One of the most persistent knee pain myths is that, if you're a runner, the sport will eventually exact its due and lead to sore, aching joints. If you run long enough, the pessimists warn, you’ll pay the price.
A recent study (the results of which were presented at the American College of Rhematology’s annual meeting) came to a much different conclusion.
Namely, 29.8 percent of non-runners in the study had symptomatic osteoarthritis compared with 22.8 percent of the runners (I have to assume they controlled for weight in their calculations, as that’s a Statistics 101 sort of thing to remember to do.)
The study was huge (2,683 people, who had an average age of 64.5), which is good, but it did have a kind of squishy longitudinal component. Anyone who was a regular runner at some stage in their life, even if it was only between the ages of 12 and 18, was tagged as a “runner.” That can be problematic, as anyone knows who remembers my analysis in the book of one longitudinal study in particular. Still, this would not be the first study to suggest running is beneficial for knee joints, so I think the conclusion makes sense.
One of the study’s authors does raise a caveat: “This does not address the question of whether or not running is harmful to people who have pre-existing knee OA,” according to Grace Hsiao-Wei Lo.
But that’s okay. That’s a lesser issue. Running generally isn’t a good idea if you already have osteoarthritis in your knees, especially if it’s painful (there are better activities that are lower impact on the joints). The good news is that evidence increasingly shows that running doesn’t cause that osteoarthritis.
Friday, January 2, 2015
Friday, December 26, 2014
Happy Holidays to All!
I ate a huge dinner yesterday cooked by my 72-year-old Mom, who is still an amazing cook. My wide-eyed five-year-old daughter described how she heard Santa's reindeer on the roof on Christmas Eve. My 18-month old son crawled onto my lap with one of his dozen board books and stabbed his little index finger at pictures of tarantulas and dolphins and panthers and told me what they were -- or what he thought they were.
The sun broke out after several days of rain, and everyone was glad for the brighter skies. It was nice to be on the leading edge of a long weekend. I've got a few around-the-house projects to occupy me and a leak I'm watching (the joys of owning a house built at the end of the Roaring Twenties). I think water may be dripping from the shutoff valve under the main kitchen sink. I just finished wrestling off the corroded, leaking faucet on the prep sink and replacing it, so this isn't a project I'm looking forward to.
So there's plenty of stuff to think about. But one thing I'm not thinking about: my knees.
They work fine. They have been working pretty well, in fact, since I published Saving My Knees. After I made the book available, I had a little nagging doubt: "What if the knee pain returns? Will I be some kind of a fraud, peddling a story that doesn't really have a happy ending? Will I have to contact everyone who bought the book and refund their money?"
But that never happened, thank God. My knees just kept getting better.
So my holiday wish to all of you is don't give up hoping. I made it through. There is a way.
The sun broke out after several days of rain, and everyone was glad for the brighter skies. It was nice to be on the leading edge of a long weekend. I've got a few around-the-house projects to occupy me and a leak I'm watching (the joys of owning a house built at the end of the Roaring Twenties). I think water may be dripping from the shutoff valve under the main kitchen sink. I just finished wrestling off the corroded, leaking faucet on the prep sink and replacing it, so this isn't a project I'm looking forward to.
So there's plenty of stuff to think about. But one thing I'm not thinking about: my knees.
They work fine. They have been working pretty well, in fact, since I published Saving My Knees. After I made the book available, I had a little nagging doubt: "What if the knee pain returns? Will I be some kind of a fraud, peddling a story that doesn't really have a happy ending? Will I have to contact everyone who bought the book and refund their money?"
But that never happened, thank God. My knees just kept getting better.
So my holiday wish to all of you is don't give up hoping. I made it through. There is a way.
