Saturday, December 3, 2016

Open Comment Forum: Your Turn to Speak!

We haven't done one of these in a while, it appears, and they have been hugely popular (much more than my blog posts, I must confess).

So go ahead: Discuss whatever you want to below. It's open mike night at the SMK blog. :)

If -- and by no means feel bound by this -- but if you're looking for a subject to kick things off, what about this, for those of you who have had surgery:

If you could do it over, would you? What do you wish you had known going in that you know now? What's the most important thing you would pass along to others thinking about having that same procedure done?

Okay, I'll step aside and get out of the way now. Cheers!

41 comments:

  1. Hi Richard, I have a success story for you, but it wont fit in the comments box. Anywhere good to send it?

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    1. Hi Richard, I have a success story for you.

      I've been checking in on your blog ever since I first developed my knee problems so its only fitting that you and your community are the first to hear about how I eventually got better. First of all I should say that I did not get better use the low load high rep motion approach that you advocate, and I don't want to cause any confusion or doubt for those who have committed to that as their rehab approach. Just saying what worked for me. Direct heavy strength training is what has eventually cured me and it was a long road (3 years) of trying everything else first before I did that as a last resort.

      My patellofemoral pain began a month following a 'routine' meniscus surgery. Initially it was palmed off by doctors as normal post-surgical pain and nothing to worry about. But it didn't go away, began to get worse, and I found my quality of life severely reduced. The pain was directly behind the patellar, very sharp in nature and the knee would give way going downhill / downstairs. Any movement placing load on the patellar (leg extensions/ squatting) were impossible due to the pain and the knee would often get hot and achy at night. Walking on the flat or uphill produced no symptoms.

      I spent one year being a good boy and doing everything the physios told me to. Nothing worked. Hip strengthening, ankle strengthening lots of semi squat variations, vmo contractions and much much more. All of it made no difference. As I began to get desperate and my mental health took a dip (a major component of knee pain) I like you lost faith in the patellofemoral diagnosis and began to see it as a way for people to say they had no idea. I spent a few months just trying to completely rest. This made my painful symptoms worse. At this point I had discovered your blog and book and began to think your motion based approach could be the answer. I abandoned my doctors and physios, self diagnosed myself as having chondromalacia and made a plan to walk myself better. This was a major error on my part as it led me down a chondromalacia rabbit hole that did me no favours (don't get me wrong Richard, I am not slagging off your approach at all, your blog / book helped in many other ways) I had no imaging evidence to suggest that I had Chondromalacia and was going purely off symptoms and presentation which in hindsight (damn you hindsight) is the last thing you want to do with knee pain because of the many different causes and varieties of pain.

      Fast forward 1 more year and my patience runs out. I had put myself on 'cartilage time' and had accepted that it was going to take a while to improve, but nothing was happening, no signs of improvement at all. Plus I never had any trouble when walking (first red flag) in the first place so there was no way to see the pain going down as I increased my step count etc. I also experimented with very light cycling and swimming during this year but also had no improvement.

      I tried a bunch more things all getting more bizzare (think pulleys and karabiners) to try and gradually load my patellar cartilage and coax it to regenerate, before eventually throwing in the towel and having a long hard look at the situation. At this point I made my first good decision and went and got imaging done (Xray, mri, ultrasound). Shocker = everything inside the looks perfectly healthy. No Chrondromalacia.

      So spending a bunch of money to get those two words of information changed everything. I decided A. to have a really good 2nd look at patellofemoral pain syndrome and find out if it really was just a catch-all and B. I was gonna find a healthcare professional who actually knew what they were talking about.

      This required a change of mindset and a willingness to go for broke. I saw A LOT of different people, I gradually worked up the pyramid of expensiveness until I was seeing doctors of national sports teams.

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    2. Things learned on this leg of the journey:

      1. Some people will have no idea about knees, will quote the textbook to you and will pretend to demonstrate how badly your patellar is 'mal-tracking' and will give you the same 4 hip, ankle and vmo exercises that everyone else does. Confirmation bias is their fave. They cannot help you, ditch and move on.

