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Fitness Epiphany

To people who know me, it's no secret that I have arthritis in my knees and it gives me screaming fits. I went to see my orthopedist on the 14th for my yearly SynVisc shot (it lubricates the cartilage and is supposed to slow down the wear and tear). He ordered new x-rays of my knees and I got to see them - the right one is much worse than the left one, which I knew, it's the one that hurts and swells when I have to walk or stand.
I was diagnosed with arthritis in that right knee when I was 34, after I fell on it and had to have it drained because it swelled so badly (they drained almost a cup of fluid/blood out of it). In the ensuing 24 years, I've been prescribed ibuprofen, Voltaren, Naproxen, and now Celebrex. At no time have any of the doctors I've seen ever suggested physical therapy or exercises to strengthen the muscles that support my knees. They have, however, every one of them suggested weight loss. And before I found FA, I thought they might be right, and I tried their diets (and we all know where that leads, right?). I even had a nurse practitioner who suggested WLS because (according to her) no surgeon would replace my knees at my then-weight of 350 lbs (and I believed her, did it, lost weight, gained it back plus some more, and got some lovely complications to boot).
Then I realized dieting/WLS wasn't the answer, was compounding the issues with my health, and started looking for different answers. I found fat acceptance, then I found HAES, and I started reading (what else do bookworms do when they find a subject that interests them and is going to have a huge impact on their life?).
The epiphany part of this whole story comes in when my orthopedist told me that every pound a person weighs puts 7 pounds of pressure on their knees, and that losing weight would help my knees. I told him I'd already dieted my way up to where I am now, and had WLS and "see how successful that was?" I'm thinking I have to be proactive here, he's not going to come up with any suggestions to help me, so I have to think of something, so I asked him "What about exercises to strengthen the muscles that support my knees? Would those help? Would that delay having to have my knees replaced?" Can you believe it? He actually said that it probably would, and he would write me an order for physical therapy so they could show me what exercises to do and how to do them.
Now, I've been seeing him for the last 4 years, why couldn't he have suggested this 4 years ago? That's 4 years I've not been working on making my muscles stronger, and it's 4 years that my knees have been getting worse - all because the only thing he could recommend was weight loss.
I went to physical therapy on Friday, talked to the therapist, she looked at my x-rays (I also have some bone spurs in there, no wonder my knee hurts). She gave me a list of 4 exercises to do, showed me how to do them correctly, and I have to go back in 2 weeks to check on my progress and see if we need to add more. I also found out that I over-extend my knees when I straighten them - a result of the degeneration from arthritis.
I didn't know how badly out of shape the muscles in my right leg were until I started doing these exercises - my left leg is fine, doesn't hurt when I'm done. But my right leg is another story, and I'm only doing 1 set of 5 reps right now (twice a day). As soon as the pain decreases, I'll increase to 2 sets twice a day, then I'll go to 2 sets of 10 reps twice a day.
Now, I hate exercise, I have to put that out there. I've started and stopped more exercise plans than I want to count, but every one of those plans was designed primarily for weight loss and if I didn't lose weight while doing it, well, that wasn't being successful. So these exercises aren't designed with weight loss in mind - strength is the goal, less pain is the goal - those are goals that are definitely more achievable than weight loss. That's something that should have been given to me 24 years ago, when I was first told I had arthritis in my knees - strengthen the muscles supporting the knees, and there will be less wear and tear, less pain, less need for medication. Why aren't doctors telling this to fat people? Why do thin people with arthritis get physical therapy and all kinds of other advice, but fat people with arthritis get told "Lose weight, it's all we can do."?

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shinobi42 February 20th, 2012 | Link | Ugh and Yay

Ugh that it took your doctor so long to make physical therapy an option. Yay, on the other hand, that you've found something that might help.

DeeLeigh's picture
DeeLeigh
February 20th, 2012 | Link | This is so true, and I

This is so true, and I really, really want to get some expert article up on BFB about taking care of joints and strengthening core muscles for better posture. I think those are really important to taking care of a large body.

