Another Meniscectomy/Arthritis Patient

Discussion in 'Health & Fitness' started by PigPen, Apr 28, 2013.

  1. PigPen

    PigPen Rookie

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    Hi Everyone. I was reading the posts in this forum with great interest and I was wondering if someone could help. I am 50 years old with two medial meniscus surgeries (1988, 2005). Recently, I have been getting knee pain to the point of not being able to play.

    I went to see two orthopedic surgeons. One said I may be a candidate for knee replacement surgery shortly. The other at the Hospital for Special Surgery first recommended a new lubricating injection called Euflexxa which showed some promise for professional athletes he has treated. Following Euflexxa, I also went to PT, 3x per week for 4 weeks. I felt great after the PT and started to play again.

    After playing for several weeks, I am back to where I started. My knee swells after playing. I have tried icing (which helps), Zyflamend and Tumeric (not sure if this is helping to reduce inflammation) and a prescribed unloader brace. I have also taken glucosamine/chondroiten for over 20 years now.

    What I am looking for is a exercise/diet/supplement/equipment (sneaker/insole/brace) regimen that can help me stay on the court. I do Yoga 3x per week and am trying to play less often. Perhaps I should try to play less on a hard court? Maybe a day of rest is always in order between matches?

    I also read about the rectus femoris tightness issue in several posts. I am extremely tight especially on the surgically repaired side to the point of not being able to reach my ankle when doing quad stretches and when I use a strap, I periodically get a hamstring cramp. I cannot come close to sitting on my heels in Yoga.

    Thanks in advance.
     
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  2. ollinger

    ollinger Legend

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    Sounds like you've been playing on consecutive days (and on hard courts, no less!), which I've always considered a serious mistake for older players. Why bother with glucosamine/chondroitin if you haven't been giving the joint surface any time to heal?? Injections of fluid into the knee may buy you some time but usually have to be repeated at least every few months. I assume you have substantial arthritis in the knee based on your symptoms and the HSS recommendations, so it's unlikely you'll be able to avoid knee replacement.
     
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  3. Ashley D

    Ashley D Rookie

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    I'm not sure I can offer much help, but your situation is interesting.
    I'm 32 years old and had a meniscal tear of the right knee about 2 years ago. I had an arthroscopy, recovered, and kept playing. I then tore my left meniscus and had an arthoscopy on that.
    My surgeon basically told me my tennis days were over and that I should take up swimming or golf!
    Have you been told not to play, and are chosing to play anyway, or did your surgeon give you the all clear to keep playing?
    Just pondering a come-back myself, that's all.
     
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  4. PigPen

    PigPen Rookie

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    Thank you for the reply. How often do you recommend older players play? Is there a regimen you know of that can help in the meantime?

    Yes I do have substantial arthritis but the HSS physician said that I am way too functional for a knee replacement at this time.

    Thanks in advance.
     
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  5. RogueFLIP

    RogueFLIP Semi-Pro

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    Continue to work on your flexibility.

    You mentioned that your quad feel tight, so I'm willing to bet that most or all of your whole lower extremities are tight. It's never about just one group of muscles, let alone one particular portion of a group of muscles.

    Get a foam roller. Learn how to use it to break up muscle knots and restrictions. Use a smaller tennis ball or something softer to break up more specific areas.

    All those muscles and soft tissues that are tight are just going to contribute to your joints getting compressed, tight, inflamed, painful, etc...

    It'll take time and effort, but combined with yoga and a strength/conditioning program, you should be able to continue with your enjoyment of tennis.
     
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  6. PigPen

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    Years before my second surgery in 2005, an orthopedist told me that my playing days were over and that I should decide between playing and being able to walk when I am older. I chose to continue playing. However, I chose to stop playing basketball.
     
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  7. PigPen

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    Yes, my lower extremities are very tight, especially my hips. I really became aware of my flexibility issues when practicing Yoga and in Physical Therapy. I have tried the foam roller and experience pain in the middle of each calf during rolling. Also some pain on the tibia of my surgically repaired knee.

    Are there any supplements that have helped?
     
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  8. corners

    corners Legend

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    If you're a candidate for joint replacement or will be in the near future, you've got severe damage to your articular cartilage already. So playing tennis is probably going to provoke symptoms regardless of anything you do. You might want to look into the mesenchymal stem cell treatments offered by Regenexx in Colorado. These treatments are still considered experimental but there is already a fair amount of evidence in the literature that they do promote regeneration of cartilage surfaces.
     