      2. Some will suggest that you go and have surgery again, and will be very convincing. My advice - put this as a last resort and try everything else before you let them cut you open again...it didn't exactly go swimmingly last time.

      3. Some will advocate Stem cells, prp, prolotherapy or viscosupplementation. I say go ahead with trying any of these that you can afford, but say no to cortisone. If they offer you cortisone, you say no. Do some research. I could only afford an ostenil injetcion, it made no difference.

      4. Very few doctors will suggest a change from the bog standard knee rehab rubbish. But those who do may ask you some VERY IMPORTANT questions: What have you already tried? Have you tried training strength through the point of pain? What happened? What changes in your knee after a good warm up?

      I didn't know it at the time but those questions are the key (or at least were for me) to beating the mystery that is patellofemoral pain.

      So before I magically get better in 4 months let me first say no it wasn't all in my head. Outside of confirmed chondromalacia The mechanism for patellofemoral pain is not well understood and only the good doctors seem to know that the mechanisms go well beyond or have nothing to do with mal-tracking. Give them time, I'm sure they'll work it out... but now, to get better:

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    3. -Have I tried training through the point of pain? Yes in the early days of flailing around trying everything I did. What happened? I was in worse pain than before for about a day afterwards and then back to normal pain levels. I assumed this was a bad sign so did no more.

      - What changes in your knee after a good warm up? I had no idea, so I tried. I did a 30 minute 'patellar focused' warm up (look up sissy squats). Minutes 1 - 15 were very painful. Minutes 25 - 30 were surprisingly more comfortable and i could bend the knee a tiny bit further. Gradually over two months I noticed that although my knee was as bad as ever normally, that towards the end of the sissy squat warm up they would feel much better and that the time taken to get to the less painful stage was decreasing. Additionally the giving way - which was a major symptom in my case would stop happening by the time the knee was all warmed up. Worryingly I did seem to have more pain than usual later in the day after a session, but overall I wasn't declining so I carried on.

      Time to test the next question - What happens if you train beyond the point of pain? So following a good warm up of sissy squats (was now taking about 15 mins to get to the point where my knee wouldn't give way due to the pain.) I would try and do a single pistol squat. To my surprise I could do it. It was painful but I could do it. Again I was in more pain for a day following these sessions but the rest of time I actually seemed to be improving so I carried on.

      I continued to warm up and try pistols until one day I found I could do them without without a warm up and they were almost pain free. From there it was plain sailing as I just gradually increased training load and volume until i was doing 3x15 pistol squats no warm up wearing a 20kg vest. At this point I was completely pain free in all parts of my daily life and was very very happy.

      I should also say that I stretched regularly, foam rolled my newly appearing (and thus easily knotted) quads I didn't follow a specific diet, and to deal with anxiety I took up meditation as per Richards advice along with the wim hof method - the mental health aspect of this battle is no joke and should certainly be addressed proactively.

      So I think if I had to give myself from 3 years ago some brief parting advice:

      1. Don't jump to conclusions about chondromalacia without any evidence but if you truly do have it then be careful and measured.
      2. It might be worth trying to train through pain just once as an experiment to see what happens. Do you definitely get worse or is it only a short after effect that then goes away? Be sure about this before you decide to throw strength training out the window.
      3. See what changes in your symptoms after a thorough warm up.
      4. Keep seeing different people UNTIL someone helps you, there are people out there who know what they're doing, they are just hard to find. You're going to have to educate yourself and take a trial and error approach with this if you want to get better.
      5 If you get better share your success story.

      I hope this story helps someone.

      Tim.

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    4. Very interesting, Tim, and thanks for sharing! Let me look at pulling out part of this as a blog post. I have a few reservations, because I think that training beyond the point of pain can turn into an absolute disaster, so I'd be reluctant about seeming to endorse it. However, I will say, there have been a few people over the years that I've been doing this blog that have a similar story: basically they got better doing very aggressive exercises. However, I know that when I tried that kind of thing, I really paid the price and it set me back probably several months.

