Saturday, January 30, 2016

Why Did My Knee Pain Come Out of Nowhere?

I’ll run Part II of Morton’s neuroma next time. I realize that since this isn’t a “Saving My Feet” blog, people aren't so interested in trouble-shooting problems with their metatarsals. However, I will note that PFPS is mentioned briefly in the second installment :).

Anyway I recently got a long comment at the end of “On the Virtues of Going Slooooowwwww” that included a line I found interesting:
It just seems strange that I had zero issues with my knees up until someday 15 months ago and they were to never be the same.
Yes, this does seem strange, I agree.

But yes, this is also very common, I’m convinced as well.

I referred the commenter to another post I did, one of my favorites. Sometimes I like to scratch an epistemological itch and try to figure out something important. In Saving My Knees, such a moment occurred when I realized that when measuring rate of change, the perceived rate will be greater as your measuring instrument becomes more precise. (I’m sure others have noticed this same phenomenon, and some statistician’s name is appended to a law stating as much.) This has huge implications.

Anyway, back to the matter of knee pain coming out of nowhere. The post I referred to is about breakdown points. The knee is a load-bearing structure, subject to forces in multiple planes. Physical structures can have breaking points, or tipping points, up to which everything may seem fine externally. So just before that tipping point is reached, there may be the absence of any discomfort whatsoever. But there could be a fine line between no pain and the emergence of some pain that then goes on to worsen to chronic pain rather quickly, which then proves practically incurable.

The tipping point analogy is intriguing, I think, because it can be analyzed in a number of ways in the context of structures. Imagine a cup that withstands the impact from being dropped say 16 inches, but from 17 inches shatters into pieces. Obviously, that’s a dramatic change in state, from whole to irreparably broken, that's caused by a small shift in our initial variable (the height from which it's dropped). That’s not what happens to your knees (especially because they’re not inaminate objects with no ability to heal), but if your knees exist in a condition of precarious homeostasis when you are pushing them too hard, maybe you are close to crossing a thin line that will send you into a downward spiral of pain and misery.

And once you hit that tipping point – once you land on the wrong side of that slim divide that separates no pain and pain – the unfortunate thing is it can take a long time to get back on the right side. But I would argue that your knee pain didn’t exactly come out of nowhere. Instead,  you approached a dangerous line, probably multiple times, that you didn’t even know you were nearing – and finally pushed across it, with disastrous results.

Saturday, January 16, 2016

The Curious Tale of Morton’s Neuroma, Pt. I

In June of 2013, more than two years ago, anyone reading this blog for ideas on how to beat knee pain would have been astounded to see me in person. I was a mess -- a limping mess. At the time, I thought (my dark sense of humor) that if someone posted a video of me walking on YouTube, sales of Saving My Knees would evaporate overnight.

But it wasn’t my knees.

It was my right foot.

Here’s the narrative of what happened (which, during a search for a cure, I later repeated to three different podiatrists).

One Saturday morning in mid-June, I went for my usual grueling bike ride of 45 miles or so. That afternoon, about five hours after I climbed off the bike, I got out of a chair in my apartment and began limping. Right out of the blue. It felt like I had pulled a little muscle in the ball of my foot. I remember shrugging and thinking, “Ah, just walk it off.”

But the nagging little injury persisted. Over the next week, it got better, but didn’t go away. Then, the following weekend, I made what turned out to be a huge blunder. I was house hunting and ended up walking for hours, checking out homes and neighborhoods in a town we were thinking of moving to. The next morning, my foot was really hurting. I was limping badly.

Now let’s fast forward about six months, or this will get really long.

The foot still hurt, though the pain had subsided to an occasional numbness/soreness. During the summer, I had taken a month or so off from cycling (I should’ve taken a few months, right after the initial incident, but I was dumb in that macho male way). I had experimented with a few things, at one point even taping a partly inflated balloon to the bottom of my foot for relief (this actually wasn’t a bad idea, but I never found a balloon made of sturdy-enough material to avoid popping). Still, I had that numb feeling in the ball of my right foot that came and went, as if I were walking on a bunched-up sock.

So I went to see a podiatrist.

He checked me out, did an ultrasound, pointed to a shape on the scan and said, “There, you have a Morton’s neuroma.”

A what?, I’m thinking.

