Re: Knee Injuries

[Peter Harrison]

You are right that there is not much pivoting, but one of the main functions
of the ACL is to prevent movement where the tibial plateau slides forward
under the femoral condyles (that is one of the basic tests to identidy an
ACL tear - grab hold of the top of the lower leg just below the knee, with
the knee bent at 90 degrees, and try to pull it forward. If it moves, then
the ACL is torn.)

A brace will help, but no brace can hold your joint as well as nature does
with intact ligaments.

2 years ago I tore my LCL and lateral meniscus. I could fence ok, but would
have to stop in the middle of a lesson or a footwork session to flex the
knee. I just had surgery to remove the torn part of the meniscus, and hope
to get back to fencing next month, but it will be interesting to see if it
is better or worse. One (older, in his 60s) guy I spoke to at the gym
yesterday said it took him 3 years before he could run without pain after
meniscus surgery.

Hopefully, someone in the group with an ACL injury will post something. I
will be interested to hear the story.

I used to work at the US Military Academy hospital, where our orthopaedic
surgeons were doing 2 ACL repairs a week. This sounds like an incredibly
high number, until you consider that they were looking after 2,000 kids
playing football. The injuries were seldom on the Varsity team, but on the
others that were not as fit.

"Bill MacLean" <l@l.com> wrote in message
news:0dl5a.27722$Hb.560695@news1.west.cox.net...
> I am interested in fencing and have a question about knee injuries. First
> some background.
>
> I'm left handed but I do not have an ACL (Anterior Cruciate Ligament) in
my
> left knee. I tore my ACL, MCL (medial collateral ligimant) and medial
> meniscus in highh school football. In 1980 (I'm 39) , ACL reconstruction
> was still pretty unusual outside of pro and college sports. The doctor
> removed the meniscus, stapled the MCL and removed the ACL. A few years
> later I had a second surgery, but that was just to remove little bits of
> cartiledge that were floating around.
>
> My knee has been pretty stable since then, but I have been pretty
sedentary.
> Anyway, I've always been interested in fencing, and it seems like it would
> be a fun sport plus great exercise.
>
> Does anyone else out there have an unreconstructed ACL? Do you wear a
> brace? I would be interested to hear what people have to say. I really
> don't want to mess up my knee again. Back in high school I had a lot of
time
> for physical therapy, etc, but recovery would be a real bummer now.
>
> Is there a lot of pivoting in fencing? From observation, it appears to me
> that most of the motion is forward and back, and involves less pivoting
> than, say tennis. Is my observation accurate?
>
> Thanks,
>
> Bill
>
>

[Bill MacLean]

Hi Peter,

Thanks for the good reply. I have an appointment with an orthepedic surgeon
on Monday, and he will evaluate me. I think that it will probably be okay.

I forgot to mention that I visited a club Wed night and did some footwork.
I actually did some lunges (slowly) on Wed while the coach was watching, and
my knee is not bothering me. It seems to me that in the lunge, most of the
inertia is from the upper thigh, so the ACL isn't as important as the PCL.
I may be all wrong about this, so I look forward to speaking with the
doctor.


Two points:

1. If anyone out there fences without an ACL or even with a reconstructed
ACL in the lead knee, I'd be really interested to hear about.

2. What is the incidence of ACL injuries among fencers? If a lot of people
with good knees end up with an ACL injury, this may not be the best sport
choice for me.


