Let's talk about pain, age, exercise and the like. I'm distressed, and its kinda long

In My Humble Opinion
1

I have been in the care of both a sports medicine surgeon and a physical therapist recently, and I found neither to be especially informative. So I look to the Dope for all my real information needs.

First, the data: I am female, 47, and obese. Although I am about 70 pounds less obese than I used to be, I could still easily stand to lose another 70 pounds.

Second, I am very limber, generally. Too much so, really: I can very nearly kneel so deep that my knee comes close to touching the ground without my heel lifting off the ground at all. It’s kinda freakish. My Achilles tendons are like rubber bands. I have naturally hyperextendeed knees and must work to remind myself to try and stand with my knees slightly bent or they will lock backwards. I was born with flat feet and pigeon-toed. I should have worn corrective shoes but didn’t. I also have pretty severely pronated ankles, as a result of which I use orthotics in my special shoes designed for people with messed up feet. 12 years ago I suffered a tiny tear in my anterior cruciate ligament on my right knee, and 14 months ago I had surgery on a small miniscus tear in my left knee. (Jesus…writing it all out like that, I don’t wonder that I’m in pain!)

I have had my legs, ankles and knees x-rayed in recent years, and while there does seem to be a tiny bit of arthritis forming, the general consensus has been that my knees are in remarkably good shape for my age and especially my weight.

While it took a very long time for the pain from my knee surgery to subside and my knee to function normally (almost a year, and it’s still not 100% there, probably never will be since they had to remove some of the miniscus cartilage - they gave me a video of the surgery and I was actually insane enough to watch it, can you imagine? I lost the weight becsue of the knee: I realized that the long recovery was partly due to the stress of carrying so much weight.), it finally did, and for the past 4 or 5 months I ahve been feeling stronger and better. When my activity level is fairly low, my legs can feel downright…good. Normal. Relatively speaking.

But when I start to increase my exercise, the pain starts. And I understand that this is normal, but shouldn’t there be a point at which the exercise alleviates the pain? And how do I know how much is enoguh vs. how much is too much.

At the moment, though, my legs are really messed up. I went to New York last week, and while I had “trained” for two weeks prior by taking longish walks most days (8-16 blocks), I just beat my legs up terribly last week taking very long walks every single day for 6 days straight. I was usually carrying a heavy backpack, but I did wear brand new, extremely comfortable and supportive shoes with my orthotics in them.

But I’ve been home for 5 days now and I’m still in pretty serious pain, particularly in my knees, both of them. And here’s exactly how it manifests: when I walk and use steps, the knee caps hurt. Very sore. When I sit or lay down for longer than 20 minutes, the knees stiffen, particularly in the BACKS of the knee, as though someone had poured glue into the joints. There is also, on the left side particularly, a sensation that is similar to a charlie horse at the top of the calf muscle, or perhaps its the ligament. It feels for all the world as though there is a “kink” in the ligament that needs to be untangled.

Activity loosens the glue feeling, but everything is still so tender and so beaten up that being really active just kind of aggravates everything.

The knees are still so sore that it’s waking me up in the night as I move around.

I also find that my legs don’t feel stable. I can feel things tweaking and slipping all over the place. Which makes sense, given all the issues I have.

But what I want to know is: what is with the stiffening? Is that arthritis pain? What is the best remedy? Is there a level of activity I can achieve that will eventually ease the pain, as opposed to causing it? What can I do to strengthen my legs to improve the alignment of the knees, knee caps, and ankles?

And really…who do I talk to about all this? Are there some kind of bodyworkers that really understand these issues that I can talk to? The physical therapist I had seemed kinda… generic. “Here, do this. Now do that.” I want some help! I want to work out, I want to be stronger and feel less pain.

Thanks for your time and attention to my whining.

2

Wow, sorry to hear of all these troubles. As a long-time distance runner, I know it is very difficult to find an MD who really understands exercise, stress and how to cope with it. Although you’ve seen a surgeon, often their only aim is to operate, not necessarily to keep the patient healthy. I might suggest you try to find a good orthopedic doc. Of course, “good” is the hard part.

There have been many world-class athletes who have had to go to a number of docs before finding somebody who could diagnose their problems, so it isn’t easy.

Physical therapists, like MDs, all vary in their diagnosic ability, so you might want to try to find another PT practioner for a second opinion. Too many of them just do the same treatments for everybody, without considering age, body condition, tolerance for pain (I’ve been told PT stands for “pain and torture” :slight_smile: )

As to your walking, it seems to me that you (as most people tend to) did too much too soon. When starting any physical conditioning, you have to ease into it gradually. When you begin to feel better, I’d suggest you take walks (much better in a park or on any grassy surface than on streets, if possible) of maybe a half-mile or so to begin with (10 city blocks), every 3 or 4 days for a week or so, then perhaps every other day if you feel well. You have to give your muscles time to recover. Building them up is a matter of stress and adaptation to stress, and unless you give them proper rest between exercise, they just won’t get stronger.

