A Knee Pain Lesson From the World of Diabetes

A recent British study caught my eye. It wasn’t about knees, but diabetes. But there’s a lesson in there for knee pain sufferers, I believe.

Researchers split into two groups 300 people with type 2 diabetes, formerly known as adult-onset diabetes. All were ages 20 to 65 and had been diagnosed with diabetes within six years.

The control group followed regular treatment guidelines.

The second group stopped taking their diabetes drugs and were put on an 825-calorie-a-day diet of shakes and soups for three to five months. After losing weight, they returned to other food and received monthly counseling to keep the pounds off.

Two years later, 36% of those in the second group, but only 3% in the control group, had blood sugar that had fallen out of the diabetes range without taking drugs.

Weight loss turned out to be the critical factor, not surprisingly. Losing weight is a great idea to help with many problems, including knee pain.

But one takeaway I found quite interesting: one of the study’s authors said the results show that type 2 diabetes isn’t an “inevitably progressive disease.”

Osteoarthritis, which is what many knee pain sufferers are diagnosed with, is often portrayed too as an “inevitably progressive disease.” Knee pain in general is similarly thrown into the basket of hopeless causes.

But I think there’s a lot that people with hurting knees and even osteoarthritis can do to arrest the downhill slide, and even begin to get better.

The first thing is to reject the dismal pessimism of the phrase “inevitably progressive disease.” I mean, have you ever heard anything so depressing? There is absolutely no light at the end of that tunnel.

I think there’s ample reason to reject that dour thinking. Some of us with knee pain who were written off have gotten better. And then you have this latest study of people with diabetes, who modified their diet, shed weight, and managed to escape a lifelong regimen of drugs.

Open Comment Forum: What Are Your Goals This Summer?

I figured today I'd throw the comment section open to whatever people want to discuss.

If you don't have a better subject, you can take a crack at this one: What are your knee goals this summer? When the weather turns warmer, hiking up mountains and cycling down by the beach become attractive (but potentially risky) activities. (Apologies by the way to our friends down under, as they're not moving into summer, but winter!)

So how do you take advantage of the pleasant, warmer weather without overstressing your knees? What are your plans?

Of course the usual rules apply: Feel free to talk about whatever you want to below. You don't have to discuss the headline question. Share your problems if you're seeking insight. There are a lot of smart people who hang out at this blog who are generous about sharing their experiences with the struggle to beat knee pain.

I hope all are having a good month of May so far!

  

Will You Ever Be Able to Return to Your Favorite Sport Someday?

I found this in the comment section. I’m pulling it out because one of these questions in particular is worth addressing:

Do you think I will be able to play football again? It gave me purpose and a social circle. I am desperate to play again. I understand it is a long recovery process, and I am willing to be completely disciplined and dedicated to that. Whilst in recovery, would you recommend wearing knee braces? My last question: out of the three books recommended in 'Saving My Knees,' which are: Scott Dye's Envelope of function, The Doug Kelsey book and 'There Is A Cure For Arthritis', is it important I buy all of them? And which book should I read first?

Okay, the easy stuff first:

Wear knee braces or not?

I’m somewhat skeptical. The ones that probably do make a difference in terms of knee support are expensive and make you look like a cyborg. The ones you can buy at Walmart (or even some high-end stores) aren’t doing anything to reduce the load on your knees.

However ... as always, your mileage may vary. You may get a placebo effect. Or, as I mention in this post, there could be a different beneficial effect. Neoprene sleeves are thought to help by aiding proprioception. That big word describes your body’s sense of how it’s positioned in space. Better proprioception might mean better balance, which could improve knee stability.

Which books to buy?

Scott Dye has no book on envelope of function that I know of. However, you can probably find some of his papers online. Still, I wouldn’t even bother chasing down one of those. You’ll get an adequate sense of envelope of function by searching this blog or from Doug Kelsey’s “90 Day Knee Arthritis Remedy” at Doug’s website.

Will I be able to play football again?

This is the question I wanted to address.

The answer is a definite maybe. That’s the best anyone can tell you. Anyone who says otherwise is probably a charlatan or a fool.

