Knees – not just getting old? #25 – After session 8 with John

Wed 22 Feb 2017

I have been doing the new exercises John showed me in session 8 last Monday, for the small tibia/fibula joint on the outside of the knee – the “proximal tibiofibular joint” – using the heel of my palm as John demonstrated, doing this to each leg, partly for comparison.

Even after I work it a bit, the affected leg does clearly feel like it is still harder right there at the top of the back of the fibula bone, compared to the same location on the other leg.

Since our session 8 two days ago, I have also noticed that when I bend the knee, I can often still feel some tightness below the joint, in that muscle area where the leg coloured up in early December (see blog #14).

Rereading the blog #19 notes from our session 7 appointment on 02 Jan, it seems that John did a bit of work on the area right around this same tibiofibular joint, at that time.  When he repeated the range of motion checks in that session, the range had improved as a result of his work.

The main difference in how we have viewed that area since session 7, is that the MRI scan has clarified that there are particular issues in that location, and this has brought both John’s and my own focus more to bear on it, both during and after session 8.

I played table tennis yesterday evening, for around an hour in total.  Although I was playing quite badly by my usual standards – probably from tiredness due to lack of sleep – I did notice that the knee was not giving any indication of me being on the verge of any pain or soreness, at any point.  However, I think this might be inconclusive, because my general level of play was way off where it usually is, and I don’t think I was really pushing myself physically, as far as I would normally be doing.

It is still too early to make any definitive judgements, but taking all the above into account, my feeling at this point is that, assuming a recovery is possible, there is some way to go, before the proximal tibiofibular joint will consistently seem to feel the same as on the other leg.

This all raises the following questions, some of which I can answer myself right now, with others needing either more time, or some comment from John.  I have marked each item as appropriate, in the () at the start of each question :

  • (NEEDS MORE TIME)  Did the work John carried out on the proximal tibiofibular joint area in session 7 on 02 Jan, to free up some tightness in that area, result in only a temporary improvement to that tightness?  If so, this might be simply because it is necessary to work that area more regularly – which I am now doing, using the new exercises John showed me.
  • (ME)  Am I doing those exercises properly, for this proximal tibiofibular joint?  I am fairly confident that I am.
  • (JOHN)  Is this tightness and hardness which we found in the proximal tibiofibular joint in session 8 this last Monday, consistent with the details about it having “degenerative change”, from the MRI report?  Or are these perhaps two different sets of characteristics, related but distinct from each other?
  • (JOHN)  Does the answer to the previous question, have any bearing on what I need to do regarding recovery?
  • (JOHN)  I am still a bit puzzled by the hardness aspect of this small joint.  Is there a possibility that the joint has become “stuck together / fused”?  If that was the case, would the MRI report have described it in a different way to how they have done, or would that still fall within their description as given in the report from 26 Jan?  Their wordings are as follows, from two sections of the report:

… patchy subchondral marrow changes involving the …. [and] lateral tibial plateau and proximal tibiofibular joint, with associated cartilage fissuring, consistent with degenerative change…

…Conclusion: Degenerative medial and lateral compartment chondropathy slightly more pronounced laterally, with further degenerative changes in the proximal tibiofibular joint.

  • (JOHN)  Based on our work in session 8, on the MRI report,  and on developments since then as outlined above in this blog page, am I right to think that recovery of this proximal tibiofibular joint, is still not a foregone conclusion?  In other words, could this still go either way – recovery / no recovery ?

John’s answer to the final question will not necessarily change how I approach taking things from here, but it will be helpful to know what he thinks at this stage.

 

 

Knees – not just getting old? #24 – Session 8 with John – Mon 20 Feb 2017

We began this session by John taking a close look at the MRI scan report details, which we discussed.  Here they are again, from previous blog #22, this time with [only] slightly better resolution:

Nelson - 26 Jan 2017 MRI scan NHS report - description - sized up

The key bits of info from this are:

  • The main cartilages, menisci, kneecap, and joint, are all in reasonably good shape.
  • My bones may be showing a little sign of getting porous – hardly surprising for a 60-year-old – but it is not serious at this point, and is unlikely to be the cause of the various issues I have been afflicted with in the left knee area.  I commented to John that, had they done a scan on my other, more healthy knee, it might have shown the same signs of getting porous – which he agreed with.
  • There is some degeneration/pathology of the smaller joint between the tibia and the fibula (“proximal tibiofibular joint”), which is located where these bones meet each other on the outside of the main knee joint, and just below it – the exact area where I have had pain, tightness, and so on.

John had not considered this smaller joint as a candidate for having anything up with it, as this is normally a fairly rare thing to come across – but if this is indeed something that has been a contributing factor, then it would explain quite well, why some ongoing problems have persisted up to now, since we have only really uncovered it properly at this stage.  Either way, it gave us something new to look into and to work on, in this session 8.

We began that by a fresh examination/checkup, with John getting me onto the treatment couch and repeating some range of motion tests as he had done in previous sessions, to judge whether there had been any change to affected left leg since then.  Although it was still not as good as in the other healthy leg, John felt that the range of motion was much better than it had been when we last tried this.  I agreed, based on how it felt as he moved each leg and took me through the same “resistance” tests in various directions, as we had done previously.

John then did some probing around this tibiofibular joint, comparing how easy it was to move it a little, vs the other healthy leg.  As he did this, both he and I could feel some stiffness / hardness in that area of the affected left joint.  There was no pain as John did this, which we both took as a good sign.

I was particularly aware of how “hard” this area felt – I had not expected hardness, and John was also a bit surprised to find it.  He did some further work on the area to try and free it up a bit, and then we repeated the range of motion checks.  There was a noticeable improvement, and as far as I could tell, the affected leg was now much closer to having exactly the same range of motion as the other leg.

