Sunday, August 1, 2021

'I'm Not Dead Yet,' as Monty Python Once Said

Reading all the comments come in after I announced an easing away from the blog was almost like having a ringside seat at my own funeral. Part of me wanted to shout, "Hold on, hold on! I'm still here!"

Yes, my posting from now on will be more sporadic. The blog might go dark for months at a time, or maybe for good at some point. But we're not at that point yet.

If you want to keep the blog alive in some form, go ahead and post questions you have, and I'll answer them (and invite others to help me do so).

Finally, I did want to post this comment from Knee Pain. I realize to many of you reading this, "Knee Pain" is just another online moniker. But she's been with me almost as long as this blog's been around.

She is one of the original hard-luck cases. Look up her success story and you'll be amazed. Her comeback is much more inspiring than mine.

She left a very kind comment, and a great update on how she's doing.   

Hurrah for 10 year anniversary!! I'm very grateful that I found your book.

I remember I practically read it in one sitting. It was very encouraging and great to find someone who could RELATE to this tricky problem of finding just the right amount of movement BUT not too much that would cause a flare up

I remember stories that you shared that I could relate to like the one where you carried something kinda heavy around Hong Kong (maybe it was a fan?) and that caused a flare up. I carried a computer monitor down several flights of stairs and that caused a flare up and I also remember pulling a suitcase on a leash and somehow even that caused a flare up (I think because the act of pulling something heavy with just arm changed my weight distribution on my legs?) Argh.

I was just reflecting recently that my bad knee now seems totally reliable. I'm doing lots of walking and hiking and biking and even backpacking and.... I've stopped worrying that it is going to have a flare up. It doesn't even send me little grumpy warning signals anymore.

That said, I feel it's important to stay vigilant and keep moving and exercising and not get complacent. I don't want a relapse.

Excellent! That's the kind of comment that brightens my Sunday!

Have a good knee day, everyone. 

Saturday, July 3, 2021

An Update On the Blog (and a Few Basic Rules)

I'm heading off on a weeklong vacation, so I thought I'd do a quick update on the blog.

I always planned to keep this blog going for a few years, then let it quietly fade away. Part of the idea was to continue the blog while the knee books were selling, as a way to support readers who had questions. At long last, knee book sales are tapering off, so I'll soon transition to a much more occasional blog.

I never thought sales would continue for this long! It's been a pleasant surprise. The message of Saving My Knees isn't probably for everyone, but some people have apparently found it valuable. But now that sales are dropping off, and I find myself increasingly pressed for time to devote to other projects, I will soon transition to spottier posting.

Also, there are few rules here. But these are a couple:

(1) I have a lot of people reach out to me. I don't really want to become anyone's knee counselor. I'm not qualified for one, and two, I barely have enough time (with two young kids and an old house) to take care of everything in my life as it is!

So the best way to ask questions is right here, on the blog. There are several advantages to that: (1) The answers to your questions may help other people who have a similar problem. (2) If I don't know how to answer your questions, I bet someone else here will.

(2) Please don't post spam comments. I just delete them. I don't mind people posting links, in the context of a comment that's related to a post (or an issue someone has), but there are comment spammers that I delete quickly. They post "thin" comments that don't really directly engage with anything on the site.

They often look something like:

Great info! I loved what you said. If you want to take care of your knee pain, try the Magic Sleeve (with a link to the bogus Magic Sleeve).

One last thing: If anyone does have questions related to knee pain, please drop them in the comments. I'm at the point where I'm mostly foraging in there to find things to post, as I get closer to this blog going semi-dark.

(Not fully dark! I want to be able to jump back in here from time to time, especially as studies pop up that validate the message of Saving My Knees!) 

Saturday, June 19, 2021

The 10-Year Anniversary of 'Saving My Knees'!

I'm actually a bit late on this but:

January was the 10-year publication anniversary of "Saving My Knees," my account of beating chronic knee pain. That whole unhappy time feels so distant now, like a long-ago bad dream that I've finally managed to shake off.

