Well, it’s about time again for an open comment forum. So, below in the comments section, please talk among yourselves. I’ll keep my piece short.
If you’re looking for a topic, here’s one: how have you found that diet affects your knee pain? This is something that interested me during my recovery. I read a lot about foods that supposedly help damp inflammation. Readers of my book know I ate a lot of garlic because of its reputation as a supercharged anti-inflammatory.
In the end, I’m not sure it did much, or anything. But that’s not to say diet was totally uncorrelated to my knee pain. I noticed a slight negative effect when I gorged on saturated-fat-heavy food, such as pizza.
So what’s your experience been? Please comment below. Or feel free to discuss whatever you want to, or just introduce yourself to everyone.
Happy Halloween!
Hi Richard
ReplyDeleteI have recently been diagnosed with osteoarthritis, and have been told by a consultant that nothing can be done apart from knee replacement surgery to both knees. As you can imagine I experience pain with movement. One of the first things I did was to drastically change my diet. I have elimated all fried foods, and have done a lot of research on what to eat. I have been this way now for two months, with the first month being literally laid up on bed. I now move about but limited. What I would like to know, does you book shed light as to exactly what you did to achieve mobility again without pain. Also how you dealth with the stiffness of the joints. I don't want to buy a book that has only research studies. Looking forward to your reply. Thanks Lesley
Hi Lesley,
DeleteSorry - I’m not Richard!
I was diagnosed with split cartilage on my kneecaps. The surgeon recommended scraping and washing but I declined because I thought it might make me worse.
It sounds like your condition is more serious than mine but I hope that this helps:
The start of Richard’s journey is to be able to walk a limited amount to begin with to a prescribed frequency.
For me, I struggled with that at first. I spent 1.5 years trying the walking.
Richard recommended Doug Kelsey so I bought his knee osteoarthritis book.
I started with very gentle knee motions and “quad sets” as recommended by DG.
I then bought the Total Trainer, Ad recommended by DG, starting at squatting 5% of bodyweight. Much less load than walking.
I’m now at 63% of bodyweight and able to follow Richard’s book during the day and DG’s stuff AM and PM.
Apologies for rambling!
I suggest sharing more about the challenges in your daily life on this site. Not to mention the medical side too?
There’s some helpful people here so fingers crossed��
Oops - I meant half a year not 1.5....
DeleteHi Lesley -- the book isn't just research studies; there's a lot of personal experience, and personal experiments -- what I tried for my knee pain, and what worked and what didn't. However, I should warn you, it's not a book full of exercises with photos and diagrams. Some people are seeking that, and if you are, this probably isn't the book you want. I talk about what I did to heal, but it wasn't very complicated. Mostly I did slow walking as a high-repetition, low-load activity. The walking built up in speed and intensity as I improved.
DeleteAs far as you know "Saving" your knees wasn't complicated. I suspect it was more complicated than you know. Which bothers me, because you conflate what "saved" your knees, with what might save another's. And that might be complicated.
DeleteThis is partly why I don't post here any longer. I think that cartilage healing is often, particularly in difficult cases, hermetic aka, exclusive to the individual.
Ed
The above post is where I partly demonstrate the glitch in my neurons that made me no friends during my rocky passage through orthopedia, but conversely, probably also helped me heal from an official, multi-focal diagnosis of grade 3 patella/condyle degeneration, with trochlea defects. A diagnosis made almost 6 years ago during a sport-med arthroscopy that produced profoundly negative and ultimately bilateral, "post-surgical changes" in my knees.
DeleteChris Hedges thinks "rebels" (if I can flatter myself that I am one, at least with things cartilage), are necessary for change, but not worth the hassle to keep around after their work is done. I changed/healed my knees and now don't want to cause disruption or sow doubt with the good work going on here and feel regret when I think I do. I don't know what percentage of chondro/PFPS sufferers fall outside the Envelope of Functions protocol to effectively heal inflammation/arthritis/degeneration...? That number of people suffering from causation that is ideopathic, with a cure that is anecdotal? I hope it is a small percentage.
Ed
You make a valid point. I feel that in this illness specifically, there is a idiosyncratic emotional/psychological dimension that cannot be overstated. However, my criticism of both of you is that you seem to be too much cartilage focused, although my feeling is that at times Racer comes closer to the kernel when speaking more about inflammation. But so much talk about cartilage may be a heritage of the structural train of orthopedic thought. Do you really believe it is cartilage you healed rather than mind/body as a unit?