It turns out that Morton’s neuroma refers to a nerve in the ball of the foot that develops a bunch of scar tissue around it after chronic irritation. A numb feeling in the bottom of the foot is a typical symptom. Depressingly, once you have a neuroma, you always have it. It doesn’t magically vanish if you stay off the foot for a month or two.

I let the podiatrist shoot cortisone into the area (not without some reluctance, I might add). The cortisone did little good. So at this point I had a bad foot and cortisone residue in my joint. Great.

Of course by then I was reading a lot about Morton’s neuromas online. That led me to observe some oddities about my “neuroma.”

* A typical Morton’s neuroma (in fact, one podiatrist online claimed the only true Morton’s neuroma) occurs between the third and fourth toe joints. Mine was between the second and third.

* The same online podiatrist said a Morton’s neuroma is never the result of injury. I was pretty sure my condition was, even if it wasn’t a dramatic, foot-caught-in-the-door type of injury.

* This podiatrist also said a Morton’s neuroma becomes apparent very slowly, over months to years. My symptoms manifested themselves rather quickly.

* He maintained as well that a Morton’s neuroma is never accompanied by swelling. But at one point, a podiatrist observed swelling in my painful foot.

Had this been Me before my ordeal in Saving My Knees, I probably would have just gotten my three recommended cortisone shots, spaced weeks apart, then scheduled surgery to extract the nerve (the only permanent solution) when they failed (which I suspect they would have).

Instead, as a smarter patient who knows doctors can sometimes be wrong, I wound up seeing two other podiatrists.

#2 didn’t think it was a Morton’s neuroma and put me in a boot, which helped a lot. But, as luck would have it, she wasn’t in my PPO network, so I chose not to see her again. Some months later, still hurting, I saw #3. He didn’t think it was a Morton’s neuroma either, and ordered an MRI, which came back clean. The next time I saw him, he greeted me, looked at the test results, and changed his mind, telling me, “You have a neuroma!”

Argh. So I really did have a neuroma?

I began mentally preparing myself for some kind of surgery (I was leaning toward cryosurgery). In the meantime, I decided to try my hardest to beat this thing. I bought wide, well-padded shoes and Crocs to wear. I also bought a roll of Neoprene padding to cut out inserts for my shoes, for even more cushioning. I cut a slit in the side of my right cycling shoe, to give my foot more freedom.

I did more stuff, but I’ll spare you the details, as this post has already gotten really long.

The critical thing you need to know: My foot got better. It feels pretty much normal again.

So my neuroma healed?

I don’t think so. I don’t think I had a neuroma in the first place, or if I did, it wasn’t the primary issue.

If you’ve read this far, you’ll want to come back for Part II in a couple of weeks. I’ll explain what I learned about Morton’s neuroma. And, in doing so, I’ll tell you why Morton’s neuroma is almost certainly one of the most overdiagnosed conditions in podiatry offices everywhere.

Sunday, January 3, 2016

Sometimes It Pays to Keep Things Simple

I recently had Internet issues that reminded me of my old battle with knee pain.

My desktop PC connects wirelessly to our home router through an adapter that plugs into a USB port. The week before Christmas, my Internet browser started to hang after anywhere from three to ten minutes. This happened repeatedly. However, my laptop computer could still connect wirelessly.

Hmm, I thought. What the heck can be causing that?

I’m fairly good with computers, so I used Google to help me try to figure out what was going on. But my sleuthing proved frustrating. Possible causes abounded. Every time I eliminated one, another two or three would pop up.

The list of suspects was all over the map. Could it be a virus? A software conflict with my antivirus software? A power saver setting? An update from Windows that created issues? And on and on.

Then, while pinging websites from the command prompt, I discovered a significant amount of packet loss. That led me to connect the PC by cable. The Internet worked fine.

Ah hah.

I went to the back of my computer, where a wireless adapter smaller than my thumb, poking out of a spare USB port, should have been grabbing the Internet signal. I suspected it wasn’t – or at least not reliably.

So I replaced it, and everything was okay again.

What I realized later was it took me a long time to get to the solution. I should have investigated the faulty hardware as a culprit early on. I got that little device from the company that provides our Internet service; the installer handed it to me as if it were some throwaway lagniappe when I asked about connecting wirelessly.

That should have been a clue that it didn’t have much of a lifespan.

Instead of zeroing in on the adapter though, I chased a lot of other theories around, some a bit wild. I didn’t look at the simple thing first: namely, something that wasn’t built well in the first place just failed and needed to be replaced.

