Saturday, August 30, 2014

Success Stories: A Plan, Determination and Unwavering Focus Go a Long Way

I found a great success story about beating knee pain that cited my book. Originally I wrote a post that had my comments interspersed. But the story is so long, and so good, that I’m just going to stand back and let the author (Luis) tell it. I’ll follow up later with some comments. (Note: I did some editing for length and because the author isn’t a native English speaker. The original version is here.)

Let me share my wife's experience. I always refer to her as a fighter. She is 35 at the moment, and in her youth, was a professional athlete who represented her country (Bolivia) in several Pan American games. She used to run 800 and 1,500m races.

Her problem in her knees started just after she recovered from a compression on her sciatic nerve that didn't allow her to walk more than 50m without feeling a sharp pain in one of her feet. She was starting to run again after 2 years of not being able to walk at all.

Her problems started when we decided to start doing hikes. In June 2012, we went on a really stiff hike (not just hiking, jogging). After two days, she started to feel some discomfort in her knees (the usual swelling under the kneecap). She didn't pay too much attention and kept training for the next month, until one day the pain was so sharp and strong that her knees started to lock with sharp pains.

We did all the medical checks. The results: blood tests fine, no deficiencies in vitamins. The MRIs showed everything was alright. Our chiropractor said there are no misalignments in the way she walks and how her body aligns, so doctors diagnosed her with PFS [patellofemoral syndrome -- also called patellofemoral pain syndrome]. Some doctors recommended surgery for a lateral release, but we didn’t follow that advice because it didn't make any sense.

The only procedure we tried was the PRP (platelet-rich plasma) shots, which from my perspective helped her a bit with her tendon because it was kind of torn. Every time she tried something like strengthening the quads, the results were just the same endless cycle of pain. So from July to December 2012 she didn't really improve much.

It was really sad hearing more than 10 doctors opine that she was not going to run again and always telling her to lie down for a couple of weeks in bed with painkillers until she stopped feeling sharp pain. After the first two weeks of taking painkillers and seeing that they didn't help, we realized they weren't the solution.

There was a physiotherapist that didn't have a degree, but his therapies were comfortable. He gave us really valuable advice. "Walk as much as you can everyday.”

After paying attention to when she was feeling more pain, she ended up using hiking boots. The boots provided more stabilization. Another thing that seemed to help at night was using a pillow below her knees. She realized her knees hurt while walking down stairs, but not up, so she started to be really careful when walking down stairs.

Before we went on our vacation trip at the end of the year, we bought some knee compression braces. She could walk for less than 250m before feeling her knees lock and sharp pain. At that time we were living in Mexico. We traveled at the end of the year to Bolivia for a three-week vacation, where her family lives. To get to the flights I was always asking for a wheelchair so we could make the connections.

We had a job opportunity to work in St. John's, Canada. We relocated in winter (snow everywhere). It was hard to enjoy walking outside so we signed up right away in a gym. We kept walking, but still had the idea that sooner or later we should be improving quad strength, so from February to April, we followed a gym routine of walking on a treadmill for 30 to 40 min, biking 10 min in the special stationary bike for knees and always focusing on strengthening the core.

I was always researching information. I used to always search on Google for exercises to help PFS, but one day I tried "save knees" and there was a book called "SAVING MY KNEES." My wife was of course skeptical because no one could find anything at this point and doctors couldn't find anything either. I read it the first time in 4 hours and was feeling more excited than ever!

Before we started to develop a plan based on his book, we still had the quad strengthening idea. In August, some friends from Mexico were going to visit us and we started to plan hiking routes. One month before, we decided to start doing leg extensions in the gym, and all of a sudden the work of 6 months started to vanish. She returned to the state that she was in in January, feeling a sharp pain just after walking 150m. She had a huge setback.

After her setback, we started to read his book over and over to see what we could come up with that could help on her recovery. We developed a plan based on walking. She couldn't walk much, but we started to do it every day, like 300 steps, and with stopping. Days passed; she started to feel better. It was funny because even though she was in pain at the beginning while walking, the next day she could feel the difference when trying to walk the same distance and felt progressively better. After 4 weeks we reached a point in which she was able to walk between 4,000 to 5,000 steps per day.

Our friends arrived in August and we started to go on hikes again, with the fear that she could have another setback (we did like 4-6km hikes), so we followed some golden rules:

1) Never go downhill unassisted or without a support that would help reduce the impact of her body being absorbed by her knees.
2) She decided not to wear the knee brace in order to be able to hear her knees.
3) Take breaks every 2km, no matter if she was feeling alright or not.