Even if you get so you can walk every day, a good thing is to do hard-easy days. One day go a mile or so, the next just do a half mile, enough to warm up, but not too much stress.

You should consider your upper body strength too. You can get a set of light dumbells and an exercise book, or even start just by doing some curls, presses, etc with a can of food in each hand. Remember, it takes a lot of time to build up muscles that have not been used for a long time, so go easy on these exercises too, maybe 3 times a week at the most, doing ten repititions of each exercise.

Considering you say you are still overweight, another type of exercise that is much easier on your joints and muscles is swimming or water aerobics if you can get to a pool. See if there is a Y where you can get to, and enroll is a program there. If not, maybe a friend has a pool.

I hope you have had a complete physical exam, including heart function. If not, you absolutely should before starting any exercise program. You’ve been carrying extra weight for a long time, and this may have taxed your heart, so it is very important to do this. If
you don’t have a family doctor, you really should get somebody to watch over your entire physical condition, especially as you do have a number of problems.

Good luck!

3

IANAD or PT. But I do have messed up knees and have in the past had a lot of the symptoms you describe.

I don’t think the locking up feeling is arthritis (I have arthritis in my knee, it is a grinding sensation, and sometimes, an audible sound). However, I have had the locking up symptom exactly as you describe (I am also hyperflexible and have oddly connected legs). It is caused, I believe, by overstretching the muscles and ligaments and tendons and all the connective tissue that holds your leg together. To avoid this feeling, ICE after you have extended yourself in any way. DO NOT wait for the pain to start – ice as soon as you can after exertion. Apply an ice pack to the affected area for 15 minutes, then take it off for 15 minutes, then reapply for another 15 minutes. (AKA 15 minutes on, 15 minutes off, 15 minutes on). If you do this I believe you will have a great reduction in post-exertion pain. You will soon learned to recognize (maybe you already do) a certain “loose” feeling in the joint that signals that you have overexterted and should ice as soon as possible to avoid pain 20 minutes later. I have iced in many public places, including a train station in Spain :slight_smile: You can make your own homemade slush pack by mixing a cup of rubbing alcohol with a 1/2 cup of water, and double-bagging it in Ziplocs.

The second thing you should consider is non-loading excercise, such as swimming or recumbent bicycling. It is extremely important to strengthen the leg muscles to help out your knee, but you must choose low- or no-impact options at this point. Does your community offer water aerobics classes? Down the line a bit definitely consider weight training under the guidance of an instructor.

Best of luck to you!

4

Some random thoughts- try a board certified physiatrist and a different PT who specializes in sports medicine. Possibly your sports medicine surgeon could recommend someone in the area. Maybe not since you don’t seem satisfied with the outcome of the surgery. Have you actually told the PT that you are not happy with your progress and asked specific questions like you have here? Rehabilitation centers often have really warm pools (body temperature) that can help reduce joint stiffness. Continue dieting - the more you lose, the better you’ll feel. Take ibuprofin and put on an apprporiate knee wrap before you exercise and ice afterwards. I also think the water aerobics and some kind of medically supervised weight training are good ideas.

5

Also IANAD or PT. But have used them lots lately.

On and off obese here, and had a bad disk herneation last year (which was 47).

  1. Keep losing the weight. The help it will do you legs will be tremendous. Some references suggest you basically keep your knees if you stay light and ruin them if you are heavy. With what little experience I have, I think your statements sound like overloading problems for your leg joints.

  2. You may well do better by losing weight for a while and not worrying about exercise until you are 50 lbs lighter. I think cardiovascular health and strong muscles rebound faster than damaged joints, so the conservative approach is better. Besides, you can diet really hard for a while, if you don’t exercise - at least I can. As a calory burner, exercise isn’t that potent. Its contribution will come later.

  3. Watch out for your back. At our age if you carry lots of weight and are very flexible, you’re a candidate for a disk herneation. I know people missing a leg or two, and they get by a lot better than someone whose back is missing. Disks are just awful - I’m still partly paralyzed, even after surgery and other grisly things. So, don’t flex your spine and carry loads or generate big forces at the same time. Keep your back in a “neutral”, natural S shape when you are standing and especially lifting. Don’t do toe touches and situps. Especially, don’t twist and load for the first hour of the day when your disks are full and easiest to burst. Do your flexing in bed or in a pool, where your weight isn’t loading your spine.

