable, and is not insulting to the surgeon. Bob mentioned Kerlan-Jobe, which is spot on. I see you live in Glendale, in the area are Bill Stetson and Scott Powell. Powell was senior Kerlan-Jobe surgeon, and Stetson was senior Southern California Orthopedic Institute(competitor to Kerlan-Jobe) surgeon. Stetson is currently team physician for US Mens Vollyball, and US Olympic Team, Powell is team physician for US Women's Soccer, and the US Olympic Team. They do most of their surgery at Glendale Adventist Medical Center. I know them both, and would let them cut on me.

http://www.stetsonpowell.com/

(Scott Powell was also the lead singer with the group Sha Na Na, and it is worth a visit to their office, just to see the memorabilia from all the concerts, and all the sports figures, on their walls)

2. When you have surgery on your knee, there is atrophy that comes from the non-use that occurs pre and post-op. One of the primary factors that determines recovery rate, is the condition of the knee unit PRIOR to surgery. There is nothing you can do about the injured tissue, however, you can do a lot to strengthen the muscles surrounding the knee, and this will significantly speed recovery. It is one reason that professional-level athletes recover so fast, they start out in such great shape, and typically have procedures done right away, before there is much muscle atrophy from disuse. You can figure out exercises for this on your own, but in my opinion, the BEST thing to do is to have a PRE-op physical therapy visit to instruct you on a home program to start NOW, to make your knee as strong as possible before surgery.

Thanks big time to everyone who has taken the time to reply to me. While I've been through 2 knee surgeries before, I was not into hiking/backpacking at the time, and as such have no frame of reference for the recovery time to get back into the mountains. Hearing your experiences is both inspiring and helpful to set some goals for myself.

Of course I will listen to what the Dr and PT's have to say as far as what is doable and when it is doable.

To answer a few concerns that some of you have posted: This surgery was not scheduled lightly, my Dr. (an orthopedic surgeon) tried the wait it out, physical therapy, rest, anti-inflamatory route, and the pain did nothing but increase over time. I forgot to mention in my original post that after my second surgery I had no problems until I fell in Dec of 08 on a hike on Baldy. That is when all this mess started up again for me.

I too am slightly cautious about going in for surgery with 'clean' scans, but my first surgery was done after 1.5 years of clean scans and they found a kneecap that was tracking out of place. Also my mom and uncle have both had torn meniscus (menisci?) that have not shown up on scans/mri's.

It is completely possible (as the Dr. suggests too) that there is scar tissue causing some problems.

I will definitely do some research into the Dr's a couple of you have suggested. I greatly appreciate the information. I will also ask about the passive motion machine thingie - I've heard of them before, and had a friend in college that had one after ACL reconstruction. It definitely seemed to speed up his recovery

Again, thanks so much for taking the time to share your experiences and knowledge with me. It's great moral support to know that so many have been there done that and are still able to get out there and do what we all love so much... climb and experience the mountains. You all rock! =)

Another story: I'm 60. No prior issues. I sprained my MCL and had a "grade 2 signal" in my medial meniscus after a sledding mishap in Dec 08. Saw a sports doc, had PT, able to do a week backpacking on the JMT in July 09. But major knee twinges. Surgeon recommended arthroscopy - done 3 weeks ago (delay due to HMO issues...). No findings, other than some "peeling wallpaper" type bone changes, which he shaved. Rest, ice, elevation for 2 days, then up and about full weight bearing. Started PT 6 days post-op, going twice a week plus exercises at home. Hiking 3 miles a day as of 2 weeks post-op. Ice, ice ice after any exercise. PT says exercises help internal swelling, ice helps the external. Important to strengthen the muscles supporting the knee, also the hip. I can bend it to 138 degrees (as the PT measures it), good knee goes to 142. Painfree, other than twinges going downstairs or downhill. Can't kneel on that knee yet - still painful at the portal sites (where they put the scope in). Good news that nothing major was found, good news that the pain is gone from whatever it was, bad news is now having to recover from the insult of the procedure. I'm impatient too, but there's lots of exercise and training to be done without upsetting the recovery, so you don't completely flap out! Good luck. Barbara

I would say that if you have something simple like some torn meniscus you'll have no problem. If you're looking at a ligament repair like ACL; then your fall hike will probably be right at the timeline limit for recovery; an iffy proposition.

Here below is an earlier post regarding my knee surgery experiences. I recommend (as a layman patient) PT as soon as possible after surgery. For my ACL it was about three days post surgery and my PT wanted me there sooner. The passive motion machines are great to get ROM back; on my week at home post ACL I'd sit with that on the couch for hours at a time. They now even have those circulating ice wrap thingies.

Good luck

And my earlier post
I had my ACL done at age 28; even at that relativley young age, some advised against surgery. My doc asked my activities and said w/o a doubt I should have it done. I did not hurt my knee skiing, I did it local - so those concerns listed above would not have been in play.
These were key points to my doc
Originally Posted By: enf
Although the "best time" is unclear, the consensus is the outcome is better when the knee has no effusion, full range of motion, and adequate strength. Hence, immediate surgery, when the knee is swollen, is not optimal.


My wait from injury to surgery was about two weeks. This was about the time it took to see doc, schedule MRI, have MRI, see doc, schedule surgery with insurance approval. During this time I was getting a lot of PT. By the time of surgery I had very little swelling and most of my strength and ROM. I know others that waited up to 3-6 months. I wanted to get it done and over with and get on recovering.

