Saturday, September 3, 2011

Comment Corner: "How Do I Devise a Plan to Heal?"

Healing from chronic knee pain isn't like healing from an ankle sprain, where you can just take it easy and wait for your body to mend itself. You need persistence -- and a plan.

Recently I got a comment from a reader -- actually a series of questions -- about how I healed (this person is trying to develop a plan for getting better). The questions impressed me, partly because the reader (henceforth "Anonymous") had obviously gone through Saving My Knees very carefully. I thought my answers would be of interest to others familiar with the book, so here they are:

1. It’s not clear how much walking you did throughout your recovery. You say you did approximately 70 steps every 15 minutes at first. But did you do only that? Or did you do 2x or 3x daily 1000 steps walks per day in addition to the 70 steps every 15 minutes?

And if at first you only did 70 steps every 15 minutes, when did you determine that you could add 1000 steps walks, and how many times a day?

As readers of my book know, I healed through a program that emphasized an appropriate amount of high-repetition, low-load movement. I did a lot of walking, as my knees tolerated that low-load activity best (gentle cycling is another option for people).

When I committed myself to a round-the-clock effort to save my knees, I was lucky in that the joints hadn't degraded to the point where all movement was painful. I was able to walk a few thousand steps at a time without ill after-effects. (By the way, I always took a 10-minute break at the halfway mark.)

So early on, I was walking about two to three thousand steps (a mile to a mile and a half, roughly), twice a day (for a total of 4,000 to 6,000 steps) in the form of "long walks." Then, while in my apartment during the rest of the day, I did periodic walkarounds every 15 minutes. (More details can be found in the appendix to Saving My Knees, where I have included entries from my knee journal.)

But Anonymous, don't get too hung up on exactly what I did. Everyone needs a different plan.

2. Earlier in your recovery, during the “pool phase” at Bloomberg, you had tried straight leg raises and found it affected your control knee. But, later in your year at home, you did other exercises (unloaded leg squats, crab walks). When did you incorporate them in your program? How did you determine it was ok?

Actually, the leg raises affected my non-control knee (the control is the unchanged variable), but I know what you mean. Yes, I did "crab walks" (also known as "the monster walk") and unloaded leg squats.

How did I know they were safe? I didn't! I tried many things, slowly, then monitored for symptoms. That's how I figured out which exercises I tolerated best. The advantage of working with a smart physical therapist is that that person can eliminate some of the trial-and-error process that's typical when you're experimenting on your own.

3. What was your diet? Had you calculated your daily caloric intake? How did you do that?

Diet questions! I can tell Anonymous is serious! My diet was rather dull actually. I ate a lot of brown rice and garlic, because it was cheap to prepare and garlic is a natural anti-inflammatory. I didn't count calories, but did watch my weight carefully.

Honestly though, I think diet had little to do with my success in healing (weight control, however, was very important). And if it did, I have good news for all of you: With little effort, you can adopt a diet that's a significant improvement over what mine was.

4. You talked about moving to Austin. Why didn’t you do it?

Ah, the flirtation with Austin! Yes, I was quite taken with the writings of Doug Kelsey, at the Sports Center clinic there, who believes damaged cartilage can be strengthened (my experience would take that claim a step further -- I believe it can heal, because mine did). I was seriously considering buying a plane ticket from Hong Kong to Austin, Texas, to have my knee strength assessed and to get help developing a long-term plan to get better.

So why didn't I? I did call Sports Center and sent an e-mail, inquiring whether they would work with me if I could come to Texas for a few weeks. I received no reply. I was going to send a second e-mail, then I reasoned that they probably didn't want a fly-in, fly-out patient when rehab takes a good nine months or so (or the better part of two years, in my case). If that was their policy, I believe it has changed now, as a reader of this blog mentioned recently that she did a phone consultation with a therapist from Sports Center. If so, that's great news, as that's the first place I'd turn to for help treating a hard-to-resolve case of chronic knee pain.

5. How did you manage for everyday tasks while taking into account standing up and steps to be taken? By everyday tasks, I mean getting dressed, taking a shower, making lunch, cleaning up around the house, running errands. Things like cooking involve time standing up. How did you take that into account in your program?

I never really tried to account for every single step I took over the course of a day or every minute I spent standing. (It's hard to do -- do you go to sleep wearing a belt with a pedometer attached to catch that first step out of bed in the morning?) Mainly I tracked the long walking I did, my reasoning being that it stressed my knees the most. If I had done a lot of incidental walking around my apartment, I probably would have tried to measure it -- but I didn't -- so I didn't. Even my counting/scoring/scientific-minded brain has limits. :)

I did try to avoid standing in one spot any longer than necessary (a certain amount of standing is inevitable, as with cooking), because that caused my knees to burn, and reducing burning sensations is always a good thing.

6. How did your wife fit into your recovery program? How did she help you? What tasks did you split, that you determined she had to do because you couldn’t?

The short answer: My wife didn't really fit into my recovery program. She tended to believe my doctors were right -- that I'd never get better -- because, well, they were doctors. But that was fine. After doing extensive reading and research, I was pretty sure I could find a way to heal, given enough time. Because my wife didn't know what I knew, I don't fault her for being skeptical. Now she's a believer, I hope. :)

7. When did you stop sitting with your legs propped up? How did you determine it was ok?

Like so many things about my recovery, it was a gradual process. I didn't just suddenly stop sitting with my legs straight out. That position did serve a purpose. Broadly, my thinking went like this: The burning in my knees was probably the result of a chronic inflammatory process because the cartilage was damaged. This kind of inflammation is bad and works toward further deterioration of the joint. So I would reduce the inflammation (and get relief) by sitting with my legs extended.

After I quit my job and dedicated myself to a recovery program, I slowly got my knees accustomed again to sitting normally in a chair. I worked my way up to sitting comfortably for about 2 or 3 hours at a time, then that period of time lengthened as I got better.

So there you have my answers to some very good questions. I'm not sure how helpful some of my responses were. I wish I could say, "Do this for 12 days, or until you feel sensation X, then do this other thing for 27 days, and then you'll be fine" -- or something like that. But there is no precise, universal solution for chronic knee pain. Everybody's at a different place with their own pain. Which is why I believe so strongly in learning how to listen -- really listen -- to your knees.

1 comment:

  1. Thanks, and great hearing from someone in Brazil. This is exactly why I love the Amazon Kindle distribution system -- it knows no borders. And you don't even need a Kindle to read the book. Wonderful.

    As for your questions: I wish there were a way to create a printed version. As soon as I find one, I will post about it. I wish Amazon had a service whereby someone who's bought a copy of an electronic book could order up a paperback or hardcover version -- a kind of print-on-demand service. I have found POD vendors, but they want a .pdf version of the book first (which would take some time to create) and they want to charge me set-up fees, up front -- ugh.

    Great idea about a list tracking links to academic articles showing that cartilage can heal and the like. All my important sources I put in my longish bibliography. If anyone knows of other medical studies, I would love to hear of them.

    No MRI made after my recovery (they're quite expensive), though I've often been curious what it would show. The trouble is, I don't think it could be profitably compared with my earlier MRI, because my knees got worse after that MRI was taken. What I have, in place of an MRI, is the "sound test" -- and my knees make much less noise when going into a deep bend than before. Plus, when I used to straighten up from a deep crouch, they would make a horrible ripping sound, as it something was tearing in the joint. I just did that same move 10 seconds ago -- hardly any noise now.