I'm so happy that you're finally getting some physical therapy and that you're already getting some insight from it. Keep us posted on how you're doing and if it ends up helping your pain.

worrier February 21st, 2012 | Link | Thanks for your post. I

Thanks for your post. I suspect arthritis is coming my way, have a few symptoms. I already have a few problems with my hips and knees. When I start exploring it with the medical profession I can start out by asking for strengthening excercises and telling them weight loss isn't going to happen. So I can kind of "cut to the chase". Useful. Yes, the medical profession. The majority of them seem determined to believe that fat people can keep the weight off if they really want to and if they say they can't "they're just lazy, greedy and just not trying hard enough". I think when they keep telling patients to lose weight they've decided to believe the patient just isn't trying hard enough, and when the patient talks about all their efforts, doctors decide the patient is "just making excuses". I think the majority of the medical profession believe in this dogma with the conviction of a fundamentalist. As western medicine is supposed to be all about the evidence I'm very disappointed in the behaviour of the medical profession around the subject of weight.

lilacsigil February 21st, 2012 | Link | My dad is thin, I am fat. We

My dad is thin, I am fat. We have arthritis in exactly the same places, as did his mother: thumbs, last two fingers of left hand, left ankle, left big toe joint. Another thing that can cause pain in the big toe joint is gout - risk factors include a diet that includes offal, consuming alcohol, being male and being over 60. Guess which one of us got the test for gout and told to lose weight - was it the offal-eating, occasional drinker, thin man over 60, or was it the vegetarian teetotaller fat woman in her 30s?

Spoiler: I didn't have gout, a disease for which I have no actual risk factors whatsoever. I'm not really sure how weight loss is going to help small joint psoriatic arthritis, either! But I have appropriate medication now and that's certainly helping.

MReap February 22nd, 2012 | Link | I have a bad left knee and,

I have a bad left knee and, like Vesta, that could have benefited from physical therapy from the get go 30 years ago after that bad slide into third base. However, it is the shoulder/hand arthritis that is the main pain in my life. So far no one has told me to lose weight for that! However, I have to say that my experience with my current ortho surgeon has been good. I blew out my right knee (yep, both of them are down for the count now) this past summer. I was dreading the consultation certain that I was going to get a lecture. Nope, first he gave me a nice (?) cortisone shot, second he wrote out orders for PT, and third we discussed the inevitable whole knee replacements looming in my future. At no time did he mention weight (I'm 5'3" and 320lbs). I kept waiting for it, but nope. I've seen him twice since, and still no mention of it. I wonder if the Powers That Be know of his apostasy from the party line? Evil

Alyssa February 26th, 2012 | Link | Osteoarthritc Knees

Vesta, thanks for sharing your experience. I too have osteoarthritis in my knees, and like you I have had to become my own medical researcher to ensure I get appropriate medical care. I was the one who discovered several years ago that Synvisc injections might be helpful to me. When I brought it up to my rheumatologist (who had never mentioned it), her response was, "It's kind of expensive"!!!! WTF? I replied, I have insurance. She grudgingly gave me the shots--my right knee was the one giving me the most trouble. And, lo and behold, it was effective for about 4 years. (The norm is 6 to 12 months.) During that time, I had moved and now had a new rheumatologist. When the pain started to return, I asked if I could have Synvisc injections. His reply, "Oh, I have found those don't work." (I would soon learn that any suggestion I had to address my arthritis was generally met with that response.) Well, obviously, he hadn't bothered to read my medical records because he was surprised when I reminded him that I had had them previously with another doctor and they had worked for four years. He grudgingly agreed to give them to me, and they too lasted another four years. In the mean time, I have found a new rheumatologist who when I requested a synvisc injection immediately scheduled it. At my six month check up, she reminded me that I could receive shots as often as every six months if I needed them. Wow, what a pleasant change.