Thanks,

Bill




"Peter Harrison" <pbharriso@hotmail.com> wrote in message
news:b35kpr$qt9$1@ngspool-d02.news.aol.com...
> You are right that there is not much pivoting, but one of the main
functions
> of the ACL is to prevent movement where the tibial plateau slides forward
> under the femoral condyles (that is one of the basic tests to identidy an
> ACL tear - grab hold of the top of the lower leg just below the knee, with
> the knee bent at 90 degrees, and try to pull it forward. If it moves,
then
> the ACL is torn.)
>
> A brace will help, but no brace can hold your joint as well as nature does
> with intact ligaments.
>
> 2 years ago I tore my LCL and lateral meniscus. I could fence ok, but
would
> have to stop in the middle of a lesson or a footwork session to flex the
> knee. I just had surgery to remove the torn part of the meniscus, and
hope
> to get back to fencing next month, but it will be interesting to see if it
> is better or worse. One (older, in his 60s) guy I spoke to at the gym
> yesterday said it took him 3 years before he could run without pain after
> meniscus surgery.
>
> Hopefully, someone in the group with an ACL injury will post something. I
> will be interested to hear the story.
>
> I used to work at the US Military Academy hospital, where our orthopaedic
> surgeons were doing 2 ACL repairs a week. This sounds like an incredibly
> high number, until you consider that they were looking after 2,000 kids
> playing football. The injuries were seldom on the Varsity team, but on
the
> others that were not as fit.
>
> "Bill MacLean" <l@l.com> wrote in message
> news:0dl5a.27722$Hb.560695@news1.west.cox.net...
> > I am interested in fencing and have a question about knee injuries.
First
> > some background.
> >
> > I'm left handed but I do not have an ACL (Anterior Cruciate Ligament) in
> my
> > left knee. I tore my ACL, MCL (medial collateral ligimant) and medial
> > meniscus in highh school football. In 1980 (I'm 39) , ACL
reconstruction
> > was still pretty unusual outside of pro and college sports. The doctor
> > removed the meniscus, stapled the MCL and removed the ACL. A few years
> > later I had a second surgery, but that was just to remove little bits of
> > cartiledge that were floating around.
> >
> > My knee has been pretty stable since then, but I have been pretty
> sedentary.
> > Anyway, I've always been interested in fencing, and it seems like it
would
> > be a fun sport plus great exercise.
> >
> > Does anyone else out there have an unreconstructed ACL? Do you wear a
> > brace? I would be interested to hear what people have to say. I really
> > don't want to mess up my knee again. Back in high school I had a lot of
> time
> > for physical therapy, etc, but recovery would be a real bummer now.
> >
> > Is there a lot of pivoting in fencing? From observation, it appears to
me
> > that most of the motion is forward and back, and involves less pivoting
> > than, say tennis. Is my observation accurate?
> >
> > Thanks,
> >
> > Bill
> >
> >
>
>

[Remise]

I don't know the statistics -- and the USFA has sports medicine people who
could answer your question -- but as a high school and college coach for ten
years, and an occasional (as for the past two years) club coach, and as a
fencer for well over 30 years, I do not recall ever seeing an ACL injury occur
on the strip.

This doesn't mean they don't occur -- after all, I tore my own meniscus in the
Summer Nationals several years ago, and by the way, have had a full recovery --
but it is some anecdotal suggestion that they are not as common as in high
school football (which I also played), where the question wasn't "if," but only
"who and when?"

B.C. Milligan
Baltimore Fencing Center

[Alison1daland]

>2. What is the incidence of ACL injuries among fencers? If a lot of people
>with good knees end up with an ACL injury, this may not be the best sport
>choice for me.

I offhand have three (or maybe four now, he has to see a doctor still) friends
who definitely have torn or partly torn their ACL while fencing. The three of
them had to undergo surgery recently. I have about 6 other friends with knee
problems, and I have knee problems (a physical therapist said he thinks its a
slight tear, so now I need to see a doctor). We all still fence constantly,
sometimes for many many hours a night, 6 or 7 nights a week. This isn't
necessarily the smartest thing to do on injuries, but fencing evokes that much
love... its really addicting. If your doctor says its ok for you to fence, go
for it and I hope that you've found something yu love as much as I do. If it
causes yo pain, take it a little easier, but dont give up on the idea
altogether simply because others have had problems. Good luck!
~ Alison

[Dirk Goldgar]

"Bill MacLean" <l@l.com> wrote in message
news:98B5a.36462$Hb.790179@news1.west.cox.net...
> 1. If anyone out there fences without an ACL or even with a
reconstructed
> ACL in the lead knee, I'd be really interested to hear about.

I've fenced competitively for 17 years with a completely reconstructed
ACL in my lead knee. The ACL tear was indirectly the reason I took up
fencing in the first place. I tore it practicing Tae Kwon Do back in,
oh, 1981 I guess, and though my surgeon assured me that the knee would
be "as good as new" after the reconstruction, I found that even after
a year of rehab it couldn't take the twisting stresses of TKD. So
after a year or so of trying, I gave up. (You should know that they
do this surgery much better now than they used to. What was a major
job on my knee, with 50+ metal sutures and 8 weeks in a cast, is now a
much lower-impact procedure.)

