Mark: Hi, it’s Mark Bossert from Top Local. We’re here with Dr. Harold Meinzer of Evolution Wellness in Langley and Vancouver and we’re going to talk about your health. How you doing today, Dr. Harold?

Dr Harold: I’m doing fantastic today. Thanks, Mark. How are you?

Mark: Great. So, meniscus. We’re going to talk about the happy meniscus or meniscus injuries. What’s going on with meniscus rehabilitation these days?

Dr Harold: Well, meniscus is one of those injuries that’s near and dear to my heart just because I tore mine, that’s almost a year and a half ago. I call it the happy/unhappy meniscus injury. Basically meniscus, it’s in the knee joint. It’s these two cushions that are made up of cartilage that our big bone, the femur and our tibia, rotate over and that thing, the meniscus, that helps stabilize the knee joint and also acts as a cushion. It’s one of those injuries that happens with all types of sports. It’s not specific. You could be playing in a non-contact sport as well as a contact sport and still injure that meniscus.

When you do, it’s very painful and can take a long time to get better. Typically that injury is a twisting-type motion. It tears the meniscus. It can occur with other structures within the knee joint, the ACL as well. The other thing I want to just point out is, which I think is funny, is that us older athletes are at risk because it weakens with age just like everything. So it’s that stereotypical middle-aged athletes that we see as well as younger ones, but in the office for sure.

Mark: What’s the process with somebody that’s injured themselves? You twisted your knee today, what do you do?

Dr Harold: Well, then you’re going to get all these great symptoms. You twist your knee, you’re going to feel probably immediate pain, immediate pain from the injury. Sometimes they’ll even hear a pop sound and that popping sound is … It’s always good to remember so you can tell your practitioner about it because that’ll help diagnose. But yeah, that’s not good. You’re going to get swelling around that knee joint. It’s going to be very difficult to bend or even straighten it. Sometimes it’ll lock because there’s little tear in there that flaps and it catches into the knee joint. People call this a catching-type pain and yeah, extremely painful. You’re probably going to be laid up. You’re going to put ice on it right away and it might even take you a couple of days to be able to weight bear on it.

Once you have that injury, whenever you can get into the office, then we’ll do a full exam onto that, possibly send you out for an x-ray or MRI depending. Now here in this province, they’re doing x-rays before MRIs. So you’ll need to have an x-ray done and that’ll be through your general practitioner. Then the treatment will be determined by the extent of the injury, whether it’s mild, moderate, severe. The meniscus is a very interesting structure. Because I describe it like this round donut and on the outside of it it’s a … They call it the red zone, so it’s got blood flow to it. On the inside or white zone, not a lot of blood flow to it. Depending on which part of the meniscus you injure, that will determine how fast you get better. Obviously more blood flow, we always want that to those structures. The white zone is that really bad zone that can take a long time to heal.

Mark: Go through the initial home treatment, the most immediate care, what’s a way to remember that?

Dr Harold: It’s usually the same one as most acute injuries. It’s that rest, ice, compression right away to try to limit the swelling, the joint response. Then if it’s really bad, then you might have to take some medication for it as well. If it’s extreme pain then you can talk to your doctor about that. And that’s the initial phase. You might be, like I say, laid up in bed or on the couch for a couple days before you can even put weight on it. Then there’s also bracing. The Neoprene knee sleeve can be very effective initially just to compress that area to limit the swelling. Once you’re weight bearing, then there’s offloading the joint, so medial or lateral meniscus-type braces that can help you walk. Like for me, I injured my medial meniscus so I have a brace that it just offloads more of that pressure and weight off the lateral side. That allows you to walk and hobble around with a cane too. Yeah, it’s very humbling.

Mark: Now I’ve gotten to that point. I’m mobile, I come into the office, what are you going to work through with somebody?

Dr Harold: Well, we’ll do that exam to determine exactly what’s happened. In that really acute phase then we’re going to use that laser into that area. We’re really going to try to drive as much blood flow to that area, bringing in those byproducts or nutrients and building materials that we want to repair that tissue with. And then we want to get rid of all the metabolic waste that’s built up into that system, so that’s the anti inflammatory effect of laser. It’s very effective to try to drive more blood flow in, accelerate that healing process into that joint. We’re starting to play around with a little bit, which is an interesting new addition to the office which we’ll probably get into another podcast, and that’s the NormaTec compression sleeve.