DeleteNo doubt cartilage has an essential role. But perhaps I am significantly younger than you and that is why I started to perceive things differently. I am grateful that mine cartilage was mostly intact during my meltdown. Perhaps this gave me a larger margin for errors. With my stupidity and the mistakes I made, I wouldn't have had a chance if I was around my 50s. Now we will see. For myself, I feel more comfortable to think that I am fighting fire rather than cartilage deficiencies, though I still have quite symptomatic lesion in the fibula. But it is ultimately fire that my mind let in the body. The same mind that tries to device a plan to heal (hat tip for this insight Racer). It is like Baron Munchausen pulling himself out of a mire by his own hair. Fire is not something that shows on a MRI or rather it appears but as an after effect. Then the after effect sets more fire.
As for EoF, I often think along the same lines. How many people are systematically outside of it so we have healing as a freak of nature rather than a rule though it is clear there is this innate capacity to heal. But consider this. To determine the real EoF is not an easy feat. At least to me. It has a lot to do with accepting and embracing the real state of affairs, which may not be an easy thing to swallow. Also, when my muscles shut down and I lost neuromuscular control, it also the mind that disconnected from the knees. TriAgain had the urge to amputate his source of pain and that is natural. How do you re-establish intimate connection with the joints again? Or rather for the first time or you wouldn't have been in this mess to begin with. It took me almost 1.5 years with several "aha" moments along the way to start to detect minutest changes in the condition and trace back the causality. Also to weed out the tendency to do as much as I can, which is not conducive for my healing because I have severe overuse injury which unlocked the arthritis gate. Oftentimes, I can do more by doing less.
Also, there are strong socio-economic implications. I would have been totally lost if I wasn't a freelancer working at home. I've set up everything according to my EoF, which is still abysmal due to soft tissue damage, which has to be surgically removed. How many people do have this comfort and not feel pushed to do some drudgery that is well beyond their real EoF? Day after day until their knees "wear and tear" for real, which is then declared normal course of life. Also how many people can get into an arduous monotonous lifestyle necessary for healing and do not go insane? And sustain it for 30-40-60 months or whatever necessary for very complex conditions? Also could there be a point of no return? I like to think that Racer's condition and heroics seems to disprove this hypothesis to a large extent.
Additionally, consider the constant pressure to "act normal" that the milieu gives you. I am a male in his prime who looks 7-8 years younger than his peers. The expectations are to be a robust productive member of society and not a cripple by any means. That is why I had a sad old man looking at me and telling me I have psychological issues rather than knee problems.
So the concept of EoF is trickier than it seems at first glance.
All the best to all healing their knees!
S.
Good post Sveto. All of that resonates with me. Regarding the point of no return, my knees definitely felt they were past that point, but my brain refused to accept it. Life was hardly worth living the way they were. And as it turns out, they could indeed be healed (or more accurately at this time, massively improved). I tend to lean more to the systemic inflammation cause too, more than the cartilage damage cause, but what do I know. I just know that (N=1), I have cartilage damage, quite severe in one spot on the back of my R patella, but it was widespread chronic inflammation in both knees that caused my 5 year nightmare, not the cartilage damage - though perhaps the cartilage damage caused the dual meltdown?
DeleteAnd I can relate with what you are saying about a state where the legs feel totally gone and life seems unbearable. Really glad that those days seems to be behind us.
DeleteCheers, pal
Hi Sveto,
DeleteDon't misunderstand me when I say "all things cartilage," that I am a cartilage structuralist, it's more of a turn of language. You know me better than that after all of our email exchanges. In my case, "my case" being the operative words, I think of my my knee problems as being inflammation, arthritis and degeneration and I approached healing them at those points, trying to understand how the three interacted with and overlapped each other, how the feedback loops of inflammation and arthritis might be at times be reversed and what stressors (psychological,structural, etc.) activated them collectively and/or separately. I built a fairly complex EOF based on what I thought was the dynamic interconnection between the 3. A fluid response to inflammation, arthritis and the state of my very real degeneration/injury, particularly to my surgically altered knee and in light of my preexisting grade 3 findings, which I tend to, ironically, think of as the least meaningful.
I hope this makes sense to you.
To the above- Good luck to all healing their knees, Racer-X, Ed
DeleteYou continue to amaze me and admittedly the last one to blame for being sterile structuralist:) I just wanted to underline that massive inflammation/rapid degeneration can occur with all structures seemingly fine at least imagewise. So it is hard to believe that structure is the prime mover as they sell it, although it is very real factor, especially beyond certain point. Also for the record - structuralism is very handy lens to see some aspects of reality.
DeleteCheers
The other thing I want to acknowledge is the hope and comfort I got from people on this blog - especially Ed - who was on the same journey as me. I got absolutely sweet FA in terms of hope from the over-paid 'knee experts', with the exception of Dr Dyes online material.