Unfortunately, the procedure that was used then involved replacing the
ACL with a section of the quadriceps tendon taken from the same leg,
and in the absence of constant training I found that my tendency to
favor that knee grew greater and greater, and the leg weakened until I
was limping as I walked and had trouble going up stairs. So I knew I
had to find something to do to correct this. Around 1985 I came
across the fencing academy where I'm now an instructor, and thought,
"Cool, maybe I can do that!" I tried it and found that, since this
was my lead leg, there were none of the lateral stresses that caused
problems in TKD. I was thoroughly hooked on the sport after my first
class, and it was only a few months before my leg was back up to
strength.

At first my knee used to ache sometimes, and I was aware of the fact
that it was the product of the surgeon's art. But that passed before
very long. The only long-term negative impact of the ACL surgery was
that, because they had weakened my quadriceps tendon, I couldn't
develop the explosive contraction from a flexed position that is
necessary to execute the move called the flèche. However, that's not
an essential move (unless you were a sabre fencer at that time) and I
managed okay without it. That weakness did pass eventually, but I
never developed a good flèche, and I atttribute that to my leg's
weakness during the time I should have been making it part of my game.
Only now is it finding its way into my fencing.

If you have any further questions about my experience with the ACL
reconstruction, feel free to ask.

--

Dirk Goldgar

(to reply via e-mail, remove NOSPAM from address)

[Bill MacLean]

Dirk,

Thanks for the all the good info. It confirms my thinking that the lead
knee doesn't appear to be subjected to very much rotation or lateral stress.
Do you know anyone who fences without an ACL at all? I imagine the
procedure is way better now than then, but I am not keen to have another
operation on my knee. With the responsibilities I now have, taking the time
involved in post surgery rehab would be a major committment that I would
like to avoid.

Do you ever use a brace? A long time ago I had a Lennox Hill derotation
brace. I was never completely satisfied with teh way the brace slid down my
knee. After the original injury, I was able to run track in high school
(without the brace) and I played some recreational tennis in college. Sorry
to say that I have now been sedentary for about 15 years, but I want to fix
that.

I am going to see an orthopedic surgeon tomorrow to discuss my interest in
learning fencing. If there is a high likliehood of re-injury I think I
might pick something else, but fencing is very appealing to me so I hope I
can work out something.

Thanks,

Bill




"Dirk Goldgar" <dgoldgar@NOalumni.SPAMprinceton.edu> wrote in message
news:E6G5a.1571$JK1.532940924@news.netcarrier.net. ..
> "Bill MacLean" <l@l.com> wrote in message
> news:98B5a.36462$Hb.790179@news1.west.cox.net...
> > 1. If anyone out there fences without an ACL or even with a
> reconstructed
> > ACL in the lead knee, I'd be really interested to hear about.
>
> I've fenced competitively for 17 years with a completely reconstructed
> ACL in my lead knee. <snip>

[Zebee Johnstone]

In rec.sport.fencing on Sun, 23 Feb 2003 00:42:33 GMT
Bill MacLean <l@l.com> wrote:
>Dirk,
>
>Thanks for the all the good info. It confirms my thinking that the lead
>knee doesn't appear to be subjected to very much rotation or lateral stress.

If you work damn hard on your form.

It is quite easy to twist that forward knee if you are slack about
keeping it where it should be.

So make sure you find an instructor who is really really hot on
correct form, so that you are pulled up every time you let that knee
fall in or that front foot land skew in a lunge.

One who is also fairly hot about rear arm position might be useful
too, a dangling arm seems to make it harder to keep the knees where
they ought to be.

Zebee

[Dirk Goldgar]

"Bill MacLean" <l@l.com> wrote in message
news:ZNU5a.50317$Hb.1129063@news1.west.cox.net...
> Thanks for the all the good info. It confirms my thinking that the
lead
> knee doesn't appear to be subjected to very much rotation or lateral
stress.

Right. Not, at least, (as Zebee says) if you maintain good form. For
most people that isn't hard to do. I have not had a single
fencing-related injury of this knee due to lateral stress.

> Do you know anyone who fences without an ACL at all?

