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).

21 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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  8. Amy brought up an important reality of MRIs: different doctors can interpret MRIs different ways. The fact is that there's a lot of guess-work involved, unless there's some major, obvious pathology. But with a lot of us with chronic knee pain, there simply isn't an obvious pathology--no "smoking gun" so to speak. Even if your cartilage is worn, that doesn't mean that's the cause of your symptoms (which Dr Dye has clearly established). I know that Richard and some of the posters on here are somewhat anti-surgery, but I had an arthroscopy three months ago (March 2017) and am really glad I did. Sometimes it's the only way to know for sure what's going on inside the knee and--therefore--what the best course of action is. At the time I had my arthroscopy my left knee had been suffering for two years from daily pain with sitting and simple weight-bearing activities like brisk walking and walking up and down stairs. I had never had a specific trauma in which I tore or broke something. The symptoms came on gradually, coinciding with a lot of hill running. Five months of physical therapy didn't help, so I had the arthroscopy. Turns out my articular cartilage and menisci were in perfect condition However, the surgeon found a lot of thickened scar tissue from synovitis, which he removed. Almost immediately the burning pain with sitting disappeared. My knee is also much more flexible than it was before. For the first time in two years, I can bend it deeply without pain. I still have some irritation with weight-bearing activities, but I'm steadily improving with physical therapy targeting muscle strength. Are the exercises irritating? Yes, somewhat. Do I still get discouraged some days? Of course. But I can see the net gain. I'm steadily improving and feel really optimistic. If I could communicate one thing to all of you, it would be to resist the temptation to make assumptions about what's causing your symptoms. Prior to my arthroscopy, both I and my surgeon assumed that the problem was chrondromalacia. We were wrong. If I had not had the arthroscopy, we never would have figured that out and I would have continued to suffer. I hope this helps somebody, because for a long time, I was just where a lot of you are now: hopeless and frustrated. Be patient. It can get better once you find the underlying problem and get the right treatment.

    Pax,
    S.A.

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    1. Thanks for sharing your story Pax.
      In my case, Condro II does not justify my disability, so I am thinking about having a diagnostic arthroscopy.
      Could you tell how long it took you to recover from arthroscopy?

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  9. One more thing I want to add, in response to "Anonymous" at the top of the thread and anyone else who's wondering about crepitus: before my arthroscopy and synevectomy I had grinding in my knee when bending and straightening it. But the arthroscopy showed that my cartilage was perfect. Maybe chondromalacia is the culprit in some cases, but it wasn't in mine.

    S.A.

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  10. S.A., it was of interest to me that when Dr Dye produced a neurosensory map of the knee he discovered that knee cartilage does not produce pain, while the synovium is highly enervated and can produce quite a lot of discomfort. Patients can have severe chondromalacia and be asymptomatic, whereas synovitis that looks fairly mild on imaging can be debilitating.

    I am not automatically anti-surgery myself; however, all the specialists I have consulted have been very reluctant to operate, warning me that it could make my condition worse than it currently is. Oddly enough, I think it would be quite difficult for me to convince anyone to perform a partial synovectomy on my knees, which I was not expecting from surgeons!

    Anonymous, I won't attempt to post my own treatment details here; however, if you would like to discuss it, feel free to contact me via the Contact form on my website. I am currently corresponding with a few other knee pain sufferers and find it can be helpful to compare notes.

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  11. Hi, everyone. 51-year-old woman here; BMI of 33.4.

    Knee problem for 15 months now. MRI showed deep partial-thickness cartilage loss in inferior portion of trochlear groove. Everything else was normal. The acute injury was probably a sprained retinaculum that happened during an 8" step-up exercise (although, mysteriously, nothing went wrong during the exercise--but afterward, my knee was blindingly painful when moved out of perfect hinge-joint position).

    I am still going up and down stairs one step at a time, with the good leg doing all the work. I am doing conventional PT. I've seen some improvement, but not as much as I'd hoped. I can tolerate 4" step-ups but not 6" step-ups or leg presses even with very light weights.

    I am very discouraged. I read Richard's book and am keeping an eye on my symptoms, trying not to do anything that makes things worse. I just ordered Doug Kelsey's "90 Day Knee Arthritis Remedy." Any other suggestions?

    Thanks!

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  12. I've noticed a strange phenomenon: I'll feel fine, then I ice, and for hours (sometimes the whole day) afterwards it's like the "pain meter" has been dialed up: I ache all the time and things that weren't hurting now do. I don't know what to make of it.

    Does anybody know anything about this?

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    1. Hi Amy, I would not ice for more than 15-20 mins at a time. I remember reading somewhere (sorry cant remember the source) that icing for more than 15-20 mins actually prevents bloodflow to the region which ends up doing more harm than good.

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  13. Hello sir. I read your inspirational book. It's wonderful and unfortunately I've exactly the same problem like you.
    Difficulty in standing, sitting with bent knees etc. Just the difference is: I got it without cycling. I don't have any specific reason for it.


