Pain Days

For the last few days I have had more pain in my knees and my feet. Not in my hip, fortunately. When I wake in the mornings and do the bed exercises I find the first ones quite painful because I am so stiff and in pain.

Today I felt like skipping the gym and I think I could have justified it, but I know that, as they say, that way lies disaster. I can miss a day now and then but I have to get back to it quickly.

Here's the thing with me: I don't seem to develop habits. Good habits, that is. I have the habit of reading my life away. I have the habit of eating when I watch television. But when it comes to things like brushing teeth or doing exercises I have to decide every single day to do them. It doesn't happen automatically. So if I miss several days in a row I'm surely in danger of missing a lot more. Today I felt sluggish and in pain and I had to talk my way through the fifteen minutes on the bike, but I knew I had to get through it. I have learned that it is important not to give in to those bad feelings too often.

Consumer Reports Agrees with Me (generally)

I got an email from Consumer Reports Health today, that included a blurb about knee arthritis. It said exercise helps knee arthritis but the jury is still out on whether it helps hip arthritis. I went to the site to read the whole article and discovered that I have to subscribe to that particular division of Consumer Reports to read it. I had not subscribed before ($19 a year) because it seemed the health advice was similar to what is reported elsewhere.

However, Consumer Reports has no ties to any commercial interest. Along with Best Pills, Worst Pills, then (a division of Public Citizen, an old respected consumer organization), it is a source that can be trusted, as far as it goes. So I went ahead and subscribed today.

In part, the article notes:

Do they work?

Yes. If you have osteoarthritis of the knee, exercise can reduce your pain and disability and help you lead a more normal life. We're not sure how well it works for osteoarthritis of the hip.

Other physical therapies, including applying superficial and deep heat or applying ice, are popular for dealing with osteoarthritis. But there isn't any good evidence that these treatments help, although they might make your joint feel better for a short time.

What are they?

Exercise for osteoarthritis can be either general exercises for your whole body, like walking, swimming or aerobic exercises, or it can be specific exercises for the joint that is troubling you. The best specific exercises for the knee may be those that strengthen the muscle at the front of the thigh.

There are many different exercises that may help your osteoarthritis. You should discuss what might work best for you with your doctor or a physical therapist. An exercise program may include strengthening and stretching exercises.

The article then offers a couple of examples of exercises that help:

Knee exercises

These are strengthening exercises for the muscles at the front of your thighs. In one exercise, you lift your leg straight up in the air. You do 200 of these straight leg-raises a day. Your knee joint doesn't actually move, but you strengthen the muscles that support it.

Resistance exercise

You lie flat and lift your heel straight up until it's 12 inches off the ground. You bend your foot up and down and side to side in a T shape, and you repeat this pattern three times.

Resistance exercise may help your osteoarthritis.

You may then move on to an exercise in which you stand against a wall and slide so your knee is bent to 30 degrees. You hold this for 10 seconds to 15 seconds and repeat three times.

General aerobic exercise

This form of exercise is designed to make you more fit overall. It improves the ability of your heart to pump blood around your body and the ability of your lungs to take in air. It can help you lose weight and feel good about yourself. Aerobic exercise should increase your heart rate (your pulse).

These exercises are similar to (but not identical to) some that I do every day.

The web page includes the evidence, something I am always wanting. I can look up the actual studies and the conclusions.

Lately I have become a little discouraged and have even missed one day of Aqua and part of my evening exercise routine. But I am calling that a break and moving on, fully charged. There is no sense in regretting what I have not done, because it is past. My next goal is to pull together all of the pieces and describe here exactly what my routines include now. At times I forget myself!

A Walk

Today I went on a Walk for Farm Animals. This is a walk to raise awareness of the plight of farmed animals, and it is the third year in a row that I have done it. Our local walk simply makes a loop around the downtown area, and takes about 45 minutes. With stopping at stoplights it takes a while to get anywhere. I'd guess the route is about a mile or a little more.

