Huh, imagine that... --- So got up today... knee felt meh. Not great, not backsliding... just stiff and sore and wobbly, a degree higher than yesterday. So did the short fast and got into my weird little workout... So, after experimentation... found my knee responded to something that feels like getting that debris out from between the articular surfaces of both bones: bent the knee a bit past 90º (basically touch more than a half-squat), and with the foot on the ground, swung the knee from side to side, whilst simultaneously straightening the knee. About the rate where 3 swings by the time leg's straight. Did this 3x -- could literally feel my knee relax the muscles across it, in response. Another tool to get the knee calm enough to strengthen the quads, which I feel is part of the problem. Wasn't able to go downhill, not comfortably yet. The downhill for the parking structure, is where it all goes to pot -- climbing, is what my knee loves to do, and will do it as long as I don't push into pain. But even the slight incline of the ramps going down? Feels super-weak... and all the strain seems caused by damage to either small muscles which locate the bursa under the patella, or the vastus lateralis / rectus femoris / vastus intermedius, all quads (that f***ing bucket really caught me just right ). So second workout at the park... starts with a gently-increasing downhill... which of course I'd be hobbling at, until the exact nadir... then it was all equally-steep climb and level-out, the reverse of the descent. Later is a short rhythm section, both turning and rising / falling... then a sharp descent to a bridge... a rest with a broad curve on level ground... then a medium climb back to the car. Figured out something else that the knee liked: if whilst going downhill, I purposely held the quad to tense, then gradually let it lengthen whilst tensing... this made the second lap feel a lot better. Copious testing of my 'knee-cleaning' tq along the way... This looked a bit goofy on the trail... but f*** what everyone else thinks. I'm here to both rehab and learn more of my client's exps, with borked ligaments and non-muscular structural damage inside the knee. Gotta do what works, even if it looks a bit crazy do not know -- hurt worst at the start, that tensing-lengthening-quads part... but brought probably the second-best relief from P, at the end of my laps. So the quads have more to do with the knee not progressing faster, than I thought Feels good so far, hours later. More tomorrow, when I push it doing the car up.
Weekend update... Yep, figured that would happen. Since doing up my car requires not doing the knee warmup / workout, instead using the time to start washing the car... the knee began to flare. Badly... Aligning it, even repeatedly, did nothing; usually that's a sign of internal inflammation and lots of P-factor (a hormone that raises P sensitivity) is in play. Cause could be the cold state of the knee (seemed calm if not pain-free upon wakeup) + the immediate dousing w/ cold water for 20 mins... then standing and bending at the waist drying, blowing water out of crevices*, then applying and buffing esp doors and end caps. Tight hams apply pressure to the knee by pulling the tib / fib rearward and headward, which is what seems to inflame bouts of 6 - 8/10 P -- the higher range, the sort that puts one in a please-f*ck-w/-me-&-find-out mood No choice but to finish the job... exhausted, came home and took a nap... 4 hrs Body really didn't like not doing my workout, painful or not. So today, point taken... wanted to hit the structure first thing and get that warmup done, then the park laps. Body despite still aching, felt ready to go vs. reverse, after the car detail. But as has been my luck since September (year changes over to the following year's animal [Horse], in Eastern traditional belief, and increases in influence over current year's animal [Snake], until lunar New Year)... that wasn't gonna happen, not without a fight. Had actually gotten b-fast... driven and parked by 0745, and stepping out to begin the climb at the structure... when realised, the only time I have today to address my fears abt the knee w/ PCP... was now (docs take holiday vacation in Dec at my state clinic, not sure when my PCP's was... so next slot could be in '26, better to see for myself) . Drove up & set appt for end of this week, phew (~20 - 25 mins roundtrip), and parked again. By now, was ~0815 -- better get started, late... Sh*t -- need to make a deposit, can't be later as my bank's teller lines are a thing of legend on Mon. Again in the car, did the deed, parked again. 0850... Now starting workout an hour past usual... cool breeze atop the structure I love so much, gone. Missed your bus, futurist But almost as if fate were being a ferryman charging for passage... breakthru in the knee -- atop said structure. --- My injury's P can be anywhere in the joint... but the classic presentation's been about 2" below the patella and 1" medial -- right where all the adductors and medial hams attach to the tibia. Muscles tense resting tone for a variety of reasons... but in this case, they're right on the edge of splinting, because the internal anatomy of the knee isn't stable for some reason; won't know exactly how, until a CT's done. So when just these muscles are told by the spinal cord to tense say 70% of full contraction, two things happen: 1) muscles are now consuming vast amts of energy in the form of ATP from blood sugar, calcium / sodium, and oxygen, without doing any work... and 2) it's much weaker, as contractile length is robbed just in resting tone. The less length the muscle has to contract its fibres, the weaker it is. So the splinting reaction's a dbl-whammy... and that's omitting the fact articular tissue in whatever joint that muscle crosses (all muscles cross joints) gets constantly compressed, meaning can't get the bloodflow it needs to heal, nor rid itself of waste... and decades of ignoring this, esp in the lower leg joints... usually means joint replacement. If you can afford it. I can't, and don't want an artificial knee joint, even if could. Know many clients with them, and only a few unequivocally endorse them; just not the same as rehabbing a sick joint with less-invasive means (like arthroscopy). If it can be properly brought back to health, an 'OEM' knee's always better than a 80/100-point operation to install a metal one. You can get a 99/100, if you're willing to wait a year and buy your surgeon's family another European ski vacation in Suisse... But thing about the knee, is the procs I use aren't specific to a certain presentation of symptoms -- like if the pain's front-inside of the knee, do this... rear-outside, do this. Simply feels for the menisci bulging where they shouldn't, then do a tq that supposedly both cleans out and re-seats the joint, letting the parts settle where they should, w/ a gentle all-in-one persuasion. Been doing it 10y at least, works. But if only one of the wheel-like condyles of the knee is painful... how do I a) diagnose what issue's causing it, and b) correct for that problem, by moving the anatomy around thru the skin? Found when P is front-inside (splinting adductors / hams)... traction the tibia, then brace the femur's front edge w/ thumbs, & lever the tibia towards the patella w/ fingers behind the tibial plateau, whilst still keeping the joint in traction. Hard to describe in words, two seconds to show you This resulted in nearly 100% resolution of the quickly-flaring P front-inside... and could feel my mind o that lap on the top level of the structure, slowly feeling