Friday, December 27, 2019

Happy Holidays to All!

This is my end-of-the-year shout out to everyone who visits regularly, semi-regularly, or even who's dropping in for the first time.

Thanks for coming by, and best wishes for your knees in 2020. If you've been on a program, whether designed by you or someone else, year-end is a good time to reflect on how well it's working. Beating knee pain can involve a frustrating amount of experimentation. Sometimes you have to look at what you're doing, in a very clear-eyed way, and say, "Hey, I'm not getting better."

That's different of course -- very different -- from "Hey, I'm getting better, but it's taking soooo long." That unfortunately is par for the course.

My knees this year have been very, very good. I think I sprained a ligament on the inside of my left knee, and because I stubbornly refuse to curtail my cycling much, it has become a bit of a nuisance injury. Still, I plan to shut things down for about a month this winter, and hopefully that will take care of it for good.

What about all of you? Anyone out there want to share the progress you've made this year? What are you resolving to do more of/less of in the new year? Leave your comments below.

Cheers, and best to all!

Saturday, December 14, 2019

A Thinking Man’s Guide to Writing a Book About Knee Pain

After a Washington Post reporter wrote an article quoting me about my recovery from knee pain, I saw a predictable bump in sales of Saving My Knees.

A lot of people were motivated to buy the book, it turns out. A small number returned it, realizing it wasn’t quite what they wanted. (In the front, I now explicitly warn people that it’s NOT a book full of exercises, but rather my personal story.)

By the way, I love Amazon’s no-hassle policy on returns. I think it keeps merchants honest and careful about quality control. I’ve used it many times myself. I don’t have a problem if someone buys Saving My Knees, then decides, “Eh, it’s not really what I was looking for” and returns it.

Some people do find the book annoying, because it’s a story, as opposed to a pared-down, just-the-basics manual on fixing bad knees. This is something I didn’t initially realize would be an issue. Rather naively, I thought, “People will want to read the whole story, because the outcome is incredible, and this is a book I myself would’ve paid $100 for.”

I suppose every author is self-delusional to some degree. Otherwise, why go to all the effort of writing, rewriting, rewriting again, and rewriting some more, when for all you know your book may sell all of 20 copies? It’s a rather masochistic exercise that does little but feed the ravenous ego, I suppose.

So anyway, I remember at first being surprised by comments in reviews about people skimming through it to get to the "good parts," or complaining it was full of “filler.” But I understand now. If you have bad knees, you just want to know, “What should I do? Tell me. My knees are hurting, dammit.”

You probably don’t care about some of the little details I dropped in there about my own life, or my athletic life before I had bad knees. In my mind, I was telling a story that had a dramatic arc, and a character (me), and I wanted to flesh these things out. But in actuality, I totally understand the mindset of that impatient reader: “How did you do it? Hurry up!”

I’ve sometimes wondered if maybe a better title would have been something like, A Thinking Man’s Guide to Beating Knee Pain.

But I do think there are some advantages to telling a fuller story, and this is partly what I wanted to convey today:

(1) Those little setbacks I had – whether from carrying a fan up a few flights of stairs, or a full backpack for a fairly short distance – may seem unrelated, but they’re very ordinary, everyday events, and every knee pain sufferer will have to recognize that these things will happen, and be prepared to deal with them.

(2) I know I’ve said this before, but negativity takes a big toll on you. And there was a period in Hong Kong, nursing my bad knees, when I was just a ball of intense negativity. So all those little things I mentioned that got me depressed, yes, I did blow them out of proportion, but this is what it’s like being in such a negative state. You do tend to hold a lot of one-person pity parties. And to get on the healing track, you need to move beyond that.

(3) I wanted to show the frustration leading up to the discovery of what eventually healed my knees. I wanted to because so many people go through this prolonged state of trying so many things, with one thing after another failing. This is part of the experience, committing mistakes and chasing dead ends, but still trying again and again.

(4) I wanted to explain what I learned about how knees work, because this helps explain why the solution I came upon makes sense. Again, I’m a logical, rational guy. I don’t want for someone to just tell me something works. I want to know why it works.

(5) And then – I like learning stuff! And I wanted to share the many things I learned. I suppose that’s the inner journalist in me talking.

What if I wrote the book really short? I suppose the ultimate condensation would be something like:

I hurt my knees.

I walked a lot.

I got better.

But that only scratches the surface of the story that was important to tell. So I told that story. But no, I don’t disagree with any reader who thinks the book does include a bunch of non-knee detail (especially at the beginning, where I’m setting a scene). Feel free to fast-forward!

Cheers, and I hope everyone's enjoying the approach of Christmas. Less than two weeks away!

Friday, November 29, 2019

Yes, You Can Avoid Knee Surgery. Read About it in the Washington Post!

The Washington Post ran a wonderful article a couple of weeks ago about alternatives to knee surgery.

I was flattered that the reporter, Sally Squires, saw fit to include a condensed version of my story. We talked a couple of times. As a journalist myself, I know that good reporters conduct a lot of interviews, and not everyone they speak with makes the final cut.

