A New Doctor

I made an appointment for next week with Dr. Scott F. Dye. I have been reading about his research over the past year and was reminded of him while reading the tutorial I purchased recently by Paul Ingraham. I thought, "Why am I not seeing this doctor? He is based in San Francisco!" I have mixed feelings about setting up this appointment though. On one hand, I'm not ready to give up on the health of my knee. I feel like I need to keep trying to find someone who will eventually be able to help me. There HAS to be something that can be done other than rest, minimal activity, and yet more physical therapy. Those things haven't worked for me so far, even my knee scope didn't help. Dr. Scott F. Dye seems to be one of the few doctors doing research on these annoying knee syndromes. He even probed his own knee to discover the real pain centers of his knee! Ouch! That's commitment to his trade. I'm hoping he can offer me some advice and alternate remedies I may not have considered yet. 

On the other hand, I'm scared. I'm afraid that Dr. Dye will look at me and say, "What do you want from me?" I'm terrified I'll receive a response to my plight similar as several other doctors in the past. They spoke to me with condescending tones and lectures indicating "you simply need to rest, you were doing too much." Ugh. I tried that, it's been 2.5 years of that. 

Either way, I need to be realistic that after all this time there is most likely no immediate cure or therapy for me and I will need to continue to deal with my cycle of trying to exercise, then my knee flares up and I'm back to rest. It's so frustrating! Still, I'm going to keep trying.

The Impossible

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. 

Worth a Try

So, I'm sure you are wondering, what have I already begun to try based on the article from Mr. Ingraham? It's rather simple in my opinion, but something that had not crossed my mind at all while trying to recover from Patellofemoral Pain Syndrome (or whatever other overuse syndrome that may be causing my knee discomfort). Mr. Ingraham states that even bending your legs at a 90 degree angle while sitting at your desk at work puts "load" on your knees. Interesting. He suggests placing a box under your desk and putting your feet up on that box so your knees are around a 20 degree angle (not straight, since locking your knees isn't good either) can help lessen the pressure between your patella and the joint of the knee. Well, hey... I figure anything is worth a try at this point!

If you haven't noticed, Paul Ingraham placed a comment on my blog in the July 28 post. That was very nice of him! If any of you reading my blog are experiencing any of the common overuse syndrome type injuries (PFPS, IT Band Syndrome, Plantar Faciitis, etc.), you should give one of Paul's tutorials a read.

I recommend Paul Ingraham’s patellofemoral pain syndrome tutorial.

If the link in this post does not work, try to access the information in the "Links" section of my blog.

Possibly the Answers I Need... Sigh

I'm packing for a work trip to L.A. and am thinking about what I have learned in the last week about my knee. As I mentioned a week ago, I've been reading some research done by Paul Ingraham, a Registered Massage Therapist from Vancouver, Canada. No, he's not a doctor, but he seems to be one of the few people out there doing extensive research on overuse injuries. I am thankful to him for the work he has done. That said, his research did not offer me any greater hope of recovery for my knee or a light at the end of the tunnel. If anything, it was a little sad f0r me to read. It's been 2 and a half years into my plight, so I am taking this information a lot better than I would have say, even a year ago.

Mr. Ingraham is straightforward. While he feels for those who suffer from Patellofemoral Pain Syndrome (PFPS), he is quite clear about the possibility of recovery. Here is what he writes:

"Untreated, even a mild case of PFPS can be stubborn, bugging you off and on for years. Many cases will recover entirely within 6 weeks to 6 months. But with a case that doesn't improve in that time, the odds of recovering seem to drop sharply: the problem might go away after applying some new ideas you learn here, or it might go on for years, or perhaps the rest of your life. Not everyone gets painless knee function back."

