Saturday, June 20, 2015

The Importance of Taking Charge of a Plan to Improve

I’ve written about this before, but I really think a turning point is when people with bad knees take charge of a plan to get better.

With a chronic condition, people often go through the same maddening series of doctor and specialist visits and receive the same unsatisfying answers. Day to day, the symptoms improve a little, then worsen, then improve, then worsen, and on and on. You don’t seem to be going in a particular direction -- except down, though slowly. You feel helpless, like a leaf being tossed about in a tempest.

This is a terrible place to be. It’s where most knee pain sufferers find themselves. Eventually, they say with a shrug, they’ll just get a total knee replacement.

Contrast this with having a goal -- healing your knees and having a plan to get there. It may be a four-month plan. It may be a four-year plan. It may be an eight-year plan. It may be a plan that turns out to have more curves and changes in direction than a mountain switchback road. Still: It’s a plan. There is a goal. That’s better than being a leaf thrown about by a random gust of wind.

To me, this is so important. This is the common thread among all the inspiring success stories I know about beating chronic knee pain. At the center of each is a person who refuses to go quietly into the night and throws himself/herself into some kind of program to improve.

I also believe that taking charge of the plan to heal greatly improves your outlook. Imagine you develop constant, nagging knee pain in March. You see doctors and physical therapists during the year. But they don’t really help and some days you feel better, some days worse. Now, on Dec. 31, as you look forward to a new year and think about your knees, how do you think you feel?

Probably scared. Uncertain. Fearful that your bad knees will just get worse.

But what if, during that same year, you develop a plan to heal. You’re not sure if it’s the right plan -- but it is a plan. Even if you don’t make a whole lot of progress, I think you’re in a different place mentally on Dec. 31. I think you’re more likely to be hopefully strategizing when you consider the year to come. Your thinking may sound like this: “Okay, I didn’t do as well as I had hoped this year. But I know that A, B, and C are definitely bad for my knees. I can’t do exercises D and E, but the bad knees seem to like F. So I’ll start on a program of G, increasing the repetitions about 10 percent every two weeks, then see where I am by the end of March. If this doesn’t work, I can always try H and I.”

The plan doesn’t need to be of your own devising. A smart physical therapist may help you design it. But you should understand it, own it, be committed to it -- and be willing to change it as soon as you can tell it’s not working. And then you should try something different. The path to healing is not straight, it’s not easy, but I’m convinced there is one.

Saturday, June 6, 2015

Knee Studies That Make Me Nervous

A lot of articles about knee pain studies land in my e-mail inbox. Recently I came across one with this provocative title:

Osteoarthritis Patients Will Benefit From Jumping Exercise

The English is a bit shaky in spots (perhaps it was translated?), but the findings are clear enough:
Progressive high-impact training improved the patellar cartilage quality of postmenopausal women who may be at risk of osteoporosis (bone loss).
Specifically, 80 women from 50 to 65 years old, who also had knee pain, participated in this Finnish study. They all had “mild knee OA,” it’s important to note. One set of subjects underwent a “supervised progressive high-impact exercise program” three times a week for 12 months. The quality of their patellar cartilage (which is located under the kneecap) improved with jumping and exercises that required “versatile rapid movements.”

Jump for better knee health! Uh, yeah sure ...

Jumping around with bad knees is not the first thing I would do. What we don’t know here is significant, I suspect. That “mild OA” may correlate with milder knee pain and minor damage, which makes more vigorous activities possible. I know plenty of regular readers of this blog who would shudder at the idea of “jumping” their way to knee health; their pain is brought on by much less strenuous exercises.

Also, it’s hard to tell what “supervised progressive high-impact exercises” means, but “supervised” and “progressive” suggest that subjects with bad knees weren’t cut loose to do jumping jacks during the first week.

My takeaway from this study is probably different from what the authors intended. I’m far from sold on advising knee pain patients to engage in jumping activities to improve their kneecap cartilage. I bet there are less impactful activities that would achieve the same end. However, if you’ve got good knees, exercises that stress your cartilage such as those that involve a reasonable amount of jumping are probably a good idea. They can help you develop stronger joints and ward off problems in the future.

An ounce of prevention!