Saturday, February 10, 2018

Unloading Your Joints: More Proof It’s the Way to Go

I’m a fan of Boston professional sports teams, so I follow a lot of news about them. That includes injury reports, unfortunately.

In October – exactly six minutes into the NBA basketball season – the Boston Celtics lost forward Gordon Hayward for the season. He broke his ankle in a gruesome injury.

Hayward is slowly, slowly rehabbing. He recently posted an account of what his recovery is like, and I thought it worth mentioning for a couple of reasons.

One: Does this sound familiar?
The hardest part of all of this is the mental grind. It's a lot of time doing pretty boring things to get the slightest bit better every day, and of course, sometimes I don't get better. Sometimes I take a small step back because my ankle didn't react well to the thing that I did the day before. And so we have to walk it back a little. That's the hardest part, and the most frustrating part for sure.
Anyone in a long-term recovery program for chronic knee pain can identify with this agonizingly slow pace of healing. Still, recognizing this is how healing happens -- little steps forward, then backward, then repeat -- is useful to avoid getting too discouraged.

Also, of course, notice his mention of those nagging setbacks that you're going to face. You will make mistakes, and push a little too hard some days, and that will lead to frustrating delays.

Two: Listen to how Hayward is exercising his ankle.
... I am slowly progressing with the AlterG. This is the first time I’ve ever used the AlterG, and if you don’t know what it is, it uses air pressure technology to allows you to rehab without putting your full body weight on your legs. It’s like you don’t have the full effect of gravity on you (which is where the name comes from).
We all know what AlterG is, right? (I wrote about it here.) AlterG is a rather expensive piece of equipment that allows you to run and walk on a treadmill at less-than-normal forces. While it costs more than a total trainer, the objective is similar, and involves lightening the load on your hurting knees (or ankle).

Gordon Hayward is a $30 million-a-year man. That’s a big contract. He could afford any kind of rehab he and the Boston Celtics wanted. That they chose a piece of technology that’s essentially a cousin of the total trainer should convince you that the joint unloading approach really works for the smartest, quickest recovery.

It’s not just Doug Kelsey and me saying it – it’s the medical staff of the Boston Celtics, dealing with athletes who make far more money in one year than I’ll ever see in my lifetime!

Saturday, January 27, 2018

Osteoarthritis, and a Post-Industrial Era Mystery

The latest issue of Harvard Magazine looks at a curious mystery.

Two biology researchers from Harvard University discovered the mystery after visiting medical institutes across the country and examining skeletons over the centuries.

They were searching for evidence of knee osteoarthritis (bone-on-bone rubbing in places where the cartilage has completely eroded, which leads to polished bone surfaces that are a telltale sign of the disease).

When they compared the skeletons from the prehistoric and industrial eras to those from the postindustrial, they found that the prevalence of knee OA has more than doubled since World War II.

You might think: Sure, of course it’s higher. People live longer. More people today are obese.

But controlling for age and body mass index didn’t make the difference go away. To be sure, obesity contributes hugely to knee OA. But it wasn’t causing the spike in cases.

The researchers still aren’t sure what’s going on, but they’re testing a hypothesis that I think will yield their answer.

Physical inactivity, they speculate, may be what’s to blame. The mid-twentieth-century shift to service-sector jobs put more people in workplaces where they got less movement. The modern desk rat was born.

We sit, and sit, and sit, and sit, and then wonder one day why our knees hurt.

Because our knees weren’t designed to do nothing at all for long stretches?

Or, as the article says, in more prolix language: there’s a “suspicion that OA is a case of human physiology being partly maladaptive to modern environments.”

Healthy, joint-nourishing motion IS important.

This, I believe, is the key to preventing knee pain, or once you have it, recovering your pain-free knees once again.

Saturday, January 13, 2018

The Difficulty of Taking a Step Backwards to Move Forward

With New Year’s resolutions thick in the air, I thought this might be a good time to talk about what might be the hardest thing to do when trying to heal aching knees.

A lot of people, especially fit people, quickly take to heart my message of “motion” when it comes to healing. After all, living things that stay at rest gradually become weak and begin to fall apart.

So athletic people immediately want to go outside and start walking 5,000 steps a day to recover their knee health.

But the motion imperative can be very dangerous, as too much motion just leads to more knee pain. The key, I strongly believe, lies in figuring out the “proper amount” of appropriate motion. And, as I've said many times before, determining the “proper amount” can be very, very hard, especially initially.

