Runners/medical types: Referred to an orthopedic *surgeon* for a minor knee problem?

Factual Questions
1

Not looking for medical advice, just thoughts on what the doctor might say (and whether he’s the right one to see).

OK, so I took up running last year, having progressed from walking while I lost 75 pounds. I ran my first 5K in April 2010, then progressed to a few 10Ks and my first half marathon in September. Kept up a moderate amount of outdoor running through the winter, then started gearing up in March or so for my second half marathon this past April 30.

All this time I’ve been doing fine, no pain other than normal soreness after really long (for me) runs. But about a month ago I started feeling a “twinge” in my right knee. Not really pain, just “hmm, something going on there.” Didn’t affect my running at all.

But the Sunday before the half, hubby and I were going to do a slow, easy 10-mile run to town and back. I made it about 1/2 mile and the knee said, “Stop.” Couldn’t run on it. Kind of like a pinched nerve. So I walked it off, and after maybe another 1/4 mile it felt better. So we walked some more, and our 10-mile run turned into a 10-mile walk/run, with more emphasis on “walk” than “run.”

So I figured perhaps I’d been overtraining a bit, and I rested it all that week before the half: only walking, and maybe a 12-mile slow bike ride on Friday.

At the half on April 30, I took a very easy pace, babying the knee. Started feeling the minor, doesn’t-affect-my-pace twinge around mile 2. But I ran through it and was feeling pretty good until about mile 8½, when it shouted “Uncle” again and I had to walk. I finished the half with about 5 walk breaks from that point to the end.

Well, crap. I figured I’d have to start paying close attention and decide if I should see a doctor, because I am (was? say it ain’t so!) supposed to start a marathon training program with the local running group on May 21. We were scheduled for a 5K race this past Saturday, so I thought I’d give it more rest and see what happened. Again, walking only (which bothers it not at all), and no biking (only because the weather was too rainy).

At the 5K this past Saturday (May 7), I was doing fine until about mile 2½ – dammit! Had to walk again. Managed a baby jog across the finish line. This is definitely wrong. I should be able to run a stupid 5K.

There was a medical tent at the race (there was also a half marathon at the event), and I stopped in to talk to the sports doctor there. He had me lie down and bent me this way and that and asked me questions. He said my kneecap looked out of alignment and I might have patellofemoral syndrome. And that because I wanted to start marathon training, I should definitely see a sports doc and get an assessment and see about possible PT, exercises, training plan, etc. That made me feel better, to know that I wasn’t being paranoid.

I called my GP this morning and got in right away. She took a look, ordered an X-ray, and asked me who I wanted to see. I had brought a printout from my insurance company’s Web site, but when they called, they were told that the docs on that list weren’t current. So my doc set me up with a Dr. M. Appointment is next Monday.

I got home and looked him up, and he’s listed as an orthopedic surgeon. Surgeon? I’ve got a minor glitch in my knee. I don’t think we need to talk about surgery! But perhaps I’m focusing too much on “surgeon” and not enough on “orthopedic”?

I guess I want to know more about what to expect. I was hoping to see someone who would be specifically sports-oriented and help advise me on how to fix this problem and still get to my marathon goal. Instead, now I’m picturing a variant of the old joke: “Doc, it hurts when I do this.” “So don’t do that!” Sure, my knee hurts only after I’ve been running for some distance. But I don’t want to just be told not to run. It helps me keep my weight down, and I’ve really gotten to enjoy it, and I’ve spent all this money on fancy gear. :slight_smile:

I’d hate to be a doctor shopper, but I’m envisioning having to do homework on local sports medicine specialists (more like the guy I saw at the race) and go back to my GP and saying, “This time, please refer me to one of these guys” and handing over a (new) list.

Hoping more knowledgable Dopers can ease my mind.

2

Yes, focus more on the “orthopedic” and less on the “surgeon”. They’re the ones that know about joints and soft-tissue injuries as well as bones, and a good one will try to avoid surgery, and then if it’s indicated, give you a good idea of your options, potential side effects, and outcomes.

