[Oldmanmatt]

Sorry to hear that Andy, I have found running helps, but only uphill after being advised short  strides are better for knees. I park up in a dip near us and run up one hill, walk down, run up the other, walk back and repeat.  One set is about 0.5 mile- a few of these a week seems to help.

Absolutely. One aspect that we definitely overlook is plyometric work.
I know I did.
I was also told, that in part, the lack of lower body/leg development didn’t just mean “strength”. It’s also to do with (relatively) poor circulation and where connective tissue is already poorly served in that department, a lack of development down there exacerbates the issue.

Plyo allowed that to be addressed, initially, without recourse to running.
(Though static rowing played a big part, too).
 I am convinced that adding plyo into my leg work, reduced, markedly, my susceptibility to both thigh and calf cramps, now.

[Nibile]

I've had three knee operations since 2014, for cartilages and medial meniscus. I have broken cruciatus ligaments in both knees and a serious condropathy.
So, recovery forum meniscus operations is quick, just a few days on crutches then usual rehab, etc. No significant loss of muscle.
Recovery from cartilages is long, 30 days on crutches, long rehab, lots of rules, lost 4 kg of muscle.
I'm more or less fine now, but: no falls/jumps, no ski, no funky moves, no hard heelhooks (toes pointing out), no running, no cycling (not that I intended to).
I do gentle hill sprints, weights, very little jumps rarely.
Avoid plyo like the plague, we are not high jumpers...
Building muscle (as always) helps, along with building strength (NOT power).

[duncan]

Andy, general advice not meant to supercede anything you get from a face-to-face consultation. Restart - or continue with -  the rehabilitation now. If you do opt for surgery, stronger legs will speed the recovery.

What to do exactly is harder to prescribe remotely. My view is somewhere between Matt and Nibile. You’re asking quite a lot from your knees if you’re snowboarding and bouldering outdoors. Both are dynamic (including ‘plyometric’) activities. If you aspire to continue snowboarding and falling from any height your rehab. needs to take this into account. If you’re happy doing what Nibs. does then you can follow his suggestions and focus on leg strength rather than power.

Start building quads. and hamstrings strength initially before you cautiously add dynamic work. Exercises should be weight bearing, or progress to weight-bearing soon.  Progress slowly. Expect set-backs. 

[Andy W]

interesting replies, thanks everyone. I'm still doing the rehab suggested by the physio, both to aid recovery and as a pre-rehab, ie build some muscle before surgery if that is what indeed happens. I'm happy to hear meniscus surgery has a quick recovery time, but I think it also depends what part of the meniscus is damaged. I read that some parts, possibly the interior section which is where my left knee is injured, heals slowly or not at all, ie no blood supply.

I think the most worrying thing I read is that after surgery, osteoarthritis is a probability. So I'm wondering if the gamble is get more years fully active in the near future with compromises later or adapting and compromising now. Who knows!

[Nibile]

With regards to plyo and power, I don't think they'll help climbing or bouldering at all.
Plyometrics involve reversing the eccentric effort into a concentric one in the shortest time possible. So a bouldering fall isn't plyometric, unless you bounce back onto the rock. Plyo puts the highest possible stress on a muscle-tendon structure, and that's why it's so effective in power building. It's also the most dangerous form of training.
But, do we really need legs' power in climbing? I don't think, unless we participate in those silly dyno comps. Power is strength+speed, I think in climbing we just need strength. I personally think that being able to perform a single leg squat is more than enough for climbing. Exploding upwars from the legs isn't that common, so there's no need to train speed.
There will always be a compromise.
The problem with general climbing and bouldering in particular is that, despite how strong a quad can be, the final strain will always be on the knee. And you can't specifically strengthen a knee, if you get what I mean.
When climbing, it's difficult to stop SHORT of an injury, that is, stopping before doing the move that COULD injury you. Trying the move could already be too much, because we try to succeed and not to fail.
That's the same with bouldering falls: we can't predict how a specific fall will be in detail, and a simple twist of the foot could be too much for an already damaged knee. Bear in mind that knees, if under excessive stress, tend to fold inside to look for a mechanic lock, and that's a problem with medial meniscus.
Of course the more muscle there's around a knee the better, but if you look closely at a knee, there's not much muscle really AROUND it, to stabilize a torsion.
Personally, I'd fix the meniscus (in fact I've done that when in need), because a broken meniscus it's both a pain in the knee and a pain in the ass.
Basically it's just 

[Oldmanmatt]

Ok...

