Book: Todd Hargrove’s ‘A Guide to Better Movement: : The Science and Practice of Moving With More Skill And Less Pain’’ – “I am turning thirty next week, and I just want to go home, and grow oranges.”

I am still trying to finish Todd Hargrove’s book on moving better, it is a good book and I think it will be useful – but I am having to concentrate to take it all in and then work out how to apply it to my knee.

Buying the book was a side effect of my ex-yoga teacher pointing out the Better Movement website to me, I liked the website – although I am still trying to read it all and the one that really struck home was the article on Fatigue is an emotion

It mentions an article by Tim Noakes where the basic idea “is that human exercise capacity is not limited by a failure of the body, but is instead regulated by the brain to ensure that such a failure does not occur.”

So when you get tired and feel like stopping it is your brain telling you to because it doesn’t want you to hurt yourself, this same brain trigger can make your brain scream “PAIN” without there actually being pain – at least not pain pain.

I have a strong feeling that this is me, my brain knows how trashed my knee was (is) and how much it hurt when it was bad, so it shouts immediately that I start doing something. And on things which I know have resulted in my being really hurt (aka running, leg press machines) I listen to my brain and stop.

One things that the website comments on this article mentioned Charles A. Garfield’s 1984 book ‘Peak Performance: Mental Training Techniques of the World’s Greatest Athletes’ which looks at the Soviet and East German sports training programs and the mental conditioning tactics – specifically the visualization stuff.

I am unsure if I am open minded to weird stuff, I find it interesting but I don’t really believe. So I wasn’t too hopeful when I tried the visualization of running a kilometre whilst staying (relatively) relaxed and without my knee screaming. I focused on the distance increasing by 0.1 until I got to 1K and it was ok – not great but ok.

The next challenge is to try running a little further with visualization and to find the book!

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Knee: Helpful muscles that I should know – “the knee bone connects to the wrist bone”?!

Off the back of the throwaway comment from the NHS ‘Specialist’ I decided to look up how my leg muscles actually work. However I don’t like gross pictures of the inside of legs and have a short attention span when it comes to medical names for stuff.

Which means that even before my knee failure, back when I could still run, I wasn’t overly into the mechanics of it, I wasn’t overly fussed what muscle connected to which other thingies, I just wanted them to work and for my IT band (aka Iliotibial band) to not get so darn tight!

However the internet tells me that the IT band is not simply one big muscle that happens to get tight and get annoying all by itself. It transpires to be made up for several muscles which join the party at various different points along the leg.

peanuts dinosaur

(Picture from collectpeanuts.com/)

For the purposes of my limited attention span there are two key leg muscles towards the top of the IT band: the Gluteus Maximus (GM), aka the Butt, and Tensor Fascia Latae (TFL).

There is also one somewhere around/below the knee, the Tibialis Anterior (TA).

The Tensor Fascia Latae is the front (anterior) muscle on the thigh part of the leg and it joins the IT band from the hip along with the Butt – except the Butt joins from behind (weird that).

I then got very confused by the internet and concluded that basically the TFL and the Butt need to work against each other (but in a collaborative way) in order for the hip to be stable and reliable.

funny bones

Then the Tibialis Anterior (TA) links into the IT band from the front and is a big muscle near the shin and is apparently used by pretty much every leg movement ever.

My yoga teacher, the ‘Funny Bones’ books by Janet & Allan Ahlberg and the ‘Dem Bones’ song, tell me that everything is interconnected, therefore a stable hip must be good for the knee. A stable TA feeding into the IT band, which has also got the hip muscles linking in from the TFL and the Butt, must have some positive influence on what happens around the knee.

I did finally look up what the difference between hip adduction and hip abduction. Adduction is squeezing together motions, abduction is away. Abducting seems to tighten the IT band so is not my friend.

Really not sure how much of that actually went into my brain and I didn’t really find any exercises which is a shame as I probably need to search the internet some more now… plus there was that other throwaway comment about the correlation between core strength and knees.

Maybe another day.

Copyright © WhereEvilThoughts 2014 – excluding pictures! Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Links may be used, provided that full and clear credit is given to WhereEvilThoughts with appropriate and specific direction to the original content

Knee: Now with added spikes

My latest random internet-inspired attempt to take an edge of my leg pain was a spiked acupressure mat.

The logic is the spikes as like needle free acupuncture, so modern medicine would say that it prompts blood flow to the spiked areas.

Alternatively in traditional Chinese medicine acupuncture is thought to help the meridian lines channel the flow of a life force is known as Qi.

spike yoga mat

Alternatively again my yoga teacher talks a lot about prana, aka energy or life force, which also carried along meridian lines.

So basically three major things that you could decide to believe in all think that the spiky mat should help my leg, it seems worth a go!

The instructions that were on the internet page, but that didn’t actually come with the mat, said to lie down on it for 20 to 40 minutes a couple of times a week (or more) to alleviate muscle pain. It says that the spikes should hurt, but in a good “joyful” way.

I’m a little unsure about joyful painful spikes, but as the NHS are being less than helpful the spikes seem worth a go I suppose!