Saturday, December 20, 2014
On Writing a Book and a Blog, and Learning Humility
After I finished writing (and rewriting) Saving My Knees -- and extensively fact-checking the entire manuscript -- I felt kind of giddy. This was a unique book, I felt. It was a first-person, well-documented story of how someone failed -- then succeeded -- in fixing bad knees his doctor said would never get better. My story vividly demonstrated the shortcomings in the traditional approach to treating chronic knee pain (of the sort sometimes caused by osteoarthritis, but sometimes not).
Bestseller lists, here I come!
Then reality bit down. Hard.
The book has sold well, all things considered, but never got close to being a bestseller. Reviews trickled in -- many positive, but others sour and dismissive.
The most humbling experience though has been writing this blog and coming into contact with so many people with knee pain who are really struggling -- and who appear to be doing many of the right things too. They’re desperately seeking the path to healing, just as I was. And they’re discovering that’s not an easy path to find.
Ah. Theories are neat; reality is messy. I still believe that switching from high load/low repetition activities to low load/high repetition makes much more sense for fixing achy knee joints. But I also recognize that while this may be necessary for some people to get better, it may not be sufficient. Big difference.
The problem is, there are different causes of knee pain (in need of different solutions), as well as various mysteries about what’s really going on in the first place. For instance, is there something weird and systemic that sets in when you have chronic knee pain that goes on week after week? I had a doctor tell me unequivocally “no.” But I’m not sure I believe him.
Sometimes I had the sense there was a poltergeist of inflammation loose in my body, and while it may have first appeared in my knees, later it began to roam at will. Apparently it wasn’t just me either who felt this way. I’ve been surprised at the number of people with symptoms similar to mine who went so far as to be tested for rheumatoid arthritis (just as I did).
So what was all that systemic stuff? I honestly don’t know. But, even though it’s gone today, I think it was real.
So yes, there are lots of mysteries about knee pain, as you’re all finding out. It’s good to stay humble -- even if you succeed in beating knee pain -- because no one has all the right answers.
Bestseller lists, here I come!
Then reality bit down. Hard.
The book has sold well, all things considered, but never got close to being a bestseller. Reviews trickled in -- many positive, but others sour and dismissive.
The most humbling experience though has been writing this blog and coming into contact with so many people with knee pain who are really struggling -- and who appear to be doing many of the right things too. They’re desperately seeking the path to healing, just as I was. And they’re discovering that’s not an easy path to find.
Ah. Theories are neat; reality is messy. I still believe that switching from high load/low repetition activities to low load/high repetition makes much more sense for fixing achy knee joints. But I also recognize that while this may be necessary for some people to get better, it may not be sufficient. Big difference.
The problem is, there are different causes of knee pain (in need of different solutions), as well as various mysteries about what’s really going on in the first place. For instance, is there something weird and systemic that sets in when you have chronic knee pain that goes on week after week? I had a doctor tell me unequivocally “no.” But I’m not sure I believe him.
Sometimes I had the sense there was a poltergeist of inflammation loose in my body, and while it may have first appeared in my knees, later it began to roam at will. Apparently it wasn’t just me either who felt this way. I’ve been surprised at the number of people with symptoms similar to mine who went so far as to be tested for rheumatoid arthritis (just as I did).
So what was all that systemic stuff? I honestly don’t know. But, even though it’s gone today, I think it was real.
So yes, there are lots of mysteries about knee pain, as you’re all finding out. It’s good to stay humble -- even if you succeed in beating knee pain -- because no one has all the right answers.
Saturday, December 6, 2014
When It Comes to Knee Pain, What’s Your Religion?
When I read an expert’s answer to how to deal with knee pain, the question above is always forefront of mind. What is their belief framework for analyzing and treating the underlying condition?
Mostly I find experts are structuralists of some stripe. In other words, they believe “your knee cap is mistracking and that’s why you have pain and that’s what you have to fix.” Some are more hard-core than others.
Take “Running Doc,” for instance, who tries to help Laura G. here who has been told she has “Runner’s Knee.” But her only exercise consists of shopping expeditions at the mall!