good enough to release the extra tone in the knee -- almost. But really weird to be in constant low-level P 3 mos, and suddenly w/ a magic tq, your knee feels like nothing ever happened to it. Stress again, almost... Reality bites... deal with it Of course'd be super-naïve to think just because I got the knee to a place it happened to like, that it could take it from here, no other work. The damage's still in there, and suspect debris' also in there waiting to pop my bubble Still had to walk downhill off the structure, after all... which is when it feels worst. And yep, that's where the bliss coupon expired -- returned not nearly as painful as yesterday... but the pipe dream was over. However this exp was valuable stuff about where the knee needed to be in 3 dimensions, in order to recreate it... meaning one can extrapolate more precisely what the knee's like internally, before a CT. Will be interesting to compare notes EDIT: Oh! Forgot to add a detail noticed whilst in that slightly-blissed-out, fleeting state of having no pain in the knee... Something noticed since as long as I can remember being hard-wired... is an intense fear of heights. Could overcome it (scaled a 6-story rappelling tower on its rickety nailed-on rungs in boot camp, then of course rappelled off) but only under intense duress. Only few yrs prior to mil, remember staying in a room at a hotel in Honolulu on holiday w/ family, and walking out onto the balcony; we might've been 30 stories up. The view down was scary enough... but remember being even more frightened looking up the side of the bldg, how on earth someone mudded those bricks in then painted over them, way up here. Still remember that moment... were at least 42 - 43y ago. So the path I walk (non-balance game) is on the exterior edge of the 4th flr of the parking structure, right next to the cable barriers keeping drunk kids from flying off the top floor (after 30y of rust in salt air, we'll see). Can see clear to the ground easily, but it's only 4 flrs, shouldn't scare someone who stood atop a rickety tower of telephone poles 20 x 20 ft, right? Gawd, was almost nauseating, up until today. Today, after that magic set in the knee... the distinctive 'ache' in the hands and feet, and slight feeling of vertigo (like a 10% dose of it)... gone. Something about the instability in the knee, increases my fear of heights even further than normal. Mind you, I don't fear flying, or even skydiving -- my fear becomes panic, when I have to stand on or hold onto something at height, like those videos of radio tower techs climbing 1500-ft towers, hand-over-hand. Just watching that makes my palms sweat... but loops in an F15? All day. Weird -- ach, my brain forgetting big things again * water in gaps in bodywork, can ruin not only a ceramic wax's finish, but can compromise its protection too as doesn't set properly -- esp this Griot's 3-in-1 seems affected by stray bits of water getting into whatever's being sprayed on and buffed
For Tuesday: Got up w/o a propa night's sleep... might've been lingering caffeine from that morning (got a free 30oz iced tea, when two baristas both made the same drink, thinking the other was too busy). Had doc and svc appts today... so time to make good on yesterday's bork show... Figured out something else: can now elicit that blissed, crumbling-gimp reaction in the knee, at will. At first was just doing the tq which brought back the quiet... but on tweaking the knee again, figured more precisely where that line betw. too-far and just-right, it was to move parts of the knee. Also thru same, may've figured out exactly what got injured... And again, when the knee wasn't 'right' past a certain threshold, vertigo w/ heights. When it was, almost zero -- even walking right up to the edge of those rusty cable fences. Still trying to figure out what the connection is, betw. inner ear, amygdala, and peripheral limb joint injury... At the park... when the knee was right as could be (briefly 95%+), could walk downhill w/o that 'trickness' upon load. The park has the steepest hills in the workout save climbing stairs, so going downhill comfortably if not totally stable, were heading in the right direction. And for the first time since Sep... sitting in the car for as long as 15 mins, didn't make the knee feel like it were at square one. Pretty excited as the second appt would prove worth beyond a doubt. That svc appt, was at the dealer. Had to bring the car in to program a new fob (a year later, they finally have the 2nd fob I should've gotten at delivery). Didn't know I had to let the svc kids take it, or would've cleaned it better. But only took 45 mins, and drove away. During that 45 mins, explored the knee. Weird to be d*cking w/ it being so well-behaved; almost wanted to leave it be for fear of square one. But did find other things the pace kept me from seeing, during the workout... The impact area the bucket trip flub tore up, felt stuck down -- perhaps w/ scar tissue. Straightening knee... now patella weren't being smashed down atop the joint, rather bulging healthily like the L knee. Applying stroking pressure thru the relaxed quad muscles across the grain of the adhesion... was 7/10 P but also made straightening knee much easier. Found hidden TrPs (trigger points, a kind of knot) under the edges of the superficial center quad (rectus femoris) and the deep center quad (vastus intermedius)... when cleared, gave the lower leg an airy, light feeling. If your bodyworker doesn't give treated limbs that light, airy feeling... they don't know what they're doing, move on. By the time they called my cell saying pick up the fob at the cashier... I could straighten both knees with almost the same effort and lack of pain... and walking to the car, even after all that time sitting down on minimal cushions in the waiting room... felt almost normal. Just did a client an hour ago -- knee was bothering me still... but only in the really fringe kinds of movement, like sitting on the massage table (one sit-bone on, one off) did the knee even announce itself -- good session, and knee didn't blather the whole time. This AM before the workout, just bending the knee from straight in bed -- not even to 90º -- were painful enough to need a breath. Fri is my doc appt; eager to see what a CT reveals
For Wednesday: Holy smokes -- the knee work in the waiting room at the dealer -- it f**king worked, better than 3 mos of established tq. And the 7 - 8/10 pain I'd wake to months now, bending knee cold... is almost gone. Little bit of stiffness w/ 4/10 pain at very end of full bend... but nearly same as the good knee. So the old instability and lack of full extension whilst standing... gone. Even sitting a while (in the car on the way to breakfast is ~15 mins drive) which used to flare badly getting out of the Prius... so low as to nearly forget it were there. The laps atop the structure were easy and only a bit stiff and sore at the end; same at the park. So the trick I'd missed, trying to follow convention w/ this chronic lingering misery (which are protocols reliable on clients 15 yrs now)... were getting TrPs (knots) & tissue / nerve adhesions out of the thigh, glute, and calf, mean little... if the inflammation that occurred right after I'd injured it, made the muscles and tendons responsible for stability, glued down and sending proprioceptive distress signals to my spine. This is why having and resolving this problem in my own leg's so valuable -- in past was just following what I were taught, educated guessing and observation of what worked, w/ the client's word to guide you. In cases where there's so