What’s sometimes needed is a willingness to go backwards to go forward.

For me, that involved scaling my program way, way back. I went from walking thousands of steps a day to simply walking once around a pool and resting for ten minutes, then repeating the sequence. Talk about boring! This also represented a kind of “rock bottom” moment for me – if that’s all the movement my knees could tolerate, they must be much weaker than I imagined.

As it turned out, hitting rock bottom was one of the best things that happened to me. I needed to accept where I was – where I really was, and not where I thought I was – to start improving. Those simple pool walkarounds made my knees feel consistently good, and I needed that. I needed to escape the frustrating swings of emotion, where my knees felt good for a few days, then bad for a few, and my progress seemed to stall.

Going too fast, too aggressively, can leave you baffled and frustrated. Sometimes it pays off to go backwards – figure out the least strain you can put on your joints, while having them consistently feel better.

Once you establish that baseline, then you can start to move forward.

Saturday, December 30, 2017

Happy New Year, Everyone!

It’s that time of December again, when we take stock of the year that was and start to dream of the possibilities of the year ahead.

I’d like to take a moment to thank the readers of this blog (and the book). My plans, at least for now, are to keep blogging at least semi-frequently until the book sales taper off. I think it’s nice for people who read Saving My Knees to find me online and active.

The book arose from frustration: doctors, I think, are unduly pessimistic about the ability of bad knees to heal, when given time and the proper treatment. I showed it was possible with my own knees (“proof of concept” to validate a hypothesis). My knees are normal today.

The book also arose from anger: after extensive research, I became upset at what physical therapists thought was the “proper treatment” for my knees, and disappointed in my doctors – who I felt should have known better – that they condoned this protocol.

Anyway, I’m not trying to hog the spotlight today. I really wanted to make this an appreciation of you readers, especially those people who share comments and insight on this site. I didn't write the best-selling knee book, but I think I’ve got the smartest readers. ;)

I’ll take that.

Saturday, December 16, 2017

Why I’m So Optimistic About Cartilage Healing

I figured I’d tackle this one straight-on today.

First things first: No, the holes in your cartilage don’t have to heal for your knees to feel better. This is absolutely not a prerequisite. There are many people walking about with cartilage defects and no knee pain. That’s not a bad club to be part of. After all, you just want to be rid of knee pain, right? Who cares if your cartilage is as smooth as a baby’s bum?

Second thing: I am occasionally asked if I have a follow-up MRI in my possession to prove that my cartilage did, indeed, heal. See my post here about why, no, I haven’t done this and why I don’t think it matters much anyway.

Another reason it doesn’t matter much: there appears to be much stronger evidence out there than a single MRI from yours truly. That takes us back to the original point: Why do I think cartilage can heal?

Take a good hard look at the table below. I copied it from a study, “Factors Affecting Progression of Knee Cartilage Defects in Normal Subjects Over Two Years.” The 86 people who participated had MRIs done of their knees at the start of the study, then two years later. (Yes, these were “healthy subjects,” but I’ve seen another study that includes knee pain sufferers that came to similar conclusions.)

The condition of each subject’s cartilage was graded for five different knee compartments. The scoring again goes like this:
Grade 0 = normal
Grade 1 = focal blistering
Grade 2 = irregular surface and loss of thickness of less than 50%
Grade 3 = deep ulceration with loss of thickness of more than 50%
Grade 4 = full-thickness wear of cartilage with bone exposed

Now look at that table. I’ve color-coded it in a way that I hope enhances readability. Let’s consider the the 14 defects that started out as Grade 3. If cartilage simply wears away, and that’s the end of story, you would expect their follow-up grade to be either 3 or 4.

But what actually happens? Yes, three of them stay at Grade 3, and five worsen to Grade 4. Yet four improve to Grade 2, and two of them – one in seven – improve all the way to Grade 1.

Yes, the sample sizes are small. Still, the pattern is repeated elsewhere (the extremes, at Grade 4 and Grade 0, suffer from the floor and ceiling effect, of course). Look at the 88 defects that started out as Grade 2. A full 31 percent of them, or almost a third, improve to Grade 1.

Yes, there are valid questions to raise. What is the nature of this new cartilage? Is it weaker fibrocartilage (actually, another researcher has found that though new cartilage starts out that way, over time it begins looking more like regular hyaline). Also, could there be misreading of results? (My take: yes, probably some, but I doubt on this extensive a scale.)

