I recently came across a comment loaded with questions and thought, “Why not just do a post answering these?” They came from someone in his late twenties who hurt himself skiing last February and is now struggling with knee pain. He’s tried a number of things to fix the problem, has many questions, and I invite all of you out there to help me with the answers if you’d like.
Q: Do you believe you could have still recovered in the office setting (which, I assume, means had I not quit my job and continued to work sitting at a desk)?
A: I honestly don’t know with certainty. I know it would have been harder, for sure. The act of sitting was causing me problems, and I had a job that required a lot of sitting (a standing desk would not have helped either, because at that point I couldn’t stand in one place for very long either).
Q: Your story somewhat ends abruptly, in the second year of recovery. Did you slowly increase your activities on the same rigid scientific approach? At some point did it feel like you came out of the rehab stage?
A: Yes, others have made the same complaint about the book, so that’s probably my fault for moving too quickly through the narrative of the latter stages of my recovery. But to me, it simply wasn’t as interesting. That’s because I began making steadier progress, suffering fewer setbacks. Yes, I was still careful about how fast I increased my step counts, etc.
Apart from that, I’m not sure that there was a clear line of demarcation where I “came out of the rehab stage.” I was pretty much healed when I rejoined Bloomberg in the last part of December 2009. Still, I had days at Bloomberg where my knees felt a little cranky. That minor discomfort did go away eventually, but that just goes to show healing is long and gradual.
Q: Does research suggest a cortisone shot prevents cartilage from healing?
A: I’m not a fan. And yes, the research on cortisone shots is not good. Just do a search on this blog for “steroid.” You’ll see.
Q: How did you explain your injury to outsiders?
A: I don’t recall this being a big issue. I mostly just said I had knee pain. If you come up with a short spiel that goes, “I have knee pain and I’m working to resolve it,” that seems to satisfy most people. They don’t particularly want to hear that much about your injuries anyway.
Q: Does research suggest age playing a factor in the speed of cartilage recovery?
A: I’ve seen at least one that shows an age-related effect, yes. But it’s significantly smaller than most people would guess. So you probably do have an edge, being in your late twenties, but I don’t think it’s a huge edge.
Q: I’ve seen your comments on diet, that you think it did not play a significant part in your recovery but losing weight is one of your 4 keys to rehab. Have you done any research on the claims that low carb/keto type diets can help arthritis patients?
A: Unloading the knee by shedding a few pounds is always a good idea for pudgy people; for thinner people the benefits may be much smaller (because there’s less fat to lose). I’m ignorant and agnostic on the effect of special diets on knee pain. Usually, diet didn’t affect my knee pain.
However, when I loaded up on fatty foods, I did seem to feel a bit worse. So it’s probably smart to try to eat as healthy as possible, and look for anti-inflammatory foods. (One other important note on diet: my experience is by no means representative; if you comb through comments on this blog, you’ll find a number of people who say changing their diet was absolutely important in getting their knee pain under control.)
Q: Do you think weightlifting, upper body type workouts, are safe to resume?
A: I would think so, but I would still carefully monitor my knees. This seems minor, but some of those exercises cause unrelated muscles to tense up, and that could cause irritation for bad knees. Also, be prepared: if you have knee pain long enough, you may find other mysterious joint issues popping up, such as with your elbows or shoulders, when you’re lifting weights.
Generally though, I think it’s good to engage in activities that get your heart pumping and get you perspiring.
Q: Any other exercising activities you came across that don’t overload the knee joints? I think my knee is responding OK to low-watt biking.
A: My favorite ideas remain walking slowly, pool exercises, and easy cycling. If your knee does well with low-watt biking, congratulations. That may be your ticket out of this mess.
Saturday, January 26, 2019
Saturday, January 12, 2019
A Success Story of Overcoming Knee Pain After Devastating Setbacks
As I’ve said, I love success stories. Mine, of course, is one. But someone who can't relate to mine may be able to relate to someone else’s, so the more success stories I can share the better.
In the early days of this blog (that takes me back!), a frequent visitor was a woman who went by the simple moniker “Knee Pain.” She was one of the people I was rooting especially hard for, as I could feel her complete determination to beat this curse of knee pain in virtually everything she wrote.
Well, she checked in late last year and told her story in the comment section. And she had made some very good progress, I was pleased to learn. Because I love success stories, I kept meaning to pull out all the bits and give them a proper home inside one of these posts.
