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On our knees: Some considerations for Boomers with bum knees

December 22, 2009

 

I’m not an aging athlete, but something of an aging track hack. Maybe some of my story will resonate with your experience.

 I was a clumsy kid, and so was compelled to take ballet. It was never a problem for me to sit in a “W” position, knees out front, legs bent like chicken wings, with feet behind. Whether dance was aggravating, causal, or irrelevant, I have hip aversion that causes my patellas to rotate off center. This is actually fairly common in girls and women.

As a 15-year-old 9th grader, I did a little jump-kick in the course of a folk dance move in P. E. My knee suddenly hurt acutely, and I just sat down while someone went for the coach. The most amazing thing about 1966 was that I got in to see an orthopedist within an hour. I was diagnosed for an acute sprain, and also for chondromalacia of the patella, a chronic and degenerative condition. The doctor said I would need new knees someday. By the time I was 20, I believed him. I knew if I wanted to travel, I’d better do it soon, while I had knees.

Life went on, and I pushed my knees through lots of hiking all over the United States, and lots of walking all over Europe, China, New Zealand, and Costa Rica. My knees hurt all the time, but they didn’t quit on me. Walking up stairs hurt most of the time, but I usually didn’t mind the pain or inconvenience very much.

Fast forward to 1991. I was 39 and I wanted to go to running camp, but my knees were swelling on 4- mile training runs. Again, I got in to see an orthopedist immediately. My question was whether or not I should be running up hills. The camp required a lot of hill runs. The doctor put my x-rays on the wall and said, “It’s curious you can walk. I don’t like to think of you stepping up curbs.” He told me that I had no articular cartilage, and that I needed knee replacements, but that I should wait five years or so until technologies improved. If anyone ever tells you that, by all means believe the second part. Evaluate the first part in light of every possible option you can find. I waited 18 years to check out my options again.

 In the meantime, I took up race walking, and won several medals in the summer of 1991. When I sprained my groin, I participated in race walk events by serving as a race judge. I regained a modicum of my humanity when I interfaced with other race walkers as people, instead of objects to pass.

Life was good notwithstanding frequent gnawing pain. Many times I thought I should have my knees evaluated again, but I just didn’t.

Recently, I thought I had sustained a knee injury after walking up and down a lot of flights of stairs. My knees ached so much more than I could remember them having ached before; worse, splinting against the pain aggravated some arthritis in my lower spine and my sciatica flared up. Walking was miserable. Getting up-and-down from a chair was miserable. I felt miserable. I was referred to an orthopedist and had to wait a month for an appointment. Welcome to the era of reform.

 I knew I would need knee replacements, but I could not adjust to the thought of the painful, long recovery. I could still walk. I could step into the shower. I could stand up at my kitchen counter and prepare meals. The thought of a wheelchair was completely untenable. I wouldn’t be able to manage crutches. I have fibromyalgia and the strain would put my neck and arms into spasm. I also have a chronic repetitive strain injury, and my hands would burn clutching the crutches. If recovery was unmanageable, surgery wasn’t an option. But going through life so susceptible to so much pain just doing things that naturally occur in daily life didn’t seem like an option, either. Alternately, I would resign myself to surgery, and then realize it was impossible. I let myself do this until I saw the doctor. I don’t recommend it; I’m just chronicling what I did.

The appointment proceeded a little strangely. The initial discussion with the nurse was about surgery. My demographics — my age, activity level, and desire to remain active — favored surgery. On the negative side, I have Addison’s disease. Addison’s complicates surgery, requiring an endocrinologist to consult on a stress dose of hydrocortisone. I have a fairly lousy track record with anesthesia. This discussion occurred before I was even x-rayed.

But this doctor, unlike the ones I saw in 1966 and 1991, x-rayed the entire line of my skeleton from hip to ankle. Like wow, he was aware that my spine and knees actually interact. His predecessors appeared not to consider this. From then on, the discussion became interesting. I was wide-eyed. I did not need knee replacements. I do have cartilage; it is worn and rough and it hurts because of this, but that does not indicate surgery. I have very classic arthritis, the typical sequelae of chondromalacia.