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  9. Ashley D

    Ashley D Rookie

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    Yeah that's basically what I was told. I think I'll chose to be able to walk. Good luck though!
     
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  10. RogueFLIP

    RogueFLIP Semi-Pro

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    As long as you don't force yourself on the foam roller and are careful and balanced when you get on/off the thing, you won't injure yourself. If you're still finding that rolling on the foam is too painful, they make softer foam rollers that aren't as dense as the typical white ones. Or you could use a ball that's soft.

    I just like using a foam roller because it can cover a lot of surface area; then I use a ball for specific restrictions in my legs, or if I need to get in deeper.

    Supplements that break up soft tissue restrictions? Uh, no. You're going to have to work those out yourself. Or pay to have someone do it for you.:-|
     
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  11. PigPen

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    Thanks Corners. There is a treatment I read about at HSS where they take a piece of cartilage from the body, grow it in a lab, then place it into the knee. Looks promising also.
     
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  12. PigPen

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    Yes, the the painful areas do feel better after the rolling.
     
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  13. charliefedererer

    charliefedererer Legend

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    How bad is your knee?

    [​IMG]

    [​IMG]

    [​IMG]
    The joint space is narrow above, because the cartilage that was occupying the space has eroded away.



    What does the expert at the Hospital for Special Surgery who takes care of professional athletes, and did you Euflexxa injection, recommend you do now?
     
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  14. Raul_SJ

    Raul_SJ Professional

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    Thanks CharlieF for the info.

    In the typical progression of knee osteoarthritis (caused by wear and tear over time as opposed to a specific injury), is the erosion of meniscus preceded by the erosion of articular cartilage?

    i.e., is it possible to have erosion of meniscus but normal articular cartilage?

    I am thinking that since the meniscus lies between the articular cartilage of the femur and articular cartilage of the tibia, meniscus degeneration will always be preceded by articular cartilage degeneration.
     
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  15. corners

    corners Legend

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    Yeah, that's a similar technology. Even more evidence for its use. One thing about cartilage is that it's kind of like neurons. Not too long ago it was believed universally that once a neuron in your brain died, it would never come back. In other words, it is impossible for your brain to regenerate. In the past ten years we have learned that this is utterly and completely false. The science on cartilage is moving in a similar direction. Studies have shown that defects in cartilage - little divots - can and do regenerate spontaneously. But this happens more slowly or not at all as we get older, and the main reason for this is that the amount of stem cells naturally occurring in our bodies declines sharply as we age.

    And the real trick is this: stem cells are stimulated by intense exercise. So even if we're older, we can promote the generation of stem cells in our bodies to heal and repair injuries, by exercising vigorously. But, the damage that we do to our cartilage is caused by violent exercise! My feeling is that tennis is a violent sport, and not well-suited to trying to heal joint degeneration by promoting stem cell growth. A better strategy, in my opinion, is to limit your tennis somewhat, or to limit the intensity of your playing style, but then add some kind of low impact, intense exercise to promote stem cell growth.

    For example, you could play doubles two or three times per week at a moderate intensity, and then swim sprints twice a week to promote stem cell growth. If you're lucky, any wear and tear incurred while playing tennis would be overbalanced by the stem cells you have generated during your intense swimming.

    The technologies we've mentioned - injection of autologous stem cells, or the implantation of a cartilage plug grown in the lab - are replicating the kinds of repairs our bodies were capable of when we were pups.
     
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  16. corners

    corners Legend

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    Yes. Studies have shown that complete meniscectomy leads directly to osteoarthritis, which is why this surgery is generally not done today. In the past, the meniscus was thought to be vestigial - a useless remnant from our evolutionary past. Now we know that the meniscus is crucial to knee function.

    Yes. In complete contradiction to what I wrote above, meniscus damage and degeneration of the articular cartilage is poorly correlated.
     
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  17. Raul_SJ

    Raul_SJ Professional

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    Thanks for the response.

    I can understand how a sudden twisting injury can damage the meniscus in a person with normal articular cartilage.

    But I wasn't clear how age-onset osteoarthritis, caused by repetitive stress to the joints over the years, can degenerate the meniscus without also corresponding degeneration to the articular cartilage.

