I’m going to throw the blog open for comments for a few weeks (popping in to clean up spam comments on weekends, as usual).
I’m having trouble typing right now because I crashed my bike on Aug. 11. I broke two bones in my hand. The money break, as the ortho put it, was the displaced fracture of the fifth metacarpal. It’s in my right hand, which is my dominant one, so that’s unfortunate.
But it will heal, and hopefully be close to what it was.
Okay, enough about me. Below feel free to post comments, solicit advice, provide updates ... all those great things that the open comment forum is good for. In short, talk to and help each other. There’s a lot of accumulated wisdom in this blog’s readership.
If anyone wants a subject to discuss: What about something upbeat? Try this: What’s the greatest achievement you can point to during your recovery? And to what do you attibute it?
Okay, all from your left-handed typist for now. Cheers!
Life time commitment when it comes to knees healing.. water walking plus yoga stretch everyday for the rest of one’s life ...
ReplyDeleteMy greatest achievment was when I was able to do squats at the highest level on my total trainer without any pain. It took many months to reach that level.
ReplyDeleteHello! I haven't written on this blog for a while, but I wanted to report back in that my knees are significantly better!
ReplyDeleteIt's been a long road. I used to love biking, hiking, waltzing, but all that had to stop when this knee trouble came along. I even had such bad flare ups that I had to be in a wheel chair because moving my knee was so screamingly painful. Also, less dramatic scenarios in which walking would cause a flare up and also insisting on taking the elevator for even 1 flight of stairs.
I want to thank Richard for the idea of using "high rep & low load" to thicken the synovial fluid. Most people focus on strengthening the quads, but that just made my knees flare up. I had to quit the "strengthen your quads" approach and stay focused on the high rep / low load method.
Since 2016, what I've been doing for knee recovery is basically high rep -low load exercises in water. I started by wearing what was essentially thick, neoprene knee braces and just did light motions for a short time. Not "swimming" but just moving gently in the water (deep water -- can't touch the bottom.) Then over time, my water workouts became longer. After several months I finally took off the knee braces -- which was quite scary, But I was super cautious and scaled back my activity level for safety. My knees complained but I didn't have a flare up. So, over time I was able to slowly built up to full-on swimming. My knees just kept getting better. Now I can full-on kick kick kick with tremendous large splashes and my knees are ok. It's amazing. :)
I've started experimenting now with land-based activities. In May 2018 I have started biking again. I started super slow on flat for a short distance like 4-5 miles. No hills. No slopes. Flat flat flat. After my ride, I stretched like crazy. Then .... Waited 72 hours to see if my knees will flare up. Everything ok? Also, during the 72-hour wait period, I do move my knees. I keep walking. Swimming. It would be a disaster to not use them during those 72-hours. But I just do light activity.
Then...,the next time I biked I did a slow ride on flat for just a little further: 5-6 miles. Then.... Wait another 72 hours with just light movement. Everything ok? Yes? Then try a little further next time. My knees did complain a little during the 72- hour waiting periods. Which was scary. So I kept to very easy flat biking for a while until the complaining stopped. But I never had a full-on flare up and the complaining did die down. So. I've been cautiously proceeding and in July I added in slopes. And if the slope is too steep, I get off and walk. I don't want to over strain my knees at this point. I'm just so grateful to be back riding my bike.
The last time I was able to ride my bike was.... October 2012. My knees had been doing well over the summer of 2012....,,but then I had a catastrophic flare up after a tough bike ride in October 2012. So. Now I've learned the hard way that even when my knees seem to be doing well, don't push them too hard too fast. Patience. Patience. Patience.
Starting July 2018, I'm also experimenting with a court sport running around after a ball. This is potentially knee suicude due to twisting and quick rushes.....so initially it was a bit terrifying. My knees did complain a bit in the days afterwards. So, I am being very cautious. I'm always waiting 72 hours before trying again. But... so far no flare up. So. I'm cautiously continuing.
Anyway.
Things are looking up! I am very encouraged and hopeful.
I hope I will be back to Waltzing again soon, too. :)
Your story is encouraging and gives me hope that there is light at the end of the tunnel. I have a few questions about your strategy and timeline.
Delete- when did you start to have knee pain? Were you diagnosed with patellofemoral syndrome?
- did you use to have pain only while exercising or even at rest? Did you have pain on a daily basis or just if you flared up the knees?
- where was your pain located and how did it feel (tingling, aching, burning etc.)?
- so basically you started 2 years ago the low load/high rep approach and stopped completely strengthening?
- were your knees pain-free when you started the exercises in deep water? Did you find that the pain gradually lessened as you kept doing the deep water workout?
- how did you manage to go about your life without flaring up the knees? Did you left your job? Did you go on a wheelchair for a long time?
