Archives for: June 2009
Patella femoral pain syndrome. I now have a name for my knee pain. SS took a course in joint dysfunction in the spring. He asked me lots of questions during the semester about what hurt and what didn’t because he was wavering between two knee problems that have similar symptoms.
The good news about Patella femoral is that it rarely, if ever, requires surgery, and it is the least debilitating of all the knee problems. The bad news is that it is the slowest and most difficult recovery.
If I have been sitting for a long time my knee hurts when I get up. However once I’m moving around, I feel little or no pain. My knees hurt going up and down stairs, particularly if I don’t keep my toes pointed straight ahead. (I am SO glad we built a one-story house.) It doesn’t hurt to run, swim, or ride my bike, but exercises that involve lunges are very painful. Not surprising to me at all is that it is aggravated by poor arch support and the tendency to pronate.
In May SS gave me six exercises to do. He said that with some physical therapy, you have to push through the pain. Patella femoral is not one of those conditions. He said that if any of the exercises made my knees hurt or pop to stop immediately. Two of them caused pain, so I just did the other four until he came home last week.
He watched me do the exercises and said my form was good on all but one of them. Someone will have to spot me on that one until the muscle he is trying to isolate gets stronger. The two exercises that hurt were for my quads. SS said that strengthening my quads is the single most important thing to do. He modified those two exercises in such a way that I’m working my quads, but not hurting my knee. Other muscles that impact Patella Femoral are abductors, hip external rotators, hip extensors.
It was gratifying to me as a Mom to watch him work, and to see how his manner was both firm and gentle. He found it helpful to spend an unlimited amount of time watching me move and modifying the exercises. He says he never gets to spend that much time with a patient in a clinic situation. I’m probably biased, but I think he will make a wonderful physical therapist.
He tells me that inflammation is not a factor in Patella Femoral Syndrome. I would concur that there has been no swelling or stiffness in the joint. However, since inflammation is such a big issue for Hunters, I can’t help wonder if there isn’t some low level of inflammation that contributes to the pain. Or perhaps physical therapists and naturopaths use different definitions for inflammation. I’m going to look into inflammation protocols.
What I am most curious about is which came first – the chicken or the egg? Or in my case - did arch problems cause my quad to deteriorate to the point that it couldn’t support my knee cap, or did weak quads and hip muscles cause me to walk awkwardly and affect my feet?
I suspect there may be a genetic component to this problem. My father told of his army days when he was marching across Italy and his feet and legs hurt so bad that he thought he couldn’t take another step. He stopped by the side of the road, stuffed dry grass under his arches, and felt immediate relief. My Mom’s knees hurt if she sits for too long. The pain has caused her to stop attending both Sunday School and church. It’s just too much sitting.
I’m hoping that if correct the underlying muscle weakness, I may find a permanent solution to both my knee and foot problems.
You probably know more about my knees that you ever wanted to know. I got off on this tangent because of a thread on the Forum. DD and I have tried some new recipes, and I’ll get back to blogging about beneficials and avoids next time.
We have had our nephew and his family visiting for several days. We’ve been doing a lot of swimming and walking. I get in a rut at times – routine house hold duties, job hunting, computer chores. Sometimes I forget that we moved to the Hill Country in part because of the many opportunities for outdoor exercise. We have had a lot of fun with our company, and every day has been filled with physical activity. But it did distract me from blogging and delay the second part of my experience with foot, knee, and hip pain.
After Fred died, I tore apart one of my shoes and tried to copy what he had done. I could never get it exactly right. Some days my knees would feel good; some days they would hurt. I tried department store variety arches, but they did not help. I talked with several people about getting custom orthotics made by a podiatrist, but they were made of hard plastic, rather than the comfortable soft material Fred had used. I called dozens of shoe stores, but no one could give the kind of personal service that Fred had always given. They didn’t have his compassion, his work ethic, or his knowledge.
Eventually I found a shoe store – a national chain called Foot Solutions – that sold several brands of soft arches that were a much higher quality than the department store brands. They measured my feet and recommended Lynco arches.
There were advantages and disadvantages to Lynco arches. They worked really well in athletic shoes, but not in dress shoes. They gradually compressed so that they didn’t provide the support, and had to be replaced. That would have been fine, except the changes were very subtle, and I didn’t recognize them until my knee began to bother me again. Then I would look at the bottom of my shoes, see that the heels were worn down. Then I would remember to buy new shoes and new arches. It would take several weeks to feel right again.