We then discussed the strange colouring up of the muscle on the outside of my lower leg below the affected knee joint, a spot that had looked a little like a bruise, and which had appeared briefly at the start of the “breakthrough” events from early December (see blog #14) – events which had ended up being a transition from limping noticeably when walking downhill, to having virtually no limp at all.  We talked about how this might be related to the various nerves that run down through the area we had just been working on, and to the lower IT Band etc.  The exact nature of what had taken place in these breakthrough events, had never been clear to either John or to my GP, with whom I had discussed this when he phoned me last week to go through the results of the MRI scan.

John found some diagrams online showing how the tibia and fibula fit together to form this smaller joint, and how the various nerves are situated there.  Although we were not able to shed any further light on just what was going on with the breakthrough events, it was good to consider the nerves and their location in relation to this joint.  John felt that it might have something to do with the peroneal nerve in particular.

Despite still being a bit in the dark about what was up in early December with this, it was clear that we had found some tightness and “hardness” in the tibiofibular joint which had escaped both John’s and my attention, until now.

John showed me how I can work this area myself, to help loosen it up.   Here is a diagram John passed me a link to, on which I have added a blue circle to show where this tibiofibular joint is located.

Knee joint diagram incl peroneal nerve - incl blue circle croped

The diagram is for a right leg, but I can easily work with this for consideration of my affected left leg, because the diagram shows what I would see in a mirror for the left one, if I had x-ray vision etc.

John’s recommended exercises for this joint involve pushing the fibula – the smaller “outside” bone – forwards from behind, at around the red spot on the diagram (below and to the left of the blue circle), and then releasing to let that bone return back again.  He said that doing the motion in a forward direction is partly akin to how it should work normally, when either walking or running for example.  I got him to show me how to do this while I stood and put my leg onto a chair.  As well as him repeating, as a demonstration, what he had done on the treatment couch, I also then tried it, using a couple of techniques he showed me that require both hands – the left to do the pushing, and the right to hold the main knee joint relatively still.

This is always to be done gently I must add – the aim is to loosen the joint up again, after it seems to have been stiff and hard for some time.  It is probably best done while on the floor or sitting on a chair, with no weight bearing on the leg.  I will be including these exercises in my usual daily routines, going forward from here.

John also advised me to slightly modify the ankle exercise I have been doing for a few weeks now, which should also be targeting roughly this same area of the knee joint.  Instead of bringing each foot up diagonally to the “upwards and outwards” position, he said it is better to “rotate” or “swivel” it into this position, from the other position of “downwards and inwards”.  I will be sure to modify how I am doing this exercise, along these lines.

John’s suggestion regarding returning to some running, was to build up slowly and see how it goes each time, and not to just assume I will be increasing distance each time – to always assess as I go along, in other words.  This is exactly what I had already expected that I must now do.

His overall assessment of the state of the joint, is that it is indeed much improved since I first came to see him last October, and that it should be OK to now try adding some light jogs into walking, etc.  He again mentioned the NHS “Couch to 5k” plan for getting in shape – which I had briefly looked at a few weeks ago.  It is a simple and gradual increase within a set amount of overall exercise time, of the percentage during which you are jogging or running, with walking making up the rest.  My picture of how this recovery might need to be addressed, is very much along these lines.

That was about it for this session, which I suspect – and hope – will be the last one I need for awhile.  As I left to make my way home, my instincts were telling me that, in this tibiofibular joint, we may have found a “final” piece of the puzzle.

By the time I got home around lunchtime after the appointment – which was a trip made by car – I had decided to try out my usual lunchtime walk of around 1.5 miles, after eating.  I had already been noticing that the leg was feeling a bit more strong and “steady”, and perhaps a bit more similar to the other, OK leg.

Before taking the walk, I first did one quick experiment which gave an interesting and encouraging result: I bent both knees down and squatted to the floor, but with my knees not touching the floor, and just held that position for a minute or so – this is the sort of pose that people in India and Asia spend a lot of time in, which John has said is one reason why they tend to have healthier knees that we do in the West.

Before today, this sort of squatting would fairly quickly have started to hurt the affected left knee joint a bit, feeling too tight especially on the outside area, right around this tibiofibular joint.  Today, after our session 8, it didn’t hurt at all, and it didn’t feel too tight either.

I then took my walk, which felt good – it felt similar to recent ones, but in general I think my steps onto the affected left leg were less tentative than recently, more solid.

This walk includes one short but steep downhill section which, going back a few weeks, was always my litmus test of whether there had been any change to the noticeable limp I had suffered from until the breakthrough events of early December (see blog #14).  Although I have not been limping at all when walking this section lately, I had still been finding that there was a trace of pain, as though I was on the verge of the joint hurting, especially in that outside area of the knee.  On this occasion however, there was nothing like that at all – as I did this steep downhill bit, my step, gait and general feeling in the left leg and knee joint, was exactly identical to that of the other, healthy leg.

This is the first time in probably nearly a year, that I can truly say that my walking gait seems to be fully “symmetrical” on the left and right legs, both when walking on the flat, as well as up- and downhill.  I will be keeping a close watch on whether this continues, as I walk over the next few days.

I feel quite hopeful from all these developments of today.  It looks like we may have found the cause of the residual issues that have persisted since both those early December “breakthrough” events, and since John was able to loosen up some lower spine tensions in our session 6 on 19 December (see blog #16) – tensions which, for many years, were making me lean over to the right a bit in my upper body.  In addition to those sources of trouble, I may simply have also been suffering from some built-up tensions / hardness in this smaller joint on the outside of the left knee area.  These may have at least partly been brought about by the other sources, remaining there unaddressed, until now.

Speaking of the work John did on my lower spine in session 6, I have concluded that those tensions probably played a fairly significant role in me ending up with the various knee troubles that I first came to John with, last autumn.  I believe they combined with the various difficulties I was having around the waist and rib areas on the same side of the body (see blog #02), to give me the knee problems which, before they all started up around a year ago, I had never suffered from before, as a runner for over 14 years.

Once again, I want to praise John’s work on this.  I have not been a straightforward patient by any means, but he really knows what he is doing, and I believe that his knowledge and experience have enabled him to eventually pinpoint, treat and recommend things I can do myself going forward to address, all the various causes of the troubles I have been having.  I feel that without his help, I might never have been able to get to the bottom of these issues.