I was still in some pain when I got to the start of the walk. I had just returned from a trip south last night, driving both ways, and trips do make me stiffer than usual. Still, I thought I would relax a bit and get more comfortable as the walk went on. It didn't. It was painful from start to finish. I focused on walking on the inside of my feet and holding myself as straight as I could but it was clear I was limping a little and that I was in pain. I had really hoped that by this time I would be walking more easily but it is not to be.

I have been reading a book about the lives of some individual farmed animals who were rescued. Because of the way chickens and pigs are bred, they gain weight rapidly and their bones cannot take the weight easily. The factory farms where they are raised are not concerned with this condition because they slaughter the animals when they are still babies - six weeks to six months old. But the lucky ones, the ones who are rescued, are left to suffer with the results of this breeding. Turkeys, chickens, and pigs reach a point when their fragile bones cannot support their weight. The hens are further depleted by the egg-laying. A factory-farm hen lays several times as many eggs per year as a hen who has not been bred for this purpose, and the laying depletes the calcium in their bones.

Thus all of these animals have trouble walking, too. I can relate. I don't carry as much weight as they do relative to my bones but I can relate.

A Fourth Meeting with Clara

On Thursday, October 7, I met with Clara again. Clara is the trainer at the gym who has been helping me build my strength where I need it to counteract the effects of arthritis. I showed her the new exercises given me by Paul, the physical therapist, and I told her that overall I felt I was at a higher level, experiencing less pain in general, than I was when we first met in April of this year.  We went upstairs to the weight room area.

She showed me a machine where I could the new hip exercises, using a band around my ankle and weights.

We discussed the sitting and standing routine, and decided I could do that on the high box that sits in the weight room area. I can also sit on that box to do the raising and lowering of my leg, with ankle weights.  Unfortunately, the gym does not have ankle weights so I will need to find mine and bring them with me.

Finally, I asked her about alternative ways to do some of the things I am doing already. She showed me a new way to do lat pulldowns, sitting on a large ball, thus efficiently working the sitting and standing muscles as well. I also learned how to do the compound row using a different machine.

I will continue to do the remaining exercises as before, except that I will alternate using the different machines for lat pulldowns and compound rows.

In the last few weeks I have lowered the weight on some things and raised it on others. I felt I needed to keep it down more on the leg press so that I could focus more on keeping my knees apart.

Since meeting with Clara I have done the new routine a few times. I found I rather enjoy using the new machines. They are a little different in how they work so they probably work my body a little differently, but also just manipulating different machines gives me more a feeling of mastery, and I am more likely to find machines I can use when I travel.

At this time I am doing the rising and lowering to a seat rather sporadically. I think I need to work in at least one time a day when I do that consciously, regularly. Similarly, I haven't gotten the sitting leg raises and curls with ankle weights in at all, because I haven't found my weights.

The visit with Clara took only a half-hour. We will meet again if I feel the need or after my next visit with Paul. So far this way of adjusting the routine is not turning out to be costly for me, which I appreciate. I don't need anyone holding my hand or walking me through the routines regularly, as I can pick up and do them myself. I can also adjust as recommended.

The Foot Pain

Today the foot pain was gone when I woke up. I think this pain is the gradual manifestation of arthritis in my foot.

So my getting around was better, my walking was better. Even standing was okay. Not that I did a lot of it, but I did it with my weight toward my big toes rather than the outside of my feet.

Right Foot Pain

For the last few days I have been happy to adjust my walk by putting my weight on my heel, then moving to my big toe and the big toe "knuckle".  Most of the time this means I walk deliberately and perhaps a little slower but the pain is less than it was. Or at least it seems that way.

This morning I woke with pain in my right foot. I managed to get down the hall to feed the cats but the pain was hard to manage and did not get better. By the time I finished my morning exercises (on my bed) and brushed my teeth and got dressed, the pain had subsided some, and my foot did not seem too bad by the time I got to the gym. However, it surged again on my way out the door and as I prepared for sewing class. It was with me throughout the class, causing me to limp to some extent. I still tried to walk the right way but I was not rewarded with less pain.