    Quite strange that there is a poor correlation between the two...
     
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  18. RogueFLIP

    RogueFLIP Semi-Pro

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    I think you answered your own question there. You could have when you were younger had a minor injury to your meniscus without realizing it. Over time with the repetitive stress and compressive forces of the leg slowly wearing away at the meniscus, you could come to a point where your meniscus is degenerated while the rest of the articular cartilage is somewhat intact.
     
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  19. PigPen

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    He told me to try an unloader brace for tennis, but not for anything else. Hasn't really worked well.
     
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  20. Ashley D

    Ashley D Rookie

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    Why is that strange? The meniscal cartilage is clearly protecting the articular cartilage from damage.
     
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  21. Posture Guy

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    From my perspective, most of the things discussed above as attempted remedies are not addressing the core issue creating the problem: the POSITION that the knee is in. I've never once seen osteo-arthritis in a properly positioned, normally used joint. Ever. Strategies like some of the things mentioned above can be very effective if first the positional integrity of the joint is first restored. As I've said on other threads, a joint cannot have functional integrity if it lacks positional integrity. It's impossible.

    So doing shots and acupuncture and foam rolling and stretching and all that stuff is basically trying to make the best of a compromised situation.

    My recommendation to the OP is the same as I've made in many other threads: get the book Pain Free by Pete Egoscue. Read the first three chapters, then read the chapter on knees and do the appropriate routine of corrective exercises from that chapter. Also, feel free to email me directly with any questions.

    Then, I wrote a blog post about knee issues a few years ago and showed a client's before and after xrays. In the before xrays, he's bone on bone. In the after ones taken 15 months later, he's not. You can check it out here.

    I wish the OP well with his knee issues. Don't stop playing tennis, man. Fix the reason why the knees hurt so you can keep on playing for many, many years to come.
     
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  22. RogueFLIP

    RogueFLIP Semi-Pro

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    I think you and I have a somewhat similar view on posture and its relation to pain and dysfunction, but a bit different approach on how to correct it.

    While I don't disagree about corrective exercises to restore any imbalances in the body, my take is why don't you reduce the actual soft tissue component that's causing the positional integrity to be compromised in the first place? I think if you did that you might find that the exercises would be that much more effective.

    Which is why I recommended he start using the roller and work on his flexibility. Obviously it's not going to fix everything, but it's a start.
     
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  23. Raul_SJ

    Raul_SJ Professional

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    If it's bone on bone, that means the articular cartilage has worn out.

    And given that the body cannot regenerate articular cartilage, how could the joint space come back to normal?
     
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  24. Posture Guy

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    Raul........i agree with your first statement. If a bone on bone condition is present, then at that spot the articular cartilage has worn away.

    The second statement, though, is a matter of great debate in the medical community and I do not profess to know the answer. There is growing evidence that interventions such as prolotherapy and PRP can assist the body in laying down new material where old material wore away. Is the new material identical to the original material? I don't know, but it seems the body CAN lay down new material on articular joint surfaces.

    Here's an interesting article at a prolotherapy journal on the subject: http://www.journalofprolotherapy.co...ion-of-articular-cartilage-with-prolotherapy/

    Did that happen in the xrays shown in my blog post? I have no idea. Simply getting the femur back into proper orientation is going to cause a much better alignment with the tibial plateau. If there was sufficient cartilage material over the rest of the glide surfaces other than the bone on bone point, it's conceivable now that the femur is no longer mis-aligned that there's enough material to keep the bones separated throughout the joint space.

    The core point remains: if a joint is breaking down, in virtually every case I would maintain that this degenerative process has originated because of joint misalignment producing excessive friction and compensatory movement patterns. Without restoring normal joint position, all other interventions will be limited in effectiveness.
     
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  25. RogueFLIP

    RogueFLIP Semi-Pro

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    So how do you think the joint misalignment occurs in the first place?
     
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  26. RogueFLIP

    RogueFLIP Semi-Pro

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    IMO this person was able to reduce the compression forces around the joint which is another factor for the degenerative process to start.

    Putting the body back into a more ideal alignment meant that there was less overall force to that particular joint upon impact; the body was better able to absorb any kind of compression force using the whole system instead of having an imbalance and causing the more compression force to be applied to that specific area.
     
