Injury frustrations, looking for advice page

[merryish]

I wasn't sure where to put this, so "odds and ends" is probably about right. I'm looking for some advice on how to talk to my new orthopedic doc at my upcoming (8/27) visit.

I've been having heel and knee problems for about a year now. They started last summer. A little background - I'm 41, female, around 290 right now and on the way down at a pretty steady clip. Last summer, the back pain that I'd been having for years abruptly vanished. Almost overnight. I took advantage and dove into a walking program, hoping to get myself a little more fit before the pain came back (I was positive that it would.)

The back pain has never returned. But I dove too hard into the walking. I screwed up my left ankle somehow -- I have pain all around the back of my heel in a U-shape (the back of the heel - not under the heel), and a big painful bump on the outside of the heel just above the heel. I can't stand to wear shoes with backs, which is fine for now but not so fine come winter. About ninety percent of the heel pain comes when I'm pushing off with the left foot; there's a pulling down both sides of the heel (but not the back of the heel). And the other ten percent comes when I dare wear any shoe that touches the bump on the back of the heel. Sometimes the pain is shooting, sometimes it's more of a pull/ache.

On the right side, I've developed a pain at the top of my foot. There's a little hard bump about two inches inward from my big toe, and that's the center of the pain. It feels almost like a knuckle I would dearly love to crack, but the thought of the pain that would go with it is uh, off-putting, to say the least. It feels very badly jammed. Pain when I try to push off with that foot.

And THEN. Because that's not enough, right? I now have bad pain in both knees. Mostly the right, but the left is also problematic. It feels like the exact same problem, only less so, on the left. The right is really, really bad. There's pain above my knee, and also a feeling of tightness - like having a balloon under the skin above my knee and toward the outside when I bend it. There's also pain directly over the inside of my kneecap on that side, just below the knee cap. All when bending, or standing too long.

I have tried... everything. I've been to physical therapy, with ultrasound, with exercises. I've been to a chiropractor for graston - that helped a lot with the heel, actually, it's far better now than it was (but still bad.) I've done ITB exercises I found on the internet. I've been to doctor after doctor after doctor. I was prescribed a boot, which I was not able to wear because of the horrifying pain and pressure against the back of my heel, and after that I basically gave up.

I can't walk more than the length of a hallway without needing to stop, and even that I can only do reeeeeaaallly slowly. When I take a step, and then move to swing my right foot forward for the next step, it feels like my leg is going to come off at the knee, like it wants to bend at weird angles that it shouldn't. I have to put my foot down very carefully because the knee feels completely unstable. I have to go down stairs one at a time, slowly, carefully (though I can go UP stairs just fine.)

I'm getting so much better in so many ways, it's really frustrating to have this holding me back for so long. I've lost 80 lbs, my diet and sleep are completely dialed in, I'm still losing steadily. But I still can't do anything.

And here's what I think is the real problem - I can't get any doctor to actually listen to me. I don't know what I'm saying or doing wrong. It's like they take one look at me and see a 290 lb woman complaining of ankle and knee pain, and say I should lose weight and that I have arthritis. They're not willing to consider any other option, and that's all I seem to be able to get myself treated for.

And I'm just really sure that's not all that's going on there. I've had popping/crackly noises in my knees for a long time, and a little bit of pain, and I know I do have some osteoarthritis. But I'm baffled as to why the pain would suddenly intensify after losing so much weight, or why it would exist mainly in tendons surrounding my knees, or why it would feel more like instability than like an aching or grinding pain. Or why it would all come on at once - from no pain to ALL the pain in ALL the joints - if I haven't somehow done damage by suddenly overdoing it with the walking. And no doctor I've seen wants to look (mri) - or really even touch - to see what's going on in there.

Any ideas? Any secret code I need to use to get the new doc on Monday to believe that there's more going on in there than just being 40 and obese?

