Saturday, June 3, 2017

Open Comment Forum, Dive In!

I started scrolling through recent months, and realized we haven’t done one of these in a while. They’re extremely popular, and probably more useful than the regular posts. :)

So I invite everyone to take over the comment section and say what’s on your mind (about your knees, or matters related to your knees).

A suggestion, in case anyone’s looking for a theme: What are you struggling with most right now? What’s the one big single thing? Tell us, and perhaps the wise commentariat (that is, the very knowledgeable people who frequent this blog) can help you find a solution!

Cheers, and hope everyone is having a good spring (or fall, if you’re in Australia).

9 comments:

  1. Richard, In your blog of 1/15/17 you spoke about how you did not see knee pain through such a cartilage-centric lens anymore, and you thought that some of your problem may have been in the bone endings and it could have been detected with a bone scan.
    Had your knees lit up like a Christmas tree on a bone scan when you were in Hong Kong, what would you have done differently to recover? Knowing what you know now about how your knees heal, how would you have modified your recovery plan to take into consideration that your bone endings were damaged? Thanks, John

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  2. This is a great question, John, and in a second edition of the book (which I'm working on now), I say that I may have done the right things for the wrong reasons. I think what I did was still the best approach -- listen carefully to your knees (and be watchful of delayed symptoms), give them the right amount of appropriate motion, and be very, very patient. That worked great. Honestly, I don't see how any other program would have helped me heal any faster.

    But to be clear on something: I did have a bunch of noisy, crunchy cartilage. While I think the damage to the bone may have been responsible for certain symptoms (the burning while sitting with bent legs, for sure), there were other symptoms that probably can be traced to deteriorating cartilage/bad environment in the joint (watery synovial fluid?). Anyway I'm kind of speculating on all that. Still, when I recovered, I noticed that my knees were much quieter, along with the fact the burning-while-sitting went away.

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  3. Unfortunately, in August 2015 I overloaded my knees badly by jumping. I tore both menisci in my right knee and developed chondromalacia patella grade II in both knees. The menisci problem was solved by arthroscopy. Both menisci were sewn and healed well, even though my retinaculum patellae was left with a badly scar. I read and followed your advices as well as Doug Kelsey’s (“The Runners Knee Bible”), Scott F. Dye’s (great lectures and papers!) and Christopher J. Centeno “Orthopedics 2.0” to name but a few. I did my thorough research and dig through out many, many resources. I also committed myself to the movement on a daily basis. I made my knees and legs much stronger and less painful. However, I do struggle with two issues:
    1) I haven’t achieved completely pain free knees yet. They are susceptible to too much load like walking with my heavy rucksack during my fishing trips or walking in the forest. Very mild pain sometimes comes and goes briefly during sitting or lying in the bed. I’m probably going to try acupuncture for that.
    2) Chondromalacia. I have that annoying grinding noises behind my patellas and that problem seems to be impossible to fix by exercises alone. I remember dr Dye’s lecture, but I would like to regenerate my cartilage to the best possible condition. I even tried bone marrow prolotherapy. Have you got any suggestions? Maybe Lipogems?

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    1. Honestly, I wouldn't obsess with getting smooth cartilage. It doesn't matter how much noise your knees make if they feel fine. But as for what you might try to improve the cartilage, I would think about lots of easy cycling, if you have enough range of motion.

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  4. Richard – Thanks for responding to my bone scan question. It does not sound like you would have changed anything. I don’t have a Dr. Dye “pebble in my shoe” situation, otherwise my orthopedic surgeon would have offered to go get it. X-rays and MRI scans don’t reveal anything that my OS thinks could be fixed by scoping my knee. I appreciate his steady and conservative approach to treating me. I’ve not had a bone scan, but I don’t think it matters. I will just continue with my recovery plan that I have cobbled together after reading you and Doug Kelsey.

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  5. My biggest frustration right now is conflicting diagnoses and even conflicting MRI interpretations! In less than 3 years, I've been diagnosed with: ACL sprain, Patello-femoral Pain Syndrome, chrondomalacia, chronic peripatellar synovitis AND Complex Regional Pain Syndrome. I believe the synovitis diagnosis is correct and that it evolved a CRPS component. What baffles me is this - how can so many doctors look at the same images and come up with such different diagnoses?! I know MRI images are very complicated, but some doctors chose to look at different images on which to base their decisions (lateral view rather than axial, for example, when synovitis and joint effusion are best visualised on the axial images!). Very frustrating. Other than that, the disability is the most difficult thing to cope with.

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  6. I also have acl sprain /small tear and chrondolamacia. Will know tomorrow if on top of that I have CRPS too as my go thinks I have it. I am very discouraged and font know what next. I am on a daily basis going back to save my knees to find words of encouragement and hope.

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    1. Anonymous, since I started using a TENS machine very recently, I have had great success with treating the sharp, lancinating nerve pain that is typical of CRPS; however, the TENS machine has had no effect whatsoever on the duller, more insidious, localised pain of synovitis that occurs after being active. My point is, you might indeed have more than one issue going on and if so, you might need to attack it using multiple treatment modalities.

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  7. Thanks a lot Amy. I also use the TENS machine since some time and probably have kept it under control as GPs are not so sure I have it as symptoms varies and are mild. I also had misinterpretation of MRIs. First one 3 OS told me I have complete rupture of ACL so the focus was on the ligament and to strengthen quads whilst chrondomalacia was ignored. I hope today 22/6 the 4th OS will give me guidance and direction. If you maybe can share your treatment and plan for recovery that would be great. Many thanks.

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