Saturday, August 29, 2015

Why Hot Showers Help With Knee Pain and Stress Hurts

I was reading comments on this blog a while back and came across a knee pain sufferer parsing his symptoms for meaning. One thing that helped with the pain, he noted, were hot showers.

Yup. Makes sense.

But why?

Well, I thought I’d share my analysis of this phenomenon (“The Hot Shower Effect”), as others have no doubt noticed the same thing. Of course, my standard disclaimer: I’m not a doctor (nor do I play one on TV).

Anyway, I think hot showers confer a similar feel-good benefit as light stretching (which made my bad knees feel better). Namely, they loosen the muscles in the leg, so that when you sit, for example, your kneecap isn’t pushed so tightly against the damaged cartilage in your joint.

Stress would naturally work in the opposite direction, by tightening the muscles and placing the joint under more irritating force.

Of course there’s most likely an additional effect at work that has to do with mood and brain chemicals. Stress correlates with unhappiness, anger, frustration, anxiety -- all negative emotions. A hot shower is tranquil and relaxing.

Having a bad knee is a difficult, depressing experience. Whatever can get you out of that zone even for a little while -- taking a hot shower, meditating, laughing at the antics of some squirrel on YouTube -- should be helpful, even if it there’s more you need to do eventually to address the root cause of your pain.

Sunday, August 16, 2015

The Dangers of Our Little Delusions

A couple of months ago, I got a really fancy bike computer that syncs up with a satellite in space somewhere, to monitor everything from distance traveled to speed. It can capture dozens of bits of data, including heartrate.

I ride hard once a week and easy three other days, so I assumed my aerobic conditioning would be between very good and excellent.

Boy, was I wrong. I wore the monitor one day on a challenging Saturday ride. I was alarmed at how quickly my heartrate jumped beyond my aerobic threshold. Even at what felt like low levels of exertion, my heart was beating about 145 times a minute.

It turned out that my “easy” rides had been too easy. I was riding a stationary bike in my basement and rarely clearing a pulse of 100. So I started going on long, easy rides outside, wearing the monitor and watching it like a hawk, keeping my heartrate from 120-135.

Now my aerobic conditioning is improving, and I’m riding better.

Still, I had really misjudged my conditioning. It reminded me of when I had bad knees, and I did something similar.

My legs were strong. I liked to walk. I knew movement nourished sick knee joints.

So I walked and walked and walked. Slowly. No uphills. And with some interspersed sitting. Still, my knees got worse.

It turned out that I had fallen victim to what is surely one of the most common delusions among knee pain sufferers:

Many people think their knees are stronger than they actually are.

I can remember becoming incredibly frustrated, because I was moving, which I knew was the right thing to do, and I was moving slowly and carefully, and I was taking occasional breaks too. But I wasn’t getting better.

That’s when I had a radical rethink of how strong my knees were. That’s when I came up what I thought was a program so simple and easy that my knees could not possibly be bothered.

I started going to the swimming pool, walking around the pool, then sitting backwards on a pool chair, with my legs elevated in a position that reduced the burning I experienced constantly. I’d repeat this endlessly -- walk around pool, rest with legs elevated, walk around pool, etc.

I did that for weeks. Boring as hell. But my knees actually began to feel better.

I talk about this in the book. An experience like that is both encouraging and depressing. Encouraging, because you see progress at last. Depressing, because you see what a deep hole you’re in.

But sometimes you have to come to grips with your little delusions in order to find a better way forward.

Saturday, August 1, 2015

On Wearing Supports for Knee Pain

I enjoy the Ask Well column at the New York Times website. It’s well-written and does a nice job of summarizing important research/studies and doesn’t blindly follow the fad of the day. I was intrigued when the idea of knee supports came up for discussion.

My completely unresearched position is that knee supports could make sense. After all, one challenge for a patient is unloading the joint. Wouldn’t a good support do just that?

So I was curious about what this (rather short) column found.

First, the most common, cheaper supports, the elastic sleeves that you tug over your aching joints, probably don’t provide meaningful mechanical support. Which means they don’t work? Not necessarily.