My GP has also been extremely helpful by having no hesitation in ordering an MRI scan on the knee, once the apparently OK results of an initial x-ray had come in, something which had left him, John and me a bit puzzled as to what might be going on.  In this instance, it has been a good mix of both private and NHS diagnosis and treatment.

My mission now is to see how it goes, from day to day and exercise session to session.  From here on, I will report in with further blog pages from time to time, even if I don’t need to see John for any further sessions for the time being.

 

 

 

 

Knees – not just getting old? #23 – Before Session 8 with John

I have been meaning to arrange to see John again but have been quite busy.  Also I was expecting to have a call from my GP to discuss the results of the MRI scan.  He ended up phoning me today, a week earlier than planned, and we talked about what the scan suggests.

His assessment of the MRI report is that my condition is the result of wear and tear, some of which perhaps goes back a few years – but that, because the menisci, main cartilages,  and other main parts of the knee joint are relatively OK and it is only some of the “lesser” parts of the joint that are showing signs of degeneration, in principle it should be possible for me to effect at least a partial recovery to being able to run again.

I have now booked to see John for what will be our 8th session, on Mon 20 Feb.  In this session, I would like us to do the following:

1] Go through and discuss these 5 questions:

  • Does the MRI report “explain” / make sense of, all the symptoms I have had with the knee? Is it “in line” with them?
  • Could a person who has suffered a trauma event, end up with a similar pathology as in this MRI report? Could I have actually suffered a minor  trauma event when – after doing foam rolling following the first run I took in late September at the time I first started to foam roll – the knee joint gave a good loud crack as I swiveled the leg into position while sitting on the floor (with no weight on the leg, and while all the muscles were relaxed)?  If this was in fact a trauma event, could it have led to the pathology as described in this MRI report?  Or are the deteails as in the report, much more likely to be the result of all the wear and tear, and the other “misalignment” issues including lower back area tensions, ITB getting tighter as a result etc, going back several months in the medium term, and in the long term, overall since starting to run 15 years ago?
  • Does anything in this report explain the issues with the lower IT Band having gotten coloured up in early December?  Does the report make any sense of the “breakthrough” events around that time (see blog #14), after which the previous pronounced limping on that leg when walking downhill, quickly improved?  Keeping in mind that whenever foam rolling, nowadays I never find any more muscle tension in that lower ITB than in the other, healthy leg, can the report explain why I can still feel what seems like extra tightness/tension in the lower ITB when I bend the knee?  Does the report suggest that the sciatic nerve might be involved in that feeling of tightness, rather than just the ITB muscles themselves?
  • Does the report suggest permanent damage? Am I likely to be able to recover from this, enough to eventually start running again?  If so, what exercises should I start off with now, to begin to strengthen the whole knee joint, which is still weak?  What exercises should I do to target the specific areas affected as described in the report?  If running again at all is an unrealistic expectation, what exercises should I do to aid whatever recovery should be possible?
  • My instincts over the last few weeks have been that, if I am able to recover and eventually run again, I must make a deliberate and gradual return to this, beginning only by introducing targeted exercises to help the knee to get stronger, and then slowly starting to do some light jogging etc – similar to the “couch to 5k” NHS approach.  I am clear this will need me to pay close attention to how the knee is feeling – before, during and after any running etc – and I will most likely have to be flexible about recovery, and about my expectations.  Keeping in mind that this will be a slow return in any case, does John think I can get back to my previous usual 4 miles of distance every 3 days?  Or is that perhaps too often, and/or too far as a distance, based on what is in this MRI report?

2] Have John check out how the knee is now, and then show me any extra exercises he recommends I do, to take it forward from here.

3] Possibly have a brief spell of jogging on the treadmill and film this from the back, to see whether there is any sign of the previous hip drop that was present before the “breakthrough” events of early December (see blog #14), and before John’s work on the lower back area in our Session 6 on 19 Dec (see blog #16).

Incidentally, I am still standing up straight following that Session 6 work, and in particular I notice that, for example when doing my usual stretches and exercises each day, the joints on the left and right sides of the upper body, continue to “pop” at the same time as each other on both sides – something that they always did “offset” before that (one side after the other), and which had been going on that way for such a long time, that I thought it was just how I am built.  It’s clearly not, and was down to those lower back tensions which John was able to address in Session 6.

I have a friend from table tennis, who is experiencing similar knee troubles to myself.  He also runs, so may have a corresponding set of exercise “circumstances” to me.  Also, when he stands up straight he leans over to one side, very similar to what I used to do before Session 6.  In his case it is more pronounced than me though.  I have recommended John to him.

Knees – not just getting old? #22 – MRI scan result: report

07 Feb 2017

I phoned my NHS health clinic today, and they told me the scan results were in, from my 26 Jan appointment.  I picked them up, and now have their report, which I will discuss with John.  Here is an image of the specifics in the report:

Nelson - 26 Jan 2017 MRI scan NHS report - description

In short, it seems the meniscus are OK, but some other things I have never heard of, are showing “degenerative change”.  I don’t really know where the various muscles and so on are located, or whether this is permanent damage or it will heal up.  I need some input from John on this.

 

Knees – not just getting old? #21 – Before MRI scan

Mon 23 Jan 2017

Since my last blog post on Fri 06 Jan, the knee has improved only slightly.  For much of the time it is still tight in the joint, and it also seems tight around the lower IT Band area when I bend it – even if bending with no weight, i.e. lifting the leg up and bending at the knee.  The rest of the time, it is a bit better than this, but still has what feels like tightness in both of those places.

Lately I have begun to think that the “tightness” in the lower IT Band is not to the ITB muscle itself, but maybe just the sciatic nerve.  Whenever I foam roll, which is 2 or 3 times a day, that lower ITB is no tighter than on the other, healthy leg.

On once occasion I tried a foam roll on the ground and  with the affected knee joint bent, to see whether the ITB would seem to be tight – but this proved to be pretty much impossible to do properly, so I did not get a definitive result from it.

