Paleo Diet and Paleolithic Diet Questions & Answers

Question

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So, I have awful knees. Like, really awful knees.

"Awful knees" translates into: tilted patellas with a long history of repeated subluxation on both legs. That is, I've had both kneecaps pop out of socket on multiple occasions throughout my life for relatively minor (stupid) reasons (i.e. turning around funny to answer my mother; playing fetch with my dog; and--I'm not kidding--getting out of the shower).

I've also injured myself during events that actually make sense (i.e. racing someone in back-walk-overs; slipping on tree roots while hiking; and running, leaping, and landing wrong).

So, this last time I popped my left knee out of socket (July 2011), I was out of commission for a good long while because I could barely walk. However, I've been following some pretty intense physical therapy, and I've made a lot of progress. I went from being unable to hobble up steps without crutches to being able to walk my dog for one mile around my neighborhood three times a week over a period of two months.

Yet, my knee still swells and hurts when I stand for too long (i.e. more than an 8 hour shift at work). Also both my knees start to feel weak (like they might pop out again) when I walk more than a mile or do too many squats (i.e. more than 3 sets of 30). I also have trouble lifting things that are too heavy and climbing too many stairs.

I'm a former gymnast, so this is all very frustrating. I love to jump and dance. But, my knees make it close to impossible for me to engage in vigorous physical activity without considerable pain or anxiety/stress. I've been coping with occasional long walks (while wearing my big-honkin' knee brace), seated weight lifting, hula hooping, an exercise bike, and tug-of-war with my border collie.

My question is this:

Does anybody else out there with tilted patellas/bad knees have any suggestions for low impact sports-related activities? Play? Exercise?

flag	asked Jan 13 2012 at 3:34 L. 380●3●11

	1) Get the surgeries you need to fix this problem to the extent to which it is fixable. www.kneeguru.co.uk/ is a good site, if you want help finding an orthopod, just axe. Injured knees get worse when left untreated. 2) Swimming, very careful weight training, possibly indoor cycling or rowing. – Daniel Kirsner Jan 13 2012 at 4:45
	Laurie, I agree with Daniel's comments. I had ACL surgery almost 2 years ago and it turned out to be a failed surgery, which means I'm going in for round 2 in about a month. You can guess that the last 2+ years of my life have been physically and emotionally draining trying to get back into triathlon shape. That being said, I'm putting together a simple blog to give people like you and I more in-depth info. I'm going to have videos, links to doctors, PTs, etc.; basically everyone I've contacted in the past 2 years as experts. If you'd like to read, just let me know. – BJ Jan 13 2012 at 21:06
	My PT told me to avoid surgery if possible because it's so difficult to come back from, so I'd like to avoid it... if possible. – L. Jan 13 2012 at 22:41
	That's absolutely true! Avoid the knife, if possible, but also be honest with yourself if conditions have not improved over a determined amount of time. If you feel/see/experience no change, there is no change. – BJ Jan 19 2012 at 17:46

anne · Accepted Answer · 2012-08-31 21:54:57Z UTC

Laurie - Your knees could be mine! I have virtually no patellar groove - my kneecaps have been sliding out since I was 15 - I'm 39 now. My first doc told me I could push them out with my bare hands, they're so unstable. My knees will never track normally - I've been the "come here you've got to see this you'll never see one like this again" patient more than once! The key is to keep the surrounding muscles strong. Supposedly, our knees will tighten up with age, as everything gets less flexible, but mine still slip out - just last Sunday night I bonked the table leg with my left knee and the patella slipped out just a little. Anyways, my doc now is a cyclist and strongly encourages me to bike tons too - I also swim (badly, but it feels good), and lift weights (carefully). 2 years ago I slipped in my kitchen and spun around 180 degrees - yep my left kneecap was on the side! I put it back into place and called 911. When the ER doc had looked at my x-rays, he said that my knee was FINE (but my ankle was broken) - I honestly think it was fine because of all the biking and swimming I had been doing! So no knee immobilization (just a boot on the ankle and crutches for that - ugh). SO, you need to go to a bike shop and get fitted for a bike - road or cruiser probably - and hit the road!!! When you're riding, keep the gears easy if you're not used to riding, until you build up more strength. Good luck and have fun!!!