much pain you can't necessarily recreate on the table (like waking up 8/10 w/ the knee cold)... can't know which tools to use, since there're lines drawn depending on the amt of pain. Medical tech still can't tell a doc / nurse prac how much pain you're feeling, like Bone's sickbay beds in the old Star Trek series; if has to be inferred thru other measurable, quantifiable means (thus why there're so many people in ERs who act for opiates: it works). Will have to ease this tq into the client pool tho... it is intensely painful, I could only do it a few secs at a time. But if I could benefit this much 3 mos after the original injury... then it's worth it. Just need consent... which is intellectual to many, many clients on the table, until they're feeling it What's still left in my knee to work: P upon twisting knee under load; lack of strength at full flexion (much improved, tho); and lingering splinting reaction when the knee's pushed a bit, like those park laps today. Still needs some work, but most of that points to general housekeeping and muscle building... so staying the course. Gradually improving, after months of up and down, is a relief. The specific tqs arrived at thru trial/error to break up adhesion & free up muscle length... are already updated in my protocol book. There's a link between innovation and desperation, for sure
For Thursday: Got a good night's sleep... but woke w/ little energy. Have been cleaning up my diet a bit further, including adding plain grilled chicken breast to aid in muscle building, w/ beans and tofu as add'l sources of protein... but my particular genes have trouble growing muscle w/o animal protein -- esp past 40. No red meat (colon cancer and atherosclerotic risk in 50s, so not hard to drop), just chicken and fish... which kidneys and gut find easiest to tolerate anyway. But the legs -- they're growing. Sure since the injury & constantly getting out there feeling out the edges of this thing... but noticeably more since doing the right kind of exercise (a lot less than I'd thought, even 5 yrs ago in covid) -- and even more since adding protein (first the extra tofu to the beans I already eat, and now w/ chicken breast, it's frankly um... like I'm young(er) again) Who the hell knew, a simple walk up the ramps of a parking structure daily -- not scaling its stairwells -- were going to grow muscle faster? My goofy arse body, apparently That said... no change in diet from yesterday... but got up w/ that 'can't I just lie in bed all morning instead of workout...?' Peeled my delusional arse from the sheets and made it to the structure for my warmup. Knee wasn't fantastic loading it a few mins (felt better overall, tho those twinges of 'trick' still poked their knobby heads out, just less often)... and during other transitions it'd go trick in past, was reassuringly stable. Just cold, maybe... that 15 mins in the car driving up couldn't have helped. Ah -- think I know what could've caused the drop in energy: had some pistachios about noon yesterday. Pistachios are one of the most potent sources of dietary potassium, eye health compounds (lutein & zeaxanthin), and B6 there is... but over-indulge, and its fructans can cause non-trivial gut upset. And the gut's happiness strogly correlates to overall happiness. Looks like I went over the RDA (~50 whole pistachios), or just not used to eating them yet. But by the time I'd driven to the park, energy deficit was gone. Interesting change subjectively in the knee: trails here both up and down used to be sources of air-teething pain. Now, it's all downhill, and what's left's ~half. Stability? Still not right. But the kind of pain that exhausts you, anyone who's broken a bone or recovered from surgery requiring 20 or more stitches knows... is almost gone. Even with a body where everything works, takes weeks to get to where you want to go do it, want to do better. Can feel the knee's close to that escape velocity, but but close may as well be a hundred miles, if you can't get to a new square one. Have more work to do... --- For bodywork... have a little cautionary story to share from today's client. A frantic, terse text yesterday... someone who hasn't seen me since before covid -- a long-orbit client, a 'Halley-lullah' Can you fit me in? Had a slot, so saw me first thing in the morning... Client had a holiday in SE Asia during that orbit... where a massage 'therapist' cracked their neck wrong -- which set into motion a grotesque chain of events... Their first symptom, was a throbbing headache, centered in a knot in the L sternocleidomastoid muscle, or SCM, in the neck. It's that diagonal muscle you see in runway models, when they tilt their heads away from the camera. They also had TMJ symptoms, shoulder aches, and a leg length issue. Never take at face value only the places the client points to as painful, to concentrate your work -- when it comes to pain interrupting sleep, it's rarely sourced where they point. Consider them data points only -- point at their neck as where it hurts most, but ime it got there due to a lot of other things lower, failing first. Sure enough, their line of work is artisanship -- Italian tile for the sadly-ballooning population of millionaires on the island. Client wouldn't have gotten rich doing it, if the work didn't exist after all. But relentlessly physical -- which brings with it, over-specialisation to a very asymmetrical use of body's L and R side. When you mud a wall or whatever needs covered in these heavy and quite ludicrously-expensive tiles... the money goes to contractors who are both precise and fast. Coming from Italy and training / apprenticing there to be in this line of work... Client's been holding a hawk (flat broad surface mounted on a handle) and tiny trowels for the intricate work of mudding the tile pattern in, for 30 - 35y now? So just that's more than enough to explain their woes. Thing is... your peripheral body's incredibly good at hiding its use-related problems, if you force it to regularly. So working in the sun on a scaffold 7 hrs at a time on the larger jobs, doesn't give wiggle room for providing the body what it needs to stay healthy -- and neither will these douchebag dentists and restaurant owners looking over your shoulder in their robes, natch. So years, if not decades, of telling the body 'deal with it', or 'I'll rest when I'm dead'... were coming to roost. The body doesn't handle this demand by miraculously fixing these problems... it just muzzles the pain signals from the affected body part -- and you carry on, thinking lack of pain means the problem's gone. Ehhht Eventually... the body'll seek ways around it -- compensation -- so often and so remote from the original malfing muscle, tendon, or ligament... that it runs out of options -- and fails. This is when I normally receive calls as a bodyworker, as the pain shoots thru the roof and finally becomes difficult if not impossible to ignore Client didn't do that. Listened instead to a surgeon, that there was a disk issue and should get cervical vertebrae fused... so the result was a neck that's now more likely to stress disks above and below the fusion in future, and still has the original neck pain. More than $20K spent on the surgery... and still can't wake up w/o pain. That was hard to listen to... airteeth So found the issue starting the neck being vulnerable to that holiday massage therapist: a bone out in the L foot, the affected side in the neck. Releasing nerves and muscles in lower leg and foot, returned the forefoot to normal feel and articulation. probably got it due to standing some way that heavily loaded the