Off-Topic Return to training after cortisone shot knee?

[mfbunch]

All,

Question up front: guidelines and stop signs for returning to training after a cortisone shot to the knee?

Background: 50 y/o, high mileage, poor judgement male with torn ACL, meniscus left knee ~18 months ago. This is the third tear after a replacement and revision. Only surgical option is a total knee replacement which (to my gratification) I'm advised I'm too young. Cortisone is for pain management, does not help instability issues. This is the third cortisone shot which I'm intentionally trying to space out to 6-8 months. The genesis of the question then is because I've received different guidelines each shot, and research varies from nothing strenuous from 24 hours to two weeks post procedure. The consensus seems to use pain as a guide, which is a bad guideline. It doesn't hurt, but I know that the hard rowing workout I did after second shot was contra-indicated.

Third shot was yesterday. This morning I did a low intensity Indian Club / Persian meel workout to keep stress off the knee. This is NOT a question on training advice - but rather resuming training in a way that allows the cortisone to do what the cortisone does.

Thoughts on resuming AXE swings and Iron Cardio (twice weekly each)?

Appreciate any insights out there!

r/Mat

 

[offwidth]

I think it’s probably borderline irresponsible for anyone who isn’t a physician and knows the intimate details of your particular situation to give you advice on this.

I would get a good orthopedic sports medicine specialist who deals with athletes and a similar physical therapist and listen to (and follow) their advice. The PT especially, should be able to help with specific strength and stability issues.

(I have had cortisone treatments on several areas and the response and return to training has been varied and different each time.)

 

[Luis T. Gonzalez]

This would be a question to present to your primary care physician and to get the necessary recommendations to physical therapy or whatever they see fit.

 

[Brett Jones]

What did your Dr. and/or Physio recommend?

 

[mfbunch]

What did your Dr. and/or Physio recommend?

That's the crux of the question. Administering nurse and orthopedic surgeon guidance follows:

Shot 1: don't immerse for 48 hours, light exercise first 24 hours, use pain as a guide for next 24-72 hours with return to full activity after 72 hours.

Shot 2 (same cast of characters): don't immerse for 48 hours, you can return to normal activity / exercise at any time. Use pain as a guide.

Shot 3 (new ortho, new administering nurse): use pain as a guide, no guidance on immersion.

Medical clinic websites (various): shot one to up to two weeks before returning to normal activity

What I'm looking for is anyone in my age range that can provide some anecdotal evidence that helps reconcile all the conflicting advice.

Some other (perhaps useful) info: I'm an active duty officer (you and I have actually corresponded before around the 2011 time frame when I was in Afghanistan), using an Army hospital that typically treats young soldiers in the 19-24 age group (they do see all age groups but doctors being doctors probably lump me in with the first category when giving advice). The websites ranged from clinics that treat predominantly athletes (I think they accept a bit more risk) to those that see folks in my age group or older (which are a bit more risk averse and probably lean towards more conservative treatment).

Hope that helps - question is a shot in the dark and in the absence of any experiential input I'll likely do something easy tomorrow and either AXE or IC session Saturday based on how I feel (intuitive versus structured commentary is priceless by the way...more in another post when I get a chance).

Mat

 

[mfbunch]

Quick update:

1-a better subject line may have read "looking for a reliable 6th stop sign"

2-after repeated correspondence with my ortho yesterday (it was an in person visit for the shot), which included a detailed layout of my workout plan for the next few days, I received a greenlight with the same broad advice, i.e. use pain as a guide. I was gratified to learn that the prohibition of activity for the first 24 hours is largely due to the numbing agent given before the shot.

3-today's workout: S&S warm-up (12-kg bell), limited range of motion on goblets, AXE repeats 6/10. So far, a little stiffness in involved knee but no pain or clicking.

4-I may make another post, but after nearly 30 years in the military and a lot of experience with medical practitioners, licensed therapists, and credentialed alternative treatment professionals, TRUST BUT VERIFY applies.

5-lastly, if anyone out there would like to share some additional stop signs for those of us on the left side of the Bell Curve distribution for common sense and good judgement, I'm all ears.

Regards, Mat

 

[Luis T. Gonzalez]

1-a better subject line may have read "looking for a reliable 6th stop sign"

I think your doctor’s indicated that any pain was the stop sign? That seems pretty reasonable. I would seize what I was doing in a day too if I began having painful sensations.

 

[Brett Jones]

Have you ever had a movement screen (FMS)?

Looking for any areas of opportunity (ankle mobility for example) would be a good way to go once cleared by your Dr.

 

[mfbunch]

Have you ever had a movement screen (FMS)?

Looking for any areas of opportunity (ankle mobility for example) would be a good way to go once cleared by your Dr.

We had an FMS screening during the War College. I can't recall my specific scores but was surprised at the results. I had a couple injuries at the time (torn rotator cuff and torn ankle ligament that I waited - like a lot of classmates - for years to get fixed in the schoolhouse) and should have shown significant asymmetry, but didn't.

In the same vein, my ACL tear is about 18 months old. The doc cleared me for most activities (running is out) in general, and specifically for AXE and IC (spelled out the workouts for him) after the shot.

Ankle mobility isn't an issue (thanks to Dynami which I purchased years ago) but stability is. But that's due to the injury and can be managed but not corrected. And I have physical therapy under my belt to prove it.

To the advice of pain as a guide, that's generally good. But there are some of us that either perceive it differently or not at all (years spent kickboxing?), who get the pain after something has given way. By the way, I'm not sure that necessarily equates to a high pain tolerance. I didn't even use motrin after my rotator cuff repair / biceps tendonesis. But once a misplaced Lego put me in the fetal position, bargaining with God.

Either way, after the shot I backed off a bit the last few days (shot was three days ago) and nothing seems aggrevated. So in the vein of my original question...I can't have suggestions for a stop sign, and since my doc said "there really isn't a set guideline for when you can get back to activity after a steroid injection" (corroborated by the available literature), here are some ideas - NOT medical advice AND consistent with most of the literature, from my admittedly limited experience and specifically for the knee:

1-avoid exercises with lower body emphasis first 24 hours (numbing agent inhibits feedback - from the doc)

2-avoid hyperflexion first 48 hours, period. Rowing, deep squatting, etc. I rowed hard because I said I would, and the doc said all good. Bad idea...soreness and clicking later, and that injection ultimately proved far less effective than the first.

3-walking and upper body exercises are good 24-48 hours (I did a club workout first two days after shot 1, first day after shot 3). Got the blood moving and had a similar tonic effect to light walking.

4-hinging seems ok after 48 hours (swings, maybe snatches), squatting at 72 hours and beyond. I'd avoid heavy deadlifts, squats, or high intensity low impact exercise (rowing, biking, swimming) until after 72 hours. If you're getting injections in the knee, running or jumping is probably not advised anyway.

Hope that is useful!