Wednesday, June 29, 2011

Whoops! Found a Mistake in the Book ...

In an unlikely place:

My e-mail address!

A reader contacted me, saying the address kicked back her e-mail. So I looked at it again and ... I confused two of my three e-mail addresses and made an error.


The correct e-mail for me is where #### equals the "at" symbol (note: I decided to change this after the first spambot discovered my e-mail on the blog and shot me a junk e-mail).

I proofread everything in Saving My Knees very carefully, except my own e-mail address. Ah well ...

Saturday, June 25, 2011

Comment Corner: I'm Only 20 and Desperate for Help

I got this comment from a reader recently (which I've edited a bit for space):

I have some worn out cartilage, or a meniscus tear from playing too much football ( soccer ) .. Im desperate for help. I went to my doc, and he said dont run or do anything for weeks and take these antiflams. … I also added glucosamine to my supplements. Result? Got fatter from lack of exercise and once I got back into it, pain was still there.

My knee doesn’t hurt when I walk or run, but when I squat it does. Its that type of motion that hurts the most, when i squat, or kneel.. when i want to get into a car, or out of my chair. I only turned 20 about a month ago, so you can imagine my frustration. I cant play football to the best of my abilities due to this injury and I cant practice bodybuilding to the fullest ( I cant work out my quads coz any exercise causes knee pain !! )

I dont want to quit my sports at such a young age, and thats why I push thru the pain sometimes, but also i dont want to risk further injury that might cause me problems in the future.

There are five or six things I could say, but I'll limit myself to three, to keep this relatively short and sweet (which I always fail to do, but at least if I begin with that intention, I have a chance of succeeding).

To the commenter: First, I'm not a doctor or physical therapist. Consider the following "things to think about." Discuss them with a doctor or physical therapist who is actually examining your knee and (hopefully) asking lots of good, sharp questions about your injury history and daily routines.

It's hard to be young, active and saddled with knee pain. But the good news is you stand a good chance of escaping a life sentence of misery if you do the right things now.

Okay then, the three things in your story that jumped out at me:

1. Got fatter from lack of exercise and once I got back into it, pain was still there.

Yup. Sounds familiar. This is a hallmark of chronic, nagging knee pain. Give it a rest for a week … two weeks … then it comes roaring back. Welcome to a club you don't want to belong to.

But sitting around getting fatter isn't a good thing at all. If you gain ten pounds, that's ten more pounds your legs need to push to a standing position when you get up from a chair -- a motion that isn't comfortable for you to begin with.

(In fact, try this: Rise from a chair. Now put ten pounds in a backpack, slip it on, and do the same thing. That feels even worse, I imagine. Herein lies the basic problem with weight gain. Instead of driving a 5,000 lb. load over a bridge with a 4,000 lb. limit, you're driving a 6,000 lb. load -- so you're moving in the wrong direction by putting on weight.)

What I would think about if I were you: changing exercises for a while. Clearly you like to be active and also need to be (or the pounds begin to accumulate). Easy bike pedaling? Swimming using a stroke that's not hard on the knees? In the meantime, it seems to make sense to avoid activities that stress your knee joints too much.

2. thats why I push thru the pain sometimes

Hmm. This is where I'd suggest you hit the reset button. There are some injuries where you can push through the pain and your body will heal anyway. On other injuries, you're just doing more damage to yourself and digging a deeper hole to climb out of.

My experience was that soft tissue injuries in the knee fall into the latter category, unfortunately. Why? Remember two key things about the hyaline articular cartilage in the joint: (1) It has no nerves (2) It has no blood supply. So it heals slowly and provides poor feedback when it's being damaged.

I would do a rethink on pushing through the pain. When I cycle now, I often "push through the pain." But it's "my lungs are burning/my legs are sore/I'm working out hard" pain. It's not knee pain. I never push through knee pain anymore.

3. I also added glucosamine to my supplements.

Hate to break it to you, but:

Surprise. Glucosamine (probably) doesn't work.

I began researching glucosamine (an important building block of knee cartilage) after taking it for months on a doctor's advice. I took the recommended dose daily. And I perceived no benefit at all.

There have been conflicting studies about the efficacy of this supplement. Some say it does work, some say it doesn't. So you could wade into a morass of studies and pick whichever ones you happen to like best, and arrive at an inconclusive conclusion.

But there's a better way to get at the truth.

Taking glucosamine orally can be beneficial only if (it should go without saying) enough of it reaches the joints to have a positive impact. This is where a big problem lies.

When you swallow a glucosamine pill, it doesn't go straight to your knee joints. It goes to your liver, which rips much of it apart. A significant portion is metabolized and broken down into carbon dioxide, water and urea.

A study of 18 subjects ("Low Levels of Human Serum Glucosamine After Ingestion of Glucosamine Sulphate Relative to Capability for Peripheral Efffectiveness," Annals of the Rheumatic Diseases 2006) revealed the large gap between how little glucosamine ends up in your bloodstream and how much is needed to be effective for your joints.

The subjects took the dose recommended for knee pain sufferers (1500 mg). Between 90 to 180 minutes later, the level of glucosamine circulating in their systems peaked, at 11.5 micromoles (a micromole is one-millionth of a mole). The authors noted:

This maximum concentration … is a much lower concentration than the glucosamine concentrations claimed by other investigators to have various significant in vitro [i.e., in the lab] effects. This raises questions about current biological rationales for glucosamine use that were based on in vitro effects of glucosamine at much higher concentrations.

In other words (my analysis): You're taking a daily pill that, for less than 7% of each 24-hour cycle, achieves a maximum concentration in your blood that is well below the level that has been shown to have a positive effect on joint health. This is a big reason I think the glucosamine story is basically a placebo story.

So there you have it: some things to think over and discuss with a qualified medical professional.

In the meantime, keep movin' in a joint-friendly way -- that's never bad advice!

UPDATE: Thought I'd do a quick update to this post. A commenter below suggests having an MRI done, which is a good idea I'd definitely discuss with my doctor. It helps to know as much as you can about the nature of your injury, though doctors are sometimes reluctant to order MRIs for diffuse soft-tissue pain -- just an FYI that you may hit some resistance.

Saturday, June 18, 2011

On Book Reviews, and Making Lemonade From Lemons


I got my first negative book review on Amazon. Of course it was only a matter of time. Sales (to my surprise) have been twice as strong in the last few weeks as usual. That means the book is finding a wider audience, and the law of averages says someone is bound to dislike it.

In the spirit of making lemonade from lemons, however, I thought I'd make a few points about what Saving My Knees is, and what it isn't. So if you're thinking of buying the book, heed well.

First though, let me clarify two things:

All the reviews on Amazon (good and bad) are real and (I assume) honest. So rest assured that you won't be lured to buy Saving My Knees through a bunch of phony reviews my family or friends or publicist wrote. I don't do that sort of thing.

Also, I was rather puzzled that this unhappy reader would remark, regarding the condition of my knees, "in the end of the story he seems to be worse." Hmmm. Did anyone else reach that conclusion? I tried to drop some clues that I got better. The subtitle, after all, is "How I … Beat Chronic Knee Pain." There is a chapter called "Recovering." And, on the last page:
As I write these closing words, in what should be my last revision to this book, it’s now more than two years after my experiment to save my knees began. I’m cycling every week again, as intensely as ever, and my knees feel good. No, I’ll risk jinxing myself by telling the truth: they feel great.
In case any ambiguity remains, let me put it to rest on this blog: I healed my bad knees. If you could experience what my knee joints are like today, and compare that with four years ago, you would not even think of questioning that assertion.

But, to be charitable, perhaps this person got confused because healing from chronic knee pain isn't a linear process. I had ups and downs. And that's a big part of my message: people with bad knees often don't improve because they can't navigate the many ups and downs and inevitable setbacks. In telling my story, I felt it was imperative that this idea come through.

Now, for people on the fence about buying Saving My Knees, let me be clear about those who probably won't like it:

1. If you believe experts in a given field -- doctors, physical therapists, for example -- must be always right, if you believe it's morally wrong or inappropriate to question authority, Saving My Knees may be too much cognitive dissonance for you.

When my experience with constant knee pain began, I was a model patient. Later I questioned the advice/treatment I got when my condition failed to improve. By daring to question the wisdom of the experts, I made many interesting findings that helped me to recover.

2. If you want a book that contains a specific, exercise-by-exercise breakdown of how to save your knees, Saving My Knees may not be for you. It's a story -- my story -- about what I learned on my way to healing. And I did learn a LOT (which I share).

I explain what worked for me (and what didn't), give some insight into why, and offer general tips on good knee health. Still, if you want an exercise guide, try Doug Kelsey's The Runner's Knee Bible. Doug is a very smart guy with many good insights who deviates from conventional (and failed) thinking about how to heal knee pain. His writings were an inspiration to me.

3. If you want an "other-directed" solution to your knee pain, this may not be the book for you. An "other-directed" solution is, for example, a pill or surgery that makes all the pain go away while you just sit back and basically do nothing but marvel at how well it works. Sorry, can't help you there. I discovered a lot, but not the magical bowa bowa root from the Amazonian jungle that restores knees to instant health with no effort. :)

4. If you think your knees can be healed overnight (or in a few weeks), and you want a book that shows you how, keep shopping. Don't waste $9.99 on Saving My Knees. Because I found out that healing the injured soft tissues in the knee joint is possible, but it does take a fair bit of time. My recovery took the better part of two years. The good news is, who cares as long as you're getting better?

Last, if you're unsure whether the book is for you, Amazon does allow a sample to be downloaded. Read it. Judge for yourself.

At the very least, I promise you it's not as boring as the other knee books out there. :)

In the meantime, keep movin'!

Friday, June 17, 2011

Check It Out: My Huffington Post Essay Is Live!

Just a quick note to let everyone know that the good folks at Huffington Post have put an article I wrote about healing knee cartilage on their site.

Here it is:

Knee Cartilage Repair: How One Patient Proved His Doctors Wrong

Saturday, June 11, 2011

A Story About Adaptation

This is a story about a big theme in Saving My Knees.

For almost two decades I've worn arch supports, generally in my walking and running (though not my dress) shoes.

After a while, arch support inserts develop creases, then cracks, then finally need replacing. That's where I found myself earlier this year.

My new podiatrist suggested a pair of expensive, high-quality, carbon-fiber supports. My insurance covered the cost, so I said okay.

When they arrived, one fit fine. The other didn't.

Various adjustments were made to the badly fitting orthotic, to no avail. I got frustrated. After much traipsing back and forth to the podiatrist's office, I wound up with an arch support that I still wasn't very happy with.

Then I read this article in the New York Times questioning the value of such orthotics anyway. Prescribing these devices sounded more like art than science. A light clicked on in my head. Did I really need arch supports anyway?

I first got them when I was running a lot. I no longer run. My new podiatrist said the arches of my feet looked normal.

Feeling confident, I quit the arch supports, cold turkey.

The first day was fine. The next few were fine, too. Then, after about a week, I noticed a constant, uncomfortable burning in my arches. I suffered with that discomfort for days.

Well, I guess I just have to live with arch supports, I thought with a sigh. Then I had a Homer Simpson "d'oh" moment: of course this experiment didn't prove that at all. I had gone about things all wrong.

What I did with my feet was tantamount to what I did with my knees, when I realized that the key to healing lay in motion. Great, I thought back then, I'll walk for hours! And my knees burned worse than ever. Because I was doing too much too soon.

Our bodies are fantastic at adapting, I strongly believe, but adapting is a process. The word suggests something measured and gradual, not an abrupt change. Adapting requires time and patience.

So I decided to try a smarter approach. Instead of asking those muscles in the arch of my feet that had grown weak from disuse to suddenly handle three or four times their usual load, I broke them in gradually to these new demands.

At first I wore the arch supports one day, then nothing the next. Then, several weeks later, I changed the cycle to one day with, then two without. Then one with, three without. Finally I was wearing them only once a week, on Sundays.

Then, after a few months, I quit them completely. So far it's worked. My arches get sore sometimes, but under the same conditions they always got sore, even when I had arch supports -- that is, when I combine a lot of standing around and walking (e.g., busy shopping days).

Our bodies have a powerful ability to adapt when we do the right things and have enough patience. That was a lot of the secret behind my healing my knees. My failed -- then successful -- experience with a pair of arch supports (that are now sitting in a closet somewhere) reinforced this critical lesson.

Saturday, June 4, 2011

And Now For a Personal Note

I started this blog almost exactly a year ago, with the intention of publicizing my book Saving My Knees, but more importantly, spreading the book's message.

I started this blog because I think the current thinking about how to treat chronic knee pain (that is diagnosed as chondromalacia or patellofemoral pain syndrome) is wrong in some very important ways.

I started this blog thinking that I would continue it for a while, then stop writing at what felt like a natural stopping point. When Abe Lincoln was asked "How tall should a man be?", he replied (so the story goes), "Just tall enough that his feet touch the ground." So when I pondered, "How long should my blog go on?", the apt and Lincolnesque answer seemed to be, "Just as long as I have something to say, and no longer."

Well, I've still got plenty to say but a little less time to say it in.

Readers of the book will remember my wife Congyu was pregnant during my ordeal with chronic knee pain. On Sept. 5, 2009, she gave birth to a lovely (and healthy) baby girl we named Joelle Simone Bedard.

On May 25 -- just a week and a half ago -- both Congyu and Joelle completed a VERY LONG immigration process and arrived from China at JFK Airport in New York City, rather dazed and bewildered, and I welcomed them into my modest Forest Hills apartment (which now has an entire drawer in the kitchen devoted to odd pieces of nursing bottles -- I never imagined that bottles could be such intricate constructions!)

I had been watching Joelle grow up from afar, posting on Flickr the photos her Mom e-mailed me. Now I get to touch her and wrap my arms around her whenever I want.

I'm getting acquainted with a 21-month-old girl who is an incredibly beautiful, curious little child (and who seemingly has no "off" switch, short of her daily nap).

What that means for this blog: I'm going to try to post shorter (though I'm not close to running out of things to say, so I want to keep writing). I may try more linking and summarizing. I don't quite know yet. I just know the demands on my time have increased greatly, though in the best way possible, so I'm going to have to get a little better at juggling all I want to do.