"My first MRI"

[Nords]

Any advice for an MRI newbie?

I sprained my left knee sparring tae kwon do six weeks ago.  It's healing but the "effusion" has been impressive and the range of motion hasn't come back as fast as it used to.  I've hyperextended both knees a couple times before but not this badly and they've never recovered this slowly.  The knee is stable again and I can wince through a half-hour of forms but it swells pretty quickly.  I'm keeping up with the stretching but flexibility is limited and there's no way that I'm ready for strength-- straight-ahead lunges are about all I can handle right now.

So after some feedback from my spouse ("It's boomeritis, you moron!") I decided to consult a sports-injury doctor.  Fresh from UH medical school, she very enthusiastically poked, prodded, & pulled-- nothing conclusive.  She brought in her boss for more "manipulative exploration" and they decided that an MRI is a good liability insurance diagnostic tool to see if I've torn an anterior cruciate ligament or a tendon.  You would think that I would feel something like that (there was no pop or major pain when I sprained it) but they say that doesn't necessarily mean that I didn't injure it anyway.

The knee will eventually heal and I'll get back to tae kwon do.  If there's damage then I apparently have some treatment options but I'll wait to learn more about "if" before I worry about options.  For now it's ibuprofen plus a neoprene compression brace to squeeze down the effusion and get the healing back on track.  I know how I injured the knee and I won't be dumb enough to try that maneuver again.

I've never had an MRI before and I'm curious about the procedure.  I understand the physics and I've seen the machines, but I've never watched one in action.  Everyone relaxed when they learned I'm a submariner ("You'll feel right at home!") but they were pretty concerned about metal in the magnetic fields.  Apparently the odd tooth filling or titanium staple is OK.  I'll have the MRI in a week or two... as soon as the doctor goes through the primary-care authorization shuffle with the military.

Anyone have any especially good or bad MRI experiences to report?  Any surprises you wish you'd been told about?  Any issues with diet or meals or the length of time it takes?  I've been told that I'll get a film, which sounds more like a photo than a movie, and that it'll settle the question one way or the other.  Is it possible that there'll be any doubt or ambiguity, or will the radiologist be able to tell while I'm still on the table?

This is the most impressive injury I've acquired since high school, and I'm finding that it's an extremely unpleasant reminder of a possible mobility limit.  (I'll never look at a staircase the same way again.)  I'll be happy to make it to black belt someday but I think I'm going to have to abandon the national open tournament plans and start acting like a mature adult.  Damn, and I've been faking it all these years...

 

[Leonidas]

Well, I can’t offer anything useful on MRIs to you, but I’ll send you my wishes for a speedy recovery.

Has the injury caused you any doubts about your choice to study Taekwondo (as opposed to something with less emphasis on kicking and jumping)? Both my sons are black belts and the oldest is learning to be an instructor, so I’ve spent a lot of time watching the training, testing and tournaments. I’ve seen at least three adults (no kids) go down with similar injuries and in each case they were (or have been told) they will be out of action for about a year.

When the boys first started I didn’t have any interest in Taekwondo, but as they got closer to their black belts I saw a lot of benefit to the training. I started thinking about taking the up the art myself, but then after two instructors (who were both in very good condition) went down with knee injuries I started having second thoughts. Over the years I’ve known too many co-workers who have been injured in accidents or by assault and I know what rehab involves, how long it takes and the chances of coming back 100%. I want to learn a martial art, but I don’t want to get knocked out of running triathlons for a year or more.

The benefit I had of three years of being a “Taekwondo Dad” made me very comfortable with all things TKD. I’m not afraid of a little pain or minor injuries, but the spillover into other areas of my life from a blown knee are more than enough to make me want to look at alternatives. I’m casting about for information on those alternatives. One option is to ask other martial artists (like you) what they think.