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Patella femoral joint pain – “She likes big words although we’ll never comprehend”

What started as patella femoral joint issues (aka runner’s knee) is increasingly confusing. I would like to give special thanks to some muppet who works in my local hospital’s radiography department who ensured that I spent several fun-packed hours typing my MRI scan results into Google one word at a time in a desperate attempt to understand them.

I ended up with a lot of scribbled notes about various terms from various places on the internet – plus some guessing from my co-workers/ husband/ cat/ random strangers.

freezing from the same day that hell froze over

(Photo from the BBC – this is from the big freeze earlier this year when Hell did freeze over)

As I went to all this effort I thought I should record these definitions somewhere as I’ll probably need them again before my stupid knee makes any progress – although given the speed and efficiency of the NHS I think hell will freeze over before my knee stops hurting.

Structural Words:

Patella – knee cap

Patella alta, aka the high riding patella – the knee cap position on the leg is rather high

Trichlear groove (aka trochlea) – the groove where the patella (knee cap) makes contact with the femur (thighbone). The sides of the knee cap should be almost parallel to the groove and the knee cap should slide inside the groove.

Lateral ridge – in the case of the trichlear groove this is the outside of the groove.

Femoral – to do with the femur (thigh bone)

Infrapatellar fat pad (aka hoffa’s fat pad) – a fatty pad filled with nerves that sits below the knee cap and behind the patella tendon.

Vastus Medialis Obliquos (VMO) – a muscle group which are very useful to help stablise the patella (including its tracking) and are potential weak if you have knee pain!

Bursa – small sac filled with synovial fluid. When working correctly these reduce friction between bones and stuff in joints.

Menisci, cruciate and collateral ligaments – ligaments!

Articular cartilage – slippy white substance that helps the bones glide smoothly. Very important stuff.

Pain themed words:

Patellofemoral pain syndrome – a blanket term meaning anterior knee pain

Anterior – in humans this means “the front”

Retropatellar articular cartilage fissure –you have damage to the cartilage on the back of your knee cap.

Chondropathy – your cartilage is screwed.

Patellofemoraldysfunction – Term so vague as to be useless, aka the chap in radiology is an unhelpful individual or totally stumped and doesn’t want to admit it.

Patellofemoral arthritis – when the articular cartilage wears down and inflames. This is usually along the trochlear groove and on the underside of the patella. Owch owch owch.

One day I want to be able to NEED a list of cute fluffy words to describe my knee with.

Copyright © WhereEvilThoughts 2014 – excluding pictures! Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Links may be used, provided that full and clear credit is given to WhereEvilThoughts with appropriate and specific direction to the original content. If you want to take my knee pain away then please go right ahead.

Patella Femoral pain VS MRI scan results VS ice

My knee utterly broke in July 2013, it had been wrong for 12 months before that and the medical profession’s stock answer had been that it is patella femoral joint issues (aka runner’s knee) and that I should rest it, dice it and elevate it.

After this many months I am beginning to lose my good humour and I am getting rather ‘eager’ to have someone with half a brain suggest an actual fix.

ice - arctic - guardian

(Photo from the guardian – ice)

The private physiotherapist took under 10 minutes to say that it was a tracking problems of the patella femoral joint and it seemed a believable conclusion as the knee cap was so stiff that it couldn’t easily move – even when manually pushed!

The treatment was £1 a minute and it got results initially – my knee certainly seemed to like the diathermy machine, the ultrasound seemed to reduce the swelling and the stretching exercises seemed to be a good idea. However after a few months there wasn’t any change in the treatment and asking for strengthening exercises (as oppose to just stretching ones) didn’t get a positive response. It started to feel like they wanted to keep me coming back by taking away the symptoms but not treating the cause.

Several months later the NHS physiotherapist didn’t disagree with the tracking diagnosis, although they did express concerns about the pain areas were what they would expect to cartilage damage. However on the letter back to my doctor they specifically said to get a MRI scan for a menisci ligament. They gave me a handful of basic strengthening exercises but didn’t seem overly interested in treating the pain side of it – the nearest they came to ultrasound or diathermy was they stuck a heat lamp on it at one point.

ice - telegraph

(Photo from Telegraph – ice ice)

For the sake of completion; the chiropractor seemed a bit of a quack said it couldn’t be a tracking problem – whilst yanking my knee joint backwards. So we will ignore him entirely.

It was concluded by the second physio clinic that I have weakness in the Vastus Medialis Obliquos (VMO), which is one of a rather useful set of muscles that help stablise the patella – including its tracking. So I knew that I need to continue to build these up regardless of the MRI result.

However I was expecting the MRI result to be helpful and something that my doctor could comprehend – this was not the case. I was already under-impressed that the results were going to my doctor and that I would have to bug them for the results, but I did and found that they a) hadn’t bothered looking at them, b) didn’t understand them in the slightest and c) couldn’t work out who to refer me to.

baby - telegraph

(Photo from Telegraph– ice ice baby)

The report was written using the biggest words imaginable and was supremely unhelpful even after I used Google to translate it – for example the report concluding that “…suggest underlying patellofemoraldyfsunction”. Strictly speaking they should have said “patellofemoral dysfunction “and given that directly translates as “bad knee” I don’t think that is a particularly helpful statement!

