This is the brief synopsis - had a really tight ITB on the hip, went to see a podiatrist who gave me orthotics to use with Asics Kayanos, too much medial suppport (especially seing as I don’t overponate too much), right knee got sore, saw an orthopedic surgeon yesterday, had an MRI today, probably need an arthroscopy to fix the problem (meniscus).
Be careful with the medical advice you seek. Podiatrists always want to give you orthotics.
But hey, at least I can still swim.
And an orthopaedic surgeon always wants to give your surgery…its what they are trained for. I hope you have received numerous opinions from numerous types of practicioners to get a balanced view.
Cheers
Use the ortho surgeon as a last resort. Use them first for fractures, etc but for this kind of a problem first try a chiro, PT, acupunturist, ART guy, massage therapist,etc. If none of that works then go with the ortho.
I’ve tried taping my knee, physio, massage etc. but my knee starts hurting after 6/7 mins of running and I have to stop. It is cleary a problem when my knee flexes to certain point.
You know, it’s hard to know what ‘this kind of problem’ is here - I would assume that the MRI showed a meniscus tear. Depending on what it looks like, I would submit that this is not a ‘ortho should be the last resort’ problem.
I have a lot of respect for chiropractors and have posted about this before. However, your statement is as unfair to orthopaedic surgeons as me saying to only see a chiroparactor for back problems. Posts on this forum often imply that the only thing an orthopaedic surgeon knows how to do is operate, and this is what we do every time we see a patient. I’m sure there are guys like this, but there’s probably bad chiropractors too. A good orthopaedic surgeon knows what to operate on and what not to, and would, in my world, often refer to a chiropractor or massage therapist. On the other hand, from what I have seen, many massage therapists would not, for example, be able to tell the difference between a PCL and ACL tear. So if you start there, are you getting the right diagnosis? My point is, I guess, that while surgery may often be a last resort (though for a bucket handle mensicus tear, it may be the only effective treatment), seeing a good orthopsedic surgeon for an opinion / diagnosis should not always be a last resort.
Deke
Deke,
Thanks for your candid reply - I didn’t rush to the orthopaedic surgeon first up, but I felt it inevitable after a while. Better to get to the bottom of the problem than do more PT, massage etc. Kind of like brushing your teeth when you have a cavity.
As soon as the problem is resolved I’ll definately return to my program of strenghtening, massage and stretching.
I didn’t mean to imply that orthopaedic surgeons only “think knife”. I used to be an orthopaedic technition in a large hospital while working my way through chiro college so I’m quite familiar with orthopaedic surgeon’s work.
The poster didn’t actually say that his problem was a bucket handle tear, which is a problem often best suited for an ortho surgeon.
Orthopaedic surgeons are usually quite busy with surgical procedures and often don’t want to be bothered with nonsurgical procedures. More than often they will immediately refer these problems to the PT’s if they are not surgical. I think in many cases, patients can be actually wasting the orthopaedic surgeons time by seeing seeing an ortho first for a non surgical problem. My suggestion was see a competent PT or chiro first. If it is a problem beyond their scope of practice then they would refer to the orthopaedic surgeon. They are acting as a screening process for the ortho. Seeing the ortho first in some cases is kind of like putting the cart before the the horse.
I think this is reasonable response, but it’s just that “screening process” and “last resort” have different nuances 
Not to beat the point to death, but I frequently hear about the rush to the operating room thing, but I rarely hear about the people that spend too long at non operative treatment, for example with a bucket handle or a large rotator cuff tear, and that this too can have long term implications.
Maybe just heard too many dumb orthopaedic surgeon jokes lately - how do you hide money from an orthopod? Put it in a book.
Deke
Sounds like my knee.
Got sent on my way and told I would just have to live with it.
First of all… Hi all!
I’ve reading this forum for a while but only now I decided to register and to actively participate.
Your description seems very familiar, I had a similar problem back in 2001…some people call it “runners knee”!
It took me some four months and a lot of headaches, but I managed to solve it, and best of all, without any surgery!
Just some really nice stretching and some physiotherapy.
I guess smartass can give you some hints on that…usually he has all the right links…
Here is one he sent me by that time: http://www.rice.edu/~jenky/sports/itband.v2.html
Sérgio Dias
Tri-Oeste - Clube de Triatlo do Oeste http://tri-oeste.inforcerta.pt/
Do some research on IT band surgery. It doesn’t get a good rap (basically, people are unhappy with how their knee feels after). I’ve fought IT band problems for years. It’s tough and frustrating. Things that help me are, 1) Bike a lot. I think I have weak quads and that really causes problems. 2) Warm up slowly. If I can’t ride for 30 minutes before I run, I at least try to walk for 15 minutes. 3) Build up slowly and never run more frequently than every-other-day.
Basically, try everything (which takes a long time) to solve the actual problem rather than treat the symptoms (with surgery).
…saw an orthopedic surgeon yesterday, had an MRI today, probably need an arthroscopy to fix the problem (meniscus).