Finally I’m getting around to that.
Here’s her story, with my editing as usual. If you want to see her full comments, go here.
Also, Knee Pain, if you're out there reading this, you're welcome to update us on your progress and field questions in the comment section below. I know it's been four months since you posted the story below.
"I was diagnosed with chondromalacia patella in 1993. In later years, it's also been diagnosed as PFPS (patellofemoral pain syndrome). Doctors say that the kneecap is not tracking properly and the cartilage has worn down too much. There's no signs of knee arthritis.
My pain is in my right knee. My bad knee doesn't swell or turn red or other colors. It seems to look exactly like my good knee -- even when it's at its most painful.
I don't have the "burning and aching.” 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.) I only get these stabs when I move my knee. Not at rest.
I didn't quit my job. As long as I am sitting perfectly still, 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. I went on 2 business trips with the help of a wheelchair when the pain was just too bad and I couldn't walk very far. I've also used a cane.
I've trained myself to never 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. As for household chores, kneeling or squatting are not a possibility. I sit on the floor or in a chair.
I've had soooo many ups and downs since 1993.
For the most part my doctors recommended physical therapy in the form of strengthening the quads and the vastus medialis. I really don't think that worked for me. Even before reading Richard’s book, I had the gut-feeling sense that trying to strengthen the quads flares up the knee joint itself, sooooo.... instead of helping me, it kind of sets me back. It was only after reading Richard's book (in 2012) that I felt like my gut-feeling was validated!
In 2010, I had the synvisc injection. That made it worse. My knee got a brand-new symptom which was that it would catch and lock up, which was horribly painful.
In 2010, I had arthroscopic surgery to smooth out the cartilage in the knee. The result was that it definitely helped with the knee locking problem! But I kept having irritation and flare-ups.
I asked my doctor if she thought I should next try the total knee replacement? She felt very confident that I should be able to get well with just physical therapy. 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. :)
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. 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.
The first "happy golden era of knee health" was approximately 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. I danced. I learned the Lindyhop. I hiked. I learned to windsurf!
But in 2006 I had a catastrophic relapse. Why? 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.
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). I wore my neoprene knee brace to start.
Some exercises involved standing in chest high water and doing movement like moving my leg in a circle. Some involved 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.
After about a month I took off my knee brace. I did have a little trouble. But I was able to work through that by just going slower and more carefully.
In July 2012, I got Richard's Saving My 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!!!
I "overdid it" on one of my bike rides and BOOM that was it. Another catastrophic relapse.
My big takeaways from Happy Golden Era #2 in combo with what I learned from Richard's 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.
3) I 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 when 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 and make sure I'm OK.
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.
Starting 2016, I used all this knowledge to try to make another big (but slow and 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 around a court after a ball -- including occasional jumping)
How I got to this point was once again using the water activity.
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. Once again, not "swimming" but more like gentle leg motions. (When I did opt for "swimming" then I just dragged my legs.)
By July 2017 I built up to swimming a mile! But still, I wasn't supplementing this with land activities.
Then in 2018 I really realized wow my knees are feeling pretty great.
So then I 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 I decided to try a court sport running around after a ball. 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 decided to try again and just be cautious. 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.
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 and 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!"
In the early days of this blog (that takes me back!), a frequent visitor was a woman who went by the simple moniker “Knee Pain.” She was one of the people I was rooting especially hard for, as I could feel her complete determination to beat this curse of knee pain in virtually everything she wrote.
Well, she checked in late last year and told her story in the comment section. And she had made some very good progress, I was pleased to learn. Because I love success stories, I kept meaning to pull out all the bits and give them a proper home inside one of these posts.
Finally I’m getting around to that.
Here’s her story, with my editing as usual. If you want to see her full comments, go here.
Also, Knee Pain, if you're out there reading this, you're welcome to update us on your progress and field questions in the comment section below. I know it's been four months since you posted the story below.
"I was diagnosed with chondromalacia patella in 1993. In later years, it's also been diagnosed as PFPS (patellofemoral pain syndrome). Doctors say that the kneecap is not tracking properly and the cartilage has worn down too much. There's no signs of knee arthritis.
My pain is in my right knee. My bad knee doesn't swell or turn red or other colors. It seems to look exactly like my good knee -- even when it's at its most painful.
