I found myself thinking recently about that piece of advice: If you find yourself in a hole, stop digging.
What brought that to mind is knee pain among Type A personalities, with whom I share some traits. They tend to be organized, competitive, ambitious.
In cases where they take part in some sport or form of exercise, they do so with more dedication and energy, and that can get them into trouble.
When they find themselves with knee pain, I imagine that many try to do what I did: work around it, deny it, assume it will just go away with a little time and with only minor changes to their workout routine.
Essentially, they've found themselves in a hole, then they keep digging it deeper. At some point, if they're self-aware enough, they realize what's happening and they modify their behavior.
To beat knee pain, Type A and more laidback Type B personalities may need wildly different approaches.
For Type B people with knee pain, the best course of action may be get moving and do more. For Type A people, it may be to do less, to ease up, and that can be a harder prescription to follow for those who are accustomed to putting out maximum effort.
I remember in Hong Kong, trying again and again to ride my bike without getting that awful burning in my knees, and I could never do it. So finally I just told myself: That's it. I am through cycling for now, and maybe forever.
That was really, really tough. But sometimes I think that, to overcome chronic knee pain, the only way you can return to doing what you love is by being willing to abandon it forever.
It's a hard lesson that a lot of Type A people with knee pain learn: A lot of furious, motivated digging just leaves you at the bottom of a bigger hole.
So true. Type A here. Repeatedly injured my knee, to the point of being on and off crutches at least four times. Surprisingly, the most challenging activity was ballroom dancing with my husband. We'd danced together for 32 years. And hiked and and all sorts of adventures. It was the spins in dancing that were destroying my knee. I really grieved when I gave it up and he did too. A lifetime of patellar maltracking just caught up with me. Now I'm just happy to walk and climb curbs. I'm still working my way back up to steps and may not ever get there. But at least I can walk long distances. And I have to be happy with that. Like you, I have gone through long recoveries and you just have to be patient with your knees.
ReplyDeleteI'm in that A-type hole now - but not knees, Osteitis Pubis which is a stress reaction in the front of the pelvis, brought on by running. Thankfully cycling & swimming don't seem to bother it, but I have an offroad triathlon in 2 weeks that I've been wanting to do for years, with an 8km run, and I can't run at all without stirring up the pain. I'm trying to convince myself to just do the aquathon (swim & bike), but am having trouble letting go of wanting to do the whole thing.
ReplyDeleteOsteitis pubis is just like my knee story - the only cure is avoiding the activities which flare it up, and it can take months.
Thank you so much for sharing this Richard. I just submitted a Year's leave of absence request from my position at my school. The awful burning has made it impossible for me to teach. I needed to see this today. And second to the last paragraph really hit me about how sometimes you have to be ready to abandon what you love to hopefully get it back someday.
ReplyDeleteI had to take a break from work also Stephanie. It was all getting too much to handle and I would describe myself as a resilient person. Knee pain is difficult: all-consuming and it requires mental strength.
ReplyDeleteI think hope is the only way to move forward. I always seem to be in A type holes although I am definitely more patient than I was.
Yes the pain changes your whole life. And people dont understand unless theyve been through it. Ive found some progress and feel more like living since the work problem has been removed. I loved my job but I miss being able to walk and have a life more. Good luck ro you.
DeleteAgree Stephanie. I try not to talk about it with others now as they don't understand. I am trying to focus on any positive experiences I have and focus on what I can do. I also try and really take care of myself. I don't find any of this experience easy.
DeleteIt is definitely nothing in even a nearby vicinity of easy. Thinking of you and hoping for you.
DeleteThis is my 37th rehab week since my patella got hit by a heavy metal plate last summer. The cottage we where renovating when this happened is now in good condition, my knee is not. Or actually everything was already healed when I finally decided to have an MRI but I'm still left with pain that is aggravated by any kind of excess load.
ReplyDeleteIt is impossible to know the exact size of the learned pain component here but I would set my bets on big or huge. However, as unlearning pain goes the same way as rehabbing soft cartilage (which still is possible even if not seen in the MRI) I have been working on gradually increasing my step count and the time and resistance on my stationary bike while trying to keep my symptoms at the minimum. Targeting pain free would have been impossible for me.
I stopped keeping a knee journal for some time ago but I still mark my morning and evening knee scores plus my step count on an Excel sheet every day to track my progress. They go up and down but the trend in all three metrics is positive.