L leg constantly -- they did mention doing all their work with just the arm and shoulder, you'd tire in a half hour. Using the core to support the movement of the masonry, requires strong set in the feet, res ipsa loquitor... When setting that bone (the cuboid) back into place... the whole transverse arch relaxed -- making it much stronger. Don't let bodybuilders fool you: strongmen will tell you, built muscle relaxed at rest, has much more strength than tight 'ripped' muscle. Extra tone = extra contractile length going to waste, making it harder to rid itself of metabolic waste at rest, esp lactic acid. Why do you think red meat has so much lactic acid in it? Could those muscles standing all the time, carrying the weight of a '90s Honda Civic have anything to do with it? Followed the problem up their L lower leg: nerve adhesions affecting peroneals, tibialis anterior, extensor hallucis longus, extensor digitorum longus, soleus, flexor hallucis longus, flexor digitorum longus, and trigger points affecting f.h.longus, soleus, and fibularis longus / brevis (peroneals). Next thru the thigh: same two problems in all adductors, hams, and minor glutes. Finally in the core, found deepest core muscles psoas major and iliacus (iliopsoas) tight as a guitar string, so worked up and tore the massive femoral nerve off its adhesions to both muscles. Minor trigger point work in obliques and ab blocks. All from specific movement patterns, over-specialising into lack of ability to do much else. Then came the real work: shoulder, neck and jaw. In the interest of brevity huuuuge trigger points, from our friend the no-cert masseuse. Probably 9 - 10/10 pain working inside the mouth -- the kind that you want to throw blows in -- and it nearly came to that. I did warn them, and they did consent, to be clear But lo and behold -- they could turn their head, and walk w/o that throbbing neck and TMJ pain again. My fee for the session, was less than a hundredth what they paid for the surgery on their neck -- which increased risk of disk problems returning. That's not doing no harm But I did have to add, should've consulted with me before going under the knife. Welp, can't turn back time -- al least they can sleep now
For Friday: Woke up better than yesterday, a bit early to boot. Makes the routine of cleaning and putting away my CPAP gear a bit less hectic, which I thoroughly dislike on the wakeup (chalk it up to nearly a decade in the US Army, doing pushups and grass drills at 0530). Made it up to the structure early -- these waning days to the winter solstice minimum, are almost the crisp and cool I remember from Seattle (similar humidity too as lived nearly the same distance from the ocean)... just 3 mos late, 25 degrees closer to the Equator My walk-up was same-old-same-old... hobble out of the car, grit teeth on the first few steps, then concentrate on form and alignment up the 2 ramps and 2 flats to the top. Felt better (still no vertigo, so knew this recent improvement was going to stick)... but still wobbling around, with only excruciatingly-brief glimpses of the freedom and nonchalance I used to exp during the old morning walks. Stabs of pain; 'tricks' jinking to the surface for me to fumble and feel in whole. Same-old, same-old... Park lap was better, but still not over that beyond-a-doubt line. Felt stronger up the last hill back to the car, but still stiff and painful in the wrong places. Could walk more gracefully than 20 mins before, but the pain wasn't any different; just traded the reasons it existed, like passing the baton. But -- had a doc appt to see about a CT in the knee today... looking forward to it. After the far-too-long searching for spots to park and walk around (just so the knee won't get cold and sore), arrived at the clinic, and checked in. Doc was super-busy, as they usually are in a state-funded clinic. So after temp / BP and interview... waited about 35 mins in total. Funny how that would seem miraculously-fast if it were your car at the dealer... but molasses-slow, when it's a doc appt seated on a hard plastic elementary school chair During that time... poked around in the knee, to consolidate how I was to describe my exp with this injury. And in doing so... found something. Wait, Wth is that...? In the back of your knee, there are two muscles in particular which I never teach clients to work themselves: the popliteus, and the plantaris. Reason being, they're too close to the big nerve trunks (tibial and common fibular), and the popliteal artery.... so a novice grinding around in there can cause serious damage, enough to be hospitalised if you're really unlucky (getting an emboli or mobile piece of thrombi or blood clot in an artery to break free in the popliteal pipe.. where it has no choice but to go where vessels only get smaller, then block flow and kill an extremity, after excruciating pain. So no, want a career after all The popliteus is deepest, right behind the head of the tibia... the popliteal artery sits atop it, then the plantaris, a vestigial muscle that serves no current function in humans since we went upright millions of years ago, completes the artery sandwich. So you can't work the plantaris, w/o compressing the popliteal artery, unless you can feel and move your pressure as to not compress the artery -- not possible in a day class Felt around... and found my R plantaris, had a TrP in it. Mind you, I've been doing this gig over 15 yrs now... and have never seen a plantaris with a knot in it. Well... better get it out, then. So in the exam room, began to work this TrP -- stiff, very sore (7/10) and apparently been there since the accident. But it has no actual function, muscular or otherwise in the calf, totally vestigial? Even when it does contract, its long tendon (longest in the body) takes up all the muscle's contractile length in stretch. Kept working it, as it's the only muscle in the leg even remotely involved w/ the knee I hadn't worked yet. Skeptical, got up to stand, expecting same-old... and stood pain-free Nah, get out of here. So tried walking around... and every move (pivoting on the ball of the foot; shifting weight rapidly side-to-side; running in place) that caused 'trickness' and pain strong enough to sit down... gone. But would it last? Doc finally arrived, so told them what I'd discovered in my knee injury... shee nodded and did a impromptu inspection of the knee. Still wanted the scan, still felt some amt of instability, plus I wouldn't know if my fix was solid, until tmw morning on the wakeup. So scheduled the scan and reference to ortho docs, and went on my way. But walking to the car... felt at least another 10% closer to that line; that line where can push the knee and it may still hurt or feel like an old injury... but can push thru that as hard as my heart and lungs can bear. The spectre of those little self-preserving stabs of pain backing me out of normal exertion like running and jumping... were still alive, just muted way down, far lower than any point since the sickening crunch. Tomorrow will tell all. But had no idea a vestigial muscle could influence proprioception (and protective pain involved, when it gets a TrP) in something as important as the knee. Zero sense of this in the good L knee... Just proves the path to mastery, is to always keep your sense of wonder and curiosity, like the student
