Saturday, October 30, 2010

Another Reason Not to Like Standard Physical Therapy for Chronic Knee Pain

A quick recap: Standard physical therapy's answer for PFPS (or chondromalacia, or runner's knee) is to try to strengthen the quads, the hips, the butt -- anything but the knee.

Why is this so bad? After all, some patients do get better under this regimen, right?

Well, if you believe what I do, it's bad because with difficult cases of chronic knee pain, this approach has a very high fail rate. It's bad because muscle-strengthening exercises can be too much for a weak joint to tolerate, injuring a patient even further (as happened with me).

And this week I thought of a new reason why it's bad: Because the clock is ticking for a knee pain sufferer ...

That means, from the onset of pain, you have an optimal window for finding the right path and getting on it. It could be a window of years, depending on the individual and the condition. But eventually, that window will start to close a little, then a little more.

I'm using this metaphor to refer to the threat of structural changes in the joint itself that throw up obstacles to healing. My greatest fear, when I had knee pain, was that I'd develop knobby bone spurs interfering with the knee's range of motion. In other words, I'd become full-blown arthritic and my best chance at winning the battle would fast recede.

The prospect of structural changes transforming my joints, in ways that could not be fixed short of surgery, scared me the most.

I recall listening to my left knee bend once, and it was if I had a band in there that would make a little dull snapping noise as it passed over some other object. Luckily, the "band" never hurt or impeded my normal motion. I proceeded with my program to get better, and whatever was causing the problem, now appears to be gone.

But for a while, I thought it was a permanent structural change. The longer hurt knees hurt, the greater the chances of the joint degrading in significant structural ways. That's why it's important to take advantage of that window of opportunity early on, when the pain first appears and it's easiest to get better. Unfortunately, that's exactly the time when Joe Patient, knowing nothing about his condition, wanders into a physical therapy clinic and gets a bunch of bad quad-strengthening advice.

My first visit to a physical therapist was June of 2007 (I'd have to consult my files to be sure of the month, but that's about right). The physical therapist treated me off and on until sometime in January of 2008. He urged me to strengthen my leg muscles; I did exercises he prescribed, sometimes feeling a little better, sometimes a little worse.

At one point, my knees blew up following his advice to lift weights in the gym, and I took a long downward slide. Basically, if my knees were about a 5 on a scale of 1 to 10 when I first visited him, by the time I left, they were a 3 or 4. So he left me in a deeper hole than he found me.

Meanwhile, this whole time, the clock was ticking. My joints were in danger of becoming permanently worse. Luckily I saw the light in time, the scales fell from my eyes, and I realized that the path away from pain was to fix the thing that hurt: to strengthen my knees first and forget about my quads for a while.

But if you're reading this, and you have painful knees, you may be thinking: What if I've passed the point of no return? What if it's too late? Well, it probably isn't. That thought is just one of many negative thoughts that flit through your head all day long because you're struggling so much with pain and discomfort. I've been there.

Next time: We'll look at a clinical study that shows you can strengthen knees. Scientific validation! Time to get geeky. Stay tuned.

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