It’s a really big compression sleeve that fits over the top of your whole leg, like a ski pant. It uses compressed air like an air bladder to pump out all that fluid out of that area as well. So that one is very effective, not so much in the very acute stage, but once you’re able to straighten the leg and have a little bit more mobility, then we can get into that. That would be determined on a case-by-case basis. Then pointing you in the direction of a brace, that’s the next step. And then once you’re able weight-bear and you starting to move again, then we want to start looking at strength and conditioning training into that joint.

Mark: Now, you don’t necessarily prescribe the training regimen. Would you send someone to an exercise physiologist or someone like that, a kinesiologist?

Dr Harold: Yeah, exactly. You want either a physiotherapist or a really great kinesiologist can help put you through the strength training that you’re going to need to build up quadriceps muscle and hamstrings as well to help stabilize the joint so that you can get back to doing something active again, which is so important. I guess right now we’re really trying to keep people away from surgery. I mean, some people might have to have it, but ideally you want to let that tissue heal. Then strengthen, rehab it, try to get back to the sport. If you have to use a brace, use a brace, and then push off any kind of surgery.

Mark: Yeah. Surgery has other effects in the long term, I guess.

Dr Harold: Yeah. Yeah. Scar tissue and then the acceleration of the arthritic condition into the knee. If we leave it to heal on its own, take a longer time frame, then you’re gonna feel better in 20 years because the joint will be healthier. I mean, you don’t want to go through that where you get close to that bone-on-bone. At some point you will if you do too aggressive a surgery.

Mark: And what about treatment protocols? Is it the typical six treatments and every other day sort of thing?

Dr Harold: Yeah. In that acute phase, it’ll be every other day. Depending on how bad it is, it might last longer than six. It could be 8, 10, 12 treatments into that area until it can start to function again and then everything else will go along with the treatment protocol.

Mark: Is this an injury … I’m gonna assume based on my experience with different injuries, is this one that’s going to go up and down? You’re going to feel like you’re really feeling better. Maybe you do your workout, your strength training, et cetera, that you need to do under supervision. And then ouch, the pain comes back and it’s time to get some more treatment. So it’s kind of a back and forth, but generally a stair step climb. Is that a fair way to … How was your experience?

Dr Harold: Yeah, I would say that’s very accurate. You’re going to have these times where things start to calm down. The inflammation is diminished and you’re gonna start feeling, wow, I’ve got full range of motion again. You’re just going to turn a little bit and twist your knee and then whammo, it’s gonna flare up. Especially if you have a flap in there, like a small floating piece, that’ll catch and then it sets that whole cascade of events into action again and then it might take you a week or so to get back to that point and it’s sort of up, down, up, down.

As you start to heal, those little hiccups become more spaced out and you have less of them. But yeah, that’s for sure. It’s a stair step effect all the way the way through. That’s been my experience as well going through it with my own knee. I used the laser, you know, almost immediately after injury. Luckily I have it at my disposal so I could definitely utilized it all the way up. The most painful thing about, I think, my whole injury was… That was a Scrabble injury, which is not a very contact sport or non-contact sport, but a Scrabble. So watch out people for Scrabble.

Mark: You went for the triple word score too soon.

Dr Harold: That’s a whole ‘nother conversation. All my patients ask me, how do you play Scrabble?

Mark: So there you go. If you’re looking for some treatment for your knee injury or even just in case and you’ve got some knee pain, old knee pain, old, even a bit of arthritis in your knees, laser therapy will help an awful lot. That’s been my experience and I think that’s the experience of everyone who goes to see Dr. Harold. You can reach him at (604) 881-2404 to book your appointment. You have to call and book ahead. They’re very busy. Located both in Vancouver and in North Langley and thanks a lot, Harold.

Dr Harold: Thanks, Mark. Have an awesome day.