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    5. Thanks T Howell. I have read of a few people who decided to get "aggressive" (or met an aggressive therapist) after trying everything else and it fixed them.

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    6. John Sarno thinks much pain in the back (and knees) have a "psychological" origin. Not that it is in your head, but that the cause is emotional stress which causes oxygen deprivation and pain. I'm not sure what I think about that but one thing that has always stood out to me is that he thinks you should walk and exercise normally with zero restrictions. Basically to ignore the pain since it is harmless. I wonder is there is some relation with this and people who just decide to take a leap of faith and exercise through pain (within reason) and recover. Not to say there is some definite mechanism, but something is going on.

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  2. The thing I would do if (God forbid! ) I had to do it all over again is slow down earlier. I didn't realize early enough the importance to take things REALLY slow. I thought that not running and not cycling would be enough. I walked but too far, too fast until my wonderful physio told me to walk no more than 20 minutes a day. I had already been struggling for 6 months then and I was still going downhill despite reducing massively my activity.
    So I embarked in a journey that was both frustrating and life changing. I'm not one to meditate like you did Richard. But forced to focuse on my tiny,slow walks, I started being more mindful. Of my surroundings, of my state of mind, and mostly on seeing myself getting better
    To be honest, walking alone wouldn't have brought me where I am today because I still spent a lot of time at my desk or busied myself around the children. My breakthrough came with water physio. Exercises in the heated pool not only helped physically but also mentally. I built up the intensity of my workout with the guidance of the physio, but I also really listened to my body. I learned from my mistakes, I found the correlations between stress, sleep, nutrition and my knee pain increasing or decreasing
    3 years on, I'm not fully out of the woods yet. I still test my strength and step down if I find something is aggravating the pain. I then build up until I can achieve my goal. For instance, I wanted to do a two hours walk. I did it and suffered for 3 days afterwards. So I waited until I got better, and did a few walks along that path, each a bit longer until I was able to complete the 2 hours walk with no side effect. Each new terrain needs a bit of preparation in advance. Yes, it's frustrating. But it's better than getting back to square one
    I'm still doing pool exercise in case you want to know. Twice a week, one session doing full body work, one doing 45 minutes running

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    1. Exactly my thoughts/advice/experience too Deloupy, though I'm still guilty of doing too much due to a 25yr+ exercise habit (addiction!). I'll write some more shortly, including a bizarre experience in NZ where I just returned from.

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    2. Excellent, Deloupy. Sounds like a really good plan you came up with. I completely understand the too far/too fast problem; I bet many active people make that same mistake (as I did too).

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  3. Here's a question:
    Where are the online discussions happening nowadays? The bulletin boards (ie kneegeeks) seem pretty dead. A friend of mine with sudden deafness uses FaceBook groups, but I wasn't able to find anything for knees.

    What online communities do you recommend?

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    1. I can't answer your question. However, we may both benefit if we exchange some emails&ideas since I think that I am also dealing with terribly irritated synovium like you. If you like, drop me a line at skolibarski@gmail.com
      Cheers,
      S.

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    2. Thanks! 'See' you soon :)

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  4. OK, regarding the meniscus trim surgery on my L knee which (along I suspect with hard cycling) seemed to trigger 'PFPS' (read classic Dr Scott Dye loss of tissue homeostasis = chronic inflammation) in BOTH knees, I don't think I had any choice. It was a big tear, and was chaffing the cartilage on the end of my femur (it is still sensitive there) so probably had to be trimmed.

    In hindsight though I wish I'd waited 6-12mths and quit all my triathlon activities just to be sure that it wasn't going to heal on it's own (as my GP suggested, but I was too impatient wanting to race again).

