Knee Pain





My story begins: 
 I scheduled TKR this year for both knees. My surgery was scheduled for November 1, 2011.
 
My quality of life had diminished to the point I could no longer hike with my friends or even walk far enough to call it a walk. Doing simple house work had become a real chore because my legs and knees would fatigue and ache long before the job was done. There are several flights of stairs involved in my daily life and I had begun to dread them all. The laundry would simply pile up because it was too challenging to navigate the stairs to the basement. My yard and garden suffered from profound neglect because I could not  stand long enough to water everything much less bend and kneel and tend to the outdoor tasks I used to love so much. The thought of going on vacation was not exciting because I knew I could not get around well enough not to be a complete bore to my travel companions. I stand in my job, and everyday when I left my office I would literally limp to my car and couldn’t wait to sit down. Which is all I did after getting home in the evenings.

Now, I should explain that I am a Professional Posture Fitness Specialist  who  has great success with my clients in keeping them pain free and out of the Operating Room on a regular basis. But I had not been walking my talk for several years. An extraordinarily stressful business relationship had taken its toll on me and when the dust finally settled, I found myself forty pounds heavier. Amazing that all this fat had been accumulating without me really acknowledging it at the time. I had become much more sedentary as I focused on computer monitoring to protect the business reputation I had worked so hard to earn over the years.  At the same time my elderly parents were declining in physical and mental health. Since they live in another state, instead of my activity level increasing as I tended to their needs, I became even more sedentary as I sat at the computer or on the phone  helping guide them  toward the best resources available in their area. This is the same  thing that happens to so many of us – perhaps different scenarios, but the same resulting stress levels and with the same destructive increase in the time we spend sitting.

My knee joints deteriorated  with all that sitting and weight and were diagnosed as 'bone on bone'  6 years ago. The pain changed over the years , sometimes manageable, sometimes crippling. During that period, I sought out the opinions of Physical Therapists, Fitness Trainers, other NMTs.  I was keenly aware that my gait had become dysfunctional and my muscles were not firing correctly, but I needed help to determine where the source of the dysfunction actually resided in my body structure. It is hard to actually diagnose yourself!

My colleagues at Nashville Neuromuscular Center were invaluable in giving me an accurate postural assessment and great soft tissue massage which helped greatly to alleviate the pain when it became too much. It was my associate at NNC who confirmed my suspicions that I had an anatomical leg length discrepancy -one leg is longer than the other- *( I will discuss anatomical vs functional leg length imbalances elsewhere in this blog. It's quite a controversial topic among bodyworkers) But this condition was unquestionably confirmed by an xray of my full standing posture. And when I put a lift on my shoes, my gait improved to the point that I no longer waddled like a duck and some of the pain in my left leg was reduced. Thank you Bethann Easterly and Paul St. John! But leveling my pelvis was not the answer to all the resulting compensations that were now causing me trouble.
I made the decision to have my knees replaced in an attempt to regain a better quality of life. And I began to acquire all the paraphernalia necessary for the long and brutal rehab – walker, toilet seat riser, shower transfer seat, lining up people to drive me during the 8 weeks I would be out of work and unable to drive.  But in one short week’s time, my inner alarm went off. This went against everything I taught and said that I believed about posture and pain and the ability to change joint pain and the human condition. 

So I knuckled down and worked all the traditional exercises in my clinical repertoire to strengthen glutes, quads, hams, calves and abs to improve the strength, position and support of my knees. When I was not making significant improvement, I reached out and took the advice of other trainers and  physical therapists, and worked their prescribed programs. To my great surprise and dismay, things still did not get better. The weight continued to pile on as I became more fearful of trying any form of cardio or lower body strengthening.

I had all but stopped giving exercise protocols to my clients because I was unable to demonstrate them myself and I’ve always held myself to the standard that I will not ask my clients to do anything I cannot do. Plus I was no longer confident that my knee protocols were going to provide the results they were paying me for.  I was prepared to give away that segment of my clientele to another therapist who advertised as a posture specialist.

When I finally hit myself over the head with the realization that I always start my clients out with small movements. I call it "oiling the joints." Restoring the ability to move and allowing a person the chance to perceive correct movement is the first step. Only then can one progress.  I had to act on that knowledge myself. No one could to do it for me.  And thus I finally set about treating myself as I would a client with these same challenges and utilizing a blended menu of subtle movements, combining techniques from Feldenkrais, Chek, Hannah, McGill, Pete Egoscue and others.  I hold certifications from both Chek Institute and Egoscue University® but I found that none of these programs individually was enough to make the real changes. By pulling pieces from each of these protocols and creating a menu individualized for my unique situation, I got much better results than from any one of them singularly.  I am using this blog to journal my experience toward my goal of avoiding total knee replacement surgery.

Rather than take away from information on Posture Fitness in general, I have created a page specifically for this issue.

