Orthodoc’s BodyBlog

Tears of the meniscus are very common knee causes of knee pain.  The menisci are "C" shaped pieces of cartilage on the inner and outer portions (medial and lateral) of each knee.  They can be thought of as shock absorbers that provide padding between the femur and the tibia.  They help increase the congruity between the bones to distribute forces more evenly.  Contact pressures increase significantly in the knee following loss of function of a meniscus.

In younger people, tears typically are the result of a traumatic injury.  As you get older (over 40), degenerative tears become more likely.  Each meniscus has a poor blood supply (in adults, only the peripheral 1/3 is vascularized), so they have poor healing potential.  Tears can be isolated or associated with other injuries (e.g. ACL tears).

Symptoms of a torn meniscus typically include sharp/localized pain especially with twisting movements of the knee.  The knee also usually swells following the injury.  There may be painful popping (Note: painless "popping" in knees is NORMAL) and/or locking if the torn piece of meniscus flips into a position where it blocks knee motion.

Most menisci won’t heal spontaneously on their own, but if they do symptoms should diminish over 1-2 months.  If they persist over 6-8 wks, then it likely won’t heal.  Surgery 30 years ago entailed removing the entire meniscus.  As these patients have come back with severe arthritis in that compartment, we’ve started just arthroscopically removing only the torn portions.  Some menisci may be amenable to an attempt to repair (depends on a lot of factor . . . leave it up to your doc), but if repair is tried the patient must realize that it could fail which would mean another surgery down the road to remove the torn piece.  At the latest ortho national academy meeting, it looks like the trend is to be more aggressive for repair in younger patients to try and save the meniscus since our other bailouts (e.g. meniscal transplants) aren’t working out that great long term (the transplants are failing 5-7 years out).

Recovery/rehab depends on the procedure performed, but in general non-impact exercises are preferred to limit the progressive wear and tear on the knees.

Virtually every weightlifter at some point in their career struggles with back problems.  While a wide variety of causes can create back pain, some overall generalizations can be made. 

 The key to back injuries is prevention.  I can’t stress this enough.  Make sure you LIFT SMART.  Most of the injuries result from improper technique and/or lifting too much weight.  The spine is not designed to carry massive amounts of weight.  Lighter weights with higher reps = a healthier back.  While using a lifting belt can help, it’s not a substitute for safe lifting techniques.  Maintaining good core strength is also important.  Most lifters mistakenly don’t train the lower back muscles regularly which can make them more prone to injury.  Also make sure to stretch/warm-up properly.

 Most back injuries are muscle strains.  Typically, it’s a sharp pain with a sudden onset.  The pain is located only in the back and exacerbated with movements.  There are no associated neurologic symptoms.  Treatment is the same as for most other strains in other areas of the body — rest until the muscle heals.  The time frame for this varies based on the injury.  Usually I tell people to listen to their body.  Once they have been pain free for a week or two, resume low intensity exercise.  Advance slowly as the body tolerates.

A symptomatic disc herniation occurs when the softer, jelly-like center of a vertebral disc squirts out through the surrounding (more fibrous/firmer) disc annulus and contact/compresses a nerve.  Herniated discs typically involve leg pain > back pain.  Pain is worse with stressing/valsalva maneuvers.  It can be associated with neurologic deficits (e.g. weakness or numbness).  90% of herniated discs also resolve with non-operative treatment (rest, anti-inflammatories, etc).  The body will absorb the squirted out disc over time.  An epidural injection may be considered to help decrease inflammation/swelling around the nerve.  Surgical descompression (usually a microdiscectomy — basically removing the part that squirted out) can be considered for progressive (worsening) neuro deficits, severe unrelenting pain, cauda equina sydrome (an emergency –perirectal numbness, pain, loss of bladder/bowel control), and/or 8-12 weeks of unsuccessful non-op treatment.

There are a ton of other sources of back pain, but in younger weightlifters the vast majority are caused by these two problems so I’m not going to bother covering other topics.

Patients always come into the office requesting xrays/MRI or other procedures (or by the time I end up seeing them, they’ve already had them done).  I’ve read many posts in the forum recommending injured patients go to their MD and demand imaging.  Most acute injuries don’t need advanced imaging and it’s just a waste of health care $$.  Since most injuries get better with PROPER treatment (thus negating the need for imaging), imaging doesn’t start coming into play most of the time at least 4-6 weeks after the injury.  Basically, I would just make a plea to leave the decision on whether or not to get xrays or an MRI up to the judgment of your physician.