While the Lyncos kept me pain free most of the time, they weren’t perfect. Sometimes stairs would bother me. I learned to use the T-Tapp technique of “No Duck Feet”. If DD and I did an exercise video with lunges, my knee would begin to hurt and continue hurting for several days. But I could hike, run, ride my bike, and do all normal activity quite comfortably, so I didn’t worry.
I began having a little more knee pain last December. I should have recognized that I needed new shoes and arches, but I missed the signals. Instead since SS was home from Physical Therapy School, I asked him why my knees hurt when I did lunges. He did some measurements, and had a theory about my knee pain. He gave me some exercises to do. The pain got slowly worse until February or March when I looked at the bottom of my shoes, saw how badly worn they were, and exclaimed, “Oh that’s what’s wrong.” I got new shoes and Lynco arches. Yet for some reason, the pain did not go away as quickly as it had for the previous 10 years.
I was better. I was not uncomfortable for most of the day. But something was still not quite right.
I had heard radio advertisements for a store called Ideal Feet. They claimed that their arches would make your feet feel better in 10 minutes. I went in and got measured. Their arches are more expensive, but they do not have to be replaced. If they stop working, the company will replace them. They have arches for athletic shoes and dress shoes. I believe they are helping, though I still can’t do lunges.
In the meantime SS took a class in joint dysfunction this spring. He called several time to ask questions about symptoms. He has put a name to my condition. I’ll write the last part of this blog about knees next week.
I am by no means an expert on knee pain, though I am hopeful that I am now on a strategy that will end my knee pain permanently. I jumped into a Forum discussion last week on knee pain, and promised to write more detail about my personal experience. It would make me happy if my failures could prevent someone else from wasting their time, or if my successes could bring someone else relief more quickly.
When my Strong Son was almost two years old, I developed pain in my right knee and hip. The only thing I knew that caused joint pain was arthritis, and I was very distressed to think that at 33 years old I was developing symptoms of a debilitating disease. Being into Health Food at that time of my life, I first tried a ton of vitamins and supplements, none of which helped. I went to a chiropractor who did not help my hip or knee at all, but did give me neck and shoulder pain.
Eventually on the recommendation of a friend, I went to see Fred – an elderly shoe salesman at a local store. Fred had sold shoes his whole life. He had gone to shoe factories to see how shoes were made. In his desire not only to sell shoes, but to help people feel better, he learned to make custom arches for his customers. He had me walk up and down the store, and told me that carrying a big active baby on my left hip for two years, was causing the pains in my right hip and knee.
He built arches for a new pair of athletic shoes. There was immediate relief, and over a period of 4-6 months all of my symptoms disappeared. Needless to say I went back to Fred for all of my shoe purchases. Because he used soft material, his arches had to be replaced a couple of times a year. He didn’t charge for the arches if you bought shoes from him. After he retired, I continued to drive to his house to get my shoes fixed. He would go to other shoe stores and pick out shoes for me that he knew would work with my feet.
Oh how I wish I had asked him to show me what he did and how he did it. I guess I was reluctant to ask him to reveal the secrets of his trade. Or I assumed that he would always help me with my shoes. One day in about 10 years ago, my right knee was starting to get a little sensitive, and I called for an appointment. Fred’s wife told me he had died suddenly. As far as she knew there was no one else who provided his kind of service.
Now what was I going to do??
Book Babes (a neighborhood book exchange club) met at my house this week. It was fun to get out the nice dishes and tablecloths. I don’t get to use them often in our casual culture. It was just too hot to brew coffee. I made green tea with peppermint, peach juice, and regular black tea. I sliced fresh fruit for a platter, and I made a walnut torte.
The ladies really liked the green tea. They also liked the walnut torte. No one could believe that it was made entirely without flour of any kind. In the course of answering questions, I wound up explaining how I got started on the Blood Type Diet. One lady had a sister in law who is on the diet. The others had never heard of the BTD. They were fascinated with the concept until I said that the two worst foods for Type Os were wheat and dairy.
One lady blurted out, “ I couldn’t live without cheese.”
This, I think, is the difficulty with mass acceptance of the BTD. A part of the world is so used to abundance and affluence that they can’t imagine depriving themselves of a food they like, even if it would improve their health. Another part of the world is so poverty stricken that they are trying to get enough calories to fend off starvation. They can’t afford to worry about avoid foods; they just need food.