So about a month ago, hiking on flat dirt, I felt a tightness/stiffness in my knee. Hasnt improved much since then. Its not particularly painful, but it just doesnt feel right, like I wouldnt want to put all my weight on it. I had an xray and MRI done, neither showing anything. The doc said its soft tissue inflammation. Which is the most frustrating part, I dont really know whats going on or whats causing the inflammation. From the symptoms, it could be bursitis, baker's cyst, or even pseudogout. In any event, I have big plans for hiking this summer, so I'm really worried that I wont be able to go, or wont be 100% if I do go. Maybe I should get a 2nd opinion, have someone else look at the MRI? Also, the MRI was done in the morning hours, when the inflammation is at its best. Would that make a difference in any problem showing up?

That needs proper medical advice.

You could try about 2 -3 weeks real rest plus an anti-inflammatory for that period. Check that with doctor though.

Cheers

> I have big plans for hiking this summer, so I'm really worried that I wont be able to go, or wont be 100% if I do go.

There's your cause. I swear once you make big plans you start to fall apart.

Do get your 2nd opinion and everything but after all that, just relax. It's a long way until summer. It may go away or you may be able to hike anyway.

I plan on it, even if it means biting a stick at the end of every day. For five years all I've thought about is "wilderness" I'm the Chris McCandless type (with more brains, since I dont ever hike without map and compass!), and I'm itching to get the hell out of NJ for good. The hardest part has been mental. Since I and my dr. don't know exactly what is going on, it leaves me feeling very frustrated and overwhelmed. Im 24 for petes sake, this is not normal.

And you aint kidding. Ive had to plow through pain on several occasions, from hemerhoids to back pain. Again, im 24, WTF!?!

@ Roger: Thats what I was told to do. Doing that, and if it doesnt heal then physical therapy they said. But not knowing what it is, and having already done an MRI, i just dont know!!!

Edited by gregpphoto on 04/05/2011 21:47:15 MDT.

"I'm the Chris McCandless type"

He ended up as the deceased type.

--B.G.--

@Bob: Way to take what I said entirely out of context! Maybe if you could read just a bit further than you did, you'd have seen the whole sentence: "I'm the Chris McCandless type (with more brains, since I dont ever hike without map and compass!)"

Edited by gregpphoto on 04/05/2011 22:09:36 MDT.

No, I didn't take anything out of context. McCandless's fatal error had nothing at all to do with maps or compasses. When he went to Alaska, he thought that he knew it all. He didn't.

--B.G.--

There was a crank operated basket that crossed the river over a gorge only six miles from where McCandless found himself trapped by the snowmelt-swollen river. Had he had a map, he would have seen this as it's marked on USGS topos. Six miles and he could have crossed the river and been home free. I wont make such a mistake. I have an incredible amount of respect for the power of nature, so I prepare myself thoroughly, both in terms of gear and of knowledge of the outdoors. My death, if it so happens in the wild, will almost certainly be from circumstances beyond my control, not of human error.

Soft tissue injuries suck and I have found through my many,many skateboarding injuries. Just work through it and ice it down every night after activity with frozen bag of peas or bucket of ice water if it a ankle. The injury will eventually go away.If you need faster results see a sports medicine doctor they work wonders compared to normal doctors.

Chris McCandless:

The subject of Chris McCandless he was not a strong swimmer and had a fear of water. Chris was not of right mind at the time to make the correct decision on situation he was in. I really don't think Chris was at the right mental capacity when he first took on the trip.

Chris could have done a couple things and survived. Learned how to swim in the ocean while he was camped out at the beach with his new hippie friends instead of jumping around in the surf. Have the knowledge that stream in the winter will become a raging river in the spring/summer when the snow melts.
Since Chris was not a strong swimmer he could have made a body raft and lashed his pack on it and handles to hold on to and went up river a couple 100 yards. Also made a emergency life jacket out of tied off pair of wet pants that has the legs tied off and air blown in to legs, Before the river crossing attempt. Chris would have eventually reach the other side of the river. Survived and we would not have a movie about him.He would have a tale to tell his children.

Gregory when things go wrong in the wild it happens fast and when you least expect something to happen for example walking on flat ground your taken out. Mull that one over in your brain for awhile.
Terry

Edited by socal-nomad on 04/06/2011 01:37:18 MDT.

Terry, at the end of the day, a simple topographic map would have shown him the cable-car that spanned the river. No need to risk swimming in a torrent of glacial melt, that's too risky. As to your point about things happening fast, as fast as greased lightning as my grandpa would say, I couldnt agree more, and I do think about that, every day. See, for me, hiking isnt just a hobby. Its an all consuming way of life, something I am going to dedicate my existence to. I think about safety in the backcountry like most 24 year olds think of girls; that is, all day every day haha,

Greg,

A lot of people have romanticized McCandless.

Here we are all about planning and developing our outdoor skills. McCandless was in over his head from the get-go. Not something a rational person would have undertaken. So you are probably going to hear a lot of negative comments.

