The patient interview paused after those words.  Until now, I had never heard of using a pedometer in this way, as in a way of limiting steps rather than of maximizing steps in a day.  A few more basic questions ensued regarding the location of pain and the length of time the pain lasts. The patient then explained an experienced limitation of someone twice her age.  However, she was only 43 years old but felt younger.

There was more I needed to know, mostly out of morbid curiosity.  The X-ray and MRI were previously reviewed and the diagnosis was known.  But how much worse could this situation get?  I then asked her, “When was the last time you ran?  Even to the car?  For a late appointment?”  She responded, “Over a year.”  I was floored.  I wondered: How did she get to this level of debility?

She told the rest of her story from the beginning.  What started with being active in a variety of sports quickly led to a number of knee injuries throughout her youth.  Surgeries led to instability, pain, and subsequently more surgery.  She just didn’t want to do it anymore and was putting off yet another surgery.  Looking for an alternative led her to seek a non-surgical option.

Diagnosed with a meniscus tear again, and this time with early-onset arthritis.  Despite the combination of events and recent diagnosis, her problem was not simply because of poor mechanics, but also biological. In fact, knee pain related to cartilage injuries may start mechanical, but the pain is biological.  A range of different inflammation cells and proteins contribute to the pain, including lymphocytes, monocytes, and leukocytes.  Various proteins and cytokines contribute to this unhealthy environment.

The challenge was trying get back to running, or even living day-to-day with a Fitbit programmed in hopes of encouraging activity instead of cutting back activity. In the end, the goal of being pain-free meant creating a healthy environment and healthy mechanics.  By the end of our process, she was able to return to walking without a step limit and attempting a couch-to-5K.

The future of treating arthritis, cartilage injury, and meniscus tears is becoming progressively biological.  Targeted therapies are evolving using needles and cells instead of scalpels and anesthesia.  The future beyond needles and cells will, in all likelihood, involve genetics and molecular techniques.