 Poster: A snowHead
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Not really sure what I am aiming to get out of posting this other than I would welcome thoughts from anyone with experience of similar injuries!
I fractured my tibial plateau back in March, fell over at low speed on a green run but managed to give my knee a really good wrench to both sides in the process as the ski didn't come off. There was minimal/no depression so luckily it didn't need pinning. In a brace for 8 weeks and then another 3 ish before I was walking normally. X ray suggested this healed very well.
At all stages it seemed they kept repeating various movement tests and concluded there was likely no ligament damage, but I kept having recurring pains in and around the knee so my consultant eventually agreed to do an MRI, which showed a "roughening" of the ligament down the outside of the knee (LCL?), and possible small meniscus damage. I'd been having sharp, hot pains occasionally in the knee if I twisted it slightly walking or during exercise, which the physio said was pretty symptomatic of meniscus damage. Consultant said to come back in 8 weeks and if it was still bad they'd look at doing an arthroscopy.
That appointment is this week. The sharp hot pains have stopped, but I still get frequent but intermittent pain all around my knee - mostly down the sides very slightly back from the kneecap, sometimes on the tendon above my knee, and a stinging pain around the knobbly bit on the tibia where the ITB band attaches.
I tried skiing in the fridge at Hemel yesterday (ok'd by my physio) which was fine when I concentrated, but painful at times when I slipped into old bad habits, or if my heel rotated outwards at any point.
My problem is I'm not really sure where to go from here - I really don't want to not be able to ski next season - and my NHS consultant doesn't seem particularly interested as I can walk. Grimaces whenever I mention skiing, constantly tells me to "be careful" but won't give me any advice on what is or isn't ok beyond not doing deep squats and "cross trainer is better than running". I don't know whether to push for the arthroscopy, as I'm not convinced its the meniscus that's causing problems. What I don't want, is a badly timed arthroscopy which means I miss skiing next season, and fails to solve the problem!
I know the NHS is being pushed to it's limits, but I'm feeling pretty disillusioned right now. Private treatment is an option, within reason, other than not having a clue where to start (I'm in London, if anyone has any advice..)
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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@nabus, this perhaps isn't what you'll want to hear, but my knee has never been quite the same since I smashed up my leg three years ago (spiral tib). BUT I have got back to the stage where I can ski well, without the knee limiting me in any way.
Hurtle is right that Jonathan bell is the ideal choice for anything interventionist.
In the meantime (and indefinitely, perhaps) there are other options too. I have been working with a very experienced personal trainer to build up the leg muscles and, critically, the flexibility and range of motion of all the major joints. It's common for knees to take extra strain to compensate for a lack of mobility in e.g. hips, ankles. I have minimal knee pain these days now that I've improved my overall posture and strength.
I had some specific physio in the early days post-injury too. I did both NHS physio and private. They were both worthwhile but were entirely different. NHS one had the objective of getting me walking again. Private took it the next step of getting as close as possible to where I was before the injury. He handed over to my PT after I'd had a few sessions.
I never did have any knee scans or anything diagnostic; I didn't see the point because I couldn't think what behavior I'd change if I had a specific diagnosis. My physio/exercise work was having enough impact that I was sure that any surgery wouldn't be worthwhile.
I was lucky; I had been working with my PT prior to the injury and I was able to go to a private physio he recommended. But hopefully you would be able to get a recommendation of a good private physio near you. It could be worthwhile exploring that route before looking at anything surgical.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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@Maireadoconnor, I did actually wonder about suggesting Claire Robertson, consultant physio at Wimbledon Clinics, as someone to consult in the first instance. I was very happy with her (sans MRI) diagnosis and advice, and never actually got as far as seeing her husband. She reassured me that a referral to him would be forthcoming if and when necessary.
I'm not sure whether there are others in the 'knee team' at Wimbledon Clinics, maybe there are.
One possibility might be to send a PM to Jonathan Bell on here and ask him where's best to start. In fact, on balance, that's what I'd do. It's also possible he'll pop up anyway when he sees the thread title.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@Maireadoconnor, +1 after my TPF. Permanent MCL damage and no idea how much meniscus is left so still doing private sports physio 4 years later but his interest is conditioning and strength so really its personal training but with one eye on the injury.
Like the OP i was getting pain at the early stage . I just looked back at what i wrote over the years and i cant really remember having it so muscle strength clearly sorted it out. I am now getting a bit of pain around the MCL but it doesn't bother me and no pain that would be related to lack of meniscus. I also take naproxen as a prophylactic when skiing.
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You'll need to Register first of course.
You'll need to Register first of course.
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Oh..and for the OP jonathan bell does a return to skiing day at hemel in the autumn. It includes a consultation with james vickers his excellent skiing physio who assess your progress and clears you for skiing. James also practises in central London .
My TPF was a big one. Injury on 1st April and back skiing...with private lessons ...at the end of November. I did 5 weeks that season. I use a CTi brace and now use a mojo but at 57 not unexpected i suppose.
Last edited by You'll need to Register first of course. on Sun 24-09-17 11:23; edited 1 time in total
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@nabus, check your travel insurance. Mine had £500 for private physio. I had 3 sessions a weeke for 3 months once i was weight bearing plus 2 gym sessions a week on my own until the money ran out then i thonk i dropped to 2 physio sessions a week. I certainly was in the gym 5 times a week. At that point I was where you are now and i think i dropped to 1 physio session and 3 gym sessions a week on my own. In year 2 i dropped to 1 physio and 2 gym sessions. Now in year 4 i have my physio most weeks but an very bad at going on my own.....and i bet thats why i have pain now. That said i hit my PB on squats and reclining leg press last week and in the last year have been doing upper body work so gave improved overall strength and good posture.