Whatever is up with the ITB, it feels like borderline pain that is sharper than in the knee joint itself.  I can even feel this borderline pain in the ITB if I press on that area with my fingers while the leg is straight and the muscles are not being worked.  This is partly why I suspect it is more to do with the sciatic nerve, than the muscles in that area.  The joint mainly feels tight around the outside, as it has done for some time.

I have done John’s new recommended ankle exercises every day since my last post on 06 Jan.  I cannot tell whether there are having any effect, but am doing them anyway.  If they are working to help the joint stay loose, I think it is only by a little.

I have done no running for 2 months now.  Since my last post on 06 Jan, I have played some table tennis.  This sometimes seems to leave the joint worse off the next day (tighter), but not always – and it does not seem to be related to the length of time I play, more to whether I hold back a bit when going for shots, or take them fully committed.  Unlike the more severe troubles I was having before early December, the joint is not sore on the day after table tennis.

When I bend the knee, even without putting weight on it, it still does not “pop” as much as the other, healthy knee joint.  When it hardly pops at all, these are times when the joint is always tighter.  When I have been working at the computer and get up, I often get a small pop from bending the knee, and the joint and ITB feel a bit less tight.  On days when I am not at the computer and do not do any sitting of that sort, the joint pops less, and is a bit tighter in general.  I find this to be a strange observation, but that’s what’s going on.  Maybe it tells us something about what’s wrong with the knee.

I have been walking most days, for around 1.5 miles or so usually.  Walking down a slope no longer results in that “goofy” gait, and there is no specific pain in the knee joint now, when on a downward slope   – but overall, I am still favouring the affected knee a bit when I walk, and I can almost always feel that something in the joint is not right, as I take each step.  I would not want to do any amount of running or even jogging on it, at this time.

I still cannot use my preferred sleeping position when on my left side.  It continues to give the same pain to the knee joint as it has done since early October last year.

I am having the MRI scan this Thursday 26 Jan.  I have spoken to a technician there, and they have told me that the area the scan will cover should include about a third of the way down the lower leg from the knee joint itself, and a third of the way up the upper leg from the joint.

With the lower IT Band clearly playing some sort of a role in the current state of the knee joint – even if it is just the part of the sciatic nerve that goes across the ITB – I am wondering whether it would be a good idea to ask the technician to aim the MRI scan down a bit lower, so it still includes the whole of the knee joint itself, but also picks up more of the lower ITB.

That is a question I would like to hear from John on, before the appointment for the scan on Thursday.

Thu 26 Jan 2017

The scan took place today.  There were no issues with how the scanning process went.  They told me the results should be with my GP in about 2 weeks.

From Marathon to Antarctic

image1

Will, after running the Berlin Marathon in September 2016.

 “Was a good run, quite sore from the outset but the cap, now known as ‘John’ worked very well to hold form. Hop flexors went to pieces around 32km but determination held it to the end!”

image2

Will has recently flown off to Antartica to film Penguins for the BBC Wildlife.

img_8047

Knees – not just getting old? #20 – After session 7 with John

Fri 06 Jan 2017

Since seeing John in session 7 this past Monday 02 Jan, the knee and lower IT Band issues hovered around being the same for a day or so, then seemed to get a bit worse for the next couple of days up to and including yesterday 05 Jan, but today there has been a noticeable improvement again.  During these few days since that session 7 appointment, I have not done any running or played any table tennis, just done my usual sets of daily exercises, and on most of these days I also have taken a walk of around 1.5 miles.

Since the appointment, my back has been really excellent the whole time.  John’s overall work on it from sessions 6 and 7, means we seem to have covered all of the back, from right down at the bottom all the way up to the neck.  It all now feels very solid and strong, as well as feeling even on each side of the spine.  My upper body and shoulder joints also continue to “pop” more equally on each side, as they have done since session 6.  If any previous discrepancies between the areas to the left and right of the spine, and/or any tensions anywhere along it, were contributing to the issues with the knee, I don’t think they are a factor any longer.

I have been fighting off the “lurgy” that is making the rounds, since about a week ago.  After starting out as just a mild sore throat and slightly runny nose, so far it has not turned into a proper cold and has not gone down onto my chest.  The recent colder, more raw air quality has irritated it and made me cough a bit – and at times this gets out of hand and becomes deep coughing that seems to be an attempt to clear out the lower lungs.  I believe that John’s work on my back has played a key part in this cough not becoming, so far, too serious.  In the past, whenever I would get something like this, I would easily end up with a bad cough that hung around for some time.

I also note that, when around a year ago I was having one of these “fits” of deep coughing, it was at that point which I seemed to pull something around the rib area on my left side, and after that the various other issues also turned up on that same left side, where I eventually ended up with the knee troubles as well (see blog #02).  I have been keenly aware of this over the last few days, and without trying have made comparisons between how my current occasional spells of deep coughing feel, and how that one felt around a year ago.

My overall assessment of this, is that I think I am structurally in much better shape now – with the back etc all aligned much better following all of John’s work, and with the revamping, as per John’s advice, of my workstation since a year ago also contributing to me sitting with better posture for a lot more of the time, and so on.  This all leaves me feeling more confident, and less worried about any recurrence of last year’s rib troubles.  If nothing else, my current deep coughing is more evenly distributed left to right than it was a year ago, and this on its own means I feel less susceptible to any similar injury.

Incidentally, it seems clear now, after the last 2 sessions with John, that the tensions just to the left of the lower joints of the spine, which he was able to release in session 6, were probably the reason that I ended up pulling something in the first place, in the left side middle rib area around a year ago, during that coughing fit.  I say this because now, aside from occasionally feeling a little mild soreness around that middle rib area now and again, since the session 6 work the rest of the issues nearby have subsided – including the more acute soreness on the left side of the body and at waist level, and other soreness in the ribs, found lower down and also on the left.