Why didn't the others suggest this common treatment (that, by the way, is not all that expensive, even without insurance) and further resist providing it? My thoughts: They wanted to punish me for being fat by withholding treatment. I think your doctor did not tell you about PT for the same reason. None of these docs suggested PT. After the first Synvisc injections, I researched some more, like you, and found strengthening the muscles around the knee joint was very important. I worked briefly with a trainer at my gym to find appropriate exercises, including weight-bearing ones. I have become a bit lax about them, and your post reminded me I need to get back in the routine. Also, water exercises work better for some people.

The bottom line is that often as a fat person I have not been able to trust physicians to provide me with optimal care. So forums like BFB are very helpful.

krisdb February 28th, 2012 | Link | knee pain

Thanks for this timely essay!

I have had three foot surgeries in the last two years - to repair anatomical abnormalities - nothing that crippled me or anything, but in an effort to improve my comfort and stability. I'm walking without crutches now, but am not back to baseline, and my gait has, of course, been altered.

Also, two and a half years ago or so, after ten years of weight stability (super fat, at 305 pounds, but stable) I had decided to go on a diet (tired of not fitting into airplane seats or purchasing clothes easily), and had lost 45 pounds. Then I lost the focus I had had; once I stopped watching everything I ate, what a surprise, I gained it back. By the time I had my second surgery last summer I was back at my starting weight, and now, after 8 months of greatly decreased mobility, I've gained twenty pounds more.

Aaaannnndddd.......I'm feeling it in my knees. They are sore and tight. I'm so frustrated! And I've been thinking I should call the physical therapist with whom I worked last winter, to see if he has any thoughts. Reading your essay has inspired me to do so and to trust that this situation can improve. It's also so good to hear others say what I think: "I don't want to go on another diet, I don't believe it will 'work', and there has to be something else that will help my pain."

Thank you!

osxgirl's picture
osxgirl
March 5th, 2012 | Link | So - please - what shoes

So - please - what shoes have you found to correct for supination?

When I was first diagnosed with heel spurs (caused, in part, by the supination) years ago, I did the search for shoes that correct for supination. And at that time, I found one (1!) model of NB running shoes that were for supination. Within a year, that model was gone and not replaced.

After that, I searched in vain for shoes. Everything I could find were either neutral or corrected for pronation. Some even claimed that they were for both pronation and supination (what?!?!! knowing what both are, I couldn't see HOW a shoe could possibly correct for BOTH at the same time - unless the correction is to hold your foot so ridged that it won't move in either direction, which is yet another problem - underpronation - in and of itself). And we won't even discuss how few shoes of ANY kind I could find in at least a wide width (D, and E would have been better).

These days, I'm wearing Z-Coils. I do like them, and think they have helped a lot. The way they correct for supination is by putting the stronger side of the coil on the outside of the foot (it goes on the inside for pronation, and the back, I think, for neutral). But... I find that they make my feet and legs tired sometimes, and I hate wearing them when driving (or even riding in a vehicle, for that matter). If we are going in the car for any long distance, I wear other shoes, and keep a pair of Z-Coils handy to switch to if I have to walk for any distance. I also find that I can't wear the Z-Coils on a treadmill - they kill my feet for that. Normal walking is fine, but not on a treadmill.

And lately I've had some leg pain. I'm starting to wonder if at least some of it is from the Z-Coils. I don't know though - the pain is mostly on one side.

Bottom line is - I would love to find some other shoes that correct for supination.

vesta44's picture
vesta44
March 6th, 2012 | Link | I have a problem with

I have a problem with supination too, my right foot is the worst - when I walk in my stocking feet, the sock on my right foot ends up with the heel and toe moving from the bottom of my foot up to the top of my foot (from the inside of my foot over the top). The heel of my shoe always wears out, and if the heel doesn't wear on the outside bottom, it wears down on the interior of the shoe - my New Balance shoes are doing that. I finally got my feet measured correctly - I'd been wearing a 10W and what I needed was an 11 AA (but I can't lace them up tightly at the ankle because I have an extra bone just above my ankle bone and lacing them tightly is painful on that bone).
I had some heel inserts that went from 1/4" to nothing (one side to the other and back to front), but the problem with those was that they wore the interior heel of my shoe down and didn't do any good after about a month or so (and I can't afford to replace my shoes every month). I've had this problem ever since I was a kid - my mother made me wear saddle shoes back then for it because I was so hard on shoes. The saddle shoes lasted longer, but didn't do much to end the supination, and it's gotten worse the heavier I've gotten. I haven't managed to talk to a podiatrist about it yet, but I'm thinking that could be part of the problem with my right knee - why it's more worn than my left one.