Ralph Furley · Answer 2 · 2012-01-13 04:07:24Z UTC

I don't have tilted patellas, but my knees occasionally bother me from years of football, weightlifting, youthful indiscretion. I'm normally able to work through knee pain fairly quickly. For low impact activity, I like swimming or simply moving in water (especially fighting waves in the ocean – obviously you may not be near an ocean) and I love my Concept 2 rowing machine. Of course, old Furls likes some other "play" and "exercise" - though not always guaranteed to be low impact.

DeanS · Answer 3 · 2012-01-13 04:24:02Z UTC

I don't have knee problems, but I know people that do and they find cycling to be therapeutic. You do mention an exercise bike, but it is much better physically and mentally to ride in the great outdoors IMHO. However, it is important to have a good bike fit and the seat set at the correct height, especially with bad knees.

Kamal · Answer 4 · 2012-01-13 04:26:00Z UTC

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Have you been "diagnosed" with hypermobility? Your gymnast past hints at such.

You probably already know this, but certain sports and activities are out (extreme yoga, things where you cut really fast like soccer). Not too many of the really fun activities are left over!

Have you considered platelet-rich plasma injections to regain some knee stability? I went to the guy in the Bay Area who did the first couple trials with it, and knees are the second best body part for them (first is elbows).

answered Jan 13 2012 at 4:26

Kamal♦
27k●1●47●165

	Wow. First of all , what in the world is a platelet-rich plasma injection? Never even heard of it! The world is full of crazy new things! Please explain! Also, no I have not been diagnosed with hypermobility, but a lot of people in my family are double-jointed in their fingers/hands (we're a bunch of weirdo acrobats). I also have a pretty hefty hyperextension in my legs. – L. Jan 13 2012 at 4:37
	They draw out a bunch of blood, spin it down to concentrate platelets, and inject it in the joint space. That is supposed to act to accelerate healing, and often does. Costs a boatload though. I had it once, and it kinda sucked. But helps many athletes (I think the Steelers used it a couple years ago). I also have hefty hyperextension in my knees, and you gotta be pretty darn careful, as I'm sure you know! – Kamal♦ Jan 13 2012 at 4:41
	Yeah, the first thing I thought of was hypermobility, too. I'm like that, as is about half my huge family. And if you're all loosey goosey AND something isn't sitting right, you're gonna have issues. Pilates has been amazing for me - I think a really good (eg. professional dancer, not someone who dabbles) instructor might rock your world. And, of course, anything in the water. – syrahna Sep 1 at 2:23

henny · Answer 5 · 2012-01-13 14:58:08Z UTC

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I think your best option is surgical repair. The only sport that I think may work is swimming because the water supports you.

I think injections may just delay the inevitable need for repair.

answered Jan 13 2012 at 14:58

henny

Kelly · Answer 6 · 2012-01-13 17:10:29Z UTC

If you live near any water body, get yourself a kayak. It's one of those great play/relaxation/exercises where (unless it's whitewater) you don't get out of breath, but you're using your muscles and lowering your stress level. It's not just your arms, but your core that gets a workout. I love it and can't wait until winter's over so I can get out again.

MsDivine · Answer 7 · 2012-08-31 22:04:56Z UTC

I've dislocated my left kneecap three times [first time I slipped on wet concrete, everyone thought it was just a freak accident; second time I was just...walking, and third time I was on mile 7 of an 8 mile run at my fastest pace ever]. Surgery won't help since the channel in my femur that your patella slides into when you straighten your knee - well, I basically have no channel. Go me.