I didn’t start by leaping onto high platforms, wearing a 70kg weight vest!*

Initially, I couldn’t run or walk long distances, without knocking everything back. Repetitive pounding had greater sequelae, for me, than strength and mobility training.
So, as I said, I started with the rowing machine, with the objective of improving circulation into my legs (amongst other things, such as rebuilding stamina/slow twitch etc). I also have frostbite damage that has to be controlled.
Plyo, allowed for some rebuilding of faster twitch stuff. I also MTB, hike, dive, swim and Yomp/Tab competitively. I would ski if I lived in France still, or could afford to take four kids skiing...
Anyway, I started by bunny hopping over a 30cm high soft beam, on soft mats.
Just as I started with body weight squats, progressed to a 10kg weight vest, before moving to the rack and barbell.
I built up over a year into those Farmers walks I linked to. That’s 36kg of weight vest and belt, with 44kg of sand filled jerry cans.
(Yes, it’s extreme, but it makes carrying a 45lbs Bergan** up a mountain, much easier).

* I still don’t, that would be silly. I only ever use the 20kg weight vest.


** Bergan = Rucksack, basically. Programmed in now, to me, and saves typing two whole letters each time!

[Andy W]

With regards to plyo and power, I don't think they'll help climbing or bouldering at all.
Plyometrics involve reversing the eccentric effort into a concentric one in the shortest time possible. So a bouldering fall isn't plyometric, unless you bounce back onto the rock. Plyo puts the highest possible stress on a muscle-tendon structure, and that's why it's so effective in power building. It's also the most dangerous form of training.
But, do we really need legs' power in climbing? I don't think, unless we participate in those silly dyno comps. Power is strength+speed, I think in climbing we just need strength. I personally think that being able to perform a single leg squat is more than enough for climbing. Exploding upwars from the legs isn't that common, so there's no need to train speed.
There will always be a compromise.
The problem with general climbing and bouldering in particular is that, despite how strong a quad can be, the final strain will always be on the knee. And you can't specifically strengthen a knee, if you get what I mean.
When climbing, it's difficult to stop SHORT of an injury, that is, stopping before doing the move that COULD injury you. Trying the move could already be too much, because we try to succeed and not to fail.
That's the same with bouldering falls: we can't predict how a specific fall will be in detail, and a simple twist of the foot could be too much for an already damaged knee. Bear in mind that knees, if under excessive stress, tend to fold inside to look for a mechanic lock, and that's a problem with medial meniscus.
Of course the more muscle there's around a knee the better, but if you look closely at a knee, there's not much muscle really AROUND it, to stabilize a torsion.
Personally, I'd fix the meniscus (in fact I've done that when in need), because a broken meniscus it's both a pain in the knee and a pain in the ass.
Basically it's just 

I think I agree with most of this. Dave Mcleod seems to also suggest that conventional rehab will only get you so far. He recommends climbing but with care.  Right now even waiting to see a surgeon I'm still going to go snowboarding in the next few days and climb on my board. With snowboarding as long as I don't do something unexpected I can cruise around with no problems at all, in fact getting down the hill on a board is easier than walking downhill. On my board as long as I'm doing hard projects that require fingers and core etc and not drop knees I'm fine. BUT I'm still doing one legged squats (not deep).

[Andy W]

Update....lying in bed after a arthroscopic partial meniscectomy. A little bit dismaying when the surgeon informed he's removed two thirds of the meniscus. He thinks  four weeks and I should be active again, albeit with the ususal medical caveats etc. 

I've accepted that osteoarthritis is pretty likely so will do much much more leg/muscle/allignment work and probably eat lots of curry (tumeric).

 

[andy popp]

I've accepted that osteoarthritis is pretty likely

Doctor examining me on one of the numerous occasions I've broken an ankle: "You're going to get arthritis, of course."

[Coops_13]

Update....lying in bed after a arthroscopic partial meniscectomy. A little bit dismaying when the surgeon informed he's removed two thirds of the meniscus. He thinks  four weeks and I should be active again, albeit with the ususal medical caveats etc. 

I've accepted that osteoarthritis is pretty likely so will do much much more leg/muscle/allignment work and probably eat lots of curry (tumeric).

