PRP Proplotherapy vs. Arthroscopy

Arthroscopy literally means “look inside”. At one time, about they only “medical” procedure they could perform (I use the term loosely) was a menisectomy (removal of knee cartilage). (What they didn’t tell you at the time is that cartilage doesn’t grow back!) Having been victimized by that very procedure, I do my very best to excoriate it, in this article.

Originally published 2014

A Valuable Alternative

At the same time, there is an alternative antidote for joint pain, in the form of platelet rich plasma (PRP) Prolotherapy. This article attempts to explain why that procedure is helpful. (However, it is mostly good for the external tendons and ligaments surrounding the knee — which helps, but is not a complete cure. There is a similar technique using stem cells and platelet rich plasma that attempts to regrow cartilage. It is still in its early stages, but that is the kind of procedure I am looking for, to overcome the damage produced by the menisectomy I was subjected to.)

What’s Wrong with Meniscectomy?

When it comes to meniscectomy, the jury is in: It’s a failed experiment that should never be perpetrated on unsuspecting humans. (Apparently there are other arthroscopic procedures these days that have a better prognosis for success. The folks at the Stone Clinic are apprised on the latest variations, so they (or someone equally good) is worth consulting. But avoid meniscectomy like the plague it is.)

In 1985, I engaged in a bit of stupidity that produced an injury to my cartilage. (I’ll provide the embarrassing details in a moment.) To recover from that injury, I had a highly idiotic procedure recommended by my doctor (arthroscopy) that essentially ended my athletic career. Compounding the stupidity, I repeated the procedure early in the 1990’s. Nearly 30 years later, in 2014, I am finally on the mend, thanks to a technique called “PRP Prolotherapy”. This article details my experiences. It then goes on to explain why arthroscopy is the worst medical procedure since bloodletting, and why PRP/Prolotherapy combined with a simple chiropractic technique (“traction”) create an alternative that is a thousand times more appropriate.

My Story

For the embarrassing details about the way in which I damaged the cartilage in my knee, read Healing the Knees. Suffice it say, I had some problems.

At that point in my life, I had learned to distrust pill pushers (medicos who prescribe a drug the way most people breathe), but I still trusted orthopedic doctors. They were the ones who fixed my jammed fingers, broken bones, and who could staple back a tendon or ligament after a serious tear. All good stuff, that got me back in the game. They weren’t just alleviating symptoms without addressing the real cause. These were people who, in my experience, had done a good job of addressing real structural problems and providing fixes that made it possible to continue with my athletic activities.

In short, I trusted them. Unfortunately, that turned out to be a mistake.

Note:
It works the other way, too. Years later, when I went head-over-handlebars on a mountain bike and banged up my shoulder, I went to a Chinese practitioner instead of an orthopedic specialist. A few months later, I had a “frozen shoulder” that could barely move! So as a last resort, I went to an orthopedic doctor who had helped me after breaking a finger. After he chewed me out for not coming to see him in the first place, he sent me to a physical therapist. (I like him! He wanted to see if we could fix the condition without surgery. Which we pretty much did — although it took close to a year.) So I pretty much continue to like orthopedic specialists — with the exception of the arthroscopic procedure! (The lesson: You always have to do your homework. Don’t take any proposed remedy at face value.)

What’s Wrong with Arthroscopy?

Arthroscopic surgery that results in meniscus removal may just be the stupidest procedure since the invention of bloodletting. If you doctor is recommending it without even discussing the alternatives mentioned here (chiropractic traction and PRP Therapy), then your doctor is a barbarian. Move on, and get another opinion.

–What arthroscopic surgery is
–basically just “looking”. But while they’re there, the only thing they can do is take stuff out.
–What the meniscus is
–my injury

The Problem with Meniscus Removal
–The problem with full or partial meniscus removal — it doesn’t grow back!
–Note: I read in one article that it only grows when we are very young.
My take-away from that is that it grows when the body is flooded with
growth hormone. After experimenting, I found that very heavy weight
lifting, coupled with high-protein supplements that promote the release
of growth hormone, were at least partially successful in helping to recover
from my arthroscopic procedure — to the point that (after a couple of
decades!) was able to resume at least some level of activity — although
nothing close to my former levels.
–long term outlook from the article
–personal experience

–what they don’t tell you is that the cartilage they remove doesn’t grow back!

–the bottom line is that results are in. No one ever recovers their former level of activity!

“Joint instability is a common result of meniscectomy, which is not surprising considering that the meniscus
is a primary stabilizing component of the knee. One of the principle reasons for meniscal operation is to
improve joint stability, yet meniscectomy often appears to have the opposite effect, eliciting even more
instability, crepitation, and degeneration than the injury produced prior to operation
. (emphasis added)

“In one study, 20 to 29 years after meniscectomy, X-rays showed 53% had significant progression
of degenerative arthritis compared to 13% of the non-operated knees.