I don't have the "burning and aching.” 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.) I only get these stabs when I move my knee. Not at rest.
I didn't quit my job. As long as I am sitting perfectly still, 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. I went on 2 business trips with the help of a wheelchair when the pain was just too bad and I couldn't walk very far. I've also used a cane.
I've trained myself to never 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. As for household chores, kneeling or squatting are not a possibility. I sit on the floor or in a chair.
I've had soooo many ups and downs since 1993.
For the most part my doctors recommended physical therapy in the form of strengthening the quads and the vastus medialis. I really don't think that worked for me. Even before reading Richard’s book, I had the gut-feeling sense that trying to strengthen the quads flares up the knee joint itself, sooooo.... instead of helping me, it kind of sets me back. It was only after reading Richard's book (in 2012) that I felt like my gut-feeling was validated!
In 2010, I had the synvisc injection. That made it worse. My knee got a brand-new symptom which was that it would catch and lock up, which was horribly painful.
In 2010, I had arthroscopic surgery to smooth out the cartilage in the knee. The result was that it definitely helped with the knee locking problem! But I kept having irritation and flare-ups.
I asked my doctor if she thought I should next try the total knee replacement? She felt very confident that I should be able to get well with just physical therapy. 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. :)
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. 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.
The first "happy golden era of knee health" was approximately 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. I danced. I learned the Lindyhop. I hiked. I learned to windsurf!
But in 2006 I had a catastrophic relapse. Why? 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.
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). I wore my neoprene knee brace to start.
Some exercises involved standing in chest high water and doing movement like moving my leg in a circle. Some involved 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.
After about a month I took off my knee brace. I did have a little trouble. But I was able to work through that by just going slower and more carefully.
In July 2012, I got Richard's Saving My 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!!!
I "overdid it" on one of my bike rides and BOOM that was it. Another catastrophic relapse.
My big takeaways from Happy Golden Era #2 in combo with what I learned from Richard's 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.
3) I 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 when 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 and make sure I'm OK.
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.
Starting 2016, I used all this knowledge to try to make another big (but slow and 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 around a court after a ball -- including occasional jumping)
How I got to this point was once again using the water activity.
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. Once again, not "swimming" but more like gentle leg motions. (When I did opt for "swimming" then I just dragged my legs.)
By July 2017 I built up to swimming a mile! But still, I wasn't supplementing this with land activities.
Then in 2018 I really realized wow my knees are feeling pretty great.
So then I 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 I decided to try a court sport running around after a ball. 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 decided to try again and just be cautious. 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.
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 and 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!"
Saturday, December 29, 2018
Hey, What's Your New Year Resolution?
Happy holidays everyone!
Some of you have been frequent visitors, and frequent commenters, and I thank you for your involvement.
Others of you drop by for a while, ask a few questions, then fade into the background. That's fine, I know what you're going through. I spent many afternoons of my recovery ricocheting around the internet like a pinball, seeking bits of insight that might help explain what I was going through and how I could get better.
Sometimes, someone buys one of my books from Amazon or Smashwords. And every so often, someone returns a book (it's so much easier to return an electronic book!) And -- this will probably sound weird -- I think that's great. It's great Amazon has a policy that, if you don't like something, you can get a no-questions-asked refund. I love that. When I wrote "Saving My Knees," I really, really believed in the message. Still, I realized later after reading a few reviews that it wasn't for everyone.
Now, on to the new year! I hope that this will be a year of steady, gradual improvement for thousands of knees out there. I know that sounds boring, but sometimes slow and boring is the way to win the race.
So let's talk! Do you have a resolution for your knees, or for your recovery program? If so, share it below. I'd love to hear what's on everyone's mind.
Cheers, and best wishes.
Richard
Some of you have been frequent visitors, and frequent commenters, and I thank you for your involvement.
Others of you drop by for a while, ask a few questions, then fade into the background. That's fine, I know what you're going through. I spent many afternoons of my recovery ricocheting around the internet like a pinball, seeking bits of insight that might help explain what I was going through and how I could get better.
Sometimes, someone buys one of my books from Amazon or Smashwords. And every so often, someone returns a book (it's so much easier to return an electronic book!) And -- this will probably sound weird -- I think that's great. It's great Amazon has a policy that, if you don't like something, you can get a no-questions-asked refund. I love that. When I wrote "Saving My Knees," I really, really believed in the message. Still, I realized later after reading a few reviews that it wasn't for everyone.