However it wasn’t all a waste of time as the MRI did reveal was that I have patella alta, aka the high riding patella. In English this means that my knee cap is rather higher up my leg than would be nice. However there doesn’t seem to be a way to correct this so good to be aware of but is of limited real use.

Someone I work with has a ladyfriend who is an NHS physio – although most of the stories seem to involve her getting covered in some icky bodily fluid by confused old people. She kindly looked over the wibble provided by a Dr Hussain and has translated it in a way that I can understand – and that matches my Google-powered buzz-word bingo results.

fat pad pinching

(fat pad photo from hughston.com– really interesting read on the page too)

There are a few things of note, most of which the dude in radiology has decided aren’t part of THE problem so has barely mentioned, although I feel that the back of my knee cap having “change” present in the cartilage is something to be concerned about! This change also backs up a tracking issue as having been present – although I can guess that the cause of this might have been horribly inflamed internal knee tissue pushing the knee cap into the wrong place.

The conclusion is that some soft tissue might be getting caught between the joint, however the chap who formally wrote up the scan results didn’t explain what tissue nor does he suggest a course of action!

My current guess is it might be the infrapatellar fat pad (aka hoffa’s fat pad) which is a fatty pad filled with nerves that sits below my knee cap and behind my patella tendon. It basically acts as a shock absorber and doesn’t like being trapped between the femur and the patella. This injury likes rest, ice, elevation and some pressure. There is also some rather drastic sounding surgery – although all knee surgery seems pretty major!

However I am currently waiting for my doctor to find a specialist to refer me to, so I fear that I will acquire a short-term addiction to ice and bugging my doctor!

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The MRI scan has landed! Bring on the claustrophobia

The letter confirming the MRI scan (Magnetic resonance imaging) appointment to take a proper look at the patella femoral joint issues (aka runner’s knee) in my left knee didn’t mention that it was going to be in a lorry trailer parked in the hospital car park.

Due to the MRI equipment being massive there wasn’t much trailer left for people to fit in. So there was a tiny claustrophobic room with a small hole to fit bodies in and a small area by a door with an ancient computer screen and one chair being shared between two technicians.

mri scanner

(Photo from ulh.nhs.uk)

I am not a massive fan of small spaces but as this was a knee scan I didn’t expect to have any issues… then they stuck me into the machine up to the top of my shoulders.  That made me very nervous, but still happier than I would have been if the CD player had been working as the hospital’s collection of CDs consisted of compilations from 1996 and Will Smith’s ‘Big Willie Style’.

So the CD playing being out of action was fantastic, it meant that I got to listen to the random machine noises without anyone thinking that I was weird.

What was undeniably weird was the vibrations made my feet twitch, which was somewhat random. Now I just need to wait a couple of weeks for my doctor to get the results and hopefully they will share them…

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Knee – Shaking my way towards a MRI scan

As far as I can tell I still have patella femoral joint issues (aka runner’s knee) – specifically with my left knee. I haven’t seen the physiotherapist for a month now, my left knee still feels tight and stiff, often sore. The muscles on the outer quad sometimes shake uncontrollably on both legs – most recently on Monday in the middle of yoga class.

I know that muscle shakes can be caused by dehydration or insufficient good fuel – I think that Monday’s shakes could have been aided by a little too much sugar that morning.

sugar

(Photo from the BBC)

It could have been muscle fatigue as I have been a little bit lax  with my physio-suggested leg exercises for the last couple of weeks. The shakes were during moves that I’ve done a lot before – variations on Warrior 1 and 2, so my body should know that it can pull these moves off. Although if my stupid muscles haven’t been exercises and stretched properly then that would probably not help – plus the sugar thing…

Alternatively, my yoga teacher has suggested that  the shaking in when my legs feel vulnerable, I respectfully counter that her tugging my leg into “better alignment” might not have helped with the cause or effect.

knee xray

(Photo that I’ve used before somewhere on a previous post – probably about my knee…)

It has occurred to me that perhaps I should try to push the leg more – to see if I can run yet, even if just for a minute. But I an nervous about trying this without a physio saying to do so, something that I am not prepared to spend £50 on an appointment to see if I get.

The NHS have me on hold, my six NHS physio sessions were woefully inadequate, I am booked in for an MRI scan in a month’s time. Google tells me that the MRI scan should give a decent view of bones, cartilage, tendons, ligaments and other random stuff – so in theory that should confirm (or deny) if  there is anything wrong that physiotherapy alone can’t fix.

To sum up – my knee is still not right. Both legs sometimes randomly have weird shaking muscles and I have to wait to see if the MRI scan shows any underlying cause. Joy.

Copyright © WhereEvilThoughts 2014 – excluding pictures! Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Links may be used, provided that full and clear credit is given to WhereEvilThoughts with appropriate and specific direction to the original content.