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  27. Posture Guy

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    RogueFlip....my apologies for not responding to your earlier response. Didn't see it.

    With respect to that one, I think working muscle imbalance AND connective tissue issues concurrently is a great approach. I refer clients out all the time for such work, and recommend foam rolling all the time. I just got back from tennis, about to hit the foam roller myself. But if ALL someone is doing is working on the connective tissue and not addressing the underlying muscle issues, then they're just not going to get there from here.

    How does a joint get misaligned? Easy. Posture becomes imbalanced for a lot of reasons but the most common one is we don't feed our bodies enough quantities and varieties of movement to maintain musculoskeletal balance from back to front, top to bottom, left to right.

    Take someone who sits at a desk all day and then their primary exercise is tennis. Sitting all day tends to lock the hip flexors in a short, tight position, shuts down the glutes, rounds the shoulders and upper back. Now the person with that compromised posture is getting up and heading to the court after work and playing a sport that presents a very asymmetrical demand to the body. My right and left sides are doing VERY different things on the tennis court. That's an issue for someone who doesn't sit all day, but for the guy who sits a lot, it's even more of an issue. If corrective counter-balancing motion isn't presented to the system, tennis will create strong right/left assymetries and as those get stronger, they'll combine with the issues from sitting to basically kick that person's butt.

    But some basic motion can help bring the body back into left/right balance, and can also counter balance the negative impacts of sitting.

    Trauma can also misalign a joint, but usually, the trauma was introduced to a body already out of postural balance, and doesn't create the misalignment as much as exploit one that's already there.
     
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  28. Posture Guy

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    As to RogueFLIP's latest post, when we have someone who is bone on bone for the reason the person in my blog post was, he's not bone on bone throughout the joint capsule. Rather, his valgus knee stress (a knock kneed orientation of the femur) was causing the lateral aspects of the knee to pinch towards each other, so not only did he hyperload that lateral aspect of the knee, he unloaded the inner aspect, so I guarantee that manifested as functional instability in the knee. He was using a fraction of the glide surface he was designed to use. reducing that valgus knee stress allowed the knee to stack more evenly, like RogueFLIP says above, and even if there's no space between the bones, the knee will be more stable, more functional, and less painful. But if space CAN be created, that's even better.

    And studies show clearly that cartilage defects CAN heal and improve. The body has an amazing capacity to regenerate if given the opportunity.
     
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  29. RogueFLIP

    RogueFLIP Semi-Pro

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    Who do you usually refer to? Massage therapists? Acupuncturists? Just curious.

    I don't disagree with that at all. Like I said, we have a similar viewpoint, just a different approach to things. I'd always want to correct any soft tissue issues first as much as possible since it surrounds everything. Which then IMO, makes any treatment modalities that much more effective.

    In my experience, some postural issues are a defense mechanism from trauma. Trying to stretch or fire other muscles to correct or compensate is trying to force the system that doesn't want to be forced which can lead to more pain and more compensation.

    But I'd imagine that persons described above are in enough pain/stiffness that they're probably not playing tennis, let alone reading these boards, so I'll leave it at that.:)


    I can agree with this to an extent, but most of the time, I don't see my patients "before"....if you know what I mean.
     
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  30. Posture Guy

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    RogueFLIP....are you a body worker? If so, what modality?

    I don't refer to traditional massage much. I think it's very helpful for kind of day to day maintenance type of things, but for chronic pain/performance issues, the connective tissue stuff I see tends to run deeper than that.

    I have an acupuncturist I refer to, but he does different kind of work. VERY deep and aggressive. Uses long needles and his approach is almost a prolo-based approach. Wants to both release trapped old blood from trauma sites, and create new hematomas in injured areas to spur healing response. His work is painful as hell but very effective.

    There's a form of bodywork here in the Austin area called Airrosti, almost a form of localized rolfing. For the right issues it can be incredibly effective. I've also referred to myofascial release folks, and I'm about to explore Bowen Therapy. Also a fan of traditional rolfing. And from time to time I refer to chiros, as well.

    I sometimes DO see cases where the body is so locked into a pattern that we have to give it space and time to unwind. That's where aspects of our ecise library like supine groin progressive in the tower can be incredibly helpful. It's not an active stretch, and it's not asking for anything to actively contract. Instead, it puts the body into neutral positions and allows the body to unwind at its own pace. It's a very, very powerful ecise. I've seen some wild myofascial unwindings happen from it.
     