The good thing about the sports docs is that they understand you want to be able to do more than walk around, and will focus on what you need to function in your sport. There can be a lot of physical therapy and medical management involved, but remember the surgeons’ slogan “a chance to cut is a chance to cure”. There’s a lot of knee conditions that don’t need surgery, but the ones that do can lead to a partial or complete return to function.

I say this as an old lady who has had meniscus surgery on both knees in the past ten years, and returned to playing soccer afterwards.

And definitely do some discreet doctor shopping, especially for opinions of runners and athletes you know. My initial surgeon referral was from a list via my PCP’s reception staff. When I saw my PCP soon after the first knee evaluation, she expressly warned me away from that guy (on her practice’s own list!) and got me a referral to another guy she said was much better. He’s the one who did my surgeries. If you get to the point that somebody recommends surgery, do all the research you can. Most insurance will cover a second opinion.

3

IANAD, but I’ve had a crapload of knee problems from volleyball and running.

I agree that you should ask the running community for a reference…and also that you shouldn’t focus on the word surgeon. If you have professional or college sports teams in the area, you could try to use their doctor, if he/she has a private practice. I’ve done that a few times with good results.

My orthopedic happens to be a surgeon…I’ve seen him a half dozen times for various knee and shoulder issues, and he hasn’t cut me open yet. I used to have problems with my patella tendon in each knee…I partially tore them back in my volleyball days. Recently, my knee pain has been on the outside part of the right knee.

Does your knee hurt more when turning, compared to going straight? That’s a useful piece of information for your doctor. If you don’t know…go find out. Carefully, of course.

I predict that you have tendinitis of some sort…will be told to take a brief rest…then put on a stretching and targeted strengthening program, possibly via physical therapy for a few weeks. You’ll also be told to ice well after you exercise, and possibly be advised to take some ibuprofen.

That’s assuming you didn’t tear anything. But nothing in your description makes me think that you did.

-D/a

4

I will be seeing an orthopedic surgeon for a minor knee problem in a couple of weeks and I had the exact same reaction as you. Make sure that your surgeon specializes in knees and sports medicine and rest assured that you are seeing the right person.

5

There may also be an element of terminology here.

Iirc, in the Middle Ages, there were two branches of practice, “medicine”, and “surgery”. Medicine had to do with prescribing drugs and possibly talk therapy. Surgery was anything hands-on, e.g. fracture setting, splinter removal, massage therapy, and anything else that required the doctor to actually touch you, including cut-open-the body operations that are now regarded as “surgery”.

6

An orthopedic surgeon should know and use both surgical and non-surgical treatments for musculoskeletal problems. Are there bad ones who rush to the knife? Absolutely. But you can’t tell by title alone.

7

OK, I guess I’ll find out more about the guy when I go see him. One of the running stores we frequent has a monthly free injury screening, which this month just happens to be this Thursday night. I may see if I can sign up for a slot just to get another source of input and maybe a recommendation.

Digital, as far as turning/straight, the answer is pretty much “neither.” It’s more an acute, “tipping point” type pain. I’m running and I can feel it sort of coming on (kind of like an orgasm, only nowhere near as much fun :slight_smile: ). Then all at once, BAM and I can’t run on it and I have to stop and walk. A minute of two or walking and it’s fine again. Lather, rinse, repeat.

I just got back from a brisk 3.7-mile walk. Knee feels fine.

8

The clinic just called. The X-rays showed a little arthritis in the knee. Yay. Add to that the arthritis I’ve already got in my neck, back, and big friggin’ toe and I might as well order my wheelchair right now.

9

Here ya go. :smiley:

There is evidence that staying as active as possible is the best thing for arthritis though you may need to change sports if it comes to that.

10

Caveat: I am not a doctor… just a runner with the usual list of “had it” injuries :slight_smile:

I wouldn’t expect arthritis to cause the “all of a sudden” type pain you are experiencing. It doesn’t sound like tendonitis either. In my experience that’s usually slower build up and doesn’t go away the next day. The kind of intermittent issue you have has got to be extremely frustrating.

