Saturday, November 26, 2011

On Cynicism, Skepticism and Pessimism

Oscar Wilde once said that a cynic knows the price of everything and the value of nothing.

What I’m going to say later about cynicism -- and its two cousins, skepticism and pessimism -- probably won’t surprise anyone. What I’m going to say next, however, may.

I am a skeptic -- and proud to be one. Don’t tell me something works and assume I’ll believe you; show me it works and tell me why. I am also, not so proudly, somewhat of a cynic. And my inner nature tends toward pessimism.

So, in other words, I’m probably the least most likely person to write an uplifting story of triumphing over adversity. I’m not a “rah, rah, go team go!” kind of guy. Of everyone in my work pod, I’d be the last choice to lead a pep rally.

In fact, writing this blog isn’t a natural fit for me. Initially, I struggled with the “voice,” if you will. That struggle arises partly from my desire to say something meaningful without sounding too confident/too authoritative (I’m not a doctor or physical therapist, after all, plus I am willing to accept the uncertainty of much of the knowledge we humans possess). But I also just find it challenging to find the proper tone -- my natural voice tends to be darker and more irreverent.

So why do I do it? And why did I write Saving My Knees in the first place?

Well, there’s something that motivates me powerfully, almost absurdly so, that enables me to overcome my natural shyness about talking about myself and my tendency toward negativity. And that’s a conviction that we must celebrate truth over lies, knowledge over ignorance, light over darkness.

When I succeeded in healing a pair of bad knees after traditional physical therapy failed, and doctors said I’d never get better, I had a few emotions.

Gratitude. Relief. Anger.

I was angry because I was confident that many chronic knee pain patients could benefit from using the same framework I used to get better, and benefit from the many things I learned (which weren’t in any “heal your knees” book on the market and which weren’t being said by most doctors and physical therapists in the field). So I said to myself: “I’m going to write this book. I’m also going to start a blog to open a dialogue of sharing.”

My passion for getting the truth out there is what motivates me, as well as my fervent wish that my message reach someone else who can be helped.

Which brings us full circle, I suppose, to skeptics, cynics, and pessimists.

If you want to heal your knees, go ahead and be a skeptic, though of the open-minded variety. While you should be willing to try things, and experiment, it's also okay to ask up front: Does this approach/treatment make sense? Why should it work? You have an optimal window to rescue your knees; there’s nothing wrong with trying to seek out the “best of class” of solutions for your problems, and experimenting smartly.

If you want to heal your knees, I’d say be careful of cynicism and pessimism though. If you distrust the motives of everyone, if you believe nothing will work because nothing has so far, don’t be surprised when, after half-heartedly “trying” a few things, you don’t get better.

The journey to recovery is a long one (it was many months for me). You will be tested more than once. You will need to be determined -- and you will need to draw upon optimism, to overcome the funks of negativity and doubt, and to enable you to push on with your plan to heal.

Sunday, November 20, 2011

How I Saved My Back

While fishing through the comment section recently, I found this:
I recall you mentioning either in your book [or] on the blog injuring your back in the aftermath of trying to manage the injury. Have you been able to remediate that yet and if so how?
And I thought: what great timing. Because it recently occurred to me that this would make a good topic for the blog. True, it’s not knee-related, at least not directly, but I’m sure there’s lots of overlap between the knee/back pain groups.

I messed up my back, as I explain in Saving My Knees, after sitting for months with my legs raised and extended -- a position I had to assume because of knee pain. On my worst days in the Hong Kong newsroom, I’d have to get up and walk around for a while because my back felt so tight and painful. At the health club, I’d stand in the shower for 10 minutes with the water as hot as I could stand, letting the flow from the showerhead massage my backside. I wasn’t in good shape.

Today I feel fine, with no lingering issues.

What happened between then and now?

Well, first of all, I was fortunate in that the back problems weren’t too far advanced when I quit my job and dedicated myself to saving my knees. So that was good. But I knew I had to act. I didn’t want to be that guy in his 50s who’s laid up on the couch half the day after an energetic snow-shovelling session. I began reading my favorite physical therapist, Doug Kelsey, curious about what he had to say about fixing a bad back. (And I would advise all you back pain suffers to check out his writings, such as this one.)