After focusing on her recovery, she has not had another setback since then. We had a great time in August and September doing short hikes and walks and were prepared for the next step. Since she was able to do 4,000 to 5,000 steps per day, our new target was 10,000 steps. Between September and December, we increased the amount of steps from 4,000 to 8,000 just progressively. At the same time we did tons of core exercises, stretching and short squats. At this point she started to feel pain free!!

Between December and January, we took 3 weeks of vacations. We went to Bolivia again and kept our religious daily walks that would get us the 8,000 steps. But for New Year, we went to Brazil for 5 days. We had no other option than to walk every day if we wanted to have fun. We walked 4 days an average of 22,000 steps per day, and every time, pain free.

Since we returned from those vacations, which were from January 2014 till today, we had been walking around 12,000 to 18,000 steps per day. But we've reached a time constraint -- it takes around one hour to cover 6,000 steps, so doing 18,000 consumes like three hours in a row. So now, we just bought some weight belts and are starting to walk with just a little bit more weight and do between 10,000 to 15,000.

In April 2014, we started to do moderate hikes with the club. At this time my wife is able to do them completely unassisted. She is really excited about running, but has learned from this experience that patience is your best ally, so she has started to jog distances between 200 to 300 meters, but just for fun. She is waiting till next year to start running long races again. She even ran with me last week 500m at a pace of 6:00min/km. And the best thing, completely pain free!!

If you want to e-mail me, for some additional advice or explanation of something that wasn’t clear, write me to


Next time: More from Luis, including his advice.

Saturday, August 23, 2014

Do You Really Want to “Freeze Away” Your Knee Pain?

Recently I spotted this: a short and not very detailed article about freezing nerves to quiet persistent knee pain.

The treatment, called Iovera, uses nitrous oxide canisters to freeze tiny needles to minus 126 degrees. Once injected into the skin, the needles freeze the nerves that are firing off pain signals. Apparently, instant relief follows.

I like that phrasing: “instant relief.” It sounds so uncomplicated. If only!

The problem is, nerves are generally useful, even when bearing bad news (i.e. tidings of pain in this case). The best thing is not to shoot the messenger, but rather work to change the message!

The downside of numbing nerves (whether using this method or taking pain pills or undergoing serious joint icing) is that you may not get some helpful pain signals that would prompt you to avoid activities that are simply bad for your particular joints. There’s a tradeoff, for sure.

But, to be fair, there are times when overactive nerves may be a problem in and of themselves. They may go renegade and start relaying sensations that are not consistent with any damage being done (or NOT being done for that matter).

All of which is my way of trying to strike a nuanced stance here: Freezing nerves doesn't have to be a bad thing. But I’d think it over long and hard first.

Sunday, August 10, 2014

Stay That Knife, Surgeon

Anyone else see this?
Over a third of the total knee replacements in the U.S. are inappropriate, according to researchers who found that many patients had pain and other symptoms that were too mild to justify having the surgery.
Actually, uh, it’s worse.

Along with the 34 percent of subjects for whom a total knee replacement was deemed inappropriate, there were 22 percent for whom the evidence was “inconclusive.” That leaves only 44 percent of the 175 subjects whose replacement surgery was definitely judged to be “appropriate.”

In other words, less than half.

Why that matters becomes clear when you see the statistics. More than 600,000 knee replacements are performed each year. That’s a big number, considering how extensive this operation is. What’s more, the number of the surgeries is on the rise.
In the past 15 years, the number of total knee replacements (TKR) has grown significantly, with studies showing an annual increase of nearly 100% in surgeries between 1991 and 2010. The number of Medicare-covered TKR surgeries grew by 162% annually over the same period.
It should go without saying that a total knee replacement should be considered a last resort. With biomechanical structures, even if they don’t work well, they’re still part of a dynamic, changing system that perhaps can heal. Once a surgeon starts sawing out a chunk of your femur to install a plastic-and-metal knee, that biological system is gone. The car-knee analogy then does become relevant. Your new knees will slowly start to wear out, just as a new car driven off the lot does. Plus, possible complications from surgery and the effectiveness of surgery are always two big unknowns.

Which all adds up to: There should be plenty of concern about unnecessary total knee replacements. In an editorial, Dr. Jeffery Katz, a professor at the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, expresses concern that “doctors were offering TKR surgeries to patients who had mild pain and little loss of function in their knees.” He further writes:
As a community of providers, we implore our patients and the public at large to engage in exercise and physical activity in order to delay functional decline and to preserve and augment functional status. We must consider whether it is advisable and affordable to use costly technology such as TKR in the same fashion.