Knee Pain, Version 100.01

[Periwinkle]

Coldfeet's recent post prompted me to post this. Along the way, I thought that he had mentioned arthritis, but couldn't find that post in a search. If I'm wrong, ignore this, Dave.

For whatever it’s worth, here's my personal take on knee pain....

I’ve put up with it for years. And put up with differing diagnoses for years – ITBS, patellar tracking, and even some B.S. about shifting body parts due to age and crepetis.

After enough vague diagnosis and suffering, I had a new GP evaluate my knees after a tough hike to Vose Spur. She immediately referred me to an orthopedic specialist. After x-rays, his verdict was osteoarthritis. I was devastated. All along, I was thinking it was something easily fixable. Not arthritis. I’m not that old! I’m 42. And I have arthritis???!!! His recommendation didn’t elicit hopefulness, either. He suggested I get a new hobby. Hobby???? Hiking isn’t a hobby for me, it a way of life. It’s why I live where I do and why I work so hard – so I can hike. He recommended something else to “exorcise my demons”. Excuse me? My demons exist in reality. I find my peace in the woods. I find myself in where I can go and how I get there. This is what I do. I no longer define myself by what I do for a living, but what I do for me. This is my life. A hobby? I think not.

Needless to say, the diagnosis and suggestion of giving up hiking and “cross-training” didn’t go over well. I didn’t even sign on for the suggested physical therapy right away. I spent a good deal of time just feeling sorry for myself.

In retrospect, it’s not a huge surprise: I was a gymnast, a cheerleader, in marching band, and hiked hard for a number of years. Plus, there’s a family history of arthritis. (My RA test is pending).

Eventually, I gave in and went to PT. Very enlightening if nothing else. Now I know that on top of plantar fasciitis (a foot tendon problem), supination (walking on the outside of my feet), I have one leg longer than the other (very common and I “compensate well”), oh, and there’s the added bonus that my knees are hyper extended (pushed out to the back). All in all, the therapist said there wasn’t a heck of a lot she could do for me. She was very impressed with my existing musculature and flexibility. I was already doing what I could: losing weight, good boots and foot beds, hiking with poles, strength training, etc. She did recommend a few exercises to focus on problem areas, but that was about it. She was all for my continuing to wear OTC knee braces to give minimal support and keep my knee joints warm.

So, what am I left with? A verdict to stay off the steep stuff unless I want to suffer. If I go there, I’m to stick to my daily regime of anti-inflammatory meds and some nifty painkillers.

What seems to work is to keep moving – only taking standing rests to keep the joints moving. To take a number of rest stops, particularly when the stabbing pains start. If I stop for a moment to rest, I seems to be able to move forward without accumulating more pain. Finally, when it all gets to be too much, I take a pain killer. This I avoid at all costs. They make me tired. But, on the upside, I can focus of what I’m doing, not how much my knees hurt.

Ultimately, it seems I’m done hiking elevation. For the time being, I’ll take it easy, then hike hard when I feel the need. And it seems I’ll need to stop soloing the tough stuff. So be it. At least I can still get out there.

 

[audrey]

I think you're doing the best thing - staying with it. Forget the curmudgeon -hobby, indeed! The guy who replaced Pat's hip 3 years ago told him it was such a huge success partly because Pat had kept hiking till 2 days before the surgery and afterwards told him he could do anything except run and jump.

I have no words of advice except to suggest a 3-month trial of glucosamine - some of our clinicians swear by it, especially the NP who had a knee replaced and has been able to delay replacing the other one because of it. It's harmless and inexpensive and may have a benefit.

 

[Garry G.]