Doug advocates strong muscles in the core, or mid-section of the body, to support the spinal column. He recommends “lock and load,” or walking around with your stomach muscles always in a state of partial tension, to engage the muscles that stabilize the spine. Personally, I couldn’t imagine having to spend the rest of my life remembering to keep my abdominals clenched. Too much work.

My compromise to take care of those muscles: a form of sit-up. Kelsey hates sit-ups, for good reason: there are plenty of ways to do a sit-up that will injure your back further. Mine are less sit-ups than isometric exercises. I lie on my back, legs folded over the couch, then sit partway up and hold that pose for three minutes -- no twisting, no violent motions. It works for me (though may not for someone with a weaker back, I suppose).

What else I do:

1. What I believe helped me the most is doing planks or bird dogs, every day (well, I take off weekends). The plank:
The bird dog:

I do a bird dog each day for 3 1/2 minutes, alternating legs, but otherwise just freezing in the pose. These are yoga positions. They will do a world of good for your back muscles, but be patient. Same as with bad knees, bad backs heal over months, not weeks.

2. Movement. Doug Kelsey once said on his blog something to the effect that (according to an old teacher) sitting does the same thing for your spine as putting a plastic bag over your head does for your breathing. Get moving! Your knees and spine will thank you. I try to get in as much walking as possible; I even take a more-distant subway train to ensure I walk a mile to work (and back) each day.

3. Weightlifting. This isn’t a must, and not a good idea early on, but I wanted a strong back that wouldn’t complain whenever I had to carry my 28-lb. 2-year-old daughter. Of course be careful. I didn’t start my back rehab with weightlifting (and honestly, I don’t do that much now anyway). I waited until my back basically felt okay, and I always, always warm up, by doing 50 repetitions of an easy weight. Plus, I don't lift too much.

3. Sweat. “Huh?” you may be thinking. What’s sweat got to do with this? But I really believe -- and I’ve probably not written enough about this -- that sweat-producing activity (when your body can tolerate it! -- e.g., don’t run four miles on bad knees just so you can break a sweat) is like getting in the fast lane for healing. This is based on Doug Kelsey’s writings and my personal experience in Hong Kong -- when I was able to walk hard enough to regularly break a sweat, I seemed to get better faster.

How long did it take my back to improve? It’s hard to say exactly (unlike with my knees, I wasn’t keeping a “Back Journal”), but I’d say a year or two. Part of what makes estimating so difficult: what’s the meaning of “improve”? After 7 or 8 months, I was certainly improved, but still had issues to work through.

Today, a full 3 1/2 years later, my back feels fine -- in fact, it’s probably stronger than before. I can ride 3 1/2 hours on a bike, bent over, with no problem. I helped a mover transport a big, heavy sleeper sofa into our apartment over the summer -- which involved moving it from the apartment of its previous owners, into an elevator, out of an elevator, into his van, etc. And when I took Cong and Joelle to Maine in September for Jo’s 2-year birthday party, at several times during the journey by train, I was loaded up, carrying luggage, like a Tibetan pack mule.

But no problem.

My spine's happy again.

Friday, November 11, 2011

What Angers Me About a News Article I Largely Agree With

The Salt Lake Tribune ran an article recently about how important it is not to sit around moldering on the couch when you have arthritis.

"Remaining sedentary actually increases the risk of injury and pain," the author writes. Through movement, a woman by the name of Margaret Crowell was apparently able to reverse symptoms of osteoarthritis in her thumbs and hands. She now leads a class in modified yoga and tai chi moves.

"Great, wonderful," I'm thinking -- this is the right message. Heal through motion! It's one of the key themes in Saving My Knees.

And then I got angry.

Because this isn't the first article I've read espousing gentle motion for arthritis pain sufferers. So the arthritis experts are figuring this out, that lots of easy movement is a good thing, but ...

Once you have arthritis, your joint (knee, finger, whatever) has undergone significant changes, some of which aren't reversible (such as bone spurs). You're already fairly damaged.