Regarding the timing of things, I am fairly sure it was well before those rib troubles started up a year ago that, due to those previous lower spine tensions, my spine was slanting off to the right in my upper body, when viewed from the back (see session 6 “before” and “after” photos, in blog #16).  I believe this because, until session 6, and for a really long time – going back so far that I don’t remember just when it actually started – the joints in my upper body and shoulders were “popping” unevenly left and right, whenever I would do stretching that targeted those areas.  Since John’s work to release those tensions in session 6, they pop much more evenly.

Re my current cough, of course I am taking the usual precautions and treating it in a sensible way.  Hot drinks of raw garlic is one thing I find works especially well.  Also, the other day at a health shop I found a great sugar-free brand of cough drops from Switzerland, called “Ricola”, with something like 7 herbs in them.  Using these really helps settle the cough down, at points when it is trying to get started up again.

I have been doing the new ankle exercise John showed me in session 7, although I forgot it on a couple of occasions.  I think I have now managed to get it into my usual routine in such a way that I can better remember to do it every day.

When the knee and ITB got worse around the middle of this week, they felt even more “too tight” and hurt a bit more than recently. Yesterday this was so marked that it was happening even if I stood upright and did not have the knee bent at all.

By the end of yesterday I was beginning to think I might have to drop out of a table tennis session planned for this evening, if it felt the same today.  But this morning, it seems to have settled down a lot – there is still some ITB tension, but it’s less than yesterday, and the joint no longer feels nearly as tight as it did, even just yesterday.  Going up and down the stairs feels much more “normal” on that knee.  This unexpected improvement seems to have left me with more energy today, and I threw in some physical household cleaning tasks at the start of the day, which otherwise I would have been disinclined to do.

Based on how it feels today, I think the knee could even take some targeted exercises to strengthen it.  I will hold off on these for a few days though, to see whether things continue in the same direction.

As for why it got worse and then better, I think it might be the result of John’s work in session 7, especially including the treatment he gave to the top of the lower leg – just below the knee joint – where he found some further tightness, in addition to the pains in the IT Band itself (see blog #19).  As well as him deciding to do some work to loosen it up, that further tightness led him to recommend the new ankle exercise.  If the outcome of loosening this, and of me doing the ankle exercise, is that the knee is now more prone to sit “correctly” in comparison to its less correct alignment as from the past several months, then the long period of time during which it was misaligned, may mean it must now re-learn / re-adjust, to being in the right place again.

The degree of worsened pain, and generally what it felt like for those last couple of days before today, was a bit different to how it had felt previously.  This supports the idea that things are still in the process of making their own adjustments.

I just remembered that I noticed one more thing today, when doing squats as part of my usual morning exercises.  The affected left knee was “popping” much more of the time as I did these, than it did even yesterday – bringing it closer to doing this as frequently as the other leg, which for some time has popped more often.  I have always thought that the less frequent popping of the affected left knee has been a further sign that it is still not right.  If that’s true, then this increase of that frequency is a very positive sign that things are on the mend.

I have decided to go for table tennis tonight after all, and to keep an eye on how the knee feels.

 

 

Knees – not just getting old? #19 – Session 7 with John – Mon 02 Jan 2017

We began this session by a review of where things are now with the knee.  John speed-read my blog #18 for this, we spoke a bit on it also.  I said that where things are can best be summed up by the fact that, even if I simply raise the affected left knee up so I am standing on the other leg only, bending the left knee while raising it and thus not putting any weight on it, the joint still feels too tight, especially around the outside area, and also I can feel the lower IT Band further down below this,  as though it is too tight, and also bordering on there being a little pain that is sharper.

After this we started some treatment .  First John checked the range of motion of each leg, as in earlier sessions.  They were more similar to each other than in the past, but the affected left leg was still not as flexible as the other one.

John had me show him how I was getting on with the modified lateral leg lifts, and was satisfied with my progress.  He also repeated the check of my back as in the previous session 6, and he found it had remained straight since the lower back manipulations he had done in that session, as had also been confirmed by the photos I had taken during the interim period since session 6 (see blogs #17 and #18).

Next John did some further manipulations on my back, starting with the middle section and working up to the top.  These were all done both to the right and the left of the spine itself, and the affected left side had noticeably more tensions in it, which seemed to release as he worked.

John continued with some work on the lower back area, again on each side, this time further down than even in the previous session 6.  He would get me into just the position he wanted, then have me take a breath and relax/release it, and then he would “push” with either his hand, an elbow, or whatever else worked best, to release the relevant joint, etc.

Next he repeated some of the range of motion checks, and the affected left leg had improved quite a lot, and seemed to me to be showing a range of motion that was now much closer to the other leg.

We discussed the apparent over-tightening of the affected knee joint and of the lower IT Band on that side.  Even after all these manipulations, which had certainly had an effect on how my back felt, the knee and IT Band still seemed too tight.  John described how the sciatic nerve also runs down past the lower IT Band, and up to the top of that bone in the leg.  He tested that bone just below the knee joint, and decided it was indeed tighter at the joint on the affected leg, compared to the other leg.  From his description, my instinct was that maybe the “almost painful” feeling I was having in the ITB was actually the sciatic nerve itself.  I could indeed also feel that sharper pain all the way up to the knee joint, right in the places where John said the sciatic is located, which would suggest it is the sciatic nerve I am feeling.

John did a bit of work on that area just under the knee joint, at the top of that long lower leg bone which runs all the way down to the ankle (the fibula? or tibia?  I can’t remember which).  He did this work on each leg, as with the manipulations to other areas, and was again satisfied afterwards that some of the extra tensions in the affected left leg had been released.

Next John showed me an ankle exercise as a recommendation to add into my usual daily exercise routine, one that he said should target this tightness around the leg bone, just under the knee joint.  While lying on my back and with my legs straight, with each leg I must bend the ankle joint “upwards and outwards” as far as I can, then straighten that ankle joint “downwards and inwards” as far as possible.  He suggested around 10 to 15 repetitions of this.  Both legs can be done at the same time.  Trying it out while lying on John’s treatment couch felt good, probably because up to now,  I have not had any other exercises in my usual daily set, that work the ankles in this way.

