Saturday, November 20, 2021

On Knee Pain and Arbiters of Truth

I want to talk about something a little different today. At first it won’t seem at all related to my experience with knee pain, but I promise to connect the dots.

I want to talk about truth, and about arbiters of truth, and about powers given to those arbiters.

We’re still in the middle of a pandemic that has badly frightened and confused many of us. We are scared of getting the coronavirus and are desperately searching for guidance on what to do.

I’ve been vaccinated: both shots, and the second one walloped me. But I’m a data and science guy. I’ve read enough about Covid, and long Covid, that I don’t want to take my chances with either one.

Yes, the vaccines in rare cases can cause bad side effects, but if you’re playing the odds, Covid has a much higher chance of leading to serious damage.

Nationwide, there’s been a push to get more people vaccinated. Amid that has been an alarming rise of disinformation about the vaccines. On social media sites now, like Twitter, staffers have begun to label tweets that are considered false or misleading.

Apparently too, according to this ABC news story, people won’t be able to comment on, like, or retweet certain messages, such as “vaccines cause autism.”

As a guy who likes data and science, I suppose I should be delighted. But honestly, this entire project makes me deeply uncomfortable.

Yes, we have a bad problem in the United States right now. The inability of many Americans to evaluate arguments, in a logical, methodical way, is stunning. We’ve increasingly abandoned reason for tribal affiliations. We’ve become a nation of Team Democrat vs. Team Republican.

And your team apparently determines how you perceive truth, as insane as that sounds.

Still, this idea of “truth arbiters” cleaning up content bothers me. “Truth” is not a static, fixed thing. It changes. And “official truth” is even more suspect. Do you recall the early days of the pandemic when the country’s top health officials told us not to wear masks, that they weren’t effective?

Imagine if the Twitter truth sanitizers had gone through tweets, labeling any pro-mask tweets as “misleading.”

As for the Covid vaccines being safe: I honestly think they are. Am I 100% sure? Of course not. Could we find out, in some longitudinal study conducted in 30 years, that people who got these vaccines had a 60% higher risk of kidney disease, or some other thing?

It seems unlikely, but possible. We’re in the early days with these rapidly developed vaccines. I don’t regret for a moment getting one, but I also don’t know what the future holds.

Imagine that there was some terrible, as yet unknown side effect of getting these shots. And that a small number of people began to tweet about it. The self-appointed truth minders at Twitter would put a damper on that dialogue, fast.

Again, I want to be clear: I’m pro-vaccine. But I also look at things with a kind of radical open-mindedness. Anything I know, I realize, might be false. It doesn’t mean that I quickly ditch any well-founded beliefs that I hold in the face of a few bits of contravening evidence.

But part of me, deep inside, says: Anything is possible. That’s why I don’t like people who screen what’s true/not true for me.

Sure, you might be thinking, good for you. But not everyone asks the right questions, analyzes critically, weighs the evidence and probes for weaknesses in it.

And that’s a deep, deep problem in America today. But I think the answer lies in lifting people out of ignorance, even though that’s a harder thing to do. If you simply stamp that ignorance “false” or “misleading,” you drive them underground, into their little warrens of like-minded conspiracy theorists.

What does this have to do with bad knees?

My book, that I felt so strongly about writing, represents a minority viewpoint. I’m sure if it were passed around to many physical therapists and doctors, they would be inclined to label it “false” or at least “misleading.”

And because of that label, many people who might benefit from Saving My Knees would have been discouraged from reading it.

So just keep in mind: today’s “truth” may not be tomorrow’s. That’s one thing that my chronic knee pain experience taught me.

Okay, I’ve gone on far too long! If you have questions about your knees, leave them below. Or, if you have a good knee story, leave that too and I’ll devote a post to it.

Cheers!