Swimming is the best thing ever though! You don't feel yourself sweat AND there's no impact!

I also love yoga, I am just super careful about some poses and simply don't do a few others.

I'm trying Bar Method classes next week - sort of like a high-intensity Pilates and strength training, also no or low impact.

Other than that, I do lots of brisk walking - 4.5 miles at a 15-17 minute mile pace 3x a week. It's fun when I'm not alone doing it!

deirdra · Answer 8 · 2012-08-31 22:19:14Z UTC

I had bad, loose knees since I grew 6" in one year at age 12, followed by partial ACL tears doing long jumps on the gym floor with no mats.

In 2000 I completely tore off one ACL and had it repaired with a piece of my patellar tendon. Since I was 46 I was highly motivated to have a good result & did my physio, icing, etc. like clockwork. My knee has been better than ever and my doctor was shocked that I healed twice as fast as "normal".

Physiotherapy can also work wonders, building up muscles to strengthen & stablilize the knees. That's how I tightened up my other knee. They are both equally tight and stable, though only one was operated on.

I would try physio first to see how much progress you can make. Even if you do decide to have surgery, you will recover faster if your knee/quad/hamstring/calf muscles are strengthened.

L. · Answer 9 · 2012-01-20 20:19:28Z UTC

In response to the surgery thing...

Firstly, there has been change now that I've owned up to the fact that I have to keep up with my physical therapy. My knee is tracking much more normally. Even my physical therapists were impressed with the difference consistent exercise made in my knee tracking! (Maybe no one else actually does what they say?) Anyway...

When I was a teenager and this first happened, I ignored my physicians with a classic, rebellious teenage angst and didn't do my exercises... at all. Ever. I refused. Stubbornly. Because I missed my sport and hated my doctor for making me quit.

When this first happened, my knee subluxed because of an accident during which I landed on a locked knee while racing someone in back-walk-overs. And, once I had undergone a six-week period of immobilization, I was told I couldn't be a gymnast anymore. Instead, I had to do boring, monotonous "knee exercises." Everyday. So, because they were boring (and I was stupid), I never did them. And, of course, my once muscular legs began to atrophy. And, then my weak knees began to sublux more often.

Interestingly, the subluxations also increased when I became a vegetarian for a year and lost even more muscle mass... Funny how that works, eh?

Knee surgery (especially knee tracking repairs) are (even according to my would-be surgeon) a dodgy, complex art. They are never a sure thing. Often, they don't work. I'm hesitant to give that a try before at least a year or two of steady, consistent physical therapy.

Which is why I was wondering if anyone else out there with bad knees had come up with novel ways of exercising?

Swimming is good, but not always practical. The bike is also good, but becomes monotonous.
Anyway, I appreciate everyone's input. Thanks!

Erin · Answer 10 · 2012-10-16 19:59:28Z UTC

I may be late on this, but I have shallow grooves, started having trouble in my early 20's, and it just progressed. I had surger called patella femoral resurfacing, which is really putting plastic under the knee cap to replace the cartilage that was gone, and a metal femoral groove. My knees work for the first time in my life. I had the surgery when I was 47. My daughter has worse knees than me and a flat femoral groove with tipped patellas. She blew out the medial patella ligament and dislocated the knee playing soccer at 12 - she has the chronic problems you talk about and that I had. She is in discomfort or pain often.

Neither of us got much help from physical therapy. I found that once you are walking, they are done with you, and that has never helped. We both worked with a good personal trainer, and that has made the difference. The other thing that helps alot is massage because the muscles are always unbalanced and it helps to release the tight quads and IT band - if they are too tight, all the strengthening in the world is not going to help you.

I had surgery on both knees at the same time, and it was hard. Took a year to get to a good place, and two years for full recovery, but I'm glad I did it. I'd been through too many years of continual problems and doctors telling me I had to learn to live with it.

Play/sports suggestions for a gal with a really bad knee?

10 Answers