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When to ski after cortisone injection?

post #1 of 14
Thread Starter 

I got a cortisone injection in my knee today and the doctor told me no skiing for 1 or 2 weeks and after that I can ski if I take a break after every descend and put my knees in the snow. Right. He did say that with absolutely straight face. And after that he suggested giving up alpine skiing alltogether and just doing xc. No chance, I hate xc...

 

There's nothing "really" wrong with my knees, they have bothered me somewhat since I was 15 yo (now I'm 35 yo). X-ray normal, MRI normal. At the moment they don't really like running or hiking (about 15 km/day with 20 kg backpack for 5-7 days) but they don't bother me so much I would have stopped either of those activities. I've never had any problems with skiing, so I don't see a reason to give it up. And today, after two days of skiing, there was less fluid in my knee than there was last week after few days just normal work. So maybe I should stop working and start skiing more biggrin.gif

 

 

post #2 of 14

If there's "nothing really wrong with your knees" why would ever think about a cortisone injection? After thirty years of diagnosed knee issues from mid teens to now, mid forties (4 MRIs, 2 arthroscopic surgeries) I had one cortisone shot to alleviate persistent bursitis. Cortisone, as far as I understand,  is not really something that you should be using if it can be avoided, especially around tendons and ligaments because it can lead to tears or ruptures.

 

I would say that you need to find the root cause of the pain not use a powerful, but with risks, anti-inflammatory to treat a symptom.

 

BTW, I still ski 50'ish days a year, cycle, hike etc. I can't do high impact stuff any more like running, but there is plenty of activities that I can still engage in. Occasionally they hurt, but rest, ice, and ibuprofen usually take care of it.

post #3 of 14
Thread Starter 
Quote:
Originally Posted by ZeroGravity View Post

If there's "nothing really wrong with your knees" why would ever think about a cortisone injection?

 

Because of the swelling that restricts movement and causes a popliteal cyst. Weirdly no pain. The doctor's theory was that the accumulation of fluid in the knee is caused by exercise induced irritation that just refuses to go away once it has started. I did try rest, ice and ibuprofen first. Since there is nothing wrong in the MRI the only thing to do to possibly get a definitive diagnosis would probably be arthroscopy.

post #4 of 14

Ahhhh, that makes more sense. I didn't get that there was chronic swelling.

 

I understand where you are coming from completely. My case was similar in the bursitis was swelling right under the tibial insertion of the patellar tendon (think Osgood-Schlatters in teens). The cortisone cleared it up within a couple of days, but was not the real cause of my knee pain. It took the scope to determine that basically the meniscus is simply worn out and is too thin to take constant impacts from running and jumping. The doctor was very specific about the cortisone protocol being right under the patellar tendon. No movement for 24hrs, limited in the 24, and followup appointment after 48. After that I was cleared to go.

 

I have taken the approach is to do what I want until it hurts, then deal with the pain appropriately, ice, rest, ibuprofen. It has meant giving up running, alpine skiing isn't usually a problem, but wearing CW-X Stablyx as a base layer helps. I only have a few rare days now where I really can't do anything strenuous. Maybe someday I'll develop osteoarthritis but when it happens, they can replace my knee(s).

post #5 of 14
Quote:
Originally Posted by Skise View Post

 

Because of the swelling that restricts movement and causes a popliteal cyst. Weirdly no pain. The doctor's theory was that the accumulation of fluid in the knee is caused by exercise induced irritation that just refuses to go away once it has started. I did try rest, ice and ibuprofen first. Since there is nothing wrong in the MRI the only thing to do to possibly get a definitive diagnosis would probably be arthroscopy.



You definitely want to avoid skiing for a little while - maybe 1-2 weeks is accurate. The reason the doc says that is because the cortisone actually temporarily weakens your connective tissue, so your knee is basically compromised right now. 

 

As for what the issue is - have you been to a good physio or athletic therapist? I'd be willing to bet some sort of movement dysfunction that's putting you off-kilter. How are your quads in terms of tightness?

 

Or find a trainer who does the functional movement screen. I'd be willing to guarantee they will see some basic dysfunction and be able to recommend some corrective exercises. "Dysfunction always precedes pain" is one of my favourite quotes, although really just relevant to overuse injuries. Or perhaps a ski collision is considered "dysfunction". :) 

post #6 of 14
Thread Starter 

I haven't been to a physiotherapist, but that might be worth a trip when I know where to go (there is a physiotherapist in our area but no *good* physiotherapist). I do have some slight anatomical issues like knocked knees (more than most women but not enough to be considered actually pathologic) and very high situated patellas (maybe more "that's interesting" than "that's a problem" - at least according the orthopedist). And my friends certainly comment that I "run funny".

 

Edit...

