Saturday, November 30, 2013

A Call for Success Stories

My intention has always been to retire -- or actually, semi-retire -- this blog eventually. I don’t want to start unconsciously repeating myself. Note I use the word “unconsciously,” as there are some messages well worth repeating to knee pain sufferers (“lose weight!” being one).

Lately I’ve been thinking about this, as I’ve grown a bit tired of hearing my own voice here all the time. It sometimes feels like everyone by now knows by story, and my beliefs, and can predict what I’m going to say.

But what about your stories?

What has worked for you?

I’m hereby putting out a call for success stories from others. And, to lower the bar a little, it’s fine to “play” even if your knees aren’t completely healed. Please include (1) Some details about yourself (age, sex, overweight or not -- but no names required!) (2) Some details on the nature of your knee problem (3) Some details about how you healed -- or what you’ve had success with to treat your pain.

Either leave a comment below or e-mail me at rb409699 [at symbol here] (my correct e-mail address; sorry, the one in the book contains a typo). I’ll use some of the stories in future posts.

Saturday, November 23, 2013

Failed Treatments for Knee Pain, Electricity Edition

TENS (transcutaneous electrical nerve stimulation) is a process whereby a device produces a mild electric current to stimulate nerves to block pain signals.

Does it work for knees with osteoarthritis?

Apparently not.

That’s according to a U.K. study of 224 osteoarthritis patients who were 61 years old on average.

They were split into three groups, all of which received education and physical therapy. One group also got TENS treatments, another got sham TENS therapy (the device looked authentic but produced no electrical current), and the rest got nothing additional, beyond the education and exercise.

If the first group had improved the most, that would be evidence that TENS is effective. If the first and second groups improved more than the third, that would suggest that TENS doesn’t work, but there’s an associated placebo-type effect that does.

Instead we got option three: all three groups were found to have improved the same amount after six weeks, then 24 weeks.  (Their levels of pain, stiffness and joint function were assessed; presumably they all benefited from the education and exercise.)

So don’t expect to get pain relief by having someone zap you around your ailing knee.

Of course my new standard disclaimer applies here (in anticipation of the inevitable person who will protest, “But TENS helps me with MY knee pain”).

While this study shows no positive benefit, your mileage may vary. If TENS makes your knees feel better, and the treatment isn’t doing any harm, you might as well keep getting it.

Saturday, November 16, 2013

What Does the Post-Recovery Period From Knee Pain Look Like?

I’ve yakked a lot about my recovery from chronic knee pain.

But it’s been almost three years since Saving My Knees was published. What have my knees been like since then?

I’m prompted to write this because here’s how most people would address someone who “beat” knee pain:

“Glad to hear you’re doing better. Hope your knee pain doesn’t bother you too much anymore, and hope you keep improving!”

Actually ...

My knees feel fine. I cycle hard again. I ride as much as 70 miles in one day, on the weekends. I’m right there in the thick of the sprints, and plenty of times I win too. When I return from cycling, I don’t ice my knees. I don’t take a couple of aspirins for “the pain.”

There is no pain. Period.

My knees still crackle a little, but much less than before. If I drop into a deep squat and straighten up, there isn’t an awful ripping sound from my joints.

There’s no sound. Nothing.

Maybe you’re thinking, “Great, so the post-recovery period is totally smooth, no bumps, no problems.”

Nope. If that were so, I wouldn’t bother writing this post. The truth is, the post-recovery -- like the recovery itself -- is a process. I remember taking a bus from Boston to New York City for job interviews in the fall of 2009 -- a full year and a half after I quit my editing job in Hong Kong so that I could focus on healing my knees -- and my joints grumbled some on the four-hour bus ride. And they did as well after I rejoined Bloomberg and had to sit, once again, at a desk for 10 hours a day.

Around that time, there were also moments, now and then, when I felt instability in my knee joints. There were times when, descending an escalator to the subway platform at day's end, I could feel that my knees weren't 100 percent yet. Last year I had some occasional and mild burning in my knees while sitting at work (I had a little this year too, though less). I closely monitored the situation, and it never got worse. In fact, I’m pretty sure it was related to the intense cycling, because during the off-season, my knees went back to feeling 100 percent normal.

Anyway the point is simply that healing knees is a long, long process. I know no one likes to hear that, in an age of instant gratification. But I really believe it’s the right message, because it's true.

Saturday, November 9, 2013

Why It’s Good to Know If You’re Type A or Type B

Most of us are familiar with the two major personality types.

Type A: Intense. Ambitious. Goal-oriented. Competitive.

Type B: Laid back. Less rigid. More reflective.