Periwinkle,
I have many of the same issues. Osteoarthritis, one leg longer than the other and I've been suffering with plantar fasciitis the past year. For my knees I take a prescription anti inflammatory before the hike and it really helps allot. I also do knee specific exercises which I think do the most good. I've been told it's important to take the anti inflammatory to keep from doing too much additional damage to the joint and it's important to ice them when you get home. The plantar fasciitis kept me off the trails for the past year and after 2 cortisone shots in the heel and a pair of orthotics I finally got back on the trail yesterday. Physical therapy didn't help at all.
I think it's very important to keep moving. I was diagnosed with osteoarthritis more than ten years ago and it hasn't progressed that I can tell but I've been pretty consistent in my weight training all that time. I don't and won't stay off the steep stuff until a have to but I do most of my hiking in winter and the cushy snow (when there is some) goes a long way to lessen the pain on the descent. I do trail maintenance in Franconia Notch in the spring, summer and fall so that keeps me outside.
Bottom line it's hell to get old for some of us.

 

[bikehikeskifish]

My guiding rule on doctors -- they must understand you for you, not you as a generic member of the human race. If a doctor says to me "Well, the average person doesn't ride 300 miles per week", or "Hiking 23 miles at age 41 is expected to cause you pain", then I pack up and leave.

There is, I am convinced, a huge market to be served -- the hardcore recreational athlete -- by the medical profession. When shopping for a new doctor, I always look for ones with sports medicine backgrounds, preferably a personal recommendation from a fellow cyclist, hiker, runner, etc. Then I google them, and if I find them in some race results somewhere, then I'm likely to have better results. The orthopedist I chose for my current knee problems was found to participate in hill running type events... so I figure he'd be a good one. Of course he was booked 3 months out with surgery patients and I settled for his PA, but it's obvious even to me after one visit that I'm not a surgery candidate yet. (I felt a bit rushed through, as though I was taking up too much of his valuable time.)

My PT doesn't hike but does play tennis and basketball and knows about knees. I'm told I am an "advanced patient". Nobody else there is doing ITB stretches with ankle weights. Most are considerably shorter and heavier then I am. "You are not our average patient", she tells me.

She didn't discount my goal when I first met her -- "I don't want to return to my desk job pain free. I want to do Katahdin the Presidentials." She listened and thinks it is reasonable and achievable. If she didn't believe it, I wouldn't either (and would have found someone else.)

Tim

 

[HikerAmiga]

For the time being, I’ll take it easy, then hike hard when I feel the need. And it seems I’ll need to stop soloing the tough stuff. So be it. At least I can still get out there.

Peri,

It sounds like a sound plan and one of moderation and I believe that is key in dealing with injuries or these conditions. It may feel like it's the "end of the world" because this news is sooo new and disconcerting but what I've learned from reading these forums is that you are not alone and there is hope for you to lead an active life and continue doing the activities you love.

I have limited experience with knee pain except for a few bouts with ITBS. Having worked with rheumatologists for 15 years, I learned by observing them that they all have varying opinions (and sometimes oposing opinions) on how we should deal with our conditions. For my ITBS for example, one expert rheumatologist told me "no steep climbing" while another equally expert one (who was himself an active person) told me, sure, go ahead and continue your hiking but do the exercises and use any rubs or NSAID's as needed. What I then decided to do was to take both their advice and strike a balance. I took it easier and slower and didn't do very steep ascents for awhile. I got better!

This AM I feel a twinge on my affected knee and I am not sure how it happened. Last I recall, several weeks ago I awoke feeling it. So this AM, I wondered if hiking with a weighty winter pack might affect it further. I notice though that as I move around it starts feeling better. So for right now, I am inclined to hike in moderation paying attention to how the knee is feeing. It's my plan.

Basically, I would suggest that you follow your heart...see your doctor and PT but listen to your body as well. No one really knows your body like you do. You are also a highly motivated individual and your attitude will take you very far!

Best of luck!

 

[coldfeet]

Hi Peri, sorry to hear about your problems....maybe i'll pick up a kayak and join you and Jay on a trip...Are you still running those marathons?

 

[coldfeet]

Dear Perri, sorry for the last post, I confused you with another friend....Your my Vermont friend...ps...I'm going to the gathering but just car sight seeing, your welcome to tag along ....how far is Ben and Jerry's?

 

[Periwinkle]

Thanks to all for the positive posts. I appreciate it.

For years, I've read about others here working through knee pain, finding out it was arthritis. I just never thought it would be me -- my problem. As disgusted as I was at first, it's been a comfort to know that people have been able to keep getting out there. That's what it's all about for me.

