Friday, July 16, 2010

Who Am I?

I'm posing this question because that's what a reader may wonder who comes across this blog.

Who is this guy, who brashly rejects accepted wisdom about healing achy knees?

First, what I'm not: I'm not a doctor. I'm not a physical therapist.

I am someone who struggled with chronic knee pain for more than a year. My diagnosis was patellofemoral pain syndrome (a terrible, say-nothing diagnosis ... and I'll go into that at some other time). I had bad cartilage lining my kneecaps, from cycling too hard up steep hills.

My credentials for writing this blog, I suppose, are that:

I am a skeptic by nature, a journalist by profession, and a pretty capable researcher with a talent for sifting through piles of research documents (medical textbooks, scientific studies) and extracting relevant information. I quickly learned that doctors weren't telling me the right story (or full story) about bad knees healing.

I am someone who believed strongly enough that his knees could get better that I quit my job and embarked on a year-long scientific experiment of sorts, testing all sorts of things, to find out what would help me heal. I recorded these observations in a detailed knee journal. I doubt that anyone has attempted such an experiment before (it's rather dull, for one thing), but what I learned was amazing.

And probably most important, I am someone who beat chronic knee pain, on my own, designing my own program for recovery.

No surgery, no magic pill in a bottle.

I want to share my story on this blog (I've also written a book). I wrote the book because, when my knees hurt much of the time, I searched everywhere for answers about what to do because my doctors weren't too helpful or optimistic. The books I found left me unsatisfied. They were written by doctors and physical therapists and were dry tomes chock full of the same advice that wasn't working for me and my really sensitive joints.

I wanted to read a story told by someone who had chronic knee pain that was like mine, hard to treat, yet who found a way to beat the condition, and what he learned along the way.

So I wrote "Saving My Knees," hoping it could inspire others.

Saturday, July 3, 2010

Dangerous Knee Myth #1: To Heal Bad Knees, Focus on Strengthening the Quads

My former physical therapist designed a treatment program around this belief, that the key to controlling my knee pain lay in strengthening the quads (the large muscles on the front of the thigh). I dutifully followed his advice and did the exercises he suggested. I made no progress for months in my battle with achy, painful knees, then eventually succeeded in damaging the joints further.

I started getting better when I rejected the "strengthen the quads" approach to beating knee pain, realizing that it didn't make sense.

It seems almost heretical to say that. If you search the Web for treatments for "chondromalacia patella" or "patellofemoral pain syndrome," you'll find the "strengthen the quads" advice doled out repeatedly.

Which is pretty remarkable, considering it fails the common-sense test. Here's why:

Just imagine you bang your elbow against something, really hard, and it begins to ache. After many weeks, your elbow still bothers you. So you go to see a doctor.

He takes X-rays and examines the joint. It's capable of moving through a normal range of motion. You tell him about the ache: low-grade and chronic, though sometimes it's worse than other times. There's nothing broken in there, he reassures you, and the joint pretty much behaves as a normal elbow would ... he sort of shrugs and sends you to physical therapy.

The physical therapist, after inspecting your elbow, recommends exercises to build up your shoulders and biceps. Having a strong shoulder and biceps will ease the load on the joint, he says. You leave his clinic with several sheets of diagrammed exercises that you are instructed to do 20 to 30 repetitions of, once daily.

What's wrong with this picture?

The problem isn't with your shoulders and biceps. It's with your elbow.

Likewise, I realized my problem wasn't with my quads, it was with my knee joints. Why not directly treat the problem? Why not focus on strengthening my joints, not my quads? Once my joints were strong enough, THEN I could worry about building up my quads. Sure, strong quads help protect knees, but their weakness isn't what's making you miserable.

Of course this raises some intriguing questions (that I'll return to in future posts): If this is such an obvious application of common sense, why don't orthopedists and physical therapists try to strengthen joints, first and foremost? Why do so many think the route to saving your knees goes through your quads? The answers are a bit complex, and I thought about them on many days during my recovery, as I focused on joint-strengthening exercises.

Some physical therapists do know better, like Doug Kelsey of Sports Center, whose writings were a beacon of hope to me during my bleakest days. Here's an excerpt from one of his blog essays:
Most of the medical profession believes that there is nothing that can be done, conservatively, for a joint with degenerative changes. The medical options are to quit doing things that make your knee hurt, use medications to control inflammation and pain and / or perform surgery - partial or total knee replacement ... Sometimes people will get sent to a physical therapist with instructions to strengthen their quadriceps muscles. Of course that often fails or is ineffective because the force needed to strengthen the muscle is beyond what the joint can withstand ... I've seen thousands of people with damaged cartilage over my career and a large percentage of them recover.
He's absolutely correct: people do recover. I did, and my crackly cartilage improved too. But I didn't get where I am now with a muscle-first approach to vanquishing knee pain. I realized it had to be joint-first. And that was a big first step.