January in the Caribbean on a cruise ship.  I was sitting in a chair, watching the turquoise blue ocean, then I stood up and experienced, out of nowhere, acute sudden left knee pain.  I tried to “walk it off” or at least move across the room without limping, but it was impossible. There was knee pain with every step and it worsened when I bent – or straightened! – my knee.  For the first time on my entire vacation, I had to take the elevator; I would have used a cane or crutch if one were available! How did this happen and was my vacation ruined?!

 

This was my experience earlier this month.  It is the experience of hundreds of people over 40 have every day. They “didn’t do anything” or did something as simple as a pivot to reach for something, and now they have debilitating pain.   The difference for me was that I had the benefit of knowledge, knowledge gained through more than 30 years of experience as a physical therapist. – And, believe it or not, within 12 hours, I had about 85% less pain and, within 15 hours, no pain at all.  Here is what I did.

 

First, I suffered through dinner because I had a commitment to be there with friends and, frankly, I was hoping the pain would just magically disappear.  If I wasn’t moving or loading my knee, it was certainly tolerable. But, alas, worse after sitting for a couple hours. Then I took the elevator up to the gym, gingerly got myself down to a yoga mat and gave my wonderful, accommodating husband directions on how to do some joint mobilizations to my knee.  The maneuvers are simple and only take a few minutes, and I wasn’t miraculously cured afterward, needing help to get up from the yoga mat, but the knee was probably 25% better. I then limped myself over to the stationary bike and cycled low resistance for 5-10 minutes. Still took the elevator back to my room and couldn’t fully bend my knee, but I was about 50% better.  That evening I did some knee swings (sitting with legs dangling, low load swinging legs back and forth) and another knee mobilization I could do myself in a hands and knees position. Did take an over-the-counter anti-inflammatory. If I woke during the night with knee pain, I didn’t panic but rather just moved the knee into a position where it no longer hurt. By morning, I could walk without a limp, but the knee was still not completely well.  To the gym for 8 minutes of low load cycling. Chose some decent shoes to wear – luckily I have some nice Chaco flip-flops with good arch support, took another OTC anti-inflammatory and set off on my planned activities. That day, we had scheduled only walking and exploring. By 1-2 hours later, my knee pain had completely resolved and didn’t return; no more meds and no more treatments. All I could think about was how lucky I was to have the knowledge to resolve my problem and how I wish everyone could have the same knowledge.

So, what was wrong with my knee?  I’m guessing an MRI, had one been ordered, would show that I have a meniscus tear and other “degenerative changes.”  These are common findings in knees over 40 and not necessarily symptomatic. “Degenerative changes” means aging cartilage, not pathology or disease.  My graying hair and my eyes that need reading glasses also have “degenerative changes.” Post-mortem studies show us that a good share of knees over the age of 80 are ”bone on bone,” even in people who have NO PAIN.  My previous day’s paddleboarding activities, likely put my knee into some sustained positions where it wasn’t used to being, although the pain didn’t start until hours later, likely from further positional stress when I was sitting.  The “treatment” helped my knee joint be able to move out of its stressed position and restore its normal function. The pain was real – take yourself to Urgent Care real –but the solution was simple; I just had the privilege of knowing how to get there.

Even in cases of longstanding knee pain, research tells us that physical therapy can be as effective as knee arthroscopy for degenerative disease – cartilage damage and meniscus tears.  That being said, there are cases when surgery is necessary to resolve the problem or when surgery may be the best time-sensitive option. If you haven’t had a big trauma, you didn’t fall or get hit by a car or such, and you suddenly get acute severe knee pain, it might be worth exploring some conservative options to treat your condition.  A PT will take a thorough history and perform clinical tests to determine the best treatments. My strategies got my knee pain free in 15 hours, no surgery recovery time needed, but I knew what to do and how to start on it right away. In the physical therapy clinic, 2-3 weeks is usually adequate time to know if your problem will resolve with conservative management.

But here’s where it gets tricky.  It is doubtful that your physician knows some of these treatment strategies unless your physician has had the great “miraculous” opportunity to experience them.  To see if some of these conservative measures may help, seek out a physical therapist with a manual therapy background. Most states have direct access to physical therapy, meaning that you don’t need a physician referral to see one.  And most insurance companies cover PT without a referral. Physical therapists are trained in the evaluation and treatment of musculoskeletal conditions, and they are also trained to work with their physician colleagues when your condition warrants further assessment or management.  Something to think about when you need to save your vacation.