    Next, I got very bad advice from my surgeon post-surgery and was told I could return doing "whatever I felt I could handle". My knee was telling me could not yet handle running, but was back into pretty hard cycling within 6 days =big mistake. Should have done very little for at least 1-2 mths, possible more.

    The most important thing I'd pass on re knee surgery is:

    1. Avoid it if at all possible if it is not a major traumatic knee injury, and even if it is a sudden meniscus tear like mine. Be patient and try conservative options first.
    2. If you do have surgery, be very slow with your return to previous activities.

    Now here's the bizarre thing. Cycling appears to have been one of the triggers for my loss of knee homeostasis (more so than running) and I've had several attempt to return to a little cycling which have all failed within weeks. Recently, I went on hols to NZ (New Zealand) with my wife who desperately wanted to ride the Otago Rail Trail (153kms over 3 days on MTB-type bikes). I agreed, but at the last minute switched from an MTB to an electric bike. We rode for 3-4hrs with a few breaks each day, it is pretty flat, but there were some incredible head-winds an my knees have never felt better! I also spent many other days stumbling across very boggy ground while fishing.

    The electric bike can be set at 0 (no motor assistance) to 5 (full boost). I mostly rode it at setting 0-1, and 2 a few times in severe headwind. Setting 1 gives you about 35-75 watts of assistance. To put this in perspective, when I rode a Half Ironman, I'd average maybe 200-230 watts, my maximum output might be 500 watts on a hill, and pro cyclists sprinting might hit 1000-1500 watts. but much of the time I had no to little assistance and my knees just seemed to get better over the three days.

    Now I'm back at a desk, I can feel them going backwards a bit, and even a easyish 35min ride (no motor) back home did not feel so great.

    So I think there is definitely a psychological/mood/stress component to it as others have noted, but I really think sitting at a desk is a major contributor.

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    1. Also to add. The symptoms of loss of knee tissue homeostasis (or PFPS as it is often broadly called) present as constant burning, aching, stiffness, hot kneecaps mostly in the anterior part of the knee. There is also a huge loss of functionality. Every-day tasks become a real chore.

      It feels like all the cartilage in your knees (especially on the back of your kneecaps) has suddenly disappeared, but it has not. Regardless, most medicos/surgeons will put it down to cartilage damage/degeneration and want to go in there and 'clean up'.

      When they go in, they will no doubt find some cartilage damage (typically patella chondromalacia or a meniscus tear as most people esp in middle age have this) and they will trim away to earn their pay. Bu in many cases, it won't help or will make it worse.

      I found it impossible to believe that the cartilage in BOTH my knees could go from smashing out a half ironman to painfull 24/7 within in pace of 1-2 months. Cartilage just can't degenerate that quickly. Hence I did not take up the offers of more surgery (and my O/S & GPs agreed), and sought other answers - finally coming across Dr Dyes work and having an epiphany....though I'm still struggling somewhat to employ his wisdom!

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    2. Tri Again, about the psychological element, you are 100% spot on
      I have a child with autism and the last 3 years have been pretty rough. When my child is in a downward phase, my knees hurt. In July, I started a year break to help him settle in his new school. He is doing extremely well and my knees too and I think the two are connected. Add to this the fact that I no longer sit at a desk and take a 1 hour walk every morning, and you have a winning combination

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  5. I would like to second the psychological element. Once I strarted doing meditation my knee pain reduced especially before sleep which helped improve my quality of rest. I wouldnt say its 100% reduced my pain but atleast I am not constantly worried about my knees.

