Sunday, January 30, 2011

Thinking About Knees: On the Lighter Side, for a Sunday Morning

I couldn't resist blogging this.

I was paging through the New Yorker on an exercise bike at the gym yesterday and came across the following cartoon that brought a smile to my face:

A man has propped open the hood of his car, which is probably broken down on the side of the road, and is staring into the engine space. Staring back at him is a needle-nosed, spiky-haired imp. The tiny imp is saying, "I'm your problem."

Wow. Wouldn't that be nice if figuring out what was wrong was that simple?

You go to the doctor, complaining of knee pain. He taps your knee with a rubber hammer, and a little spiky-haired imp sticks his head out the side, his mouth full of your chewed-up cartilage, and says, "I'm your problem." The doctor wrestles the imp out of the joint, and into a pocket of his lab coat, then smothers him, and you walk out of the clinic with pain-free knees.

Well, we can always dream. :)

Friday, January 28, 2011

Here Are My "Radical" Beliefs About Healing Bad Knees

I had a funny little moment of awareness this morning.

I was thinking about "Saving My Knees," my story of how I did what my doctors said I couldn't: heal my bad knees. I was thinking about how finding a big, mainstream publisher for the book turned into a hopeless quest.

Because, well, I lack a medical degree and my ideas about how to fix bad knees are presumably too "radical," too far outside what's accepted and what makes sense.

That's when I had that funny little pop of an epiphany. Basically, I said to myself: Am I really the radical here? Am I the one whose ideas about healing bad knees fail to meet the common sense test? Just how wild and outlandish are the things I believe in?

So I decided to do a compare-and-contrast exercise. The list below spells out, in simple form, what I believe in. It will show you what allowed me to save my knees and encouraged me to write a book about my experience of discovery and recovery. To counterbalance my "radical" perspective, I also include the received wisdom of traditional physical therapy and doctors.

Me: Focus on directly fixing the problem (bad knees).
Traditional Physical Therapy and Doctor's Advice: Focus on fixing something adjacent to the problem (the muscles that lie around the joint, which you are told to strengthen).

Me: Taking a pill (glucosamine) every day won't help your knees (especially when two separate medical studies have shown that pill is torn apart by the liver and the contents never reach your joints in meaningful amounts).
Traditional Physical Therapy and Doctor's Advice: Glucosamine can help your body mend bad knee cartilage (two of my doctors prescribed it).

Me: Lengthening muscles around your knees (stretching) may briefly make you feel good, but won't have a significant long-term effect on healing your bad joints.
Traditional Physical Therapy and Doctor's Advice: If you have bad knees, you should stretch various leg muscles.

Me: Trying to stretch a tendon (iliotibial band) that has the tensile strength of soft steel is most likely a complete waste of time.
Traditional Physical Therapy and Doctor's Advice: You should stretch the iliotibial band.

Me: Healing bad knees will probably take a year or two -- if you're lucky.
Traditional Physical Therapy and Doctor's Advice: Healing bad knees should take a few months (note: this is implied -- if you believe stronger quads are the key to escaping knee pain -- see point number one on the list -- this follows, as muscles can be strengthened in a matter of weeks or months at most.)

Me: Bad knees are not usually caused by a mistracking patella, especially if you're say 40 years old and this "mistracking patella" never bothered you much in the 39 preceding years after you learned how to walk.
Traditional Physical Therapy and Doctor's Advice: Bad knees are usually caused by a mistracking patella.

Me: Cartilage has a very good capacity to heal under the right conditions. A cut in your skin heals, a broken bone heals. Would humans really be created with a substance in their knee joint that must take continual pounding and abuse and has either no or very little capacity to heal?
Traditional Physical Therapy and Doctor's Advice: Cartilage can't heal (or has a very limited capacity to).

Scan that list. Think about it. And ask yourself: Who's the "radical" here?

