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.
Yes, Dr Dyes videos and papers were the key to me solving the puzzle (theoretically at least, practically, I've been to impatient to make it work 100%). His work led me to believe that most of my pain was probably due to chronic inflammation of the synovial structures, and much less about cartilage damage, and that gave me much hope.
ReplyDeleteDr. Dye has been a major help in my 3+ years healing as well. The recovery is still ongoing to some extent but now it is mostly fun. I am still building my lost muscles though a lot of it is back. Pain is not an issue but I keep on playing on the safe side. Still avoid mountain biking for more than 40 km and also keep an eye on the elevation gains so I don't get suddenly overboard with it. I feel good overall but there is still work ahead because my ambition is to gradually get to my previous shape and ways of using my knees, which is not that simple after 2 years of barely being able to go to the store on the other side of the street.
ReplyDeleteGood luck everyone!
Thanks for posting this Richard. I've struggled for just over two years with a right knee issue and had been through 6 orthopedists, all with varying diagnoses (chondromalacia, cartilage “pothole,” etc). Finally, after reading your wonderfully helpful book and clicking around the web I realized that Dr. Dye practiced nearby in the Bay Area, so I made an appointment to see him about 6 months ago.
ReplyDeleteWhile I am not out of the woods yet, I believe his diagnosis (chronically inflamed synovium) is correct and I am confident I am on the (slow) path to healing. Dr. Dye's solution of icing, corrective soles, and above all patience in not stressing the knee in any way is EXTREMELY difficult to follow for those of us who enjoy active lives, but seems to be the best approach for me. I'm sad he is retiring and wish him well. Sadly, there seems to be few, if any, doctors out there who follow his iconoclastic approach (I believe he did say there was another guy in South Carolina or thereabouts whom he had mentored).
Thank you so much for publishing this blog Richard, it’s helped give me hope through some really dark times. Good luck to all on this journey!
yes, I'm sure lots of people's pain is written off as chondromalacia, when in fact it is chronic synovial inflammation that is the main problem. I've sent links to Dr Dyes material to all my specialists, but their response has been underwhelming to say the least. I think the synovial problem is far more common than they give it credit for, esp. in people who really work their knees hard.
DeleteJust a quick update here. I saw the great Dr. Dye last month for a progress check. Turns out, he's not exactly retiring but limiting future office visits to once a month.
ReplyDeleteUPDATE. I'm writing this a year and half later, happily pain-free. However, this is not due to Dr. Dye's course of treatment. After a year of following his "don't exceed the envelope of function" advice, I was no better than when I started. In fact, Dye’s counsel to take copious amounts of ibuprofen (without telling me to take a break now and then to let my stomach heal, nor reminding me to always take the pills with meals) resulted in me contracting GERD, which took a frustrating year to subside. Finally, Dr. Dye's response to this was dismissive, telling me to “take it up with your internist."
ReplyDeleteAnyway, I think he was in fact trying to heal my knee, which did not happen. Luckily for me, a different orthopedic surgeon went in arthroscopicaly and found that my meniscus was in fact torn, and folded over on itself. Thus the tear had not shown up on any of my MRIs. He trimmed it (removing about 5%) and cleaned up some “crab meat” cartilage under my kneecap. This was 10 months ago, and after a few months of rehab exercises, etc., I am back to full activities. For me that means hiking, biking, and running around the tennis court at age 50. One thing I have done to help my joints is lost some weight. “Best thing one can do,” according to my surgeon. I hope everyone on here on the path to healing. Chronic pain and loss of activity can be devastating. KEEP FIGHTING! I was gung ho for Dr. Dye’s non-invasive approach and devoted when it didn’t work. That doesn’t mean it won’t work for others. But 3+ years into my knee odyssey I’m happy to report I am all better. Cheers.