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  6. I have had two remote assessments by Dr Dye in the past few months and he has satisfactorily disproven chondromalacia as being the source of my 2 years of knee pain. He says there is no evidence of chondromalacia on my MRI scans and that my cartilage looks good; however, there is joint effusion present on my scans as well as a swollen synovium, which 2 radiologists, 2 physiotherapists, three GPs and an orthopaedic surgeon all missed when examining me/looking at my films in the past. He diagnosed me with chronic peripatellar synovitis. It started in the left knee but began in the right after it worked harder to compensate for the left for months (I used to take stairs by stepping up and down with my right foot only and this caused the same overuse loss of tissue homeostasis that originally occurred in the left). Dr Dye has proven through arthroscopy without anaesthesia on his own knee (to create a neurosensory map of the knee) that cartilage itself feels no pain (as it lacks its own nerve supply) and his own severe chondromalacia is asymptomatic to this day. I think many people suffering from chronic knee pain are blaming cartilage when their synoviums or Hoffa's fat pads are more likely to be the problem. This was certainly the case for me.

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  7. Has anyone dealt with muscle inhibition following their knee drama? I begun to research this question, which seems to be a major issue for a lot of folks. Just read that vibrations, ice and activating the hips while recruiting the quad may help to circumvent the reflex inhibition to some extent. If anyone has a story to tell it will be great to share their experience.
    Cheers!

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    1. Hi Sveto,

      I had severe pain induced muscle inhibition post-op on my patella where it was "shaved" and found a TENS unit to be of use. Even if a TENS doesn't build muscle, it at least electrically stimulates muscle when you can't manually do the deed and in my opinion helped me stave off absolute disuse atrophy. Does it have other benefits: like helping circulation, or psychologically? I thought so. Something here about "action being the antidote to despair," at least to some degree with cartilage, as long as you are healing, however slowly.

      Also- As you know I was big on rubber-band exercises using straps placed just under my patellas (I developed CRPS and severe bilateral inflammation/chondromalacia post-op too) to "redirect force" as the sports-MD's and PT's are fond of saying, while also helping keep the point-load close to the joint and reducing torsional force on knees whilst doing exercises. "R.E.I." (an outdoor store franchise here in the US) carried a product called "Pro Gym Extreme" that had everything in it except imagination. Not sure they still carry it, as that was 4 years ago. I shipped that kit to Australia some time ago to a fellow chondro sufferer, along with some sketches I drew. Not sure if he had success with them?

      Racer-X

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    2. Sveto-

      To clarify- My pain inhibition originated behind the patella and kept me from using my quads to lock-out my knee when seated. It took me 2 1/2 years to accomplish that feat. In the first year post-op I lost several inches of quad circumference/muscle mass on my surgically altered side and an MRI at that time revealed advancing bone disuse osteopenia. Today I am cycling at a high level again and my quads are within about an inch of each other. I have always been right-side dominant and a bit less muscled on my "weak side."

      R-X

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    3. Yup, the rubber-bands definitely helped me R-X, and rapidly led me to other leg strengthening exercises such as deadlifts, kettlebell swings & I'm now doing sissy squats (which worked for another poster on here). The key for me is loading to strengthen my wasted quads, but not at high levels of knee flexion.
      I'm at about 80% fixed now, but still on anti-inflammatories (Celebrex)as per the Dr Dye recommendation as they were the only thing that allowed me to get on top of the chronic synovitis. Plus icing if I over-do it.
      I now do short run/walks (5kms) and rides (up to 20km/45mins) regularly. I'm hoping to get off the Celebrex in Feb.

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  8. December 29, 2016 Dear Mr. Richard Bedard, A physiotherapist I wrote to told me that "exercise" cannot regrow cartilage. I even sent her the links to the research you cited. Could you perhaps post or send me links which include the MRI scans of your knees proving the regrowth of your knee cartilage so that I could send it to the medical professionals who were taught regrowth was not possible? Sincerely, David Smith

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    1. Hmm. Did she read the studies? The main one I cite (it's discussed at some length in the book) shows that changes in cartilage appear to be dynamic, with defects getting both better and worse over long periods of time. On an MRI, cartilage has appeared after a period of a year or two where there was previously just bone. I'm not sure that exercise regrew it, or how it regrew, but there was none and then there was some.

