Here’s is the third (and last) part of TriAgain’s story. If you skimmed the others, today's is the one to read closely! This is lessons learned. I find these quite interesting, so I’m just going to let him tell you what worked for him and either didn’t work or made his knee pain worse, and get out of the way!
The Bad
* Full-body-weight, leg-muscle strengthening exercises: too much load and frequency, so exceeded my envelope of function [i.e., capacity of the knee to handle the load]
* Anti-inflammatories: a short-term solution only and can cause long-term problems
* Stairs
* Knee taping
* Crouching, squatting, bending forward too much
* Icing: I had no swelling, but iced to relieve the pain. I was doing this a lot before the real chronic pain struck. I’ve since read that icing can cause CRPS
* Glucosamine (supplements): did nothing
* Iron (supplements): did nothing
* Body awareness: one thing triathlon can do is make you hyper-aware and paranoid of every little ache and pain in your body. You can focus on things too much, until they do become a problem, or become harder to solve.
The Good
* Becoming OCD about monitoring your knees, figuring out what makes them worse, what makes them better, and sticking to that, while gradually edging up your activity levels. For many, this will mean forget triathlon for the foreseeable future
* Walking
* Stretching
* TENS machine: my physio got me onto this and it was a Godsend for reducing the constant pain. I suspect it was working on the near-CRPS component of my pain and helping rewire neural pathways.
* Meditation: good for pain control
* Hoka shoes: they look ridiculous, but the difference in knee impact even when walking is noticeable and they help you get gentle knee movement without more damage
* Topical ointments (Lawang oil, emu oil, Tui cream): I think these work by relaxing the muscles/joint. There is also some evidence the menthol in these helps distract you from pain and has positive neuroplasticity impacts
* Stretching: as for above
* Hot baths/showers: as for above
* Fish oil: not sure about this one, but I continue to take it
* Losing the triathlon obsession: this took almost three years, but once I started getting some decent pain reduction, that became far more important than my need to race again. In fact, it made me realise how stupidly obsessed I’d become with the sport.
* PRP injections: I’m sure these helped, but were not the silver bullet
* Fly-fishing: the gentle walking with frequent stopping seemed to agree with my knees, as did being away from a desk, being in a nice outdoor environment, and wading in cool water
Weird things that worked
* Acupuncture: no idea why this works, but my Chinese medicine guy put the needles in my elbows as apparently that opens up the healing channels in the knees. I also meditate and relax a bit during these 30-45 minute sessions so maybe that is the thing?
* Neuroplasticity exercises: have a look at this and this. These indicate that you don’t have to just “manage” (i.e. live with) your pain, but can beat it my rewiring the CNS. I set up a little animation in Powerpoint which showed the pain centres in my brain shrinking, and it definitely had a positive effect.
* Backballs: these are self-massaging balls provided by my physio for your back which you lie on and they massage either side of the spine. I found there were some spots high up in my back which when massaged resulted in a noticeable reduction in knee pain. This could have been related to CRPS and changes in ganglia in the spine.
Saturday, April 28, 2018
Saturday, April 7, 2018
TriAgain's Success Story (Part II)
Now for part two of TriAgain’s knee pain story. There is a large section of his account where he talks about finding my book and blog, which I will not include here, so as not to (1) be accused of self-stroking :) (2) repeat what those of you who read my book already know.
He also mentions finding other success stories: “Ted” from California, Luis and his wife from Bolivia, and Terry42 from KneeGeeks.
And he talks about three other big influences (you’ll find all three on this blog; just do a search):
(1) Scott Dye and his framework for understanding knee pain in terms of “tissue homeostasis” and “envelope of function”
(2) Paul Ingraham, a really cool writer, hard-nosed skeptic, and myth buster
(3) Doug Kelsey, an Austin, Texas, physical therapist whose thinking is like a breath of fresh air in a stuffy attic
Instead of condensing what he wrote about Dye and the others, I’d like to focus on a diagnosis he said he received. I think it’s useful partly because this was NOT my diagnosis (nor do I think I had it, based on the symptom set), but I bet a lot of other knee pain sufferers would find it relevant.
