Knees Are SO MUCH Better!

Today I took what I want to be my "normal" morning walk - out the door, down into the park, back up through the neighborhood, about a mile and half, with some significantly steep but short hills down and up to the park. I've been doing this off and on for years, but recently I've fallen way off. The fact that it hurts before I even start, and will hurt more once I get going, has been one of many barriers. (Other barriers include my reactive barky dog, any weather less than optimal, having to get dressed, and sheer inertia.)

But this week, I've had to head out first thing, just as the sun comes up, to do a daily vacation backfill on a citizen science project, hyper-local network of national precipitation reporting, CoCoRahs.  It's on the "normal" route, so some days this week I've kept on going to complete the loop. Today was the first pain-free day in months! 

My knees have steadily deteriorated over the past several years. I tore my meniscus and had it repaired back in 2018. But now, it's a loop. The more the knees hurt, the less I move. I went to physical therapy a year ago, after they were really bad. Symptoms included not only pain, but also restricted mobility - I simply couldn't bend them all the way. The PT really helped with both pain and mobility. I was then motivated to keep moving by active vacations, in March and April. But perhaps from overuse, the knee pain grew enough worse that it grew increasingly easy to blow off the daily walk, despite my fantastic Iceland vacation coming up. After all, I had satisfied myself with what I could do in March and April, Iceland in July would be just as good, no?

Well, no. A couple of months off from active training eroded both the quality of my knees and also my aerobic fitness. I did a whole lot on the Iceland trip, but it was hard. I didn't do as much as I wanted. There were often options for different activities and I backed off the most active ones, hiking up volcanoes for example. I spent a fair amount of time in my nice little cabin, with my feet up and knees bent, popping tylenol and rubbing stinky and persistent but effective voltaren gel into both knees. They never once didn't hurt on the trip, and haven't really stopped hurting since.

When I got back from Iceland, I signed up for a trip to Greece. More about that another time, but everything I've read suggest all the places I'll want to go will involve stairs with no handrails. Time to fix these knees!

(As an aside, I am fully bought in to the mind-body approach to pain management. I can minimize suffering I have from pain, and even reduce and even eliminate some pain, through mindful meditation and somatic practices. It has really helped me avoid catastrophizing about issues, and my back pains and even migraines are less of an issue. These practises also help avert physical symptoms manifesting in response to external or internally generated stress, something I clearly used to do a lot. These practices include breathing, visualization, and self talk approaches that really help keep things on a more even keel. 

The way I think about these practices and my knees is this: my knees have mechanical issues that send messages to the brain. I can interpret these signals as pain, or call them sensations, and I can observe them from a distance with kind curiosity. All this helps, but there is value in also trying physical and mechanical things (exercise, strengthening, pain medications) to reduce the volume and urgency of the messages being sent to my brain.)

My previous sports-medicine doctor retired, and so I found an orthopedic surgeon to consult. My basic questions were, what could be done to help the knees short of replacing them, and was I damaging them them further as I used them? I wanted another prescription for PT because while I know many exercises for the knees, I find the skilled supervision helpful. 

The doctor said no, I couldn't damage the knees with movement, was happy to give a referral for PT, and also suggested cortisone shots in each knee, which he did right then and there. The actual shots were quite painful, but it only lasted for a few minutes until a local anesthetic kicked in. Then, over the past few days, the local anesthetic wore off and the steroid gradually kicked in. 

And hooray, they seem to be having an effect! 

The doctor said, and my independent reading confirms, that the only proven interventions to actually improve the knees (as opposed to alleviate pain) are exercise and weight loss. No supplements have been shown to have more than a placebo effect. So I can do whatever I want in exercise, if done correctly it will help, but the pain will likely be there. If I can bear it, I can do it, and if I keep doing it, I can keep doing it!  As to weight loss, that is a topic for another day.

I celebrated this improvement by putting in for a place on a short overnight sail on my schooner, about a month from now. I had held off, thinking about all the ladders on the ship. But now I'm ready to go for it!