Episode 12 | Patient Story | Guest: Alex, patient at LBSM
Exercise is not a hobby for Alex. It is essential. A sedentary, often stressful job in film production means that her four or five weekly sessions – HIIT, strength training, yoga, running – are how she manages her mental health, her energy levels, and her relationship with her body. When that was taken away, the impact was significant. And it was taken away for a long time.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth sits down with Alex to trace a story that begins with a pop during a sprint in February 2020 and winds through months of wrong diagnosis, lockdown complications, delayed surgery, and a slow, carefully managed return to full fitness.
The injury: a pop at the end of class
It was the last five minutes of a Barry’s Bootcamp class. Alex was sprinting on the treadmill when she felt and heard a pop. She had to stop immediately. By the time she got home, her knee had ballooned. She needed crutches for the first week. She knew something significant had happened.
She went to a physiotherapist the next day, having already researched her symptoms and suspected a meniscal tear. The physiotherapist assessed her, performed the relevant tests, and concluded it was a hamstring tear. A GP confirmed the same. The diagnosis stuck.
Alex had reservations from the start. She mentioned her suspicion about her meniscus at least three times during those early appointments. But the tests came back negative, and she did not have the classic “locking” sign – a physical block preventing full extension of the knee – that is a strong indicator of a meniscal tear. And so she trusted the diagnosis, partly because she wanted to.
“I personally wanted to believe it was not a meniscus thing because I knew a meniscus thing would be much worse to deal with,” she says. “I was fighting with myself.”
A deceptively fast recovery – then lockdown
The hamstring diagnosis led to a hamstring rehabilitation programme. And it seemed to work. Within two weeks, Alex was back doing Lagree (a demanding reformer Pilates). Within six weeks, she was back running. The knee felt fine. The swelling had gone. She had no pain.
Then lockdown happened. Her physiotherapy stopped abruptly. With nothing to do and nowhere to go, she threw herself into running – building up to a 10K with a Garmin watch and a training plan, sprinting intervals, four runs a week. Eight to nine weeks in, the knee blew up again. No pain this time, but significant swelling that would not go down.
Online physiotherapy began. The view: perhaps she had come back too quickly, perhaps the muscles were not strong enough, perhaps it was biomechanical. She rebuilt her strength remotely. The knee settled again. She started running again. And then a physiotherapist, finally seeing her in person in the summer, noticed something important: she could not fully straighten her leg.
That is the definition of true locking – not stiffness or clicking, but a physical block preventing full knee extension. It had been there for months. Possibly since the original injury. Alex had not noticed it; she had been on a sun lounger in Ibiza and thought her leg felt tight, but had not connected it to the knee.
The right diagnosis: eight months later
Alex was referred to Dr Seth in the summer. The clinical picture was clear: a history of significant acute knee swelling (not typical of a hamstring tear, which causes bruising behind the knee rather than ballooning of the joint), and a loss of full extension. An MRI was arranged.
The scan confirmed a large posterior horn meniscal tear. The entire back section of the meniscus was torn and had migrated away from its normal position. The tear had been present, undiagnosed, for eight months.
Dr Seth referred Alex to Mr Kash Akhtar, a knee surgeon at London Bridge Sports Medicine. His assessment was direct: this was a catastrophic injury, the meniscus was severely displaced, and without surgery she would be at significant risk of early knee wear – a trajectory towards knee replacement. But there was an additional complication: eight months had passed since the tear. The longer a meniscal tear is left, the harder it is to repair. He could not guarantee he would be able to fix it.
“Going from someone who has never been to hospital, never had injuries, never had any problems with anything – to being told this is a catastrophic injury, that was such a huge psychological and mental journey,” says Alex.
The decision to operate
Not every meniscal tear requires surgery. For most tears, a structured rehabilitation programme – sometimes with injections to manage symptoms – is appropriate. But Alex’s tear was a specific type: an unstable bucket-handle tear in which the cartilage was displaced and causing the knee to lock. In an active person in her late 40s who needed high function from her knee, conservative management was not a realistic option.