Well, the doc describes her problem instead as “Maller’s Knee” (for anyone curious about who the great physician “Maller” is, I think this is just an attempt to be clever). He then goes on to equate “patellofemoral syndrome” with “chondromalacia patella” (as I note in my book, they’re not technically the same, but it’s a revealing confusion).
He does promise the reader that “understanding the real cause makes treatment easy and pain relief possible in a short period of time.” To me, after hearing so many stories from knee pain sufferers engaged in a frustrating battle to beat their problem, this phrasing sounds a bit glib, to say the least.
The underlying cause, he tells us, is your ....
Feet.
And your parents stuck you with those feet, so your pain is -- well, sorry bub -- your biological structuralist destiny, you might say.
How does he get from your feet to your knees?
Here’s one example he gives:
Your foot rolls in (pronates), leading to your kneecap mistracking and scraping along one side of the patellar groove, leading to the cartilage under your kneecap getting eroded away, leading to ... pain.
So what’s the solution? Interestingly, one would assume -- after such a bleak kind of structuralist analysis -- that nothing short of surgery to fix the cursed defect would do much good.
But actually, he states that arthroscopic surgery helps maybe one out of 100,000 sufferers (a bit hyperbolic I’d say, and I’m no fan of surgery either). No, the real solution: orthotics.
His apostolic faith in orthotics made me smile. Here is the New York Times telling us that a longtime researcher into orthotics has found they don’t really work and when they do, it’s not clear why. And so, “The idea that they are supposed to correct mechanical-alignment problems does not hold up.” (After reading the article I bravely gave up the shoe orthotics I thought I couldn’t live without, and I’m perfectly fine today without them).
As for Running Doc’s “first mover” in his chain of events resulting in knee pain misery -- that maltracking patella -- that too may not be the problem for a large number of cases of knee pain. (See this study I’ve linked to about a kajillion times.)
So at this point you may be thinking, “Okay smarty pants who isn’t a doctor, what’s your religion?” And I’d have to say my thinking aligns best with that of Dr. Scott F. Dye and his thinking on “envelope of function” (see here). Basically, when you exceed that envelope over a period of time, you’ll get knee discomfort then pain. If I were talking to Laura G. about her problem, I’d be more curious about the following than what her feet are doing:
What’s your weight? Is it where it needs to be? Has it changed recently? By how much?
Did your amount of non-exercise movement change before the onset of knee pain?
Were there any traumatic knee events you suffered in the year or two preceding the knee pain?
Can you describe how you use your knees, 24/7, during a typical week?
Of course I could be off base with this line of inquiry in Laura G.’s particular case. It’s always possible that she was born with crappy feet and is now paying the price for it. But somehow I doubt that’s the real problem.
Mostly I find experts are structuralists of some stripe. In other words, they believe “your knee cap is mistracking and that’s why you have pain and that’s what you have to fix.” Some are more hard-core than others.
Take “Running Doc,” for instance, who tries to help Laura G. here who has been told she has “Runner’s Knee.” But her only exercise consists of shopping expeditions at the mall!
Well, the doc describes her problem instead as “Maller’s Knee” (for anyone curious about who the great physician “Maller” is, I think this is just an attempt to be clever). He then goes on to equate “patellofemoral syndrome” with “chondromalacia patella” (as I note in my book, they’re not technically the same, but it’s a revealing confusion).
He does promise the reader that “understanding the real cause makes treatment easy and pain relief possible in a short period of time.” To me, after hearing so many stories from knee pain sufferers engaged in a frustrating battle to beat their problem, this phrasing sounds a bit glib, to say the least.
The underlying cause, he tells us, is your ....
Feet.
And your parents stuck you with those feet, so your pain is -- well, sorry bub -- your biological structuralist destiny, you might say.
How does he get from your feet to your knees?
Here’s one example he gives:
Your foot rolls in (pronates), leading to your kneecap mistracking and scraping along one side of the patellar groove, leading to the cartilage under your kneecap getting eroded away, leading to ... pain.