39 comments:

  1. I think that eventually enough information/patient experience comes together to understand a topic in its entirety. Also, no one patient is the same and has exactly the same condition.
    The key is to remain open-minded and try and understand whilst reading all sides of a topic.
    For example, many people with mild anterior knee pain may do very well with strengthening VMO/squats/patellar taping/stretching/whatever else as they were always likely to get better...the biggest contributor probably being modification of exercise.
    Severe/chronic knee pain is a whole different entity and the knee can only heal if you don't push it more than it can handle...you discovered this by finding your own graduated exercise program. I think the physios/orthopods are all correct in a way- even the orthopod who told you that it was arthritis- is was in the sense that you had joint inflammation. Unfortunately, there is not a one size fits all and most patients are only seen in 10-15 minute interviews with physios/surgeons/chiropractors each having their own lens and specialist information for treatment. Very few look outside their own box.
    It is hard to critically analyse a topic, as most of us don't take the time to do it. Re vaccination, the film 'Social Dilemma' helped me understand why people think the vaccination is a hoax...they get fed this information via their social media feeds. I wish people for every opinion would make themselves read the opposite opinion. It is quite hard to do though.
    I'm very glad you wrote your book, it was extremely well researched and has many good thoughts on healing.

    ReplyDelete
  2. I think the problem is a bit of a one-size-fits-all too with both covid and knees. I had covid in February and got one shot in July and then developed horrible ear ringing and I had tightness in my throat the day of the shot. When it was time for my second shot I did not go. Two weeks ago I had a physical and had antibodies. Plenty of covid antibodies. Doctor said it showed I had had natural infection and still had antibodies....after everybody pressuring me to go ahead and get my second shot.
    Reminds me of my experiences with my knees and physical therapy. I continue to go because everybody says to go. my doctor. everybody. I have multiple conversations with my PT about not pushing my knees too hard and one time it will be okay in the next time I'm on the couch for days because he will push it too much again.
    I want to just quit and do my own therapy. I really do. Yet there's all these voices telling me I need to keep going. That's why I come to this site because I like to hear a different point of view. I was supposed to go back to work January 3rd and I am still on to crutches and there is no way I'm going to be able to go back to teaching full-time so everything is coming to a crunch for me.

    ReplyDelete
    Replies
    1. It makes no sense to me that if physio exacerbates symptoms for days that it would be a good thing. It means that whatever the nature of the exercise prescribed, it is too much for your joints. It is this such difficult balance of keeping muscles strong with an inflammed joint.
      I have come to realise that I am the only one who is experiencing the knee pain. I imagine many of the physio's have never had knee pain. I have taken a different approach now; I am getting advice from physio and trying the approach but seeing it just as advisory and it's up to me whether or not I do it/modify it/ditch it.
      Working is a difficult thing as for me it improves my sense of worth as I am finding the whole experience very depressing. If you are still on crutches are you able to go to work? Can you work part time? Are there modifications at work that could assist a return?
      Trust your instincts would be my advice.

      Delete
    2. Every time I've gone back to work I have always regressed. Right now I'm having more pain than I was before the surgery and I was struggling to Work even three - /4 days a week.
      I have a commute and driving makes my knee pain bad. I laid in the tub tonight and just cried because my sore knees have affected everything today -my Thanksgiving which I just got through.
      I feel like my physical therapist just not going to be able to adjust with me. I guess I'm going to have to quit going.
      Thank you for responding to me today. We have talked before. I am Stephanie who has posted with you before but I go by Paige.

      Delete
  3. I feel for you and have so much compassion. Knee pain affects everything in ways that people without it don't understand. It takes a lot of courage just to get through the days sometimes. It sounds like you should not be working at the moment unless you can do it via Zoom etc. That is a difficult decision and one which only you can make.
    I do think that there is always some hope with treatment options. Without knowing too much about your injury/age etc.and whether there is an expectation that you will heal....there are options down the line surgically and so one would hope that if conservative measures fail, in the future you could have more definitive surgery which hopefully would mean you would be much more functional and have less pain.
    I would find a physio who focuses on joints and is aware of how irritable your joints are at the moment.
    I am fully aware of how awful it is to be in this situation though..it affects one on a physical/mental and spiritual basis....I send a lot of compassion and wish you courage and resilience.

    ReplyDelete
  4. Thank you Lindsay for your understanding and compassion. How is your own knee journey going right now?