I’m definitely more Type A than B (though I consider myself to be reflective and creative too, so there’s some bleed-over between the categories).

One thing I found interesting during my knee pain recovery was that knowing which “type” you are is actually useful.


Well, it suggests which kind of traps you have to be particularly careful about.

For instance, take a Type B personality. You are more likely to make one of these mistakes:

* Not faithfully sticking to the movement program, that involves slowly building intensity over many weeks, that is the best way to heal (or so I found).

* Not observing closely enough (through a knee journal or otherwise) the condition of your knees, day to day, with the aim of figuring out what they like and don’t like, and how fast to proceed with a program to heal.

The Type A personality must guard against different risks, I found out (as a mainly Type A’er).

* Always wanting to push harder, to scoop up gains faster, often with the goal of returning to a much-missed athletic lifestyle. A typical Type A comment would go like this: “My knees were definitely getting better, so on Saturday, I ran four miles, even though I haven’t run that far in eight months. Judging from the way my knees feel today, I think it was a mistake.”

Of course!

* Not being able to take a day off. Or maybe even several days off. Or admit that (for reasons that aren’t maybe even understood), your knees have suffered a setback and you need to hit the reset button. Sure, you’ve been walking two miles a day for the past month, but for now you have to reduce that to one mile for a while.

* Making knee pain recovery a joyless drudgery. I know I was occasionally guilty of this. Counting steps, taking notes -- it’s all good, but don’t forget to smell the flowers. Don’t become a prisoner of your “my plan to heal” spreadsheet.

Healing knees is a long, challenging process. There will be pitfalls along the way. Knowing which personality type you are -- A or B -- can help you avoid some of those pitfalls.

Saturday, November 2, 2013

What’s Your ‘Viewing Frame’ for Understanding Knee Pain?

I came across a cool story not long ago in a New Yorker article. The larger article was called “Giving Voice,” about how a surgeon pioneered methods to help singers regain the richness of their voices.

The story concerns the surgeon, Dr. Steven Zeitels, and a surgical laryngoscope -- a device that holds the throat open during operations -- that he designed.

The typical scope had an oval viewing area, even though the vocal cords (when viewed down the throat) form a triangle. His laryngoscope had a triangular opening. That meant he could see areas that were obscured before.

Using the old equipment, surgeons had concluded that cancers in the front of the vocal cords were especially deadly.

“The reason was, they didn’t see them in the first place,” Zeitel says. “They attributed a biologic process to the fact they never saw them!”

A beautiful story, for what it says about how we can unknowingly misinterpret the world because of the limitations of our viewing frame.

It’s true literally -- as with a piece of medical equipment -- and figuratively -- as with a set of beliefs that leads to restricted vision.

What does this have to do with knee pain?

In brief: everything.

One thing I discovered during my own odyssey with bad knees:

What your doctor or physical therapist believes about chronic knee pain -- what causes it, what are the chances of a bad joint healing -- matters a whole heck of a lot, because such beliefs directly influence what that person will advise you to do about the pain.

But, what I came to realize, is that they often see the problem through a certain view-restricted frame, sort of like that oval laryngoscope. That’s the frame of imbalance/crookedness. E.g., your knee pain is being caused by hip muscles that are too weak, or a hamstrings-quadriceps strength ratio that’s out of whack.

If you’re a doctor or rehabber, and you view knee pain this way, chances are very good for example you’ll believe that the origins of knee pain are a mistracking patella. But the important thing for patients to know (when your doctor or physical therapist presents this analysis as fact), is that this is just a theory.

Mistracking kneecaps may cause most patellofemoral pain. Or not.

Here’s a study (that I’ve cited a few times before) that provides evidence contradicting that theory. Researchers carefully observed a group of subjects and found no correlation between the degree of kneecap mistracking and knee pain. (Sure, it’s a small study. But the results are intriguing, certainly.)

The trouble is, if you believe that crookedness/imbalances are basically the source of knee pain (and that constricts your viewing frame), you’re going to waste a lot of time with subjects like me, who don’t have mistracking kneecaps, or other structural issues.

Of course, you might just conclude “patellofemoral pain syndrome cases that don’t have a clear cause related to muscle or structural imbalances are very hard to treat” (aping the language of our oval laryngoscope users). You might even venture that my condition is “unfixable” (I felt that my physical therapist, after a while, basically gave up on me).

And that would be a shame, because you would’ve given up on someone who eventually healed his knees.

(So what is the correct way to view knee pain with the aim of overcoming it? I would argue a perspective such as “envelope of function” makes much more sense. For more, see here and here.)