 

Best of luck with the recovery Andy! Is it mostly lateral or medial? Medial apparently is much less necessary so can easily live without it. Definitely get on that muscle and alignment work. Apparently I am slightly bow-legged, which has massively helped reduce the wear in my lateral compartment (where I am missing meniscus) so I think a good alignment is key

[Oldmanmatt]

I've accepted that osteoarthritis is pretty likely

Doctor examining me on one of the numerous occasions I've broken an ankle: "You're going to get arthritis, of course."

I thought I was done for when I got the arthritis diagnosis (big toe, Hallux Rigidus), five years ago, I was in constant pain etc etc etc.
I’ve just learned to manage it, really. Hardly any issues with it now. Ran a 10k  last Wednesday and a 6k + 200 mtrs ascent on steps/stairs and 100mtrs on fixed rope/scrambling up a cliff, with a 12kg bergan(behind Red Gate beach, if you know Ansteys) on Friday, for instance.
It’s pretty deformed now and the biggest issue are the bone growths rubbing on certain footwear. Simply ditching “”Trainers” or “Running shoes” in favour of Approach shoes and a good, stiff soled, trail shoe (essentially, stiff soles with plenty of rocker).

A knee will be more problematic, but you really might find the right brace etc. I did a 24k, with a 20kg bergan, over Pen-y-Fan and back, in just over 4 hrs, with a torn MCL and a good brace. Fair enough, I couldn’t do much except wince and look sheepish for the four days/week after, but it was doable.

I tried several different braces, until I found one that I could run in without crying like a baby, or, worse, being fine until I got 8/9k onto Dartmoor before gradually collapsing into a gibbering wreck, before cursing and swearing and limping back to the car, in a manner that would evoke pity from a Tourettes sufferer (obviously, once in sight of the car park or random passing strangers, I would seem perfectly fine and sprightly, if touched a little with the “wedding photo smile/rictus”).

Anyway, the up shot is, if it gets beyond control, the growths can be shaved/ground down, apparently. Which sounds nice, I shall look forward to that.
I’m told I have decades, yet, before I need to be overly concerned...

[SA Chris]

Well, based on my n=1, my knee issues have resolved themselves since I started running, especially up and down hills, and that strength gain has definitely improved my skiing, I can go longer without getting tired or stopping, technique less sloppy in soft snow, etc etc.

Agree about snowboard setup though, simple test is to strap in and crouch right down, if you can feel strain on inner or outer knee, adjust your stance accordingly.

[Ged]

Update....lying in bed after a arthroscopic partial meniscectomy. A little bit dismaying when the surgeon informed he's removed two thirds of the meniscus. He thinks  four weeks and I should be active again, albeit with the ususal medical caveats etc. 

I've accepted that osteoarthritis is pretty likely so will do much much more leg/muscle/allignment work and probably eat lots of curry (tumeric).

 

Hi Andy,

If it's any reassurance to you,, I had this done a couple of years ago, and I'd describe my recover as complete. The only occasional tweak is when I kneel down. Otherwise I've done shit Loads of climbing with knee drops and knee bars, falling off high boulders (which hurts my back), long distance fell running etc.

Stuff that helped me. Obsessively do physio rehab exercises that were suggested post surgwry. Cycling really helped regain movement and strength. Thereafter, I got a lot better at glute and quad work.

I have no idea about skiing, but I dont see why most other sports won't be ok

[Andy W]

Update....lying in bed after a arthroscopic partial meniscectomy. A little bit dismaying when the surgeon informed he's removed two thirds of the meniscus. He thinks  four weeks and I should be active again, albeit with the ususal medical caveats etc. 

I've accepted that osteoarthritis is pretty likely so will do much much more leg/muscle/allignment work and probably eat lots of curry (tumeric).

 

Best of luck with the recovery Andy! Is it mostly lateral or medial? Medial apparently is much less necessary so can easily live without it. Definitely get on that muscle and alignment work. Apparently I am slightly bow-legged, which has massively helped reduce the wear in my lateral compartment (where I am missing meniscus) so I think a good alignment is key

Thanks Coops, I did some reading in medical papers about osteoarthritis likelihood and there was a study that found knee leg alignment as a big factor in outcome. So I agree that work on alignment and muscles must be a good thing. Good luck with your injury management.

[Andy W]

I agree snowboarding at least with my moderate ambitions of cruising on soft off piste snow seems quite safe, this fits in well with walking uphill, currently snowshoeing, which gives a stable platform and base. I imagine uphill on a split board would be ok as well. Bouldering outside i think is ok if you choose problems wisely. My injury occurred on what felt like an innocuous twist on a sport climb, however I wasn't warmed up and a mild fear of being on a rope probably meant I hadn't listened or recognised signals that would have made me leave the move if I had of been bouldering.