Similarly, when I had chronic knee pain, I remember Googling my symptoms a lot. I bet that anyone reading this right now will recognize themselves in that sentence. We all do it, desperate to find answers. In my book, I even mention getting tested for rheumatoid arthritis, wondering if I had some autoimmune disorder.

But Google can be more curse than blessing. It can lead you in a thousand different directions, none of them profitable. It will convince you that you have some extremely rare disease.

The simple thing to consider when you have grumbly, achy knees and medical tests don’t turn up a clear culprit, like a tear in a ligament, is that you simply have a damaged, weakened joint that can no longer tolerate the burden placed upon it.

In that scenario, you have to modify activity, scale back activity – but stay active somehow. You let go of all the weird little symptoms that don’t make much sense. You focus on bringing back your knee joint, little by little. It will take a long time. There will be more ups and downs than a world-class rollercoaster.

For a lot of us though, I think the simple approach makes a lot of sense. And, at least in my case, when I got better the weird little symptoms that made me suspect some systemic disorder went away anyway.

Saturday, December 19, 2015

It's That Time of Year Again!

Yes, time for my annual holiday message.

First, I hope you're all looking forward to the Christmas break. It's a great time to celebrate family and community. Smiles and kindness and hugs and good cheer have their own healing power.

As the old year turns to a new one, for knee pain sufferers it's a good opportunity to look back and assess, and then gaze hopefully forward.

Are you in a better place on Dec. 31 than you were on Jan. 1? What was the dumbest thing you did to your knees this year? What was the best thing? What was the best lesson you learned? Did you find a low-stress, high-repetition activity and figure out how to make it work for you?

Looking ahead: Do you have a plan? Even better, maybe you have a Plan A, a Plan B, a Plan C, and even a Plan D if none of those work out. Are you feeling optimistic? Remember, negativity exacts a tax on the healing process.

Also, something I consider very encouraging: Any time you're in a better place on Dec. 31 than you were on Jan. 1, guess what? You're getting better! It may not be much better, and maybe you wanted to be all healed in three months, but it's a gain, no matter how small.

Next year, I'm going to talk about a few things other than my knees. For one, I now have a "frozen shoulder" that I'm dealing with :(. But, on the happier side of things, the Morton's neuroma I was diagnosed with in my right foot is no longer an issue.

I'm going to share some of my other ordeals here, because for example the odd tale of my Morton's neuroma really should be told. I came to understand a LOT about the Morton's neuroma diagnosis in the past couple of years. So if you've been told you have MN, stay tuned.

Okay, that's it from me for now. All my best, and a big thank you to all the good people who take the time to comment here, and help others!

Saturday, December 5, 2015

More Evidence That Cartilage Can Heal

As you all know, nothing cheers me like a good success story – or even a small yet significant victory on the long road to healing.

Well, one member of our small community here who uses the handle gcoza posted this comment this week:
Today I went on my second MRI of my left knee. The first was prior 27 months and showed significant chondromalatia patella on the upper medial side of the patella in the area of 12x9 mm. New MRI medical report showed no sign of chondromalacia patella. Nothing!!!
He even posted the before and after images of his knees here.

This is great news, but if the irregular cartilage has really filled in, I’m not that surprised. As I mention in my book, clinical studies show that cartilage defects can change A LOT over two years. Places where the cartilage is worn almost to the bone can suddenly look almost as good as new.

I can remember reading all this and thinking, “Damn, this is big. I’m reading all these articles and books about healing bad knees. Why doesn’t anyone mention this?” Instead, much of the prevailing thinking cleaved to a sort of “car part” model, if you will. That is, you could think of your knee cartilage like the tread on your brand-new tires. After time, it simply wears down.

It’s a simple, fatalistic, and profoundly flawed way to analogize about human bodies, which are full of cells that are constantly renewing. Hell, if we weren’t built that way, all of us would die of senescence at the age of three or so.

So congrats to gcoza. He is quick to note that he hasn’t beaten knee pain yet. He’s better, but still has a good way to go. But man, it must feel unbelievably good to stare at an MRI that essentially says, “Hey, all your hard work at recovery is paying off.”

Now, granted, that fill-in cartilage is probably of the inferior fibrocartilage variety that’s less durable than the original. But as I have mentioned before, over time fibrocartilage has been shown to begin to take on characteristics of normal hyaline articular cartilage.

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.