      As for my cartilage: I'm honestly not sure what happened inside my knees. I know that they healed (as in, I no longer have knee pain and they feel pretty normal). I know that the awful crunching noises I once had are a lot quieter now (but still there, yes). Am I sure the cartilage healed? Or is it that the synovial fluid is just much healthier? I don't know how much is one and how much the other.

      I doubt an MRI now would show much change in my cartilage -- if you read the book, you'll remember I had "mild" chondromalacia. So an MRI isn't suddenly going to show a big hole that's been filled in. However, a couple of those studies I cited -- they found cartilage that appeared over bare bone. Tell her to get reading! :)

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  9. To Richard Bedard,
    I am curious how your knees are now. Are they without pain?

    I have the same problem as you. I've had it since a fall 51/2 years ago. Before that I had some click in my left knee sometimes when I got up from a sitted position. I'm definitely better. I most of the time only have an ache in my left knee. I do some knee exercises and stretching. I think If I relaxed more it would be good. I'm always up and down stairs, doing this and that. I am starting to take collagen with glucosamine, Genecol is the brand name. I had been taking glucosamine with condroitdn and MSM, but stopped because I didn't think it helped. I'll see if this new combination works better. I swim 10 laps, 3 times a week and enjoy the sauna after. Sometimes my left knee hurts afterward! Any suggestions?

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    1. My knees are normal, or probably better than normal considering I am (gulp) 54 years old now. I try to avoid suggestions/advice, but swimming sounds good (if your knees tolerate it well -- if they don't, you can always wear floaties on your ankles, as I did) and stairs are usually bad. Maybe you can find a way to limit the up and down on stairs? And yes, glucosamine is probably worthless.

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    2. Thanks, Richard. My physiotherapist said stairs are good! Seems everyone has a different idea. I did read your book, but can you send me a link to the study on rebuilding cartilage under the kneecap or tell me where it is in your book?

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    3. If you tolerate stairs well, I suppose they can be great ... but many people don't. The study wasn't specifically on growing cartilage under the kneecap. It was a "natural history" study -- so no one underwent a certain regimen; changes in their cartilage over time were simply measured. Here is what I wrote in the book:

      "In one study, published in 2006, Australian researchers tracked changes in the knees of eighty-four healthy people. Various locations in the joints were graded using the standard zero-to-four scale. The subjects started out with a total of nineteen spots of really bad cartilage that scored either a “three” or “four” (meaning that the tissue was at least half worn away, or even gone altogether).

      Amazingly, over a two-year period, these sites recovered the best. More than half of them improved — one went from bare bone to full thickness. About a fifth stayed the same, and about a quarter got worse."

      This is the abstract of the study below; it may be behind a paywall now. You might find the full thing if you Google around. The big takeaway to me was: changes in cartilage are dynamic. Some defects got better, some got worse. If cartilage damage was irreversible, one would expect them all to get worse. But a roughly equal number got better as got worse.:

      https://www.ncbi.nlm.nih.gov/pubmed/16567605

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    4. So from what I understand from the study, there is no clue as to what made the cartilage improve on one group. Is that correct?

      Yes, my physio said stairs are good for me, but I don't think that's true. Also his exercises don't seem to be working.

      Have you read any studies on Genecol? I'm trying that now. It's a combination of glucosamine (500) mg.and collagen. You take 3 before bed.

      I think drinking water is also good, but I can't seem to drink more than a couple glasses a day!

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    5. Claire said "Yes, my physio said stairs are good for me, but I don't think that's true. Also his exercises don't seem to be working."

      If your problem is the type of PFPS symptoms Dr Dye describes (burning, aching, stiffness, loss of function but with no obvious cause on x-rays/MRIs etc.), then I'd be confident saying your physio is wrong, esp. re going down stairs which is typically worse than going up.

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    6. Claire, see the post I just put up five minutes ago re: your point about "there's no clue as what made the cartilage improve." Correct, it's a natural study. But I point out why the fact that it's a natural study makes the results even more encouraging.

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  10. Really, how did you knees get better?

