Sunday, May 27, 2012

Of Chinese Finger Traps and Beating Knee Pain

Ever see one of these before?

It’s called a Chinese finger trap and made of braided bamboo. The harder you try to yank your finger free, the more stuck it gets.

To achieve your goal -- escaping the trap -- you have to behave in a counter-intuitive way. Don’t struggle and pull. Relax and push gently into the trap.

Knee pain sufferers would do well to heed the lessons of the Chinese finger trap. That’s especially true for those of us who have Type A personalities and tend to be competitive overachievers.

Take my own experience in Hong Kong. I fell into my own Chinese finger trap of sorts, after my employer agreed to allow me to work half time for three months, so I could try to heal my knees.

I had done the research and knew my joints needed motion to get better. And so, I vowed to use that free time to move, move, move. The first week I spent a lot of time walking slowly.

And my knees got worse.

I finally realized I was trying to beat knee pain the same way I’d train for a 5k road race. But my program was too intense for a pair of weak knees. I needed to back off, relax, and not try to grab six months of gains in a few weeks.

If you want to borrow lessons from the Chinese finger trap, I’d say you need to:

Know when to ease off. Don’t be ashamed to take a light day of exercise, or even a light week, if you need to. If your daily walks normally total 5,000 steps, maybe you cut back to 3,000 steps for a while, if your knees suddenly start complaining.

Get enough rest. Sleep helps injured tissues mend. Sleep makes you a healthier, nicer person with a better, more upbeat outlook. (P.S. Lack of sleep has now been found in a recent study to help cause diabetes and obesity, through impairing your glucose control mechanism.)

Meditate if you’re stressed. When you’re stressed, your muscles tighten. If you have pain while sitting, tighter muscles just worsen it. Also knee pain can make you very angry. Try to find a way to lose that rage and negativity. I tried meditating for a while. It helps!

Be as happy as you can. Make yourself smile. The very act of smiling, even forced smiling, improves a bad mood. Find what’s good in your life and celebrate it!

Saturday, May 19, 2012

My Plans for This Blog

Recently I logged onto this blog, behind the scenes, and discovered -- gasp! -- I've just done my 100th post.

That milestone put me in a reflective mood. I thought again about how long I plan to keep this blog going and reasonably fresh with so many demands on my time (one of them turns three in September :)).

The good news (assuming you find this blog worthwhile and interesting) is that I don't plan to just turn out the lights. I'll probably just reduce my posting to, say, once a month, and the posts will be shorter.

I do want to pop in, from time to time, partly because I really believe the current medical thinking about how to treat chronic knee pain is going to evolve. I think, further, it will evolve toward the message in Saving My Knees. And I want to be able to chronicle that, as it occurs over the years. So, with luck, I'll be blogging on some kind of infrequent basis in another 20 years. :)

My immediate plans are to work through a backlog of ideas for posts that have piled up. I'll do that once a week, as I have been. When I'm done, I'll probably do a shout out, similar to the bartender's, "Last call for drinks!" -- inviting anyone who has questions about anything to ask (and hopefully I, or other readers, will have some useful insight).

So I'll work through these questions. Then, once I feel I'm talked out (nothing's worse than that chatty guest who overstays his welcome), and I'm in danger of prattling on about previously prattled about stuff, I'll put the dimmer switch on low and walk away.

Sort of.

I'll still be in the background, monitoring comments. I'll still be looking for good news articles to share with you. I'll just be less active, that's all. And I can gain traction on 39 other little projects kicking around in my head. :)

Saturday, May 12, 2012

More Reasons to Lose Weight If You Have Knee Pain

I once described losing weight as the closest thing I knew of to a "Get Out of Jail Free" card for knee pain sufferers.

I really, really believe that.

I recently blogged on the subject. Today I'm back to take another bite at the apple (a fruit, by the way, you might consider eating more of to help you shed a few pounds).


Because it's such an important message. Because I think a good 90 percent of knee pain sufferers can benefit from it.

Whoa, that's high, you may be thinking. But even if you're not obese, or even technically overweight, I bet that losing at least two or three pounds will help your knees. It helped mine, and I was thin at the time.

To show you why losing weight matters, I'm going to try to quietly slip back into the shadows and let others do the talking.

A 12-year study in the U.K. looked at knee pain in women 50 years and older.

The conclusion:
This study found that higher body mass index (BMI), previous knee injury, and radiographically confirmed osteoarthritis are predictors of persistent knee pain in women 50 years and older.
You can't control whether you had a previous knee injury. You can't control whether you have osteoarthritis as indicated by X-ray. You can control your weight.

Australian researchers conducted a one-year study of 111 obese patients who had weight-loss surgery or took part in a program of diet and exercise.