Be careful with the medical advice you seek. Podiatrists always want to give you orthotics.
and surgeons always want to cut you…
Orthotics are the right answer IMO, surgery is usually not. Surgery won’t address the biomechanical problem that caused the injury in the first place…
I’d advise a second and third opinion from some non-surgeon medical professionals before getting the surgery.
That’s amazing; you can diagnose over the internet with virtually no history, description of the symptoms, and don’t even want to wait to hear what the MRI shows.
This is just what I was talking about in my posts above - you guys must know a lot of really crappy, aggressive orthopods, I guess. In my office, my hit rate for surgery is well under 25% of the patients I see, and in Canada I see a fairly selected group of patients as you can’t self refer. I really don’t know any orthopod who couldn’t diagnose ITB irritation (which is what all the internet diagnosticians are coming up with), or anyone who would want to operate on it off the bat.
Deke
“in Canada I see a fairly selected group of patients as you can’t self refer”
As you know, the situation in Canada is different from the US. To get to the orthopod you have to go thru the family physician which IMO as a chiro is a waste of OHIP money for me to have to send to the family physician first rather than direct refer to the ortho or other specialist. I did have an ortho locally who would take direct referals and we had a wonderful relationship. Since I had been a orthpaedic technition I was very familiar with a lot of procedures we got along great. Unfortunately he moved and the guy who replaced him was a complete jerk. I sent him a few patients and he made a point of bad mouthing all chiropractors in front of the patients despite the fact I was sending them there because I thought that their conditions were beyond my scope of practice.
It’s very frustrating being a chiro in Ontario, particularly now that it appears that we (and physios/optometrists) may be cut out of the OHIP system. An absolutely assinine move by the provincial government since all studies indicate by doing so it will actually cost the system more money, but it’s politics, not common sense. If it actually happens I may consider either moving or going into teaching at a community college.
I agree, it is a waste. There is a similar situation here in BC, and MSP no longer covers chiropractic. The chiropractors that I’m friends with are doing fine despite this. Like your friendly orthopod, I will see people referred by them, but I do just get the GP to send me the patient’s medical history; this doesn’t cost the system anything.
I know orthopods like the one that replaced him; I don’t really get what they’re going on about, but in general it seems to me to be an old timer attitude which is dying out.
The job situation may not be that different, but if you’re thinking of moving, Vancouver Island is a nice palce to live, and you can ride year round, as long as you don’t mind a little rain 
Deke
" Vancouver Island is a nice palce to live,"
That’s a bit of an understatement isn’t it? The Island is the nicest place to live in Canada IMO. The only thing is that real estate values are a bit high.
My daughter is studying languages in Calgary and is thinking of transferring universities to Victoria next year. My son is in high school with his mom in Golden and wants to study film making at UBC when he’s finished, so i have a lot of incentive to move there, but AFAIK it sucks bad for chiros in BC since being kicked off the provincial health plan. The average practice initially dropped about 30% at first but I think they’ve been slowly bouncing back.
That’s amazing; you can diagnose over the internet with virtually no history, description of the symptoms, and don’t even want to wait to hear what the MRI shows. /reply]
yep, I can. That’s because I have thirty years’ experience…
weak gluteus medius and (possibly) footstrike problems caused the ITB. Bad orthotics (or running shoes) caused the knee. Fix the orthotics to fix the knee. MRI is not a panacea: its results need interpretation. Surgery is not the appropriate response to the vast majority of running injuries. I advised the original poster to get more opinions, and I stand by that advice, snarkiness notwithstanding.
African,
I had 3 miniscus tears repaired in February and was racing again in early May. It definately slowed me down a bit, but I found that it let other little nagging injuries and aches heal up. I was swimming after two weeks and riding my bike up to 4 hours per day (on the trainer with no resistance). I let my doctor and physical therapist know how important training was to me and they tailored my rehab around it.
On the flip side, my doctor told me if I wasn’t so fit he wouldn’t have performed the sugery on me because after about age 30-35 the miniscus will not heal properly in sedentry people. One more reason to stay active.
Good Luck,
Todd
Well, I stand by my comments, though I admit I was inappropriately snarky. I don’t care how much experience someone has (though I don’t really know what you do) - a careful history and physical examination is essential to a diagnosis no matter what your profession, and I think that suggesting treatment without them is ludicrous not to mention potentially dangerous. I can name 10 things that could mimic ITB, and most of them I could rule out with a history and physical.
You accuse orthopaedic surgeons in your post above of being quick with the knife - at least we would examine the patient. I agree that MRI needs interpretation, and also the the vast majority of running injuries don’t need surgery, and probably that fixing the orthotic would fix the knee. It’s just that you don’t know that, you’re playing the odds. That’s what the physio, chiropractor, sports doc, etc doesn’t have to do.
Deke
T
ry a good sports massage therapist and go for several sessions and see what happens after that…they can work wonders sometimes.