A few follow up comments:

• I haven't taken glucosamine yet, waiting to see how I do with PT alone. I have tried it on my dogs in the past, with limited success. I'm willing to try it myself.
• As for the plantar fasciitis, that actually has been less of a problem since I started really getting out there. After some PT for that, hiking in good boots and foot beds lessened the pain. As long as I keep hiking, it's less of an issue!
• As much as the ortho specialist’s comment put me off, I still can see where he's coming from. The good thing is, my primary GP is also trained in orthopedics, and completely "gets" it. She's doing everything she can to follow through and get me back on the trail.
• Last but certainly not least is a finally comment about weight: My own body weight was an issue. Reducing that was key. On the other hand, I've long realized that an overnight pack or winter pack is going to put a huge strain on my knees. That's why I've become such a "slacker": not winter hiking and using huts in season. Every pound counts. I haven't sawed off my toothbrush handle yet, but I have worked at reducing my pack weight (and body weight) over all.

All in all, I’ve resigned myself to facing reality. There’ll be no hiking the AT for me. It was always a pipe dream anyways. I did do the NH 4Ks. And I did swear off lists after that. So, maybe it’s all just meant to be. I’ll just to do what I want to do when I need to do it. Because it’s there. That works for me. As for not being able to just head out by myself to where I want to go? Eh, I’ll manage that too. It really isn’t the end of my world, I guess. It’s just a different way of looking at it.

P.S. There’ll be no playing in VT for me – I’ll have to work all of MLK weekend.

 

[sli74]

Forget the curmudgeon -hobby, indeed!

You tell em, Audrey !!!

I have no words of advice except to suggest a 3-month trial of glucosamine

Also, my Dad swears by Flaxseed oil . . . the scientist in me rolls her eyes but I have seen his pain (back pain and shoulder pain) be helped by his daily intake of flaxseed oil . . . they even sell it in a capsule

Disclaimer: Take the above as just a suggestion and NOT medical advice cause I am not a doctor (okay, I am . . . but not that kind of doctor )

sli74

 

[Shardik]

Periwinkle

After x-rays, his verdict was osteoarthritis. I was devastated. All along, I was thinking it was something easily fixable. Not arthritis. I’m not that old! I’m 42. And I have arthritis???!!! His recommendation didn’t elicit hopefulness, either. He suggested I get a new hobby. Hobby???? Hiking isn’t a hobby for me, it a way of life. It’s why I live where I do and why I work so hard – so I can hike. He recommended something else to “exorcise my demons”. Excuse me? My demons exist in reality. I find my peace in the woods. I find myself in where I can go and how I get there. This is what I do. I no longer define myself by what I do for a living, but what I do for me. This is my life. A hobby? I think not.


Ultimately, it seems I’m done hiking elevation. For the time being, I’ll take it easy, then hike hard when I feel the need. And it seems I’ll need to stop soloing the tough stuff. So be it. At least I can still get out there.

Hi Periwinkle,

Long time lurker here.
Will pass on my history ect. after ..if you or any else needs it.

Same thing happened to me. Avid hiker, male age 51, for the past 20 years.

Knee pain...osteo-arthritis....on Sunday first Doctor advised me to change my life-style and get used to it. When I got into my car , I had a good cry.

I cancelled all of my club outings .

After, went straight to get Glucosamine and downed a pill right at the drug store.

Monday, I got on the phone and made appointments for 2nd and third opinions.(Denial)
Second Doctor got me X-Rays , Physio and referral to an Orthapedic Surgeon ,after my urgent requests. I , like you , Periwinkle , and so many here..live for this stuff. At this point going up stairs was painful.

I am under Physio now twice a week and training 6 days a week. Besides physio , her program includes swimming , step machine and stationary bicycle.

My friends are short-roping me jogging on a padded track.. Since this started two months ago my condition has improved 70%.

Still waiting for my MRI though.

I intend to kick serious ass , WHEN I can get back into the mountains.

Periwinkle, you live in a beautiful place and you will enjoy the mountains.

Shardik