 Suddenly I had hope for relief without a horrific recovery scenario. I did not have to contemplate six weeks of utter helplessness in a wheelchair that my house wasn’t designed to accommodate, unable to reach the sink, or to get into the shower myself. There are new injections available, not of steroids, but of hyaluronic acid.  Hyaluronic acid is a component of synovial fluid, and promotes and smooths cartilage, and smooths the roughened surfaces that cause the pain. I will be able to receive these injections next month. In the meantime, I could begin polishing my cartilage myself, by pedaling a recumbent exercise bike that would not harm my back as it helped knees. I was excited and encouraged. A huge burden wafted away .

It was completely counterintuitive to me to try to pedal a bike. I had given up riding several years ago because of the pain in my knees, neck, and back. But I was going to give this something in excess of my best shot. My husband took me to Sears and I tried the cheapest recumbent exercise bike in the store. It felt fabulous.  It was $149, a fraction of the bill we would see for the morning’s visit to the orthopedist.

My husband assembled the bike in about an hour and a half, and I pedaled happily for my aspirational five minutes. I did a few five-minute stints. Now, when my knees become stiff from sitting, I pedal a few  minutes to revive them.

My light assignment is five minutes a day on the bike, building up at my own pace to 30 minutes a day. In addition, I am to keep walking on my treadmill.  My doctor predicts with confidence that the injections will reduce the pain to where I can exercise more easily and negotiate the stairs I encounter in life without hard and enduring pain.

One proviso is that I have a very light frame. My doctor said that if I had been heavy, I would almost certainly have needed knee replacements by now. The alignment of my hip and knee would have conspired to consume my cartilage. But regardless of your body type, if you have been told you need knee replacement surgery, I would suggest finding out whether your doctor knows about hyaluronic acid injections, and whether they would be indicated in your case. For me, the prospect of these injections instead of surgery is the difference between something simple and something untenable.

A surge of energy has displaced the burden of anxiety over prospective surgery and recovery. The specter of six painful weeks and an inconvenient wheelchair has given way to the reality of some simple shots and enjoyable pedaling on an unobtrusive bike. The injections are a month off, and I will write a sequel to this post once I have had them. In the meantime, prospects are everything.

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6 Comments
  1. Vic permalink
    December 22, 2009 1:51 pm

    “For I am fearfully and wonderfully made. . . .”

    May the spinning smooth your knees to hinds’ knees, and set you upon your high places.

    And may we take our compass around Naches Peak yet again.

  2. December 22, 2009 3:10 pm

    A-a-a-hay-men!

  3. December 25, 2009 7:30 am

    Hi Lauren,
    I came over from Keeping House. Wow, I see what you mean about being past rubs and teas! You have had some battles. It is great to hear that you can get relief without surgery, though.
    Love your husband’s comment. May this dream become a reality for you two!
    Off for more of a read here.
    Ruby

  4. December 25, 2009 8:10 am

    Hi Ruby!

    I always love to welcome Aussies onboard.

    Actually, though, I do get some relief from ultra-strength Tiger balm with the RSI that has plagued my hands and arms for a year now. And like my chrysanthemum tea, it’s from Malaysia! It doesn’t really touch my knee pain though. Tea is my placebo. :-)

    May you enjoy a healthy and very joyful Christmas today and a very blessed year to come.

  5. Grace RN NJ permalink
    December 30, 2009 4:39 pm

    Lauren,

    Ah, now I get to to see you! The bike looks great-glad you are tolerating pedalling. Praying all goes well with the injections. How was your Christmas?

  6. December 30, 2009 8:28 pm

    Happy New Year, Grace!

    Hey, it was the best Christmas we’ll see for another 3 years — a long weekend. :-)

    Yes, the pedaling is actually helping my knees, along with quad sets I’m doing. But all I have to do is walk through the aisles of Target to revive the old ache. The first injection is Monday, and I’m praying for significant relief. Then, all I have to do is deal with the sciatica and walking should be such a breeze…. :-)

    Oops — there is a leap year in there. We won’t see another 3-day weekend for Christmas for 6 years. Sigh.

    How are the outlaws?

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