Weekend (Sat): So f*** me, that vestigial muscle (plantaris) was the key to getting this knee over the hump to normal in function. headdesk Bending the knee after 7 hrs full... effortless. In fact the L knee were more sore, from its months-long, unwanted babysitting of the R. But knew as soon as descending from the walk-up casa... it wasn't right. Well, take a port in a storm... Structure warmup: not too bad. Am seeing a pattern now that could explain what's actually effed-up inside the knee -- of which only menisci, ligaments, and debris in the synovial fluid lubricating and nourishing the knee, could be the problem. If it feels virtually pain-free unloaded, then upon few mins walking (doesn't matter up, down, or level), feel that familiar tight ache inferior and medial to the patella, where the adductors and hams attach to the tibia... then since it's been the only constant in this whole 'chilada of pain-mock-recovery-pain, w/ only glacial improvement... then it probably isn't ultimately a matter for bodywork to solve. Oh no, bodywork helped keep it from getting worse, as a layman would probably already be scheduling arthroscopy they may not need (and for some, need pay out-of-pocket)... but my tools are only providing support / assistance. What's damaged inside the knee's taking this long, because bodywork can't fix it. So glad I'd decided on further tests and imaging -- because need to know exactly what the sitrep is. Man, the issue's been taken down a notch tho, in all aspects of the injury, based on today's workout. Descending the rather hairy-for--a-gimp first hill of the park lap, it always used to hurt in that 'ah!', 'trick' way... and would only abate when nearly ¾ thru the lap. Today, nothing -- in fact, felt almost normal, even when transitioning to the even-steeper 1st uphill, probably a 15% grade and not far off climbing stairs. One of the reasons I like this park trail, is being right in town but varied almost like a mountain trail... natural challenges to lower body, just paved which is nice (a fall on loose ground with this knee? It'd put me on crutches, bet). Last bit ending in the same grade uphill as the 1st uphill... just fine. But by now that tight ache began to form... so need to monitor it to see if it's just that part of my knee being abraded unnecessarily by the vestigial muscle's shens, and it needs time to heal and recover... or if it indeed needs surgery to correct. The mere fact it improved so much by correcting the behaviour of a minor player in the knee, seems to point to not as much damage as it felt like before yesterday... but can't expect the miracle recovery anymore. Final verdict, with imaging... Have been scouring my notes and research papers for anything about the plantaris muscle being involved in splinting reactions across the knee by all the major dominants... nothing. Doesn't ring a single bell from >15y doing this, either -- and I'm pretty good at remembering the non-intuitive ones. Hmm
Weekend (Sun): Wash day. Not lost on me this is the same activity what injured the knee Was able to complete within the 15 mins (= $15), which sets in stone this routine for me (why I hadn't figured this out years before, may just be my brain -- can imagine & turn on any axis in 3D in my head, then feel, locate, and treat issues using this 'brainar'... but can't figure out how to wash a car w/o all the 'ticks' I need to check off for 'washing car' -- until the searing pain insisted. Then again, pre-covid was rolling in a lot more income than now ). No parking structure today, just used the work washing to warm up. Next is drying, blowing out all the water so the ceramic coat keeps integrity, then wipe off the collected dust (slight breeze today) so I don't orbitally-buff it into a new ceramic layer. Knee did not like this activity -- far less than the actual workout, even if I'd dbl'd the laps / distance. Have to slightly hyperextend the knee to get the buffer on the centerline of the roof and hood... which is how it got injured. So much so, rather than travel to the 2nd spot to do the doors and end caps, took a lap at the nearby park (was a tiny bit surreal, not feeling the same feelings going there to detail the car rather than workout, since the drive's very similar). This lap was just what the knee wanted, thank god for that... Stopped at the supermarket to get some chicken breasts to feed my workouts, and got the door jambs and sills done - something only an hour prior would've been excruciating. What the knee wants right now / indefinitely, is gentle, steady warmup and a bit of challenge up- / downhill to get muscles and fascia involved / moving lymph. After the lap, knee looks nearly normal, vert little swelling -- that's the act of walking pumping lymph where it needs to go out of the lower body). After the wash, filled up like a half-arsed balloon... so could be worse, but not even sightline-close to normal... Fewer of the alignments are needed lately (post-plantaris-discovery) to re-seat the knee -- so that little bastard and its mega-tendon's adhesions resisting stretching (esp the ankle dorsiflexing, or lifting toes headward) are undeniably involved in 20% or more of the issue. Am tools-down at what else it could be... but now I'm in the weeds re: exp working w/ hands, since these internal structures aren't easily accessible, if at all. Hence, the imaging. Still getting slowly better... it just hates the weekly (and unavoidable in this dusty-arse place) wash routine. Need that sorted, since the pain's forced skipping a lot of the detail, just to not backslide the knee progress)
Monday, 08 Dec: Made a couple chgs from past wk's routine: climbed and descended a floor using a stairwell. lengthened park lap by about 50% Had to use the loo off the stop, which in the mall is up a floor from my usual parking place. Not really my choice -- ground level, you get homeless traffic around your car plus restricted access to the ramp. 3rd level is where the skyway into the mall is, so tonnes of traffic, vehicle and on foot. Top level's not in shade. So 2nd level, which is a deserted one everywhere but right next to the stairwell to the skyway. Typical of modern Americans, to park where you walk the absolute shortest distance into any place of business. I park next to the only other person on island who agrees, you can still access the mall one level up, just have to go thru Macy's. Which despite its dwindling but persistent cachet elsewhere, seems to hide a tonne of bargains in plain sight, given the 3 - 4 people I ever see in there anymore. Not an obstacle -- it's A/C'd in there, just as when I moved back here >15y ago (and the mall was far more vibrant). Back to the workout. Climbing that stairwell was excruciating, back when I didn't know it was as bad as it is. No more vertical laps, until more basic, healing work were done. But tested the knee on that one flight up and down... and it seemed okay. Not a cue to skip the ramps, but nice to see some progress, as I don't feel I've been too conservative working it out, either. Did my 3 laps on top (which wasn't my best nor worst lap since doing them), then down ramps all the way to ground, then up to the Prius. So far so good... Parking and getting out... felt rather good. Normally the structure warmup leaves me with a bit of soreness / stiffness, which I need to realign the knee to calm down. Now, only a bit of checking and circles w/ the knee, and off I went. There's a spur off the lap in the park trail, that goes somewhere I'd no idea about -- knee felt good enough to explore. Turns out it leads to some bldgs which are part of the larger park complex -- no idea this place had a comm'y pool. Orbited on sidewalks and thru a lot, then across a small dirt field I can only assume would've contained some other facility, but funding ran out. Reconnected to the spur, and backtracked to my usual fork in the