I personally find that it's the activities of daily living that are keeping my knees in a flared up phase. But I have to work to support myself and to do all the house chores on my own, since I am single.
Sorry for so many questions, but I am in a desperate search for hope and optimism.
Hi Marion. I'm glad my own journey is giving you hope. I will write a longer reply later, but just wanted to post this quick reply now to let you know I saw your questions.
DeleteKnee Pain,
DeleteThank you for providing your story. I also appreciate the thorough detail below about your 72-Hr Rule & definition of "risky activity".
I too am interested in your answers to the questions Marion has asked.
If you don't mind I would like to ask a few additional:
- Did you ever have noticeable swelling in your knees & did that go away?
- How did you perform your deep water activity? Was it essentially treading water with your arms and gently moving your legs? Did you use a flotation device? And for how long would you do this in each time (min) in the beginning, was it daily? And how gradually did you increase the duration?
I too know these are a lot of questions and appreciate your time in helping the rest of us.
-John
Hi John. This is a quick note to say I saw your questions, too. I feel I want to carve out time to write out a thoughtful reply. I will try to make time this weekend.
DeleteI'm sorry that anyone is suffering from knee woes. So tricky and frustrating. I'm grateful everyday that currently I'm doing so well. And I'm I'm walking the fine line between feeling exciting and wanting to do more vs. being terrified I might "over do it" and go into a knee relapse. So. Am trying hard to follow my own rules and be slooooow and cautious and patient. Patient patient.
Great to hear, Knee Pain, and thanks for the update. I think it's always valuable when people check back in with updates, after a few months or years, and tell us how they're doing. Cheers!
DeleteHi! I keep trying to write out answers to Marion & John, but I've been working on my knee pain & recovery for soooooo long that I write way too much and it wasn't very organized. But. Finally I've broken it into segments!!
DeleteI think I'll do better by tackling just one segment at a time.
But first, don't get discouraged by my background and history which is pretty dire (in my opinion because I had to live through it) and I have gone through so much discouragement.
But. Take heart! Because if someone with my extreme levels of ups and downs and disability has finally (hopefully) gotten to a place where I can swim, bike, and play a court sport (running around after a ball -- including jumping!!), then I would think there is hope for other people as well.
BACKGROUND & SYMPTOMS & STRUGGLES
DeleteI was diagnosed with chondromalacia patella in 1993. In later years, it's also been diagnosed as PFPS. Doctors say that the kneecap is not tracking properly and that is what causes the pain -- that the cartilage has worn down too much. There's no signs of knee arthritis.
My pain is in my right knee. Left knee has been doing ok all these years! But starting around 2010 it's been complaining due to me over-compensating. But, it is hanging in there.
My bad knee doesn't swell or turn red or other colors. It seems to me to look exactly like my good / healthy knee -- even when it's at its most painful.
Unlike most people in this blog forum, I don't have the "burning and aching" you all talk about. Instead, when my knee is irritated / flared up, I get stabbing pain when I bend my knee. The severity of the pain can range from a just a dull stab to a gut-wrenching pain. (It feels like a flying elf is hovering over my knee with a long knife and gleefully plunges it into my knee. The level of pain depends on how big of a knife the elf is carrying that day.) I only get these stabs when I move my knee. Not at rest. Just depends on how irritated my knee is.
So... When my knee is super flared up then yeah it's just completely unbearable. But when my knee is not too flared up, then I'm just walking around super cautiously hoping that I don't do anything to aggregate it. Then. If it hasn't had a flare up for a while then I cautiously feel like OK now maybe it's time to exercise a little bit to try and actively improve it. But. So often this causes a setback.
I didn't quit my job -- I think mainly because my knee does not hurt unless I move it. So. as long as I sitting perfectly still, then it doesn't hurt while I'm sitting. My type of work uses a computer, so I can still type with my fingers without moving my knee.
In fact, I went on 2 business trips with the help of a wheelchair when the pain was just too bad and I just couldn't walk very far.
I've also had to use wheelchairs to get through museums, sea world, airports and other typical holiday attractions when I've had an extra bad flare-ups during vacations. Which was a bummer, but no way I was just going to sit in my hotel room!
I've also used a cane for when the pain was bad, but not bad enough for a wheelchair. Also, when my knee is pretty bad then I would take a taxi to work in order to walk the fewest amount of steps instead of take the bus. But for the most part, I just move slowly.
I've trained myself to never ever run or jump. Ever. That would cause a flare up. I don't even move quickly. Stairs are a constant nemesis (especially walking down stairs), but I can conquer them one at a time, making my good knee take on all the burden. Even curbs on sidewalks, I always use the good leg to get me up the 1 step. Squats? Lunges? No way. Wall sits? No, tooo much pressure on the joint.
As for household chores, kneeling or squatting are not a possibility. I just have to sit on the floor or in a chair. For example, for cleaning sticky spots on the kitchen floor, I have to literally just sit on the floor with my bad knee straight. No kneeling.