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

osxgirl's picture
osxgirl
March 6th, 2012 | Link | Yep - I've been going to a

Yep - I've been going to a podiatrist for years. He is the one who first told me to get shoes that correct for supination, told me to find that they would probably have to be running shoes, and told me that (I think) runner's guide or something like that was where I could research to find who made the shoes I needed. But that was YEARS ago, and it seems that within a year or so of getting shoes to correct for supination, all the manufacturers quit making them! They now just recommend getting cushioning shoes, which do help some, but not enough.

Like you, I found that a pair of shoes would only last about 1 - 2 months at the most before they were so worn down on the outside that I could barely walk because of the pain. And the only shoes I found that were even close to helping cost between $100 and $150. No way could I handle paying $150 a month for shoes!

As I said, the Z-Coils have helped a lot, but there are a lot of circumstances when they are uncomfortable for me. They are my "go-to" shoes though, and I have 7 pairs! They run between $200 and $280 a pair, depending on style (sometimes cheaper if you can catch a sale). I've found that they usually last me a good 3 years or more - the shoes themselves, that is. I have to replace the coils and the insoles about every 6 months. Coils cost about $75 last time I bought them. I don't remember how much the insoles were, but I believe they weren't much ($10 - $20 perhaps?) Given how much I was previously spending, this save a lot, even if it is a larger initial outlay.

The other problem with the Z-Coils is - the last store that was close to me closed recently. And unfortunately, though you can get them on-line, you really should go to a store, both to buy them and to get "tune-ups" they aren't working well for you. The reason is - they have a built-in orthotic that is modified to fit your foot. I need wide shoes. Z-Coils don't come in wide widths - but they can be widened. The store just stretches out the orthotic, and works until they fit my feet right. It can be done by the consumer - basically they just heat up the sides of the shoe and then reshape it to fit. But I find they are better at doing that. And they know all the ins and outs of which way the coil should be positioned for your feet... things like that. I stocked up when the store was closing, but in a couple of years, I'm going to have to figure out what to do. And if I need the shoes adjusted in the meantime, I may have to try and do it myself.

The podiatrist did have custom orthotics made for me. But I find that I still need a specialized shoe. They don't work in the Z-Coils at all, since an orthotic is built-in to them, but I don't really need them in the Z-Coils because of that. For other shoes - I find that I have trouble finding shoes that support my feet the right way AND that I can put the orthotics in. Most of the time, the orthotics make the shoes too small. I've tried to get extra depth shoes so the orthotics will fit, but they don't have the right kind of support. Add to it that the orthotics tend to give me blisters when I wear them, and.... sigh.

This is an on-going battle for me. I find walking to be pretty painful in general. I want to get exercise, but it's hard to do when it hurts a lot.

DeeLeigh's picture
DeeLeigh
March 7th, 2012 | Link | That's interesting. I wear

That's interesting. I wear out the outsides of my shoes quickly as well. Always have. It's especially noticeable because I walk so much, and usually in work clothes and my good shoes. Sometimes I buy oxfords and get them resoled once or twice before getting rid of them. Sometimes I buy Eccos, Munro Americans or Clarks, but they cost around $100 (less if I find them on sale) and generally last around a year if I'm rotating 2 pairs. By the time I throw out a pair of shoes, they're usually listing pretty dramatically to the side, with the heel worn down into the plastic supports, and have a hole in the center of the footbed.

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