Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain by Richard Bedard Page B
Authors: Richard Bedard
Tags: Health
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measurement (zero, one, two, three, four)? Instead of rating a location a “three,” for instance, what if they could measure the equivalent of inches in our height example above?
If so, a 3.3 defect that changed to a 3.1 would count as an improvement, whereas under the old scale, both 3.3 and 3.1 were considered “3.” Simply because of this greater measurement precision, and for no other reason, the number of observed subjects whose cartilage got better somewhere in their knee joint will rise. (Of course we also must accept the corollary: more of them will be found to have a worsening at some area in the joint too.)
All this may seem a bit arcane or tangential. However, it’s very significant. A five-point scoring system isn’t that precise at all. Had the researchers possessed better technology and more confidence, they might have expanded their scale to accommodate fifteen different grades, fifty, or even one hundred.
The implication is worth pondering. Knee cartilage may conform to a very dynamic model, constantly changing both for worse and for better. I found that very heartening. It struck me as a cutting-edge view.
Advances in high-tech imaging will be critical to settling the matter. It’s risky and unethical to slice open living knees just to satisfy scientific curiosity, so we depend on machines to peer inside the joints. At this point, it appears the heavy lifting will fall to the MRI scanner, a relatively recent invention.
The first X-ray image dates all the way back to 1895; the first MRI scan of a human subject didn’t occur until 1977. Three years later, the first commercial MRI machine was manufactured. A couple of decades after that, the technology became widely used in clinical studies of cartilage and osteoarthritic joints.
Further refinements in magnetic-imaging technology may reveal surprises in how knee cartilage changes over time. At least two studies using MRIs have already spotted one puzzling trend: the worst cartilage defects stand the best chance of getting better!
In one study, published in 2006, Australian researchers tracked changes in the knees of eighty-four healthy people. Various locations in the joints were graded using the standard zero-to-four scale. The subjects started out with a total of nineteen spots of really bad cartilage that scored either a “three” or “four” (meaning that the tissue was at least half worn away, or even gone altogether).
Amazingly, over a two-year period, these sites recovered the best. More than half of them improved—one went from bare bone to full thickness. About a fifth stayed the same, and about a quarter got worse.
That blew me away. In fact, there was a lot of information I uncovered that really buoyed my hopes. Cartilage could become stronger. It could also thicken over time. And if it was completely worn away at a certain location, it could even regrow again and often did.
Later, it occurred to me that I shouldn’t have been so astonished. Why shouldn’t cartilage be able to heal and adapt? The rest of the body does. I play guitar, so the skin on my fingertips thickens into calluses to withstand the pressure of the thin metal strings. Astronauts in outer space rapidly lose bone density from living in a weightless environment.
With my newly gained knowledge about how knees work and how cartilage can improve, I felt more confident about charting a path to recovery. At last it was time to devise my own experiment to get better.
8 The Experiment
It wouldn’t be easy to develop a plan to heal my knees. For one, I would have to make a realistic appraisal of my condition and think deeply about what I reasonably could and couldn’t achieve. Also I’d have to find some suitable exercise to put in motion a pair of knees that didn’t like doing much of anything.
But first, there was one nagging, unresolved matter to confront: after reading a mound of scientific studies, did I really know what I thought I did?
All
If so, a 3.3 defect that changed to a 3.1 would count as an improvement, whereas under the old scale, both 3.3 and 3.1 were considered “3.” Simply because of this greater measurement precision, and for no other reason, the number of observed subjects whose cartilage got better somewhere in their knee joint will rise. (Of course we also must accept the corollary: more of them will be found to have a worsening at some area in the joint too.)
All this may seem a bit arcane or tangential. However, it’s very significant. A five-point scoring system isn’t that precise at all. Had the researchers possessed better technology and more confidence, they might have expanded their scale to accommodate fifteen different grades, fifty, or even one hundred.
The implication is worth pondering. Knee cartilage may conform to a very dynamic model, constantly changing both for worse and for better. I found that very heartening. It struck me as a cutting-edge view.
Advances in high-tech imaging will be critical to settling the matter. It’s risky and unethical to slice open living knees just to satisfy scientific curiosity, so we depend on machines to peer inside the joints. At this point, it appears the heavy lifting will fall to the MRI scanner, a relatively recent invention.
The first X-ray image dates all the way back to 1895; the first MRI scan of a human subject didn’t occur until 1977. Three years later, the first commercial MRI machine was manufactured. A couple of decades after that, the technology became widely used in clinical studies of cartilage and osteoarthritic joints.
Further refinements in magnetic-imaging technology may reveal surprises in how knee cartilage changes over time. At least two studies using MRIs have already spotted one puzzling trend: the worst cartilage defects stand the best chance of getting better!
In one study, published in 2006, Australian researchers tracked changes in the knees of eighty-four healthy people. Various locations in the joints were graded using the standard zero-to-four scale. The subjects started out with a total of nineteen spots of really bad cartilage that scored either a “three” or “four” (meaning that the tissue was at least half worn away, or even gone altogether).
Amazingly, over a two-year period, these sites recovered the best. More than half of them improved—one went from bare bone to full thickness. About a fifth stayed the same, and about a quarter got worse.
That blew me away. In fact, there was a lot of information I uncovered that really buoyed my hopes. Cartilage could become stronger. It could also thicken over time. And if it was completely worn away at a certain location, it could even regrow again and often did.
Later, it occurred to me that I shouldn’t have been so astonished. Why shouldn’t cartilage be able to heal and adapt? The rest of the body does. I play guitar, so the skin on my fingertips thickens into calluses to withstand the pressure of the thin metal strings. Astronauts in outer space rapidly lose bone density from living in a weightless environment.
With my newly gained knowledge about how knees work and how cartilage can improve, I felt more confident about charting a path to recovery. At last it was time to devise my own experiment to get better.
8 The Experiment
It wouldn’t be easy to develop a plan to heal my knees. For one, I would have to make a realistic appraisal of my condition and think deeply about what I reasonably could and couldn’t achieve. Also I’d have to find some suitable exercise to put in motion a pair of knees that didn’t like doing much of anything.
But first, there was one nagging, unresolved matter to confront: after reading a mound of scientific studies, did I really know what I thought I did?
All
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