 

[JB]

I had a knee injury about a year ago.  I was windsurfing in waves at Kuau and was heading out and preparing to jump when I was pushed straight back by a powerful wave.  My left knee twisted and I could feel that something was wrong.  It wasn't severe pain but I couldn't straighten my leg.  I sailed for another 45 minutes hoping my knee would pop back in.  The next day I realized that something was definitely wrong, my knee was a bit swollen, and still 'locked'. A couple of days later I saw the orthepedic at kaiser and he said: "I think you have a torn meniscus, If you want it fixed quickly I'm available for arthroscopic surgery tomorrow morning.  You'll have to go under general anestesia." Having never had surgery, surgery tomorrow made me a bit anxious so I started asking questions. "WHat could go wrong"? He said that if I had a torn ACL (which he didn't think I had), that they'd have to fix it later, and I'd go through the surgery again.  I opted for the  MRI which cost me $750 out of pocket, a day trip to Oahu, and a four week delay in the procedure.  Turned out to be the wrong call.

After the injury I talked with many people who had torn ACLs.  They all had extreme pain and swelling.  My swelling was relatively minor. The doc said that I probably would not have continued sailing if my ACL had been town.  I have two friends who have torn ACLs that were never repaired.  One is very athletic and does fine without it.

The thing I remember about the MRI is that it was very loud.  They gave me some headphones so I listened to relaxing Hawaiian music, but there was still a lot of banging.  A few day later they sent me a CD with a sequence of digital images, a rendering program, and the radiology report which confirmed the docs diagnosis of torn meniscus.

The arthroscopic surgery was easy.  I walked in and out, did about two weeks of PT, and was cycling with a week and wavesailing in two weeks.

If you passed the ACL test, and didn't have severe pain and swelling, and don't have a locked knee,  I'm surprised that they are considering an MRI.  If you're knee stays locked, you may have a meniscus tear like I had.  Those MRI machines are expensive.  Maybe you should ask them if theirs is 'payed off'.  After that, it's gravy.

 

[farmerEd]

MRI's are no big deal...no worse than a xray. If I remeber correctly the issue with metal is that the machine acts like a big magnet and will literally pull metal out of your body if you have any (like small metal shavings in your eye from working in a metal shop). Out of caution (and since I do a lot of repairs around my farm and work with all kinds of tools) my doctors ordered an x-ray first to make *certain* their were no small fragments that would cause trouble. If there is any chance you have bits of metal in  your eyes, you may want to mentioned it to your doc and see if it still a concern with the newer machines.

My only nervousness was about what they might find...not the procedure itself; luckliy my MRI confirmed I was healthy and the symptoms that instigated the  test in the first place went away as fast as they appeared.

 

[Michael]

Don't worry about the MRI. All you have to do is stay still, and listen to the music of your choice. I found it very relaxing. No pain at all.

 

[donheff]

I had a strange experience with an MRI. I injured my right knee (or so I thought) - it swelled up and was very difficult to walk on for several weeks. The injury spontaneously recurred about a year later and a friend who is an orthopedic surgeon talked me into coming in for an MRI. He discovered and showed me a verticle tear in the patella tendon - basically a milder version of what Clinton got. He advised me that I should get surgery sooner or later. Since the injury was periodically flaring up it was likely to continue doing so with increasing frequency and severity. I opted to wait.

About six months later, it flared again and then subsided. Once again I opted to wait. About a year later the same thing happened -- but on the OTHER knee , I went to another specialist for a second opinion and got diagnosed with gout (which I already knew I had in my foot but didn't associate with the knee). Now I am taking allopurinol and haven't had a problem in te five years since.

MRIs are very powerful but interpreting the results is an art. I assume I still have a minor tear in the tendon - just not serious enough to cause problems.

 

[kat]

Don't worry about it. Michael summed it up. Be still. And it's kind of interesting.

I think MRI's could be different, say for a back instead of a knee. I had one for my knee, after a car accident, and it was simple. My friend had one for his back and got very phobic.

 

[Outtahere]

I'll echo everyone else, don't worry about it. The comment about you being a submariner is the claustrophobic aspect, some people cannot deal with the closed in feeling they get being in the MRI machine. I've had 3, two for my knee and one on my head (yes there are brains in there) and I'll take that over a lot of other tests.