road, across a bridge and on around the football fields -- knee still feeling fine. For the first time since discovering the park... knee hasn't ached enough to lean against a strategic lamp post, to reset it. Still felt achy and stiff in that low medial knee... but there was strength in it now, at the end of a 50%-longer park lap, in one section 15%-grade. Good, may be onto something. On that extra excursion, discovered another way the lap can be lengthened, which is to take it onto neighborhood streets. This is a quite pleasantly non-rough part of town, given the police station's within a mile, a major K-8 schools down the street, and most of the residents are Boomers with enough old(er) wealth to keep the neighborhood from becoming a suburb of L.A. like many other parts of Maui have become. So walking around side streets is decidedly less cagey than other places well-known to locals. If it weren't, this park'd be swarming with homeless and the inevitable strata of mischief, meth, and anarchy they bring. So far the only complaint I have, is some cougar's lap dog's been shooting turds all over the far side of the trail whenever they pass thru, and their owner can't be bothered by the responsibility. Who knows if they live in the neighborhood or not... but my money's on yes. Don't let me catch a f***king dog owner not pick up after their crap on a public trail -- my knee will be the only visible part outside their third point But nice workout! We'll be doing this length probably as default -- until of course the knee gets even better: may even think about running again, if I don't in fact need arthroscopy
Tues, 09 Dec: Wow. Have to say, think my body's finally getting the memo re: using the abundant (and actually not-that-much-more-expensive) amts of chicken breast stuffed down my gullet over the last close-to-month. My diet since 2013's panc attacks, have been far more greens / beans than the 40y prior (btw, panc isn't recommended to wait to get, to prove you need your diet chg'd )... so not surprised it's balked a bit at daily animal protein. Would've eaten more plant protein... but have proven time and again, this body likes plant protein for maintenance, not for building parts with (otherwise, why even option for any animal protein; more than a decade cruelty-free's worked fine for me, even thru covid when I were running -- took a year to build my legs back to running 2 x 6:30 miles in a row, tho. Animal protein stresses kidneys and liver far more than plant -- need any proof of effect on performance and homeostasis, watch 'The Game Changers'). First sniff: huh, getting out of bed's not the seconds-long torture it used to be, esp that 1st load, feet on floor. Could feel the old twinge / trickness... but felt somewhat muffled, in... strength? 90d+, have not felt this feeling, but in tiny flashes atop the structure, hmm... Structure: as took the stairwell yesterday for a loo break... tried it again to see what may've changed. And lo, same extra strength climbing stairs. Not as normal-feeling as first trying vertical laps... but better, even than yesterday. Wut...? Laps on top: the same slight wobbliness, until working the plantaris -- then calming to the dull ache low-and-inside patella. But warming the knee also lengthens ligaments, muscle and fascia -- so may be less stable-feeling... which it was. Descendedthe ramps and up one level to the car; status-quo here. Park: same longer route... which by eerie chance met someone who'd gotten a knee replacement 10 mos ago, same leg even Saw them hobbling in the unique gait someone w/ a prosthetic uses, that swing / catch-heel-strike, rinse-repeat. Seemed athletic, so asked their opinion on the surgery. Meh, was the response -- but will take a bit longer than a year before they'll really see, apparently. Am old enough to recognise this meeting wasn't exactly random: in Buddhist dogma, it's called the Law of Affinity Finished the lap... only the plantaris (and its adhesions on that long-arse tendon) were misbehaving towards the 'worse' side of the dial... easily fixed. Could feel my center quads (rectus femoris (superficial) and vastus intermedius (deep)) fire and get a bit exhausted on all downhill descents... so something's getting used to the routine if those major dominants start working again. The intractable and persistent tension in R adductors and hams a month ago, fading to dull roar... only palpable now w/ the steepest ascents. Gawd, what a relief significant improvements are just around the corner
Mostly to document the process of getting this knee back into function; if you want to read along, lots of tips to solving your own soft tissue problems... if not, it's just to keep up with how I'm doing. Besides, a diary isn't dialogue... and this is forum for non-Prius / non-Toyota stuff, so -- Wed 10 Dec: interesting morning: woke up on-time for once (past few weeks have been waking in the wee hours except not to wee ) and got on road to start the day a bit early, ~30 mins. Today's last day to collect fluids for doc appt 7d from now, so had to fast. Hadn't eaten anything from ~2pm yesterday... so well qualified. probably why my sleep normalised, tbh -- lots of meal fluctuations (type, time, amt) were bunging that up... but luckily got good data. Was unusually cool for Dec here (in the high 50s at a hair above sea level). My current town (not my hometown) is known for being 'cold' in the wintertime, since cold air pooled in the crater caldera atop Mt. Haleakala, piles up w/ trade winds, and flows down its rather steep and smooth south and east flanks -- so can be 10 - 12ºF cooler than the rest of the island. Even so -- driving from there into town 15 mis N, where no such collection exists... still rather chilly in the breeze atop the structure. Realise not going to get any sympathy from people living in actual 4-seasons winter (lived in Hokkaido and Bavaria and D.C. and Seattle as many years as some of you have been alive, so quite familiar -- dues were paid in full ). The knee hated it -- had to do a variety of things to keep it calm, to complete laps quickly enough to get it warm and keep it there. Ended up moving the medial meniscus and tibia backwards, which is opposite to what quenches the burn on a hot day. Didn't understand why that worked... until getting to the park. What happened overnight, was slept with one leg -- the bad leg, of course -- slightly bent and falling to the outside, rather than the held-neutral-w/-pillows normally. Perhaps fasting had raised my metabolism, which increases sleep restlessness, historically. So knee were bent and sat splayed cold -- rarely a recipe for a mellow knee by the park lap. Took the unique combination of a long distance downhill over broken surface (park let the grass grow over half the asphalt path downhill, plus tree roots break up and heave it), then immediate medium climb, then whoops of both over 50m. I'd added the steepest climb after that, then a long downhill again over broken ground... then a flat circuit 'rest', ending with a final medium climb out. No matter how many laps I'd do on that structure, wouldn't exercise this knee enough to get the 'sleep splint' out of the leg. Interesting. As before, never had a bum knee... so forgive if this is old news for you fellow gimps out there. Knew ambient baro and temp affect how sensitive they can be, so was a pretty graphic demonstration. Best part is after the longer park lap, the knee continues to feel better by the end. Just what I do w/ it & for how long, will affect results -- can't exercise earlier or later than this window mornings... so happy my fumbling in the first 60d haven't set me back too far
