Knee Problems historical posts June 1998

repair of cracked or broken Patella

Posted by Taylor Riley on June 03, 1998 at 20:49:31:

Dear Dr. Stoll, I recently fell on my left knee cap. I hit hard on a stone while wading in a river. I fear it may be cracked pretty badly because of a sensation that burns when my knee is nearly fully bent, like as I get to mid squat and beyond. It feels as if the tightening skin around my knee cap is causing pressure that flexes the crack. Im wondering what you might suggest to heal the crack. I work in a prosthetic lab and have begun to wear a neoprene knee brace my friend/boss gave me, with side stays and knee cap cut out. I feel better but was wondering if this is stable enough to allow the bone to knit? Thanks! Taylor


Re: repair of cracked or broken Patella

Posted by Walt Stoll on June 05, 1998 at 11:47:23:

In Reply to: repair of cracked or broken Patella posted by Taylor Riley on June 03, 1998 at 20:49:31:

Dear Taylor,

Hoh long ago? Any "crack" in a bone will lose calcium (thus enlarging the crack) for at least a couple of weeks. This is why you should have an xray to see. If there IS a crack, the patella should be immobilized to keep it from falling apart. THEN, you would REALLY have a problem.

NO responsible trainer recommends squats any more. Especially with this kind of injury, you are doing yourself harm to do them.

Your most likely diagnosis is a bruise of the patella with bleeding under the capsule. If that is the case, time is the only thing that will help a lot (about 6 weeks)--unless you kneel on it or do squats.

Questions?

Walt



Re: repair of cracked or broken Patella

Posted by Taylor on June 05, 1998 at 21:29:21:

In Reply to: Re: repair of cracked or broken Patella posted by Walt Stoll on June 05, 1998 at 11:47:23:

Thanks for the info! In response to "how long ago?" I fell on it about 5 days ago. The squatting I was refering to was actually just the motion not excersises. I'm going for an x-ray tommorrow so we'll see. What sort of options are there for immobilizing a knee cap? It seems pretty difficult short of casting my leg. I have a sense that your suggestion of a bone bruise is probably closer to the reality, though I'm not experiencing any swelling or discomfort unless I flex the knee past 90 degrees, thats when it feels like a burning. The x-ray will tell for sure though. I appreciate the common sense answers. Thanks again, Taylor


Re: repair of cracked or broken Patella

Posted by Walt Stoll on June 07, 1998 at 12:29:21:

In Reply to: Re: repair of cracked or broken Patella posted by Taylor on June 05, 1998 at 21:29:21:

Dear Taylor,

The weakest time for a fracture (after the calcium has been resorbed in preparation for healing of the fracture) is at about 10-14 days. I am glad you are getting the xrays.

Bending the knee past 90 degrees is the problem. How much weight you apply to do that is but an aggravation of that mechanism. I am glad that you are not doing full weight flexing (squats) but even bending it past 90 degrees causes aggravation of this condition.

Let us know what you learn.

Walt



Re: repair of cracked or broken Patella

Posted by Taylor on June 08, 1998 at 20:00:30:

In Reply to: Re: repair of cracked or broken Patella posted by Walt Stoll on June 07, 1998 at 12:29:21:

Hi Dr. Well the x-ray said everything is in one piece and the Dr. I saw suggested the bone bruise too without knowing of your prior suggestion. So I guess its just a matter of letting my body do its work, while I tone things down in the knee bending department. Thanks again for your informative help, I wont hesitate to write again with questions. Sincerely, Taylor Riley


Torn Cartilage -- Drs. Stoll & Ferguson

Posted by Antonio on June 24, 1998 at 21:22:55:

Dear Drs Stoll & Ferguson:

Just a brief not to update you on an item that may be of significance to Dr. Ferguson.

Today, I had Chiro # 3 do both a McMurray (for medial meniscus) and an Apley compression tests on my bad knee, as described in the link below, and both of them were negative (no pain). Chiro # 3 had done the Apley test when I started with him in May and was also negative them. I wanted him to do these tests now to have a comparison point with the patient from the article of the Activator Co, who had a positive McMurray test while she was in pain.

I plan to continue with Chiro # 3. We plan to have weekly adjustments for 4 to 8 weeks and then decrease the frequency as in the activator article. (I should confess that curiosity made me go to Chiro # 4 for a couple of times, but did not find his adjustments any better to those of Chiro # 3. Chiro # 4 also wanted to have more frequent treatments plus "electrical acupuncture".)