The pain is on the right side of my foot, toward the heel but in front of the ankle, and radiates through that section, from bottom to top. The top seems to be the most painful.  When I point my toe the pain worsens.  I haven't found a position that takes the pain away. I might even indulge in some tylenol for the first time in quite a while. 

At the gym I did not do my usual five and a half minutes on the treadmill, because no treadmills were available each time I looked. So I do not know if walking on it would have helped or hurt.

Learning to Walk Again, and Other Stories

not my knees but they could be

I have been trying to put my finger on what especially disappointed me about my last visit to the physical therapist. Paul answered any questions I had but I did not know what to ask, perhaps. As I thought about it later I realized I wanted more of a "test". I wanted to know more about what I have accomplished, and the tools at Paul's disposal would not really give me that. I have thought about this some more and figure eventually I will get a complete physical, or at any rate a near-complete one, perhaps when I first can start on Medicare, which is next January.  That won't tell me where I've been but it will provide a marker for the future.

In the meantime I have been trying to work in the new Paul exercises. I haven't done all of them yet even and I haven't worked out when I will do them or how often. I am thinking I'll blend them with my morning routine eventually, but I will also fit some in throughout the day.

One of the new exercises is the rising from a chair one, without hands. I have been doing that somewhat randomly, as it occurs to me and when I am in the right frame to do it. I have found that if I have been sitting for a while it is going to be too painful. So when I am near a higher chair or the bed I try it then, a few times up and down.  This is going to be tremendously important as time goes on. As I am better able to rise and sit without hands my life is going to be different, better.

Similarly walking. I have been trying to focus on my steps every time I walk now. At first it was awkward but it is getting easier and it seems to be causing me less pain. I sometimes think of myself and "my new legs", feeling such hope that as I adjust my gait the pain will gradually lessen and again my life will be better.

None of it is instant. Wouldn't it be wonderful if Paul said, "Have you tried X?" and I try it and say, "Wow!! I can walk without pain now!" No instant therapy here. Yet I feel these latest exercises are coming closer to what will really help and I will see a difference, I will be able to tell maybe in a month.

Second Time with the Physical Therapist

This morning I met with Paul, the physical therapist, for the second time. It has been about two and a half months since we last met. I hoped to see clear positive changes from the work I've been doing.

There were some, but they are small. I should have expected that because Paul said it would take a long time for changes to be measurable. The positive changes were in the range of motion for my knees. They have both increased. There may have been improvement in other areas as well, but not as measurable. The alignment of my knees is just about the same. As Paul said, "It's not worse!", which is true.

I felt a little deflated that there wasn't some huge improvement that was magically measurable. But we moved into additional areas and I see some real potential for improvement here:

* Paul showed me how I should be walking on my feet. I told him my feet felt off-balance and he watched me walk and showed me what I need to emphasize. I need to start with my heel and then move to my big toe and the "knuckle" of the foot. I have been walking more on the outside of my foot for so many years I can't remember any other way. As soon as I tried walking the right way it seemed that walking was less painful. It takes a bit more effort so I don't see this changing overnight. But now I am aware of specifically how to place my feet and this will make a difference.

* He showed me a "test" for rising from a chair. It involves rising from an 18"-high chair with arms crossed in front, continuously for 30 seconds. That is, seeing how many times one can rise from the chair in 30 seconds. I did it six times. The average for my age is about 12 - 15 times. So that's my goal, get to average. And to get there I will start out with higher seats and rise very slowly and lower very slowly. Honestly, I was surprised that I could get up that way at all! I think some of the exercises I have been doing have started to give me enough strength to do so, and I am very encouraged and even excited about this. Getting up from a seat without using my arms is something I have wanted to be able to do for a very long time.

He gave me more hip exercises that I can do with resistance bands, and something for my knee - unfortunately, we forgot to get me copies of that exercise. I will have to ask. Let me see if I can remember, though:

Sit on a high surface and place a weight on my ankle. Let it swing comfortably for a bit, then raise up and hold, then bend inward and hold. I think this one is to extend the range of motion of the knee.

My next step, then, is to make another appointment with Clara and discuss these new exercises with her so we can work out changes to the gym routine.