I wanted to pull out this question because many active people ask it. They want to know, “Will I ever be able to dance/bicycle/rock climb/whatever again?” For me, it was ride my bicycle, of course.

I tried hard to get back on that bike as soon as I could. I got back on the bike before my knees were ready. I tried biking, failed, tried biking, failed.

To get better, I think you have to move beyond that question of “Will I ever be able to participate in my favorite sport/activity again?” You have to accept that the answer might be “no.” You have to look for new physical activities that won’t stress your knees that you can do in the interim.

I gave up on biking for a while, after even easy cycling disturbed my knee joints. So I decided not to even think about it. Pushed it out of my mind. I told myself I could be happy just being able to go for long walks. Once I made my peace with that, I no longer was focused on, “When will I be able to get back on my bike?”

Before then, I had been rather obsessive about cycling. But sometimes you have be prepared to move on. I did, and then when I got better, many months later, I rolled the bike out of the driveway, took a deep breath, climbed on the saddle, and slowly off I went.

So maybe you can play football again (which I assume is what we Americans would call soccer). But for now, you might want to think about pushing that thought far out of your mind. That tends to make things easier during what can be a long recovery.

A Cautionary Tale From the Big Medical Business of Knee Pain

Knee pain is a big, big business, not surprisingly.

Here’s an alert from Seeking Alpha, a website covering news on publicly traded companies, that shows starkly what small companies have at stake with cartilage restoration technologies.

In this case, Histogenics apparently developed a treatment called NeoCart. It’s described as a “cell-therapy based implant designed to help restore and heal knee cartilage through the use of a patient's own cells.”

I’ve written here and here about autologous chondrocyte implantation. I’m not sure how NeoCart works exactly, but it sounds a lot like ACI.

Alas, the NeoCart story may have a sour ending. I’ve been skeptical about ACI; I’m doubtful that it will lead to a result better than an old-fashioned microfracture. And sure enough, here are the findings of a study that sent the shares of Histogenics into a nosedive:

NeoCart, when compared to microfracture, was unable to demonstrate a statistically significant improvement in function and pain.

When the news came out, back in September, the stock abruptly plunged more than 75%, to about 60 cents a share. Think of that. If you had invested $100,000 in this company, overnight you wound up with less than $25,000.

Back in September, the CEO of the company hastened to assure investors that the results weren’t as bad as they looked.

If you believed that, if you held on to your stock, thinking “It’s going to rebound now” – and investor psychology shows people do tend to cling to their losers, hoping they’ll recover at least somewhat – you’re in even worse shape now.

Its latest stock price is 11 cents, or about one-fifth of its value in September. Right now it’s trading in the basement of the penny stock dungeon, jerking up and down on vapors and wisps of news.

What’s the upshot here?

Well, if you’ve got money to blow out your, um, ears, you should realize that investing in small companies whose fortunes are riding on unproven medical technologies is always going to be high risk. So caveat investor.

But for me, it’s at least as significant to ponder that maybe surgeons like Scott Dye have it right when they espouse a belief in doing as little surgically to heal bad knees as possible. If you can mend your bad knees without any kind of surgery, so much the better.

But if you’re going to do something to restore lost cartilage, maybe the simpler, less-invasive microfracture, which aims to stimulate your body to heal itself, beats this fancy, complex technology where your cartilage cells are grown in a lab then sutured back into your joints.

Something to ponder.

Pro Tip: How to Navigate This Site

So, some news first: I had an interview recently with a freelance writer for the Washington Post. Her topic (a very good one) was how to avoid knee replacement surgery. Well, that’s something I’m not bashful about talking about. If my knees had continued going downhill, I have little doubt that right now I’d be sitting in an orthopedist’s office, and the subject of knee replacement would be front and center.

She asked me how my knees were. That was the icebreaker question. I told her they weren’t normal. I think her breath caught slightly on the other end of the line. I could almost hear her thinking, “A relapse? Did I pick the wrong person to talk to?”