Even if it is some sort of cartilage or tendon/ligament thing that needs cleaned up with surgery I wouldn’t stress about it too much. I run with a few folks that have had their knee scoped out (meniscus trimming I think) and are back to running within months and are faster than they ever have (including a marathon PR and BQ.)

I entirely understand the desire for the goal marathon (and I’ve run a few races while being probably-to-sick-to-be-running-but-screw-it), but try to look at the long term picture. There are plenty of marathons to run. This isn’t the last marathon on earth :slight_smile:

Even if the first doc calls for the knife you can always (and probably should) get a second opinion. He won’t cut you open on the first visit.

Good luck with the diagnosis. I hope they find the actual problem and you get get it resolved quickly, via whatever means, and get back out on the roads/trails.

PS: cycling, swimming ,and water-running may all be options for you to maintain fitness.

11

The only thing I’ll add is to make sure you’re being referred to the “knee guy” within an ortho group. I had a knee issue and was referred to an orhtopedic surgeon in a group who ended up telling me he’s really the “elbow/shoulder guy” and had to get yet another reference. Try and save yourself that hassle if possible.

12

And the funny thing is that some of the “surgery” isn’t what I would call surgery. I hurt my shoulder once, saw an orthopedic surgeon, and got billed for surgery that was coded “CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE”. “Closed” meaning not open meaning no incisions or such.

13

runner pat: Hardy har har. :stuck_out_tongue:

It just figures, I’m registered for all these races this year! Half marathons in August and September (which align with the long-run mileage for the marathon training program) plus the marathon later in September. I think all nonrefundable. That would be a lot of money down the rathole.

I’m also signed up for a marathon WALK on June 4. That should still be doable, I think, but part of the reason for it is to provide a baseline max time for running the September marathon.

The arthritis in my big toe is the only one that “jabs” me, but that only happens when I’m sitting or lying down. So far it hasn’t acted up when I’m running (thank Og). But my plantar warts do their fair share. I had them burned off once, but never again. I’ll just live with them.

I could live with switching to cycling, if it came to that. I rode a fair amount in college and even did a (slow, leisurely) century once. But I’d still need something to do in the winter. Swimming is out because there’s no pool close by, and I’m not driving 40 miles minimum round trip daily just to get to the place where I want to exercise. I don’t have that kind of time in my day. With running, I step out my front door and I’m ready to go, no time or gas required. I’ve got an elliptical that I like, but how boring and lonely for every day.

ETA: I did snag an appointment for a free screening at the running store on Thursday night.

14

I didn’t mean permanently (though that’s an option I guess). I just meant while you deal with the current knee issue. Of course you’ll be back running again! (Optimism!)

Also, it doesn’t hurt to ask about refunds. The worst they’ll say is no! Of course, you should wait until after you get a solid diagnosis if what’s actually going on. Given the races are a few months away you may only be out a $20 processing fee. Some race directors may let you defer to next year (at no or minimal cost).

15

Oh sure, unless the doc prohibits it (and I can’t imagine why he would) I would keep up with the cycle (I just bought a shiny new bike) and walking, and maybe elliptical. Guess I’m just thinking ahead to worst-case scenarios.

I suppose I could still technically “do” the marathon, just walk most of it if it comes to that. They close the course after 6 hours, but there’s an early start 2 hours earlier. I’m hoping to do the walking marathon in 6 hours or less, so I could probably finish the regular one with mostly walking and a bit of running – just with my time in the toilet.

16

Surgery is considered a last resort for Patellofemoral syndrome.

Expect an MRI of your knee to exclude a meniscal or ligamental injury and unusual causes of knee pain.

Orthopaedic surgeons tend not to be knife happy- many of them went into that specialty because of their own interest in and enjoyment of sports. They’re all about regaining function and returning to activities you enjoy.