I am slowly working my way back to practicing yoga. My orthopedic surgeon has given me a thumbs up on my recovery, and does not need to see me again. I have been putting in a daily average of 30 minutes walking and 30 minutes stationary bike for about a month. I've gone back to climb the eight flights of stairs of my office building. I've been doing some of the rehab exercises. I had a session of acupuncture on my knee today, and I'll get a massage tomorrow, so I've been lavishing care on my body.
If I do a lot of walking, I will have a little discomfort in my knee the following day and it will feel stiff. I've also noticed recently that I have a lot of discomfort in my right sit bone, probably due to the hamstring. I can't take sitting down for a long time.
I am aiming to start up yoga class again next Tuesday at Thrive Yoga. Pierre Couvillion will teach that evening. Although it's a relatively advanced, all-levels, vinyasa flow class, I would prefer to have the watchful eye of a yoga therapist watching as I move through the poses. He told me he could indicate modifications of those poses that might be risky for me.
I really miss the community of the yoga studio, and also the disciplined structure that a regular practice builds into my life. Even though I should have more "free time," I don't seem to get a lot more done. I really miss the big muscle movements from the vinyasa. Aerobic exercise or weight lifting does not provide the same kind of satisfaction.
I got to the gym twice this weekend, and put in two sessions of 60-minutes each on the stationary bike and another 25 minutes on the elliptical trainer. I lifted some weights, enough to make me sore two days later. During the week, I was able to do a few short sessions of rehab.
Earlier in the week, I got my sutures removed and the doc said that everything looked fine and to come back in three weeks. He suggested that I do some physical therapy to get back up to speed.
I also checked in with Pierre Couvillion who recommended that I take at least a month, maybe two, to ease myself back into yoga. Is he being overly cautious? Or am I just an ingrained overachiever who always has to push harder and farther.
More graphics than you may want to see of my torn meniscus,but I couldn't resist. Photo courtesy Dr. Graeter
Today is the first day in which I've been able to string two sentences together. I had my outpatient surgery on Friday afternoon, and was on pain medications until last night. I took off my surgical bandages yesterday, and now keep an Ace bandage to support my knee. I ice the knee as often as I can (15 minutes at a time). Yesterday, I was able to walk around without crutches. Today, I can climb stars. I can go down stairs only one step at a time, placing my injured leg first. The doctor says that I can start exercising on a stationary bicycle by next Saturday. I will get my stitches out early next week. I expect to be back at work tomorrow unless I wake up with a complication (say, overdid walking and stair climbing).
The operation itself went rather uneventfully. I had to wait about 90 minutes at the GW Hospital before they started the surgical prep. I guess they just want to make sure patients are on site and ready for the procedure, but it's boring. I was briefed about the procedure and given post-operation instructions. I was wheeled into the surgery room and I was unconscious before I could take in the full surrounding. I just noticed that it was chilly.
I got a second opinion on my knee injury about a month ago and decided to have orthopedic surgery with Dr. James Graeter because he's on my health insurance network and that will hold down costs. After he looked at my scans, he told me that yoga poses that are really dangerous for the knee are Ardha Baddha Padmottanasana, Gomukhasana A or any pose in which the knee is flexed sharply. The risk is that the meniscus will be pinched between the femur and tibia bones. In this type of pose, the leg is often rotated and that may put additional stress on the menisci or expose them to the bones in harmful ways. hero's pose (or Virasana) (or variations on it) is another risky pose because your upper body is pressing down on your legs.
Once I understood the knee's peculiar risk in yoga, I realized that precautions have to be taken. For instance, putting a rolled-up hand towel or blanket behind the knee so that the bones are stretched apart. Because you can put your knees at risk in both standing and sitting poses, you have to think hard about how best to wedge the towels between your calf and your thigh.
Because there are no nerves (or blood flow) in the menisci, there's no way of telling if damage happens. It's only when you have debris floating around in your knee bursa that problems develop. It can actually lock up your knee so that it can't move.