 

[Dawg52]

I had one about 10 years ago. When I saw that little tube I had to fit into, I figured I better not think about any naked women as there wouldn't be enough room for me and my little buddy in there.     But seriously, its not a big deal. I didn't have any music to listen to so I had to think about something else to get my mind off the noise. Sounded like someone jackhammering concrete.

Good luck!

 

[larry]

Nords, that's just the way of the hands and feet (and knees). Sorry, couldn't help myself.

My wife recently had an MRI done on her head (they didn't find anything) She was not accustomed to lying perfectly still in a confined space but finally made it through. Took about 45 minutes for her.

 

[Jay_Gatsby]

I want to learn a martial art, but I don’t want to get knocked out of running triathlons for a year or more.

Have you considered non-striking martial arts like Aikido? It focuses on using your oponent's movements against him/her in a "circular" way. There's nothing like grabbing a punch or a kick and letting the person's own momentum put his/her butt on the ground...

 

[OldAgePensioner]

I fought in Muay Thai tournaments in the UK in 2001 and got caught with a nice Kao Loi from a kid from Liverpool.

MRI was fine except for the loud grating noise that the machine puts out. Lasted about 30-45 minutes. I can still remember that sound.

 

[SteveR]

I have had more than 10 MRIs. The big deal is metal in your body. MRIs are essentially huge electromagnets that induce a massive magnetic field in your body. The effect is to modify the spin of water molecules in your tissues and this is then picked up by the antena you are lying on while in the chamber. As long as you don't have metal in your body..implants, screw, plates, bullets, metal fragments, etc. you should be fine.

They will place you on a moving table that will slide into the machine. Imagine a huge donut. You will be in the center. The machine makes a LOT OF NOISE...mostly vibrations, thumps and pounding sounds as the magnets are energized and then moved around.

If you are clastrophobic (I doubt it since you lived in a steel can for months on end) it can be an issue. Some people freak out because it is a very tight space unless you get an Open MRI which has a much more open environment.

Sorry about your injury and I wish you a good prognosis and speedy recovery.

 

[SelfRighteousNerd]

"MRI" stands for "Machine that will find something wrong with you no matter what."

But as long as you keep it down by your knee you should be OK.

 

[Robert the Red]

You should ask for the DICOM files of your images -- most scanners write image files in this format now.  It's a peculiar format, but you can find various DICOM viewer programs out there for free.  (In a pinch, send the files to me and I'll convert them to JPEGs for you.)  Then you can play with your images on your computer, not just peer at the film.  Whether they'll give the files to you depends on how cooperative and busy the scanner technologists are (don't ever call them technicians, or the cooperativeness level drops rapidly!).

The usual fear for metal is RF power deposition.  Ferromagnetic metal could also be moved by the main field.

The most common side-effect of MRI is claustrophobia.  If they give you a contrast agent to enhance the images, there is a 1-in-a-million chance you'll have a major allergic reaction to it.   (You're more likely to get in a car accident on the way to the scanner.)  There is a remote possibility of minor burn, if you have metal bits in your knee area, or are wearing metal-based makeup there.

Slightly off topic, but I've often felt that MRI scanner tech is a good career option for a bright-ish kid that doesn't really want to go to college.  It's a 2 year education, the pay is pretty solid ($50K to start), and it's a very portable occupation.  At present, to become an MRI tech, you first have to become an X-ray tech, but that is likely to change in the next couple years.

 

[Payin-the-Toll]

Why hasn't anyone mentioned open-sided MRI?

 

[Robert the Red]

Why hasn't anyone mentioned open-sided MRI?

Open MRI scanners have smaller magnetic fields, and so produce lower-quality images.  As a result, lots of radiologists don't like them, especially when looking for some problem that may require high resolution -- like a small tear in cartilage.

For non-emergency diagnostic brain imaging, the 'standard' is now 1.5 Tesla magnetic field, and the largest field open MRI that I know of offhand is about 0.4 Tesla.  (For comparison, the Earth's field is about 0.00005 Tesla at most locations.)  I'm not sure what the 'standard' is for cartilage imaging.

 

[Maximillion]

I back up Jay's statement, having taught Martial Arts for many years, there are alternative styles that are designed for those who are ageing/maturing.