I commented to John that when I get into one of my usual sleeping positions, lying on one side, if it is on my right side (with the right leg thus under the other one), bending the right ankle joint to stretch it, usually gives a nice healthy “pop”, but when lying on my affected left side (with the left leg under the other one), bending the left ankle joint almost never gives any pop, and has not done so for a long time.  My instinct is that this discrepancy is due to this extra tension that John found just under the affected left knee joint.  If so, and if both John’s work today and doing the new exercise are to have the desired effect, then both legs might eventually behave more similarly to each other, when I do this ankle stretch while in bed.

I commented to John further, that when bending at the knee, the affected left knee joint still does not give off a “pop” as often as the other, healthy right knee joint.  I said that I think this is another sign that things are still not right in the affected left joint.  I will be keeping an eye on whether this now also changes over the next period, following our work in this session 7 today, and as I add in the new ankle exercise.  My suspicion is that we may now start to see a change to this.  I also told John that my instincts remain the same regarding possible damage to the meniscus – at this point, I still don’t believe there is any.

We spoke briefly about the upcoming NHS MRI scan of my affected left knee joint, which is scheduled for Thu 26 Jan.  John was pleased that we have a relatively early date for this, and said that there was not much more we could do until the scan results are in.  He thinks the scan will show something, but does not know just what.  It ought to tell us if anything is up with the meniscus, for example.

In the meantime, I will add in the new ankle flexing/moving exercise, and see what effect, if any, this has on how the leg feels.  I believe it will make some kind of a difference over time.  Today’s session 7 work on my back and knee joints, may also have an impact on what’s going on with the affected knee and its lower IT Band – I imagine this should show up over the next few days or so, if it is going to make a difference.

 

 

Knees – not just getting old? #18 – Before session 7 with John

Sat 31 Dec 2016

Despite the very positive signs over the 3 days before my previous 23 Dec entry in blog #17, in the week and a bit since making that entry, the knee has not settled down as I would have expected.

That evening of 23 Dec I played a bit more table tennis – only around an hour in total with a rest in the middle – but this did not feel as good as my previous 3.5 hour session from a few days earlier in that week.  When doing some movements, I could feel that same pain at the outside of the knee joint in the usual place, especially if I had to move forward to make a shot close to the net, and then move backwards again.

Although I did not have any soreness or stiffness to speak of after this session of table tennis or on the next day, the joint continued to feel weak, and I could also feel the lower IT Band muscles being overworked, whenever I would bend the knee to any degree or make any movement that involved the lower leg.  As well as feeling that set of ITB muscles being tightened more than they should, there was even a little amount of muscle pain in them at times.  These symptoms have persisted since then, up to today 31 Dec.

I have also still not been able to adopt my usual sleeping position when on my left side in bed, as it continues to start hurting in the knee joint, within a minute or two of trying out that position.

I have continued doing all my usual morning and late afternoon exercises, including the modified lateral leg lifts to target the glutes, as well as all the usual number of squats.  The squats are possible, but they do also show that the joint isn’t quite right yet.

Walking has stayed the same – I don’t have the significant limp any more when going down a slope, but doing a downward slope does still give some pain to that outside part of the joint.  I have not tried to do any running, and prefer to wait until the MRI scan scheduled for Thu 26 Jan, in case the meniscus has damage.  Instead of any running, I have been walking a little more than usual – although given the fact that I am doing nothing aside from that and my usual exercises and table tennis, I ought to be walking more, to take up the slack in my usual running routine, which for cardiovascular exercise is especially good.

I took a long walk on Boxing Day, on paths in the forest and including much up- and downhill work.  This was the first time in a while that I had done any walking “off-road” and over uneven terrain, and I really noticed that the knee did not feel 100%.  I could feel it being on the edge of pain for much of that more challenging walk, though almost never properly into pain, and it was weak.  I need to start some exercises to build up the joint strength at some point, but for now will hold off on that, until it’s clear what is still wrong with it.

Whenever I bend down at the knee, the outside of the joint in particular feels like it is under too much pressure, and usually I can also feel the lower IT Band to a degree that I would describe as “too much” on the affected leg, especially when comparing it to the other, healthy leg when doing the same movement with it.

On the positive side, as far as I can tell, John’s work from session 6 on 19 Dec to straighten up my spine, which was leaning to the right, has held up properly since then.  For example, the two sides of my upper body continue to feel similar to each other when I stretch and “pop” the various upper back and arm joints, which they did not before session 6.  Also, the “banana” stretch (see blog #02) still results in the left and right sides of the body feeling very similar to each other, whereas before, there was a big difference between them.

Also good news, is that the other areas on the affected left side of the body, one spot near the waist and two others near the middle and lower ribcage, have settled down and are almost never felt now.  John’s assessment in session 6 of these, when he said he thought they were caused by tensions near the lower spine – which he addressed in that session – appears to have been correct.

My instincts are that something is still putting the IT Band under too much unnatural stress, and this is giving the continued trouble with the knee joint.

Based on how the upper body has felt, I suspected that doing another photo of my back would show the spine is still straight.  Having taken a photo, I was at first quite surprised to find that it suggested things had reverted back to much the same as before John’s work in session 6.  But then I noticed that the photo was not straight in the vertical, when the lines of the door I was standing in front of were taken into account – and then, after I did some photo jiggery-pokery to correct for this, it turns out the spine is indeed still straight.

Below is that photo, after adjustments so the vertical is in line with the edges of the door, which I then cropped off the picture.  The usual yellow lines show that both the spine itself and the position of my elbows are unchanged since 23 Dec.

nelson-back-view-31-dec-cropped

There is a possibility that the persistent troubles with the knee are due to meniscus damage.  But I would not expect that in itself to also make the lower IT Band continue to tense up.  The upcoming MRI scan is the only way to find out if the meniscus is OK or not, but it is not taking place for nearly 4 weeks, after which I might also have to wait a bit for the results.  In the meantime, I am thinking it would be a good idea for John and I to investigate this further.