  4. Your legs will do way, way better with less weight. Daydream about long walks and light airy feelings while you fast.

Best luck!

6

two quick notes:

  1. Don’t forget to freeze the slush pack I decribed. :slight_smile: It may be reused over and over. Periodically put it in a new fresh ziploc though.
  2. Never place this kind of icepack directly on bare skin. That is asking for frostbite – place a light towel or cloth between your skin and the pack. Don’t worry, it will get plenty cold.
  3. A lot of people find icing a semi-unpleasant experience, but once you see how well it does alleviating and preventing pain, you will start to almost enjoy it. In the meantime, suck it up and ice that knee!
7

Since you’re looking for advice, I’ll move this to IMHO.

-xash
General Questions Moderator

8

Stoid, do you have a proper diagnosis for your hypermobile joints? Being so loose that you’re wobbly on your feet ain’t normal.

I have (slightly) hypermobile joints too, but I didn’t know it until recently. My joints were becoming increasingly painful after I turned 30, and the pain and symptoms would vary. Sometimes a sharp pain in the knee resulted from movement, but the loading made no difference. Push hard, or move freely, it hurt just the same. Bizarrely, applying pressure on a point just below the kneecap totally removed the pain for as long as the pressure was applied. Also my left shoulder would sieze up, then my neck, and all my joints would start to crunch and crack. My body became quite stiff and twisted. Exercise hurt, but not exercising hurt even more.

This year I have worked out, on a strictly mechanical basis, what is wrong with me. I’ve been having chiropractic treatment and deep muscle massages for a few months and that has managed to relax previously seized muscles and more-or-less put my bones back into the position they should be. My condition of permanent pain and discomfort has been thankfully downgraded to mostly bearable discomfort and occasional milder pain. But the only way I can keep this up is by keeping all my muscles relaxed, which is a full-time job. Certain of my muscles around the neck and shoulders need massaging several times a day to keep from permanently tensing up, and I’m very careful after something strenuous like cross-country mountain biking to relax all my muscles aferwards. The ice-bath is a good idea, and is used by lots of sports pros as part of their recovery technique.

In my case, the pain and joint stiffness comes from a combination of loose joints and tight muscles. When one of my muscles decides to tense up, it pulls the attached bones out of position, and then other muscles tense up in an effort to correct this, and before long everything is tense, stiff and crunchy. My muscles seem to be trying to take up the slack in my joints. I only found this out by months of experimenting with therapy, drugs (mostly muscle-relaxants and anti-inflammatories), foul-smelling embrocations, scalding hot showers, ice packs, and regular applications of an industrial-strength electric massager.

Stoid, I’d recommend seeing a doctor for a proper hypermobility diagnosis, if you haven’t got one already. You may have loose joints because the ligaments are too long, or if they’ve got too much flex in them. This may be due to just an extreme of morphology, or may be something intrinsically wrong with a key fibrillin protein, or suchlike. If the latter is the case, then a proper joint diagnosis is crucial, as parts of your heart and other internal organs use the same building blocks as your ligaments. I doubt you’ve go what I’ve probably got (Marfan’s syndrome, in the middle of lots of tests at the moment), but your symptoms sound eerily familiar to me. There are a number of things that cause loose joints, and just the biomechanics of the joints being too loose causes problems in itself.

9

Here’s a couple things I learned from my PT:

Do your warmups without putting your weight on the joints. The bursa is a bag of lubricating fluid between the joint parts. It deflates at rest, and it pumps up during exercise. So, warmup on a stationary bike or do that imaginary-bicycle thing lying on your back. Once the bursa pumps up, you’ll have less pain.

About the kneecaps… Do a few slow half-squats in front of a mirror. Do your kneecaps move sideways during the squat? That really hurts. If so, you may have unbalanced muscle development in your quadriceps. Your PT can help you train out of that by developing the VMO (which I think is short for vastus medialus oblongata, the part of the quadriceps closest to your other leg.)

10

I just want to chime in with a “way to go” to trying to get more exercise and not just giving up, although I am sure it’s tempting with the pain.

way to go!

11

IANAD or PT. I did have that cramping sensation in the backs of my knees (primarily my right knee, but also my left) for a while this summer. My massage therapist correctly diagnosed it as sciatica (in my case, caused by falling during a limbo contest :rolleyes: ). It went away after about six weeks. Generally speaking, for sciatica, they tell you to sit as little as possible, but it sounds like that would not be a good idea in your case.

Good luck!

12

Well? Have you been icing? Any change?