Tai Chi(, Old Man's Kung Fu) or Aikido are good styles ,designed to prolong the career of a Martial Artist.

I was never a fan of TKD, not the style but the system, too many of them are belt factories and too many clubs are Trophy Hunters, throwing in the same "Green Belt" year after year at Tournaments.

Avoid any club that wants to sell you a Contract.

 

[brewer12345]

Oh ****, the black beast of the northern wastes is back. Run for the hills!

 

[astromeria]

As a slightly claustrophobic overweight asthmatic who gets occsional "dry patches" in her throat which result in stopped breathing and for which the only cure seems to be breathing out harshly then sitting up and drinking something and breathing in deeply (thank goodness this has become less frequent), my head-first in a closed MRI resulted in a new 45-minute mantra: "I am NOT going to start screaming Lemme Outta Here! I am NOT going to start screaming..." Not to mention what sounded like little workmen with loud pneumatic hammers, which nobody prepared me for--at first I thought the machine was broken! My second MRI was years later, open construction, wiht my head sticking out--piece o' cake.

 

[SteveR]

Why hasn't anyone mentioned open-sided MRI?

Actually, I did in reply #12.

Robert the Red knows his stuff. My experience is mostly first hand as a patient rather than an engineer.

Open is the only way I can deal with the confined space without major drugs.....long emotional story I will not go into here....

Image quality is an issue with some units and some radiologists but the technology is getting better all the time.

Big magnets and small patient space=better image

Small patient space with nothing visible but an off-white tunnel 4 inches from my nose=panic and no image being made because I am not there

I will take a less than perfect image for none at all.

 

[Nords]

I have two friends who have torn ACLs that were never repaired. One is very athletic and does fine without it.

Thanks, JB, I agree that surgery isn't such a great idea. I think the doctors are covering their assets with the MRI but with my history I'm not complaining. My instinct is to avoid surgery as long as I can work on the PT and the strength. I'll be over in Kahului 10-12 Nov for Kiffman's tournament; I hope to be able to spar and not just do the forms.

As long as you don't have metal in your body..implants, screw, plates, bullets, metal fragments, etc. you should be fine.

(like small metal shavings in your eye from working in a metal shop)

Hunh, that's why I got so many questions about submariners and metalwork. I was far more concerned about vasectomy titanium staples...

Nords, that's just the way of the hands and feet (and knees). Sorry, couldn't help myself.

Ouch, good one-- a little subtle for this crowd!

"MRI" stands for "Machine that will find something wrong with you no matter what."
But as long as you keep it down by your knee you should be OK.

At this point I'd rather know "how much" than wonder about "if". And, hey, welcome back, we've missed you!

You should ask for the DICOM files of your images -- most scanners write image files in this format now. It's a peculiar format, but you can find various DICOM viewer programs out there for free. Then you can play with your images on your computer, not just peer at the film.

Excellent, thank you, I'll talk to them about that.

Have you considered non-striking martial arts like Aikido?

Has the injury caused you any doubts about your choice to study Taekwondo (as opposed to something with less emphasis on kicking and jumping)?

Well, I've heard from a 60-year-old TKD instructor who broke his hip on a five-board break of his 4th dan test, but he got the belt. He listed a litany of other injuries in 18 years of competitive TKD and he's back in action, so I think that I'm still ahead of the game.

But I'm hooked. Judo was OK but our dojang has great people and a great team of instructors. When our kid started a couple years ago I could not sit on the sidelines. If martial arts were a little more popular in 1970s Pittsburgh my life would have turned out quite a bit differently (especially that concept of self control). At 45 I'm the oldest guy in our dojang and the only older active TKD competitor I've seen in Hawaii is a 56-year-old grandfather. 95% of the focus is on the little/lightweight teens & 20-somethings for national & Olympic competition. I don't think the sport has much understanding of what's euphemistically called the "Ultra" age & the "unlimited" weight category, and that's a huge Boomer revenue-earning oversight.