So what’s the solution? Interestingly, one would assume -- after such a bleak kind of structuralist analysis -- that nothing short of surgery to fix the cursed defect would do much good.
But actually, he states that arthroscopic surgery helps maybe one out of 100,000 sufferers (a bit hyperbolic I’d say, and I’m no fan of surgery either). No, the real solution: orthotics.
His apostolic faith in orthotics made me smile. Here is the New York Times telling us that a longtime researcher into orthotics has found they don’t really work and when they do, it’s not clear why. And so, “The idea that they are supposed to correct mechanical-alignment problems does not hold up.” (After reading the article I bravely gave up the shoe orthotics I thought I couldn’t live without, and I’m perfectly fine today without them).
As for Running Doc’s “first mover” in his chain of events resulting in knee pain misery -- that maltracking patella -- that too may not be the problem for a large number of cases of knee pain. (See this study I’ve linked to about a kajillion times.)
So at this point you may be thinking, “Okay smarty pants who isn’t a doctor, what’s your religion?” And I’d have to say my thinking aligns best with that of Dr. Scott F. Dye and his thinking on “envelope of function” (see here). Basically, when you exceed that envelope over a period of time, you’ll get knee discomfort then pain. If I were talking to Laura G. about her problem, I’d be more curious about the following than what her feet are doing:
What’s your weight? Is it where it needs to be? Has it changed recently? By how much?
Did your amount of non-exercise movement change before the onset of knee pain?
Were there any traumatic knee events you suffered in the year or two preceding the knee pain?
Can you describe how you use your knees, 24/7, during a typical week?
Of course I could be off base with this line of inquiry in Laura G.’s particular case. It’s always possible that she was born with crappy feet and is now paying the price for it. But somehow I doubt that’s the real problem.
Saturday, November 22, 2014
Old, Bad Beliefs Die Hard
I came across this Internet article on the VMO (vastus medialis oblique), one of the four muscles that, collectively, are known as the quadriceps. About halfway through, I noticed an interesting assertion:
For starters, the role of a mistracking kneecap in causing pain may have been oversold. This study (rather small but intriguing) found no relationship between the amount of patellar mistracking and reported knee pain.
Then there’s the problem of strengthening the VMO in isolation. That, by implication, is what someone with a weak VMO in this scenario needs to do. After all, if your problem is maltracking, and you strengthen all the muscles equally, then it seems you would have the same amount of maltracking, only with stronger muscles causing it.
So how do you strengthen the VMO in isolation?
Well, you can’t, as Doug Kelsey has observed a number of times, such as in this passage:
... patellofemoral pain syndrome. A misaligned patella results in pain on the front of the knee, ultimately caused by a weak VMO.My initial reaction was along the lines of “Whoa, back that truck up!” For one, if you read a lot of the literature on patellofemoral pain syndrome (PFPS) from informed sources (as I’ve tried to do), you’ll discover there’s much confusion about what indeed does cause PFPS. (Actually, to take a step back, it’s not even clear that this is a meaningful diagnosis in the first place.) So this article’s pat suggestion that your knee pain is caused by a misaligned patella that in turn is caused by a weak VMO is venturing way out on a limb.
For starters, the role of a mistracking kneecap in causing pain may have been oversold. This study (rather small but intriguing) found no relationship between the amount of patellar mistracking and reported knee pain.
Then there’s the problem of strengthening the VMO in isolation. That, by implication, is what someone with a weak VMO in this scenario needs to do. After all, if your problem is maltracking, and you strengthen all the muscles equally, then it seems you would have the same amount of maltracking, only with stronger muscles causing it.
So how do you strengthen the VMO in isolation?
