We're Losing One of the Good People ...

Sadly, it appears Dr. Scott F. Dye is retiring. "Silvertongued" posted this in the comment section the other day:

I've been seeing Dr. Dye since last year. I'm lucky enough to live driving distance to his office. He's been instrumental to my recovery. He's a great doctor and very compassionate, as we have been sharing over the years in this forum. He told me last visit that he'll be retiring at the end of this year.

As some of you know, I discovered Dye rather late, during my post-recovery. True, during my recovery, I did happen to come across his name in a magazine article. He seemed a bit odd though. What stuck in my mind from the article was a certain incident, when he wanted to better understand the source of patellofemoral pain:

He noted that many patients who had arthroscopic surgery for other reasons had fibrillated cartilage in their patellofemoral joint, but did not have patellofemoral pain. Meanwhile, patients with presumed patellofemoral pain might have pristine cartilage in their knee at the time of arthroscopy. This led him to ask the question, “What anatomic structures in the knee can really feel pain?”

And so (it would have been interesting to be a fly on the wall during this experiment):

Dye asked a colleague to perform knee arthroscopy on his knee without anesthetic. During the arthroscopy, the surgeon would probe different anatomic structures, and Dye would report what he felt. ... He discovered that he had almost no pain with palpation of the patellofemoral joint, while probing of the anterior fat pad and anterior joint capsule was exquisitely painful.

I can just about hear him scream when that probe touched his synovium. All in the name of science, I suppose, but at the time I remember thinking he was a bit eccentric.

Years later though, I came across his "envelope of function" framework for how to understand and recover from knee pain. This was something completely new for me. Intrigued, I read a few of his scholarly articles. It soon become clear that he belonged to the smart set when it comes to knee pain: he made a lot of common sense suggestions, debunked some myths, and analyzed diffuse, chronic knee pain in a way that was completely logical.

I then looked up some of his videos on YouTube. He is an, um, refreshingly direct and original speaker, not shy about his disdain for certain wrongheaded beliefs. I urge you to look him up on YouTube, as he really is entertaining.

So in honor of the retiring Dr. Dye, I am listing below some of my posts about him and his beliefs. If you're a new visitor, still trying to figure out your knee pain, I urge you to take a look. It's good stuff.

Why You Need to Know About the “Envelope of Function”

What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?

Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)

Update: A commenter below actually says Dye is not retiring, just "limiting future office visits to once a month." So if you're interested in seeing him, it would be worth placing a call, it appears.

A Musing on My Occasional Knee Recklessness

I may not be the best role model for someone trying to figure out how to manage the post-recovery period after beating knee pain.

This occurred to me a couple of months ago. I was struggling with a little pain at the side of my left knee.

What happened: As some of you may remember, I broke my hand in two places while cycling on Aug. 11 of last year. That left me in the basement, racking up miles cycling in the virtual reality world of Zwift, and sometimes badly disobeying my doctor’s orders to minimize sweating under my cast.

Eventually the cast came off and I was cleared for cycling again, but by then it was late in the season and I figured I’d just stay inside, logging miles on Zwift, until April.

Now normally, I take off a month or two during the winter and only do easy stationary bike cycling. I figure it’s good to give my knees a little break. Not this year though. Frustrated about the broken hand, and trying to preserve some semblance of conditioning, I did long rides and races on Zwift, pushing myself hard. My best ride, I averaged 251 watts for 51 minutes, which I thought was respectable.

But, during a race on Zwift, I pushed down hard with my left leg to go up a sudden steep climb and got a sharp pain on the inside (medial) of my left knee. It kind of lingered for months. Every time I thought it was gone, I’d move my leg/knee a certain way – and bam – there it was again.

I think it was a ligament sprain. In any event, intense cycling wasn’t helping any. So early in July, I finally went into knee conservation mode. I began cheating on pedaling, putting more stress on my right leg. I backed off sprints. I went out on more rides alone.

It took about a month, but the knee got better and I’m fine now.

But the experience did make me think: Wow, I managed to heal my knees and then dove right back into the kind of crazy cycling I’ve always loved to do. Which is great on one level: I did succeed in returning to doing exactly the same intense physical activity I had grown to love.

However: a more sensible me might have toned things down a bit. I probably could have avoided some of the little burning-under-the-kneecap episodes I’ve had since 2011, when I published the book. I’ve talked about those before, and they never lasted more than a few weeks or a month, but I think they came about because, well, I like to ride my bike really damn hard.

If I had just wanted the most trouble-free knees, I would have adopted a moderate riding program, not the cycle-til-you-want-to-collapse riding that I often do. So maybe this isn’t the most sensible way to handle your post recovery. Still, I will say that I’m always careful now to monitor symptoms. When I feel as if a knee-related problem is starting to spiral out of control, I modify my behavior and nip it in the bud.

The takeaway here is that I’m not encouraging anyone to do what I’m doing. It’s rather hardcore. But I’m also saying with my example that, if you bring your knees back from a painful state, and do it carefully, that there’s a good chance you can return to doing whatever you want. Just take small steps to get there. :)