DeleteI'm partly with you here, Ed. I think there's a more idiosyncratic element to healing bad knees than I first thought. Still, I'm wary of going too far with that, because if most people have to find their own unique path to healing, and there is hardly any overlap between those paths, then there really isn't much to be gained from shared experience for them -- which I thing is not only depressing, but mistaken. I guess at heart I'm optimistic that most of us can benefit from a certain framework, in this case envelope of function, though some changes in protocol may be needed at the margins.
DeleteBut -- I'm sure there are hard-luck cases that are very idiosyncratic. Also, by the way, when I say that healing my knees wasn't complicated, this is one of my favorite paradoxical constructs. It was the easiest/hardest thing I've done. What I mean more by that is that it was based on a simple activity, and that was walking. But in totality -- trying to gauge feedback from my joints, experimenting, etc. -- yes, it was certainly very complicated. I realize that in trying to answer people who comment here, I'm not always clear on such things.
Anyway, glad you're doing well. I'm sure at this point, if we were on bikes, you'd beat me up the mountain!
I'm with you Richard. I think the protocol that cures the most people should be the model represented by science for medicine (insert knees here). As opposed to the for profit representation that rules the paradigm now, that tried to kick me under it's bus and who I hold accountable for the arduous and perilous journey it took to heal my knees. Yes, my approach is impractical as "model" and anecdotal at best.
DeleteAs to the top of the mountain via the bike- This season I "cranked" out some OK 20 minute numbers for an old fart (and I'm 55 YO) and better as an(X) sprinter : )
Thanks Richard... For your work blazing some of the major the trails that I followed. And to Dr. Dye, Paul Ingraham and Doug Kelsey too. I owe all of you a lot. I made a few of my own.
Good luck to all healing their knees, Ed
I think yours is a great story, Ed, and so is TriAgain's. I think you were both in a deeper hole than I was. My hat's off to you two.
DeleteWhen biking and running before the problems arises at the same time i was taking Proton-pump inhibitor for my gastrics problems i always felt my joint much more dray.I noticed the same effect when on creatine!
ReplyDeleteWhen on BCAA the dry sensation on the joints
slightly subsidize.
I bet that the long run omeprazole intake had a crucial role in my knee problems.
I discovered that additives in processed foods, especially preservatives in foods and medications, made my knee pain and inflammation much worse! I have multiple food intolerances/sensitivities and identification of them, followed by total avoidance of them, definitely improved my condition; however, it did not 'fix' my knees.
ReplyDeleteLook into "nightshades" and inflammation. There's a lot to learn, so make it a project. There's a book worth of info just there. I went nightshade-less for a few years when I was a fully involved, post "sport-med" procedure, bilateral degenerate and I think it helped reduce my inflammation. The nightshade free life is difficult if you like potato chips, tomatoes, salsa, etc. Now that my knees are better, I eat nightshades in moderation.
ReplyDeleteI'm not a vegetarian now, but when I was experiencing severe inflammation I hoed that row, so to speak (go certified organic, again with no nightshades). If you do insist on meat, stay away from the industrial strength, antibiotic and growth hormone extravaganza stuff. Grass fed is expensive, but I think helps reduce inflammatory response. Also when thinking of meat, keep it lean. Obesity is a possible structural cause of arthritis/inflammation, but certain types of fat and their tendency to oxidize are another less talked about source of inflammatory causation, systemic and otherwise.
Caveats eating foods with sources of phytic acid, like beans. I eat beans cooked from scratch only, which is a 24-36 hour process. Phytic acid causes intestinal duress and reduces the availability of nutrients.
It's good to think simply about food. Read ingredients. I am absolutely against artificial sweeteners(AS). One brand of (AS) converts to formaldehyde when heated in transport. You'll have to do the footwork on the others. My point is, back to nature, with food and otherwise.
Ahh diet... I think it would be easier to see what people were eating, rather than pontificating about some fraction of what I did or didn't eat/ingest.
Like: Alcohol? Some types, all in moderation. Some types (like "lite" beer) not at all.
Sugar? No. Why? It's complicated.
Etc., etc., ad nauseam.
Then there are ideas about the relationship between food and addiction and addiction and depression and depression and inflammation. Not necessarily in that order.
Good luck to all healing their knees, Racer-X, R-X, Ed
Diet is my biggest weakness Ed in an otherwise quite disciplined life. I know there's lots of stuff I really should not eat much of at all (processed carbs, sugar, too much beer/wine) for weight control as much as inflammation control - but this is my area of vice! I'm trying to go more paleo but laziness in this area usually defeats me.
DeleteMy knees continue to improve though. Just this week I was thinking they are probably now 90% back to normal and seemed to have gone up another small level. I can squat & crouch a lot more now.
Cheers mate.
No judgements my friend, there are different paths to the top of the cartilage healing mountain. The important message, that cartilage heals and sometimes differently per individual.