Then I explained that my knees are much better than normal. That’s the crazy thing. I emerged from this knee pain saga with knees that are probably in the top 5% for my age. Honestly, I do not have knee pain, and can chase my kids through the snow without problems, and so I feel very, very fortunate!

I will let you all know once the story runs, assuming she lets me know (or if she doesn’t, one of you can let me know, and I’ll provide a link to it). Of course there’s no guarantee my voice will be in the final story – I’m in the journalism business, and I know a good journalist leaves a lot of material on the cutting room floor – but I think there’s a decent chance.

Now for today’s subject: pro tips on searching this blog.

I realize I’ve been posting here now since June 14, 2010. Wow. Almost nine years.

Since then I’ve covered a lot of territory. So here’s how you can find some things if you’re new and are seeking help:

* If you search the blog for “success story,” you’ll find some detailed stories from people who have overcome knee pain (or are making great progress in overcoming it). I love success stories. Some of these stories you may relate to better than my own.

* If you search the blog for “Scott Dye,” you’ll find more about Scott F. Dye and his concept of the “envelope of function,” which for my money is the smartest framework for understanding and devising a plan to heal from knee pain.

* If you search on “glucosamine,” you’ll find plenty of material on why I think the supplement is basically a waste. But of course, if you think it works, go for it. The only damaged party will be your wallet (unless you’re diabetic).

* If you like reading me being philosophical, puzzling over unusual things, try these:

Of Breakdown Points and Discontinuities in Healing, Part I

Of Breakdown Points and Discontinuities in Healing, Part II

* If you want to read about debunking bad structuralism, go here:

The Odd Tale of the HQ Ratio

* And, last, one reason I’m so optimistic about the ability of cartilage to heal:

Why I’m So Optimistic About Cartilage Healing

Why I’m So Optimistic About Cartilage Healing, Take 2

The World Needs More 60-Year-Old Physical Therapists

Seriously.

I was thinking yesterday about why physical therapy latched on to its muscle fixation, when it comes to treating bad knee joints. You know the tired old song: Strengthen the quads to overcome the pain from ailing, balky knees!

Of course (as so many here can testify), the quad exercises end up further hurting the knee, which isn’t healthy enough to tolerate the force needed to strengthen the muscles. I had this frustrating experience myself and only started getting better when I rejected such catastrophic advice.

But where did the advice come from in the first place, and why did it prove so popular?

I can’t testify to its origins, but one thing I have noticed about physical therapists: they tend to be young, perky, athletic people. They like to stretch too. They eagerly acquire new stretches.

And it seems none of them have had the chronic knee pain that they are advising you on.

Is experience of a thing a necessary condition for advising on that thing? We don’t require a medical doctor to have lived through every problem he’s giving recommendations on, certainly. Nor should we.

But a certain humility and awareness of mortality and open-mindedness to alternative solutions comes with age, at least in the realm of physical ailments. This, I think, is a good thing when faced with the intractable problem of chronic knee pain. As a patient, I wouldn’t mind a little genuine empathy – if not with my knee pain, then perhaps with the fact that the body does betray its owner sometimes in mysterious ways, and can bring any of us low with pain that has no clear source and no clear solution.

That’s why I’d welcome more 60-year-old physical therapists who have had bad knees, bad elbows, bad feet – who have fought the good fight for months with a condition only to have it recur, then to subdue it, again and again, and finally win in the end. I’m not saying all physical therapists have to be mature adults, with hair shot with steely gray, but wouldn’t it be nice if a few more of them were?

Open Comment Forum: What Does Your Knee Like Best?

I'm going to keep this short, as I'm really tired this weekend. The usual rules apply: you can choose to answer the question I pose, or you can talk about whatever you want to.

It's an open comment forum. All of you are driving the bus.

Anyway, I thought it might be useful to start with this question: What does your knee like the most? Is it half an hour in the sauna, a short and slow walk, a massage, a meditation session, or what?

By sharing what personally works and what doesn't, I think we can all help each other.

All fine with my knees by the way (no, I don't say that to gloat, but rather as a perfunctory update, as sometimes people do ask how much knee pain I still have). Both knees feel good. It's like a rebirth!

Cheers.