    ReplyDelete
  5. I continue to experience pain, inflammation and loss of function in both knees and no improvement so far with conservative treatment. I have a good physio who is building hip and core strength and conditioning the joints. I am doing everything I can and it's frustrating when you don't see any improvement whatsoever.
    I find the whole situation mentally draining. Seeing an orthopedic surgeon next week although I want to avoid surgery if at all possible, especially since I don't appear to have any pathology on imaging. Still, I would like to know what the thoughts of the surgeon are and what options there are, if any.
    I think it is possible I have fat pad impingement but I may be wrong. I may try a steroid injection into the fat pad.
    I totally understand the frustration, anxiety and hopelessness you feel. It's awful. I think being hopeful is the only way forward.

    ReplyDelete
  6. I'm sorry to hear you aren't improving. I guess you have the burning pain? Does he do PRP injections? I had two of those. They were 500 dollars each. Insurance doesn't cober them usually.. One did help my fracture heal supposedly. It had been stagnate in healing. Steroid injection helped for a week or two when I had it but I know for some people they make a lot more of a difference.
    I hope your visit goes well....

    ReplyDelete
  7. Thank you. Yes, I have the awful burning pain. I want to try a steroid injection into the fat pad if the surgeon agrees with me.
    I am not sure about PRP. He hasn't mentioned that.

    ReplyDelete
    Replies
    1. Steroids help a lot of people but for me I had my injection when my knee still had a slight fracture in it and my second doctor didn't even see it...duh. Therefore I had to wait 3 months before my new doctor would do the PRP because steroids halt healing and get in the way of the p r p helping

      Delete
  8. For some of you it sounds like Knee Pain has taken over your life, you'd do yourself a service and read this account of how he abolished his pain. My understanding that this author has corresponded with the author of this blog as well:

    https://inscape489664645.wordpress.com/2018/07/24/my-knee-pain-success-story-a-surprising-road-from-despair-to-joy/ (My Knee Pain Success Story: A Surprising Road from Despair to Joy)

    ReplyDelete
  9. I'm getting a file not found at that link I posted earlier, maybe this one will work:

    https://inscape489664645.wordpress.com/2018/07/24/my-knee-pain-success-story-a-surprising-road-from-despair-to-joy/

    ReplyDelete
  10. This is really interesting- thank you Brian. I agree, knee pain has taken over my life.

    ReplyDelete
  11. I've been there. The methods this guy writes about in that link have worked for me before, I hope you get some measure of relief too.

    ReplyDelete
  12. I have cartilage damage as a result of a car accident, and it shows on MRIs. Also had a patella fracture. I found this to be interesting reading but I found myself to be a very different situation. One thing that I did see that has become a common theme on this blog and others is that the traditional physical therapy and Doctor care did not help him. Every time I go to physical therapy and my knees are stretched beyond their limits and I am down for four or five or six days, this message is being driven home for me. Unfortunately I am in a situation now where I pretty much have to go for reasons related to my job. This is the recommended method by my doctor to get better so I have to show that I am trying, which frustrates me, because of course I've been trying ever since this happened. I feel like Im in PT jail.
    Now I'm having a very unusual problem where my doctor recommended shorter visits and when I told my PT this he balked at that. So now my doctor and my PT are disagreeing and I am stuck in the middle. Now it's easy to say to just go somewhere else for PT oh, but I have been to three clinics here in my town now and this is by far better than the other two so now I have anxiety each time I go to PT and knowing I am going to have to Stand My Ground about a shorter visit. I mean the whole thing is just getting absolutely crazy.

    ReplyDelete
  13. Paige - I hear you. Keep in mind that even a full fracture of the largest bone in our body will heal in 6 weeks. If you're experiencing chronic pain that goes on for longer than a reasonable timeframe (in my case, years) then it's likely other factors are at play. I urge you to explore what is described in that link above, also at the TMSWiki, or just simply google Sarno's book on Amazon. It's the best <$10 I ever spent. And besides, at this point, with knee pain taking over your life, what have you got to lose?

    ReplyDelete
    Replies
    1. Yeah I read it...Im glad it helped you. Ive got dashboard knee...losts of cartilage and other types of damage were involved.
      Now Ive been diagnosed with a rare condition called CRPS.
      Everybody is different...Im glad you got better. Its just not emotional for me...there are a lot of factors at play. Thats why I sometimes say I dont really fit in on this blog but I come here to get varying pointa of view.
      Thank you for sharing. I like reading different people's experiences.