I've had soooo many ups and downs since 1993. Actually. Mostly downs I guess. Minor progress..... and then a setback. Over and over and over and over and over. :( I've had setbacks caused by
-- carrying heavy things (such as a heavy old computer monitor)
-- pulling a rolling suitcase
-- running to catch a bus
-- dancing
-- biking
-- any activity where I need to put weight on a bent knee.
-- setbacks for absolutely no reason. This is the worst when I have a horrible flare up an I do t think I even did anything to flare it up. :(
I promise. There's a happy ending. (I hope.) But. I thought it would be helpful to have a section called "background & symptoms" to see the "lows" before sharing what treatments I've tried.
TREATMENTS (that didn't really work)
DeleteFor the most part my various doctors have recommended physical therapy in the form of strengthening the quads and the vastus medialis. I'm sorry to say that I really don't think that worked for me. Even before reading Richards book, I had the gut-feeling sense that when I'm trying to strengthen the quads, it flares up the knee joint itself, sooooo.... instead of helping me, it kind of sets me back. So I was very discouraged.
(It was only after reading Richard's book (in 2012) that I felt like my gut-feeling was validated! Meaning.... strengthening the quads was not the right initial treatment for me. That before I can strengthen the quads..... somehow have to help the knee joint itself not me so aggravated. Then once the knee joint is at a certain stage of calm health, then I can start CAREFULLY strengthening the quads.)
I've also tried insoles for my feet.
Ive also tried Taping the knee cap. (This had some success as you'll see later, but, now I don't think it's because the knee was taped! I think it was because I was doing slow, low load / high rep exercise and my kneecap just happened to be taped at the time.
In the 90's, some surgeons suggested lateral release, however I did not take that option because The success rate wasn't very encouraging and also because they said that if I do the surgery or if I do not do the surgery I would still have to do the same knee exercises for the rest of my life anyway. Anyway. I always felt I could get better through physical therapy / exercise .....yet I couldn't quite solve it.
In 2010 I had the synvisc injection. That made it worse and my knee got s brand new symptom which was that it would catch & lock up, which was also horribly painful. (I think I'm a super rare case that actually seemed to have a negative reaction to the synvisc.)
Then in 2010 I had arthroscopic surgery to smooth out the cartilage in the knee. Before I had the arthroscopic surgery in 2010, I went to another doctor for a second opinion. That doctor thought I should get a total knee replacement. So. I decided to go with my original doctor's more conservative assessment and just smooth out the cartilage using the arthroscopic technology.
The result was that it definitely helped with the knee locking problem! My knee never once locked up again after that.
But. I don't feel it helped with the original problem. I kept having irritation and flare-ups.
I asked my doctor if she thought I should next try the total knee replacement? But she felt very confident that I should be able to get well with just using physical therapy. So. I was happy with that because I really did not want to do a total knee replacement. And also I really did hope that I would be able to get better. So, I kept trying to use natural methods to get better. But .... Not very successfully ....until I tried water therapy starting in March 2012. More on that later. :)
As recently as 2014/2015 I had another super painful knee flare up (caused by absolutely nothing!!) where I could just barely walk and yes once again had to use a cane and also get pushed through the airport in a wheelchair. I was soooo discouraged.
But wait!! There's Good News in my next installment. But I just wanted to share my history so you know where I'm coming from.
DeleteWHAT HAS WORKED!!
OK so as I wrote previously, my knees are doing very well right now and I'm grateful every day.
Currently I can swim, bike (up to 10 miles with small slopes), and play a court sport (running around after a ball on a court -- including jumping!!) I can walk up and down stairs without pain.
I'm still scared I could have a setback, but I keep trying to move cautiously forward.
This is the THIRD TIME I've gotten to this "happy golden knee health level" with my knee. Unfortunately ....the first two times I got to this happy golden level ...... I had catastrophic relapses that put me back in the Well for years. Yes, it took me YEARS to climb out of the Well. But I think part of the reason it took me so long was because I didn't have this concrete strategy of "high-rep / low load." So. Here I am again and hope to stay here this time!!
I think that the thing that seems consistent with how I've achieved the "happy golden knee health level" is the low-load / high rep that Richard talks about in his book.
I sort of "discovered" this on my own two times. I didn't have an explanation for it as I did not yet read Richard's book and I didn't realize I was doing "high rep / low load"
However now this third time that I am achieving this "happy golden level of knee health," I did specifically think about high-rep/ low-load as my Sole Strategy. First thicken the synovial fluid and get my knee joint to a happier place. Then only after my knees are feeling a ton better, try strengthening the legs.