    But an important thing which I missed or may be it's not in your book:
    Did u feel any sort of abnormal weakness in your leg/legs after walking a couple of miles?
    I've been wondering since long. It just happens in my left leg and it's annoying not able to find the cause. Moreover I am into 7 month of my injury. I hope you get time to answer my mail. Lots of love from India ๐Ÿ˜‡

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  14. No Karna, I never had any abnormal leg weakness. But you have to understand: my legs were very strong when the knee pain struck. So the weakness may be more common for someone who starts out without a lot of leg strength.

    It's curious that you have all these symptoms and no idea what may have caused them. Then again, it could have been building over a number of years perhaps, and something small pushed you over the edge. Anyway, I'm sure you're seeing doctors/specialists and trying to figure out what's going on, and why.

    Thanks for the shout out from India! Interestingly, sales of the book have been consistently decent over there, so I know some of your fellow citizens have read it too. Knee pain knows no boundaries unfortunately.

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  15. Thanks for your time sir. I've been to 6 orthopedists, 3 physiotherapists, 2 ayurvedic doctors (India is famous for Ayurveda) 1 bone setter too ๐Ÿ˜….
    Okay so this is going to be long. Sorry but I need to tell you everything as you're the only person who has motivated me well.
    * I used to play tiring cricket on weekends and for a month I regularly played badminton. I never got any indication of damage in my knees. I've been a good sprinter too but I was not a professional athlete anyway. Last I ran 100m was in 13.59 secs but again that was not my routine. I had a normal routine just like my fellow mates playing with me.
    * My warning bell came after a 140 km drive to a temple and back home. While sitting on the floor I noticed a sharp pain in my right knee. I never knew how far knee pain can go so I just thought of it as a sprain and went to play next day. Note that I had no problem while running or jumping. Only problem was sharp pain while bending my right knee fully. I got the same sharp pain in my left knee the next day. I still ignored it as I still thought it's due to an abnormal jump or an abnormal shot.
    After a week I got rid of the sharp pain in both knees but I started feeling abnormality in walking. That was followed by a constant dull pain while standing too. Without any delay I went to my favourite orthopedist who told me it's just some swelling in knees due to overuse. He penned down some NSAIDS and told me to have them for a couple of weeks and assured me that it'll be fine after that.
    *It didn't work. This guy told me to wait and rest until the knees recover. I went to another smart orthopedist who told me with a straight careless face that it won't get better. I've patella alignment issues which could be there since my birth. He further advised me to not run, climb stairs and jump throughout my life if I want to be pain free for the rest of my life. He wasn't sure with just the xray so he recommended glucosamine chondroitin pills for 21 days to see if it relieves pain.
    Most of the doctors and all physiotherapists agreed that I've chondromalacia patella or anterior knee pain or patello femoral pain.
    *So then I went for an MRI and nothing showed in it. Note that I did not get burning until my first 2 months. It all started after my foolish attempt of trying to run and use stairs to check if the problem actually worsens with that. The burning still hasn't left me after that. My left knee is always more sore.
    * Giving up on doctors I read your book on Kindle and then started my recovery regime too. I've bought MI band for accurate step counting which I wear on my left ankle. I am following all your guidelines as per the book.
    With this I would like to tell you I've done physiotherapy for more than a month and it hasn't helped me. It's increasing the pain actually. I am still working on some light excercises for glutes and quads. I walk about 3000 steps on AVG everyday.
    *I've no issues in bending the knees in air obviously but extending my legs results in popping and a feeling of cartilage rubbing. My age is 21 and I wonder how muscle imbalance can occur so suddenly.
    * I am facing problems in getting up from chairs and also using stairs is troublesome for me. Just like you I get pain the next day or the day after that. Sitting and standing has been troubling me since the 3rd month. Weight has never been a problem for me as I am just a bit underweight. I am persuing engineering and I can't stay away from my routine so it just goes on. I've tried walking more steps but it causes my left leg to feel weak.
    * I am sorry again for this long msg and I don't know if you'll reply again after reading so much. Thankyou so much for your time sir and I am looking forward for your next book.
    PS: I just want to prove my doctors wrong and beat chronic knee pain๐Ÿ˜…. I just hope I get old knees back and I can live a good sports life ahead. Love from India. Thanks.

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    1. Yes, the traditional physical therapy (which I got too) can be deadly for knee pain. I'm usually skeptical of theories that blame malalignment, muscle imbalances, crookedness. But sounds like you've got a hard-to-diagnose problem.

      Anyway, I hope you can find a good physical therapist. You need someone who believes in what Doug Kelsey believes in -- not sure how you can find that person in India, but I bet such a physical therapist could help.

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  16. Things I've tried are: ozone injections, glucosamine chondroitin msm gel, some physiotherapy, massage, some cycling, application of oil on knee directly, NSAIDS, resting, meditation everyday, fish oil supplements, multivitamins, and praying for my recovery everyday.

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