 

The Decision: To Prehab or Rehab - 11.13.11

I have a few months to catch up on, and then I hope to go forward in real time. From my daily notes I can report that from the first day I decided to commit to putting myself first and follow the advice I would give to  a client, and with the same effort I expect from them, I began to get better -- significantly better.

 From the first week I began to employ my own little Posture Fitness Menu, I began to see biomechanical and gait improvements I had not seen with any other past attempts. AS LONG AS I DO MY WORK EVERYDAY. I had to take responsibility for my own condition and be disciplined enough to really commit to getting better, no matter what it took.

 This has become my priority. Has this been a miracle moment straight-to-the-top result? NO! But the overall trend on the graph of improvement has continued to be a rather consistent upward gain.  As I began incorporating more small-movement-modalities, I began to see improvements in other areas of my body -- better hip and shoulder range of motion, etc.

 Having read all the pre-op literature about the total knee replacement surgical procedure and the rehab period and what to expect in therapy post op, one thing became clear to me: The necessary rehabilitation effort was going to be the same regardless of which path I took. The only difference was this:
  • If I had the surgery, I would be  unable to work, generating no income for 2 months, and be in excruciating pain for several weeks while I made physical therapy my life's focus for several hours a day. I would be dependent on other people to drive me to and from the therapy and do all the other errands I needed  in the course of daily living.
  • If I postponed the surgery, I would be in moderate pain while doing my own physical therapy at home for an hour or more every day, but still able to work and pay my bills and I would remain independent and able to drive and ambulate without narcotics.
Now almost everyone I know who has opted for the TKR, either single or bilateral, has had good outcomes, and is very happy with their decision. But something about cutting the ends of my bones off, just makes me think twice.  I decided I had very little to lose by choosing to see if my own "Pre-Habilitation" could keep me out of the O.R. and that brutal post-op rehab. And thus my journey began.

The Cobbler's Children- 11.13.11

As a clinical neuromuscular  massage therapist  and corrective exercise coach, I have been specializing in relieving pain by restoring posture for over 20 years. But it is challenging to evaluate and assess your own body. I had been helping everyone else but myself. There's an old saying, "The cobbler's children have no shoes." And I really needed to supply myself with the same care I took of my clients

 The process - 11.14.11
Yesterday I walked for exercise for the first time in years. Not even a full mile, mind you, and my cardio was not up to par, but I had no knee pain and was not limping. That's a victory for me!

When I began my dedication a few months ago, to change my posture and avoid bilateral total knee replacement surgery,  I could not walk from the house to the end of the driveway to pick up the newspaper without limping and wincing with pain in one or both knees. Walking down any incline was ridiculously painful, and when I walked back up the slight incline to the house, I noticed I kept my left leg stiff and straight; it would not propel itself with the quadriceps. The muscle simply would not fire to let me walk properly. It was obvious to me that my gait was 'wonky' and the left leg just wasn't working right. My foot hit the ground with a wobble, but I could not for the life of me see where the key dysfunction was. I walked toward many mirrors for months trying to assess my own gait. I asked many physical therapists to assess my gait and see what I was feeling. Why weren't my quads and glutes working? I saw many professionals in my attempt to figure out how to turn them on (the quads, not the professionals!) and where in my gait dysfunction was the key to correction. I did lots of quad and glute strengthening work with no change in outcome.

From the moment I had scheduled the bilateral TKR surgery, I was committed to being in as good a shape as I could be to deal with it. I immediately began doing the pre-op knee program  twice a day:

Elevated ankle pumps
Knee Press Downs
Straight Leg Raises
Supine isolated Glute contractions
Heel slides
Sitting Quad Extensions
Seated Hamstring Stretch

A few of these were quite painful for me. But I kept reminding myself that it was not as painful as it would be after the surgery, so Just Do It! (that simple Nike slogan has really helped me with so many things over the years)

Just from doing these simple exercises, I was amazingly better within a couple of weeks. To the point that I first began to think maybe I could get by without the surgery for another year. I decided then to give it a couple more weeks and told myself that if I maintained the progress and improvement, I would postpone the surgery and give myself even more time to get in better shape. By the end of the next month, I was beginning to believe that I might actually be able to avoid the surgery altogether if I walked my talk, did the work necessary to get my total body posture back in the position it should be for proper knee joint functioning. And I put together the first Posture Fitness menu for myself, based on what I saw in the mirror and what my colleagues had seen in their evaluation of my posture, and using all the small-movement exercise modalities which I knew would address more specifically the Fascia (connective tissue) rather than focusing on the individual muscles. 

Now, the only question in my mind was "is it too late?" The cartilage is gone and that's ultimately the reason it hurts, right? But how can it be then, that I  am without pain for these recent days and weeks, when the cartilage situation is the same that it has been for years?  Hmmmmm?! Could it be that it's the position of the bones of the joint that are grinding  and  if I can move those bones into a better position, the joint will move smoothly and the pain will abate? Bones do not move by themselves, so I will have to work on the proper muscles to stretch and strengthen specifically to reposition the joints.