The findings:
Weight loss in obese patients correlated with improved knee cartilage thickness and quality, even in those who had previously existing osteoarthritis.
What was fascinating was that this study, using sophisticated measurements, showed that the actual quality of the knee cartilage improved:
Patients ... had delayed gadolinium-enhanced MRI assessments of the knee, which can reveal the distribution of the glycosaminoglycans found in articular proteoglycans. Glycosaminoglycans are present in high levels in normal cartilage but in lower levels in cartilage that is decaying ... [Researchers] found that weight loss as low as 7% of body weight was associated with preservation of cartilage quality, and that better quality of the cartilage also improved the knee range of motion.
And, finally, more support for the Saving My Knees proposition that cartilage damage doesn't have to be the beginning of the end:
"These findings suggest that early cartilage degradation may be reversible. This has great clinical relevance as it indicates an opportunity for intervention or change before irreversible change in cartilage morphometry occurs," Lyn March and colleagues [the study's authors] stated.
Danish researchers put 175 obese subjects suffering from knee osteoarthritis on a protein-shake-and-soup diet. During the first eight weeks, participants shed an average of 26 pounds.
Losing weight helped more than 60 percent of the participants reduce their knee pain and improved their ability to walk, the researchers found.
The November issue of the Nutrition Action Healthletter had a big article on fighting chronic inflammation.

Many knee pain sufferers have inflammation issues. However, it's still murky exactly how inflammation can be subdued. Well, largely murky.

One thing is clear, according to the article, which quoted Walter Willett, chairman of the Nutrition Department at the Harvard School of Public Health.
"The most powerful way to reduce your inflammatory factors is to lose excess weight."
So there you have it.

What are you waiting for?

Saturday, May 5, 2012

The Frustrating Puzzle of Cause and Effect

Recently I’ve been thinking about cause and effect.

As I wrote in Saving My Knees, one of my doctors once more or less shrugged and said about my knee pain, “You’ll have good days and bad days.” The more I thought about it, the less his comment satisfied me. It represented a philosophy of hopelessness. It sounded too much like knee pain strikes in a totally unpredictable way. My goal was to heal so I sought to isolate what helped -- and harmed -- my knees.

It’s not easy though figuring out cause-and-effect relationships with bad knees. A skeptic recently asked how I was sure I had cartilage damage, and how did I know it was causing my pain symptoms? Well, I’m pretty sure that it was somehow contributing to my pain, as I explain here, but am I 100 percent certain? No, of course not. But a treatment plan designed around this assumption worked, when a traditional approach failed.

What I found interesting about this skeptic was that he seemed little inclined to turn his skepticism inward. Could there be a flaw in his own Structuralist model that has its own understanding of cause and effect when it comes to knee pain?

A week or so ago, I came across an interesting knee pain story that seems relevant to this topic. Someone was talking about how she (I recall it was a she, though forgot to bookmark the page) beat knee pain by basically relearning how to walk. I don’t remember the specifics, but there was some biomechanical issue she blamed her pain on -- how her heel landed or toes pointed or some such -- and she slowly trained herself to walk properly, over the course of some months.

A victory for Structuralism! Structuralist diagnosis and treatment validated, right?

Maybe. Maybe not.

After all, what are you going to do, if you’re relearning how to walk properly? Practice a lot. And probably walk more slowly as you’re practicing.

So maybe you end up doing a lot of easy strolling -- which is kind of similar to the Saving My Knees program. But your conclusion is entirely different: you healed because you fixed your bad biomechanics!

Of course someone can argue, if cause and effect is so hard to pin down, how do I know I’m right, in my broad approach to beating knee pain? I don’t of course -- not in any absolute sense.

But I submit that my thinking is much simpler and more logical: you have knee pain because the tissues in the joint are being stressed beyond what they’re capable of. So you (slowly) strengthen them. And don’t worry that your butt muscle is too weak or your left hamstring is too strong. Chances are, that didn’t cause your knee pain.

And of course I think I’m right because my beliefs shaped my own program to heal. And, though it wasn’t fast, in the end it worked quite well.

Update: The perils of working too quickly! I never bothered to hunt down the story I cursorily summarize above. In the comments below, someone helpfully provided the link to the tale of the knee pain sufferer who relearned how to walk (turns out for starters it's a man, not a woman -- oops).

A couple of follow-up notes: It could certainly be that this person had a structural issue that he patiently corrected -- the fact that the onset of knee pain was at about age 12 suggests something other than the typical wear-and-tear story of knees breaking down over time. I'm not saying structural issues are never significant; my suspicion is simply that they're way over-diagnosed.

Also: he talks about how he used a foam roller to loosen his IT bands. As I discuss in Saving My Knees, your IT bands have a tensile strength of soft steel. So I'm a little dubious about the efficacy of that foam roller.