circus injury, need some advice

[reubendotdotdot]

Hi all, my name is reuben, i am a new member, just registered.

A little about me. I am a 27 year old Male, have done gymnastics since i was 12 or so and have been a circus and street performer for the last 5-6 years. I have, and do, put a lot of wear and tear on my body, my chosen vocation forces it.

i have a question regarding a recent injury, i would love any advice or help on the matter, and thank anyone so much for replying.

I am writting here because i am an english speaker currently working in Valencia spain... and quite often its very hard to make heads or tails of what the doctors are saying. I am a professional Circus performer, specializing in "Chinese pole". I recently during a show developed a really bad pain starting in the back of my right leg behind the knee, and working its way down to my calf and lower. It was during a show after a specific move which hits my leg very hard on the pole, i am use to a pain in this leg, its a reacuring thing, but this time it was a lot more, i had been working 2 shows a day with no days off for over a week, so recovery time for injuries. i fiished the show and limped off stage and had to lie down with my leg up, it was hurting alot.

i went to the hospital, after i refused for a while, purely because i couldn't walk anymore, and just behind my knee it was getting very very puffy. After a consultation and the next day seeing a doctor and getting what they call a "cardiograph" but it looks like a ultrasound to me, i was told i probably burts a "baker cycst" behind my knee, and fluid had collected in my calf, but they would do an MRI to confirm. Since then i have been put on a diet of painkillers (trying not o take them) anti-inflamatories and i inject myself everyday with something called CLEXANE supposedly for circulation, and keeping my leg high and on crutches. injury was on 20th of december.

now i am sorry for this but these are the results that i was given from MRI, in broken english maybe, my doctor tries to write in english for me but even if it is perfect english, i just don't exactly understand...

--------------------------------------------------------------------------------
"interfascial liquid level in a deep hole in the popliteal muscle, fat edematizacion the regional fibrillary fracture in the proximal insertion twin external and fibers proximal bilateral soleus.
degeneration of the horn intrasustancia previous Deol external meniscus and posterior horn of the medial meniscus without breaking"
--------------------------------------------------------------------------------

I talked to my doctor, and go see her again soon, from what i can make of it, i don't actually understand whats wrong, but i can start to move my foot and ankle in circles and slowly put preasure, maybe swimming and riding an exercise bike for rehabilitiation.

right now, all the swelling has gone down, actually my injured calf is now getting smaller than my good one, there is not to much pain if i touch or press lightly anywhere on my calf or behind my knee, but my foot is in a constant point. If i try to flex my foot to a walking position i feel a little pain in my calf, but much more, a restrictive and tightness all through my muscle back there, mainly focused it feels inside quite clost to the bone and a little to the right... being a circus person and an ex-gymnast, i really want to pull my foot and streach it out, but i don't know if that is good or not. i can get my foot close to a right angle without touching it, but thats about as far as i feel comfortable.


wow that was a mouthfull. Sooooooooooo, my real question is, how long would an injury like this, with correct rehabilitation, take to heal? i really don't even know if its serious or not, doesn't feel too serious but i just don't really know. My doctor said not to do much at all, other wise risk the chance of a thrombosis. I am asking because in 24 days i am meant to start my next contract in New Zealand, and am trying to toss up whether to cancel it? I have been told more or less three weeks till its good, but is this to 100%? i really need 100% or close to it to work. You can see in my website http://www.reubendotdotdot.com/

in the video's, the type of things i do. I do put a lot of wear and tear on my body. I want this to heal properly, because my body is my work and without it, i lose all prospects of employment. I would be flying back to Australia on mid next month, but i will stay here if it looks like it will take a while to rehabilitate because my work here is obligated to cover my medical costs.

Main questions are:
1. whats actually wrong in simple terms
2. how long to heal to 100%
3. opinion if i should cancel work
4. is this going to be a ongoing thing or a once off
5. any rehabilitation advice


Thank you for listening to me, i do hope there is someone out there who can shed a little more light on this, and exactly how worried and careful i should be.

kind regards
reuben

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[physiobob]

HI Reuben, thanks for the post and nice youtube video on your website. People should watch this before commenting on your issue as it give an idea to the forces you are putting through your body.

I have to say that your history sounds like you have perhaps torn a structure in the back of the knee. Obvious suspects are the popliteus muscle (a small muscle in the back of the knee that assists unlocking from and extended (straight) knee. The wear and tear on the meniscus is probably normal for someone with your vocation.

As for a bakers cyst, was there a swelling in the back of the knee prior to this issue? It might be possible and often people don't touch the back of their knee that often (unless painful) so these can be hiding there unnoticed. All a bakers cyst is is a herniation of the knee capsule (like a bladder in a basketball) and the fluid pushed out through a weakness in the bladder causing a 'cyst' like appearance.