The condition is called “complex regional pain syndrome,” which sounds like phantom pain at first – but it definitely is not. So here’s TriAgain (again):
“Some posts on KneeGeeks suggested I should research CRPS.
CRPS stands for Complex Regional Pain Syndrome. It sounds like some BS that is all in your head (you are imagining and/or making more of the pain than you should) – except it is not. It is real neurological changes in the ganglia of the spine and brain, and sometimes the local nerves in the affected area. What this does is massively increase your sensitivity to pain.
The 13-year-old daughter of one of my board members got CRPS after hurting her knee at soccer – except the pain was in her foot. She was in agony with terrible burning pain, and even the light touch of a sheet on her foot made it worse. She spent two weeks on a ketamine drip (nasty stuff) and had mirror therapy and other interventions to rewire her neural pathways. It was a 12-month recovery process.
Full-blown CRPS has symptoms including burning pain, discolouration of the skin, clammy or sweaty skin, extreme sensitivity to touch and pressure. I had the burning pain and discolouration in my kneecaps, so thought I should ask my GP about it. He agreed it was a distinct possibility. In the meantime I’d found a top pain specialist and got a referral to see him.
The pain specialist diagnosed patella chondromalacia (which I already knew, but don’t think is my main problem), muscle wasting around the knees (not surprising) and pre-CRPS, which meant not full blown CRPS, but getting there.
He prescribed a whole host of things:
* A book on pain management (good, but seemed to be suggesting the need to accept your pain and get on with life. I later found material which indicated through neural exercises you can overcome pain.)
* Natural supplements to reduce pain
* A nerve pain medication (Lyrica) which is pretty nasty. It made me very hazy and though I got some initial relief, weaned myself off it after a few months as I couldn’t function at work
* PRP injections – I had three in each knee and this guy only charged $110/pop. These gave some almost immediate relief, I’m sure helped with cartilage healing, but were not the magic bullet. I still had to be very careful.
* The only negative – the dreaded single-leg shallow squat within the range of no pain to re-build my VMOs. As stated above, impossible and counter-productive, though to be fair you can’t expect a pain specialist to be a knee expert and know the theory of envelope of function.
* One other treatment for CRPS is a controlled and graduated return to activity to rewire the central nervous system to learn that the physical activity causing you pain is not actually doing you physical damage. This led me into some very useful material on neuroplasticity (anyone see the Todd Sampson program ‘Redesign My Brain’?).
The take-home message: the whole CRPS experience led me to some excellent work on central nervous system rewiring techniques, and while not the entire answer, had a host of benefits.
Having figured out the conventional wisdom (leg muscle strengthening) was not working, I had to find another way.
Before the move, I’d long since given up cycling and running, and even kicking while swimming was starting to look highly suspect. At the new flat, there was a little 15 min walking circuit I would do every morning.
One positive to come out of my tri training program was lots of pull and band swimming, so I did nearly all swimming like that to limit kicking. Several times I tried getting back on the bike and for a few weeks, thought I was getting on top of the pain, but then went backwards again.
So I walked for 20-30 mins every morning before work, and either swam, did the little gym circuit, walked on a treadmill for another 15-20 mins, or did upper body weights at lunch/on weekends. I did this for about 12 months.
Between then and now, I’ve had up to a 90% improvement in the knee pain level, and a 50% improvement in function. However, it can fluctuate and go backwards at times.”
He also mentions finding other success stories: “Ted” from California, Luis and his wife from Bolivia, and Terry42 from KneeGeeks.