Sigh... So you ask, what are the new ideas I have learned? Well, there are a few. One I have already started giving a try, the other seems almost impossible to do. Basically, once a person experiences PFPS an upset of the tissue homeostasis in the anterior knee area has occurred, usually due to trauma or long time overloading. I most likely fall into the long time overloading category, since I do not remember any specific trauma to my left knee. Up until I read this article, I figured "overloading" meant running or athletic activities of some kind. It's very interesting to learn, that is not always the case. More details to come...

My Knee Hurts

My knee has been bothering me for the last week. I guess I did a little too much on my vacation and need to take one of those "steps back." Ugh. Also, it seems as if the swelling I once had in my knee has minimized slowly over time. While I once thought this was good, I now feel as if it was some needed cushion! Who knows what's really going on in there? I wish I knew. Here is a list of my workouts over the last week or so. For those of you athletes, you won't think this was much, but it resulted in pain and aches in my super-sensitive left knee.

Saturday, July 12: Westin Maui gym workout - 1 hour treadmill (46 min walk/14 min running interspersed) + lunges, push-ups, ab exercises, etc.

Sunday, July 13: Rest day

Monday, July 14: Ka'anapali shore path 1 hour walk/run (44 min walk/16 min running interspersed). In hindsight, I probably needed one more recovery day before I did another walk/run.... the shore path was so inviting.

Tuesday, July 15: Kayak/snorkeling/hiking trip - The hiking was not too strenuous and the kayaking was a great arm workout! I wanted one adventure day... it was vacation!

Wednesday, July 16: Rest day

Thursday, July 17: Ka'anapali shore path 1 hour walk, evening flight home to SF.

Friday, July 18: Rest day

Saturday, July 19: UCSF Mission Bay pool swim, 40 minutes.

Sunday, July 20: Rest day

Monday, July 21: Rest day

While I was lying by the pool on my trip (this is mostly what I did outside of the above listed activities) I was thinking of what I could possibly do next about my knee, if anything. Since I've been home, I've been doing more Internet research on anterior knee pain. You never know when something new could pop up, right? I am also considering making a follow-up appointment with Dr. Anderson. I wonder though, is there any more she can do? My guess is that she'll probably tell me how Pilates is really good for me, not high impact activities. Great. The more research I do, the more I understand that I'm dealing with a syndrome. That means it's a mystery, different from one person to the next. Whether my knee pain is patellofemoral pain syndrome (PFPS, sometimes called kneecap tracking pain) or Hoffa's Syndrome (fat pad inflammation), my experience is unique. The recovery of every person takes a different path and per Matt Fitzgerald's information in Brain Training, it's up to me to find my own path.

This past weekend I came across an interesting publication online, what I have read so far, there are similarities to Mr. Fitzgerald's findings, and then some. At first, I thought it was a scam. It is titled SaveYourself.ca and it's written by a Registered Massage Therapist in Vancouver, Canada named Paul Ingraham. A Registered Massage Therapist? O... K... I read on. The basic of it is that Mr. Ingraham has done a great deal of study on several common athletic injuries and has provided his findings, for a nominal fee. Hmm. PFPS, Iliotibial Band Syndrome, Plantar Faciitis, Lower Back Pain, etc. I wasn't sure of the validity of this information until I read he has included research findings from his work with Dr. Scott F. Dye of the University of California, San Francisco. Interesting, I've heard of him. I read an article in Runner's World last year about knee injuries and the many syndromes involved. Dr. Scott F. Dye was included in this article, among other medical professionals. Alright, I thought maybe Mr. Ingraham's online publication was reputable information. I decided to spend the $14.95. Maybe I would read something I hadn't heard before? Maybe not. At least it could be good to read if theories I have learned in the past are backed up and supported by additional research.

As usual, I will keep you posted on any new information I learn. You must all think I'm a bit off my rocker with all of these new books and articles! Hey, it's all I can do. Unfortunately, I'm dealing with knee pain that has no instruction manual for recovery. Per Paul Ingraham, I need to "Save Myself." I'm doing my best. Hopefully his article will help.