Neoprene sleeves are thought to help by aiding proprioception, according to   Dr. Robert A. Gallo, an associate professor of orthopedic sports medicine. Proprioception is the body’s sense of where it’s positioned in space (interestingly, this ability appears to decay among knee pain sufferers).

We are told:
In theory, improved proprioception around the knee joint could augment knee stability by improving your balance.
Of course there’s another reason why they might work: the placebo effect. The placebo effect can be very powerful. I think it’s behind a lot of glucosamine’s perceived benefits, for example. I’m very skeptical of the glucosamine story, after the supplement did absolutely nothing for me and my research uncovered no reasons why it should have.

But back to knee supports: So let’s say neoprene doesn’t mechanically unload the joint (which isn’t surprising, if you think about it -- that a small piece of synthetic rubber could significantly alter the alignment or movement of a joint that regularly handles loads of your body’s weight plus; it would be kind of like expecting a reed of straw to hold up a brick). What then would help?

What could be useful, Ask Well says, are bulkier braces that really do unload the joint. These are more complex (and expensive) and sort of make you look like a cyborg. These braces have been shown in studies to help people with knee arthritis.

Me, I never used a brace/support. I did try patellar taping. Once that seemed to work really well. And on other occasions it didn’t work at all.

Oh well. Maybe that was the placebo effect too.

Saturday, July 18, 2015

Forbes on Hyaluronic Acid Injections: Don’t Waste Your Money

I found this article by a Forbes writer (who suffers from knee pain) to be a good read.

Readers of this blog may recognize that meta-study he references that’s critical of hyaluronic acid injections. I wrote about it back in July 2012.

I then followed a year later with this post, which in many ways was more interesting, as it deconstructed a counterpoint meta-study that found the injections provided “significant improvement in pain.”

So was it simply a matter of warring meta-studies, with nothing resolved in the end? Well  . . . the second meta-study, it so turned out, was “supported” to some unclear degree by makers of viscosupplements and put out by an “open access” publisher. Lots of funny odors coming off that one.

So is hyaluronic acid -- a kind of synthetic synovial fluid, which is the “oil” that your knee joints need to stay lubricated and easy moving -- a waste of money?

Judging from anecdotal evidence, I don’t know. I’ve read comments from some patients who claim to experience a lessening of symptoms after the procedure. However, the effect of the shots can wear off in as little as three or four weeks. And then, you have other patients who claim that they felt worse after getting the shots.

So it’s kind of a crapshoot. Anyone considering viscosupplementation should look long and hard at the treatment. This is a moneymaker for a number of drug companies, and for doctors who give the injections. Make sure that when they recommend what to do with your knees, they’re looking out for you, and not their own wallets.

Saturday, July 4, 2015

Do Your Knees a Favor and Get Enough Sleep

Here’s a study, the results of which (published in Arthritis Care & Research) surprised me not at all.
Researchers discovered poor sleep habits among people with knee osteoarthritis (OA) appear to increase their sensitivity to pain resulting in an amplification of discomfort.
The study included 208 subjects (72 percent of whom were female). They were split into four groups: osteoarthritis patients with insomnia, OA patients with normal sleep habits, then two control groups of healthy subjects -- half with insomnia, half who slept normally.

The group with knee OA and insomnia had the greatest degree of “central sensitization” -- a condition of the nervous system where pain signals are amplified.

I’ve mentioned before how important getting a good night’s sleep is. I think it does wonders on different levels: It gives your body downtime to mend, puts your legs in a relaxed, non-stressful position, and improves your outlook on life in general.

So if you’re trying to win the knee-pain battle, and you’re not getting eight hours a night (or whatever constitutes a full night of rest for you), maybe you need to rethink your schedule to give yourself enough good, restorative sleep time.

Saturday, June 20, 2015

The Importance of Taking Charge of a Plan to Improve

I’ve written about this before, but I really think a turning point is when people with bad knees take charge of a plan to get better.