However, no one wakes up one morning with osteoarthritis (I'll limit myself to this common wear-and-tear form of the disease), completely taken by surprise ("What! Last night when I went to bed I felt fine!"). For example, if you have osteoarthritis of the knee, you've already spent a fair bit of time -- years, most likely -- coping with and complaining about your joint pain. And, getting back to the original point, this is what made me mad.

There is a wonderful window for intervention early on with knee pain! You can heal, even if your cartilage crackles every time you bend down to pick up your slippers. I know you can because I did (and because medical studies show the tissue can heal, and because a very smart physical therapist by the name of Doug Kelsey has shown at his Austin practice that patients with knee pain can get better).

But what typically happens early on, with the first onset of knee pain? You flail around for a while on your own. Maybe you see a doctor, who just shrugs if your knee moves normally and advises you (if you're a sporting type) to take it easy for a while. Or you see a physical therapist who recommends stretching and quad strengthening (the first of which doesn't help fix the underlying problem, and the second may make it worse).

Gradually, you resign yourself to your bleak fate (and your cartilage breaks down some more, and osteophytes form and get larger, and your range of movement becomes restricted, and ...)

Crazy! Because what those arthritis patients are doing at age 65 when their joints are trashed is what they should've been doing at age 45 when their joints were starting to give them problems! Lots and lots of gentle movement is a great prescription, but it's coming too late.

That's what infuriates me -- that knee pain isn't being treated seriously, systematically and properly early in the disease cycle of arthritis.

Seriously means doctors should stop shrugging helplessly and saying there's nothing they can do yet for hurting knees and should start focusing on early intervention to stave off arthritis.

Systematically means the design of a user-specific movement program aimed at gradually strengthening the bad knee.

Properly means the right kind of motion -- not high-load, low-repetition (quad strengthening) but low-load, high-repetition (knee strengthening).

Friday, November 4, 2011

My Most Popular Blog Posts

I thought I'd try something a little different this week. Namely, I'm going to whisk back the curtain and let everyone have a glimpse of information that's normally available only to me, as the author and manager of this blog.

At first I thought listing the most popular posts would just be an amusing bit of trivia, but then I realized the list serves a larger function. Basically, it's a "vote" by readers on what they found most useful on this site. So if you've landed here for the first time, here are five past pieces of writing you may want to check out.

1. Comment Corner: Can Even Badly Damaged Knee Cartilage Heal? (469 views)

This blog post was prompted by some smart reader questions left in a comment section. The surprising answer to the headline question: in at least two studies, areas of cartilage with the worst damage had the highest rates of improvement.

2. "What Should I Do If I Have 'Weak' Knees?" (343 views)

This comment from a reader puzzled me initially, and honestly, still puzzles me somewhat. The anonymous writer didn't have pain so much as "weak knees" -- but they didn't feel like they were going to give out. So, if there's no pain and no instability, I wasn't sure what to think -- except that it would be wise to strengthen those knees, because otherwise there probably will be pain at some not-so-distant point in the future.

3. What Does "Knee Strengthening" Mean Exactly? (196 views)

While it's fairly obvious what strengthening quadriceps muscles refers to, what about strengthening knees? What does it mean for a knee to become stronger? This was an important topic to cover on the blog, I thought, because focusing on strengthening my knees was how I escaped my chronic pain.

4. If Strengthening Quads Was Really the Answer to Beating Knee Pain, I Wouldn't Exist (148 views)

I'm pleased that this post made the top five, because it's probably my most convincing effort to show that "strengthen your quads" shouldn't be the prime focus of a patient with chronic knee pain. I discussed how I healed my knees as my quads got weaker (in fact, when I threw all my energy into strengthening my quads, I almost trashed my knees -- a not uncommon experience with traditional physical therapy, sadly).

5. How Can You Read "Saving My Knees," an Electronic-Only Book, If You're Kindle-less? (129 views)

No great insights, just practical advice on how to read a book that's available only in electronic form. (Note: I'd love to find a way to allow people to make paperback copies from their Kindle versions. Unfortunately, all the print-on-demand outfits I've reviewed so far require various set-up fees from me, north of $100, as well as a separately formatted .pdf. But if anyone knows of a service that can print books off a Kindle copy, with no one-time startup/set-up fees, let me know!)