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 ing_luisgonzalezrangel@hotmail.com

Luis

Next time: More from Luis, including his advice.

15 comments:

  1. Mr. Bedard,
    Many thanks for posting today's blog and the helpful information it contains.

    Is there any possibility that you might consider making the diary you kept during the period you were figuring out how to heal your knees somehow available for purchase -- hopefully in a manner that could be downloaded and printed as a hard copy. Thankyou for your time and consideration.



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    1. I included some of the diary as an appendix to the book, to give everyone an idea of what I was tracking and what the entries looked like. But honestly, it's pretty boring. It doesn't really lend itself to easy reading. I'm not sure it would be all that useful.

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  2. Leg extensions are very dangerous. My pain level increased massively after ill-advisedly doing a few sets at the gym a few months back. It's awful they seem to frequently feature in generic knee pain help manuals. Brilliant success story! Daisy

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  3. such an inspiring story! Thank you for sharing it. I also deeply admire Luis' love for his wife, he was part of the healing, taking these steps (litterally!) with her. Fair play

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  4. Hi Mr Bedard,
    I have been following you blog and have read your book and found it inspiring. You approach many subjects but I am missing comments on one treatment that does help with arthritis related burning: What do you think about steroid injections into the knee just once or twice? They do supposedly decrease inflammation without the anti pain component that NSAIDS have. I would love to hear your take on intra-articular steroid injections to control inflammation. I have followed your advise for 6 months but have had many setbacks. I am not sure if a steroid injection to ease the inflammation would help or impair my progress. I would so very much appreciate your input because I am just at another setback and would very much like to hear what you think.

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    1. Sorry to hear of your setbacks. Getting better takes a lot of time, and involves a lot of frustration certainly. On steroid injections: I had one for my elbow, when I developed some bursitis during my knee pain ordeal. I'm reluctant to endorse these shots -- doctors seem to love them, but I recall reading somewhere that they leave residue in the joint. In my case, I had some lingering issues with the steroid-injected elbow for a few years (it's fine now). Anyway, that's just me. You may have a different experience. It may be worth exploring the pros and cons with your doctor.

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  5. I have been posting on this blog on & off for 2 years. I am very touched by this story and I resonate with a lot of it. I applaud their discovery that they need to proceed slowly. Once you start feeling better it is easy to get over confident, try to progress more quickly, and then have a setback.

    I have made significant progress myself and last weekend walked 6 miles on flat, slowly, and I seem to be doing fine. But this post was a great reminder of myself to keep going slowly slowly Slowly.

    From the person who formerly posted as "Knee Pain" from 2012 & 2013.

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    1. This is "Knee Pain" again. Maybe I should have added that even though walking 6 miles on flat may not sound like a big deal, it's a huge huge deal to me. I'm one of the type of PFPS sufferers like Luis' wife who literally was unable to make it through the airport without a wheelchair. Most recently in Jan 2013 but other times earlier as well --. Which has been both heartbreaking & frustrating for someone with "not much wrong" with her knee other than the mysterious PFPS.

      So. I've come a long way -- not as fast as I would have liked, but overall I'm hopeful that I'll be able to keep improving and get back to hiking, waltzing, road biking.

      - from "Knee Pain"

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  6. To: Mr. Bedard or "Poster Knee Pain"

    Is it possible to develop PFPS while recovering from a nondisplaced patellar fracture (my fracture has healed, but my knee has gotten progressively worse although latest MRI shows that everything is supposedly fine).

    And in the course of healing your knees, did either of you pursue physical therapy in water? If so, was it helpful? Or if not from personal experience, would this be something you might recommend drawing on general knowledge or research data.

    Many thanks.

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    1. I'm not an expert, but I would think it's possible. My thinking is this: while you're healing from the fracture, your cartilage is weakening somewhat, exposing any latent issues there. Just a guess. And PFPS is such a broad and rather useless diagnosis anyway, you could probably wind up with the symptom set after a lot of different problems.

      I tried some water therapy (which I mention in the book). Land therapy turned out to be better for me. But that's just me. Water therapy can be a very good way of rehabbing bad joints without putting them under too much stress.

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    2. Hello,

      This is "Knee Pain." yes, I did have quite a bit of success with gentle water therapy. I will emphasize this is not at all the same thing as "swimming." the act of swimming is much too stressful for my knee joint. However, I found a book on water therapy with specific careful exercises for knees. In fact, this book had recommended exercised for people post knee surgery, which I thought was very interesting and I appreciated that the book took care to provide very gentle exercises meant for movement during healing. Hurray!


      One thing that surprised me was that I did quite a lot of the therapy in the deep end of the pool while wearing a floatation belt. So, basically i did leg movements while floating vertically and neither leg was touching anything. The parts of the therapy that involved where I could stand were "leg swings." also interesting is that the book did not including "walking in thr shallow end" as part of thr Therapy. Interesting.

      However, as with everything, have to still go slow and be very careful. Listen to your knees.

      Also interesting is that in doing the knee therapy water exercises in the book that I had found-- I never had to put my face in the water or even get my hair wet. Which is funny because i had prepped with goggles and a water cap for my hair. So. A lot of surprises for me when I embarked on my water knee therapy. :)



      I have the "delayed pain" effect that Richard's book explains. So... Even if I don't feel any painful effect 4, 8, 24 hours after exercising... I'm not in the safe zone yet. The pain could still be coming! So..., need to be cautious and not add in new things too quickly.


      Good luck!
      "Knee Pain"

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    3. I am doing hydrotherapy with a PT specialised in water rehab. The first session, I thought I was going to fall asleep in the pool, it was so exhausting. I was also very concerned that I felt pain afterwards, and she said to take it easier next time. I braced myself for a very painfil next day, and.... nothing. I woke up fine. The next day I was fine too. The discomfort eventually came back a few days later. Then I had another session, didn't feel any pain during the session, and felt grand afterwards. 3 sessions later (another 8 to go plus the ones I'm meant to do by myself), and I abandoned the walking stick for the first time in weeks this weekend. I can still feel the weakness in my knee, and I'm being extremely cautious, but at least it is no longer uncomfortable
      Like Knee Pain, I don't have to put my face underwater, and do a lot of exercises in the deep end with a flotation belt. However, some exercises are done standing at chest depth, with progression to the more shallow end as people feel better. A lot of emphasis is put on the position of the legs and knees as we walk in the water, which is something most people do incorrectly (duck feet anyone?)
      I'd recommend starting water therapy with the guidance of a PT. I had tried it before using a book, and felt it wasn't as efficient (I guess I did some of the moves incorrectly)

      Knee Pain, I wish I could walk 6 miles on flat, that'd be quite an achievement!

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  7. Mr. Bedard -- Very grateful for your reply. Many thanks.

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    1. This is "knee pain" agsin. Maybe I should mention that the water therapy book I used is called "The Complete Waterpower Workout book" by Lynda Huey & Robert Forster with programs for fitness, prevention and healing. Yay! You'll see Part 2 chapter 9 is "specific rehab exercises for the lower body."

      Even so, I had to work up very slowly & carefully to the "flutter kicks" and even more slowly & carefully to the "bicycle" movement and even more slowly & more carefully to the "slap kicks." but. Actually it was exciting & satifying to incrementally see progress. :)

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  8. Many thanks to everyone who has taken the time to post about water therapy. The information has been very helpful.

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