And he talks about three other big influences (you’ll find all three on this blog; just do a search):
(1) Scott Dye and his framework for understanding knee pain in terms of “tissue homeostasis” and “envelope of function”
(2) Paul Ingraham, a really cool writer, hard-nosed skeptic, and myth buster
(3) Doug Kelsey, an Austin, Texas, physical therapist whose thinking is like a breath of fresh air in a stuffy attic
Instead of condensing what he wrote about Dye and the others, I’d like to focus on a diagnosis he said he received. I think it’s useful partly because this was NOT my diagnosis (nor do I think I had it, based on the symptom set), but I bet a lot of other knee pain sufferers would find it relevant.
The condition is called “complex regional pain syndrome,” which sounds like phantom pain at first – but it definitely is not. So here’s TriAgain (again):
“Some posts on KneeGeeks suggested I should research CRPS.
CRPS stands for Complex Regional Pain Syndrome. It sounds like some BS that is all in your head (you are imagining and/or making more of the pain than you should) – except it is not. It is real neurological changes in the ganglia of the spine and brain, and sometimes the local nerves in the affected area. What this does is massively increase your sensitivity to pain.
The 13-year-old daughter of one of my board members got CRPS after hurting her knee at soccer – except the pain was in her foot. She was in agony with terrible burning pain, and even the light touch of a sheet on her foot made it worse. She spent two weeks on a ketamine drip (nasty stuff) and had mirror therapy and other interventions to rewire her neural pathways. It was a 12-month recovery process.
Full-blown CRPS has symptoms including burning pain, discolouration of the skin, clammy or sweaty skin, extreme sensitivity to touch and pressure. I had the burning pain and discolouration in my kneecaps, so thought I should ask my GP about it. He agreed it was a distinct possibility. In the meantime I’d found a top pain specialist and got a referral to see him.
The pain specialist diagnosed patella chondromalacia (which I already knew, but don’t think is my main problem), muscle wasting around the knees (not surprising) and pre-CRPS, which meant not full blown CRPS, but getting there.
He prescribed a whole host of things:
* A book on pain management (good, but seemed to be suggesting the need to accept your pain and get on with life. I later found material which indicated through neural exercises you can overcome pain.)
* Natural supplements to reduce pain
* A nerve pain medication (Lyrica) which is pretty nasty. It made me very hazy and though I got some initial relief, weaned myself off it after a few months as I couldn’t function at work
* PRP injections – I had three in each knee and this guy only charged $110/pop. These gave some almost immediate relief, I’m sure helped with cartilage healing, but were not the magic bullet. I still had to be very careful.
* The only negative – the dreaded single-leg shallow squat within the range of no pain to re-build my VMOs. As stated above, impossible and counter-productive, though to be fair you can’t expect a pain specialist to be a knee expert and know the theory of envelope of function.
* One other treatment for CRPS is a controlled and graduated return to activity to rewire the central nervous system to learn that the physical activity causing you pain is not actually doing you physical damage. This led me into some very useful material on neuroplasticity (anyone see the Todd Sampson program ‘Redesign My Brain’?).
The take-home message: the whole CRPS experience led me to some excellent work on central nervous system rewiring techniques, and while not the entire answer, had a host of benefits.
Having figured out the conventional wisdom (leg muscle strengthening) was not working, I had to find another way.
Before the move, I’d long since given up cycling and running, and even kicking while swimming was starting to look highly suspect. At the new flat, there was a little 15 min walking circuit I would do every morning.
One positive to come out of my tri training program was lots of pull and band swimming, so I did nearly all swimming like that to limit kicking. Several times I tried getting back on the bike and for a few weeks, thought I was getting on top of the pain, but then went backwards again.
So I walked for 20-30 mins every morning before work, and either swam, did the little gym circuit, walked on a treadmill for another 15-20 mins, or did upper body weights at lunch/on weekends. I did this for about 12 months.
Between then and now, I’ve had up to a 90% improvement in the knee pain level, and a 50% improvement in function. However, it can fluctuate and go backwards at times.”
End Part II
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