Today, for example, I went on a 64-mile bike ride ... a hard 64-mile bike ride. I felt fine during the ride, and I feel fine now afterwards. No Advil. No ice packs. No anything (well, my quads did grumble this afternoon when I walked down the stairs from the second floor).

I realized that, even if my knees fell apart tomorrow (which I very much doubt), I will have had 10 great years that my old orthopedic doctors would never have guessed lay in my future. What's more, my knees have gotten stronger over the years.

For example, in the several years following the publication of the book, I did have some minor issues from time to time. Sometimes I would have a little burning sensation around the kneecaps, the same as when I was suffering from chronic knee pain. These episodes would be rare, and last only a few weeks, but I took the symptoms very seriously.

But in the last several years -- maybe even four? or five? -- I haven't had that burning sensation at all. In the future, I realize, it may come back. But for now, I take this as a sign that my knees have healed, and adapted to the intense stresses I regularly put on them.

Over the winter, for instance, I rode my bike indoors, in the basement, in virtual worlds created by Zwift. I rode with groups that were stronger than me; I would spend three hours, without stopping, pedaling like mad to stay with the "B" group. Sometimes I averaged about 230 watts over that period.

And ... the knees were fine, even though I pushed them harder than I probably should have.

Ten years after publishing the book, I've gotten smarter about a few things. For one, my story doesn't resonate with everyone (in the latest foreword to the book, I even tried to scare off people who I didn't think would care for it very much).

But I think the message is a powerful one. I don't pretend at all that it originated with me; Dr. Scott Dye and Doug Kelsey figured this out first, and I took liberally from Kelsey when trying to put together a program to heal.

In the book, I just wanted to tell my own story, hoping it would inspire others and, most of all, give them optimism. I suppose I took a chance; what if I had published the book and my knees had fallen apart two years later? I would've felt like a fraud.

Instead, everything worked out great for me, and I'm certainly grateful. If you have knee pain, you can beat it. Remember that. You can beat it. I did. And if you look for "success story" on the search bar for this blog, you'll find plenty of other people who did too. 

Sunday, June 6, 2021

Of Magic Pills and Surgery

A brief post today about magic pills and surgery.

I saw this yesterday:

When it comes to battling with joint pain in a natural way, certain remedies like the use of methylsulfonylmethane (MSM) may be helpful.

That word is certainly an impressive concatenation of chemical prefixes, and gave me flashbacks to high school chemistry. I will add that I know nothing about methylsulfonylmethane.

(I have written extensively about glucosamine and chondroitin, which rigorous scientific studies have turned against as solutions to knee pain. They are most likely placebos, it appears.)

So why am I down on something that I know nothing about?

It's more like this: we want things to be easy. Take a pill. Or schedule a surgery. And whatever ails us is fixed.

Essentially, you hand over control of your knee pain to a surgeon, or to the researchers who came up with the formulation for the pill.

But I don't think it usually works out well with knee pain. My experience is that YOU have to get involved with YOUR knee pain. You can't outsource the problem to some nutraceutical company, or orthopedic surgeon.

You have to focus on beneficial movement, monitor symptoms closely, and not lose sight of the end goal, day after day after day.

But you may be thinking: What's wrong with taking a pill? Maybe it will help.

Maybe. But it may also lull you into thinking that you can be less vigilant in your own efforts to fix the problem.

Anyway, for the record, I took a number of different joint pills. I don't think any of them helped in the least. I also followed a strict program of movement that gradually increased in intensity, and that worked.

That's how I think knee pain suffers get better, not by popping something out of a bottle. (Note: there are times of course when surgery makes sense, but there are far too many knee surgeries for problems that can't easily be fixed by that kind of intervention.)

Sunday, May 23, 2021

A Bad Knee, a Pessimistic Doctor, and a Muscle-Obsessed Physical Therapist

I got this comment -- a story really -- and it's a long one, so I've edited it down. You can find the full comment here. I've underlined some parts that I found interesting.