HAPPY GOLDEN KNEE ERA #1
The first "happy golden era of knee health" was approx 2000- Sept 2006. This started by me taping my kneecap into the "correct spot" (what I learned from a physical therapist) and then gently biking. I started off with just very short and easy. Flat. I would walk my bike up any slopes. Over time, I built up and was able to bike further and with tiny slopes. Then, over the course of months and years, I built up more and more and I could bike really tough routes and even up mountains. I danced. I learned the Lindyhop. I hiked. I learned to windsurf! I could walk up and down stairs without pain.
Now looking back, I don't know if taping the knee cap was actually helpful or not. I might have really been that I was doing a high-rep low-load exercises very carefully and gradually. Or maybe the tape did help because my knee like that extra support.
But! In 2006 I had what I call "a catastrophic relapse." Why? Well. I'm Not totally sure, but I SUSPECT it's because i had a lifestyle change in which I wasn't as physically active. I stopped biking as much. More sitting. Less moving. And then, after a night of very intense waltzing... boom. That was it. Back to all the pain. It was devastating. And I wasn't able to climb out of that painful knee place until 2012. (I call it "being in The Well" when my knee is so irritated and flared up and I can't do anything without it seeming to get worse.)
HAPPY GOLDEN KNEE ERA #2
DeleteThen in HAPPY GOLDEN KNEE ERA #2
Then in March 2012-October 2012 I had my second happy golden era of knee health.
I got the idea of doing water therapy!
I got a book called "the complete waterpower workout book" because it has suggestions for people with bad knees (and all sorts of other injuries).
It also has photos showing what to do.
I wore my neoprene knee brace to start.
Some involved standing in chest high water and doing movement like moving my leg in a circle. Some involve wearing a floatation waist belt in deep water and moving my legs in different ways.
I also learned I have to listen to my knee because it didn't like all the leg exercises -- even the ones to help with "bad knees." For example .... swinging my leg forward with a straight leg -- as I recall -- was too intense for my knee initially.
So, I had to just skip some leg motions, and then sloooowly work up to them.
One great thing that I learned is that the speed of the leg motion makes a huge difference. So maybe with one activity, moving my leg super slowly is safe but if I move it too fast then the resistance from the water is too much and then that is not good.
I think the one my knee liked the best was basically the one where I'm floating with the waist floatation belt in the deep end and I lift one knee up slowly and then move it down slowly, and then do it with the other leg. So eventually picking up speed over time then it's almost like jogging in place. (But you can't start with the mentality that you're going to be jogging in place. I might be too intense. So initially just thinking of lifting the knee up and then putting the knee back down like super slow motion jogging.)
Anyway. After about a month I took off my knee brace. That was scary. And I did have a little trouble. But, was able to work through that by just going slower and more carefully.
In July 2012 I got Richard's Saving any Knees book and read it in one sitting.
I learned about high-rep / low load.
I learned about delayed onset pain.
I started posting on this blog about how I was improving.
Then after my knees were starting to feel better I started gently biking again. And I could go up and down stairs without hurting. Amazing!! And then I started biking more and i started biking more.
I thought I was CURED!!
But. No!!!
Then I "over did it" on one of my bike rides and BOOM that was it. Another catastrophic relapse. That was October 2012. I admit I was pretty discouraged.
Now looking back, it's clear I pushed it too hard too fast to go from gentle water therapy in March 2012 to pretty intense biking in October 2012.
DeleteTAKEAWAYS FROM HAPPY GOLDEN ERA #2
My big Takeaways from Happy Golden Era #2 in combo with what I learned from Richards book were:
1) I'm a believer in low-load / high-rep thicken the synovial fluid. I saw it work two times for myself -- even though I didn't know it was called that or that the biking and the water-therapy were essentially doing the same thing.
2) I definitely agree with the idea of not even attempting to strengthen the quad muscles until after I've got the knee joint itself feeling calm and stable. That it's not aggravated by the least little thing. healthier (by going high rep / low load)
3) was so glad to learn that Delayed Pain Onset is a real thing. Not my imagination. it Helped give me the courage to believe in my own hypothesis that maybe I'm doing something only days later I will feel the negative result. So. I need to be patient and "let the dust settle" after doing knee activities make sure that I'm OK. This developed into my "72-hour waiting period rule" that I wrote about in another post.
4) Patience. Patience patience patience patience. I promised myself 100 times that if I ever got the chance to get to another "happy golden era" again, then I would be a lot more patient.
5) i'm grateful to have terminology for this strategy because .....well-meaning people tell me "you need to strengthen your quads" and then I can reply "well, my approach is to do high/rep low-load activities to thicken the synovial fluid first, and then when the time is right I will do the quad strengthening exercises." It's just nice to have something very specific to say instead of "quad exercises hurt me too much" then I get lectured on how well you have to have some soreness in order to improve and no one believes me that the quad exercises are actually damaging me and sending me backwards."