Dr Seth was clear with her: not everyone with a meniscal diagnosis needs an operation. But in this case, for someone of Alex’s activity level and ambitions, leaving this untreated would have been, in his words, “a disservice to you and your health and how you’ve managed your body over all these years.”
Alex decided quickly. Four weeks of pre-operative physiotherapy followed – building quadriceps strength as much as possible before surgery – and in October 2020 she had the operation. Mr Akhtar was able to repair the tear. It had been a close-run thing.
Recovery: six weeks non-weight-bearing and a long road back
The first two weeks after surgery were, by Alex’s description, horrid. She was non-weight-bearing for six to eight weeks – no pressure through the operated leg at all, to protect the surgical repair. She needed crutches for everything. She spent much of the time on the sofa. Even a shower was an effort.
She was fortunate in her circumstances: a flat on one level, a supportive partner, a physiotherapist who visited at home. She also found ways to maintain a routine. While watching her trainer’s online classes during lockdown, she would do her physiotherapy exercises alongside them – a way of feeling present and active even when confined.
After eight weeks, she began putting weight on the leg again. After nine weeks, she was walking unaided. Then came the work: rebuilding the quad that had atrophied significantly during six weeks of non-weight-bearing – visible to her, “a chicken leg” compared to the other side. Strength testing guided the programme throughout, ensuring the injured leg was catching up to the other before load was progressively increased.
By six months post-surgery, Alex was almost equal in strength between both legs, had been signed off by Mr Akhtar, and was beginning a progressive return to running.
The psychological journey
This episode is as much about the mental experience of serious injury as the physical one. Alex reflects with notable candour on the trauma of the process – going from a person for whom exercise was non-negotiable to sitting in a wheelchair for six weeks, being unable to make a cup of tea unaided.
She describes reliving the experience, the anxiety about re-tearing, the mental block around loading the knee again once she was allowed to. Dr Seth raises the term PTSD – not in a dramatic sense, but as a genuine acknowledgement that significant medical events can leave a psychological mark that deserves attention, not just the physical recovery.
What helped: a consistent team (Dr Seth, Mr Akhtar, and her physiotherapist working closely together), clear communication, and an unambiguous shared goal of getting her back to full activity. “I never felt you didn’t care. You always knew everything. It was a real team approach and I felt protected throughout this journey.”
What Alex would tell anyone in a similar position
“Trust your gut instincts. You know your body best. Get proper specialist advice. Get a scan. Go to a specialist. Keep searching if you’re not sure.”
She is also emphatic about what not to do: become a passive patient. “Don’t give up on being an active person and kind of lie in bed and think I’m now this injured person and I can’t do anything. You can do a lot.” Upper body work, single-leg exercises, indoor cycling, mindfulness – she found legitimate ways to stay active and mentally engaged throughout a very long recovery.
And her final reflection, looking back: “I think I will be in a better place when I start running now than I have ever been. I know how to help myself. I know what to look out for. And I have the psychological confidence to push and be as normal as I was without thinking about it.”
A note on meniscal tears and diagnosis
Alex’s story illustrates several important clinical points that Dr Seth draws out during the episode:
- Significant acute knee swelling – particularly when the knee “balloons” acutely – is highly suggestive of an intra-articular (inside the joint) problem, not a hamstring injury, which causes swelling and bruising behind the knee
- Locking – inability to fully straighten the knee – is a key sign of a displaced meniscal tear and requires hands-on clinical assessment to identify; it is very difficult to detect remotely
- A deceptive recovery – some meniscal tears allow a period of apparently normal function before the knee becomes symptomatic again, particularly when loaded progressively
- Trust your instincts – if a diagnosis does not feel right, it is always reasonable to seek a second opinion and appropriate imaging
For more information on meniscal tears, causes, and treatment options, see LBSM’s guide to meniscal tears.
If you have knee pain that has not been properly investigated, or a diagnosis that does not feel right, the LBSM team can help with assessment, imaging, and onward referral to the right specialist.
Book an appointment at lbsm.co.uk/booking
Listen to the full episode below ↓