Now, on to the new year! I hope that this will be a year of steady, gradual improvement for thousands of knees out there. I know that sounds boring, but sometimes slow and boring is the way to win the race.
So let's talk! Do you have a resolution for your knees, or for your recovery program? If so, share it below. I'd love to hear what's on everyone's mind.
Cheers, and best wishes.
Richard
Saturday, December 15, 2018
Don’t Take That Meniscus in Your Knee for Granted
I just read an article about the meniscus, that rubbery, crescent-shaped piece of cartilage that helps absorb impact between the long leg bones that meet in your knee.
Decades ago, the common medical wisdom was that the meniscus wasn’t all that important, and when it was torn, surgeons simply took it out.
Of course common medical wisdom was wrong.
Patients who had their meniscus removed often developed arthritis in their knee later. That suggested the meniscus actually played a critical role.
Now we have new, and quite sobering, details about what happens when the meniscus is extracted from the knee.
According to a new study, “extensive cell death occurs within hours during vigorous exercise.”
Researchers used a powerful microscope to observe what was happening, minute by minute, as the vigorous activity was occurring. The article says that half of the cells that create new knee cartilage were dead within four hours (I assume these cells were chondrocytes?).
Whoa. That’s really grim.
Now, an intriguing question (that the article doesn’t pose, but that occurred to me): Are people who have an injured/torn meniscus also susceptible to a certain amount of cartilage cell death? Because their meniscus isn’t working as well as it should?
For me, the bottom line is that I don’t find this study surprising. What I find more surprising is that medical savants of 40 years ago could have looked at a rubbery cushion in the knee joint and decided that it really wasn’t that significant.
Medical hubris at its finest.
Decades ago, the common medical wisdom was that the meniscus wasn’t all that important, and when it was torn, surgeons simply took it out.
Of course common medical wisdom was wrong.
Patients who had their meniscus removed often developed arthritis in their knee later. That suggested the meniscus actually played a critical role.
Now we have new, and quite sobering, details about what happens when the meniscus is extracted from the knee.
According to a new study, “extensive cell death occurs within hours during vigorous exercise.”
Researchers used a powerful microscope to observe what was happening, minute by minute, as the vigorous activity was occurring. The article says that half of the cells that create new knee cartilage were dead within four hours (I assume these cells were chondrocytes?).
Whoa. That’s really grim.
Now, an intriguing question (that the article doesn’t pose, but that occurred to me): Are people who have an injured/torn meniscus also susceptible to a certain amount of cartilage cell death? Because their meniscus isn’t working as well as it should?
For me, the bottom line is that I don’t find this study surprising. What I find more surprising is that medical savants of 40 years ago could have looked at a rubbery cushion in the knee joint and decided that it really wasn’t that significant.
Medical hubris at its finest.
Saturday, December 1, 2018
One Reason Bad Knees Don’t Heal
So I found out that my brother, he of the torn meniscus, decided against surgery for now. He learned that his health insurance would leave him exposed on thousands of dollars of the cost and decided to take a pass. But his doctor told him he should expect to have a knee replacement in ten years.
How’s that for a future? Ugh.
Now, if I were him, I would not accept that. I can imagine a doctor saying the same thing to me about ten years ago, and today my knees are fine. But I also know that a lot of bad knees never heal. For us active types, there’s a very good reason for that.
Quite simply, it’s because we can’t give up what we love doing most. For me, it was cycling. For him, I think it’s hiking and weightlifting.
With knee pain, I think there has to be a sort of “come to Jesus” moment. Your knees have to get so bad, your misery so complete, that you resign yourself to the fact that everything must change.
Everything. And that means that sport that you love has to go.
I know I clung to cycling for as long as I could. I convinced myself I’d pedal differently, or stop going up mountains, and gradually the pain would go away. It did not. But I labored under this delusion for as long as possible, unwilling to face the truth.
Unwilling to have that “come to Jesus” moment.
I believe one key turning point in my recovery was fully, and unconditionally, accepting this statement:
I will stop riding my bicycle, and I may never ride it again, and I’m okay with that.