CURRENTLY: HAPPY GOLDEN ERA #3
DeleteOk this is my last installment. Finally! Lol!
Starting 2016, I used all this knowledge to try to make another big (but slow & gentle) push for a third "happy golden knee era."
It worked!! (So far!)
-- I can go up and down stairs without pain.
-- I've walked without knee pain for up to 5 miles
-- I can bike up to about 10 miles with small slopes
-- I can swim for up to 90 minutes
-- I'm playing a court sport (running a court around after a ball -- including occasional jumping)
So how I got to this point was once again using the water activity.
(One reason for doing the water again was that my bike got stolen. Although. I could've just used a stationary bike in the gym. But. Water activity just appealed to my spirit more. Also. It worked so well for me in 2012.)
However, this time I did my water activities in cold water. (BTW: I was learning on another post that maybe being in Cold Water helped reduce inflammation and that might've helped with my success this time.)
I did once again start with essentially wearing a thick knee brace to support the knee. Once again, not "swimming" but more like gentle leg motions. (When I did opt for "swimming" then I just dragged my legs.)
Over time, I built up to not wear the neoprene any more. Initially my knee was grumpy to lose the support, so I was scared. But, I was super patient and slow and I got through it fine.
Then I built up to actually swimming including my legs. (Instead of just dragging them.)
And I didn't really do any land exercises to supplement this. I just did the water activity.
And then over time I kept getting better.
By July 2017 I built up to swimming a mile!
But still, I wasn't supplementing this with land activities. Just swimming 2 times per week and sometimes 3 times per week.
Then in 2018 I really realized wow my knees are feeling pretty great.
So then started experimenting with land activities such as walking up to 5 miles
And I was doing really well so I invested in buying a road bike in April 2018. I started super cautiously riding short easy distance on flat. 4-5 miles. Then wait at least 72 hours. See how my knees feel. Bike another 4-5 miles on flat. Then wait at least 72 hours. see how my knees feel. Then. Bike 7-8 miles. Then .... guess what..... wait at least 72 hours. See how my knees feel.
Then. Wow well, my knees are doing so well. So. Then I decided to try a court sport running around after a ball. Trying to return the serve. Hit the ball back to the opponent. Then.... after a court session... wait at least 72 hours. See how my knees feel. I do not bike within those 72 hours!! That would be too much. If I swim, then I mainly use arms and let my legs kinda just relax. Move the knees, but nothing stressful.
The court sport did stress my knees some. I did get a few SMALL sharp stabbing pains within the 72 hour waiting period. So that was kind of scary. I had to decide.... what am I going to do? Am I going to try again? Or not?
I decided to try again and just be as cautious as possible. After a couple sessions, the small stabbing pains went away. Now it's been two months of trying the court sport and I'm not having any stabbing pains anymore. I am gaining more confidence moving quickly and even jumping (a little bit).
Anyway!
This is where I am now.
But.
I know I have to remain cautious.
I need to remain patient.
And it's really hard to be careful & patient because I'm feeling very excited that I can once again do all these different kinds of activities!! I feel like my life possibilities are opening up again!!
But. I do not want another relapse that's going to send me back into the Well. That already happened 2 times. So. I don't want that to happen again.
I hope this has answered Marion & John's questions. I know it was a lot more long-winded than you expected!!
Richard, sorry to hear about your broken hand!! Ouch!!
ReplyDeleteHi! I wanted to share a little more about my "72-hr Waiting Period Rule." This has significantly helped me with not having a significant relapse / setback / flare-up.
ReplyDeleteI developed this rule for myself via self-observation in conjunction with what Richard says is called Delayed Onset Pain.
As for the self-observation, I noticed that the pain almost never occurs WHILE I am doing an activity (which is diabolical because I don't even know when I'm hurting my knees. So frustrating.). However, my knees might flare up or complain 8 hours later, 24 hours later, 48 hours later, or even 72 hours later.
I was wondering if I was crazy. But then I read what Richard wrote about Delayed Onset Pain. Bingo!!! Suddenly I had a name for this phenomenon and I had the confidence that it is real.
(And. I'm talking PAIN. The bad kind of pain. Not just "muscle soreness." To me, Muscle soreness is considered a Good kind of discomfort. In fact, if I can ever exercise my legs enough to cause muscle soreness, that is a reason to seriously rejoice. But usually, any activity that would cause muscle soreness would be tooooo hard on my knees.)
Anyway.
My personal theory is that after doing some potentially risky knee activity (i.e., an activity that might cause a strain, a flare up, a setback), then I need to be careful for 72 hours. I have to just be patient patient patient and wait to see if my knees have a negative reaction.
During that 72 hour waiting period, it's important that I still move. I should not just be frozen in fear and try to protect my knees by not moving at all. That is also bad. I need to walk. Move my knees. Gently. However, don't do anything crazy like .... move quickly.
