My knee and me
Nobody understands me.
OK, that’s an emotional over-reaction. Nobody understands my knee.
But that’s not true either. Or rather, it is and it isn’t.
I have a patellar maltracking problem in my left knee, due to atrophied quadriceps muscles, in turn due to previous knee problems. As the knee bends and straightens, the kneecap tracks off to the side of where it should be, causing irritation to the underlying tissues, because the quads aren’t pulling as strongly as they should in the opposite direction.
That condition is well understood by the appropriate medical specialists. But, in my experience, management of it is not. I’ve seen two specialists, two or three general practitioners and maybe six or eight physiotherapists. Of those who thought they understood the situation, all seemed to think I was over-sensitive to pain, or lazy, or that the main issue was really depression, or some combination of these. You might well be thinking they might be right, but I’m writing this, for myself in the first instance, to try to get down what’s really going on in and around my knee, and in the hope that it might help somebody in a similar situation.
OK, I was over-reacting, at the top of this piece, for a number of reasons that I won’t bore you with, except this one: I’m prone to depression anyway (so the medics were not completely wrong, or at least had some excuse), and this condition, imposing physical inactivity and social isolation as it does when at its worst (in combination with some other factors), dragged me down really quite deep at times, and it’s been threatening to do so again. This after a longish period of feeling all that was behind me—I’ve been off anti-depressants for the best part of a year.
The problem, which many people don’t seem able to get their heads around, though it seems quite simple to me, is that sometimes the condition flares up—the irritation causes inflammation—and that’s a slippery slope, because the worse it is, the more easily it’s made worse still. And on the other side of the coin, the less flared up it is, the more of the exercises I can do, so the better still it gets. Until I go too far.
The solution as the medics see it is very simple: build up the quads. But, depending on the degree of flare-up, the exercises can make it worse.
For a few months up to around mid-summer I was doing the exercises, and the quads were getting stronger, to the point where one day I managed a nine mile walk over rough ground with no ill-effects, the most I’d done in several years. But the following week I went to a three day conference in Edinburgh, by public transport (parking in Edinburgh is nightmarish), which was too much, and then, a week or so later, when it seemed to have improved a little, I thought I’d get away with doing some gardening, but I was wrong, and that started a downward spiral, so that now I’m spending all day every day sitting in my easy chair using my laptop, reading, playing my guitar or watching television. Not only are the unavoidable trips to the toilet and kitchen painful—not seriously so, but a sign it’s getting no better—but just getting a bit tense, so the quads contract a little, hurts too. Meanwhile, because that’s hardly exercise, they’re wasting away again.
I think maybe what the medics don’t appreciate is that, when it’s flared up, the off-centre kneecap is no longer the main problem. Almost any movement that involves the kneecap causes pain and prolongs the flare-up. The priority at that point is to get the inflammation down. (By the way, the inflammation is of the tissue under the kneecap, and it’s not visible, the pain being the only symptom.) But, back when I was still talking to the medics, it was flared up most of the time, but I didn’t really appreciate that and so failed to communicate it to them, and they just said “if you won’t do the exercises, it won’t get better”. But to me, doing the exercises was one of the surest ways to make it worse.
Five weeks later: Not only am I now managing to attend a full-time course at Edinburgh University, but I’m keeping the business going too, and I’ve had a two week camping holiday on the French Riviera since writing the foregoing. What made the difference? In general terms, a much more positive attitude. Specifically, I realised that I had to learn to walk again, in a way, but that it would be very easy. I already knew that I could do a great deal more wearing my walking boots than without them. What I then realised was that I should walk as if wearing them even when I wasn’t. My main problem had been not using my left leg properly, but the relative inflexibility of the boots forced me to do that, and I just had to get into the habit of doing it all the time. So far so good!
August 21, 2009
Posted in: announcements
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