Thanks for the push evaino, I called a sports physiotherapist who specialises in lower limb problems, gait analysis etc. So in three weeks I might know what I can do myself to make the situation better and keep it that way...


Edited by Skise - 11/29/11 at 4:04am
post #7 of 14

another reason to rest after a cortisone shot is that you want the stuff to stay put for as long as possible after the injection and excessive movement can make the cortisone migrate from the injection site, interfering with its efficacy.

post #8 of 14
Thread Starter 
Quote:
Originally Posted by Mom View Post

another reason to rest after a cortisone shot is that you want the stuff to stay put for as long as possible after the injection and excessive movement can make the cortisone migrate from the injection site, interfering with its efficacy.



Well, there was no talk of rest just no alpine skiing. The first 24 hours after the shot (that I read most people have been adviced to rest) I was working so the knee got about 10 hours of rest during the night which luckily was quiet. About other 14 hours was walking and standing + some sitting and driving... The doctor knows what I do for living and that I would have needed sick leave to get any rest after injection so it was his choice to skip the rest part. Their company provides the health care for our employer and they are also the only doctors who are allowed to give us sick leave. Which they of course never do if we have all our 4 limbs and head still attached since they are payed by our employer.

 

On the positive side the cortisone has taken the swelling away and I have full range of motion in my knee. On the negative side is that there is pain after all (when it first was painfree but swollen), I just didn't notice it before because it comes in a position that was not possible before the swelling went down. It's actually quite sharp and in a specific place and just in those certain positions, fully extended with weight on or rotating and extending at the same time. So one more trip to the doctor I think...

 


Edited by Skise - 11/29/11 at 11:13pm
post #9 of 14
Thread Starter 

The pain went away so I did not go to doctor. The left knee is still ok, but now the right one is swollen. Duh. And I'm very very sure there has been no pain at all in the right knee before the swelling or in the early stages when I still had free movement. I first noticed the slight swelling after a week of not skiing (also not running or anything else) and then it has gone worse and worse. It doesn't seem related to skiing, but considering I had no problems before the ski season and now both knees...

 

I went to physio therapist to hear that I stand wrong and walk even worse. He spent an hour inspecting me sitting, standing (on both legs, one leg, mirror table...), laying down and on treadmill. Next appointment in January when he should have some excercises for me. I just wonder what are the odds that I learn to walk differently after almost 35 years of walking like I do now... It would have been a lot easier if he had said I need 140 e custom orthotics and I'm good to go.

post #10 of 14
Thread Starter 

The right knee was more or less swollen for about 3 weeks. I skied xc for about 0.5 km (then got fed up with too little snow in the forest) on Sunday a week ago and the next day knee was still ok, after 3 days it was really really swollen and I realised it was so bad I had trouble working and probably would be unable to work through weekend. So I went to see a doctor, had some more blood tests, joint fluid tests (the fluid was not clear like it should be and the doctor was worried I might have a bacterial infection there - hardly likely because still no pain). Eventually 40 cc of fluid was taken out and cortisone injected in. Orthopedic surgeon who was consulted said the reason for these kind of painfree swollen joints is usually never found out and they may recurr or not. Empty and inject cortisone as needed.

post #11 of 14

So they didn't send your joint fluid for any kind of analysis? No blood tests? Are you sure you saw a doctor???

 

We don't really use cortisone - it's usually a mix of a few steroids & local anesthetics. 

post #12 of 14
Thread Starter 
Quote:
Originally Posted by Velobuff View Post

So they didn't send your joint fluid for any kind of analysis? No blood tests? Are you sure you saw a doctor???

 

We don't really use cortisone - it's usually a mix of a few steroids & local anesthetics. 



Like I wrote I had blood tests done and the joint fluid was tested (bacterial culture and crystals I think).

 

I use cortisone all the time although I never do wink.gif (It's always hydrocortisone, prednisone, prednisolone, methylprednisolone... but that says nothing to most of my clients - cortisone they understand) This was probably methylprednisolone (I didn't ask though) and if it was a product with local anesthetic in it she forgot to ask me if I'm allergic to them.

 

post #13 of 14
Thread Starter 

And after 7 visits to different doctors the last one has decided I have a tear in the anterior horn of my medial meniscus and need surgery. He was confident it was there already 2008 when I had the MRI done, just didn't show in the MRI.

post #14 of 14
Thread Starter 

 

Quote:
Originally Posted by Skise View Post

And after 7 visits to different doctors the last one has decided I have a tear in the anterior horn of my medial meniscus and need surgery. He was confident it was there already 2008 when I had the MRI done, just didn't show in the MRI.

 

On Wednesday arthroscopy proved him wrong. The medial meniscus was just fine (as was the lateral one). Instead a very irritated plica in the front part of the joint and another one less irritated medially.

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