I am a 28 year old female, very active, but unfortunately twisted my knee 3 years ago getting ready to take off for a run on wet grass. The sharp pain was horrendous, as my leg twisted my knee tensed and it felt like I had torn everything in there. I carried on stupidly as I was in a bootcamp and embarrassed to highlight myself as injured!! As a 25 year old healthy girl at the time, I assumed it would fix itself and carried on about my life ignoring the niggle up the stairs and when hiking. I initially went to a doctor who told me I had patellofemoral pain syndrome and to get back in the gym.

I never had pain squatting or lunging with weights, it was only the act of load bearing with my knee over my foot where I got the sharp pain. Similarly to a few previous comments I have read on your blog, the pain when I work out seemed to disappear and even after prolonged weights I found improvements in my knee and could run up the stairs no problem! Well I think all of this was not allowing it to heal properly as the pain always came back when I didn’t work out for some time.

I think the strength on the other areas were maybe masking the knee problem short term, who knows! But I certainly didn’t do it any favours getting back lifting weights. Pain started to feel a little more prominent this past year. I can walk totally fine. Hiking is my passion and something I haven’t been able to give up. But this causes me a lot of pain the next day and is hard on the joint coming down.

All of this led me to pay for an MRI to see what was going on. It showed I have a ‘punched out lesion within the cartilage of the patella in a central position. There is thinning of the trochlear cartilage in association with this. No reactionary oedema but evidence of a dominant lateral trochlear facet which is slightly dysplastic. Grade 3 chondromalacia’

The specialist said I could require arthroplasty in the distant future, but I should focus on swimming and cycling to manage it and avoid impact activities. He said there is no way to treat it and it will continue to get worse with age. Sure enough I left feeling very upset, hopeless and frustrated.

My strength PT said we should be still focusing on strengthening quads, glutes, calves core and hips etc but he has me still load bearing with some weight which I don’t feel is the best option for healing after reading through the blog! Would you agree? I have a lot of range of motion and don’t get any pain walking but when bent with pressure I’m getting the sharp pain. I have only just recently the past two weeks started to feel a burning sensation in that knee after movement. Is this a worrying sign that it is getting worse?

Desperate to find a way to combat the pain and make sure I am not doing further damage. I am due to go traveling to Canada (I’m from the UK) in a matter of months, a trip I have planned for a long time when my knee wasn’t causing me these problems) to do a lot of hiking which is so important to the trip. I don’t want to miss out on life because of this, but also do you think I could progress my grade 3 into grade 4 if I hike?

The magic question I suppose is, do you think it is possible to turn grade 3 chondromalacia around and live pain free!? I have an unbelievably healthy lifestyle, my passion is fruits and veg and I am 5ft8 and 51kg so I have this in my favour!

For starters, congrats on the healthy lifestyle and the ideal weight! You're young, eating well, and not carrying around a lot of extra pounds (or kilos). That seems like a good way to start a healing journey.

Next, I avoid giving advice. I'm not a medical professional, and even if I were, I've never seen you (or your knees). But I will share some things to think about.

I half-like the specialist. He said to focus on swimming and cycling and avoid impact activities. That strikes me as quite sensible, at least early on. Once your knees are in better shape, maybe you can do impact activities. For now, swimming and cycling, as long as your knees tolerate the activities well and you are careful not to push too hard, are two of my favorite "knee rehab" exercises (along with slow walking).

But I only half-like him. He also said there is no way to treat your condition and it will continue to get worse with age. Boy, he's a real cheery fellow, huh? I know nothing about your knee, but I think his dire prognosis is probably crap. One of the best things I read, early on during my struggle, was from Doug Kelsey, who was responding in his head to a doctor who had just told a patient that he'd never get better. And Kelsey's reaction was terrific, along the lines of: That's ridiculous, absolutely ridiculous.

Hope is so, so, so important. Orthopedic doctors should be smart enough to know that at least some knees do heal, without surgery. Mine did!

I'm not crazy about the strength physical therapist. I see the word "strength" and I wince. One thing I've come to realize about many physical therapists: they're young, frightfully fit, and haven't had any personal experience of whatever they're giving you advice about treating.