Saturday, January 22, 2011

Am I Really Some Crazy Guy Who Doesn't Believe in Strong Quads?

Okay, the book is out, so it's time to get back to the regular business of the blog ...

One thing I realized recently: someone not familiar with the story of my recovery might stumble upon bits of my writing, specifically my dismissal of quadriceps strengthening to heal bad knees, and say, "Well, this idiot clearly doesn't know anything."

EVERYBODY says that to cure patellofemoral pain syndrome (a.k.a. runner's knee, chondromalacia patella), you have to focus on strengthening the quads, or those large muscles in the front of your thigh. By everybody, I mean doctors, physical therapists, your grandma from Dubuque ...

And I think this advice is wrong -- sometimes dangerously so, as when following it leads you to injure yourself even further.

So does this mean I don't think quad strength matters? Strong quads, weak quads ... whatever.

Not at all.

Having strong quads is GREAT. They do help preserve your knees. My quads are quite strong right now. I spent the summer chasing aerobically fit, young (mostly) cyclists along flats and up hills in western Long Island. Some Saturdays I was in the saddle for almost 70 miles. The rides were intense. We would start with 40 to 50 cyclists. At the finish, there might be five or six of us.

But my own recovery taught me that, when your knees hurt, it's absolutely wrong to FOCUS on strengthening your quads first. Ironically, this conclusion turns out to be simple common sense and "strengthen your quads to beat knee pain" turns out to be baffling advice -- when you stop to really think about it.

Because: Your focus should be on what hurts, on the weak link in the chain. When you have bad knees and walk half a mile, or climb two flights of steps, and then have pain -- it's not your quads that are grumbling, but your knee joints. Your quads may be weak, average, or even strong (I happened to have fairly strong quads at the time I developed chronic knee pain). But one thing is certain: your knees are weak.

So you gotta strengthen your knees first. And what I discovered works best for that, as I outline in my book, is a program that focuses on easy motion that over time increases in intensity and duration. And by "over time," I mean months, not days. I fashioned a plan to heal that centered on walking and pretty much walked my way to stronger, healthier knees. THEN I got back on my bike and really started building up my quads.

I know I've blogged on this subject before. But it's so important I wanted to hit it fresh, with a new year upon us. That quad-strengthening approach is hardly ever questioned ... which is what I find truly crazy, because it really doesn't make sense. The cart has been put before the horse. Why don't physical therapists see this?

Well, one does. I'm going to cite Doug Kelsey again. If you put the two of us in a room, we might not agree on absolutely everything about healing knees (he once advocated taking glucosamine; my research led me to believe it's probably worthless), but Doug is the smartest PT, by a long shot, that I've come across anywhere.

Here he answers a reader's question about a program to heal patellofemoral pain syndrome (abbreviated below as PFS). The bold is mine:
Almost every exercise program that you find for PFS targets muscle (quadriceps strengthening, stretching of the hamstrings, etc.) and having stronger muscles is helpful but weak muscles are not the primary problem. The muscular weakness is in response to the changes in the joint. Some clinicians argue that cartilage does not respond to exercise; that it is biologically inert. However, there is ample scientific evidence proving that cartilage does respond like other biologic tissues of the body (muscle, tendon, ligament, bone) as long as the motion-force combination is within a certain range.
So you need to strengthen the joints. And you can. I'm living proof.

P.S. I'm going to start a new (occasional) feature where I lift some of the cases from the comments section and devote posts to them. One thing I know (from my own experience): people with hurt knees have an insatiable desire for knowledge, and they're eager to tell their stories, hoping someone can provide a glimmer of insight. As I've made clear (I hope), I'm NOT a physical therapist or a doctor, just someone who did a lot of reading and experimenting who saved a pair of bad knees that doctors said would never get better. So I won't offer any advice, more like "things to think about and discuss with a medical professional." We'll see how it goes.