When interviewing me, Squires was quite careful and thorough. As she explained in the article, she has been suffering from her own travails with knee pain, so I imagine that the research she did had a special resonance.

She gives a great overview of the dimensions of the problem our country has with sore knees: one in four adults have chronic knee pain, and the number of sufferers has jumped 65% in four decades. About 680,000 total knee replacements were performed in 2014.

Can you imagine that? That’s about one in 500 Americans  – in just a single year. What’s more, when adjusted for population, that rate doubled from 1991 to 2010. As her article notes, the number of knee replacements is outpacing operations for coronary artery bypass surgery.

This country has a crisis of bad knees, it seems.

Squires also quotes someone about the delayed onset of symptoms with knee pain. This is critically important, and I don’t remember reading much if anything about this when I undertook my own journey to save my knees.

It means that the activity you do now may seem pain free, but your knees might protest hours later. And if you don’t connect the dots between pain now and something dumb you did yesterday, your knees may never get better because you’ll never try to modify your behavior! I talk about this at some length in my book; it was a key revelation for me.

Finally, one small thing: she did mention that I still notice some burning in my knees when sitting. Honestly, I did suffer occasional spells of burning in my knees (when sitting) during the “post-recovery” period after I healed enough to go back to work.

But the problem with burning under my kneecaps lessened over time. I haven’t had any issues for (I think) two years now. I have to put “I think” in parentheses simply because it’s been a while, and I no longer track every little sensation from my knee joints.

But she’s correct that I did have this problem, and it took a while to shake. And it’s not like my knees never complain. I really beat them up sometimes (like in a very intense Thanksgiving bicycle ride this week). I still like to play hard.

And I’m glad that I can again!

If you haven’t read the excellent article that Squires wrote, please check it out here.

Saturday, November 16, 2019

Humans, Salamanders, and the Ability of Cartilage to Heal

Get a load of this: a scientific study is confirming that cartilage does have the capacity to regrow. Hooray!

Of course some of us have believed that for a while.

The reporting on this discovery has a kind of breathless tone of disbelief. The researchers who did the study call this ability we possess a “salamander-like” regenerative capacity. Salamanders, of course, can regrow limbs and parts of major organs.

As I’ve said a number of times, at least two studies done a decade or so ago have discovered that deep holes in cartilage can fill in naturally, at least part of the way, over a few years.  (For more, see here and here.) That doesn’t surprise me at all.

From an evolutionary biology standpoint, it just makes sense.

The cartilage in our knees takes a banging over the course of decades. It’s hard to believe that it would be designed so that it just wears out, like the tread on an overused car tire. Cartilage should have some natural regenerative capacity. Indeed, evidence has been found that, when damaged, it does try to repair itself.

The problem is, cartilage changes slowly. Defects in the tissue can easily get worse if too much pressure is applied to the knee joint. So getting better isn’t quick, or easy.

Anyway, more details on the study:

Researchers at Duke Health found that molecules called microRNA oversee the regeneration process. These molecules are more active in animals that are known to efficiently mend their own damaged limbs or fins, such as salamanders or zebrafish.

The research team thinks the microRNA could be used in treatments that could possibly reverse arthritis.

By the way, the researchers also looked at the age of cartilage in different locations in the body. It happens to be “young” in the ankle, “middle-aged” in the knee, and “old” in the hip. That, they suggest, could be why arthritis occurs more often in hips and knees.

So there you go. As you focus on gentle, low-load movement to heal your knees, you may be awakening your inner salamander!

Saturday, November 2, 2019

The Dangerous Shift by Orthopedists to 'Symptom Control'

I’m feeling a bit sour. This kind of irked me:
A new review of how specialists and primary care doctors treat knee osteoarthritis (OA) finds that the use of pain-relieving prescriptions has risen dramatically, while lifestyle recommendations and physical therapy (PT) referrals have dropped.
The next sentence provided needed context: doctors appear to be increasingly concerned with “symptom control” rather than treating the underlying issue. The analysis was based on data collected from national surveys conducted by the Centers for Disease Control and Prevention.

The lead author on the study, which was published last month in Arthritis Care & Research, rightly says we need to shift our thinking away from taking care of the immediate pain and toward preventing a further decline in physical health.

Well, yeah. Short-term fixes for hard-to-solve, long-term problems aren’t a good idea. It’s like using zip ties to hold your car’s battery cables together (I’d link to the YouTube video where I saw this “fix,” if I could only remember where – I discovered the video when I had to replace my own battery cables.) Short-term fixes are sometimes necessary of course because you need some way to get your car home, or in the case of your knees, to manage pain that's reached unbearable levels.

But, once the pain abates, you should start thinking of a long-term plan to take care of the problem.

Below are more details from the study, which I found mildly horrifying. The researchers discovered that:

* In the 2007-2009 period, orthopedic doctors referred patients to physical therapy 15.8% of the time. Less than a decade later, in 2013-2015, that figure dropped almost by half, to 8.6%.

* Many of these doctors also abandoned “lifestyle counseling” (e.g., exercise recommendations, advice about managing weight). Specifically, lifestyle counseling fell from 18.4% of all visits to less than half of that, or 8.8%.

