I don't like the word
impossible, I really don't. It's so final, so complete. But, even though I hesitate to use the word here, it may apply. I mentioned in my July 28 blog that there was another thing I learned from reading Paul Ingraham's tutorial on Patellofemoral Pain Syndrome. Paul writes about a fictional woman he calls "Jan." Jan has suffered from PFPS for some time and she is Paul's character he created to describe how someone may finally recover from the ongoing symptoms of PFPS. First, Paul says Jan needs to spend a month or two figuring out what her knee can handle and what it cannot. This involves keeping careful track of what activities cause no pain (0), minor/pain delayed by 3+ hours (1), moderate pain/pain delayed less than 3 hours (2), and immediate pain (3) . After this has been documented, the next big step is to rest. Jan takes a month off of work for
nearly total rest of her knees: every single item on her list is verboten for 4 weeks. Also, she cannot sit with her knees bent at
any angle greater than 20 degrees. Her husband and family do the cooking and driving. She is allowed 1 hour of walking a day, but in 6 short 10 minute increments.
I realize nothing is really impossible if you want something badly enough. Thing is, I am not able to take a month off of work to lie on my couch and I don't have a husband to help me with things around my house. Sure, I suppose my parents would probably try to help... still, it just seems so hard. The point is nearly total rest to the knee and joint. Paul feels like in some chronic cases, this is what is required to finally get past the see-saw of going outside of that envelope of function of the knee, flaring it up again, then having to go back to the drawing board.
After the month of rest, Jan is to start back to the minimal activities that do not bother her knee, then over time the hope is to be able to slowly work her way to more activity and increase that envelope of function to a full recovery. I'm sure this type of recovery is a different experience for each person depending on the injury.
Can I do it, you ask? I don't know. I really don't know.
1 comment:
Hi again, Ali. The bright side of a good strategic resting plan is that it doesn’t have to be as extreme as “Jan’s plan.” I hope that Jan’s story is a good demonstration of the full extent to which the most desperate knee patient can go to. It was particularly written for those many patients who think they have “tried everything,” when clearly they haven’t.
Also bear in mind that the stakes are very high with severe chronic knee pain. Of course it’s extremely tempting to conclude that you “can’t” take a month off work ... but if you were seriously injured, you wouldn’t have a choice, and you would survive it, and you — oops, wait a second, you ARE injured, aren’t you? ;-)
See how that works? Economics are powerful. Few people take time off work unless they are literally unable to. But the stakes here are high, and it’s not at clear that it isn’t just as necessary to take time off for severe chronic knee pain as it is for a broken back. The price of failure to treat this problem could be permanent pain and disability, and that kind of talk can (and should) change your perspective on how much time off work you can afford.
But, returning to my the more reassuring perspective, many patients do NOT actually require as intense a plan as “Jan” did. Many people succeed by applying the same principles ... to a more manageable degree!
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