Sunday, November 22, 2015

Hey Look! We’re No. 1! :(

I could almost present this image below without comment. It was tweeted by Conrad Hackett of the Pew Research Center.

So who leads the world in knee replacement surgeries?

In the U.S., 226 people out of 100,000 had knee replacement surgery in 2013 (at least, that’s how I read that statistic). That’s more than one out of five hundred people.

Now, the good part of that statistic: To some degree, it undoubtedly reflects the advanced state of medical care in the U.S. Where patients in other countries have to suffer with terrible knee pain, in America they can get a brand-new pair of joints.

But it also undoubtedly reflects the fact that the U.S. is full of a lot of overweight, even obese, people who are not moving enough and who are wearing out their knees prematurely.

The good news is, if you’re reading this right now, you’re probably part of the percentage of the population that’s working really hard not to wind up on the operating table.

So keep moving. And I know I’ve said it here and here and here and here and here, but:

Lose some weight.

Sunday, November 8, 2015

How to Run With Ridiculously Little Impact

Here’s something cool, though I just discovered it’s been around for more than six years! It’s called a “gravity-reducing” treadmill. A company called AlterG (Alter Gravity -- get it?) makes the machines.

Here’s an image I lifted from AlterG’s website (I doubt they’ll mind, as I’m basically doing free publicity by writing about their space-age treadmill). Cool but a bit weird-looking, eh?

So, you may be thinking, what’s going on in that strange-looking closed compartment below the runner’s waist?

Well, after the user is zipped into place, the air pressure is increased in that chamber, to simulate the effects of low gravity. A control panel allows a user’s body weight to be decreased in 1 percent increments, up to 80 percent.

Imagine that. A two-hundred-lb. man running on a treadmill as if he weighed no more than a five-year-old!

If this approach to exercise sounds kind of familiar, it should. I’ve mentioned plenty of times the idea of “unloading your joints.” Doug Kelsey is a huge proponent of this approach to make exercise pain free.

So naturally, I’m delighted to see anti-gravity treadmills. It’s a perfect machine for a knee pain sufferer looking for a way to get active again.

Well, almost perfect. Forget about buying one of these little workout gems. A recent Businessweek article priced them at $36,900 to $80,000. Ouch. But it sounds like they’re popping up in physical therapy clinics and tony gyms, so sniff around and you might find one near you.

If I have a chance to try out the treadmill -- you know, semi-popular bloggers sometimes get the chance to sample merchandise for a review ;), I’ll let you know. Or, if by chance any of you out there has used this anti-gravity device, let us know below what it was like.

Sunday, October 25, 2015

Old Bad Beliefs Die Hard: The Story of the Q Angle

Recently I found it curious that my Google search net snared a knee pain article from a physical therapist urging people to correct their “Q angle.”

It was like coming upon one of those stories about Japanese soldiers being discovered in the jungle decades after World War II ended, skulking about in camouflage, believing that they were still actively fighting the United States.

“Q angle” certainly has an air of mystery and mathematically infused importance, just by the very term. It ought to mean something. Something really important.

Anyway, this is one of those terms that you can spend 1,000 words defining and still fail to make clear. Or you can simply borrow an image and voila:

This physical therapist blogger -- whose clients include “numerous pro athletes from the NFL, NBA, MLS, and the WNBA” -- tells us:
When I see a Q angle that is off, I also see an excessive amount of rotational force absorbed by the knee. Furthermore, the meniscus and other internal structures of the knee are compromised more when the Q angle is increased.
Let me cut to the chase here, because the author doesn’t clearly state the “issue”: He’s basically saying a Q angle that is too large is probably the source of your knee problems. Women tend to have larger Q angles, due to natural anatomical differences, such as wider hips.

A few decades ago, the Q angle was the hot go-to theory among structuralists looking for causes for your aching knee. The thing is though, there’s evidence a bad Q angle is not the boogeyman it’s been made out to be.

If you recall my blog post about the study called “Hip Strength and Hip and Knee Pain Kinematics During Stair Descent in Females With and Without Patellofemoral Pain Syndrome,” perhaps you recall this line I quoted from the researchers’ report:
Many studies have not supported the relationship between an increased Q angle and PFPS [patellofemoral pain syndrome].
Paul Ingraham, who I often cite here, delves into the Q angle more deeply and also bashes the idea that it’s some kind of “aha” measurement for discerning and fixing knee pain. He asks the big question: Does the size of the Q angle reliably measure how the quadriceps is pulling on the kneecap?

He cites a study that looks into this question, and ends up concluding, “Clinicians are cautioned against using the Q-angle to infer patellofemoral kinematics.”

So among researchers, the Q angle theory of knee pain has been discredited. But old theories die hard. That’s a good thing to keep in mind if someone starts in about how your knee problems are due to your Q angle. They may be fighting some long-ago war.

Saturday, October 10, 2015

Here’s One Neat Trick to Beat Insomnia

There. I’ve always wanted to write a click-bait headline. ;)

But seriously, there is a payoff here. We’ll get there in a moment.

Insomnia, especially as you grow older, can be a serious problem. Once you have knee pain, it gets even worse.