Oh also, I roll out the muscles around my knees using "yoga tune up" therapy balls within a few hours after the risky activity to help them from becoming too tight. I do think this helps.
The reason why I have to keep moving is because -- it seems to me that if I don't, then the muscles get extra tight around my knee and then that causes trouble. At the worst, tight muscles seem to pull my kneecap down (down through the joint towards the back of the knee.) And if that area under the knee cap is aggravated, then it feels like pressing a slate down into an open wound. Not good. Even if the area under my knee cap isn't aggravated, after some activity the muscles seem to just get extra tight over the next few days and my knee just doesn't like that. Thus, by keeping doing gentle movements and massage, then it prevents the muscles around the knee to get too tight.
Anyway. After the 72 hours, it doesn't necessarily mean that I'm totally safe. My knees may still be aggravated , but not to the point yet of me feeling pain. So. It's like Sleeper Aggravation...... lying in wait for the least excuse to have a flare up.....Waiting to POUNCE. So, it's sneaky.
So!! If I'm going to do the risky activity again, then I just do it the exact same intensity (or even less) AND I'm totally tuned into how my knees are feeling. I don't increase the activity intensity yet. Just be patient patient patient. Listen to my knees.
And then sloooooowly increase the intensity. Carefully. And wait at least 72 hours before the next attempt.
Anyway. This is the basics of my personal 72-Hour Rule.
I want to clarify what I mean in my above post when I say a "risky activity."
ReplyDeleteWhat I mean is a planned activity that I think will help gently move my knees along the way to health, but that I'm concerned my knees might react negatively. It's a calculated risk based on careful observation of how my knees are doing.
For example, when I tried to start up biking again in April 2018, that was risky! But, I was very careful and cautious to minimize the risk and maximize my chance of success. I rode on a super flat surface in a low gear for just 4 or 5 miles. Slowly. With lots of rolling/coasting. So. That was a "risky activity" for my knees. I was worried my knees could flare up or have a setback. But, i had been doing so well for a year, so I was reasonably confident my knees could handle it. And they did! Now I've built up to 10 miles including some slopes.
I just didn't want any one to think by "risky activity" I meant anything thoughtlessly craaaaaazy like....spontaneously deciding to crawl across the ground after a dog or whimsically sprinting to catch a butterfly. Those would be completely out of the question.
Sorry about your hand, Richard! Hope you heal quickly.
ReplyDeleteI've been heartened by some improvements this summer. For those of you who don't know my story: For three years I've had "patellofemoral pain syndrome" in my left knee that stems from a running overuse injury. A year and a half ago I had an arthroscopic partial synovectomy, which helped but didn't get rid of the pain. I've been doing physical therapy on and off since then (no noticeable improvement from this). The arthroscopy showed some softening of the cartilage under my patella, but otherwise my cartilage is in good shape.
I am fortunate to be in a teaching profession that gives me three months of vacation in the summer. I have used that time to travel. I have done a lot of sight-seeing, which has involved LOTS of walking, sometimes for up to six or more hours a day. Remarkably, the more I walk the better my knee seems to feel, not just that day but the next as well. On days when I don't go out and walk around, I definitely notice that my knee is stiff and sore. Getting away from my job and off my butt for large portions of the day has really been a good thing. Also, I've started a stretching routine and ditched all muscle-strengthening exercises that irritate my knee (what it tolerates best seem to be straight leg raises with an ankle weight and clam shells with a rubber band).
Walking hills is still a challenge. I feel the soreness later that day or the next day. Same with too many stairs. This really discourages me. I'm happy to be able to move around and do most day-to-day activities without my elastic knee sleeve, but I miss the active lifestyle I use to have. I've started swimming to get in some cardio, but I can't go more than 30 minutes without soreness, and I can only tolerate straight-legged strokes. Cleaning my house is the absolute worst, because of all the knee rotation involved in my movements. Lots of turning this way and that REALLY makes my knee cranky.
I have a question for anyone who might have some advice about this: if you're doing yoga, have you found that it helps your knee pain or makes it worse? Does it hurt at first and then get better? Kneeling and sitting cross-legged really makes my knee hurt, both during and after, but I'm wondering if that means I should do it MORE. I.e. do I need to stretch the muscles and tissues around my knee? I bought a book that recommends this for resolving knee pain, but I don't want to trigger a bad flare up.
Pax
Hi Pax
DeleteI tried Yoga, but all the poses with the legs crossed and bent are really overloading patellofemoral joint. Same with breast stroke swimming.
Have you tried deep tissue massage or IMS (a type of dry needling) to help loosen the muscles and tissue? I have never tried these myself, but have heard of a few people who had benefits.