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    1. I did a post here: http://savingmyknees.blogspot.com/2013/05/how-i-saved-my-knees-in-dialogue-format.html

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  11. Thanks for your suggestions, Try Again. I have been diagnosed as having PFPS. Mostly what I feel is an ache on the inside of my knee cap, which my massage person said was a tight muscle.

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    1. The main thing to remember is that PFPS is not a real diagnosis. It is code for "your knee hurts in the anterior (front) area and we don't know why".

      In my experience an ache is much better than a constant burning/tingling plus an ache as it indicates you do not have the severe loss of tissue homeostasis Dr Dye talks about.

      Is is a sharp catching pain on stairs, or just a dull ache?

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  12. Can you give me Dr. Dye's complete name and address so I can look up his work? Or send me a link? Claire

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  13. Look here - http://kneeexpert.com/

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  14. Hi Richard, I have just finished reading your online book Saving My Knees. The similarities are uncanny, chondromalacia diagnosis, in my case which led to a further complete loss of cartilage in one spot at the end of femur bone in the trochlea (argh!!). At that point I started a journey seeing 4 different PT over the course of last year, including 2 different Knee specialists. All of the PT were head strong on the muscle first approach, which in each case always resulted in set backs. They just cannot help themselves but rush this process!! Understanding how cartilage requires time ( & lots of it) no wonder this happened. The Specialists in hindsight were great, but at the time left me feeling only more despondent as PT always failed me. Both Specialists indicated there was no need for surgery, even stating this is no indication I would ever need a knee replacement. Both specialists are very well respected & one stated there is "no cellular cure, no matter what some doctors will tell you" then he went on to joke about what medical schools those doctors would have gone to!! So this was said to me in May 2016. Without me continuing with a lengthy history of my past 'bad knee year', I just wanted to touch base and say how your book makes so much sense to me. Having been an very active person all my life the biggest challenge has been missing out on exercise, an outlet that has always provided me with good mental health. Need I say more on that point - I suffered just the same as you described. So I begin another journey now, getting on cartilage time and finding the right amount of walking that suits what my knee joint can handle for now. Current goal: reduce the setbacks by finding my knee joints' happy place. Thanks for writing your book, I know this is going to be a timely & tricky process but I have hope. I am new at this blogging so hopefully my message posts.

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    1. Thanks for writing! Best wishes for you going forward. Actually now I try to say "get on knee joint time" -- it can take a long time for knee joints to get better, and your end goal isn't to have perfect cartilage anyway. It's to get rid of the pain and discomfort. Check back later and let us know how you're doing; this is a great community of people here!

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  15. Hi Richard. I just finished reading your book, and for the first time in over 6 months got on my trike and did about 5 minutes. This last three weeks were horrible. I am 72 and weigh 250. I lost 25 pounds recently and still have knee pain. Still loosing though. My X-Rays and MRI showed "bone against bone." The surgeon said you need two knee replacements. He gave me a cortisone injection and sent me on my way never expecting me to resurface after the big issue of my weight. I know I need to lose the pounds. Have you had similar stories of success come your way with the elderly overweight lady who does not want them to cut me up?

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  16. I love your self characterization: "the elderly overweight lady who does not want them to cut me up." I completely sympathize!

    First, if I were you, weight loss would be my big goal, front and center. I wrote a post once about "How can you lose weight when you can't lose weight"? You may find it worth a look:

    http://savingmyknees.blogspot.com/2014/01/comment-corner-how-can-you-lose-weight.html

    I'm not sure I've exactly had a story quite like yours, but then again, everyone is unique. I know that someone who reviewed my book (quite favorably, I'm happy to say) was elderly and was told she needed a knee replacement. She started doing walkarounds in her apartment, and building from there, and I think in the end she avoided surgery.

    But weight loss is the big thing. It's not the only thing -- your knees won't magically feel fine if you lose 100 pounds -- but you will be in a much, much better position to succeed. Good luck!

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