With a chronic condition, people often go through the same maddening series of doctor and specialist visits and receive the same unsatisfying answers. Day to day, the symptoms improve a little, then worsen, then improve, then worsen, and on and on. You don’t seem to be going in a particular direction -- except down, though slowly. You feel helpless, like a leaf being tossed about in a tempest.

This is a terrible place to be. It’s where most knee pain sufferers find themselves. Eventually, they say with a shrug, they’ll just get a total knee replacement.

Contrast this with having a goal -- healing your knees and having a plan to get there. It may be a four-month plan. It may be a four-year plan. It may be an eight-year plan. It may be a plan that turns out to have more curves and changes in direction than a mountain switchback road. Still: It’s a plan. There is a goal. That’s better than being a leaf thrown about by a random gust of wind.

To me, this is so important. This is the common thread among all the inspiring success stories I know about beating chronic knee pain. At the center of each is a person who refuses to go quietly into the night and throws himself/herself into some kind of program to improve.

I also believe that taking charge of the plan to heal greatly improves your outlook. Imagine you develop constant, nagging knee pain in March. You see doctors and physical therapists during the year. But they don’t really help and some days you feel better, some days worse. Now, on Dec. 31, as you look forward to a new year and think about your knees, how do you think you feel?

Probably scared. Uncertain. Fearful that your bad knees will just get worse.

But what if, during that same year, you develop a plan to heal. You’re not sure if it’s the right plan -- but it is a plan. Even if you don’t make a whole lot of progress, I think you’re in a different place mentally on Dec. 31. I think you’re more likely to be hopefully strategizing when you consider the year to come. Your thinking may sound like this: “Okay, I didn’t do as well as I had hoped this year. But I know that A, B, and C are definitely bad for my knees. I can’t do exercises D and E, but the bad knees seem to like F. So I’ll start on a program of G, increasing the repetitions about 10 percent every two weeks, then see where I am by the end of March. If this doesn’t work, I can always try H and I.”

The plan doesn’t need to be of your own devising. A smart physical therapist may help you design it. But you should understand it, own it, be committed to it -- and be willing to change it as soon as you can tell it’s not working. And then you should try something different. The path to healing is not straight, it’s not easy, but I’m convinced there is one.

Saturday, June 6, 2015

Knee Studies That Make Me Nervous

A lot of articles about knee pain studies land in my e-mail inbox. Recently I came across one with this provocative title:

Osteoarthritis Patients Will Benefit From Jumping Exercise

The English is a bit shaky in spots (perhaps it was translated?), but the findings are clear enough:
Progressive high-impact training improved the patellar cartilage quality of postmenopausal women who may be at risk of osteoporosis (bone loss).
Specifically, 80 women from 50 to 65 years old, who also had knee pain, participated in this Finnish study. They all had “mild knee OA,” it’s important to note. One set of subjects underwent a “supervised progressive high-impact exercise program” three times a week for 12 months. The quality of their patellar cartilage (which is located under the kneecap) improved with jumping and exercises that required “versatile rapid movements.”

Jump for better knee health! Uh, yeah sure ...

Jumping around with bad knees is not the first thing I would do. What we don’t know here is significant, I suspect. That “mild OA” may correlate with milder knee pain and minor damage, which makes more vigorous activities possible. I know plenty of regular readers of this blog who would shudder at the idea of “jumping” their way to knee health; their pain is brought on by much less strenuous exercises.

Also, it’s hard to tell what “supervised progressive high-impact exercises” means, but “supervised” and “progressive” suggest that subjects with bad knees weren’t cut loose to do jumping jacks during the first week.

My takeaway from this study is probably different from what the authors intended. I’m far from sold on advising knee pain patients to engage in jumping activities to improve their kneecap cartilage. I bet there are less impactful activities that would achieve the same end. However, if you’ve got good knees, exercises that stress your cartilage such as those that involve a reasonable amount of jumping are probably a good idea. They can help you develop stronger joints and ward off problems in the future.

An ounce of prevention!