Saturday, October 8, 2016

Knee Pain and the Weather

Here’s a rather in-depth article about the relationship between pain and weather. The authors pored over a lot of different studies to reach their conclusions. Which are ...

That the link betwen the two is unclear. Actually, to be more accurate, it appears rather weak.

They looked at a number of painful physical conditions, from arthritis to migraine pain. I’m going to stick with the osteoarthritis end of things, as that’s what those of you with bad knees care most about.

Why should the weather influence perceptions of knee pain in the first place? Some theories:

* When bad weather moves in and barometric pressure drops, the surrounding air pushes on the joint with less force, allowing tissues to expand and causing uncomfortable pressure.

* Or, an alternative theory is changes in barometric pressure “may augment cytokine pathways.” More cytokine activity may damage host cells.

* A combo of rain, cold temperatures, and low pressure may cause pain by increasing swelling in the joint.

I encourage you to read the whole article, if you want more. I’m going to jump to the conclusion and in particular this line.
Studies that typically report the strongest correlation between meteorological phenomena and onset of pain are often poorly designed, utilizing self-report mail surveys and small sample sizes, not blinding participants to the research hypotheses, or relying on subjective memory recall.
Okay, that’s not hopeful if you’re trying to prove a connection between weather and pain. Still, the authors note that the issue is far from settled. At the least, certain individuals could be more sensitive to changes in the weather.

I’m not sure myself. I did think my knees were a bit crankier in Hong Kong when a big storm was nearing. And weather effects on one level make sense to me: the lousier the weather, the more likely you are to be unhappy, and there is a definite link between depression and pain.

What about everyone out there? Do changes in the weather affect how your knees feel?

Saturday, September 24, 2016

If Your Doctor Can’t Figure Out Why Your Knees Hurt ...

You might want to get a bone scan to  look for abnormalities.

The more I watch Dr. Scott F. Dye speak (thanks to TriAgain for yet another link), the more I’m convinced that knowing what's going on with the bone behind the cartilage is often critical to understanding knee pain. That’s what Dye thinks, and he makes a good case.

He attacks a lot of the received wisdom on what causes knee pain. He’s refreshingly unorthodox. For instance: what surgeon hates surgery? But he pretty much does, except for limited instances, and he appears to favor the least amount of surgery possible.

He’s also almost vitriolic in his dislike of structuralists. You know, the dozens of doctors who tell you your problem is because your kneecap is mistracking. I remember my first orthopedic doctor cited this as a reason for my pain, then when I queried him further on the point, he kind of mumbled it away. That’s probably because my kneecaps sat quite normally in their groove on my X-ray. So he probably realized that that standard argument was absurd.

Dye also doesn’t think much of blaming cartilage defects for your pain. On this, I’m not quite convinced – the cartilage does attenuate forces traveling through the joint, and if it’s damaged or missing, well, that seems significant. And Dye himself (through self-experimentation – now that’s dedication!) identified the synovium as being highly innervated, and a possible source of knee pain. So perhaps fragments of damaged cartilage could migrate through the synovial fluid to the synovium, irritating it?

Still, in his defense, he claims to have grade three chondromalacia in one of his knees – and it’s totally asymptomatic. So maybe I’m guilty of overselling the line “heal your cartilage.” Even so, I think my program for getting better would have fit a lot of his criteria for what makes sense for fixing bad knees: go slow, and stay within your “envelope of function.”

Curious about Dr. Dye, and what the heck I’m talking about? Check out these links:

Why You Need to Know About the “Envelope of Function”

What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?

Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)

Sunday, September 11, 2016

Decoding What Those Crackly Knees Mean

I found this research study interesting and wanted to share:
Engineers are developing an acoustic knee band equipped with microphones and vibration sensors that can listen and measure sounds inside the joint — and could lead to a way to help orthopedic specialists assess damage after an injury and track recovery progress.
Hmm. Apparently the listening device on the knee band was created by combining microphones with piezoelectric film, which is very sensitive to vibrations. The microphones are placed against the skin.