And they love strengthening muscles: because their playbook is full of strengthening exercises (and stretches). Stronger quads are great, but not if the effort to strengthen the muscle is greater than what the knee can tolerate. Unfortunately, you don't always realize that until the next day.

You might think, "Well, working out with weights helped my knees before, didn't it?" Okay, maybe it did. But maybe your knees aren't in the same place anymore. They could be worse, or more sensitive to the heavy loads and the bending.

Last, will going on this planned hike cause your knees to worsen? Maybe yes, maybe no. It depends on a lot of variables. How many miles a day? How many miles a day can your knees tolerate? How fast? How much climbing and descending? How many breaks? And you have to ask yourself: If this hiking trip isn't working out, is there a Plan B that you're confident enough to execute? Or do you just plan to suffer through?

Some thoughts. And one parting thought: If you bought Doug Kelsey's book, then you made a smart move. His book should be an invaluable guide on your journey. Doug really, really knows his stuff.

Sunday, May 9, 2021

Anyone Out There Want to Share a Prolotherapy Experience?

A very short post today.

I got this comment:

Richard, and others here: I am curious what you think about pro treatments. I am grade 4 chondromalacia patella in left knee and grade 3/4 in right knee since a car accident 15 months ago. According to x-rays the fracture in the left knee has finally healed but my pain has not decreased dramatically. I am constantly taking off from my teaching job and have had 4 doctors and 2 physical therapists and am still like this. The prp is not covered by insurance. I had one treatment 2 mos ago and it may have helped the fracture heal the rest of the way but I'm still suffering immensely.

First, to be clear: I know very little about prolotherapy, or platelet-rich plasma therapy (I understand that they are somewhat different). Doug Kelsey, whom I have great respect for, has written about PRP here.

So what I think of prolotherapy, or platelet-rich plasma injections, is probably not that valuable.

But a lot of people with knee pain are regular (or semi-regular, or occasional) visitors to this blog. Anyone out there have an experience with prolotheraphy they want to share? I'd be very interested to learn whether it's been helpful, and what the pluses and minuses are.

Sunday, April 25, 2021

Why I Don’t Try to Convince Others of What (I Think) I Know

I thought I’d heard about every question under the sun about chronic knee pain, my experience with it, and what I learned. Then I got this question, which I found intriguing. It got me thinking:

I'd be curious to hear if you or any readers have successfully convinced their doctors/therapists that anterior knee pain is mostly mistreated. I've begun to introduce ideas like envelope of function and how a joint first approach trumps addressing biomechanic irregularities. All of my therapists entertain the discussion and do not dismiss me, which I greatly appreciate. However, none have embraced those ideas. Frankly, I understand why. It feels like the height of arrogance for a patient to tell a doctor they are mistreating people. I feel like the crazy patient sometimes. Still, I feel compelled to convince medical professionals they are treating the most common type of knee pain incorrectly. Has anyone successfully convinced their doctors? Richard, do your doctors in Asia know you wrote a popular book on the subject?

A lot to unpack here.

First, I’m not surprised your therapists “entertain the discussion” and “do not dismiss” you. This sounds much like my physical therapist in Hong Kong, as I mused about various ways to treat my pain. But I reached the point where I think I could’ve told him that aliens were beaming me messages from deep space, and he would’ve murmured with a similar understanding.

So I would counsel against mistaking superficial “understanding” with an openness to changing deeply held beliefs.

And, as for whether my doctors know I wrote a popular book on the subject: Sadly, it’s only been sort of popular (sales are a pale fraction of what Stephen King’s next novel will do). And I assume, no, they don’t know. I have made no attempt to tell them. I don’t think it would matter much if I did.

So, to get to the real question: Why not try to spread the word to doctors and therapists that there are some serious problems with their approach to knee pain?

* I don’t proselytize about knee pain. It’s a waste of time, really. When people in the real world ask me about my experience, and they seem genuinely interested and open-minded, I’m happy to share.

