Who wants a blog about knees? "WE DO!!!", shouted nobody. Well that's too bad because if there's one thing I've learned it's that quite often in life you don't get what you want. So suffer up.
Here's a picture of a knee pinched from the inter-web, because another thing I've learned in life is that too much text and no pictures is unbearable.
So anyway, 3 months ago my knee was a bit swollen, just above the kneecap on the right hand-side. It wasn't all that sore and I ran on it for another week but that was making it worse so I stopped. I thought I was being extremely sensible and conservative as in the past I would have just run on it and hoped it would go away until I literally couldn't. (run on it.)
I went to a physio sooner rather than later and she said she didn't know what it was but I was quad dominant and had shocking balance so do these exercises. Increase your booty. I did all the exercises and in fact still do and now I've got a marvellous booty and I can do (well kind of) arabesque balances. But I've still got a swollen knee.
I went to see my GP and he thought it was maybe bursitis so encouraged me to try more icing and lyiing with my knee up, but that didn't do anything.
Then I went and got the fluid taken off and an injection of hyaluronic acid as it still wasn't clear what the problem was and the hope was that would be enough just to soothe the joint and get it back moving again. It was nice to see my unswollen knee again, albeit briefly, until it filled up again.
Then I was going to go to another physio. The first one had been a bit snippy with me and when I emailed her, which she said I could, to ask if the knee still being swollen after a month was a problem, she didn't get back to me, so I thought fuck off I'd like to work with someone who is actually interested, - but first I went back to my GP and told him where I'd got to. He ordered x-rays to rule out any funny business, or indeed arthritis, and there was no point in going to a physio until I had the results of that. Turns out at the moment it takes a week to get a doctors appointment and then you're supposed to give it 7 days after the x-ray for your GP to get the results. I thought I was being clever by allowing 8 days because things don't always go to plan, but when I got to the GPs the results weren't back yet and then the soonest next appointment I could get was another 10 days. Much as I love the NHS I hate the fucking NHS.
("How can you complain about the NHS when some babies can't get clean water and have flies in their eyes?" I hear you say. My response is this. Fuck off. Stop trying to relativise my pain.)
WAIT, anyway, Hold the bus!! I forgot James the Chinese Medicine guy. Well maybe not medicine but Tui-Na massage (who he?) and acupuncture, moxibustion, man of inspiring words!! He was really nice. He cheered me up immensely, told me my body knows how to heal, that everyone in the western world's hips are far too tight, and right in front of me squatted in a way that defied belief. I burst out laughing - an anxiety reaction - and said "Stop doing that it's ridiculous." Maybe I can find you a picture. Kind of like this.....
I told him "yeah but I can't do that". "Yes you can", he said "your body is amazing."
I was just about to say "Thanks very much." when I realised he didn't mean me per se....anyhoo (I'm lolling.)
So yeah he was really encouraging and he did some wild massage on my legs with cupping which in case, like me, you didn't know, is putting glass jars that have been heated on the inside, on your skin, which creates a vacuum and draws - I don't know what - sucks at your skin and it's good for you. Feels great in a "Jesus are you sure" kind of way. I went to see him twice and each time my legs felt great afterwards, but my flipping swelling persisted. He gave me a lot of advice about attending to the joints and about mobilising my hips so I can do that crazy squatting thing, which I'm a little ashamed to say I have let drop. But there are so many threads to it.
So, at last the x-rays were back and I had a phonecall appointment with my GP and he said, nothing funny on the x-rays, they're normal, so that was good in itself. It meant whatever was going on was soft-tissue. I've got a mind that can easily create a catastrophic scenario so I was reassured even though my GP was unimpressed. The other thing he tried to get me to do was take anti-inflammatories. I'd said no the first time and now I felt like, well that's what you're supposed to do so I better take them and I got the prescription filled and took them for a day, but I don't know, changing your whole system just to alter one small part of you doesn't make any sense to me - and then I read all the warnings about ulcers and gastric bleeds and even cardiovascular problems and I stopped taking them. I had a dig around to see what I could maybe take instead that wouldn't kill my digestive system, or indeed my heart and found a chapter in a book by Neal Barnard called 'Foods that fight pain' that talks about the control of different types of prostaglandins and how you can do it with Flax-seed oil, borage oil and vitamin E, so I've been taking them. I think they have helped a bit.
