Thanks to Nathan Dumlao for his photo
This past weekend longtime friends from south of Seattle visited us. Jan and I have been dear friends since college days at CSULB in California and I am very familiar with her arthritic woes. But as she uncharacteristically hobbled in, leaning on her husband, John’s arm, it was like they were dragging an opened parachute behind them. Her arthritic knee was so swollen I thought she was wearing a knee brace beneath her jeans. She wasn’t. They are typically lighthearted individuals, but this was taking the wind out of their sails.
Jan had recently seen another orthopedic surgeon regarding her chronic knee problem. She joked this was number 52 in the parade of orthopedic consults over the decades. During the long slog of painful deterioration of her knee, no doctor offered effective relief except for the dangling of the knee replacement along with “but not yet, you’re too young, and you’re not in enough pain.” She participated in physical therapy through the years and kept up her millions of miles of swimming.
Grace in the face of the harsh
Through it all, Jan has remained upbeat, kindhearted, generous and encouraging. This longstanding thorn in her knee has honed her ability to be grace-filled through the fire. She is lovely, and you’d love to be with her. Everyone does. That’s why she had to have two wedding receptions in two different states to accommodate folks. But that’s another story. Suffice it to say, Jan isn’t a whiner.
During this last orthopedic visit, she received some hard facts. Her trochlea, where the kneecap or patella sits and rides over on the femur, was shallow and was why the patella relentlessly pulled to the side and would partially dislocate easily and so often. Physical therapists had for years been trying to get the patella to sit well on her knee. They provided lots of exercises and taping techniques, but the outside muscle and overlying tissue had shortened over the years, so the usual treatments weren’t working well.
This doctor told her she was a tricky patient, explained the mechanics and impact of tendon shortening and weakened ligaments, and how even the surgery wasn’t a sure fix for reduction of pain and improvement of function. I appreciated the candor and depth of his explanations, relayed to me by Jan and John. He tried to improve her symptoms with an aspiration of the knee and then an injection of cortisone. But he left her demoralized. While her knee felt better, her normally buoyant spirit sagged. She was understandably discouraged.
The we-can-do-better part 😉
I was frustrated for her. While the doctor gave her (mostly) correct information, it wasn’t the whole story. It was a partial story couched as if it was the only story. He didn’t direct her to physical therapy, or to an exercise group where she could have benefitted from the support of other folks who also were struggling with similar issues. Patients improve in pain management and function if they have social support; exercise groups are a good place to obtain that. He didn’t talk to her about the impact of motor control and re-training, fascial work, or chronic pain management. While I would not expect him to have mastery of these areas, he ought to have known about them and where to refer her for help in these areas. While he drew from his vast box of orthopedic knowledge, he gave her no encouragement. He addressed the body before him as if it was uninhabited with a soul.
And this is our typical healthcare methodology. The partial story approach doesn’t take the entire person into consideration. It’s not holistic. A specialist sees the patient through the lens of “Parts.” This doctor saw an arthritic knee with 60 years of deterioration and failed to see the woman who was motivated to reduce the pain but just didn’t know how. Would surgery help? If not, what then? He answered the first question and didn’t guide her to anyone else who could answer the second, leaving her without hope.
I believe a goal we clinicians must have with each patient session is for the patient to be encouraged and understand how to better tackle their problem. They should always have some hope. And they should feel empowered.
So the next day we went to work together and I assessed her leg. The skin was cold, which told me the fascia was tightened down, restricting blood flow and neurological communication with the muscles. She could barely flex and extend her knee and only while assisting it. When I gently moved her knee, her range was significantly restricted and she yelped. Her muscle control in her thigh was shut down, in protective mode.
For 15 minutes I cupped her thigh and calf, moving the cups around to stimulate the circulation and mobilize the fascia. Her leg warmed up and the muscles seemed to regain life. I moved her leg for her, through full range with no to minimal pain. She looked at me, questions in her eyes.
And then within the next minute, she was able to fully move her leg on her own with full range and barely any pain. Her eyes grew wide, but the true test was to get up off the floor where our treatment was taking place, and then stand up. She arose by herself with the “butt first technique” I had taught, and amazement lit up her face.
Sidebar, when this happens with other patients, tears often show up. Not with Jan. She burst into laughter. 😊 She walked around and then, after my instructions, gingerly marched up the stairs to shout to her husband, “JOHN!!!! MY KNEE FEELS GREAT! IT’S A MIRACLE!!”
I chuckled as I had heard these words before with my patients with knee or hip problems after cupping them. It never gets old.
We celebrated by going to an outdoor garden art store and walking around for an hour 😊. And then walked around downtown for 20 more minutes. To her surprise, the pain never returned to its moderate or severe levels.
That was yesterday.
Today, she came upstairs with much-improved mobility and discomfort. After another cupping session of 10 minutes, in which I taught her how to cup herself, we commenced with her exercise program of awakening the motor control of the hips and pelvis to guide and power the legs. First: a modified squat with the help of exercise cords attached to the door. Her funky motor programming needed to be retrained, and she did great.
Her program will be 2-fold: cupping and exercise. The cupping begins daily, gradually reducing to a few times per week, and then as needed. Exercise will be easy and practical, especially since she works primarily from home. 4x during the day, she’ll grab her exercise cords and perform those squats, but with 1 of 3 goals: either 1) do the squat slowly and feel all of the muscles working in the core and hips and legs, or 2) work with weight transfers and challenge left versus right hip muscles, or 3) work with quick repetitions, to get more cardio.
Jan will also see a physical therapist weekly for a few months, with the goal of being discharged to a specialized gym where the trainers know how to work with clients like her. She will be on a progressive strengthening program “forever”, just as we all should be. I include myself here😊.
Jan and her husband, John, left this afternoon to return home, with spirits visibly renewed and re-envigorated. This time, Jan was straight and tall, exuding her joy and confidence as she walked out of the house, and down the steps, of her own accord. No hanging onto John’s arm. No parachute being dragged from behind.