I had the patella tendon method done and also had a medium bucket handle meniscus tear. I was awake and watched my surgery - very cool.

I began PT post surgery at three days and I felt this key. Some patients I met in PT had less aggressive docs who didn't send them to PT for many weeks. Those patients really suffered.

Since my doc has two kids to send thru college, I've since torn my meniscus twice more in the same knee and now am left with what my doc call about "5% - just to say you still have something there". During both of these subsequent surgeries my ACL graft was examined and reported fine.

It's been 15 years and I still run, hike, ski, snowboard, cycle, play hoops, football etc. It was about 9 months post ACL repair before I could do these things - on doc's orders for graft strength. I essentially lost an entire ski season. I am fortunate with no meniscus. My only problem is that I cannot run hard three days in a row - that's the only time I experience any knee pain (so far)

So, should you choose surgery, you also have to look at what type - cadaver graft, patella graft or hamstring tendon. There may be even other choices.

That's just my experience

Please listen to Ken he is absolutely right on about everything he said.The doctors he listed are excellent. Another SCOI knee specialist who is great is Dr. Ron Karzel,M.D.
http://www.scoi.com/

I might add there ain't nuttin' wrong with an "attempt." There ain't no law advising you not to be in the area. Won't cost you anything but gas and a place to stay and maybe a burger or two and fries as well as PANCAKES!

Heck, hike at your own leisure to Lone Pine Lake (don't push yourself too far) and take it all in. Feel the breeze. Feel the sun's warmth on your face. Soak your feet in the lake or streams. Smell those flowers. Take pictures. You might just see something you never saw on your previous attempts.

I feel just being in the Sierra Nevada is good therapeutic medicine anyhow.

So, GET OUT THERE THIS FALL!

Have fun.

I would second what Bob R. and Ken have mentioned. Kerlan/Jobe is one of the pre-eminent ortho clinics in the world, and are used to dealing with world-class athletes, which means they are familiar with sports injuries and getting you back to an active lifestyle.

You mentioned the mal-tracking patella on your second surgery. This falls into the Patellofemoral Syndrome I mentioned in my first post. Did they perform a lateral release? Just for your information, a mal-tracking patella can be diagnosed non-invasively, and in most cases can be corrected non-surgically, but you have to have a PT who understands how to approach it. Seeing as you've had a problem with this before, I would tend to lean towards this as the problem. It's also possible you have broken down some cartilage under the kneecap or over the condyles of the Femur, a result of uncorrected mal-tracking, which is giving you the pain. Also be aware that correcting mal-tracking surgically by such procedures as a lateral release typically only temporarily solves the problem for a very active individual in many cases.

Get the second opinion.

Thanks.

The first surgery was a lateral release, the second surgery was basically a repair of the first (it didn't heal quite as the first surgeon had intended) as well as a clean up inside my knee. The second surgeon was one of the US Ski Team dr's, and my current doc said it seems he did everything right and good. I didn't have problems with this stupid knee until I fell on Baldy last winter. (onto a rock in the trail of course..)

I'm going to look into the dr's that have been mentioned and see if it's possible to look into seeing them... unfortunately though i have Kaiser, so I don't know if itw ill be possible, but I may be able to at least get some information off their websites.

Again, I can't thank you all enough for all the encouraging words to get back out there when it's safe for me to. And for the reminder that attempts are fine even if i don't make the summit (though I do like my 2 for 2 record on whitney right now lol). I actually just got some new trekking poles (bd trail shock) off steep and cheap yesterday, so those will be waiting with my new purple camelbak pack for when my knee is ready for the trail.

I've been reading on this board for sometime now and have seen you give some great advice and support to others here, and I just want you all to know how much I appreciate you taking the time to give your insights both to me and to everyone else. It's beena great resource for hiking/backpacking, and now a great morale boost for me right now. I said it before and I'll say it again... you guys rock! =)

Tif: Have patience. Listen to what the physical therapist says. Also, be in as best shape as you can PRIOR to the surgery. That helps a great deal. You lose so much muscle tone going through the surgery that the better shape you are in before the surgery, the better you are coming out.

Bob

but I want to be in/on the mountains NOW!! haha

I need to work a bit more on the in shape before surgery part. It's been so hard to do anything (walking more than an average city block makes me want to claw my knee off most days). I really need to get back into the pool (i was a competitive swimmer through college) on my lunch hour - definitely one of the perks of working at a college... access to the gym/pool on a lunch hour a 5 minute walk from the office.

again, i can't thank everyone enough for really helping me keep/put this whole thing in perspective. As simple/uninvolved as this surgery might be, it's really been freaking me out and taking a toll on me mentally.

=) tif

++1. I highly recommend Kerlan-Jobe. The doctors there are first rate. I had my knee scoped in 2001 and the recovery was about 9-10 months. Back in April last year I ruptured my left biceps tendon (off the bone) and didn't hesitate to get in. The surgeon, an arm specialist who on staff with the Angels, reattached the tendon and after 6 months of frustrating PT (and following orders to the letter) I'm 100% cleared.

I lost a whole summer of real backpacking but hey the mountains are still there! Take your time, follow the PT and surgeon's orders and recommendations (after a 2nd opinion! ) , the mountains will be there.