Exercise adaptations, treatment ideas for post-traumatic osteoarthritis
January 7, 2023 1:29 PM Subscribe
I've got bad post-traumatic osteoarthritis in my left ankle, from a fracture in 2017. I'm in my mid-30s and (formerly) quite physically active. Help me brainstorm exercise options that don't involve weight-bearing or ballistics, especially safe, pain-free, non-ankle-weightbearing exercise I could do at home (or at my building's small gym) as part of my daily routine! Also please help me make a comprehensive list of all treatment options and better understand the basics of each, so I can have a productive discussion with my podiatrist this week.
I'd love to hear folks:
- talk about ways I can exercise and stay strong and healthy without worsening my left ankle pain and injury!
- discuss any treatment options that are not on the treatment list below. These can be as simple as a specific kind of massage or a new PT exercise, or as complex as some surgery I haven't heard of.
- discuss your own experience with any specific treatment for ankle osteoarthritis (either your own injury, or your professional-but-YANMD experience) -- I'm interested in both positive or negative experiences.
My x-ray summary:
"Advanced tibiotalar osteoarthritis with bone-on-bone morphology, subchondral sclerosis, and subchondral degenerative cyst formation. Status post plate and screw fixation of the distal tibia without evident hardware loosening or failure. Widening of the medial gutter suggests underlying syndesmotic disruption."
My exercise situation:
- I am an open water swimmer and former competitive swimmer. I can still swim, but I can only do open water for maybe a third of the year currently (since cold-water swimming in 46F water aggravates the ankle arthritis). For pool swimming, I can only push off the wall with my good foot, which puts extra strain on the right knee.
- I can't run.
- I can bike, especially with my ebike, but when I already bike for my commute in the pouring rain among cars that want to squish me, it's not super attractive to go out and do it again after work as an extra form of exercise, at least not in the winter.
- I had to stop barbell weight-lifting due to ankle pain. I do have access to a small gym both in my apartment building and at my office, but am not sure how to use these resources -- maybe I could do upper body freeweights exercises sitting/kneeling/laying on a bench? Please link resources if you have them!
- I can't do social dance or gentle solo dance anymore.
- I can't do sun salutations anymore, and am not sure how to do much standing yoga with my injury.
- I am just starting to try pilates and am cautiously optimistic about that, but I can only go once a week.
My treatment list so far:
0. physical therapy (been doing this periodically for the past four years, going to try again but not sure if it will help)
1. steroid injections (currently getting these, with diminishing returns)
2. viscosupplementation (my first injection is scheduled for this week)
3. ankle replacement (according to my podiatrist these are not super great for young, active folks and often fail within 8 years, he does not recommend)
4. ankle fusion (wouldn't be able to flex my ankle for stairs/dance/swimming, prone to end in amputation 10-15% of the time anyway)
5. platelet rich plasma (AFAIK, not supported by published evidence for serious ankle osteoarthritis)
6. stem cells (AFAIK, not supported by published evidence for serious ankle osteoarthritis)
7. various "cartilage repair" options (super curious, but it's definitely a serious surgery and I can't tell if it is legit or not?)
8. amputation (I see happy amputees who are able to return to being athletes and live much more active lives, but I'm concerned that prosthetics are extremely expensive and need to be replaced periodically, especially athletic prosthetics like running blades that are, what $20,000?! and aren't covered by insurance... and it seems like socket pain becomes as difficult of a problem for some people as the ankle pain was to begin with)
9. acupuncture (I've been doing this weekly for a few months without noticeable improvement; my acupuncturist wants me to try seeing a different acupuncturist for a new perspective but I'm not sure it's worth the effort)
10. heat therapy (I sometimes use a heating pad or a hot water soak for my foot, but it's not clear it really helps... Visiting Arizona for a week and laying in the sun and swimming in a warm pool did help some, but I am not yet willing to leave my city, my job, and all my friends to live somewhere hot)
Thanks in advance for any help you can give!
I'd love to hear folks:
- talk about ways I can exercise and stay strong and healthy without worsening my left ankle pain and injury!
- discuss any treatment options that are not on the treatment list below. These can be as simple as a specific kind of massage or a new PT exercise, or as complex as some surgery I haven't heard of.
- discuss your own experience with any specific treatment for ankle osteoarthritis (either your own injury, or your professional-but-YANMD experience) -- I'm interested in both positive or negative experiences.
My x-ray summary:
"Advanced tibiotalar osteoarthritis with bone-on-bone morphology, subchondral sclerosis, and subchondral degenerative cyst formation. Status post plate and screw fixation of the distal tibia without evident hardware loosening or failure. Widening of the medial gutter suggests underlying syndesmotic disruption."
My exercise situation:
- I am an open water swimmer and former competitive swimmer. I can still swim, but I can only do open water for maybe a third of the year currently (since cold-water swimming in 46F water aggravates the ankle arthritis). For pool swimming, I can only push off the wall with my good foot, which puts extra strain on the right knee.