It's hard for me to fathom how I could have gone a whole month without writing here, after practically four years of steady commentary on my personal practice and the happenings of yoga in America and the world. Since my injury, there was a lot more shaken up than just my knee cartilage. Over four years, I structured my life around my yoga practice, focusing on making it to my classes first once a week, then twice, and, in the past two years, four times a week. And I fit the other parts of my practice around that routine -- pranayama, meditation, writing here and exploring how the whole experience shaped my life. With the injury, I lost an organizing axis around which my activities circulated. I seem to be able to do less in my day even though I have more "free" time on my hands. Go figure.
In more practical terms, I've had some time-consuming and mind-numbing issues with my computer. I had to reinstall my Windows XP operating system twice, and then reinstall my applications and configure the whole shebang according to my working habits. I would not wish that experience on anyone, and it drives home to me the need to be systematic about safeguarding data and taking precautionary measures. And I was supposed to be working on freelance web assignments and other duties during that period. There was at least two weekends, perhaps more, of my free time wiped out. I don't think I've caught up with the backlog of tasks yet.
This coming Friday, I will undergo arthroscopic surgery on my right knee to clean up my medial meniscus tear at George Washington University Hospital. It's outpatient so I will be home in the evening. I will be on my back for three-four days.
I sought out a conversation with Pierre Couvillion, a wandering yoga instructor and bodyworker, about my knee injury. Pierre has been filling some teaching holes at Thrive Yoga due to the August vacation absences. I wanted the opinion of someone who understood yoga and bodywork with a non-medical outlook to balance against what my doctor and acupuncturist told me. He recommended going ahead with the surgery because Western medicine deals more effectively with meniscus tears than other health alternatives.
Although I can trace my injury to the Rumbaugh workshop (part 1, part 2) a month ago because that's when it started to hurt, I can not say that it was the cause of the injury. At no time did I sense a jab of pain or feel that I had gone too far. It was only the next day that I notice a minor ache in my knee. It was two weeks after the event that the injury got in the way of my yoga practice. Pierre told me that injuries often happen at workshops because the "glow of a extraordinary teacher" frequently blind us to the limits of our bodies. I know that I was physically tired towards the end of the weekend, which is a double edge sword: the fatigue breaks down resistance in the body, but it can make me insensitive to the natural limits.
I've made major changes to my life style in the past five years. When I finished my Masters degree in May 2003, I was in sad shape. Working full time and getting a graduate degree, I smoked, ate poorly and was sedentary during work hours and at home. I was at least 30, maybe even 40 at times, pounds overweight. This blog documents my long slog back into a healthy life style. I've only been running since October last year. I've tried to increase my exercise regime's intensity gradually, both with the practice of yoga and running. That's why I adopted Chirunning, because it tried to reduce the heel's impact on the ground. But I could have abused my meniscus over the past year or worn it down over the past five years, or it could have been a problem that was just waiting for the right trigger to set it off, like a piece of paper that had been folded repeatedly in the same place and finally tore apart. Although I've tried to prevent myself from doing harmful things, like fit into lotus pose before my body was ready, I am still laboring with the body with tight hips that has sat in front of a computer for 20 years (if I had sat crosslegged on the ground all my life, I probably would not have this problem). My tight hips are going to stress my knees automatically, and I noticed that as my legs gradually moved closer to resting on the ground in easy pose, it increased the torque on the knees. I am one month short of being 59 years old, after all, and the body starts breaking down at this stage.
There are lots of adjustments that can be done to protect the knees, but when you have a torn meniscus, there's no way around it.
What I am trying to say is that my injury did not happen because I was a bad yogi who was misusing his body. It's not my fault. I think I was especially at risk because my tightly wound muscles were loosening a different speeds.
It's now confirmed: I have a torn medial meniscus that requires surgery. The debris poses a medium-term risk to the integrity of the knee, and Dr. Connell recommends cleaning up the knee by the end of the year, at the latest. He did not leave open a medical option for wait-and-see. The arthroscopic surgery is an outpatient procedure and requires three days of post-operative rest at home. It would then mean 4-6 weeks of recovery and physical therapy before taking up physical exercise. I could expect full recovery within three months.
