Knee and Physical Therapy

My Orthopedic Surgeon told me I need a Total Knee Replacement because I am "bone on bone".  I want to put that off as long as possible so I am seeing a physical therapist. I climb hard, 3 times a week, in addition to stretching every morning. My knee issue doesn't affect me much while climbing except my knee isn't as strong or have as much range of motion as the good one. I'd like to know if physical therapy is going to be very effective for obsessed climbers like myself. The stretching aspect of physical therapy I think can be effective because I go through more range of motion than even climbing provides but the strengthening aspect of the physical therapy I doubt will help much because climbing probably provides as much or more strengthening than physical therapy. Are there others out there that have opinions on this.

There's a pretty broad range of 'strengthening' for PT. You'll need to find a place that regularly works with athletes and ideally climbers. For instance, my PT has me squatting and deadlifting several plates to address chronic knee pain due to a lifetime lack of adequate glute activation. In my experience, clinics that do mostly e.g. post op care tend to by default prescribe exercises that are pretty trivial for someone active.

The whole bone on bone thing is not the reason, as far as I can tell. I have bone on bone in my rt knee, my lumbar spine and my neck. Various things like rest, ice, antiinflammatories oral and topical, massage, stretching… all help and I can function with minimal pain.

The reason to have surgery, again as far as what my own orthopod says, is when the pain becames an unmanageable issue. For the knee, you can have steroid injections, and can try prp, and a gel injection like Syndvisc. All of those things can put off the need for a knee replacement.

It sounds like it would be worth you getting a second opinion. You’ll no doubt end up with a knee replacement but who knows when. 

Hi John!

Arthritis is one of the most common diagnoses treated by physical therapists and the knee is the most common joint affected by osteoarthritis. Physical therapy has been proven clinically and in research to be successful in managing arthritis. Additionally, physical therapists can help guide your decision for other treatment options if necessary. That being said, for strengthening to be truly beneficial it needs to be challenging. If you feel like you are not being challenged sufficiently by your PT, it may be time to discuss this with them or find a PT more familiar with your needs and activities. The great news is that your knee doesn't bother you much while climbing which is a sign that PT (that is appropriately challenging) would be successful for you as opposed to more invasive options such as injection or total knee replacement. The even better news is that the other options are most effective when combined with physical therapy as well so PT first can only benefit you in the long run if you're with the right provider for you.

While the article I'm including here is about the hips, the hips have a direct influence over how the knees function due to their proximity to each other and there are muscles that cross both joints. This article has strengthening exercises included that are excellent for lower body strength overall and is specific to climbers. It can be helpful to get started or to add on to your current routine.

https://theclimbingdoctor.com/stronger-hips-for-injury-prevention-and-climbing-performance/

Climbing is also amazing for strength, mobility, and exercise in general. On the other hand, there are a variety of movement categories that can help with arthritis that you may miss depending on the type of climbing you prefer. A good PT will be able to look at how you move overall, and what categories of movement you would benefit from. In addition to strength and mobility these include power, endurance, and stability. PT also considers all factors that contribute to pain, such as your nervous system, in addition to your imaging results so there is benefit aside from muscle strengthening alone.

As a doctor of physical therapy, I have seen success with people with knee arthritis seeking PT consistently if they are being challenged well. Again, if you feel like your exercises aren't challenging you know that your PT should be able to progress them, and if not there are doctors of physical therapy out there who can! 

Good luck on your rehab journey! If you have any questions or need further assistance don't hesitate to reach out.

Thanks, ZMC, Phylp and SIG for the help. I will digest your comments further and respond herein soon. SIG, should  I seek out a Doctor of PT? Where would I find one that knows climbing and is around Sacramento?

It’s always “It depends” as to whether or not knee replacement is needed. Best to try less extreme modalities before getting replacement. My experience may give you some hope that you might not need replacement, especially as I’m 13 years older than you.

Issues with L knee. In my 40s, I tore my L medial meniscus playing basketball. The only treatment back then was excising the meniscus. About 5 years later in a bouldering fall, I tore the anterior cruciate ligament in the L knee. For at least 25 years now as shown by Xray, I’ve been bone on bone in the L knee. I can still hike, climb, and lift weights. I avoid activities that lead to pounding motion such as running or basketball.

 I’ve lifted weights for 70 years and believe that’s been helpful. The main exercise for the legs are power cleans and dead-lifts. I do some light weigh squats as heavier squats hurt the back of my kneecaps (I assume I have chondromalacia).

Rob.calm

John,

I would definitely recommend it! You can ask members or staff at your local climbing gym if there is someone that they prefer to go to. Otherwise, there are a few providers in your area on the link I'll post below who have interest in climbing. Hopefully with these options you'll be able to find the right person for you!

https://theclimbingdoctor.com/portfolio-items/rock-rehab-community-2-2/

John Robinson wrote:

but the strengthening aspect of the physical therapy I doubt will help much because climbing probably provides as much or more strengthening than physical therapy.

So I just want to add that I disagree with this.  Good physical therapy will teach you the cross training exercises you need to be doing to protect your knees  and then you take this and make it part of your maintenance program. Leg press, leg extension, curls, squats, lunges, etc are all done in crosstraining routines under loads you will not achieve in climbing.  The shoulder, back, knee, neck etc maintenance routines that I developed after PT are the most important practices I have for being able to still climb.