No, I don't. I do know someone else who's had a reconstruction --
more recent and much less intrusive than mine.

> I imagine the
> procedure is way better now than then, but I am not keen to have
another
> operation on my knee.

I can't blame you.

> Do you ever use a brace?

Not on my right knee, at least not for so long I don't remember when I
last did.. I have had occasional problems with my left --
non-reconstructed -- knee, and have worn a brace on that knee from
time to time. My orthopaedist informs me with a grin, "You've got bad
knees."

> I am going to see an orthopedic surgeon tomorrow to discuss my
interest in
> learning fencing. If there is a high likliehood of re-injury I
think I
> might pick something else, but fencing is very appealing to me so I
hope I
> can work out something.

I can't say whether it would be feasible to fence with no ACL at all.
For that, I'd imagine you'd need a brace of some kind at least, but
it's really a medical opinion you'd need, not mine.

If you do take up fencing, you might consider moving to epee as soon
as you've mastered the fundamentals of foil (many salles, my own
included, start all beginners with foil). Although epee *can* be
fenced as athletically as the other two weapons, it's also possible to
fence epee successfully with reduced mobility.

--

Dirk Goldgar

(to reply via e-mail, remove NOSPAM from address)

[Fencerbill]

In article <xWV5a.1577$_p2.535479418@news.netcarrier.net>, "Dirk Goldgar"
<dgoldgar@NOalumni.SPAMprinceton.edu> writes:

> it's also possible to
>fence epee successfully with reduced mobility.

That is why it is called the old man's weapon.

Bill Hall

[Dirk Goldgar]

"Patrick C." <pat@outer*spambloc*reaches.com> wrote in message
news:Xns932B7651856B3tsr5634989BCrsgd452@204.127.2 04.17...
> "Dirk Goldgar" <dgoldgar@NOalumni.SPAMprinceton.edu> wrote in
> news:E6G5a.1571$JK1.532940924@news.netcarrier.net:
>
> >
> > At first my knee used to ache sometimes, and I was aware of the
fact
> > that it was the product of the surgeon's art. But that passed
before
> > very long. The only long-term negative impact of the ACL surgery
was
> > that, because they had weakened my quadriceps tendon, I couldn't
> > develop the explosive contraction from a flexed position that is
> > necessary to execute the move called the flèche. However, that's
not
> > an essential move (unless you were a sabre fencer at that time)
and I
> > managed okay without it.
>
> Could you possibly expand on that comment about the fleche (and how
you
> made that accented "e" in your post!). As someone interested in
re-starting
> sabre fencing after a many year absence, I've been somewhat worried
about
> stressing the back knee, and the fact that I had surgery in the 80's
to
> repair a torn tendon. The fleche seems like the most stressful thing
one
> does to the legs in sabre. But, can one get by without it? And was
it used
> more in the past than now? I did them way back when, when I fenced
in
> college, but even that young it was pretty hard to get that
"explosive"
> effect.

If you're returning to sabre fencing, you'll find you don't have to
worry about the flèche at all, because it's been banned from sabre,
along with any forward cross-step. Most sabre fencers seem to think
this change was good for sabre, making the game much more interesting.
My personal opinion is that the move should not have been banned, but
rather referees should have been made to enforce the rules that were
already on the books regarding loss of right of way in the course of
multiple cross-steps. However, that seems to have been a losing
battle. I only fence sabre occasionally anyway, so my opinion doesn't
count for much.

Although the flèche is gone from sabre, the weapon still puts a
premium on mobility and rapid changes of direction. And many sabre
fencers have adoped a move called the "flunge", which begins as if it
were a flèche, but snaps the front leg forward at the last moment
before the back foor would pass it -- a very athletic move indeed.

As for the accent over the "e", try pressing Alt+0232 (on the numeric
keypad). If you open the Character Map application and choose almost
any of the normal fonts, you'll see a variety of accented characters.
If you click on one, if there's a keystroke combo to generate it, that
will be displayed at the bottom right of the window.