I have a few questions for you. I am 1 year into PFS and, if I don't get signs of improvement over the next several months, I would start considering an arthroscopic synovectomy. I am a patient of Dr. Scott Dye, one of the few doctors who has a theory about PFS, and the only surgery he would do in these cases is synovectomy.
- Why did you decide to have surgery? Was it you or your OS who suggested that?
- How was your pain at rest and during activities before the surgery?
- How is your pain at rest now? Do you still have pain when sitting at a desk for instance? Or when standing when you teach?
- Did you regret it or do you think you have improved, even though not totally recovered?
Thanks.
Hi Marion. Thanks for the suggestion of deep tissue massage and IMS. I'll look into those.
DeleteI had the arthroscopy at my orthopedist's suggestion. Physical examination, X-rays, and MRIs showed no obvious pathology, and 5 months of physical therapy made no improvement. The doctor said looking inside my knee would give him a better idea of what was causing my pain so that he would know how to help me. Everything looked more or less normal, except for some abnormally thickened synovial tissue, which he removed. That's the only thing he touched. I'm glad I had it done because it really improved my range of motion and ability to sit for long periods with my knee bent. Before that, long car rides, plane rides, meetings, etc. were torture because of the burning pain. Trying to get comfortable while at rest was virtually impossible, except when I was lying down. It seems the thickened, sensitized tissue was getting pinched when I bent my knee. These symptoms have not completely disappeared, but I would say the synovectomy improved them by about 75%.
What the synovectomy did not improve was pain with weight-bearing activity. It made it neither better nor worse. My ortho pedist said physical therapy focused on muscle strengthening would take care of that, but it has not. I don't know whether I'm doing the wrong kind of exercises, haven't been doing them for long enough, or simply need to pursue a different kind of treatment altogether. So far, the only things I've definitely noticed have helped are stretching and walking a lot (on even surfaces).
Hope this is helpful!
Thanks Pax, it is definitely helpful sharing your experience.
DeleteI have the same relentless burning pain you describe. And I bet is inflamed synovium in my case too. The fact that synovectomy improved that part of your pain gives me some hope that surgery may be helpful, as a last resort though.
Was the post-surgery traumatic? Did you have to be on crutches for long? When were you able to resume your normal life (work, car drives etc.)?
Regarding the PT that you did after surgery, what exercises did you do exactly? Are you confident that you have actually built muscles?
For many people, especially after 30 yo, it's difficult to build muscle mass, and it's easier with high loading exercises which however are not good for the patellofemoral joint itself.
Maybe you could see a different physical therapist and have a second opinion?
I forgot to ask...
DeleteWhen you say that surgery didn't improve weight-bearing activities, what symptoms do you have exactly? Does the burning pain come back if you overdo or walk hills? That would be a sign of inflammation...Or is it a different kind of pain?
My recovery was pretty easy. I was on crutches for a day or two but was able to put weight on my leg after that (the surgeon told me to do so as soon as I could tolerate it). I had to wear a thick full-leg bandage for a week, which prevented me from bending my knee, so I looked kind of funny hobbling around, but was otherwise mobile. My knee was kind of sore for a few weeks, but otherwise, there wasn't much interruption to my day-to-day life (which by that point had become pretty sedentary anyway). I don't drive, so I can't speak to that.
DeleteAs for PT, they had me start with a few basic things I could do at home: bending my knee (while sitting), quad sets, straight leg raises, side-lying clam shells. As my knee recovered, they had me do more challenging exercises (leg press machine, knee extender machine, hamstring machine, sideways crab walk with rubber bank around my knees. This is the discouraging part. These really make my knee sore. It's a catch-22. My doctors and physical therapist all tell me that in order to correct the faulty joint mechanics that are causing my knee pain I need to rebuild the leg muscles that have significantly wasted from lack of use. But I can't do the exercises for long before I get discouraged and quit because the soreness they cause make it harder for me to do even basic day-to-day activities.
To answer your last question, the pain I still have varies according to the activity and how much of it I'm doing. Sometimes it's an uncomfortable stiff, full feeling, like there's a softball inside there. It feels swollen (although it doesn't look visibly swollen). I always get this when I clean my house because of all the turning and rotating. Other times it's just a general soreness around the front of my knee that I sometimes feel in the soft tissues along the inside of my knee (I think tendons or retinacula may be involved). I get this after swimming too long, walking too long, walking hills, or climbing too many stairs. This soreness is somewhat different from the burning sensation I used to feel before my synovectomy when my knee was bent at rest. I still get that sometimes, but usually only when I've already irritated my knee from doing some other weight-bearing physical activity.
It's discouraging that I still don't know what the underlying cause of the pain is. You could say that there's some "synovitis", but that's usually a secondary symptom, caused by something else (except in the case of some autoimmune inflammatory diseases, like rheumatoid arthritis, which I've tested negative for). All the medical professionals I've consulted say the problem is faulty joint mechanics, but they're unable to explain to me exactly what's going on and why I'm feeling pain. Is my patella maltracking? Is my femur rotating inward? Is one of my legs shorter than the other? Are the tissues around my join too tight? It could be so many things.