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  31. RogueFLIP

    RogueFLIP Semi-Pro

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    Thanks for the reply. Interesting stuff. Couple things I can look up later.

    To answer your question, I'm a physical therapist. But in the clinic we do 99.9% John Barnes' Myofascial Release. If you're familiar with his work, so you can see where my bias come from :twisted:
     
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  32. Posture Guy

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    Very cool. I've referred to Barnes' therapists and had it done myself. It's an outstanding modality in the hands of the right therapist.

    I'd love to go to Sedona for one of their 10 day intensives. Just not practical at this point.
     
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  33. RogueFLIP

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    Unwindings are part of the Egoscue method?

    That must have been quite a sight to see if you've never seen a myofascial unwinding before. LOL, I remember the first time I saw one during a seminar. I think the whole attendance was silent, WTF is going on? :)
     
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  34. Posture Guy

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    Yeah, one of our clinics had a video they took of a guy who looked like he was having an epiliptic seizure once he got to a certain level. His whole body was shaking, wasn't violent, just......odd. The therapist ran over wondering if he was ok and he said he was fine, it actually felt good but he had no idea what was going on. After about 5-10 minutes it stopped and he felt awesome.

    Some of our stuff is very active. Some of it is putting the body into a position passively where it's then invited to unwind and release. Usually it's not particularly dramatic, but sometimes it is.

    The body is very, very cool.
     
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  35. RogueFLIP

    RogueFLIP Semi-Pro

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    Yes it is....

    "Odd"....yeah that's the nice term....:)

    That client was just thawing from the flight/fight/freeze response....good that the therapist just let the client do what the client felt like he needed to do.

    So I'm curious to know from a non-MFR trained perspective what do you think is happening during the unwinding process since you've seen it?
     
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  36. Posture Guy

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    When I started doing the main ecise that uses the tower, I couldn't get below the 3rd level without my entire mid back feeling like a combination of cramping and snakes wriggling. The sensation would start at the first level, intensity at the 2nd but be manageable, and by the end of 5 minutes at the 3rd level I couldn't take it anymore. I'd switch legs, start at the top, the process would repeat. After 3 levels on that side I'd do an ecise called Airbench that cooled everything off and I'd feel great. After 2 months of doing this daily, finally my t-spine said "ah, screw it, we're done holding on" and it let go and I can't even describe what I felt, but at that moment, my back felt tons better and my herniated discs were no longer an issue. It was amazing.
     
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  37. Posture Guy

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    RF...great question. Just got back from a tennis match that kicked my butt. Gotta go eat and do a short post-tennis routine and hit the sack. I'll answer that question tomorrow (hopefully I remember).

    but I believe it definitely involves myofascial chains (akin to what Tom Myers writes about in Anatomy Trains) remembering what their normal lengths and tensions are supposed to be, and going through a process first of resisting, then relenting.

    The cramping in my mid back I felt? My mid back was being invited (not forced) to release a measure of kyphosis and it felt like it just had to hold on. That's where I got my stability after my car wreck took my lumbar spine offline. Took awhile to convince my t spine that it was safe to let go. Once it did, wow.
     
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  38. PigPen

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    Posture,

    I will certainly purchase the "Pain Free" book. I most certainly have imbalances in my body, especially on the right side where I had the two knee surgeries. Luckily I am not yet bone on bone. Also had a back surgery three years ago where the physician removed a piece of a disk that flaked off and was compressing on a joint.

    I went through a short stint of PT after which I felt great. The PT did massage therapy and alignment of the knee and hip joints. Only after playing tennis for a few weeks did my knee start to bother me. It swells after I play and is most painful on the outside whereas my surgery was on the inside. During PT, the tibia massage was very painful as was the attempt to straighten my leg on the table. By the way, my rectis femoris muscle is very tight on that side to the point that I cannot grab my ankle when attempting to do a quad stretch.

    I now must take ibuprofen before I play and ice after. I realize the ibuprofen is a temporary measure and would like to fix the root cause.

    Great information thus far on this thread. I would like to thank all posters for their insightful contributions.
     
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  39. Posture Guy

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    PigPen.....this has been a fun thread, thanks for having pain so you could start it and ask about it!

