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).

15 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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  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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