That was both a depressing and liberating realization. The sweaty physical activity I took part in, those wonderful, heart-pumping, intense workouts, involved cycling. Losing that seemed terrible.
But it was necessary.
I switched over to easy, high-repetition motion. For some people, that can be cycling. For me, it wasn’t. I found my body liked slow walking the best. I structured a program around that.
And, over the course of many months (as I detail in my book), I healed.
I’m not sure if my brother is at that point yet, where he can say, “I may never go hiking again, and I don’t care.” I don’t think so. But I think that’s the beaten-down point you have to reach, and in some odd way, embrace, before you can begin the journey up and out of a pit of despair.
What about those of you out there who are active? How have you dealt with this problem of resisting facing the reality of your limitations?
How’s that for a future? Ugh.
Now, if I were him, I would not accept that. I can imagine a doctor saying the same thing to me about ten years ago, and today my knees are fine. But I also know that a lot of bad knees never heal. For us active types, there’s a very good reason for that.
Quite simply, it’s because we can’t give up what we love doing most. For me, it was cycling. For him, I think it’s hiking and weightlifting.
With knee pain, I think there has to be a sort of “come to Jesus” moment. Your knees have to get so bad, your misery so complete, that you resign yourself to the fact that everything must change.
Everything. And that means that sport that you love has to go.
I know I clung to cycling for as long as I could. I convinced myself I’d pedal differently, or stop going up mountains, and gradually the pain would go away. It did not. But I labored under this delusion for as long as possible, unwilling to face the truth.
Unwilling to have that “come to Jesus” moment.
I believe one key turning point in my recovery was fully, and unconditionally, accepting this statement:
I will stop riding my bicycle, and I may never ride it again, and I’m okay with that.
That was both a depressing and liberating realization. The sweaty physical activity I took part in, those wonderful, heart-pumping, intense workouts, involved cycling. Losing that seemed terrible.
But it was necessary.
I switched over to easy, high-repetition motion. For some people, that can be cycling. For me, it wasn’t. I found my body liked slow walking the best. I structured a program around that.
And, over the course of many months (as I detail in my book), I healed.
I’m not sure if my brother is at that point yet, where he can say, “I may never go hiking again, and I don’t care.” I don’t think so. But I think that’s the beaten-down point you have to reach, and in some odd way, embrace, before you can begin the journey up and out of a pit of despair.
What about those of you out there who are active? How have you dealt with this problem of resisting facing the reality of your limitations?
Sunday, November 18, 2018
Healing Your Knees With ‘Virtual Reality’ Cycling
Okay, a confession up front: I know this won’t be the most popular post of all time, or even in the top 20. Still, I have been to other (virtual) worlds on my bike, and I want to share what I have discovered, and how it may apply to people recovering from knee pain.
The backstory: On Aug. 11, I crashed on my bike in the rain and broke the fifth metacarpal in my right hand, badly (I also broke the tip of my ring finger, but the orthopedist pointed out that was essentially small potatoes compared to the oblique displaced fracture of the metacarpal).
I was very, very morose about this turn of events, as this apparently meant I would miss the best cycling month in the New York City area: September (as well as August naturally). And I did miss it. I wasn’t cleared to ride my road bike outside until last month.
But I was determined to do something, even while wearing a cast. While encasted, I was advised not to sweat excessively (bacteria flourish on dirty, sweaty skin), but I couldn’t see myself spending Saturday mornings taking leisurely walks to Main Street. I evaluated some options (believe it or not, I had my eye on a fast recumbent bike, and was getting close to pulling the trigger on the purchase, then I found out that basically everyone would drop me on climbs.)
I ended up buying a smart trainer instead and joining the community of “Zwifters” and riding in my basement. The Zwift subscription costs $15 a month. The Zwift setup can range from a few hundred dollars to a few thousand; you can find the breakdown on YouTube videos.
What is Zwift? It’s a virtual world where you pedal on your bike, which is attached to a trainer, which in turn communicates your level of effort to the Zwift software. The software may be on an iPad or a PC (and if you want to add another layer of complexity, that device may in turn be hooked up to a smart TV that shows you cyling in the Zwift world.)
The harder you pedal in real life, the faster your bike-riding avatar goes.