Insomnia, or difficulty falling asleep, is an enemy to someone trying to heal their knees. Sleep is your friend. Sleep allows your body to rest and recover. Also, at sleep, your body is relaxed and your legs fairly straight, both of which should make you feel more comfortable.

Now, on to how to beat occasional sleeplessness. To be fair, I’m talking more about mild insomnia. Mine often comes after waking up around three a.m. to use the bathroom, then settling back into bed and lying there awake for 10, 15, 20 minutes, thinking, “Why can’t I drop back asleep?”

This trick has to do with breathing.

In the sleep state, you take longer, slower breaths. One night, as I was having difficulty falling asleep, I challenged myself to start breathing as if I were sleeping. That is, I tried to make my breathing slower and deeper.

Within minutes, I actually fell asleep.

I found this experiment quite interesting, so I repeated it another night. When I couldn’t sleep, I just focused on my breathing. Slowly in, slowly out, slowly in, slowly out.

Again, I fell asleep after a few minutes.

Now, the thing is, you actually have to focus on your breathing. You can’t just say, “I’m breathing more deeply now,” then let your mind wander. You have to concentrate on breathing in and out slowly, as if you’re sleeping.

And I’m finding that when you do that, sleep will usually follow.

Anyway, as everyone who reads this blog knows, I’m extremely curious and love to experiment. This is one case where it really paid off well for me. I sleep better now. I don’t need the sleep because of bad knees anymore, but because I have a 10-hour-a-day job and a one-and-a-half hour commute to work. That’s good enough reason for me!

Saturday, September 26, 2015

What I Hope Will Become a Full-Fledged Success Story

I found something buried below a recent post that I wanted to share.

TriAgain, as anyone who regularly dives into the comment section knows, has been participating for a long time in the dialogue here about how to heal painful knees. His interest, like that of so many others, arises from his own struggles.

Over the course of many months, he has shared his story with all of you in bits and pieces. Recently he set down the long version in a forum for triathletes. (U.S. English speakers, note that the Australian usage of “trannie” differs from ours ;). Also, TriAgain says there's a little "salty language" in his account FYI).

First, here’s a trimmed-down version of where he says he’s at right now:
3.5 years into the journey, pain down by 70-90% (varies a bit), function up by about 50% ... Day-to-day living/tasks much better. I do think prolonged sitting was a major factor in my demise.
This sounds pretty good. Not victory yet, but a lot closer. Note that he’s been working on healing his knees for 3.5 years. That will no doubt sober up first-time visitors to this blog. But sometimes the process takes a long time as you navigate setbacks and figure out what works and what doesn’t.

His full story is extremely detailed and quite interesting (I had to skim some parts, as I read it on a workday morning over breakfast and my train schedule is unforgiving). He credits Scott F. Dye with helping him arrive at a good framework for understanding what was going on. Dye’s common-sensical idea of “envelope of function” I wrote about here.

One thing I find interesting about TriAgain’s story is that he can wade about for hours, fly fishing, while on a rocky riverbed -- and his knees aren’t bothered.


I wonder if: (1) fly-fishing is something he enjoys, so he’s relaxed (2) the walking is slow, at a sort of aimless wandering pace, which when combined with some standing, makes for a winning combination of easy movement and rest (3) water helps a lot by cushioning the impact on his joints: walk over a rocky field and you’ll find the activity is very knee unfriendly, but walk over those same rocks under a few feet of water (which effectively unloads the force that your body lands with) and the experience is quite different.

Anyway, I encourage everyone to read this story. It’s broken up into pieces, and you can tell by the interspersed comments that TriAgain quickly manages to hook his audience. A good read (and encouraging for others worried about how long their knee program is taking).

Saturday, September 12, 2015

On the Virtues of Going Slooooowwwww

My contributions to this blog will soon become less frequent. Honestly, I just don’t have as much left to say. I don’t want to become like that tiresome grandparent who’s always telling the same story, as if you haven’t heard it eight times before.

Of course, I’ll always be monitoring the comments. And the best way to reach out to me, as I’ve said before, is to leave a comment.

Occasionally, when thinking up ideas for blog posts, I ask myself which messages are worth repeating -- what have I said that should be said again and underscored, with a few exclamation points added at the end? One such message, I believe, is lose weight.

Another is this: you won’t believe how slow healing a pair of bad knees is.

No, really. You. Have. No. Idea.

Now some of you, whose knees aren’t too bad, will be on the comeback trail in a few weeks and may be much better after a month or two. If so, congratulations and utter a small prayer of thanks. Because you got off really easily.

Most of you won’t be so lucky. You’ll spend months tinkering with a recovery program, changing diets, exercises, and all sorts of variables. You will wonder if you’re making progress. Self-doubt will sometimes become intense.

The problem is, often it can be hard to tell if you’re moving forward or running in place, going nowhere. I think this is especially true for people with really bad knees, who most likely need to spend a few years just to get them to improve from terrible to bad.

I know there are a lot of mysteries about how healing occurs. But I think it can. That, to me, is a tremendously inspiring message.

But it’s always good to keep in mind that slow, gradual progress -- even slower than you think is slow -- is the best way to go.

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.