Friday, January 21, 2011

If You're Having Problems of Any Kind Buying/Reading "Saving My Knees," Read This

"Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain" is now on as an electronic Kindle book. I'm still waiting for the product description to be added, but the book is ready to be ordered and downloaded.

Why is it only electronic? That answer's here.

How can you read it? Or buy it if you live abroad? That answer's here.

Now, what if, after following the instructions given on the link above, you still don't have a way to buy or read the book?

Welcome to the trouble-shooting post. I'll fix problems here, best I can. Explain your issue in the comment section below and I promise to periodically update this post with possible solutions.

Monday, January 17, 2011

How Can You Read "Saving My Knees," an Electronic-Only Book, If You're Kindle-less?

Q: Argh ... I didn't find an Amazon Kindle under my Christmas tree this year, so how can I read your book "Saving My Knees"?

Another made-up question ... but I wanted to do three blog posts, addressing three important matters. One: Why is the book electronic only? Two: How can I read it then? Three: What if I still don't have any way to read it?

Today's installment: "How can I read it then?"

Amazon should be processing the book in the next 24 hours, at which point I'll add a link here to where the book can be found online. If you own a Kindle or Kindle DX, you can download "Saving My Knees" and you're off to the races ... you'll be virtual-paging through almost 55,000 words that will get you thinking about your knees in new ways and challenge some of your beliefs about how to heal.

But what if you don't have a Kindle? Here are some solutions, all of them absolutely free.

If you own an iPad, you can download "Kindle for iPad," which should enable you to read any of Amazon's electronic books on your iPad.

If you own an iPhone, you can download "Kindle for iPhone."

If you own a BlackBerry or Mac, or a device that uses either the Android or Windows Phone 7 operating systems, go here for your solution.

I saved the best for last, because most of us own ordinary ol' PCs and not any of this other fancy gadgetry. That's no problem at all, as "Kindle for PC" will set you up nicely to peruse e-books all day long.

I've been using Kindle for PC for a few weeks now (partly to preview "Saving My Knees," to see how it will look as an e-book). I usually refrain from being a software cheerleader, but Kindle for PC is very, very neat, even if, like my good friend Molly, you hate technology and belong to the Lead Pencil Club.

First, the feature set: If you've just finished the Evelyn Wood speedreading course, you can display the book in newspaper-like columns, to whiz through the content faster. If you like your book to fill the computer screen, that's an option. If you want to change font size, font display, or how many words are crammed onto a line, you can tweak any of that, easily. And it goes without saying that you can quickly jump anywhere you want to in the book.

Kindle for PC does other things too, but here's what I think is coolest: it opens up a whole new world of free books. Access to free, quality content always elevates a good piece of software to great. For example, old books in the public domain (whose copyright protection has expired) can be downloaded from Amazon ... at no cost (I'm a huge Lewis Carroll fan so my first selection was "Alice in Wonderland"). Also there are some modern books that cost absolutely nothing too, such as a rather good thriller I downloaded for kicks.

Okay, you may be thinking: I've got a device to read the book on. But I live abroad. What about payment? (You'll pay $9.99 at most for "Saving My Knees", depending on the size of Amazon's discount.)

As I understand, Amazon's U.S. e-books are available through the U.K. site (with the payment automatically converted to pounds). My guess is that Amazon will expand this option this year to other countries ... we'll see.

So what about the rest of you, who don't live in the U.S. or the U.K.?

I'll admit I haven't done a lot of research into this yet. But I did find a Web page that shows how to buy a Kindle book from without a U.S. billing address, by using a gift certificate purchased with an international credit card.

Note: I can't vouch for this method, as the site is not Amazon-sanctioned, but anyone who gives this option a try, share your experience in the comments section and I'll be sure to update this post.

So there you have it! If this still doesn't help you, the last of these three posts will throw the floor open to the truly hard-luck cases to describe their problems, and we'll figure out solutions.

