Stuck with chronic injuries, diagnosed with Hashimoto's

Medical Q&A [Moderated]
1

Hello,
First of all I’d like to thank all the BBM crew for the content and general message - it really changed my life and my attitude towards training and health in general.
I had a nasty chronic back pain for a few years which I solved about 4 years ago in a few months starting with the low back template. Other minor aches and pains were also easy to fix since I started following BBM content.

However, for the past 2 years I’ve been struggling with a nasty injury and I seem to be running out of options and ideas.

I’m a 29 year old male, around 160lb, 5’9", have been training for a few years. About 4 years ago after the low back rehab I got really consistent and got to ~300lb bench, 430lb squat and 500lb deadlift, and then (already 2 years ago :() my knee gave out. It started as a ~2 week weird feeling which felt too mild to even change anything. Then suddenly after a squat session it got visibly swollen overnight with greatly reduced ROM for a couple of weeks. Took me a few months to get back to normal weights although it never went away completely, it just wasn’t as debilitating, but still some discomfort in almost any activity including walking. Then the same overnight worsening happened after one session and from that day I was unable to get back to almost any real volume at all (swelling and limited ROM went away in a couple of weeks but other symptoms did not). Its almost 1,5 years now and counting.

At the very beginning I consulted an orthopedist and got an MRI, which revealed a radial tear on my lateral meniscus which according to the doc seemed already scarred/old. With my understanding of the current studies, something like that is generally common and may or may not contribute to symptoms and it should not be something that require any surgical intervention, but maybe there’s some nuance that I’m not familiar with.

Current symptoms include general discomfort in everyday activities such as walking, I cannot really comfortably get to past ~90 degrees unless the knee is completely unloaded. I basically cannot brisk walk, cannot ride a bicycle, cannot run, jump or anything like that without immediate worsening of the symptoms the following day or two. The most volume I was able to do without greatly increasing symptoms were very light open chain exercises like leg extensions/curls with some minimal initial progression. Even bodyweight squat with reduced rom makes it worse.

Adding to the already almost 2 year old knee injury, ~6 months ago I started developping something like a golfers elbow on my right arm, then shortly after I experienced a minor tear like feeling after a heavy close grip bench set that is also not going away till now regardless what I try.
I tried self programming, tried various rehab programs including BBM knee rehab and I even worked with one of BBM rehab crew for about 3 months trying to address all 3 injuries (with the focus on the knee) with basically no improvement. I paused about 2-3months ago and we concluded that it makes sense to search for some global issue that could be affecting my recovery, since I was recently diagnosed with Hashimoto’s.

My tsh never got above 6 or 7 and my T3 and T4 levels were normal all the time with very minimal variation, but I never really felt any symptoms, it was initially caught during some unrelated bloodwork. As a long shot, my physician put me on Euthyrox (I believe it’s the same as Levothyroxine in US) and TSH went up to normal range, but I have not felt any change at all. I was also told to see a rheumatologist to check if there’s any other autoimmune condition going on that could affect my connective tissue. I had a marked as “slightly positive” ANA (1:160) and then also an ANA3 test done, which was marked as “slightly positive” or a single plus for dsDNA antibodies (which I believe are markers to check for lupus).
Then I got another test which was called ELISA and as I understood its a more specific tests that shows the amount of the antibodies, which turned out negative for the dsDNA with the result being 0,11 with the cutoff being 1,0 for positive. Also had an elbow ultrasound that revlead an “enthesopathy” in the wrist flexors. All that made the rheumatologist concluded there to be no connective tissue disorders going on and suggested further physio/ortho treatment.

So I am now still in the same miserable place unable to do any progress on basically any of the issues that I have going on.
My assessment of the situation is that either there is some condition that affects my ability to recover or the upper body issues might have developped due to general stress and more sedentary lifestyle that is a result of the chronic knee injury (and that’s the only “real” injury here in that case), but the first ~year or so of the knee issue my attitude was generally very optimistic so I don’t think there was any psychological aspect that could add to the issue not resolving itself.

To sum this up - is there anything else that could be checked from a global, not just rehab point of view? I’m aware of the dangers of overdiagnosing/overscreening and I even think it was already done in some extent so I don’t want to end up in another possible diagnostic dead end.

Are there cases for some non-trauma knee injuries that just have to be dealt with via surgery? That is something that I would really like to avoid especially since from what I read, the newer the study the more it says that conservative treatment works exactly the same as surgery followed by rehab.

Can Hashimoto’s alone cause inflammation processes to happen that could potentially affect joints/recovery functions, even if thyroid panel is within normal or subclinical?

I really tried to be consise but did not want to exclude something possibly relevant to the case, apologies for the lengthy post!

2

Thanks for the post and for sharing the details. I can appreciate that this has likely been very frustrating, in addition to painful and, possibly, scary for you. Unfortunately, there’s a lot going on here that, while perhaps non-contributory to your experience, is beyond what we can do via this forum.

Based on the workup you have had however, it is not readily apparent there is some global issue. It seems like you’ve had a long experience with knee pain that, up until now, has not responded well to activity modification. It’s possible further modification, +/- an appliance like an unloader brace for some time, may be helpful. It is also possible surgery is a reasonable option for you. As with many things pertaining to medicine, it’s not really black and white with respect to surgical interventions and knee pain. I think your main priority should be at improving function and reducing symptoms rather than choosing a particular method, though conservative management often does well.

My recommendation would be to follow up with your rehab coach to identify exercise you can do and progress from there. While anything is possible, I do not suspect an underlying condition that limits all response to exercise. At the same time, I would follow up with your physician for a potential referral to ortho for evaluation of your knee, along with any other current medical concerns.

3

Thank you for your answer Jordan. I will continue working with my rehab coach. I also have an appointment in a few days with ortho that I scheduled some time ago, I figured it makes sense to reassess it after almost 2 years and maybe get another MRI if needed.
I do however have some questions that I think are more generic so maybe you will be able to help out here.

  1. When we’re talking knee surgery, I was generally under impression that this type of intervention only makes sense if there’s any high force trauma resulting in torn ligaments etc. I have trouble understanding what would that surgery even do in a case of chronic knee pain without a traumatic origin, when the only finding in the imaging being a radial tear of the meniscus, which from what I understand are present across population without real correlation with pain symptoms. What do surgeons do in such scenarios?

  2. I know that as pain is multifactorial, stress factors outside of physical activity can influence one’s response to rehab etc. But is there any solid data indicating how big of an influence that can have? I’m trying to eliminate some life/work stress, but it is really tricky and requires sacrifices to be made but if there’s a potential for significant improvement I might reassess some things.

  3. Last question is Hashimoto/autoimmune related - I heard the exact opposite stances in the past, one was that if the hormone levels are kept in check, there should be no symptoms present, and the other one was that even if the hormones are in check, the condition/antibodies themselves can cause various symptoms such as joint pain, general fatigue, brain fog to name a few. I haven’t really found anything solid on the web.

4

Sure, I’ll do my best.

  1. Not necessarily. Surgery is an option in a number of other cases. I don’t know your specific history or if surgery is a good option for you, but I wouldn’t rule out surgery for only acute, traumatic causes. I would not say that all meniscus tears don’t correlate with pain.

  2. Yes and the answer is a lot, though this would be difficult to quantify, e.g. 50% of your experience is due to non-activity-related stress, or similar. I would favor more energy being directed towards activity modification vs. life stress, in general.

  3. I side with the former on this one.

5

Alright, thanks a lot for all the answers!