[kelvin]

I think the most worrying thing I read is that after surgery, osteoarthritis is a probability. So I'm wondering if the gamble is get more years fully active in the near future with compromises later or adapting and compromising now. Who knows!

That's a choice only you can make but personally, I went for it after my third operation on the right knee. Two thirds of the lateral meniscus removed, most of the other removed in the previous ops and the photos showed arthritis riddled throughout the knee. Told not to skydive or fall off boulders or climbs. I'd not ran for 3½ years due to pain. That was in 2011.

In the next 10 months, I got fit, completed an adventure race and ran the Hadrian's Wall ultra in a day.
I've had an 8 months climbing trip in Europe, also climbed a lot in the Swiss Alps and my knees are not often a problem.

I did all my physio and more. Just get the legs as strong as you can. I had to correct my running style and that helped hugely but these days, I can no longer run. I can do hill sprints however, without pain.
Karate helped massively at the start and some yoga but I've stoppedboth now as I really want to save the knees for the hills.

In hindsight, I'll never regret running the ultra. The consultant told me five years until I'd need a knee replacement, that was in 2011 and here we are in 2021 and I reckon I've still got five more years.

Don't get despondent, learn what's good pain and bad pain and set some goals.

Oh, and boswellia extract is currently keeping the inflammation aware for me. Possibly worth a try.

[mrjonathanr]

I have had a fair few tendon problems recently, in elbows and biceps and listened to podcasts by Jill Cook and Karin Sibernagel and Pete Maliaris. They are at the leading edge of research into tendons -I would really recommend a listen. Most research focuses on Achilles and patellar tendinitis but there is relevance for upper body tendons too.

Searching their name+ tendons on thé podcast app and plenty comes up. Physio Edge, Squat University, Talking Tendons.. there’s loads.

To what extent this would help with arthritis, meniscus and so on I will leave to you, but a stronger knee has got to be a good protective factor.

[SA Chris]

....twist knees and dislocate hips getting off chairlifts. You name it, I've seen it.

[SA Chris]

Are you saying I can't make a perfect dismount ramp?

Issue was the lift I worked on was was only one of the 3 base lifts that wasn't a detachable, a bit intimidating for the first time, especially for novices, but tempting for them when the queue was always less than the others 

[SA Chris]

I was out touring the other day, the last section was an uphill followed by a path through the woods, so I still had skins on and heels released. The final bit before the road was a narrow steepish section, where my mate opted to take off skis and walk down, but I opted for the guts or glory choice, managed to get to the bottom, tried to come to a stop and faceplanted in a heap of snow.

[Andy W]

Update....lying in bed after a arthroscopic partial meniscectomy. A little bit dismaying when the surgeon informed he's removed two thirds of the meniscus. He thinks  four weeks and I should be active again, albeit with the ususal medical caveats etc. 

I've accepted that osteoarthritis is pretty likely so will do much much more leg/muscle/allignment work and probably eat lots of curry (tumeric).

 

Hi Andy,

If it's any reassurance to you,, I had this done a couple of years ago, and I'd describe my recover as complete. The only occasional tweak is when I kneel down. Otherwise I've done shit Loads of climbing with knee drops and knee bars, falling off high boulders (which hurts my back), long distance fell running etc.

Stuff that helped me. Obsessively do physio rehab exercises that were suggested post surgwry. Cycling really helped regain movement and strength. Thereafter, I got a lot better at glute and quad work.

I have no idea about skiing, but I dont see why most other sports won't be ok

Hi Ged, thanks for the encouraging reply. How much meniscus did you have removed? I must admit I was a bit dismayed when the surgeon told me 2/3rds had been removed. Encouragingly I can walk without any pain already.

[sheavi]

I had 50% removed in 2010.  Was back climbing in 4 weeks.  Not really had any issues since, no pain full movement and strength.  I'm just cautious w/ certain high rock-overs now. Osteoarthritis is a risk factor but will be multifactorial if it does happen and not a given. 

[Davo]

You may find this podcast about osteoarthritis helpful / interesting. Describes well how compressive load is thought to help with regeneration of cartilage and that shear forces should be avoided (mainly through strengthening of the leg muscles).

https://podcasts.apple.com/gb/podcast/the-physio-matters-podcast/id785762010?i=1000511907520