I want this book to be distributed as widely as possible because I think the message is very important and this kind of inspiring, fact-based story isn't available anywhere (and, amazingly, I've yet to find the scientific studies that I cite in "Saving My Knees" in any other "heal your knees" books). My hobby is troubleshooting and thinking around corners (that was part of the secret to my success in recovering), so I'm sure we'll find a way for everyone who wants to read this book to have that opportunity.

Saturday, January 8, 2011

Why Is "Saving My Knees" Available Only as an Electronic Book?

Q: I have followed your blog and read your comments about beating knee pain at sites including KneeGuru, and am curious about your story. I would like to read "Saving My Knees." But why is it available only as an electronic book? Why can't I buy a paperback version? Couldn't you find a publisher? If not, why not, if this book is really any good?

Okay, that's an invented question. But it's a good one. If I had knee pain and was about to lay down a ten spot for a book that exists only in bits and bytes, that I can't carry to the park on a warm, sunny afternoon, I'd sure as heck want to know the answer.

After all, you may be thinking, here's a guy who's well-educated (I attended Harvard, then New York University for a master's degree), who is a veteran journalist working for a leading global news organization, who undertook a closely observed and unprecedented experiment to save his knees, whose extensive research into knees and cartilage is reflected in a Select Bibliography that spans three single-spaced pages -- and he can't manage to sell a book about how he beat knee pain, in a world where there are tens of millions of knee pain sufferers?

Something doesn't make sense here. Something must be wrong with this book, right?

At this point, I'm going to turn the tables and engage you, the reader, for a moment. Because when I was hurting all the time, I very badly wanted to buy a smart, sensible book written by someone who conquered knee pain. I desperately sought hope. I wanted an inspiring story to lift my spirits. And I bet you've probably looked for the same thing.

Now here's my question: How many books fitting that description have you found on the shelves of your local bookstore? Go ahead. List all the titles.

I'll give you a minute. Okay, a few minutes ... still waiting ...

I'm guessing that your list looks about the same as mine would've, four years ago. Zero. No books. Nada. We don't really need another knee book written by a medical doctor (sometimes paired with a physical therapist), full of stiff writing and photos of exercises and rather dull anatomy lessons. We've got plenty of those. But we don't have any first-person accounts that speak more personally to a knee pain sufferer: I was there, I hurt all the time too, and I beat this thing, dammit, and here's my story. So there clearly is a profitable niche, just waiting to be filled.

Now brace yourself: This niche is not going to be filled. And now I'm going to tell you exactly why.

When I began approaching literary agents with my manuscript, very excited -- I had written and extensively rewritten "Saving My Knees" and even hired four perfect strangers, for a small sum of money, to review this manuscript and make suggestions, which led to further changes and improvements -- I soon slammed hard into a brick wall. It became clear to me no agent would agree to represent my book to publishers, and no publisher would ever agree to buy it.

Why? As an agent told me bluntly, I'm not a doctor. I'm not an authority about knees who possesses a medical degree. Of course there's a rich irony here. Had my supposedly qualified doctors written a book about me several years ago, the title would have been something like, "Why Richard Bedard's Knees Won't Heal: A Look at Why Knees Afflicted by Chronic Pain, That Don't Respond to Treatment, Never Get Better." And of course that book would have been dead wrong.

I find it curious that it's not considered valid for me to write this book, even though journalists have a long history of writing about things that they're not degreed experts in. Examples could fill up pages. What makes a book about one's bad knees different? My guess is publishers would identify two main things: (1) This is a health-related book, and a different standard applies. (2) This is my personal story of how I healed, so there may be a presumption that I'm offering advice, a la a doctor.

Now when you read my book (assuming you do), you'll find the advice I do give isn't all that radical. For instance, one of my four golden rules for bad knees is "lose weight." Simple. But while the doctor wags a finger in your face and says, "Lose weight and that will help your knees," I don't wag a finger in your face. I show you -- through my experience and studies I have read -- why you need to lose weight. You can wag your own finger in your face. :)

So my not being a doctor (or physical therapist) was a big obstacle to getting this book published. But I also realized that, even if I surmounted that obstacle, another one just as big awaited me.