Thu 11 Dec: Christ -- woke middle of the night, knee nagging. Turned out I'd left the room fan on one setting too high (during day hotter than wee hours) and this besmirches my gimp knee's calm, apparently So clicked it down & switched to oscillate... then woke the usual 0530 reveille much better knee-wise... but lacking straight-thru sleep, great Sure enough, knee was pretty cranky. Even on the 20 min drive to the structure (incl'g getting b'fast and drink), was already crying out. This hasn't happened for about a week, so concerned abt this workout. Still doing the staircase climb 1 level to the mall as if going to the loo... but just orbit the upper deck of the mall and circle back. Drop down same level as the car, go down to ground level using the ramp, then up again, all the way to the top. Ulch. Knee wasn't having it; had to align it twice as were beginning to tweak... that warning place, I know stopping to sort wasn't optional. Had to do it one more time in the 5 laps up top (added 1 xtra lap today since a text came in from a client and had to stop to answer, since I'm not a 12yo who can text in their sleep ). Nope, still cranky. Was a bit warmer and a tenth of the edge shaved off... but drove to the park a little hesitant. Oh great -- more county workers were cutting tree limbs and grass there, right around my parking spot. I d u n n o about you... but I hate having sticky sugary grass clippings spat all over my car when wash day's still 3d away... so parked elsewhere. Luckily been familiar with that 'hidden' one in the neighborhood, since part of the add-on to the lap from a couple days ago. No one parked there, okay. Drove over... and down a level lower (around the swimming pool)... a truck of workers were dumping out to trim trees. Gonna be trimming close to my car up there? Nah, should be fine. Ah, thanks... so now could start the lap from this point. Weird -- hadn't thought about that re: knee rehab (well I am already slow and on the ASD/ADD spectrum, which doesn't help ). Really didn't have to lengthen the lap, but just expose the knee to varied challenges at different times, by starting in different spots along the lap. There's even a car park on the opposite side of the lap (don't use it since usually packed w/ pickle-ballers using the tennis courts before work). If ends up helping the knee from this southeast end, why not use a northwest start too? Got to see my prosthetic-legged 'friend' passing thru pool car park too -- just a hello but this time a hello back. Trundling down a 12 - 15% grade did start out sore and 'tricky'... but by the time the ground leveled only 20m away... felt different. Could feel tiny lines of prickly 'coolness' in the knee around the attachment points for the medial-thigh adductors and hams, plus in the knee around the medial meniscus there. So my intuition to 'tough love' the knee, wasn't completely off-base, just had to adjust tqs. Once this coolness faded, the knee began to relax -- which was nice since the next 30m would be all 12 - 15% downward... but flat the 200m after that. Climbing 15%+ at the end of that flat (my usual last challenge) saw the weed-whackers going to town on some overgrowth I endorsed cutting down (about up to your thigh, way too high for a park but county coffers are what they are, in Cheetolini's reign). So rather than stay on the path covered in fling, signed I were going to walk thru the car park, out of the way -- pls continue whacking. Wow, the broken and long downhill to the old drainage stream (my usual first challenge)... was fine. Not as strong as 2d ago but chalk that up to a lack of proper sleep. The very steep hill after, was also not as easy as usual... but the knee felt warmed and non-petulant. Since cresting that big hill were usually < 40% of the lap before I'd switched start points... felt strange entering the nearby car park to see the Prius -- lap over. Very different vibe than the middle start point -- and knee felt great, if still not 100% there. No low-medial stiffness / pain at all. So the trick is to vary the challenges, so the body has something to adjust for, huh? Thought I were still in the 'take it easy, we're still healing' phase. Guess now the trick isn't to lengthen the workout, just give the knee different things to chew on. My guess is this mobilises lymphatic flow using different muscles (I'd also started walking on grass next to the trail, esp up that 15% hill before the middle car park, as people 100y ago here on island, didn't have any paved roads but dirt w/ grass on the sides of them walking to work for the mills -- so why walk on asphalt only? My dad was barefoot until freshman year in HS in the '50s, and he's never had any ankle, knee, or hip issues thru his 80s). In all a pretty good if from-left-field-sort of workout. Live and limp and learn
Fri 12 Dec: Got a good night's sleep, and knee were in good kit today Headed out slightly early... but aw jings, rained last night. Guess the clear autumn days can't last forever. Now come the waves of low stratus & drizzle 3 mos, that's juuust enough to attract grit and dust... & make Sunday wash day more crouching work Yep, same in town. Got drink and grub, drove to the structure. Knee felt strong enough to climb the stairs, tho not very close to how strong it was a month ago. Fuggit, 5 laps around the top level again then. Knee were quite rebellious -- sore and that low-medial pain was back... tho changed in a good way by the end, to spread around the two condyles rather than focus on that one spot. Also felt much more strain in the quads -- which is always a good sign. By the time were heading to the park... leg was warm and loose, but not all that capable. Just this past week felt stronger post-structure laps -- wonder if I were pushing too hard with this extra lap? Drove to the park, and chose the southeast start point. Ah -- the immediate downhill was uncomfy at first... but the knee seemed to like it better each step. Negotiating downhills well, are significant in a knee's recovery... because that's when teakettles get involved, if you've bunged it up. So being able to do these 15% downhills w/o having to sit on curb air-teething 5 mins, that's actual recovery. Whilst rounding the corner to lap the football (soccer for Americans ) field (2nd flat and recovery for the big hill climbing to the middle car park)... saw a minivan stop right next to my car -- not parking, stopped right behind it, as if checking it out. Glared at it whilst walking the long straight... then decided to dbl back, need to see Wth this nonsense was about. Just getting to the foot bridge, drove away -- in a hurry. Mothergrabbers... eff off Up the big hill, and down the bigger one, at the middle start point. Rained so couldn't use the grass... but the path were clear, mostly due to heavy drainage from the rest of the neighborhood (was built on an old collection area with a stream at the bottom... so the only thing keeping this former sand-dune area from washing away, are the mesquite trees lining it. Also means it drains really well, but anything solid gets a torrent of water -- half the path were pristine-clean, the rest filled with red mud and sand drifts, like a river delta or flood plain. By the time the lap were over... felt pretty good. Pain was down to 3 - 4/10, and strength were maybe 85 - 90% of full. Stability is where the least progress' been made, and probably means lasting injury in the knee. But if I can keep this pegleg at least carrying strong muscles and non-adhered joints and tissue... will be way easier if I need surgery.