FYI — I’ve had personal experiences with both of these injuries.  Early in my lifting career I would periodically strain a paravertebral muscle in my lower back.  As the years have gone on and I’ve stopped "maxing out" and lifting heavy, the strains have disappeared.  I also have added some exercises into my routine that focus on my lower back.  I also never felt personally comfortable with the proper technique for deadlifting, so I don’t do it — and I wish some other that I see at the gym would follow suit   It’s a tough exercise.  If you can’t do it right, then don’t do it.  Or use light weight until the technique is peefected.  I also don’t squat anymore and depend on leg presses (so my spine isn’t loaded excessively — I have no data to support it, but I assume this will make spine degeneration less likely over time).  Last Fall, I had an acute herniated disc in my neck.  It was a clinical diagnosis — I never had an MRI.  Basically, one day I was repping 315 on the bench.  Then a few days later I had neck pain radiating to my shoulder blade and I struggled doing reps at 135 (I lost a ton of triceps strength).  The pain went away in a couple weeks of rest/NSAID use.  The triceps strength is just about symmetric, although my bench isn’t completely back (related more to some contralateral shoulder issues I’m having — I’m falling apart haha!).

 Thanks for reading.  Let me know if you have questions.

A number of people have contacted me with questions related to various injuries they have sustained.  While browsing the forums and blogs, I have realized there is a ton of information/advice out there for these topics.  Some of it is good, but unfortunately there’s a good amount that’s bad.  So I figured it might help if I summarized some of the more common lifting injuries.  Feel free to contact me if you have questions about what I cover or if you have any suggestions on areas you would like discussed.

 I’m going to start off with rotator cuff injuries since most lifters at some point in their career struggle with their shoulders.  The rotator cuff is a generic term for 4 muscles that surround the head (ball) of the humerus.  The most commonly injured muscle (the supraspinatus) assists with abduction.  The other cuff muscles primarily internally and externally rotate the shoulder.

Impingement of the cuff can occur with arm elevation and/or internal rotation as the cuff pinches between the humerus and the undersurface of the acromion (the bone above the shoulder joint).  Typically you’ll see pain radiating down the lateral arm to the deltoid insertion that’s aggravated with overhead activity.  It’s also worse as night b/c many people sleep with their arms over their head causing impingment.  It can also occur at night when you are supine and gravity no longer is pulling the humerus/cuff down away from the acromion.

Impingement either causes irritation of the cuff ("tendonitis") or can eventually tear the cuff.  In general, tendonitis causes pain with little effect on strength while tears will result in weakness with overhead acitivity (although the remaining cuff and the deltoid can sometimes compensate for the weakness caused by tears).  You DON’T want to ignore or work through tendonitis since you’ll eventually rub a hole through the cuff and end up with a tear.

Treatment of tendonitis involves creating more room for the cuff between the humeral head and the acromion (to alleviate pinching).  This can be done by strengthening the other cuff muscles which can depress the humeral head inferiorly.  You can also strengthen the scapular stabilizers so they can better coordinate redirection of the acromion away from the humerus as the arm is elevated.  These are the goals when a doc sends you to "physical therapy".  You can also try oral anti-inflammatories as well as cortisone injections to decrease swelling in the tendon.  A thinner tendon is less likely to get pinched between the humerus and the acromion.  Most tendonitis can be treated conservatively without surgery, but it takes time (i.e. months).

If non-op fails for tendonitis, then surgery can be considered to remove the offending "bone spur" or "hook" that’s causing the pinching from under the acromion which gives more room for the cuff.  Most docs do this arthroscopically.

Most tears (especially by the time someone reaches my office) won’t heal without surgery.  Whether the surgery is arthroscopic or open is controversial and individual surgeon’s opinions will differ based on a variety of reasons.  Recovery after a repair is much longer than removing the bone spur alone since you must wait for the tendon to heal before using the muscles (otherwise it’ll re-tear).

Many people come to the office either with an MRI ordered by their primary doc or they want an MRI.  I get MRIs on people that present initially with significant weakness or on those that have failed therapy/injections (MRI is only needed if we’re starting to discuss surgery).

Naturally, this is the simplified version of cuff injuries, but hopefully it provides a basic understanding for you.  Let me know if you’ve got questions.  Good luck lifting!

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