"Why are you even worried about your knee being swollen if it's not that sore?". I hear you ask. Well that's a good question. There's quite a lot on-line about it. It seems that if your knee is swollen for too long it tends to break down the tissues and the bone - so things that you didn't have a problem with will develop a problem. "But why is your knee pissing out fluid from God knows where if it's not even good for it?" you say. Another good question. A really good question. I struggle to see my knee as some kind of mad gangster that is holding a gun to my head for no good reason. I think the answer is it's distressed, that's why.
Anyway, off to another physio with me. This guy specialises in knees and looks after a football team. When he sees how bad my knee is after 3 months of relative rest and this and that and I can't even straighten my leg properly he says he's best spending both our time writing a referral back to the GP to say I need an MRI scan and specialist intervention because it's clearly not healing. He looks gloomy and depressed. He sticks some medical acupuncture needles in my leg while he's typing - very odd - he puts electricity through it. He doesn't stint himself either - he uses really a lot of needles, which I have no objection to, because if there's any upside to this it's that I quite like a new experience and this is a new experience for me. I lie there while he huffs over the wording of his letter and really what preoccupies my mind is how I'm going to gently handle my GP so that I can convey the message in a palatable way. - will he take umbrage at me being in touch again with letters from people asking for things? Or will it be fine? I don't know if I have to make another appointment and wait 10 days to deliver the news in person or if it would be alright just to email it all in. I've just come to the conclusion that I'll phone up and ask the receptionsists who are always pretty nice - they'll know how this needs to be handled, when my new physio is satisfied with his writing and comes back to me. He takes out the needles and gets me to do a few things and he seems to be deep in thought. He gets me to do a wall squat and hold it for bloody ages and after a while he has more of a twinkle about him. He gets me to do leg extensions and lots of them. He says this nice thing "because you're bloody strong aren't you?". It's the best thing I've heard about myself in a while. I tell him I've been avoiding using my quads because of the whole idea that if you're quad dominant your quads pull your kneecap up hard against the bone and that causes a problem. He lets out a big explosive sigh. "Uh well, it's professional opinion isn't it?" he says "80% of the population are quad dominant. 80% of my football team are quad dominant. They can't change it either. And their knees are fine. Fair enough strengthening your glutes if your glutes are weak, but the first thing I'd do with someone with a knee problem is strengthen the knee. Why wouldn't you?"
I am certainly not going to argue. Do you know what? I just want my knee back working so I can run again. I'm missing it badly. He tells me to go away and do a rake of exercises (but don't do anything tha makes my knee feel worse) and come back in a few weeks and we'll see where we are.
So I've been doing them and my knee does seem better, at least sometimes. I go through hope cycles and gloom cycles so it depends what day you get me on. In the meantime I happened upon a couple of things. One is a program for knee rehab by a Feldenkrais instructor and physical therapist Marek Wyszynski who has taken a deep dive into understanding knee health, initially through his own experience of tearing a ligament playing basketball and since then through client work. Feldenkrais is all about increasing your awareness of what you are actually doing with your body - the felt sense - and hence finding comfortable efficient movement patterns and dropping bad habits. That's actually an inadequate summary but it'll do for now. Moshe Feldenkrais who originally developed it started with a knee injury the docs couldn't fix and fixed it himself. The thrust of the program is to create optimal conditions for your knee to heal - focusing more on keeping your knee as comfortable and non-inflamed as possible while doing gentle exercise rather than a more component focused approach. For example - current thinking about my knee by those who have bothered to think about it at all, is that I've got a meniscus tear - which can take you down a certain road. The meniscus apparently gets a very poor supply of blood and tissues need blood to heal because that's where the goodies come from - so I think medical wisdom is that if you have a tear of a certain severity, the only answer can be surgery because it can't fix itself. Even if I could get surgery, though, then it's a long rehab, and oftentimes what they do is take away a bit of the meniscus, which doesn't necessarily re-grow and I think I'm right in saying that people who have meniscus surgery get arthritis sooner than average. So not a happy picture really. Even if it was just great, with the current state of our NHS and wait lists or what not, if that was what was prescribed for me it wouldn't happen any time soon. But that view is not the only view.
I was watching a talk by an orthopaedic surgeon, Scott F Dye this morning who is escoriatingly critical of a gung-ho surgical approach. It makes him so angry it's actually enjoyable to listen to, if a bit niche. It's here. His view is in accord with Marek's that you need to concentrate on allowing the knee to heal, which he says it can if you don't over-tax it. And you have to be patient.
So that's where I am. Doing exercises. Trying not to overdo. Trying to be patient.
I'll see my football physio guy in a bit over a week and I'm hoping that he thinks I'm making progress and doesn't get that look about him again - the depressed look.
See you in a while.