Well, you can’t, as Doug Kelsey has observed a number of times, such as in this passage:
The VMO is one of four muscles which all share the same nerve: the femoral nerve. Muscles contract when nerves tell them to contract. Since the VMO has the same nerve as the other three thigh muscles, it will contract along with the others. You cannot make the VMO contract by itself.Strengthening the VMO to correct a mistracking patella is a typical old school recommendation for treating chronic pain from achy knees. Tease the reasoning apart, bit by bit, and it falls to pieces. Yet the advice lives on in many corners of the Internet.
Saturday, November 15, 2014
Of Goats, Noses and Knees
Here’s a novel location to pinch a little cartilage for rejuvenating a worn-out knee joint:
Your nose.
Apparently a study on goats (I know, from weird to weirder) showed that the cells in their noses that make cartilage could perform the same function in their knees.
So now researchers are seeing if they can replicate the results in a human trial. Full results weren’t available when the summary linked above was written, though we were told the patients were doing “extremely well.”
This story somewhat surprised me. I would have guessed that knee and nose cartilage are from two different families, so to speak, and one wouldn’t be able to properly substitute for the other. But looks like I would be wrong. :) In any event, if you have bad (or no) cartilage in your knees, in another 10 or 20 years, doctors may be assessing your schnoz as a potential donor site.
Your nose.
Apparently a study on goats (I know, from weird to weirder) showed that the cells in their noses that make cartilage could perform the same function in their knees.
So now researchers are seeing if they can replicate the results in a human trial. Full results weren’t available when the summary linked above was written, though we were told the patients were doing “extremely well.”
This story somewhat surprised me. I would have guessed that knee and nose cartilage are from two different families, so to speak, and one wouldn’t be able to properly substitute for the other. But looks like I would be wrong. :) In any event, if you have bad (or no) cartilage in your knees, in another 10 or 20 years, doctors may be assessing your schnoz as a potential donor site.
Saturday, November 8, 2014
Platelet-Rich Plasma Therapy Wins Some Fans
This article recently caught my eye.
A Utah doctor told assembled colleagues at the annual meeting of the American Society of International Pain Physicians that studies are showing the efficacy of platelet-rich plasma (PRP) therapy for various conditions, including knee osteoarthritis.
Dr. Richard Rosenthal cited for example a paper showing that patients (the subjects were age 45 to 85) had a significantly smaller chance of reinjuring their rotator cuff after a massive tear if they received PRP gel. A different study demonstrated a salutary outcome for lower back pain sufferers.
Caveats are in order of course, as the article notes. PRP is still a relatively young procedure. Issues remain to be sorted out, from the proper protocol for treatment to identification of differences among some 40 products currently on the market.
One voice of caution, Wellington Hsu of Northwestern’s school of medicine, notes that there are “holes in the evidence for PRP in the management of osteochondral lesions and knee osteoarthritis.”
So, expect further studies. The good news is, if PRP continues to shine in clinical trials, insurers may agree to pick up the tab for the procedure -- some $750 per injection -- which (at least in the U.S.) they won’t do now.
A Utah doctor told assembled colleagues at the annual meeting of the American Society of International Pain Physicians that studies are showing the efficacy of platelet-rich plasma (PRP) therapy for various conditions, including knee osteoarthritis.
Dr. Richard Rosenthal cited for example a paper showing that patients (the subjects were age 45 to 85) had a significantly smaller chance of reinjuring their rotator cuff after a massive tear if they received PRP gel. A different study demonstrated a salutary outcome for lower back pain sufferers.
Caveats are in order of course, as the article notes. PRP is still a relatively young procedure. Issues remain to be sorted out, from the proper protocol for treatment to identification of differences among some 40 products currently on the market.
One voice of caution, Wellington Hsu of Northwestern’s school of medicine, notes that there are “holes in the evidence for PRP in the management of osteochondral lesions and knee osteoarthritis.”
So, expect further studies. The good news is, if PRP continues to shine in clinical trials, insurers may agree to pick up the tab for the procedure -- some $750 per injection -- which (at least in the U.S.) they won’t do now.
Subscribe to:
Posts (Atom)