- I can't run.
- I can bike, especially with my ebike, but when I already bike for my commute in the pouring rain among cars that want to squish me, it's not super attractive to go out and do it again after work as an extra form of exercise, at least not in the winter.
- I had to stop barbell weight-lifting due to ankle pain. I do have access to a small gym both in my apartment building and at my office, but am not sure how to use these resources -- maybe I could do upper body freeweights exercises sitting/kneeling/laying on a bench? Please link resources if you have them!
- I can't do social dance or gentle solo dance anymore.
- I can't do sun salutations anymore, and am not sure how to do much standing yoga with my injury.
- I am just starting to try pilates and am cautiously optimistic about that, but I can only go once a week.
My treatment list so far:
0. physical therapy (been doing this periodically for the past four years, going to try again but not sure if it will help)
1. steroid injections (currently getting these, with diminishing returns)
2. viscosupplementation (my first injection is scheduled for this week)
3. ankle replacement (according to my podiatrist these are not super great for young, active folks and often fail within 8 years, he does not recommend)
4. ankle fusion (wouldn't be able to flex my ankle for stairs/dance/swimming, prone to end in amputation 10-15% of the time anyway)
5. platelet rich plasma (AFAIK, not supported by published evidence for serious ankle osteoarthritis)
6. stem cells (AFAIK, not supported by published evidence for serious ankle osteoarthritis)
7. various "cartilage repair" options (super curious, but it's definitely a serious surgery and I can't tell if it is legit or not?)
8. amputation (I see happy amputees who are able to return to being athletes and live much more active lives, but I'm concerned that prosthetics are extremely expensive and need to be replaced periodically, especially athletic prosthetics like running blades that are, what $20,000?! and aren't covered by insurance... and it seems like socket pain becomes as difficult of a problem for some people as the ankle pain was to begin with)
9. acupuncture (I've been doing this weekly for a few months without noticeable improvement; my acupuncturist wants me to try seeing a different acupuncturist for a new perspective but I'm not sure it's worth the effort)
10. heat therapy (I sometimes use a heating pad or a hot water soak for my foot, but it's not clear it really helps... Visiting Arizona for a week and laying in the sun and swimming in a warm pool did help some, but I am not yet willing to leave my city, my job, and all my friends to live somewhere hot)
Thanks in advance for any help you can give!
Best answer: I don't have a huge answer for you but as a person who recently broke my ankle, I was pretty amazed to see that a trainer was able to concoct an entire workout plan that did not include me moving my ankle. Over the course of 4 months I was in a splint, then a boot, then a brace, and I was able to keep working out the entire time. Dumbbells, barbells, bands, while sitting, lying on a mat, standing still, etc.
posted by BlahLaLa at 2:11 PM on January 7, 2023 [1 favorite]
posted by BlahLaLa at 2:11 PM on January 7, 2023 [1 favorite]
Response by poster: BlahLaLa -- interesting. I've had at least 4 different (and quite expensive!) personal trainers since 2017 and none of them have been up to the task. I am waiting on a consult with a trainer who is also a physical therapist, so maybe they can help me design a workout I can do independently.
posted by cnidaria at 3:19 PM on January 7, 2023 [2 favorites]
posted by cnidaria at 3:19 PM on January 7, 2023 [2 favorites]
Don't bother with acupuncture. It isn't evidence based.
I used to use a TENS machine for various painful joints.
posted by kathrynm at 3:27 PM on January 7, 2023
I used to use a TENS machine for various painful joints.
posted by kathrynm at 3:27 PM on January 7, 2023
Best answer: Just to add some anecdotal regarding PRP and stem cell - and friend of mine went the PRP route for a knew issue, had an extreme allergic reaction the platelet carrier used in the injection, and has been left permanently hobbling on a gimpy knee.
Also, I’ll never use a trainer that is not also a physical therapist - there are so many ways to injure yourself, and most trainer “certifications” are worthless when it comes to avoiding injury.
posted by dbmcd at 3:41 PM on January 7, 2023
Also, I’ll never use a trainer that is not also a physical therapist - there are so many ways to injure yourself, and most trainer “certifications” are worthless when it comes to avoiding injury.
posted by dbmcd at 3:41 PM on January 7, 2023
Cnidaria, I do hope that new trainer can help you. Though I'm now in month 5 since my break, and the break itself is healed, I had major tendon injury so I'm still quite restricted. My genius trainer has definitely been able to adapt workouts for me, and I hope you find someone who's great too.
posted by BlahLaLa at 3:51 PM on January 7, 2023
posted by BlahLaLa at 3:51 PM on January 7, 2023
Best answer: My SO has osteoarthritis and had manipulation under anaesthetic. It worked for about eight months. It's a good alternative to surgery. One challenge is that many surgeons don't do it. A doctor who does knee or shoulder mua may be able to find you a good referral.