The knee still hurts but I think it is somewhat better. The ""vacation"" experience with multiple stairs and plenty of walking did not hurt it much. I also got real sick the last day and since I am back I have not been feeling like doing much. So, this is inactivity is probably helping the knee. When I get better I will start some walking like Dr. Ferguson recommends. Chiro # 3 is still recommending the stretching/strengthening exercises. (I have not told him he is nuts for this. Hopefully in 4 to 6 weeks I can continue doing these exercises).

Lastly, yesterday I ordered the Traumeel homeopatic ointment (for the knee) that they used in the article from the Activator Co. I guess it is one of those things that "it can't hurt and it may help some...".

Dr. Stoll, thanks for the skilled relaxation suggestion to increase the good cholesterol. However, at this moment, I don't have time for skilled relaxation (sounds terrible but is true), however, retirement time (from my main job) is coming soon (maybe this year)and as soon as I retire I will put skilled relaxation at the top of my priority list.

Will keep you informed. If you have any comments or suggestions please let me know.

Best regards to both of you,

Antonio





Re: Torn Cartilage -- Drs. Stoll & Ferguson

Posted by David Ferguson, D.C. on June 24, 1998 at 22:39:01:

In Reply to: Torn Cartilage -- Drs. Stoll & Ferguson posted by Antonio on June 24, 1998 at 21:22:55:

1. Thanks for the article. I really enjoyed it. Much appreciation to you.

2. Glad to hear that objective testing is showing improvement in your knee. Hopefully this will progress.

3. There is no way for me to say this nicely so I'll just say it and that will be that. Saying you don't have time for skilled relaxation is like saying you don't have time to get better. Skilled relaxation takes only a short amount of time. Starting out with two 10 min sessions (surely you have 10 minutes when you first wake up and before you go to bed) would be a good idea. The connection between your bodies innate ability to heal is directly tied to the mental benefits of skilled relaxation. When you decide to start walking spend some of that time doing skilled relaxation. The skilled relaxation will serve you much better. In terms that a fitness guy like you can appreciate JUST DO IT!

Knowing how to get started isn't always easy so I'll give you my personal take on it. What is the one thing you need most? That is what you concentrate on.(look away and think of 10 things that you really need in your life right now) You can think of 10 things that you THINK you need but you would probably not come up with the one true answer. This thing you need, you can probably go 2 minutes without. Your brain can only go about 3 minutes without. Air. Air. Air. Feel the air go in and out of you. Concentrate on that like it's the best movie you have ever seen. When your mind wanders don't force it back but gently bring your thoughts back to your breathing. Starting is that simple. Do it for 5 minutes right now. Be well.


I Welcome Your Advice

Posted by Antonio on June 25, 1998 at 22:35:47:

In Reply to: Re: Torn Cartilage -- Drs. Stoll & Ferguson posted by David Ferguson, D.C. on June 24, 1998 at 22:39:01:

Dear Dr. Ferguson:

Thank you for your reply and advice of last night. I welcomed it and you did not have to apologize for it. I don't see how can anyone not welcome comments like the ones you gave me. To be honest with you I am also pretty straight out and tell it like it is.

Yes I do have 10 minutes twice per day for the skilled relaxation, and so far I have done 3 sessions (one last night after I read your message and 2 today) per your method. They have been 5-6 minutes long (and the time goes fast). When I get to the 10 minutes for a while I will ask my library to get me again the workbook recommended by Dr. Stoll's book: "The Relaxation and Stress Reduction Workbook by Davis, McKay etal". I got that book here from my library a few days before and after my vacation. I just took it back this week.

Question: Do you have any recommendation for the breathing while doing the skilled relaxation. I have been between breathing normally and breathing deep and then releasing the air slowly.

My not having time for it now came after I got the skilled relaxation workbook and seeing all the different possibilities to practice skilled relaxation. I also had a little bit of skilled relaxation about 12 years ago as part of a Stress Management Class. The skilled relaxation part of that class involved a 30 minutes exercise, lying down (so you do not get hurt if you fell asleep). You contracted and relaxed every muscle of your body and then took a trip (via tape) to an imaginary paradise where all your muscles were completely relaxed. They recommended NOT to do it after 8:00 PM for fear that the energy boost you got from the exercise will keep you awake at night. So, you see, at this moment I did not want to invest the time and effort I thought was required to master the skilled relation per the Workbook or per the old class I took.

If Dr. Stoll makes a 2nd edition of his book it will be good to put a page with a summary of the method like you described it to me so that people will not be afraid of the difficulty of getting started

Well Dr. Ferguson, thank you very much again for your skilled relaxation advise. I will update you and Dr. Stoll regularly on how I am doing with both the knee and the skilled relaxation.