The native Zwift world (called Watopia, which is probably meant to sound like a utopia for cyclists as all the roads are bereft of cars) has a variety of geographical features. There are underwater roads that travel through transparent tunnels, a volcano that can be climbed to the summit, and a rather daunting “hors category” Alpe mountain climb.
The cool thing about using a smart trainer is that Zwift tells the trainer if you’re going uphill or downhill, and how steep that grade is, and the trainer adjusts accordingly. So it’s quite hard to push up a 13 percent incline, but of course you’ll pedal down that grade with no effort at all.
Now for the quick bullet points, to get to the heart of the matter: How well does virtual reality cycling (like Zwift) work for knee rehab?
* First, virtual cycling keeps you engaged. Unlike a stationary bike, where you better bring something to read or have a fertile imagination, the Zwift landscape is always changing. And other cyclists, from all over the world, are passing by (sometimes Zwift feels like a geography test of “name the country that flag next to that person’s name belongs to”).
Also, there are group rides segregated by level. The riders “virtual chat” back and forth (you can see their messages come up on the Zwift screen, even when you’re not part of the dialogue).
* But Zwift worlds are not flat. I’ve noticed that the default route choices in the software never send you up a mountain, but they can still send you up some steep hills. This isn’t optimal for someone healing from knee pain. You do have the choice of making a U turn anywhere to avoid an ugly ascent, and I suppose you could make an effort to stick with flattish roads.
Or, if you’re not on a smart trainer, I guess you could just stick with easy pedaling, even though it’ll take a while to get up that hill.
* One negative is that Zwift tends to bring out your inner competitor. It’s very much geared to more-intense athletes who like to monitor their personal records, and want to see if they can beat their last record on a timed hill climb, or if they can pass that guy four seconds in front of them.
* Another possible negative: A lot of these Zwift athletes are pretty damn good. Example: I began climbing a big Zwift mountain in August, trying to hold 230 watts or so. Then I got better. Recently I was trying to hold 280 or 290 watts on the climb, and I broke my previous record and passed a lot of people on my way up.
Intrigued, I checked my personal record for the Zwift climb, to see how I compared with the others. I felt pretty good about myself until I found out I was about 25,000 out of 176,000. Ugh. Are the others really that fast? Or are some of them “digital doping” (i.e. lying about how much they weigh to go faster). I suspect it’s some of both.
* Another Zwift negative: The software forces you to ride in a certain world anytime you log in. Zwift controls which world everyone will ride in on a given day. I’m surprised that riders have no choice, as Zwift just created a “New York City” world that’s frankly awful.
Anyway, my feeling on Zwift as a rehab tool is it could be helpful, but more for people who are at a more advanced stage of their recovery. It is an interesting world to ride in. I know that I’ve gotten noticeably stronger on climbs. But I wouldn’t want to tempt the Knee Gods with some of those efforts unless I felt pretty good about how my joints felt.
The backstory: On Aug. 11, I crashed on my bike in the rain and broke the fifth metacarpal in my right hand, badly (I also broke the tip of my ring finger, but the orthopedist pointed out that was essentially small potatoes compared to the oblique displaced fracture of the metacarpal).
I was very, very morose about this turn of events, as this apparently meant I would miss the best cycling month in the New York City area: September (as well as August naturally). And I did miss it. I wasn’t cleared to ride my road bike outside until last month.
But I was determined to do something, even while wearing a cast. While encasted, I was advised not to sweat excessively (bacteria flourish on dirty, sweaty skin), but I couldn’t see myself spending Saturday mornings taking leisurely walks to Main Street. I evaluated some options (believe it or not, I had my eye on a fast recumbent bike, and was getting close to pulling the trigger on the purchase, then I found out that basically everyone would drop me on climbs.)
I ended up buying a smart trainer instead and joining the community of “Zwifters” and riding in my basement. The Zwift subscription costs $15 a month. The Zwift setup can range from a few hundred dollars to a few thousand; you can find the breakdown on YouTube videos.
What is Zwift? It’s a virtual world where you pedal on your bike, which is attached to a trainer, which in turn communicates your level of effort to the Zwift software. The software may be on an iPad or a PC (and if you want to add another layer of complexity, that device may in turn be hooked up to a smart TV that shows you cyling in the Zwift world.)
The harder you pedal in real life, the faster your bike-riding avatar goes.
