My Knees

I am terrified of something bad happening that will prevent me being physically active. I so enjoy being able to get out there and do stuff, and it's the only way to win the long-term battle of the bulge. If it's specifically sharply painful to move, my laziness has a much bigger hook to use to keep me on the couch.

Right now its the knees that have me worried. I'm clearly someone with a big family history of osteo-arthritis, and the knees have been a constant ache for months. Every now and then, usually when going down stairs, one or the other will turn into a piercing shooting pain. I can live with the low level pain, but I'm afraid of the high level pain.  Every time I've tried to ride a bicycle more than a couple of miles in the past few years, the constant pain level has gone way way up afterwards, though not during.  I do squats and lunges in my various training routines, and again sometimes trigger the big pain but more often just slightly elevate the constant ones. Ice works, and ibuprophen - but ibuprophen eats my stomach.

I finally went to the doctor this week. This is the same doctor I saw for my major back problems a few years ago. She is a "physiatrist", the high priestess of sports medicine rehab in our area, so the appointment was scheduled six weeks ago. Given the pain is not yet debilitating, I had to wrestle with a constant "just suck it up and get on with life" mentality in order to keep the appointment.  I think it was worth it.

Based on my description and a physical exam, she is pretty confident we know what is happening and a first stage of how to deal with it. No rushing off for x-rays and MRIs necessary for Dr. F.  She showed me on a model what is happening - my kneecaps (patellas) apparently have rough edges (probably from arthritis) and so rather than floating nicely along the grooves made for them, catch on the edges. But my ligaments appear fine, which is apparently very good news. The raspy motion causes irritation which causes swelling which causes pain.

Now the trick is what to do about this? Her prescription is a mechanical approach - keep the patella squarely on center, not catching on either side. That means --- EXERCISES! To strengthen the muscles that move the knee cap. She wrote out instructions for my trainers to use. (Apparently buns of steel would be helpful.) It also means very sturdy shoes with big arch supports - I've got to go a sports shoe store and buy some inserts.

She also gave me a prescription for a topical analgesic with a very StarTrek name:  Voltaren Gel.  You slather it on sore joints several times a day as an alternative to ibuprophen or celebrex. This stuff is like magic. It's kind of annoying because a lot is needed often, and its messy to apply to the knees. But it is apparently reducing the inflammation, and it is certainly working on the pain.  I'm supposed to follow up in a couple of months to see if this is working, or if we need to contemplate other measures.

I asked her about the homeopathic approach - chondroitin and glucosamine.  I remember reading in the New York Times a couple of years ago a fairly definitive study that said it had no affect on knee pain. Dr. F. said that's true, but it appears to have some mild affect on loosening up, especially in the mornings. Double blind studies show measurable differences in patient perception of how long it takes their joints to un-stiffen from overnight. She suggested recording my morning issues, and then starting a three month course of condroitin and at the end comparing to what I had written down from before. I think that is currently too many new drugs to take so for now I'll give it a pass.