I have a feeling you might have something going on with your injury other than "soft tissue," since it occurred suddenly, without a trauma you can identify. Might be a good idea to seek a second opinion.

@nick: Im not so worried about that aspect because things like bursitis and baker's cyst can arise without injury and be caused by bad posture, continuous kneeling, etc. That said I will probably get a second opinion just to be sure about everything.

Greg - what you are asking really needs the expertise of a physician that examines the issue. If you felt uncomfortable with the diagnosis of the first physician, do find a second physician and have them look at it as well as well as review the imaging. You may want to have this second opinion given by a doctor specializing in sports medicine or orthopedics. Physical therapy is another option that you may pursue regardless.

I'd also recommend not falling into self-diagnosis which it appears you may have started to do since you are throwing out various indications. Given the quantity of info on the internet, it's easy to do, but a bad thing to do for many reasons - let the trained professionals do the diagnosing, not you and the internet.

After the injury, did you proceed with RICE (Rest, Ice, Compression, Elevation)?

Edited by rmkrause on 04/06/2011 22:29:29 MDT.

Ryan, I was told by the doctor soft tissue inflammation. That very diagnosis can actually mean anything from simple inflammation to cysts or bursitis. Soft tissue is anything other than bone. If indeed an MRI can spot things even when they are not inflamed, then I have no problem with the doctor I am seeing now. Like I said, I got the MRI done in the a.m. hours when the inflammation is at its best and least swollen. In any event, it is only if the injury worsens or does not heal that I worry about a misdiagnosis. For now the treatment would be the same no matter what type of inflammation I may have. Lastly, since when do you have to be trained for eight years to know simple things about your own body? I'm not trying to self diagnose brain cancer here.

There are 2 things I'd suggest besides rest, ice and anti-inflammatories to help soft tissues heal. One is, find a good, talented massage therapist. Sometimes the pain is due to unbalanced muscles pulling hard on one another. My boyfriend was having numbness and pain in his foot when he was hiking. His doctor told him that he had a pinched nerve in his back, and that the numbness meant that "the nerve is dying". Doc's exact words. We have a massage therapist in town that is versed in neuromuscular therapy and St. John's massage schools. 3 sessions with her, and the pain stopped.

The other modality I'd suggest is look for someone who has a cold laser, specifically one of the new more powerful ones. K-laser is the company that makes the best ones on the market, and I believe their web-site has a search function to find who might be in your area that's certified. I'm a veterinarian, and we have recently gotten one in the clinic. I've been very impressed at how the laser helps to reduce swelling and pain, in very short order. We tried it out on each other for our chronic aches and pains, before treating our patients, because we could tell each other if it was good/bad/indifferent. I have a thicker right foot, that when I hike longer distances will start to bother me. Laser takes the pain away very quickly. Also, I torqued my knee snowshoeing, and the knee was tender enough I couldn't kneel on it. 2 sessions with the laser and the swelling was gone, and it was much more comfortable.

As someone who has medical training, although I wouldn't class myself with a top-notch sports medicine person, I do think that there are portions of the neurologic system that we ignore, don't think about, or flat out don't know about. One of these areas is the feedback between the muscles and the pain nerves. Same thing flies with ligaments, tendons, and fascia. If ibuprofen doesn't take care of it, and we can't cut it out, we don't know what to do with it.

Greg - your initial post indicated a certain level of uncertainty with the diagnosis given by the first doctor, have questions concerning the MRI that was performed and frustration over a lack of improvement and you explicitly asked if seeking a second opinion would be a good idea. Given what you stated in your OP, seeing a second physician or a physical therapist would be a good idea.

Also - inflammation is not simple, and it becomes a bigger issue to resolve if it goes from an acute problem to a chronic one.

while some bakers cysts go away without much (if any) treatment, I developed one 6 days into a 10-day solo trip. I finished the hike, but the day after I got home the cyst burst, my leg swelled up like a sausage, was completely numb and would not support my weight.

Hopefully, it responds well to RICE and doesn't re-occur. If you have big plans for hiking this summer, you're likely to be putting even more stress on your body, so I'd look for a cause now.

Have you been active (exercising, working out, hiking, etc.) during the month since it came up?

Baker's Cyst is kind of a strange item. I had never heard of it until I got it one time. Typically, it starts from an injury or maybe from knee surgery. As a result, a little void forms next to a bursa, and then over time it can fill up with fluid. In my case, I walked around with that for twenty years without knowing it. Then one day, perhaps from a blow to the knee or maybe from kneeling pressure, the little fluid-filled void bursts, and the fluid drains into tissue just below it, and that might be the calf muscle. The diagnostic test is when one calf muscle circumference is an inch more than the non-affected calf muscle. Almost overnight, the leg can swell up like a balloon, and walking even a block or two might be very painful. The doctors will have you sit a lot, keep it all elevated, do ice packs, and take aspirin. The whole thing will go away within days. It is certainly not life-threatening unless it manages to hit you out in the middle of a weeklong backpack trip and you couldn't walk home.

--B.G.--