Curiously, my knee was feeling fine today, with no pain or stiffness, so the news surprised me because I was imagining that I was recovering. If I had felt like this last week, I would never have gone to a doctor. The main problem of the meniscus is that it does not heal. It's a piece of cartilage that has no blood flow, and once it gets torn it becomes a piece of debris that can mess up the rest of the knee. Some people actually have their knees lock up on them because the meniscus moves between the bones and impedes movements.
But Dr Connell is in the business of solving problems by surgery so he has a professional, business and scientific bias to using surgery to fix injuries. He does have a reputation for not automatically prescribing surgery, which was one of my reasons for consulting him.
I already had an appointment with Kelly Welch, my acupuncturist, and so I asked him about the best course of action. He suggested waiting to see how my knee felt. He's had problems with both knees, at least one of them due to overaggressiveness in yoga poses. His biggest reservation about operating is that once part of the meniscus is removed, the knee can never return to its normal state.
He advised against future running because it put so much stress on the knee, even with the best technique. That's a kind of hypothetical questions because I don't have enough confidence to even jog. We closed out the session with acupuncture and electrical stimulus to the knee (so he's got a professional bias, too).
I woke up this morning and felt a big relief in my knee. The relief of tension that I had felt yesterday after treatment had continued after a night's rest. Yesterday, I was really sore, and felt tired from the difficulty of walking and climbing stairs. I could feel the strain building up in my shoulders as I clinched with each step with my right leg. I have started icing down my knee this weekend. I previously thought that my knee did not show any signs of swelling, but today I did detect some puffiness above my knee, which may be a sign of inflammation. Another symptom is that I get pain relief from ibuprofen.
In other words, I am treating it as if it is an injuruy, not just a nick or ding that will go away with a little rest and time.
Another consequence is that I've gone up five pounds over the past four weeks. I have to cut back on my calorie intake due to the drop-off in my physical activity.
Acupuncture chart from Hua Shou (fl. 1340s, Ming Dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo : Suharaya Heisuke kanko, Kyoho gan 1716). Courtesy of Wikipedia.
My knee bothered me more each day as the week went on. Ibuprofen has become an essential intake several times a day. Last week, I could still feel capable of taking a yoga class. This week, it's out of the question because of the increased pain and the sensation of instability. I was lucky to already have a Friday appointment with my acupuncturist, Kelly Welch, only three blocks from my office. Kelly also practices Ashtanga yoga and had two bad knees so he has first-hand experience about dealing with the problem.
I gave him the background on the injury, which I have already laid out here in excruciating detail. He asked about where the pain was felt, zeroing in on medial side of the knee. He really did not give me a "diagnosis" in a medical sense, leaving that for a Western physician who could use MRIs and other tools to rule out things like arthritis, torn ligaments and other nasties. He gave me some pointers about how to keep up with my yoga while not injuring it further by using a rolled-up towel or blanket between my thigh and calve behind my knee whenever I have to go into hero's pose or similar poses that put pressure on the joint. He gave me the name and phone number of his orthopedist, who handles a lot of sports related cases. He also gave me the name of his massage therapist who has worked with people with knee issues, too.
Kelly did acupuncture on my right knee and left elbow (China medicine is into the yin-yang thing so a Chinese doctor would always treat the opposites to restore balance). He also applied some electrical stimulus, a slight sensation of being shocked. He adjusted it so that it did not reach discomfort or pain. And then he left me to simmer for 20 minutes. The treatment seemed to release a lot of muscular tension that had built up by the pain -- and the anticipation of pain. As always with acupuncture, the treatment seems to wash me clean of tension and compressed energy. I feel lighter, more clearheaded.
Finally, Kelly set me up for three more weekly appointments for follow-ups on the initial treatment.
As soon as I made it back to the office, I shot off an e-mail to the optometrist's office assistant and set up an appointment for next Wednesday afternoon, the soonest that he could see me.
This is not an xray of my knee, but it will serve to illustrate my plight.
My previous entry about my nagging knee injury brought two comforting comments: Mary suggested that I see a sports specialist/orthopedist, and Melissa mentioned that a yoga therapist might help and pointed me in the direction of Doug Keller. Keller is based here in the DC area, but spends a lot of time traveling to yoga workshops and teacher training around the United States and the world so he is not immediately available. His site does contain an archive of about dozen articles that he wrote for Yoga+ magazine, and one did deal with knee issues. I have downloaded several to apply them to my multiple aches and pains.