So what were these poor patients leaving with, if not referrals to physical therapy or good advice about the importance of controlling their weight? You guessed it: little pieces of paper for their local pharmacy.

The number of prescriptions written by orthopedic specialists for nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubled, from 132 per 1,000 visits to 278 per 1,000, and tripled for narcotics, going from 77 per 1,000 to 236 per 1,000.

Personally, I think what many of these orthopedic doctors are doing is shameful. I’m not sure how much of it is because of the long-legged twentysomething drug reps showing up every few weeks with new pills and free goodies to shower on power prescribers, but I think there’s a better way.

True, it’s a harder way, a longer way. Still, if you minimize the pills, and stick to a careful regimen, you can actually improve the health of your bad knees. This isn’t just my story anymore, but the story of a fair number of other people who are regular visitors to this blog!

Saturday, October 19, 2019

On Quads Sets and Easy Passive Motion

Okay,  so here’s a comment I received (lightly edited):
I am a little worried right now, as unfortunately, I experience pain when walking. I also experienced it while biking. I am not sure yet what low-rep activities to pursue at this point, and I can't take off work to devote my time to laying with my legs up. Sometimes the pain comes on directly during physical activity, and other times will just appear as I'm resting, even laying down, usually at night. I also have an adorable 20-lb. daughter that I have to carry around quite a bit... unfortunately I think it is causing a toll.
Question: Some studies you mention say isometric quad sets improve, thicken viscosity of the synovial fluid. So I'm thinking about keeping some of those exercises and abandoning the wall sits, one-legged squats my PT had me do. Any thoughts? Also wondering how this works, as it doesn't seem like there is any motion involved with these exercises. 
Another question: it appears that bearing appropriately light load and motion is the best combo. In the study with the rabbits, did it seem that they were bearing load when they were attached to the passive motion machine? It seemed to indicate that motion, no load, allowed regrowth of cartilage only when a hole had reached the cartilage. I am considering whether or not bicycling in the air, while laying on my back, would be a smart way to get more motion without overloading and damaging the cartilage.
First, on this: “I'm thinking about keeping some of those exercises and abandoning the wall sits, one-legged squats my PT had me do.”

This sounds like you have a real muscle-first kind of guy. In other words, a typical physical therapist. As I see it, the trouble with “wall sits” (put your back against the wall and slide down, until it looks like you’re sitting on an invisible chair) and “one-legged squats” (squat down on one leg, then straighten up) is that they’re great for people with good knees (or knees that aren’t too bad) but can be disastrous for people with tender, easily upset joints.

When I had chronic knee pain, both of those activities bothered my knees. Eventually I simply said, “no more.”

Now, as for the isometric quad sets: Right, a study showed subjects who did them had thicker viscosity of their synovial fluid. How does that work, when there’s no motion? You know, that’s a good question. I’ve wondered it myself. How the hell does that work?

In any event, I have to confess: I’m not a huge fan of isometric quad sets. I guess they could be a useful way to build up your quads without irritating the joint (though sometimes they do irritate it, oddly enough). I have wondered if perhaps the thicker synovial fluid that researchers found was due to something else.

Then again, maybe quad sets are a good idea, which is my way of saying, “You might want to try them and see if they’re useful for you.” In any event, the bottom line for me is they didn’t factor in my recovery.

On the rabbits and passive motion: Yeah, no load. That’s my understanding. Like when your physical therapist grabs your leg, and moves it through a range of motion, and you just lie there on your back and watch.

So would lying on your back and pedaling in the air be the equivalent? Uh, I’m not sure about that. I just got on my back and went through some “air pedaling” motions, and it was harder than I expected. It certainly wasn’t easy peasy passive motion. However, you can always try it – I’m usually quick to point out that I don’t have advice or answers necessarily, but just like to share my thoughts on things.

I think it’s easier to replicate near-passive motion on a stationary bike. Set the resistance to zero, for instance. Or try to pedal backwards. Still, if your knees get cranky doing that, maybe this isn’t the best activity for you. One other option, if you really think you need to go back to square one, are what Doug Kelsey calls “sliders.” You basically put your feet on something like a dolly, and move your legs back and forth using its smooth rolling motion (I think).

I would definitely find out how Doug advises the exercises be done.

You might think about starting there, and build up to something harder later: easy cycling, or walking, or whatever.

One last note for everyone out there: I talked to the Washington Post reporter again, and she says that the article that she’s writing got delayed, but it’s planned now for early November. I’ll keep you all posted!

Sunday, October 6, 2019

Any More Success Stories Out There?

From time to time, I like to encourage people to send in their success stories, or even updates about what they're doing that's working well.

The small community that we have here benefits greatly from hearing voices other than mine talking about what works (and what doesn't) when it comes to knee pain.

So consider the comment section open to success stories or updates! Some of you have been visiting this blog for years, and have years of struggling with knee pain before that. You have long stories to tell that make mine seem quite short by comparison.

Anyway, that's all from me! Not a lot to report on my end ... I don't really think about my knees too much anymore, and that's kind of a nice place to be.

Cheers!