posted by parmanparman at 4:00 PM on January 7, 2023
posted by parmanparman at 4:00 PM on January 7, 2023
Best answer: Bring the open water to your next training session by trying this “no walls” workout in the pool.
posted by Iris Gambol at 4:25 PM on January 7, 2023 [1 favorite]
posted by Iris Gambol at 4:25 PM on January 7, 2023 [1 favorite]
Best answer: I’ve ended up with Pilates as my preferred form of exercise after a bevy of ankle/knee/hip injuries, so I think it’s very likely it works for you when the other exercises that you’ve listed don’t work, especially if you’re seeing someone 1:1 who can modify the workouts appropriately. I have at times used the YouTube channel Blogilates for ideas when I’m trying to rehab. It’s not as good as in person instruction, but it’s usually pretty obvious which exercises will and won’t involve your ankles and a lot of the workouts are heavy on lying and kneeling poses. Just skip all the ones with burpees and some of the warmups that involve a bunch of moving around and replace them with cat/cow.
posted by A Blue Moon at 5:53 PM on January 7, 2023
posted by A Blue Moon at 5:53 PM on January 7, 2023
Best answer: I had a triple spiral ankle fracture 19 years ago -- two plates, seven screws. Two things helped:
1. Warmer is always better. I started with an elastic fabric ankle sleeve, but they wear out fast. I graduated to three neoprene ankle sleeves. Three because they did make my foot sweat, and they need a day to hang dry. Your sleeved foot will probably not fit in some of your shoes. I do recommend Mueller's, as most comfortable and longest lasting. Just last year I realized that boots are warmer even than a sleeve, so now I wear only ankle (or higher) boots and don't need the sleeve at all.
2. Gentle flexion. A PT/OT bodyworker could and did unwind the overstressed muscles and tendons, but the benefit only lasted a couple hours. Recently a new PT demonstrated an exercise that's reduced my pain level in half:
Work up to five back-and-forths several times a day, with the goal of full weight-bearing. Now I do ten daily. After two months I graduated to a 5/8" plastic pipe. On bad-arthritis-weather days, I still use the pencil.
One moral to the story: new PTs can have great ideas even 17 years after injury.
posted by Jesse the K at 11:00 AM on January 8, 2023 [2 favorites]
1. Warmer is always better. I started with an elastic fabric ankle sleeve, but they wear out fast. I graduated to three neoprene ankle sleeves. Three because they did make my foot sweat, and they need a day to hang dry. Your sleeved foot will probably not fit in some of your shoes. I do recommend Mueller's, as most comfortable and longest lasting. Just last year I realized that boots are warmer even than a sleeve, so now I wear only ankle (or higher) boots and don't need the sleeve at all.
2. Gentle flexion. A PT/OT bodyworker could and did unwind the overstressed muscles and tendons, but the benefit only lasted a couple hours. Recently a new PT demonstrated an exercise that's reduced my pain level in half:
Work up to five back-and-forths several times a day, with the goal of full weight-bearing. Now I do ten daily. After two months I graduated to a 5/8" plastic pipe. On bad-arthritis-weather days, I still use the pencil.
One moral to the story: new PTs can have great ideas even 17 years after injury.
posted by Jesse the K at 11:00 AM on January 8, 2023 [2 favorites]
Response by poster: Update:
I got my viscosupplementation injection today, and will know in a couple weeks if it worked.
I'm also getting evaluated for an ExoSym orthotic, which my podiatrist recommended! Being able to hop around happily like a mountain goat is something I haven't been able to do since I broke the ankle in 2017. If I have results like these patients, I will be over the moon.
posted by cnidaria at 9:21 PM on January 10, 2023
I got my viscosupplementation injection today, and will know in a couple weeks if it worked.
I'm also getting evaluated for an ExoSym orthotic, which my podiatrist recommended! Being able to hop around happily like a mountain goat is something I haven't been able to do since I broke the ankle in 2017. If I have results like these patients, I will be over the moon.
posted by cnidaria at 9:21 PM on January 10, 2023
Response by poster: Update update: I got the ExoSym and it's fabulous. I'm not sure how to describe it other than "life-changing".
posted by cnidaria at 10:38 PM on March 2, 2023 [2 favorites]
posted by cnidaria at 10:38 PM on March 2, 2023 [2 favorites]
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11. weight loss (apparently an evidence-based option? I've put on a bit of weight recently due to the injury disrupting my abilities to both exercise and stand up in the kitchen and cook, so I've been eating crap. Starting next week, I've signed up for a healthy meal delivery service with lots of veggies, lean proteins, and whole grains, and am hoping that will help me lose some weight)
12. specifically avoiding alcohol, sugar, saturated fats, and refined carbs (I've read this can help reduce osteoarthritis inflammation)
posted by cnidaria at 1:43 PM on January 7, 2023