Of course all knees make noise: pops, creaks, crackling. Often these are benign. But when you have knee pain, they're called "crepitus" and take on a new significance. It turns out, even if the noises are hard to make sense of, there is at least one message in there:

An injured knee makes markedly different sounds than a normal knee. “It’s more erratic,” according to Omer Inan, an assistant professor of electrical and computer engineering at Georgia Tech. “A healthy knee produces a more consistent pattern of noises.”

Inan, in recording the sounds knees make, has encountered challenges. Fluid that surrounds the joint interferes with sound waves, and moving your knees causes its own kind of noise that can drown out other noises that are more important.

As someone who listened hard to his injured knees, I’m interested in what they find. I do think knee sounds are meaningful, but I also think it’s very hard to figure out that meaning.

Friday, August 26, 2016

Another Open Comment Forum, Jump In!

It seems it's about time to do one of these. The first two were enormously popular. Also, it's fun for me to sit back and watch everyone talk.

How's everyone doing? Summer is almost over. Was it a good one for your knees, or was the warm weather too tempting and did you try to do too much? (I realize this should be completely flipped on its head for our handful of Australian contributors, who are probably sitting inside waiting for the snow to end.)

If anyone's looking for a topic: Are there any changes in footwear that have helped you? I relate the story in the book of those special, expensive shoes I bought that were supposed to be the greatest for joint pain ... and turned out to be an absolute flop.

Or talk about whatever! Cheers.

Saturday, August 13, 2016

Don’t Rush Back Into Hard Activity After Knee Surgery

I’m a Boston Red Sox fan – a bit of a closet one, now that I live just outside of New York City.

Some big offseason news for the baseball team was when they acquired Craig Kimbrel from the San Diego Padres. Kimbrel is a “closer,” a pitcher who enters the game in the late innings to shut down the opposing batters from scoring any runs. In the world of closers, Kimbrel is a pretty darn good one too.

Once the season started, there were a few bumps for him in making the transition from one team to another (and one league to another), but everyone agreed that he threw an assortment of filthy pitches that could leave opposing hitters flailing at air. It looked like the Red Sox at last had the ace reliever they sought.

Then, in July, we got some uh-oh news:
The Red Sox have placed closer Craig Kimbrel on the disabled list with a medial meniscus tear in his left knee, the team announced.
I’m not a surgeon of course, but I’m kind of a knee guy, and I thought, “Ah, hope the team is smart enough to handle this well.” Kimbrel was scheduled to have surgery and miss three to six weeks. I thought to myself, “Give him a couple of months.” Knee surgery isn’t a walk in the park, even for a young (Kimbrel is 28) elite athlete.

Then, on Aug. 1, my heart sank when I saw this:
Closer Craig Kimbrel returned to the Boston Red Sox on Monday, three weeks after surgery to repair a medial meniscus tear in his left knee.
I’m thinking, “No, give him more time. Sure, he feels great. Lots of people feel great right after surgery. But the truth is, they’re more frail than they realize.”

But Kimbrel took the mound and performed brilliantly. However, things didn’t go so well for him during a game after that:
Craig Kimbrel had the worst outing of his career Tuesday night, walking four batters ... the Boston Red Sox closer spoke of knee soreness after the outing.
Oh boy, I thought. This was completely avoidable. Now, to be fair, his manager said that the next day Kimbrel reported no knee soreness at all. True? I don’t know. But even if so, I’d say that knee soreness after surgery should be treated like a wildly flashing red light.

Post knee surgery, don’t rush things. Don’t be deluded by the fact that, when you walk, there isn’t knee pain anymore. Well of course not: you’ve been lying around for weeks, not putting any weight on your joint. Meanwhile, the cartilage cushioning your knees has been getting softer.

Obviously, the last chapter in this story hasn’t been written. And obviously, I’m not the Red Sox trainer overseeing Kimbrel’s rehabilitation program. If I were though, I’d try to go easy on that knee through the end of this season (which ends in late September for teams that don’t make the playoffs).

Then, during the next offseason, I’d consider getting him going on some gradual leg/joint strengthening. Maybe buy him a high-end bicycle and a plane ticket to southern California and tell him to start nice and slow, then perhaps work up to climbing some of those mountain foothills by the time spring training for baseball players rolls around next March.