DeleteI know, I know, your at 90 %! Amazing and "awesome," as some say in California. It makes me smile... We've been through a lot.
Cheers to you too.
I do low carb. It helped a little, but wasn't magic.
ReplyDeleteDiet, stress and sleep quality all play a significant role in the level of my joint pain I've found. I've learnt lot in the past couple of years but one option I would point people to would be the fasting mimicking diet that Professor Valter Longo developed. You don't need to buy the expensive set of not very much food for a week from ProLon - there are recipes online you can use instead. It's 5 days and you can do it as little as once or twice a year but it basically clears out old damaged cells and creates a load of stem cells in various tissues and when you feast against on day 6 you get a regenerative effect. Suppresses inflammation etc. He's done a TED talk here https://www.youtube.com/watch?v=dVArDzYynYc
ReplyDeleteHere's another fascinating thing: Fibre and knee osteoarthritis.
ReplyDeletehttp://ard.bmj.com/content/early/2017/05/26/annrheumdis-2016-210810
There were no structural differences between the high fibre eaters’ joints and low fibre eaters’ joints or at least that could be seen. The difference was in their likelihood of experiencing joint pain. So they might both have radiographic OA but the high fibre diet seemed to reduce the chances of experiencing symptomatic OA. Why?!
The authors state “ Dietary fibre reduces body weight and inflammation both of which are linked with knee osteoarthritis (OA). We examined the association between fibre intake and risk of knee OA”
We know that fibre interacts with gut bacteria to produce various beneficial effects on the body. But if inflammation was reduced and thus pain was reduced does this mean that inflammation has no role in changing the joint structure? Anyway in some ways that's academic. If you want to avoid inflammation and pain in your knees then eat more fibre. Studies on the gut microbiota have shown that it's important to eat a variety of fibre as well. Don't just go all out for a single type.
And lastly.. Here the authors show see that magnesium intake correlates inversely with radiographic knee osteoarthritis
ReplyDeletehttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127666
So eat more greeny leafy vegetables, almonds etc which all have lots of fibre too.
I started drinking concentrated cherry juice for other issues, and an added bonus was that it helped with the inflammation in my joints (knees and left hand). But I think I got the most benefit from taking a strong probiotics supplement. Within 3 weeks, a lot of my digestive problems had calmed down, but also I slept better, had more energy, and less pains overall. I give probiotics to my kids who have adhd (child 1) and autism (child 2), and it improves their behaviour greatly, but also their sleep and general wellbeing. If you read this book, it explains the link between the gut and the brain and the impact on the body functions: Gut: The Inside Story of Our Body's Most Underrated Organ, by Giulia Enders
ReplyDeleteFor me personally I discovered sugar was a major irritant to my knee. At my favorite coffee shop I ordered a coffee with medium cream and light sugar, but the barista must have mixed the two because there was a lot of sugar. Not wanting to waist it, I drank the whole cup. That night my knee felt much worse than it had in months. Since then I've cut way back on sugar and have felt better, not as if the absence of sugar is healing my knee but allowing it to heal, slowly. I didn't go cold turkey but I avoid juice and anything with added sugars. I use coconut to sweeten my breakfast instead of honey.
ReplyDeleteHi,
ReplyDeleteI would love to get the opinions of Richard and this community on my chronic knee pain.
I'm 38. I started feeling minor knee pain in my right knee starting in my early 20's. The pain has worsened over time without any major trauma. I assume that it could be osteoarthritis but i feel powerless to do anything about it. If there is a way to heal or save my knee or rebuild cartilage, I want to try it. I've had xrays and an MRI that seem pretty inconclusive. I've tried PT. I'm am active healthy person. I don't experience pain when walking. That majority of the pain is when going up stairs and placing weight directly on the knee. It sounds creaky, medical term Crepitus. The osteo PA was very dismissive of me, telling me to take ibuprofen when it flares up. However, it's never outwardly swollen. This is not an athletic injury. I have tried a couple of calcium supplements recently. Jarrow Bone Up seemed to make it feel worse . Now I'm talking Garden of Life plant based calcium. I was vegetarian in my 20s. Now I'm vegan.
Thank you and Happy 2018 to all!
Hmm. Stair climbing can be really hard on bad knees. But if you tolerate walking well, that's a good sign at least. A couple of quick thoughts: (1) You could look at investing in a total trainer (or finding a place that has one that you could use). That would allow you to practice unloaded squats, with the intent to increase the difficulty over time, so that you strengthen the joint. (2) If you can tolerate cycling, that's a great exercise for building up quad muscles, which could help take some strain off your knees. Other readers here may have different ideas. Good luck, and check back and let us know how you're doing.
ReplyDelete