If these ongoing issues are not due to the meniscus, and they are not from stored tensions just to the left of the lower spine – which I believe are permanently cured – then what else could be causing them?  Has there perhaps been a shift of the unequal leg lengths I have had for many years when standing – for which I have worn a “straight left-to-right” insole in all footwear on the same, affected left knee joint side for the last 6 years (see blog #01) – a shift that means I am now not standing “evenly” from left to right, on the affected left leg / foot?  Or are there other tensions elsewhere in the body that we have not yet discovered, perhaps “hidden” until now by the significant ones in the lower spine, and maybe also playing into the mix by tightening up the left leg’s lower IT Band?

The only way to find out will be to see John again.  I checked his appointment schedule for next week, and he has a session available on Monday 02 Jan, which I have booked.  In that session 7, we will have one objective, which is to have him check me over thoroughly, to find out if there is anything else that we can treat, and which we may have missed so far, and if not, whether anything we have done so far – including the work on my walking and running posture, my workstation setup and posture, and all the things John has been able to address – is still not right and needs further attention.  I will dress in my running gear once again for this upcoming session on Monday, in case we decide to get me back onto the treadmill etc.

Knees – not just getting old? #17 – After session 6 with John

Tue 20 Dec 2016

There are a number of positive signs following session 6 yesterday.  The treatment John carried out to release some tensions in my lower back, to the left of the spine, is already starting to look like it may resolve a lot of the issues that have been outstanding since the breakthrough events of early December (see blog #14).  Here are a few observations since our appointment yesterday:

  • There was a small amount of bile in my stool yesterday evening.  This is very unusual for me and normally only happens if I have been ill, or when the body is having some sort of clearout.  I suspect this is a consequence of the tensions that were released by John’s treatment yesterday, being close to the lower part of the colon, kidneys etc.  To me this is a good sign.
  • When I went to bed, while adopting a temporary position I use to stretch the back muscles out a bit, there were no pains to the waist or rib areas, where I have sometimes had them since the other issues in those areas first appeared much earlier in the year (see blog #02).  John had told me near the end of our session 6 yesterday, that he thought those pains were caused by the tensions near the spine, the ones he was able to release.  It looks like he was exactly right about this.
  • I tried adding 2 inches of foam rubber between my knees as I got into one of my usual sleeping positions in bed, one that for the last few weeks I have been unable to use, as it has tended to give pain to the outside of the affected knee joint.  John had suggested in our session 6 that I try something along these lines, such as with a feather pillow etc.  Failing that I used some foam.  This did not work, and I still began to feel the usual pains after just a few moments, which did not surprise me as it seems to be the actual weight of the other leg on top that has been causing this pain, and even with some padding between the knees, that weight is still there.  However, after abandoning the foam, I got into one of the alternative positions I have tried using over the last few weeks, one for when positioned onto my left, affected side – and unlike the recent attempts in this position, which did not allow me to drop into sleep as it was just not comfortable enough, this time I was able to nod off easily.  I think this might be partly because the waist and rib areas were not giving any pains as all, as outlined in the previous bullet above – either way, it’s a new development, one I welcome.
  • I woke up this morning noticeably more refreshed after the night’s sleep, than I had in some time.
  • After rising, as I did my usual morning foam rolling and exercises, which include a variety of different movements, stretching etc, I noticed that the joints in my upper body  – back, neck, and shoulders – seemed to feel a little different, and they “popped” more evenly left to right, as I did various stretches and exercises.  I have been aware of the “uneven” quality of these, for many years.  Are they down to my upper body having been leaning a bit to the right, which John’s manipulations seem to have addressed?
  • I was able to do the lateral leg lifts exercise properly, just as John showed me in session 6 yesterday.  It does work the muscles a bit differently to how I had been doing it before.
  • I seemed to cough a bit less than usual as I exercised.  This coughing has been around for a long time and is not due to having a cold or anything.  Also I am not a smoker, so it’s nothing to do with that either.  I have always put it down to maybe just the air quality here in Bristol or something along those lines, but perhaps my own posture has also been a factor.
  • When I did the “banana” stretch (see blog #02), I felt the various muscles much more evenly on the affected left side, compared to the right side.  Again, my previous observed “unevenness” in the two sides when doing this stretch, is something John had suggested was due to those same tensions he had managed to work out of the lower back – and again it appears he was spot on with this assessment.
  • While laying on my back with my knees up, I usually do a few different exercises.  They include: a set of 60 pressing down onto the legs with the hands for around 2 seconds and then releasing this for 1 second, to work the abdominals as an alternative to sit-ups (I had a hernia about 15 years ago, and must not do sit-ups); stretches for the back of the neck; swinging the knees back and forth (another one for the abdominals); wrist exercises; getting the backside up off the floor while keeping the head and feet on it (to stretch the spine in a “reversed” way), and some further neck stretches done while lying on each side.  Over recent days, the continuing issues I have had with the knee joint included the outside area getting sore and stiff – and also some soreness down a bit onto the lower leg and onto the lower IT Band – after just a minute or two in any position with the knees bent, such as this one in which I do all these exercises.  This morning, there was almost none of that soreness or stiffness at all in this position, only a brief “suggestion” of it for a few seconds, which then disappeared.  This is a marked change also.
  • As I did the swinging of the knees back and forth exercise to work the abdominals as in the previous bullet, the outside of the affected knee joint did not give any pain at all – this is another significant change.
  • During recent morning exercise sessions, the lower IT Band on the affected leg had often felt a bit tight, even after foam rolling – or if not tight, it was certainly being activated by various of my usual exercises, in a way that I thought was wrong – it was as though it was being “coupled” with movements of the knee joint, and was on the borderline of actually hurting a bit, which even when doing a specific exercise which is supposed to work that muscle group, should not happen.  Today this did not seem to be taking place at all, as though it had been “uncoupled” from the knee joint to some degree.
  • Near the end of doing my remaining exercises, I usually include a set of 3 dozen squats.  John and I had spoken about this in our session yesterday, when I asked him whether he thought I ought to leave them out for a while, given my recent troubles with the outside part of the affected knee joint.  He pointed out that in the Far East, there are very few instances of knee problems such as we have in the West, and this is partly because the people there spend much more time down on bent knees than we do – which naturally works the joint more.  My question to John was due to there being a possibility that I have meniscus issues outstanding in the affected knee joint, and after we spoke a little on this in session 6 yesterday, we agreed that it was a good idea for me to try and do the usual squats as best I could, watching out for any pains and backing off if needed.  As I did the squats this morning, the joint felt better than it had for some time.  In fact, it was now “popping” much more often, nearly as often as the other, healthy right knee joint does – again, something that recently it was not doing, which I have always taken as a sign that things are not right with it.  Not only was I able do all 3 dozen squats as per my usual routines, I breezed through them easily, and there was no pain.
  • Since starting the day with my usual foam rolling, exercises and then breakfast, I have been working at the computer, getting up and back down fairly often as usual.  After I get up each time, the knee feels much better whenever I go downstairs, than it has been doing recently.  It would typically feel noticeably weak as I did the stairs, but today it doesn’t.