The native Zwift world (called Watopia, which is probably meant to sound like a utopia for cyclists as all the roads are bereft of cars) has a variety of geographical features. There are underwater roads that travel through transparent tunnels, a volcano that can be climbed to the summit, and a rather daunting “hors category” Alpe mountain climb.
The cool thing about using a smart trainer is that Zwift tells the trainer if you’re going uphill or downhill, and how steep that grade is, and the trainer adjusts accordingly. So it’s quite hard to push up a 13 percent incline, but of course you’ll pedal down that grade with no effort at all.
Now for the quick bullet points, to get to the heart of the matter: How well does virtual reality cycling (like Zwift) work for knee rehab?
* First, virtual cycling keeps you engaged. Unlike a stationary bike, where you better bring something to read or have a fertile imagination, the Zwift landscape is always changing. And other cyclists, from all over the world, are passing by (sometimes Zwift feels like a geography test of “name the country that flag next to that person’s name belongs to”).
Also, there are group rides segregated by level. The riders “virtual chat” back and forth (you can see their messages come up on the Zwift screen, even when you’re not part of the dialogue).
* But Zwift worlds are not flat. I’ve noticed that the default route choices in the software never send you up a mountain, but they can still send you up some steep hills. This isn’t optimal for someone healing from knee pain. You do have the choice of making a U turn anywhere to avoid an ugly ascent, and I suppose you could make an effort to stick with flattish roads.
Or, if you’re not on a smart trainer, I guess you could just stick with easy pedaling, even though it’ll take a while to get up that hill.
* One negative is that Zwift tends to bring out your inner competitor. It’s very much geared to more-intense athletes who like to monitor their personal records, and want to see if they can beat their last record on a timed hill climb, or if they can pass that guy four seconds in front of them.
* Another possible negative: A lot of these Zwift athletes are pretty damn good. Example: I began climbing a big Zwift mountain in August, trying to hold 230 watts or so. Then I got better. Recently I was trying to hold 280 or 290 watts on the climb, and I broke my previous record and passed a lot of people on my way up.
Intrigued, I checked my personal record for the Zwift climb, to see how I compared with the others. I felt pretty good about myself until I found out I was about 25,000 out of 176,000. Ugh. Are the others really that fast? Or are some of them “digital doping” (i.e. lying about how much they weigh to go faster). I suspect it’s some of both.
* Another Zwift negative: The software forces you to ride in a certain world anytime you log in. Zwift controls which world everyone will ride in on a given day. I’m surprised that riders have no choice, as Zwift just created a “New York City” world that’s frankly awful.
Anyway, my feeling on Zwift as a rehab tool is it could be helpful, but more for people who are at a more advanced stage of their recovery. It is an interesting world to ride in. I know that I’ve gotten noticeably stronger on climbs. But I wouldn’t want to tempt the Knee Gods with some of those efforts unless I felt pretty good about how my joints felt.
Saturday, November 3, 2018
If You Take Painkillers, Opioids May Be a Poor Choice
I spotted this article about a pain medication study a while back (underlining is mine):
So, basically, Tylenol beat Vicodin. Sounds like a good reason to chuck the Vicodin in the trash. After all, as a doctor quoted in the article says, if opioids don’t work better, there’s no reason to use them considering “"their really nasty side effects -- death and addiction.”
In case you’re wondering, the study randomly put patients in either the opioid taker or non-opioid taker groups. Further details:
A yearlong study offers rigorous new evidence against using prescription opioids for chronic pain. In patients with stubborn back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.The opioids that were tested included the generic version of Vicodin. The nonopioids they were up against included generic Tylenol and ibuprofen.
So, basically, Tylenol beat Vicodin. Sounds like a good reason to chuck the Vicodin in the trash. After all, as a doctor quoted in the article says, if opioids don’t work better, there’s no reason to use them considering “"their really nasty side effects -- death and addiction.”
In case you’re wondering, the study randomly put patients in either the opioid taker or non-opioid taker groups. Further details:
Patients reported changes in function or pain on questionnaires. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function. Both groups started out with average pain and function scores of about 5.5 points. Pain intensity dropped about two points in the nonopioid group and slightly less in the opioid patients.Many of you already know my position on medication for chronic knee pain. Personally, I took as little as I could. I wasn’t worried about becoming a drug addict, but rather the fact that the drugs muted the signals from my knees that I was trying to listen to in order to figure out how to get better.
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