Friday, December 26, 2014

Happy Holidays to All!

I ate a huge dinner yesterday cooked by my 72-year-old Mom, who is still an amazing cook. My wide-eyed five-year-old daughter described how she heard Santa's reindeer on the roof on Christmas Eve. My 18-month old son crawled onto my lap with one of his dozen board books and stabbed his little index finger at pictures of tarantulas and dolphins and panthers and told me what they were -- or what he thought they were.

The sun broke out after several days of rain, and everyone was glad for the brighter skies. It was nice to be on the leading edge of a long weekend. I've got a few around-the-house projects to occupy me and a leak I'm watching (the joys of owning a house built at the end of the Roaring Twenties). I think water may be dripping from the shutoff valve under the main kitchen sink. I just finished wrestling off the corroded, leaking faucet on the prep sink and replacing it, so this isn't a project I'm looking forward to.

So there's plenty of stuff to think about. But one thing I'm not thinking about: my knees.

They work fine. They have been working pretty well, in fact, since I published Saving My Knees. After I made the book available, I had a little nagging doubt: "What if the knee pain returns? Will I be some kind of a fraud, peddling a story that doesn't really have a happy ending? Will I have to contact everyone who bought the book and refund their money?"

But that never happened, thank God. My knees just kept getting better.

So my holiday wish to all of you is don't give up hoping. I made it through. There is a way.

Saturday, December 20, 2014

On Writing a Book and a Blog, and Learning Humility

After I finished writing (and rewriting) Saving My Knees -- and extensively fact-checking the entire manuscript -- I felt kind of giddy. This was a unique book, I felt. It was a first-person, well-documented story of how someone failed -- then succeeded -- in fixing bad knees his doctor said would never get better. My story vividly demonstrated the shortcomings in the traditional approach to treating chronic knee pain (of the sort sometimes caused by osteoarthritis, but sometimes not).

Bestseller lists, here I come!

Then reality bit down. Hard.

The book has sold well, all things considered, but never got close to being a bestseller. Reviews trickled in -- many positive, but others sour and dismissive.

The most humbling experience though has been writing this blog and coming into contact with so many people with knee pain who are really struggling -- and who appear to be doing many of the right things too. They’re desperately seeking the path to healing, just as I was. And they’re discovering that’s not an easy path to find.

Ah. Theories are neat; reality is messy. I still believe that switching from high load/low repetition activities to low load/high repetition makes much more sense for fixing achy knee joints. But I also recognize that while this may be necessary for some people to get better, it may not be sufficient. Big difference.

The problem is, there are different causes of knee pain (in need of different solutions), as well as various mysteries about what’s really going on in the first place. For instance, is there something weird and systemic that sets in when you have chronic knee pain that goes on week after week? I had a doctor tell me unequivocally “no.” But I’m not sure I believe him.

Sometimes I had the sense there was a poltergeist of inflammation loose in my body, and while it may have first appeared in my knees, later it began to roam at will. Apparently it wasn’t just me either who felt this way. I’ve been surprised at the number of people with symptoms similar to mine who went so far as to be tested for rheumatoid arthritis (just as I did).

So what was all that systemic stuff? I honestly don’t know. But, even though it’s gone today, I think it was real.

So yes, there are lots of mysteries about knee pain, as you’re all finding out. It’s good to stay humble -- even if you succeed in beating knee pain -- because no one has all the right answers.

Saturday, December 6, 2014

When It Comes to Knee Pain, What’s Your Religion?

When I read an expert’s answer to how to deal with knee pain, the question above is always forefront of mind. What is their belief framework for analyzing and treating the underlying condition?

Mostly I find experts are structuralists of some stripe. In other words, they believe “your knee cap is mistracking and that’s why you have pain and that’s what you have to fix.” Some are more hard-core than others.

Take “Running Doc,” for instance, who tries to help Laura G. here who has been told she has “Runner’s Knee.” But her only exercise consists of shopping expeditions at the mall!

Well, the doc describes her problem instead as “Maller’s Knee” (for anyone curious about who the great physician “Maller” is, I think this is just an attempt to be clever). He then goes on to equate “patellofemoral syndrome” with “chondromalacia patella” (as I note in my book, they’re not technically the same, but it’s a revealing confusion).

He does promise the reader that “understanding the real cause makes treatment easy and pain relief possible in a short period of time.” To me, after hearing so many stories from knee pain sufferers engaged in a frustrating battle to beat their problem, this phrasing sounds a bit glib, to say the least.

The underlying cause, he tells us, is your ....


And your parents stuck you with those feet, so your pain is -- well, sorry bub -- your biological structuralist destiny, you might say.

How does he get from your feet to your knees?

Here’s one example he gives:

Your foot rolls in (pronates), leading to your kneecap mistracking and scraping along one side of the patellar groove, leading to the cartilage under your kneecap getting eroded away, leading to ... pain.

So what’s the solution? Interestingly, one would assume -- after such a bleak kind of structuralist analysis -- that nothing short of surgery to fix the cursed defect would do much good.

But actually, he states that arthroscopic surgery helps maybe one out of 100,000 sufferers (a bit hyperbolic I’d say, and I’m no fan of surgery either). No, the real solution: orthotics.

His apostolic faith in orthotics made me smile. Here is the New York Times telling us that a longtime researcher into orthotics has found they don’t really work and when they do, it’s not clear why. And so, “The idea that they are supposed to correct mechanical-alignment problems does not hold up.” (After reading the article I bravely gave up the shoe orthotics I thought I couldn’t live without, and I’m perfectly fine today without them).

As for Running Doc’s “first mover” in his chain of events resulting in knee pain misery -- that maltracking patella -- that too may not be the problem for a large number of cases of knee pain. (See this study I’ve linked to about a kajillion times.)

So at this point you may be thinking, “Okay smarty pants who isn’t a doctor, what’s your religion?” And I’d have to say my thinking aligns best with that of Dr. Scott F. Dye and his thinking on “envelope of function” (see here). Basically, when you exceed that envelope over a period of time, you’ll get knee discomfort then pain. If I were talking to Laura G. about her problem, I’d be more curious about the following than what her feet are doing:

What’s your weight? Is it where it needs to be? Has it changed recently? By how much?

Did your amount of non-exercise movement change before the onset of knee pain?

Were there any traumatic knee events you suffered in the year or two preceding the knee pain?

Can you describe how you use your knees, 24/7, during a typical week?

Of course I could be off base with this line of inquiry in Laura G.’s particular case. It’s always possible that she was born with crappy feet and is now paying the price for it. But somehow I doubt that’s the real problem.