All of the above are highly encouraging.  I am beginning to think that I might not have any outstanding meniscus issues with this knee at all, and that everything still going on since the breakthrough events in early December (see blog #14), is down to those tensions in the lower back which John was able to loosen up in session 6 yesterday.  If so, then the next few days should see further improvements.  In any case, I have already seen enough change in the right direction, that I have decided to play table tennis this evening, and see how it goes.

Fri 23 Dec 2016

Things are really looking good now.  The knee has been improving every day since the start of the week, when John did some work manipulating out tensions just to the left of my lower spine, in our session 6 on Monday 19 Dec.   On the Tuesday evening after that I played table tennis again, and by then the knee was feeling better enough that I was able to play for 3.5 hours non-stop, with no issues of soreness or pain, either that evening or the next day.  I played very well, which is a bonus.

Each day since then, the pains to the outside part of the knee joint have been a bit less and less, and now they are unnoticed most of the time.  My upper back, shoulders and arms also seem to be keeping that “evenness” on each side of the body when everything pops as I do various stretches, which suggests I am still standing up straight, as after John’s sterling work on Monday 19 Dec.  More on this shortly.

Last night I think I was able to get to sleep using my “normal” position when on my left side, for the first time in weeks.  I am not certain, as I went into a deep sleep to start with, and seemed to have rolled off that side and onto my back temporarily, when I next woke up.  I will know for sure over the next few nights.  Either way, I did not have any knee pain that prevented me from getting to sleep after having started out in that usual position, and I didn’t feel that previous soreness at any of those other spots, by the waist and near the middle and lower ribs (see blog #02).  This is all a big change from before session 6.

I also don’t seem to be needing as much sleep as before, which makes sense as the quality of it is better.  Being more properly aligned means I am getting a better rest through the night.

I have kept up the lateral leg lifts exercise as part of my usual routines, and will continue to do so.  After doing them, I can really feel the correct set of glutes having been worked, partly because I then immediately sit on a chair, pull each leg back one at a time until the hip joint gives a “click”, then also one at a time, put one leg across the other and do a stretch to touch my chin onto the foot of that crossed leg – something that always tells you which muscles around the hip area, you just managed to target.

My coughing during exercise does not in fact seem to have improved since session 6, but I am not especially concerned about this, as it’s something I have had going on for years, and is probably unrelated to these recent physiological shifts, after all.

The “banana” stretch continues to feel more “even” on each side.  I have now noticed that it’s not just that I can feel more muscles now being worked on the left, affected side of the body – the ones on the right side are also now being worked a bit less than before, and these two things together result in the two sides being closer to each other, in how they feel.  To me this means that before, when doing this stretch on the apparently healthy, right side, it was in fact not giving the right results, and was overworking all the muscles down that side, while those on the affected left side were being underworked.  I think this is simply due to the vertebrae joints that had been working “in tandem” with each other when they should have been moving more independently as I stretch and do other movements, and the cause of that “tandemness” was the tensions that John released in session 6.

There is no soreness or stiffness to the knee joint during any of my usual morning exercises now, and I barely notice the previous more sharp pains to the outside of the joint, as I do my usual squats.  At this rate those pains may disappear completely in another few days or so, which if it happens, will be the first time since around spring of this year, that I don’t feel them at least while doing some activities, such as hoovering.

Walking also seems to be showing more improvement.  I had been relatively close to being fully “even” in my walk on each leg already, and am that much nearer to this now.

I thought it would be a good idea to take another photo of my back, to see whether it confirms my instincts that everything John did in session 6, has continued to remain correctly aligned.  Below is the result, from today Fri 23 Dec 2016.  I think it does show that things have stayed about the same:

nelson-back-on-23-dec-2016-cropped

The only thing I do notice from this, is that the left elbow seems to be “back” to being a bit higher than the right one.  But the spine itself is still straight, and that’s the important thing as, according to John, the area he worked on in session 6, just to the left of the lower spine, has most likely been the source of my continued IT Band troubles, which have also affected the knee joint and slowed its recovery down, until that work John did.

Today I received details of my NHS appointment for an MRI scan on the knee, something my GP recommended we do, following the x-ray results that came in a week ago, and which did not show any bone or attached cartilage wear to the joint, leaving him / us with no indication from the x-ray, of what might be wrong.  The date for this MRI is Thu 26 Jan 2017, so just under a month from now.  For the time being I will assume I am going to attend this appointment, and will confirm it.  If over the next 2 weeks or so, things improve to the point where John and I feel there is no need, I can always cancel it.  But given the long period of several months during which I have had the various issues with the IT Band, the knee joint and the other areas on the same left side of the body, I am inclined to go ahead with the scan, even if recovery seems complete.  If nothing else, it will enable having a “benchmark” set of results for future reference, should there be any other and/or further issues with the knee, for example.