      Delete
    2. My fracture took 16 months to heal ...yeah it was crazy. In other words my 1st doc really screwed up...i should've had surgery.

      Delete
    3. Paige, at one stage (during my 6 year knee pain journey) I was diagnosed by a pain specialist as having borderline CRPS and put on nerve pain meds. But it was crap. What I had was exactly what Dr Scott Dye describes in his research (chronic inflammation of knee structures, most likely the synovial lining), which no medicos seemed to know about (I even asked one if this could be the problem & he said no). Once I got that inflammation under control with Celebrex, things improved a lot over 6 months.

      Delete
  14. It's all very interesting. It's true that a fracture takes 6-8 weeks to heal if immobilized but if a fracture involves an articular surface like the patella cartilage or hip or any articulating surface it's an entirely different situation as the joint surface has to tolerate load and the cartilage has to heal/produce fibrocartilage etc. That becomes the tricky goldilocks zone of healing where the joint needs to move, but not too much. I suspect healing of an articular cartilage is imperfect but it doesn't need to be perfect as the research shows. The guy whose blog you mention does rest a lot and does joint strengthening. Half of this battle is working out what to do when you are resting. I think that the mental side can make the physical side worse and so definitely important to address all at once. I'll read the texts you mention; thanks Brian.
    In terms of having to go to PT Paige- maybe you can go and get the exercises and then selectively do what is useful? All health professionals want people to get better and have their best intentions but ultimately you know what's working and what isn't. In all of this journey what I have realised is do things that help, don't do things that don't and above all listen to your body. It's been a hard lesson for me.

    ReplyDelete
    Replies
    1. Yeah its maddening...like I said I feel like I almost have to go..but today I'm up early with all this anxiety about going.
      Id love to do some kind of zoom group as I feel it would be nice to share more without all the typing all the time. Not sure how to exchange info though with this being public. I'm up for ideas.

      Delete
    2. I do plan to leave when I'm "done" today. Gonna have to be assertive. An hr is just too much. I am done for sure with the routine of a therapy session and then I'm down for days. I have to have some kind of life in between.

      Delete
  15. I'm happy to do Zoom etc but wouldn't want to post my personal details on the blog.

    ReplyDelete
  16. Yeah...me either. Oh well...we can type. :)

    ReplyDelete
  17. Lindsay you'll be happy to know that I had a productive conversation with my PT yesterday. My appointment went much better and I'm not on the couch in pain today!
    Also wanted to tell you that my general practitioner gave me a prescription for a low dose of Cymbalta daily. Is supposed to help with joint pain. I had never heard of it for that so I am trying it right now but I always like to share things like this with people that are struggling. I just started it.

    ReplyDelete
  18. That's good news; pleased to hear it. It's finding the precarious balance for exercises.
    Yes, cymbalta can help nerve pain if there is an element of that.

    ReplyDelete
    Replies
    1. Lindsay, have you looked into the Dr Scott Dye material, his work on loss of tissue homeostasis etc? Your burning pain but with no clear imaging pathology makes me think that could be your issue (which I also had, but solved following the Dr Dye ideas & 5/6 months on Celebrex to get on top of the synovial inflammation).

      Delete
    2. I think at this point I've read every bit of information on the internet. I know more about knees than I ever thought I would. Yes, I've read all his papers. They make a lot of sense to me.
      I'm getting nowhere at present, if anything I am worse. I find it difficult to limit steps when at work but can't imagine how down I would get if I stopped working. I am getting a lot of opinions at the moment and doing as little as I can physically. I have started a NSAID and icing twice a day as he suggests. I really appreciate your help; many of your posts have been extremely helpful.

      Delete
  19. I started taking it this week and it is definitely helping some already so I'm glad.

    ReplyDelete
  20. This was an interesting post. What you said "today’s “truth” may not be tomorrow’s" reminds me of my own knee journey.