Pax
That's really the paradox with knee issues. You can't build muscle without stressing the joint, but you need those muscles to limit the loads on the joint.
DeleteYou should look for a PT who specializes only on the patellofemoral joint. Unfortunate it's not easy to find one...where are you from?
Another thing I read about that is becoming popular for rehab is blood flow restriction training. Basically you tighten a band around your legs to restrict the blood flow and you do your exercises with that on. Research found out that you can maximize muscle growth by using only 30% of the max weight you can tolerate on a leg press or leg extension machine.
Hi
DeleteI have been doing Iyengar yoga for my knees for the last few months apart from other movement and here is the deal.
While bending the knee is absolutely important to keep it in good health or to enable it to heal, in no way should you stress your knee so much as causing a discomfort or pain. You should use ropes while sitting cross-legged and bricks while sitting with your knees bent as in a "HERO" pose.
Basically, using props while doing yoga minimise the pressure on joint while providing maximum benefits.
Google on how to use props in yoga for knee pain and check the variations of sitting poses.
Hope this helps! :)
Thanks for the yoga advice, anonymous!
DeletePax
May I ask you a couple of questions, Anonymous? (and anyone else who would like to chime in). You say you've been doing yoga for your knees for a few months. Has this helped reduce your knee pain? If so, what poses or maneuvers have been most beneficial? Did you find that some poses were irritating at first but then got better as you continued to do them? The book I bought a while back about yoga for knee pain suggested sitting on props during "hero" pose. I tried it a few times sitting on a pile of books but it still made my knees sore later that day and the next day (but not during the activity itself). I'm wondering if I continue to do this if I will make things worse, or if my knees are just stiff and out of condition and will improve if I keep doing the modified poses. If anyone can share their experience with this I would greatly appreciate the insights!
DeletePax
Hi Pax
DeleteMy knees haven't cured completely but yoga helps. You need to do stretching with standing poses and then try to increase your range of motion by bending your knees at an angle that is comfortable. So, you need to maintain a balance between increasing your range of motion while not hurting your knees.
When your knees get sore, you should do stretching with poses like trikonasan, Viparit karni (legs up the walls), supta padangusthasan (with rope). These reduce the swelling that might have happened while bending your knees.
Also, while you do hero pose or any knee bending, tie ropes around your knees. It helps in creating space.
Hope this helps!
Let me know if you need to know more! :)
Hi Pax,
DeleteResponding to an earlier post of yours...have you tried swimming with a buoy between your legs? Right now swimming (and kayaking) are the only two cardio activities I can do. I found that swimming with a buoy between my legs allows me to focus on upper body and not strain my knee with kicking. Hope this helps!
Thanks for all the suggestions. Regarding the swimming question, I have heard about using buoys to minimize knee irritation. I might give that a try, although I do pretty well without it as long as I do straight-legged strokes. Anything involving bending and rotating the knee, like the butterfly, are bad news.
DeletePax
Greatest Achievement - defeating 5yrs of crippling PFPS (which I'm sure was mostly due to chronic synovial inflammation, which no Australian medico was anywhere near diagnosing despite me specifically asking them) & discovering mountain biking along the way. Too much fun....despite a crash in Jan 2018 which broke a collarbone (now plated with 11 screws) & 2 cracked ribs. That stuff is a complete walk in the park compared to PFPS!
ReplyDeletehttps://youtu.be/l0iu0qVypic
My greatest achievement thus far was moving from that sharp bone overload pain to just the burning pain. It doesn't sound like much but it took a while. Still a long road ahead, but as long as I keep moving forward, I'll get there. I'm working with a PT now that is top notch.
DeleteJD
Hey JD
DeleteWhat was your diagnosis exactly?
What did you do to move from the bone overload pain and how long did it take you?
Will your book help with someone that is bone on bone from osteoarthritis?
ReplyDeleteI think the approach that helped me definitely could help someone in that position. However, I want to caution that this book isn't a conventional knee book. It's my story, and what I learned along the way, and the science supporting what I came to believe about healing bad knees.
DeleteMany people are looking more for a book that includes exercises. For that, I'd recommend Doug Kelsey's "The 90 Day Knee Arthritis Remedy" over "Saving My Knees." Good luck.
Hi Richard,
ReplyDeleteWhat's the science behind low resistance and high revs on the stationary bikes? Why does that help and what changes inside your knee when we do that?
Cartilage apparently makes positive adaptive changes when it gets easy, high-repetition motion. The flexing of the joint pushes nutrients into the tissue and waste products out (I talk about this in the book). Actually, easy, high-rep motion I think is just good for joints in general.
Delete