Here are my 2011 xrays. I  In a few months I will take another set and we'll see definitively what has changed from my efforts.




INFLAMMATION- 11.16.11

My knees are not happy today. It's not the sharp grinding joint pain that made me schedule TKR surgery; but rather the discomfort of inflammation. I recognize all too well that those of us with joint pain and arthritis are not well-served by consuming sugars, carbs, or alcohol (same as sugar). For the past two nights I've enjoyed dinner with friends and there was wine involved. But today I am paying for that with stiff sluggish knees.  Plus I wore a shoe yesterday with a bit of a heel. Never good for knees.
The TKR surgery promises to eliminate any arthritis pain because there would no longer be any nerves in the joint to transmit pain, nor would there be any natural joint surface to become inflamed. But my goodness, why would I want to put myself through such a major surgery, when I can control this inflammation situation simply by avoiding certain foods and shoes which create my discomfort.
So at least for today, I'm still choosing to control the situation by lifestyle modification rather than surgery. My experience predicts that I will feel much better after doing my routine this morning.

Client Comment -11.21.11
I'm not the only one benefitting from practicing a PostureFitness® menu for knee pain. Here's what one of my clients sent me this morning:

Client comment:
"Thanks for checking in.  I have been doing the program you gave me daily and am happy to report that my knees are feeling great.  In fact, I'm planning to go to the Y today--- first time in three months!  So they have paid off for me in a very good way.  I'd love to come in to see you next week for my next installment. " 

~ It's a good thing and I am so happy to be able to help.

Great Progress! -1.10.12

OMG. My knees have felt so good for the past weeks that I have been able to be much more active. Thus I have not been sitting at the computer so much and totally forgot to update this blog over the holidaze. These days I hardly even think about knees or limitations. The recurrence of pain or fatigue is very infrequent now and almost assuredly associated to periods of inactivity. Keep moving people! But be sure you are moving in the right way. I'll get into 'the right way' next post - dysfunctions and compensations. Eye-opening stuff!!

Oh how the mighty have fallen - 2.13.12

Got a bit too cocky for my own good. Last week, for the first time in over 3 months , my knees were as problematic as they have ever been. But just for two days. As soon as I got back on my exercise program, the pain was resolved as the joints  became better positioned. Once again, I had been feeling so good, I forgot to do my daily Posture Fitness routine.

I see this happen with my clients all the time and I have always wondered about their choices. The two things I do know and feel very confident about are that
 1. I can make the pain go away all by myself with no drugs or surgery and
2. The only obstacle for me is Me! (and making time)
We just have to make that time the most important in our daily agenda and keep it there.

The club I was on the verge of joining is filled with people who see their pain as a distraction to be dealt with as quickly as possible -- Cut it out or turn off the symptoms with drugs. They are not interested in expending any personal energy on resolving the cause of the pain. They just want to pay someone to make it go away.

Our pain tells us a huge amount about how we are living our lives. We should listen to it. It is telling us something is wrong. I have decided to give my knee pain the time of day it deserves. Everyday, for at least the next 6 months, maybe longer. Can I find the time to do that? No, we never find the time; we have to make it. Carve it out and hold it sacred. This determines our quality of life after all, for goodness sake!

 I am working with a client who has experienced excruciating pain for over a year. Last month, he told me when he did his exercises every day, he was totally pain free. But he said that 45 minutes a day was too much time on top of everything else he had to do. I question the logic in that thinking. For myself, I will get back on the wagon and invest that hour a day toward reaping the reward of a pain free knee without the trauma of surgery or the cost of prescriptions and doctor visits. We really are in control here. We just have to accept responsibility.

Move for Success- 3.15.12

I keep upgrading my exercise menus. No, not adding more weight or deeper squats; simply more realignment to increase mobility. It looks almost wimpy until you try it. When I practice repetitive moving the right way on a regular daily basis, I do not have pain in my knees. Woo-Hoo! Small price to pay. Think about it. Today as I walked I notice more clearly the dysfunction in my gait and could identify the mechanism of incorrect foot placement. As I consciously corrected, I also connected to the feel of how the leg and glute muscles fire differently. My new source of inspiration for my next PostureFitness menu. 


April 4,2012
I am happy to report that my knees are still pain free 6 months after I canceled the bilateral total knee replacement surgery. Just came in from a hilly walk which I would not have been able to complete 6 months ago due to pain. But this morning, I actually wanted to keep going; only time kept me from it. It is exhilarating not to be restrained by knee pain anymore.

Jan 7, 2013
Still moving well. Still happy with my decision to postpone the TKR for now. I will reassess at a later date.

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