    When I was originally diagnosed with Chondromalacia Patella ... seemed like the most common treatment was to get a "lateral release" in which they cut a tendon that is pulling the knee cap out of alignment. I decided to not get that surgery. Nowadays, I don't think anyone recommends lateral release anymore. I think it was decided it wasn't effective.

    Later in my knee pain journey (after I feel like I had tried everything,) I did decide to get arthroscopy -- mainly because my knee had decided to develop a new symptom and lock up - which was not only painful but literally caused me to fall down. not good. I did get a second opinion before going for the arthroscopy. The second doctor recommended a total knee replacement. Wow. I decided on the less radical surgery. That did indeed fix the knee locking but it didn't solve the original knee pain problem and neither did the follow up Physical therapy.

    I think it was at this point i read Saving My Knees and I tried the light load / high rep approach in conjunction with the water therapy book that I had mentioned before and that is was ultimately worked. (although, it def wasn't immediately successful and took me many years to "get it right.")

    So, I'm grateful I didn't go with the lateral release surgery that was "the truth" at the time. And, I'm grateful I didn't go for the total knee replacement even though that was what that doctor thought was the only solution.

    ReplyDelete
    Replies
    1. I find your posts very encouraging. I feel like I am headed for surgery but I definitely want to give conservative treatment a long try. I can't do many of the exercises in the aqua book at the moment but definitely some of them. Thanks for your insights.

      Delete
    2. Thanks for the follow up. I hope it helps you. I am rooting for you!

      When I started with the book, i wore a neoprene knee brace. Also, i found that moving slow put the least amount of strain on my knee.

      I know it's so hard to try something without knowing if it will actually help or not. I feel like I had tried everything including acupuncture, rolfing, Cortizone shot, synvisc injection, physical therapy, yoga, Chi walking, glucosamine with Chondroitin and finally the arthroscopy. This water activity and very cautious light biking were the only things that actually seemed to help my knee.

      But, we are all different! I hope you can find something that works for you.

      Seems like the one thing that benefits us all is being patient and not over-doing-it. I definitely had a trend of trying something and feeling like it might be helping..... and then over-doing-it and then going back to square 0. Or, in my personal pain-scale system: -5 (i.e., negative 5) Big sigh :-( And then having to go through the emotional process of berating myself for over-doing-it and then promising myself I'll never-over-do-it again and then build up the emotional fortitude to try again.

      I think the emotional side of all this pain and setbacks and progress and then setback is actually pretty big. It's mentally and emotionally hard to go through these rounds of success and setbacks... and then pick ones self up again and try again without any guarantee that it's going to work, but, you have to hope that it is going to work this time. And again. And again.

      I implemented a 72 hour rule for myself which was that after I did something that was potentially a knee aggravating event (i.e., might cause a flare up), then I did not allow myself to do anything else that was knee-intensive for 72 hours. (water therapy or a light bike ride would count as something that could aggravate my knee. Also, accidentally doing something like jumping or making a quick dash to catch a bus would also count as a possible knee aggravating event) During the 72-hour wait period, I did still need to do light movement of the knee joint by doing mellow walks because sitting still was not good for my knee. Movement was important for my knee. but, no additional "risky actions" until after i was assured my knee wasn't going to flare up. This was incredibly difficult to do though because it is very very hard to be THAT patient. I would try to talk myself out of it saying I was being too paranoid. BUT, i had suffered many many (heartbreaking) setbacks from over-doing-it so so so so many times! So, I tried to be strict about my 72-hour approach to avoid another setback. I found that avoiding setbacks is such a huge key to success. I know that seems obvious! but I found that avoiding setbacks was hard to achieve due to either impatience or abundant enthusiasm or a desperate hope.

      Delete
  21. Smart Lindsey. I just saw my 4th Dr today. This one wants to do mri with dye to get a better look at the knee.

    ReplyDelete
    Replies
    1. Let us know what it shows. Good you have more imaging.

      Delete
  22. Dr Dye talks about some type of bone scan which highlights areas of inflammation/loss of tissue homeostatis.

    ReplyDelete
    Replies
    1. Yes. I'm having a bone scan on Dec 30th. It will be interesting to see what it shows.

      Delete
    2. Let us know how this goes for you. Is it a bone density scanning - or something else?

      Delete