[Lewis]

But I'm baffled as to why the pain would suddenly intensify after losing so much weight

Too much too soon I should think. Try rest and ice and it'll probably improve.

Take the rest and give it a chance to get better. I doubt a doctor's going to do much to address such a problem other than surgery or anti-inflammatories or painkillers. I don't think they've got anything else in their toolbox, though I may be wrong.

I don't think you need to hurry into exercise.

Any ideas?

I would take two or three Alexander Technique lessons and see what a teacher can tell you about how you're using yourself. We all tend to develop bad habits over time, holding a little too much tension here or there, leaning forwards or back more than necessary (and stopping ourselves falling over from that with extra tension), having antagonistic muscle-pulls going on. Once you add the excess weight you're still carrying and the additional volume of exercise and perhaps extra hurry, which again tends to interfere with how smoothly you move, I'd think you would multiply the effects of that.

Find a Teacher | American Society for the Alexander Technique (AmSAT)

[merryish]

Thanks, Lewis - I should probably clarify, my big exercise plans died when the knee and ankle pain started. I've been resting and icing for most of the year. I don't do ANY exercise, aside from some very gentle cycling on the recumbent bike in the living room, that I don't absolutely have to. At this point I'm not looking for a way to get more exercise in; I'd just like to be able to walk around the grocery store without wishing for a wheel chair.

I've also been icing everything from the knees down for months, and I've been on frankly excessive doses of anti-inflammatories constantly for a year.

I do think there are other options - actual targeted PT for what's actually wrong would be a huge leap forward for me, I think - I just don't know any way to convince my doctors to look beyond the "Oh, she's fat and so she's got arthritis" automatic diagnosis. If I just have arthritis, I need better pain medication; and if it's not just arthritis, I'd like to be treated for something I actually have.

[George]

I first want to say I applaud your efforts here. I think you have started on something that will pay off a lot in regards to health. Don't give up, and try not to get frustrated.

The pain is frankly because you are loading musculature, connective tissue, and bone that isn't strong enough to handle the 290 pounds being loaded in that dynamic movement of walking, and when you push beyond what it is accustomed to you are inflaming those areas through overuse. You are going through what is known in training as the alarm phase. The body doesn't like what is happening so it revolts. This changes over time, but in your particular case, the time is going to be extended because of the weight. Take it much slower or you can cause injury. Rome wasn't built in a day, a week, or a year. Getting to health from unhealth can take a lot of time.

Walking is good, as is any movement, but have you thought about something to build up the musculature at the same time, such as bands, or free weight/body weight exercises (yes, you can do these even at 290 pounds)? Also if the pain is coming more from one side, have someone watch you walk. Are you leaning to a side. Are you truly walking in a balanced manner? How is your balance on your feet? Can you stand on one leg for 30 seconds or more without losing your balance?

Another idea is swimming if you aren't shy about getting into the pool. In the water there is less pressure on the joints, and swimming is by far a great way to get the heartrate up, while at the same time a good pool (not the warm pool outside, the real cold pool) causes your body to burn more calories because of the transfer of heat from the body to the cooler water from the pool through conduction. Think elite swimmers; they eat 6,000+ calories a day but are lean. Their bodies have to burn a ton of calories to maintain temperature in those cool pools (real swimming pools aren't warm at all).

I'd really take a look at the foods you are eating and dial in on making healthy choices. The body is going to move towards balance, but you have to train and eat for the balance you are looking for. Losing a lot of weight is awesome, but you have a long way to go to have your weight in line with what your body can truly handle.

Best of luck, hopefully my jabbering helps.

[The Return of Dado]

Injuries? Maybe you pay too much attention to discomforts that you are able to safely ignore.

[merryish]

Uh.... Dado, if in the space of one year you went from being able to walk a mile and a half with ease to not being able to make it down a grocery aisle without intense pain and feeling like your leg was about to swing out of true and come off at the knee, would YOU ignore it?