    Just kidding! Well, about the having pain part.

    From an Egoscue perspective, I think the type of work RogueFlip does would be VERY complementary.

    And to continue to answer RF's question above, it's funny, one time I was talking with Pete Egoscue and I told him that I thought something he said in "Pain Free" was accurate, but incomplete. He gave me a funny look, like "oh, this should be good" and asked what that was. In Pain Free, he writes "bones go where muscles tell them to go." I said, "bones go where muscles tell them to go, and where connective tissue permits them to go." He laughed and said "absolutely right, no question", then explained that he didn't want to confuse the message in the book, and added that he sees a lot of connective tissue issues resolve as postural balance is restored. And I see that, too. But sometimes, connective tissue gets "stuck" in a dysfunctional pattern, and that's where something like the Barnes technique can be incredibly powerful and helpful.

    I'm about to try a new therapy on Friday, Bowen Therapy. Never heard of it until a month ago, from a client. Sounds like a form of osteopathic manipulation I used to get years ago, very gentle stuff. Will report back on another thread if I find it helpful.
     
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  40. Raul_SJ

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    Thanks PostureGuy and RogueFlip for the information.

    It's quite remarkable to see the patient's before/after x-rays and how the joint space has returned to normal after undergoing Egoscue treatment. I presume the patient did not have any PRP intervention, which seems to suggest that the Egoscue treatment alone has stimulated the body to regrow cartilage.

    I would also be interested to hear CharlieFederer's opinion on how the knee joint space was able to return to normal.
     
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  41. Posture Guy

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    I spoke with this client and he took some supplements, but had no injections into the knee.

    Speaking of joint supplements, the one to me shows the most promise is Flexcin. There is some interesting research emerging on undenatured type II collagen. I also see a lot of anecdotal stuff about ceytl myristoleate.
     
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  42. PigPen

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    As far as supplements, I have been taking glucosamine/chondroiten for over 20 years and lately Zyflamend.
     
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  43. Posture Guy

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    PigPen......i'd take a good look at Flexcin. It's a well constructed product. I like it a lot and one of the top nutritional guys in Austin I know recommends it as his top joint supplement.

    And I think Zyflamend is solid. Helps in a lot of different areas.
     
    #43
  44. PigPen

    PigPen Rookie

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    Thanks Posture. Ordered the "Pain Free" book yesterday. I am trying to work out an appropriate regimen for someone of my age. I am realizing that this routine must change as a player advances in age.

    Unfortunately, I play with a bunch of 4.5/5.0 guys who like to play on hard courts. However, I play on Har-Tru quite a bit as well. Is there a difference in surface for ones body in your opinion? I also compete with the younger guys in their 20s.

    I have tried to cut down my tennis lately to 3x per week with at least 1 day of rest after I play. I also do Power Yoga 3x per week as well.

    I will look into Flexcin and continue with Zyflamend.

    By the way, I am a big believer in PT. I have great admiration for my therapist who has helped me work through many injuries.

    Any other suggestions?

    Thanks in advance.
     
    #44
  45. charliefedererer

    charliefedererer Legend

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    It depends on how much of the cartilage has been lost, how badly the synovial lining of the joint is damaged, and the condition of the exposed or underlying bones at the joint (See illustrations in post 11.)

    As usual, Posture Guy is giving you solid information on correcting any abnormal alignment or muscle imbalances that could further injure your knee.

    My own theory on myofascial release is that is effective in relieving the localized:
    1. cramping of muscle at a site of muscle fiber damage and subsequent inflammation
    2. breaking down "scar tissue" (collagen deposition) that occurs as a result of inflammation, in which scar tissue abnormally adheres to fascia, muscle, tendon or ligament, so that muscles can not slide/contract normally.




    Below is a representation of the architecture of cartilage:

    [​IMG]

    The architecture of cartilage is immensely complicated.

    In the figure above, the "bubbles" represent the spaces in which the living cells are contained.

    Those living cells put out "extracellular matrix" [here colored blue in the illustration] which hardens to form the hard rubber like composition of cartilage.

    To further complicate things, different types of fibers run through the cartilage - some firm, some elastic and some bonelike.

    All of theses elements are in a constant state of wear and repair, and rely on intact nutrient supply for the living and repairing to go on.