Physio is £40 per session in the gym
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Thanks very much for all your comments!
Saw a registrar today who was much more communicative than the consultant I have seen previously and agreed that an arthroscopy doesn't seem like it would be much use or help at the moment. So I think more physio is probably the way forward - I've been doing the exercises I've been given by the NHS physio and been in the gym but I probably could be pushing harder at this point.
No money in my travel insurance for private physio I don't think (and I fear Jonathan Bell is beyond my budget!) but definitely something to look into.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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@nabus, where in London are you?
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@nabus, after having my op for a year in meniscus cartilage, I was suffering from pain doing squats. When I relayed to the physio she did a few tests and concluded that what was happening was the muscles weren't quite firing at the same time so she that when I squatted they weren't smoothly drawing the knee cap up. She then tests this by applying some tape and getting me to squat again which as utterly pain free. Over time and with more exercise those muscles have got back to where they should be in terms of firing when they should etc but until they did for skiing I used a knee support designed to help that (sorry can't remember the right term). Could this be your issue as skiing obviously involves that same movement? I would mention to your physio and see if they agree (I will try and remember more technical detail)
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Patella stabiliser is the knee support and if you google on patella mal-tracking think that should give you more detail
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Private treatment is an option, within reason,
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Pay for a private consultation with the best knee guy around your area (who also does NHS, which is most I think). Try to find someone with a good understanding of sport in general and skiing in particular (easy enough, as the private knee guys tend to 'advertise' their expertise in ski related injuries). If they conclude treatment is necessary ask to be moved to their NHS list.
The above worked really well for me. My consultant was a star, fixed up one knee (trauma) and was keeping a watching brief on the other (worn out). Unfortunately he was killed in a tragic surfing accident trying to help some teenagers who were struggling (including his own lads, I think).
Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Tue 26-09-17 13:48; edited 1 time in total
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PS You don't get any special treatment once into the NHS, but you do effectively get to choose whose care you are under.
There was absolutely nothing wrong with my first consultant (allocated by NHS) but he failed to grasp the requirement to be skiing again as soon as feasible, even though I linked the ability to ski to my livelihood.
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You know it makes sense.
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@nabus, I suggest a consultation with James Vickers; he has a ski specific exercise programme - wimbledon clinics published it on their facebook page with James doing the videos.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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@richard_sideways I'm in North London, currently being seen at North Mids.
The MRI I had suggested there could be a small amount of damage towards the front of the meniscus but it was far from definitive.
I do have some pain if I do a really deep squat (bum touching heel) but suspect that is mostly tightness /lack of muscle.
The pain I had skiing in the fridge was worst when there was sideways pressure on the outside of my ski behind my foot - so eg if I did a turn slightly downhill from a bump which then caught the back of the ski (why is this so hard to explain!)
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Poster: A snowHead
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@holidayloverxx thanks for the recommendation - I'll have a look at those
@nickyJ that's interesting, where was your knee hurting? My physio did tape my knee at one point as I was getting pain at the bottom front of the kneecap after squats or running (not doing much of that on consultant advice but physio told me to test it a few times) but the tape didn't really do anything
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@nabus, the pain felt inside the knee to me. She test it by getting me to tense my leg while straight and she had her fingers on either side just above the knee to feel when the two main muscles fired.
The tape the put one my leg was quite high (above to knee) and was to hold up up out the way for squatting. Though patella stabiliser knee support has Similar effect (and meant I didn't need to learn how to apply the tape when I went skiing).
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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@nabus, I got a TPF at the EOSB this year but went to Wimbledon clinics and had a very quick diagnosis (and still have the massive credit card bill to show for it!) of not just the TPF but torn ACL, torn LCL and damage to the peroneal nerve and my physio thought that there might be some meniscal damage last time I saw him in July. I would recommend a more specialist ski focussed physio, we don't live that far from Wimbledon but the physio from there works even more local so they might have one working out of north London. I still have pain and nerve tingling every single day, sounds similar to the area of pain that you describe, although not when actually doing anything just noticing it when resting - and , bizarrely, driving, which is one thing I really struggle with as it's my clutch leg and you know what London traffic is like. Good luck with getting fixed for the season!
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You need to Login to know who's really who.
You need to Login to know who's really who.
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@always29, James Vickers works with Jonathan Bell. He is a ski specialist and also works at CHHP in Harley St.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Guess what @nabus managed to break, close to exactly a year later? The other tibial plateau... At least it was doing something difficult this time 
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You'll need to Register first of course.
You'll need to Register first of course.
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@skeksis, oh b*gger
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Not according to the UK Doctor...
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Jan 2019 I caught an edge and had a forward slightly twisting fall resulting in a front flip which broke pieces off 4 vertebrae and a severe tibia plateau fracture and torn meniscus. My right ski released as soon as the fall started, my left never did. The force broke the ski , a newer pair of Nordica enforcers. I was only going 10-15 mph at the time. My bindings were marker griffons. My Din was set at 6.5. I have been skiing for almost 50 years. And consider myself to be a conservative advanced skier. It’s taken two surgeries and many, many hours of P.T. To get my body together after this, but after 22 months I will be skiing again soon. Has anyone else experienced marker bindings failing so badly? For the life of me I cannot understand why they didn’t release. If you saw my ski bent like a pretzel ( looks like the first 18-24 inches of the tip was bent in on itself). You probably would be puzzled too. For people recovering from a tibia plateau fracture surgery the key for me has been stretching and constantly doing the exercises and weights. If anyone else has had a similar experience with marker bindings please let me know. I think I’m switching to look with the turntable heels. Thanks.
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