Knee surgery is a big thing. Give it the respect, and time for recovery, that it deserves.

Sunday, July 31, 2016

Yet Another Study Weighs in Against Surgery for Knee Pain

On knee pain, two solid, almost unassailable truths have emerged:

(1) If you want to reduce your pain and you’re overweight, lose weight. I’ve given up citing all the new studies that link excess weight to knee pain, as I could probably mention one every month, but what’s the sense? The message is always the same. If you’re still debating this one, you probably still think the earth is flat too.

(2) Surgery is a bad idea for most cases of chronic knee pain. This is more an emerging truth, but the evidence just keeps stacking up. Most recently was a study summed up by the Washington Post with the headline “Maybe You Don’t Need That Knee Surgery After All.”

The study included 140 adult subjects, averaging 50 years in age, with knee pain from a tear in the meniscus. (Important: the tear was degenerative, as opposed to the result of a specific injury.) The participants either had arthroscopic surgery followed by a daily exercise regimen or worked with a physical therapist on neuromuscular and strength exercises a few times a week for 12 weeks.

At the final two-year checkup, the researchers found basically no difference between the surgery and physical therapy groups in their level of pain, ability to function in sports, and quality of life.

For the full study (as of this writing, it’s not paywalled), go here.

Saturday, July 16, 2016

Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)

You MUST watch this. Honestly. TriAgain left the YouTube link in the comment section. When I finally got time to view the whole thing, Dr. Dye's remarks left quite an impression and actually left me wanting more.

This is unvarnished, straight-talking Scott F. Dye, who has been described as a “renegade knee theorist.” He calls himself a “surgical minimalist” as well. Most importantly, he has thrown his weight behind the only medical theory of understanding chronic knee pain (“the envelope of function”) that makes sense, at least to me.

The YouTube video is a 56-minute presentation (and q&a session) that he gave that I could write pages and pages about. Instead, I’ll just touch on some highlights.

* The worst cases of knee pain he sees are “iatrogenic.” That’s a very significant word to know. Because it means, basically, the surgeon caused the problem. Well, not the initial knee pain, but the surgery to “correct the problem” made it worse.

He shows a slide of several knees that went through multiple surgeries. Each knee got worse after all the operations.

* Chondromalacia is not a death sentence (he has asymptomatic grade three chondromalacia, he tells us). Also it’s not the same thing as patellofemoral pain syndrome. This common confusion clearly irks him; he even mentions that the Mayo Clinic website wrongly uses the two as synonyms.

“This is total and utter nonsense,” he says.

* Patellofemoral pain syndrome does NOT correlate with malalignment. There’s one study I usually cite as evidence to support this; he lists what appears to be a dozen or so studies.

What’s more, he makes the point that it’s dangerous to try to make adjustments based on perceived malalignment. He shows an X-ray where the kneecap looks tilted – but if you look at a different image that includes the cartilage too, you see the cartilage on the patella and end bone actually mate perfectly.

So what if a surgeon had gone in and tried to shave off some cartilage or perform a lateral release to “fix” that kneecap, which was actually perfect for that particular person? That’s how you get iatrogenic problems.

* He believes the key to understanding what’s wrong with painful knees is through a bone scan. This I find quite intriguing. I often thought that some kind of bone scan would have revealed the problem in my knees that the X-ray and MRI didn’t really detect.

(Yes, I blamed bad cartilage, and I still think there’s some truth to that, as excessive force on the joints may reduce the ability of cartilage to absorb shock, but I think a bone scan may have found other problems.)

* He is incredulous when talking about “PT Nazis,” who encourage patients to work through their pain threshold. I almost stood up and cheered. This approach is just nuts. I know it now, you should too, and Dye remarks, “This is just sickening.” He’s right. “No pain, no gain” makes sense for muscle growth, but not for a sore and aching joint.

* Then, finally, on being a surgical minimalist, he says “less is more.” He also conjures up a really neat image when he says, “Sometimes we surgeons have to get the pebble out of the shoe.” Notice the implied modesty there. This isn’t surgeon as superman, trying to remodel your entire joint. Rather, he’s trying to remove something small that doesn’t belong in a well-functioning joint.

Watch it. You’ll be glad you did.