To me, this constitutes very interesting, and compelling, evidence that cartilage changes are a two-way street. Cartilage doesn’t just get worse. It’s always getting worse and getting better. And if it can get better, then why not try to enhance that ability? (Note: this was a “natural” study, meaning that some subjects saw positive changes in the tissue, and they weren't even on a special regimen!)

Saturday, December 2, 2017

Taking the Big Leap: It’s Not an Easy Call

Every so often I like to mix into this blog something both personal and current. How’s this: At the end of September, I got laid off in a restructuring.

It happens. If you’re a little older and experienced, it happens more often.

But, as readers of my book may realize, I take a perverse pleasure in proving wrong the people who underestimate me. Orthopedic doctors in Hong Kong didn’t think my knees would get better. After extensive (and obsessive) research, I found what I thought was lots of evidence that they were dead wrong.

It took me many months, with much detailed record-keeping and experimenting and patience, but in the end, I healed. My knees returned to normal. This became the greatest achievement of my life, and nothing else is really even close.

Today I wanted to revisit a hard decision I made, now that I find myself among the ranks of the unemployed again. Early in 2008, I made up my mind to quit my job in order to try to heal my knees. Sitting at work with bent legs was impeding my effort to heal, because my knees were constantly inflamed.

First, let me make something clear: I could never advise another knee pain sufferer to quit his or her job. That’s a very individual decision. It’s also a calculated gamble. Had I never managed to heal, I would have found myself unemployed, and maybe even unemployable.

But if you’ve got chronic knee pain, it may be worth considering. If you do, here are some questions worth asking yourself:

How much do activities that I must perform at work worsen my knee pain? Those “activities” can even be non-activities, such as sitting. Or maybe you’re roaming a warehouse eight hours a day, fulfilling Internet orders. Or maybe you’re dealing with a crushing amount of stress.

Do I have any evidence that my knees will improve if I devote myself to healing them? Do you have a good feel for what your knees like and don’t like, and what kind of program will provide the kind of nourshing motion that will enable them to get better?

If I leave my job, what support do I have? Financial support could be savings (and you’ll want to calculate how long it will last). Emotional support could be friends and family.

How hard will it be for me to rejoin the workforce in six months, or even a year? Clearly, some of this depends on factors beyond your control, such as the job market, but certain high-demand professionals may find it easier to transition back into full employment.

What are my goals, in terms of healing, before I rejoin the workforce? And, if things don’t go well, when do I give up and either live with the pain or turn to pain medication or surgery? It’s good to have goals before you set out on what could be a challenging journey.

Is there a way for me to keep working, but only part-time? If you recall, in Saving My Knees, I proposed an experiment, with my doctor's support, to try to rehabilitate my damaged knees. My employer agreed, but unfortunately, the experiment was too short. Still, it did prove to me that I was on the right track with my thinking.

Again, it’s a difficult, courageous leap to take, and not for the faint of heart. It may be worth it for you, or it may not be. I can’t decide that for you. Only you can.

Saturday, November 18, 2017

Inflammation and Knee Pain, One More Time

I’ve already touched on renegade inflammation and knee pain a few times, such as here and here.

But the subject of inflammation and knee pain is intriguing enough, and relevant enough (and what’s been found lately is also contrary enough) that it deserves plenty of space.

Take this article, now two years old:
Knee osteoarthritis should no longer be thought of as a "noninflammatory" condition, as inflammation associated with synovitis or effusion plays a bigger role in worsening pain than mechanical load, according to a new report from the Multicenter Osteoarthritis Study, published online November 10 in Arthritis & Rheumatology.
There were 1,111 people in the study, aged 50 to 79 years, who either had knee osteoarthritis or were at risk for it. Initially, 21 percent of the subjects reported frequent knee pain.

One of the doctors involved noted an unexpected result:
I was surprised that we found no relation of bone marrow lesions to pain sensitization because one of our hypotheses, based on animal models, is that mechanical and/or inflammatory lesions can lead to sensitization.
What was related to “sensitization” instead? Synovitis, or inflammation of the synovium.

Oh, another interesting finding that has grim implications:
The authors suspect that once sensitization has occurred, just cooling the inflammation might not be enough to correct it.
So what’s the takeaway? Trying to quell inflammation early may be smart, the researchers suggest:
[Their findings] do suggest that early targeting of inflammation might reduce sensitization ... Preventing the altered neurologic processing of nociceptive signals that usually occurs in OA might also prevent the progressive worsening of pain.