The progress has been slow but things look much better now than for six months ago. I have recently started walking very short distances outside without crutches. For longer distances I still need them. For two months ago I could not walk even to the nearest bus stop without increased symptoms or pain. Now the length of my setbacks is usually not counted in weeks anymore but days. I can do chores at home almost without the need to limit myself or take pauses. For some time ago I still needed to do as much as possible sitting. I still mostly work remotely (my job allows this) but I have been at the office a couple of times during the last weeks.
I just want to send you a message of hope. Small injuries can take a long time to heal. People can recover quickly from big injuries. Every case is different but with patience and perseverance we get better. It can take a long time though.
Thoughtful and insightful words. A lot of it for me is acceptance. I also have the ability to push through pain barriers which was good in athletics but not for recovery of injury. Patience and perseverance a not my strengths but I am getting there. It sounds very much like you are heading in the right direction which is 100% your own committment to healing.
DeleteThank you, Lindsey! I would not describe myself as a patient person either. And just that no one gets the wrong idea: when I mean short distances I really mean 200-300 meters - not 2000-3000 meters. And yes, I still do get setbacks. I'm in a middle of one right now after being overconfident last weekend.
DeleteDont be too hard on yourself Honeyblush. Its so hard not to overdo it...good luck to you.
ReplyDeleteI wanted to come here to thank you Richard. Getting diagnosed with chondromalacia as a Type A go-getter personality was crushing. Months later when I found your book, I cried I was so excited that such a story existed. Almost every part of your story resonated with me -- intensely biking San Francisco hills prior to diagnosis, negative doctors, PT that just made things worse.
ReplyDeleteI have so much more to be positive about now. I'm more confident in testing out my recovery plan, and it's exciting that some movement (vs. none) is what it takes to move forward. Like you say in this post, I have come to terms with the fact that I likely won't be able to do what I did before -- cycling, skiing, dancing, hiking. And I'm okay with that. Being able to walk is such a blessing and it's worth all the focus and trial and error just to do that without pain.
Thank you again! I hope to pass on the knowledge.
Jill, you may well be able to bike etc. again. I am now. My chondromalacia and other loss of tissue homeostasis symptoms are 99% gone. It took over 6 years, but this stuff can heal, despite what the 'experts' say.
DeleteThat's inspiring to hear! I'd love to get back on the bike one day in the future!!
DeleteTriAgain --- Keep posting your methods and results - it's giving me hope. Are you biking up difficult hill again too?
DeleteIt is excellent you keep posting TriAgain and also KneePain. I find you both very encouraging and inspirational. I am using a lot of your advice. You have healed and are giving back to this community. I really respect that. Thank you.
ReplyDeleteThanks Lindsay. It was the worst 6-7yrs of my life (well, aside from being sent to boarding school at 14) and the only hope I got was from sites like this. Other people who had been through it or were going through it. Their stories were far more useful that any highly paid expert, with the exception of our local OS who said whatever you do, don't have surgery for this.
DeleteI have been offered an arthroscopy (chondroplasty). I'm leaning towards no. It's very appealing but there's no quick fix. I don't have sharp pain/mechanical problems either). The idea would be to smooth the cartilage but realistically you've just got less cartilage although it may reduce inflammation. A lot to think about.
ReplyDeleteThat's pretty much what my OS said about smoothing out the cartilage on the back of my kneecaps. I've not had another MRI on them for over 10yrs. Back then it showed quite severe fissures in that cartilage, but now the pain is basically gone, so I think it has healed itself (which some experts say is impossible, but other research clearly shows it's possible).
DeleteAlso, of all the supplements I've tried over the years, the only one I think has a real effect is collagen powder which I have every morning in a drink.
I had that done Lindsey. But I had a piece of "concrete" - that is what it felt like - on the left side of my knee. He also removed plica - which is controversial. It did help me but if it jadnt been for feeling like I was hitting concrete on the left side qhen I tried to walk I wouldnt have. Thats the only benefit I got. I still have the "burning" pain in it.
DeleteI decided to go for the arthroscopy. Mainly as I could feel what I felt was a chondral flap on the right knee and also wanted a diagnosis (after repeat normal MRIs). I felt the treatment was not good without the knowledge of what was actually going on.
DeleteI was correct- I had a chondral flap so hopefully this surgery will stabilise that cartilage rather than allowing the damage to propagate but who knows..
I am day 6 post op now so will let you know how I get on. Definitely as I recover I will use the high rep/low load principles which I have no doubt is the correct way forward.
Stephanie- hope things are going OK and you are keeping your spirits up. I'm finding this little community very helpful.
It's just reading/jigsaws and watching the world go by for me for a while.
Oh ok... Well I hope it helps you as much as possible. Yes the jigsawss help! I still do them often myself. :)
ReplyDeleteWill check on you again soon!