--

Dirk Goldgar

(to reply via e-mail, remove NOSPAM from address)

[Carol]

"Patrick C." wrote:

è is alt+` then e

[CLHagenMN]

In article <vf96a.1580$S63.538160256@news.netcarrier.net>, "Dirk Goldgar"
<dgoldgar@NOalumni.SPAMprinceton.edu> writes:

>My personal opinion is that the move should not have been banned, but
>rather referees should have been made to enforce the rules that were
>already on the books regarding loss of right of way in the course of
>multiple cross-steps. However, that seems to have been a losing
>battle. I only fence sabre occasionally anyway, so my opinion doesn't
>count for much.

But you're trolling, anyway!

;-)

[CLHagenMN]

In article <slrnb5g7di.ian.zebee@zipperii.zip.com.au>, zebee@zip.com.au (Zebee
Johnstone) writes:

>
>If you work damn hard on your form.
>
>It is quite easy to twist that forward knee if you are slack about
>keeping it where it should be.
>
>So make sure you find an instructor who is really really hot on
>correct form, so that you are pulled up every time you let that knee
>fall in or that front foot land skew in a lunge.
>
>One who is also fairly hot about rear arm position might be useful
>too, a dangling arm seems to make it harder to keep the knees where
>they ought to be.
>
>Zebee

I have to agree with 'Z' on this - I have seen Dirk fence, and his form, in
this respect, is quite classically correct: i.e. the front toe stays very much
pointed straight ahead, upper body remains centered so as to not come forward,
inducing twisting, which tends to affect the knee.

Perhaps his TKD experience carried over somewhat...

[Zebee Johnstone]

In rec.sport.fencing on 25 Feb 2003 03:54:34 GMT
CLHagenMN <clhagenmn@aol.com> wrote:
>
>I have to agree with 'Z' on this - I have seen Dirk fence, and his form, in
>this respect, is quite classically correct: i.e. the front toe stays very much
>pointed straight ahead, upper body remains centered so as to not come forward,
>inducing twisting, which tends to affect the knee.

The classical stance is very efficient if done right, and it does seem
to put less stress on joints. If more on muscles Browsing over the
photos of fencers I see on the net, many seem to stress the joints a lot
- bad foot and knee position mostly, but that dangling arm turns the
torso and cants it some, puttin even more stress on badly placed feet
and knees. Young fit athletic types can do it, this rather second hand
old fart has to do it right, or can't do it at all.

It does take a deal of practice under the eagle eye of a good
instructor though. It's amazing that although we've had out feet all
our lives, it's very hard to work out where they are without
looking...

("don't look!" is right up there with "Turn your knee out!" as the
signature cry of the fencing master...)

Considering how the classical stance is so very different to the
normal "stand up and walk" way the knees and thighs and feet work, it
takes a long time and sore thighs to get it right. But if you want to
keep a damaged knee working, you have to put that effort in.

>
>Perhaps his TKD experience carried over somewhat...

You definitely need good balance for a kicking art! Most Asian
martial artists I've seen start fencing have a problem with weight
distribution though, especially kickers. They tend to have their
weight on the back foot, which makes it harder to move quickly,
compared to being centred.

If they can get that right though, they are usually nicely balanced
and upright. I guess being kicked a lot is a good incentive!

Zebee



--
Zebee Johnstone (zebee@zip.com.au), proud holder of
aus.motorcycles Poser Permit #1.
"Motorcycles are like peanuts... who can stop at just one?"

[Carol]

Zebee Johnstone wrote:

> The classical stance is very efficient if done right, and it does seem
> to put less stress on joints. If more on muscles Browsing over the
> photos of fencers I see on the net, many seem to stress the joints a lot
> - bad foot and knee position mostly, but that dangling arm turns the
> torso and cants it some, puttin even more stress on badly placed feet
> and knees. Young fit athletic types can do it, this rather second hand
> old fart has to do it right, or can't do it at all.

There is much to say for good form -- it protects you from injuries!

Your body has 2 ways to support itself -- either by muscles or by skeleton. A
built-in redundancy of systems. If the muscles fail, the skeleton takes over. It
is much better to have muscles support, because fencing activity is to hard on the
skeletal system, which is why some fencers have knee problems -- better building
of the muscles will prevent these problems.

Now, the dangling arm is another problem -- it is OK if your body is operating
undr muscles -- it will have no impact. However, if your body is operating under
the skelatal sysyem, it will create torsions and problems because the muscles
aren't strong enough to counter-act the forces.