The helpful responses reminded me that the yogic path should not be isolated, that we can reach out to others for advice, support and commiseration. That's why we have yoga studios where like-minded practitioners can share their experiences. The Internet itself opens up the whole world, both for giving and receiving. Sometimes, injuries and other obstacles get me all wrapped up in the tangles that my mind gets trapped in.
I think my concern was three-fold: first, my yoga-empowered changes have been altering the way that my body parts are moving and changing at different speeds due to variable flexibility, strength and awareness. Second, the injuries themselves can engender changes in the body, compensations for a gimpy knee that may jeopardize my gains of the past four years. Or at least, that's what my neurotic mind was telling me, which just amplified the repercussions of the injury. Third, my ego was telling me that a good yogi would not be hurt himself so I must be failing in my practice in some respect.
Alternatively, I could also take this incident as an opportunity to learn more about how my body works, how it heals, and how it changes in the face of handicaps and stimuli. Greet it as a kind of anti-vinyasa that I have to recognize, accept, deal with, learn from and then assimilate into my yogic path.
I should note that Melissa Garvey and is based here in Washington, DC where she freelances as a writer and editor, and has her own website and YogaPulse blog. Following a link from her blog, I found a fascinating, even-handed article in June 2007 issue of Self, Bad Karma, about the risks of injury in yoga practice. Mary is "anonymous."
Labels: injury, knee, reading, therapy, yoga_resource
For the past week, I have not done any running, jogging or used elliptical trainer, or other gym equipment. The only yoga has been some light, simple stuff at home, except for a Flow I class with my daughter Stephanie at Flow Yoga. This weekend, I did not jump out of bed to get my yoga time in first, as I usually do.
Why? My right knee has continued to bother me, giving me a troubling sensation of instability. Three weeks since the injury first appeared, the day after the Thrive Yoga workshop ended. Probably the most striking complaint is that the knee cap is making a popping sound with a lot of regularity, especially after sitting cross-legged for a while. It has gotten marginally better this week, but not enough to feel that it's healing. I can do yoga without any problem, but I may aggravate the injury in half pigeon or easy pose without even realizing it, even though I never try to push beyond my edge and I flex my foot so that it stabilizes the knee. I have a sneaking suspicion that the injury has more to do with my hips than my legs.
I now believe that I am going to need a professional evaluation, but I am not sure who I should turn to. I have an appointment with my acupuncturist, but I am not convinced that he will be able to address this particular problem. Should I go to my personal doctor, since it's about time for my annual physical? Go to a chiropractor? Go to a professional doing bodywork (Trager, Hellerwork, Rolfing)? Should I find a bodyworker who is familiar with yoga-type injuries? Should I find a sports specialist? I've spent several evenings mulling over the options, Googling and trying to narrow down the options.
For the past week, I have been concentrating on getting priority tasks done at home. They had been piling up since I got back from Spain, and I really needed to focus on them. I had to force myself over and through some mental obstacles. That's why I have not been posting here, even though I have more to say about the Rumbaugh workshop.
It's now undeniable that I have a gimpy knee. It has been bothering me for the past week, with no improvement, so it will be hanging around for months to come. I don't even know when it happened. There was no sharp pain from injury, no sign of tearing a ligament. I just woke up after the Rumbaugh workshop and had a pain in my right knee. Now, it is a steady problem and I walk with a limp, with stiffness and tenderness above the kneecap. I don't see or feel any swelling. The right side is my least flexible. It's frustrating because I had not been trying to force myself in Lotus or anything crazy. I have a sneaking suspicion that my condition is due to a realignment of my leg muscles (quads and hamstrings), which resulted in new cartilage in my knee being rubbed and it's caused inflammation. This is probably connected with my overpronation, poor mechanics and excessive sitting.
This injury means that I will not be running or jogging for some time. I will try to get my aerobic exercise at the gym on an elliptical trainer or stationary bike. I have kept up with my yoga, getting in two sessions of Forest Yoga at Thrive. The injury does not affect me in most vinyasas, and I am careful in any pose that stresses the knee.