    [If interested, you can get a detailed description of the architecture and matabolism of cartilage here: Mechanical Behavior of Articular Cartilage http://www.intechopen.com/books/inj...s/-mechanical-behavior-of-articular-cartilage



    Trauma and inflammation can interrupt any of the elements that make up cartilage: cells, extracelluar matrix or nutrient supply.

    Living cartilage cells can not move to areas of injury to start a repair process.


    Therefore almost all insults do not result in actual repair, but in tiny islands of "scar tissue" in the cartilage.

    Too many insults, and the "scar tissue" itself interferes with the nutrient supply of the cartilage.



    Researchers are working on a way to recreate the complex functioning cartilage structure, but we are many, many years [?decades] away.


    Smoothing worn surfaces, and getting more smooth "scar"surfaces to form from procedures like "microfracturing" can now be done.
    But these should not be confused with restoring healthy "normal" cartilage.
     
    #45
  46. PigPen

    PigPen Rookie

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    Thanks for the great info CF. Thorough as usual. Do you have experience with supplements that have worked? Just curious, are you an orthopedic?
     
    #46
  47. Chas Tennis

    Chas Tennis Hall of Fame

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    FYI

    There is a very interesting new reply in an active thread on back pain.

    It is about recent research that indicates that a considerable amount of back pain may be caused by a bacterial infection.

    Of course, it is well known that Lyme disease, a bacterial disease, mimics some symptoms of arthritis especially of the knees. It has been misdiagnosed as arthritis in the past.

    Anyway, bacterial infection is a research area that might eventually involve more than just the cartilage and other tissues of the spine.

    I hope that they have found something!

    Reference defining Modic Changes : http://en.wikipedia.org/wiki/Modic_changes
     
    Last edited: May 9, 2013
    #47
  48. charliefedererer

    charliefedererer Legend

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    I am not an orthopod, and but can give you my wife's experience with glucosamine/chondroitin sulfate. (She's a primary care porvider.)

    She states some patients really seem to have pain relief with this combination.
    Those that respond with decreased pain stay on it.
    Those that don't have a derease in pain after a couple of months come off.


    This seems to be in keeping with the big (1583 patients) National Institute of Health trial in which:

    "Overall, there were no significant differences between the other treatments tested and placebo.
    For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared with placebo—about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.
    For participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief."
    - http://nccam.nih.gov/research/results/gait/qa.htm

    "Should people with osteoarthritis use glucosamine and chondroitin sulfate?
    People with osteoarthritis should work with their health care provider to develop a comprehensive plan for managing their arthritis pain: eat right, exercise, lose excess weight, and use proven pain medications. If people have moderate-to-severe pain, they should talk with their health care provider about whether glucosamine plus chondroitin sulfate is an appropriate treatment option."
    - http://nccam.nih.gov/research/results/gait/qa.htm


    Unfortunately, I don't think there have been any large well conducted studies that have shown any supplements or drugs that alter the underlying disease process itself.
    (Most large drug trials target pain, not changing the disease, as their endpoints.
    There doesn't seem to be high hopes of finding a drug/supplement that will change the underlying disease process.)
     
    #48
  49. Chas Tennis

    Chas Tennis Hall of Fame

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    Are the joint tissues that are removed in surgeries ever examined for bacteria?
     
    Last edited: May 10, 2013
    #49
  50. Posture Guy

    Posture Guy Professional

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    Charlie, great posts. Your stuff is always so educational.

    I'm just going to provide my perspective on one issue. Osteoarthritis is often (if not usually) referred to as a disease process. In our (Egoscue) view, it's not a disease, but simply the body's response to dysfunctional loading of the joint, which creates friction that exceeds the joint's "tolerance". The body responds dynamically to that negative stimulus and what we see as osteoarthritis is that response.

    You don't "catch" osteoarthritis in the way someone might "catch" the flu, for example. And it's not some independent process (in most cases) the way cancer, for example, is.

    Pete Egoscue has said "I've never once seen osteoarthritis in a properly positioned, normally used joint" and in my clinical experience, I agree with that statement. EVERY time I see a joint with degenerative changes, I'm seeing a joint that is fundamentally mispositioned in such a way that it has directly contributed to the degenerative process.

    And from our perspective, that's good news, because the position of a joint is something one can positively effect.
     
    #50

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