Horse play leads to knee injury

INJURY: Greg Bell's right knee would never have crouched this well with the cartilage injury that John Van Dalen expertly repaired. PICTURE / SUPPLIED

There are a couple of bits of gristle in the knee, acting like cushions and at the same time providing a soft but secure cup to increase the knee's stability. I call them the menisci, but you may know them as cartilage.
I discovered mine personally in the year 2000. It was my Y2K glitch. I was running the programme "Horsey ride Dad" and the horse's capacity for one child at a time was breached. Yes, there was room for two young sons on my spinal saddle. All was going to plan. I went forwards, and then a wall loomed high in front of me and I had to take evasive action. Naturally you throw in a tack to the right, perhaps as an influence from hours of watching team New Zealand on the waters off San Diego or the North Shore, but with two lumps of our future leaders on the back of the horsey, and a twisting pivot action (scouring seems a more descriptive word), my inside cartilage said "rrrrrippp". After the riders had left the recently malfunctioning and grumbling horsey, I stood up to the richest, deepest, juiciest crunch and thud I imagined my knee could ever make. Not severely painful but disconcerting to say the least. Neither of those two offspring at 19 and 20 remember that fateful ride.
It's interesting what happens when you injure yourself as a health professional. Firstly the general public hold you to account, and you hear the line "but you're a physio, you shouldn't get hurt" at least 13 times. Unfortunately, when you graduate from physio school, the "get out of A&E free" card is not handed out. Whereas in some new age health forms a master lays hands on the practitioner and imparts some cosmic energy flow, this is not the case for physiotherapists. We are also subject to the laws of gravity as much as mere mortals, and of course the laws of cause and effect. I would estimate that the time it takes for my physio brain to kick in is 0.5 seconds. Unfortunately it took 0.49 seconds to twist my knee horsey style.
Secondly, as an injured physio, you over diagnose yourself because we have assimilated the textbook of worst case scenarios. A feature of diagnosing called differential diagnosis kicks in. This is the inquirer inside asking the question, "what else could this be?". In physical medicine there are classifications of injuries we call horses, zebras and unicorns. You are more likely to see "horses" in everyday physio. For example, cartilage tears seem to be horsey, which is appropriate for my injury. A zebra might be a ruptured tendon attached to the kneecap, and a unicorn would be a piranha biting off your knee cap, simultaneously infecting you with Ross River virus whilst you were watching Wanganui Athletic win another game. In other words, quite unlikely but maybe not so rare as my elaborate example. Joseph Mazur, in his book The Math and Myth of Coincidence, says that as a mathematician, if you have an event that has a probability that is non zero, then it will happen. Good luck Athletic!
My point is that I would start thinking of unicorns first in my knee injury, just because I can. You do tend to think the worst when you get a rush of adrenaline, cortisol, cytokines and interleukin 6 through the blood vessels straight after an injury. Eventually we physios stop catastrophic thinking and settle down.
Back to the menisci. You usually damage them in a twisting fashion with the foot planted on the ground. You could fall over and force your knee into full bend. For me, it was knee on the ground and the world twisted 90 degrees on me.
The features of a meniscal injury are annoying. Your knee could lock on you, and that hurts a lot. You find you can't kneel any more, or when you try, you end up off centre towards the uninjured side. Actually, I claim this as the sign of Gregory, as I have yet to see it as a recognised test. When you disco on the sore leg when it's slightly bent, you will lose your groove. This is why a clever clinical sort invented the disco test. It's great because it's very informative, and amusing to request of a patient. For me, all those years ago I discovered that when running around chasing my sons through our house, hurdling the couch was agony as bending the knee fully pinched my torn cartilage.
Tears can appear in different parts of the cartilage, and the potential for healing is greatest if the tear is closest to the skin. The deeper into the knee you go, the less the cartilage is supplied with blood, so a tear where there's no supply of blood means poor chance of healing. It is best to seek help with a cartilage tear because if it's appropriate to have keyhole repair, you can get back to close to normal function. Of note is that it's also possible for tears that are nearer the surface to settle down with targeted exercises and avoidance of deep squats and disco. This is true of my other knee which was injured when I was Marist Casuals star signing in 2001 for two big matches, but that, as they say, is another story. I had keyhole surgery about nine months after my equestrian incident, and after a month or so my knee felt great. What really helped me was getting the knee strong before surgery. What didn't help was the ACC staffer who rang me and asked if the horse had been put down!
A physio can diagnose cartilage damage through careful history taking and clinical tests. A physio who has already injured his cartilage can diagnose these injuries really well. We'll give you a good set of exercises to help you either rehab the knee or get it ready for surgery. Physios mobilise or stretch joints in a specialised way, which may be all you need. It's worth getting the knee looked at if any of the above resonates with you, and be careful those equestrian dads. Take your time turning and avoiding walls, and for goodness sakes, one child at a time!
Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz