Comment Corner: Sleeping Position, Signals From Bad Knees

I received the comment below recently. By the way, if you're trying to get my attention about your knee issues, here are a few helpful ground rules :):

1. The best way is to leave a comment after one of my blog posts (I check the comments each week and sometimes cull future posts from them.)
2. If you leave a comment, another helpful reader may be able to provide you with some good insight that I either don't happen to have or that I simply overlook. The hive mind is always superior to that of the individual! :)
3. I'm not a doctor or physical therapist (though I did learn a LOT healing my own knees, an experience I recount in Saving My Knees). Whatever thoughts I have are simply "things to think about and discuss with a qualified medical professional."

Here's the comment; I've whittled it down to the questions mainly:

I'd like to thank you for your blog. :) It has given me hope since I injured my knee about a year ago and after that I developed chondromalacia or something like that, well I have pain in my knee and a tiny crepitus, some cracks also. I guess it happened during and after the time I limped. :( I'd like to get my active life back. I have read everything I have found about chondromalacia but the things you and Doug [Kelsey] say make the most sense.

If you have time, I'd like to ask some questions.

1. During the time you had knee problems, when you slept, how did you position your leg? I'm trying to sleep with my knee straight. There's still some motion and I'm wondering if that's bad for the knee.

2. What do you mean with negative signs that one's knee gives? I've been trying to cope with my knee so that it doesn't actually hurt (I avoid things that make it hurt like crossing it) but it does have some strange sensations every now and then like something tickling it from the inside. Do you think that it's better to try to avoid all the sensations that differ from what my healthy knee feels like or only the pain? My pain isn't that bad but it's annoying, a dull ache.

3. What do you think of prolotherapy? I think Doug uses it...

Okay, answering your questions, one at a time:

1. How to position a bad knee while sleeping?

I didn't obsess too much over how I slept (except for not sleeping face down -- neither my knees nor back liked that position too much). But that's because my knees were basically happy in most sleeping positions. After all, they liked to be fairly straight and elevated -- or at least not lower than the rest of my body -- and that describes how most of us sleep.

(By the way, if you do want elevation when you sleep, you might try resting a pillow under your bad knee.)

But otherwise: I think you're naturally going to move when you sleep, short of donning a straitjacket before turning in. You dream, you move. You'll end up tossing and turning without even realizing it. So attaining the perfect sleep position may not do much good if your body (once asleep) decides to thrash about.

What strikes me as more important: Making sure you get enough sleep in the first place. When I had bad knees, I took special care to ensure I got a full eight hours every night. Your body needs "down" time to repair injuries. That's my best insight on the subject of sleep.

2. What exactly are the negative signs from a bad knee to be watchful for?

That's a great question with no easy answer. Just think of all the sensations from a bad knee: sharp, dull, aching, stabbing, pulsing, intermittent, etc. And think of all the places you can experience those: deep in the joint, near the front of the knee, near the back, on the medial side, on the lateral side, a little above the knee, a little below.

Obviously a doctor examining you can map certain pain/discomfort signals to specific injuries. But I found that, with bad knees, there are a lot of weird sensations that come and go of unclear origin. Some hurt. Others just annoy you. All the while, you're wondering, "What does this mean, and how should I modify my behavior?"

A couple of thoughts:

A. You need to learn to listen to your knees (see the "Four Golden Rules" chapter in my book) and become a first-rate translator of the language that your bad knee speaks. Try to figure out which sensations signal that you're heading for trouble if you keep doing "x", and which are more or less normal grumblings from an unhappy joint. I think this is where knee patients have to be much more involved in their own recovery.

B. Your bad knee will grumble. That's inevitable. You can't cease all leg movement until you're sensation-free, or your joints will rot away. So, again, you have to get busy decoding the signals from your joints -- for example, which activities bring on the tickling and what happens when you ignore it -- does it get better or go away, and under what conditions? How painful is it? Etc., etc.

Learning how to listen to your knees can be aided with the use of a knee journal (I jotted down daily observations and even assigned scores to how my joints felt, twice a day). Working with a smart physical therapist (like Doug Kelsey) would be optimal.

3. What do you think of prolotherapy?

Honestly, I don't know enough about it to have a strong opinion. But anything that Doug Kelsey likes is definitely worth a look. So, instead of blathering along in ignorance, I'll refer you to Doug discussing the subject here.

Next Week: Why I'm no longer being allowed to post on KneeGuru. What happened left me a bit stunned. I'll give you the full details; you can be the judge.