OCD...which exercises can and which can't?

[simon]

Hi, maybe people have opinions on this?

I was recently MRI'd for a case of tendonitis in my right foot. This turned out to be mild but the suprise was being told I had an osteochondral lesion of the talus dome (medial side). The radiographer commented no displaced/detached fragment, normal tibeo-talar joint space and no joint effusion. It was classified as IIA. I have had no pain anywhere near this part of the ankle, so I suppose it must be asymptomatic.

The orthopedic specialist said to stop all running and hiking, said there was no treatment and that it would get much worse. He didnt touch the foot. I will seek a 2nd opinion as his seemed too extreme and negative. To my untrained eye on the MRI it looks like the cartilage is 99% intact, but there is an area on the MRI darker than the rest of the bone just beneath the cartilage and from what I can tell is probably about 12mm long and 8mm wide and in the centre of the inner side (medial) of the talus. A few of the images are posted below.

The damage may have been caused doing mixed martial arts when 9 years ago I had a serious sprain and was on crutches for a week or so. That "accident" may have involved pressure on the outide of my right leg below the knee with the foot stationary, so that the tibia may have been rolled hard onto the talus; the pain was certainly extreme.

So now my plan is to wait for a few months, get a second MRI to see if there is any change and seek a second opinion from another specialist. I will stop running and any high impact activity on hard surfaces and stop hiking. These all risk the tibia rolling against the side or front of the talus (again, as far as I can tell from looking at anatomical diagrams).

But safer exercises might be light skipping in the gym, as this would be vertical and the movements kept small. As well as that maybe some light cardio movement on mats, perhaps star jumps and lunges etc. As long as these do not result in pain do they seem low risk or am I misunderstanding the mechanics of how this kind of damage can progress to a worse state? Is pain the best guide as to the safety of activity?

In the absence of pain it seems too extreme to stop activity, which will lead to muscles weakening which can cause its own set of issues. There must be compromise exercises that work around the risks. Or could the interpretation of thr MRI have been wrong, could it be more a form of scar "tissue", or some kind of other stable state, this explaining why there has been no pain there for 9 years?

Thanks for any opinions or advice.

[ocdnetadmin]

To my untrained eye on the MRI it looks like

Unfortunately, I doubt you or anyone else on this forum is trained or qualified in any way to read / diagnose MRI charts. Please begin from a position of ignorance and listen to the judgment of trained doctors rather than that of yourself or people on this board when it comes to analyzing MRI charts.

As for the tendonitis, that is how I noticed my OCD. It got worse and worse from that point on. I would not ignore the pain.

Thus, I think conservative paths are the way to go here. A few weeks to a month of rest is not going to do any permanent damage. You have the rest of your life to be physically active. Learn the discipline to be INACTIVE, at least until you figure things out. This is a serious injury you have. I would not jump rope or lunges or whatever else you are planning.

[simon]

Alan, when you noticed your OCD for the first time was there any pain from that or was the pain only from the tendonitis?

I have no pain from the part of the foot with the OCD, doesnt that indicate that exercise that doesnt cause pain is not doing harm, especially if it mechanically isnt creating loads that impinge directly on the OCD area?

[ocdnetadmin]

I don't remember exactly. But the foot is composed of hundreds of small muscles. A weakness or defect in one part of the foot can manifest in pain in other areas. In general if you have tendonitis I think that is a bad sign, indeed.

If you proceed (carefully) the answer will be pretty clear in the next few weeks to months.
Maybe the tendonitis will go away and your OCD isn't very serious and you can continue your active lifestyle with no issue.
Maybe not...

What is the cause of your tendonitis? Is perhaps a question worth asking.

[simon]

Alan, the cause of my tendonitis was probably getting back to boxing exercises with a lot of footwork that I havent done for so long that I was not used to it. Could the OCD have made that more likely, maybe shifting to rely on stronger parts of the foot? Yes, a possibility, but in the absence of OCD related pain then what signal would cause that shift to occur?
 

In these exercises there is a lot of pushing off the back foot to move forwards or the front foot to move backwards so I think I over did that. Those exercises would not have caused the OCD which I suspect happened years earlier in martial arts/jujitsu sparring when somebody applied an illegal take down method in a stupid way. So I think i may have been living with the defect for a long time. It was the tendonitis that got me to the hospital for an MRI though which is when the OCD showed up. And exacarbating all of it over the years...who knows....jujitsu...judo...mma...hill running....all forms of abuse.

I am planning on a second MRI soon to see if there has been any further deterioration as its been a few months now since the first one. The tendonitis has definitely gotten a lot better though. Giving up running and hiking completely and doing skipping and light boxing exercises seems like a middle ground.

Whats the alternative, just cycling and swimming and otherwise avoiding even light walks? Being active has been such an important part of my life that its hard to imagine existing without it. In the absence of pain in the area of the actual OCD the hope is to manage the risks by choosing safe forms of activity. When I say safe I mean that cause no pain and seem mechanically unlikely to stress the area of the OCD.

By the way I submitted my details and some MRI images to ankleplatform.com, run by a specialist in the Netherlands whom you may be familiar with. They kindly looked at the MRI and replied that the MRI does look like typical OCD saying no treatment without pain but if deep ankle pain develops then ECBMS, whatever that means. They also noticed bone spurs in the anterior joint, so its more complex than I thought. In the absence of no pain on palpitation of the joint then no treatment but if there is then they say scopic removal of osteocytes. So far no pain there although an occassional tiny twinge at a certain angle under high load. As you say, the foot is complicated, it gets more complicated the more I learn. I wish I had understood a little of it when I was taking so many stupid risks and acting like I was invincible. Too late now.

[ocdnetadmin]

I think it's good you are thinking about cutting back on your activities. You have the right mindset IMO, one that I struggled with maintaining when I had my OCD.

I can only speak from my experience - my tendonitis was a direct precursor to the OCD getting diagnosed. My ankle never got better, only deteriorated from that point on.

Your plan is a solid one, I think. Proceed slowly, curtail the pounding activities, see how your ankle reacts. Can you cycle? Swim? Hike? Walk 1 mile? 2 miles?   See when the pain kicks in and adjust accordingly.

Most important thing as you already understand is to curtail the risks significantly. If you aggravate your ankle again, say, if an opponent does another illegal judo move, it doesn't even have to be a direct strike to your ankle to cause damage. You already have a weak/injured/unstable situation in your foot which increases the risk of more injury IMO.  It's similar to how a basketball player with weak ankles has a greater risk of hurting his ankle again , even from simple movements that a healthy ankle would handle perfectly fine.

As for continuing your active lifestyle, I feel you, I really do. I recently played basketball again for the first time in 8 years because I missed it so bad. Granted, I can't ball like I used to, I had to adjust and move around the court like an old man, and I barely jumped the entire time, and i absolutely refused to play full court, and I asked to guard the slowest / least athletic guy on the opposing team every game.   After that game my ankle hurt a bit so I am taking as long as a week or more to rest.

It's these kinds of adjustments you will learn to make. It's all about managing the pain. There are posters on this board who continue to run / ski / whatever even with OCDs. I'm sure they aren't professional athletes but we have one life to live and we need to do what makes us happy. OCDs aren't a death sentence, they're an injury to live with and adjust to.

Goodluck, i hope that helps..

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