Best regards to both of you

Antonio


Re: I Welcome Your Advice

Posted by David Ferguson, D.C. on June 25, 1998 at 23:37:15:

In Reply to: I Welcome Your Advice posted by Antonio on June 25, 1998 at 22:35:47:

"Question: Do you have any recommendation for the breathing while doing the skilled relaxation. I have been between breathing normally and breathing deep and then releasing the air slowly."

I think that one of the mistakes made by so many books regarding this is that they try to break everything down to its parts. Western thinking always seems to mess everything up. They always want to create a formula because we ask for one. Soon the whole thing becomes so complicated that you read two pages of the book and go 'well to hell with this, I didn't know it was so complicated'. If they make the book short and sweet then people will either not buy it or think 'woopdeedoo, 3 pages, I'll read this while I'm standing in line to buy this other book'.

Skilled relaxation is a destination and a journey. Just like life, we all take different paths. My path may not be exactly like yours and yours not like mine. Like feeling a hair beneath a piece of paper the destination of skilled relaxation is a subtle thing. At first you think 'well I think I got there but since no one can explain it exactly, then I may just be wasting my time'. After a while you go 'yep there it is'. The only objective way I am aware of to KNOW if you are there is through biofeedback(as you know from Doc's book).

Point being, find your own breathing. I personally like a few deep breaths at the beginning. It seems to shake out some "interanl cobwebs". I then try to get into a very comfortable position and focus on relaxing every muscle, starting at the toes and working my way up. I seem to find places that I didn't even know I was tense. It almost feels like I'm paralyzing each new point I reach. When I get to my head I feel a "hood" pulled over it and focused down to my nose where the air is going in and out. I focus on that breathing(normal breathing). That's MY formula, but it doesn't have to be yours. One thing that I have noticed is that I rarely feel like I am falling asleep. What I do feel is similar to being hypnotized. (Side note: I was hypnotized once and led to do some strange things as part of a stage type show, I was "brought out" wrong and too fast and it left me in a 2 hour state of paranoia. Something I don't want repeat and have never experienced with skilled relaxation) Anyhow, I seems to me that if you do actually fall asleep that you are either not really concentraing on your breathing or you need some sleep BAD.

Experiment with your own method. Use mine as a starting point if you like but don't be afraid to mold it to fit you or throw it out if you find a better way.


Re: Torn Cartilage -- Drs. Stoll & Ferguson

Posted by Walt Stoll on June 26, 1998 at 12:05:25:

In Reply to: Torn Cartilage -- Drs. Stoll & Ferguson posted by Antonio on June 24, 1998 at 21:22:55:

Dear Antonio,

Please let us know when you do find the time for the skilled relaxation if, as I suspect, you will say: "Why in the world did I put this off so long?"

The feeling people have that they do not have time to do this skilled relaxation is based upon the fact that they have never done it.

Unless the technique is "effective" by the definition in my book & on this website, it is not worth doing. As soon as an effective technique is used, one quickly realizes that it IS 24 times as effective as sleep. Within a week, the individual is sleeping a lot less minutes that both times a day practicing the technique is taking. One has MORE time rather than less.

Besides, the very best time to do it is on arising, since the technique is 24 times as effective as sleep, anyone getting up a half hour earlier to do it is much more rested at the usual time of arising than they would have been if they had stayed asleep till then. That means they only have to find one more time a day to practice in order to get all these "wonderful" benefits.

ANYONE who cannot find 20 minutes a day for themselves needs to consider what they are doing with their lives and NOT to wonder why they have many stress-effect related conditions.

Sorry, Antonio. I just couldn't resist the opening you gave me!

Namaste` Walt



Re: Torn Cartilage -- Drs. Stoll & Ferguson

Posted by Walt Stoll on June 26, 1998 at 12:09:20:

In Reply to: Re: Torn Cartilage -- Drs. Stoll & Ferguson posted by David Ferguson, D.C. on June 24, 1998 at 22:39:01:

Thanks again, Doc Dave.

I would like to make one comment, however:

Doing one of the relaxation times within 2 hours of retiring will not do the job. One needs at least twice a day NOT counting any done within 2 hours of retiring.

Once one is well, one can cut to once a day in most cases. To resolve a condition, the least I have seen that reliably does this is 20 minutes twice a day.

Walt



Re: I Welcome Your Advice

Posted by Walt Stoll on June 27, 1998 at 09:55:58:

In Reply to: Re: I Welcome Your Advice posted by David Ferguson, D.C. on June 25, 1998 at 23:37:15:

Dear Doc Dave,

Once again you are saying what needs to be said.

Thanks, Walt



1998: May Jun

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