Sat 13 Dec: Interesting workout today. If you were hoping to read about something what might help your own knee issues, read on... So by now don't need to play-by-play the routine -- you know what I do; unfamiliar, do some reading above. If details chg I'll note them here, but otherwise just wanna talk about things noticed / learnt, & the when & where. A fair bit of pain this AM -- but not upon wake-up / first load feet-on-floor. Mostly going down the stairs to the condo, and getting in the car. On the structure, ramps didn't bother me much... but did notice new things doing the 5 laps on top. First of all, my feet ached by end of lap 3. Something about the variance in the routine's making smaller muscles ache in that post-workout-soreness way -- which is nice since I've not felt that since the accident in Sep. Feeling actual 'workout-workout' pains, and not this trick knee's 'gotcha' stabs of 8 - 9/10... ferf***'ssake, about goddamned time So since lap 5's a cool-down lap, got to take stock of what's actually struggling: Center quads -- hooray, wouldn't be aching w/ muscle-building soreness, if the knee were still too broken to strengthen them. Gastrocs -- finally feeling they're doing more than just splinting... and not being graceful about it either (incl'g the aforementioned plantaris 'wedge' of weakness). Bottom of the feet incl'g the good L foot... man, they're sore and wanting a bit of rest. Good... Park start were from SE again. Initial drop was an improvement, even w/ the sore feet and ankle-crossing muscles... Place your thumbs of both hands an inch below the R patella and 1/2" to either side of the patellar ligament, you find the bony 'shelf' of the upper tibia, where the 'wheels' (condyles) of the femur spin on the menisci attached to that broad surface. Finding where your fingers go, is a bit more involved; pay attention as there's a tonne of things in the back of the knee you should never f*** with. With your thumbs on that forward tibial 'shelf'... reach w/ middle fingers (your strongest) to the edge of the fold of the knee. On the inside (medial side) of the knee, your L middle finger should feel the thick tendons of the medial hams, semitendinosus and semimembranosus. If you venture a bit more towards the thigh centerline back there, can be a guitar-string-like tendon -- this is the semimembranosus. You want to be further away from the centerline of the femur on the inside. R middle finger should land on the thick tendon of the other ham: long head of biceps femoris, which is unambiguous as it's the only muscle in that area. In order to stay away from the deep back of the knee.. you can reach with the fingers and hook each ham tendon by putting pressure headward on their inner sides. However if you feel an electric-shock-like pain doing this on the lateral (outside) ham, attempt later -- your common fibular nerve is adhered to the ham, and may be damaged doing what we'll do to the knee, which requires a bit of hand strength. This is best attempted standing, leaning back against something solid, as you need from ~90º - 135º to full-extension of the knee. Firmly apply 10 lbs pressure w/ thumbs, to the tibial 'shelf'. Use the pads of your middle fingers w/ an equal 10 lbs, to hook and press upward on the tendons in back, which will safely hold the femur in place and allow pressure w/ thumbs to move the big bones relative to each other on their menisci. But first you must separate them before fully-extending the knee -- which is the only time you can shift anything in the knee joint. Standing and bending over... apply this 10lbs as instructed, whilst knee bent ~90º - 135º. Hold this pressure, then w/ heel lightly on the ground, swing the knee medial and lateral about 6 - 8" each way, still holding pressure. If your menisci aren't horribly damaged and can be realigned... they'll respond to the next part. Whilst swinging and holding the knee 'open' w/ your pressure... straighten the knee slowly. Only straighten whilst simultaneously swinging. If you're like my knee, may hear a sickening dull crunchy grinding (like teflon blocks being crushed), then maybe a pop. If not, apply load to the leg slowly by putting your weight on it, and see how the knee feels doing normal movement, like walking. Doing this first thing at the park, improved the knee on downhill loading a lot today. So much so... when the pain happened swapped places: now the uphills were becoming sore (barely in the knee, more in the feet and top of thigh), and downhills more easy and comfy w/ each step. Did the full SE lap, and got to the car a bit tired (quads and feet were burning) but the knee was great. Whimpered a little on esp uphills today... but has been waaay worse. None -- as in zero -- of the muscles splinting for their lives when I began this structure + park journey, were even involved today. So far, the only place the knee really objects to the workout, is on top the structure, first 4 laps... which is warmup. A very good workout today, and will continue to press this knee for results before Feb when my imaging appt is