Often when a Bakers Cyst bursts the swelling goes away rather than appearing. So the fact that your developed after the injury does not really point to this. You might well have torn your posterior cruciate ligament which often tears the posterior capsule and releases the swelling down the calf all the way to the ankle/foot.

The best overview I can suggest is that the fact you cannot fully straighten the knee with a flexed ankle means that something cross the back of the knww and the ankle is involved. This would point to the muscle of the calf or popliteus. That is if you can also straighten the knee fully with the ankle pointed.

If you can't straighten the knee in sitting with a pointed ankle then something more internal might be the issue. Unfortunately in this case you are going to need someone to have a 'hands-on' look at the knee. I am sure there's plently of willing people in NZ to assist.

Best of luck

[reubendotdotdot]

Thanks for your reply physiobob... so helpful to read something in english.

i had a meeting with my spanish doctor yesturday finally, and from what i can work out in my broken spanish, explained in my un scientific terms...

my knee is slowly wearing away, but this for me i think is normal, since i have been doing actobatics since the age of 12, both knees probably look roughly the same if looked at internaly...

i had a baker cyst (shown in MRI, not to my knowledge), but there is no fluid left in it, it ruptured and filled my calf with fluid, in the middle of my calf in between the muscles i think (i really need a basic lesson of anatomy)

i have broken some fibers in one of the muscles in my calf, which is restricting movement...

at the moment i can walk on a tip toe, i can point my whole leg streight, but a full leg flex pointed (balarina style) still causes pain in my lower calf. i can flex my foot to about 10 degrees off a right angle, but its slowly getting better. i started rehabilitation with a physio, and he used elctronic things to make my muscle flex and release, and then used heat, then ice, and made me make circles with my foot. i have set a date by the 9th of this month to re-asses whether to go to my next contract or not, depending if i can jump and land without pain.

It is still very hard to gauge what pain is good and what is bad for me, i have trained for so long and have been pushed into all kinds of positions, that pain is hard to define for me at the moment. I thought i stopped taking the pain killers so i could feel more about what was going on, but i actually stopped taking the anti-inflamatories because everything is in spanish and i read it all wrong

anyway, many thanks, i think i will heal ok, if i am learning anything from this latest injury is to listen to my body more (i was hurting for a number of days in my leg before this final breakdown injury) and be kinder to my tool, and that i am starting now to have a sinscere interest in the physiotherapy world and practice, this forum is wonderful! something i can study in the future when my body finally say's enough and i can live in one place!

kind regards
reuben

[opihiman]

Thanks for your reply physiobob... so helpful to read something in english.

i had a meeting with my spanish doctor yesturday finally, and from what i can work out in my broken spanish, explained in my un scientific terms...

my knee is slowly wearing away, but this for me i think is normal, since i have been doing actobatics since the age of 12, both knees probably look roughly the same if looked at internaly...

i had a baker cyst (shown in MRI, not to my knowledge), but there is no fluid left in it, it ruptured and filled my calf with fluid, in the middle of my calf in between the muscles i think (i really need a basic lesson of anatomy)

i have broken some fibers in one of the muscles in my calf, which is restricting movement...

at the moment i can walk on a tip toe, i can point my whole leg streight, but a full leg flex pointed (balarina style) still causes pain in my lower calf. i can flex my foot to about 10 degrees off a right angle, but its slowly getting better. i started rehabilitation with a physio, and he used elctronic things to make my muscle flex and release, and then used heat, then ice, and made me make circles with my foot. i have set a date by the 9th of this month to re-asses whether to go to my next contract or not, depending if i can jump and land without pain.

It is still very hard to gauge what pain is good and what is bad for me, i have trained for so long and have been pushed into all kinds of positions, that pain is hard to define for me at the moment. I thought i stopped taking the pain killers so i could feel more about what was going on, but i actually stopped taking the anti-inflamatories because everything is in spanish and i read it all wrong

anyway, many thanks, i think i will heal ok, if i am learning anything from this latest injury is to listen to my body more (i was hurting for a number of days in my leg before this final breakdown injury) and be kinder to my tool, and that i am starting now to have a sinscere interest in the physiotherapy world and practice, this forum is wonderful! something i can study in the future when my body finally say's enough and i can live in one place!

kind regards
reuben

Hi Reuben,

first, you look freaking amazing doing the stuff you do...

Second: there is a good chance that maybe you did burst the sac of the baker cyst. Your Sx would actually present exactly the way you describe. If it is the bakers cyst ... Time is you best friend. The fluid that leaks out will be a very irritating substance outside of the joint space. Time will help the body to reabsorb and remove those substances.

A calf sleeve may be helpful to get you more mobile...
Calf Sleeve Calf Support
If you want to try some thing before buying...an ace bandage maybe like a 3" wide.

Wrap from toes to knee in spiral ... The compression may feel pretty good

Third: You have Hit the nail on the head with your discovery of paying attention to you body more. If more people could do this alot of problems will take care of the selves.

Good Luck

OPI