I'm glad I started TKD because the biomechanics that I've learned has helped me avoid self-inflicted problems. I stretched excessively over the past 25 years without realizing that it makes me prone to knee/ankle injuries. Although I can put both feet behind my head and achieve other moderately-weird contortions, I've also stretched ligaments & tendons to the point where my joints have way too much instability. (I thought it was genetics but I know better now.) If I'd kept it up I would've ended up in a wheelchair in my 70s. I'm not wrapped too tightly now, so to speak, but with the aid of "Stretching Scientifically"[url] my joints will hopefully tighten up. I've sprained each knee & ankle joint at least three times over the last two decades but the injury rate has slowed way down.

I also used improper technique that we didn't catch until six months ago. Just before the round kick connects you're supposed to turn over your hips and have the leg moving straight across at the target-- moving straight across the floor in a direction perpendicular to the target plane so that the instep strikes straight on. I wasn't making a full hip turn (too slow!) so I was striking 20-30 degrees off the perpendicular and putting a lot of sideways stress on the knee joint. This is apparently pretty common in us older students but we're not as common so instructors don't see it very often. About a thousand hip turns later I have the muscle memory to do it correctly, just like Tiger Woods "fixing" his golf swing. Since that epiphany I've stopped hurting my knees in practice and the strength exercises are finally eliminating the weakness. I'm also scoring higher in matches since the kicks are connecting with much more force.

This latest injury is a stupider problem-- boomeritis. I'm very slow to accept that there are some moves, like a 360-degree spinning hook kick, that I shouldn't use in sparring. During that match I had just earned myself an axe kick to my face and I was a little testosterone-poisoned shaky. I was off-balance during my next move when I twisted the knee. It got extremely wobbly but with all the adrenaline sloshing around I didn't feel a thing until I tried a second twisting move and fell over. I'll keep sparring-- for now-- but deceit & cunning will have to have to replace the cool kicks. We had just finished a tournament so I was trying new moves and I certainly won't repeat that mistake.

But overall I'm in the best shape of my life, and not just physically. TKD has given me a lot of personal knowledge and helped develop a great relationship with our kid. It's easier to set an example when you're ER because you can show up regularly-- our instructor always tells others how much I've improved just by showing up three times every week. My core strength & flexibility is tremendously better and I don't pull muscles anymore. It's improved my balance, timing, & reflexes by an order of magnitude (my surfing, too). I won't be so careless again and I'm glad that these injuries have forced me to figure out my mistakes. I'll probably stop competitive sparring after I get my black belt but I'll be doing forms for the rest of my life. I may take up "old man's martial arts" like hapkido or aikido someday but I'm not in any hurry to drop TKD.

Leonidas, I'd strongly recommend a checkout with a sports physician (maybe bring your older son along to explain things if the doctor isn't a martial artist) and then a couple months' lessons. With proper technique and common sense (I finally have one of them) you'll be fine. Your kids will simultaneously laugh at you and respect you more while renewing their own commitment to the sport. It's the best father-daughter experience we've ever shared, better even than surfing. (How many kids get away with head-kicking their parents?) You have a lot to offer-- you've probably picked up a few career-related dirty tricks that your sons would appreciate and that instructors could use for their personal-defense classes. You set an example that encourages other parents to join in-- at least six parents personally hate me because their kids said "Aw, c'mon, her Dad does TKD, you can too!" And your experience will also give a lot back to the sport, as I will, during teaching and in judging forms & matches at tournaments.

 

[maddythebeagle]

Interesting on the open vs. closed. I have had 10+ mri's on my head and they are always closed. I dont think it is a big deal. 45 minutes and it is over. You fill out a survey on potential metal parts on your body and that's about it...

 

[Maximillion]

brewer, is the fact that you suspect I am an African Canadian a reason for your inane and nonsensical comments?

It would serve everybody's best interests if you dealt with the topic at hand instead of your own personal agenda. :

I was a very serious Martial Artist, but for meeting my Future wife, three of us were moving to HK to study with a Chinese Sifu, arranged through Chinese Contacts, at that time Kung Fu was not taught to outsiders.

I once had a meeting arranged with a young Chuck Norris,a nd fortunatly for me, he got a movie part, it would not have been pretty.

He is/ was, very good.

 

[cute fuzzy bunny]

I'd like to introduce you to him right now.