Let me take a moment to show you what that was. I'll do so by presenting you with the following hypothetical, that takes us on a little historical journey:

It's two hundred years ago. You're a journalist. You have asthma. You go to a doctor, describe your asthma symptoms, and he recommends a controlled bleeding from your arm into a bowl (Google "bleeding bowl" to see what I mean) to correct your breathing difficulties. You think to yourself, "Okay, I'm not a doctor. I do know that doctors often prescribe this bleeding into a bowl thing. I'll submit to whatever he thinks is best because he's the expert."

But a week after the procedure, you still have asthma, just as severe. You return to the doctor. He tries another controlled bleed. You go home, find yourself still struggling with asthma, then begin to wonder, "Hmm, why are they bleeding me into a bowl? How does that really help cure my asthma?" So you do a lot of research. You run some experiments on yourself. And surprise: you find that bleeding people into a bowl doesn't seem to make much sense for treating asthma. You finally find a way to heal, sans bleeding therapy.

So you write a book, hoping to inspire other asthma sufferers who think there is no hope. You title it: "Saving My Bronchial Passages: How I Healed My Asthma and Why Bleeding People Into a Bowl Isn't Smart Medicine for Asthma Sufferers." You get your manuscript in tip-top shape, then go out to try to sell it to major publishing houses, and they ...

Shut their doors in your face.

The problem is, they would need your book to be reviewed by medical professionals. And the state-of-the-art thinking in the medical community is that bleeding people into a bowl is an appropriate treatment for asthma. And you -- just an ordinary journalist without a medical degree -- are challenging this well-entrenched medical wisdom. Forget about finding a publisher.

Two hundred years ago, that would have been the end of the story, and you would have died clutching your unpublished manuscript -- frustrated, then vindicated later by medical progress.

Today, the Internet has democratized access to information. Sure, there's a lot of bad info to wade through. But for an optimist about knowledge, and about the contagion-like property of good knowledge, as I am, it's clear that a smart book about healing knees just might take on a viral property and spread to help millions -- even if the publishing establishment rejects it.

I can be a bit of a renegade, you'll find in "Saving My Knees." But that's not really my nature. I started out as a perfect patient. I became a renegade only after doctors and physical therapists failed to help me heal. You'll see that much of the advice and information I was given -- that I had a condition called patellofemoral pain syndrome, that I should focus on strengthening my quads, that taking glucosamine would help my cartilage heal, that stretching the iliotibial band was important to get better, and so on -- was most likely wrong or useless.

Following the advice of doctors and physical therapists got me stuck in an endless rut where I never got better (and even got worse, following a physical therapist's advice!), where I was constantly frustrated and depressed. I didn't start healing until after doing a major rethink of everything. The major rethink didn't involve me staring at my navel and thinking big thoughts. I went to Knee School 101, Self-Directed Study. I pored over many clinical studies and medical textbooks -- and stumbled upon the writings of an incredible physical therapist, Doug Kelsey.

So that's my long-winded answer why you should trust a guy peddling an e-book. "Saving My Knees" is my story, certainly. I don't pretend that you need to do exactly what I did, to save your knees. But I think that I discovered a framework for healing -- and I'd be surprised if my observations don't help you in some way. Or at least give you hope -- and that may be just as important as anything for a knee pain sufferer.

Saturday, January 1, 2011

Whoops! We're Out of Order!

Not in the Robert's Rules sense, but rather my latest post on whether to exercise through pain was put here by, below my Christmas post, instead of above it.

That was probably because I started writing it up on Dec. 24, then abandoned the effort because of a bad head cold, and went with a short "Merry Christmas" theme instead.

Anyway, that explains why the last two entries look non-sequential, if anyone was wondering ...