Also, I wrote a book, and that’s my rather long argument about knee pain. Naively, I wrote the book thinking that everyone who suffered the same kind of lingering, hard-to-treat pain would find the book a nugget of gold in a slag pile of outdated thinking.

Of course they didn’t (check out my one-star reviews on Amazon – fortunately, not too many, but there are some). I made a kind of solipsistic error, I suppose, in thinking that most people would be like me and would approach the problem the same way, with the same kind of “I’ll beat this if it takes 20 years” determination, and willingness to entertain theories that deviated from the mainstream.  

* Can you really tell doctors anything? I’m only being a bit facetious. You, the patient – the one supposedly seeking advice from them – are trying to tell them they’re wrong? Because you saw something on the “internet” and Googled a few research articles? And meanwhile, they see knee pain patients day in and day out; they took the med school courses; they cut open the cadavers; they did the grueling residency.

I do believe the smarter doctors – and I think there are a good number – do realize the human body is maddeningly complex, that they don’t know perhaps as much as they wish they did, that they can learn from patients as well as pass on learning to them. I’ve had people on this blog say that they’ve shared some of my ideas with doctors, who say something like, “That makes sense.” That’s at least with regard to high repetition, low load exercises like walking.

* But they often aren’t willing to go much farther. Well, why not? Why not wonder if they don’t have an accurate picture of knee pain, and how damaged cartilage can be made healthier, or even restored?

Well, in part because I think this demands an exceptional individual, honestly. It demands a kind of radical curiosity, along with a sh*tkicker willingness to discard an accepted orthodoxy. And that’s hard. That’s very, very hard. How many people do you know who are willing to jettison a whole knowledge base – you know, put it up for intense examination, then toss it out the window if it seems flawed?

As a species, we’re invested in our narratives, our beliefs, our received knowledge.

I think stretching is a great example. My sister-in-law is a personal trainer. I think she’s a smart woman. She’s asked me about my knee pain before, and I’ve told her my story. I’ve also said that I think stretching is probably a waste of time (though, again, by all means, if you like to stretch, and it feels good and you’re not doing any contortionist stretching, it could well be fine for you or at least not harmful).

At that point, I can see her shutting me down. Stretching a waste of time? This is a heterodoxy of a high order indeed. So I could point her to studies that I’ve read, but why bother? On this point, she’s basically signaling, “Whatever you say on stretching, I’m not going to believe it.”

And why should she? Imagine you’re a personal trainer. You learn all these cool stretches. You share them with your clients. You trade stretches with other personal trainers. You are an expert in stretching! This has worth in your world. And then someone has the audacity to come along and suggest it may not be valuable after all! Why would you think about abandoning this thing you are so deeply invested in?

* I do sometimes wonder how money might be distorting all this, at least a little.

Think about it: If cartilage can heal (if slowly), why would anyone but the impatient (I suppose there are plenty of those), get a cartilage replacement? So all the surgeons trained to do those operations, all the companies that culture cartilage cells for implantation – how are they going to support themselves and be profitable?

I realize this has a deeply cynical, even conspiratorial ring to it. I don’t mean it to sound that way. But honestly, who’s looking into natural cartilage restoration? Where’s the money in that? There are financial incentives in this world, and they can at least subtly flavor how orthopedic surgeons view things.

Anyway, goodness, this has gotten much longer than expected. For me the bottom-line answer to the question posed above, I suppose, is I wrote a book. I’m immensely proud it has helped some people.

I don’t feel the need to convince anyone at this point. For a while, I did, and I was passionate (almost to the point of tears) about my story. But now, I guess my story is receding into the long narrative of my own life, as my knees have been fine for over a decade. I don’t want to get into a debate with people who swear by glucosamine, or who don’t think cartilage can get better.

Heck, just last week I saw my wife had bought some knee joint pills. If I were a zealot, I guess I’d go in and give her a long explanation why I think she’s wasting our money, and why I doubt she’ll find relief. But there’s no need to. If she wants my opinion, she knows where to find me (under the same roof). Hah!