Knee pain is something that a lot of people can relate to. We almost all have knees, we use them daily, and they are one of the first joints to wear out. Athletes often have knee issues, as do very sedentary or overweight people. Let's face it: the knees take the brunt of our impact, regardless of what we're doing. Especially over time (which is a polite way of saying as we get old and crusty). And there are so many things that can go wrong, so many ways to have "bad knees."
I've always had knee problems. As a child, I would wake up screaming and crying from the pain. This was before weight issues, I might add. They were chalked up to "growing pains." (Which I don't fully understand. I am short. It's not like I grew too rapidly, or anything. It just coincided with puberty, when your body goes through all kinds of changes. I suspect that "growing pains" was a way for my parents and doctor to explain something complex and un-understandable). At any rate, my dad would rub my knees and try to talk me through relaxation exercises, but I think it was the Advil or Tylenol that would eventually kick in and help me go back to sleep.
Patellofemoral Pain Syndrome
Sounds impressive, right? It's not. Just a fancy word for common knee pain. The patella is the kneecap, and the femur is the leg bone, and where the two meet is the joint known as the knee. Still, when you have chronic knee pain that can be caused or triggered by a variety of reasons, it sucks. It's frustrating. It holds you back. physically and mentally. And it makes you feel just a little crazy because the same motion doesn't always create the same pain - you can't duplicate the pain when a doctor needs to know what motion causes the problem. Sometimes it's okay, sometimes it's not, which makes you question your sanity. And it's always there, at the back of your mind: "what's the next totally random motion that is going to be THE ONE that causes injury?"
Patellofemoral pain syndrome
It shouldn't have been that surprising, then, that I dislocated the patella when I was in highschool, given that it happens mostly to girls, mostly in their teens, and with my history of weak knees. What was surprising was that I did it while playing a tambourine. For real. I went in for the big finish, stepped out the wrong way, and found myself on the ground. I thought someone had pushed me, until I went to get up and realized that my kneecap was on the side of my knee, not at the front. Then the pain kicked in. There is nothing like ruining the last period of the last day before Christmas holidays by being rolled out on an ambulance gurney in front of the whole school because you just had to show off in a performance of Feliz Navidad.
I dislocated that sucker (always the left knee) two more times. The second time was, again, because I was showing off. I was impatiently waiting for someone to come and help me to carry a canoe back to the shed at the day camp I was working at, and I decided to try a solo flip-up and portage it myself. One second too long of extra strain and I was down for the count, lying in the goose poop on the grass, grateful for a co-counsellor who had the foresight to keep the kids away so I could swear and make ugly pain faces. (Oddly enough, it was the very last day of the summer. There seems to be a correlation between popping the kneecap out and various "worst possible moments").
The last time it happened was in Japan. I was there for a conference, it was only the second or third day, it was raining, and we were walking to a restaurant along a gently-sloped tile walkway. It was a tad slippery, but that's all that I know. I still don't understand what happened. I just slipped and fell. It could have popped out, and when I fell I knocked it back in. Or perhaps I lost my footing and the strain forced the knee outwards. I'll never know. What I *do* know is that being in that kind of pain and not being able to communicate with doctors, having to worry about travel insurance coverage, different medical customs, and navigating Tokyo on crutches were all part of the experience that eclipsed the knee pain. I still have one spot on my knee that is numb from where the doctor used the biggest needle I've ever seen to draw blood and fluid from a bruise, to reduce swelling (according to my poor translator), and he hit a nerve.
What has also come along with the three dislocations is fear. It's been over 13 years since the last dislocation (October 2000), and to this day I have a near-paralyzing fear when I'm on ice or anything unstable. The slightest twinge or hint of pain, and the fear kicks in. Because I remember. I remember the pain, I remember the frustration of immobility, and I remember how much weaker I was after each pop.
All the dislocations don't quite explain the dull ache kind of pain, though. This, I've been getting more of lately. Accompanied by a weird crunching when I bend the knees in certain ways. A visit to the doctor and a few x-rays later confirmed early arthritis. Not very surprising given family history, and my own history of obesity. Of course, it could be related to the patelofemoral pain syndrome. The two are often confused. But this is the kind of pain that comes after leg day, or when I'm tired, or when I just haven't stretched or used the leg muscles enough. It's the kind of pain that is annoying, but which I know that I have to push through to keep on exercising, to keep on strengthening the muscles, because that's the only thing that will help to delay the onset of the nasty, debilitating kind of arthritis. I'm just trying to hold it off until, oh, let's say, my 70's instead of my 40's.
Move it or lose it.
NOT moving your knees can be as bad or troublesome as over-use. It's rare that I'm at my desk for an entire day, anymore, but when I am I really notice the lack of movement. The place I feel it the most is in my knees. Getting up after sitting still for too long elicits many creaks and cracks from those joints. They say that sitting is the new smoking, and I can believe it, because I have to focus on getting up and walking around at work or I'll seize up like the Tin Man in Wizard of Oz.
And I recall that it took me twice as long to recover the first time that I dislocated the kneecap, because I kept the whole leg immobilized for too long. At any slight sign of pain, I froze up and stopped, and that caused the entire leg to seize up. It was therefore more painful each time I tried to move my knee. I've since learned to differentiate between the pain. There is immediate, cease-and-desist pain, which tells me that the motion I'm doing is clearly not a good one. Danger, Will Robinson, Danger! Then there is the far more common "ow ow ow ow ow" achy pain that comes with either a lack of use (after sitting, or after standing in one place for too long), which just needs to get the joint moving again, or the "something is degenerating beneath the patella, and wearing away, but there's nothing I can do about it" pain. Those are the ones to push through, for the greater good. In other words, I feel better when I'm moving.
All of which brings me back to why I'm writing about the knees at this particular time. Yesterday was leg day, and after a high-impact class on Saturday, they were still a little hurty. By today? Ice and Ibuprofen are required. As Mat had me doing lunges and other "push" exercises, I felt more immediate pain than usual. Of the patelo-femoral kind, rather than arthritis. Each time, I stopped, but the fear was also kicking in. He made me stop what I was trying to do (well, what I was failing to do), and had me foam roll. Always, with the foam rolling and stretching! What was interesting was that, afterwards, I was able to do the steps with more ease. Still with pain, but far less, and with far better range of motion.
Damn. I hate when I have to admit he's right.
Calf stretches, foam rolling, yoga, TRX flex, anything that gets a good leg stretch. Apparently "just after I work out ... when I remember to ... when I feel like it ..." is not often enough. Yet another daily routine to add to the list of healthy habits, stretching and foam rolling are going to have to be at the top of the list if I want to save my knees. (Which will also make my registered massage therapist sister happy; she's a public stretcher, she believes in it so much).
Mat had asked me to let him know how my knees were, after yesterday.
Me: "One word: ow ow ow ow ow."
Mat: "I'm going to check your alignment tomorrow."
Me: "You make me sound like a car."
Mat: "Cars are easier to fix."
Me: "But more expensive."
Mat: "Are they? You only have one body to live in. Best to invest in that, rather than a new one."
Fighting inflammation. Stretching. Exercise - smart and varied exercise.
That's how you keep your vehicle running for as long as possible.
Even if you got a lemon.
(By the by, if you see yourself in my descriptions and think, "yeah, that's ME!" then check out this resource for everything you ever wanted to know about Patellofemoral Pain Syndrome and general knee pain).