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