“Another group of researchers found that 21 years after meniscectomy, 71% of operated knees showed
signs of at least mild degeneration and 48% showed signs of moderate or severe joint degeneration.

“After a 13 year follow-up the failure rate in one Swedish study was 29%. In this same study, knee function
showed a statistically significant decline in the meniscal-repaired knee compared to the non-operated knee.
PRP as First Line Treatment for Meniscal Tears

And if nothing else convinces you, take a look at Tiger Woods. Doctors managed to do to him what no professional golfer could — make him lose!

Note:
I knew he had that particular surgery when I heard a commentator talking about how he was going in for another
procedure to “clean out” the knee. That’s the euphemism doctors use for removal of healthy tissue that doesn’t grow back.

The remarkable thing, to me, was how quickly he seemed to recover. Years later, when I began investigating PRP Therapy, I discovered that it’s something Tiger Woods used to help recover from that particular surgery — to the extent that he is capable of walking five miles a day, 4 days in a row. (After experienced first hand the debilitating effect of that surgery, I can tell you that I’m pretty darn impressed.)

So we’ll look at PRP Therapy in a moment. First, though, I’d like to introduce to a chiropractic maneuver known as “Traction”, and make a bit of a plug for weight lifting.

Why You Want Chiropractic Traction

Traction is a chiropractor maneuver where they basically yank on your limbs and wiggle them around a bit.

–would have given my flap a chance to return to position
–might have been the only thing I needed to eliminate the pain
–the doctors I went to never even presented it as an option!
–and after the flap was put back in place, the PRP therapy discussed next is that all would have been needed to knit things back to together

–would have allowed the cartilage flap to move back into place

–more from knees article

Why You Want PRP Prolotherapy!

To put it mildly, it works! When I mentioned I was looking into it, a tango dancer I know said she had used it for her neck. When I asked her if it helped, she said simply, “It’s a life changer”. In this section, you’ll find out why.

Prolotherapy and Osteopathy

Prolotherapy is a technique that arose from the practice of osteopathy. Sounds like the study of bones, right? That’s orthopaedics — which deals with osteoporosis, among other things. (Confusing, I know.) But osteopathy is different.

Osteopathy is a branch of medicine that recognizes the body as the real healer. It’s goal, therefore, is to help the body heals itself. The doctor’s job is to help provide the right conditions for that process to take place. (Yes!). In addition, it focuses on identifying the causes of the problem, resolving them, and restoring health. (Double yes! Triple yes! If these guys don’t watch out, they’re liable to give doctors a good name!)

–inflammation is the first stage in the healing process
–it causes platelets to be recruited to the site, along with various “growth factors”. The platelets, in turn, recruit fibroblasts, which have their own growth factors. They recruit the next things in the chain (and accompanying growth factors), and so on, until the healing is complete.
Learn more: The Resources section points to many detailed articles at the Hemwall Medical Site.

In Prolotherapy, a salt solution or sugar solution is added to the cells. That solution is an irritant that produces inflammation, which induces a healing response from the body!

Note:
There are two ways to reduce inflammation. One is to promote healing. (MSM lotion and Vitamin C, for example, are both helpful.) The other way is to prevent the inflammation. That’s what aspirin does. Unfortunately, in the process, it also prevents healing! (It’s kind of like fire trucks blocking your driveway. You can get them out of the way faster by putting out the fire, or you can put up roadblocks to keep them away. Only one of those options is a sane solution.)

 How Prolotherapy Works

–sugar or salt solution
–causes inflammation, which recruits platelets to the site, along with various growth factors (the first stage in the healing process)
–those platelets and their growth factors, recruit fibroblasts, which have their own accompanying growth factors,
–they, in turn, recruit or generate the next stage of the healing process — and so on, in what is in actuality a cascade of healing stages, each of which has its own growth factors.

Note:
Going in, I knew about human growth hormone (HGH). But apparently that is just the main “trigger” hormone that tells
cells to grow. It turns that that there are

Platelet Rich Plasma (PRP)

The “PRP” part of the procedure stands for “Platelet-Rich Plasma”.
–centrifuge
–so once the healing process begins, the platelets are right there, ready to start
–of course, they get moved around into the blood stream, too. So they’re not the biggest part of the process. PRP makes the procedure maybe as much as 5% more effective (to hazard a guess). But the real work is done by the Prolotherapy solution, which initiates a healing cascade that goes on for weeks.

 A Visit to the Doctor

–draw your own blood and put it in a centrifuge, to spin out the platelets.

–In general, something like 6% of your blood consists of platelets. The centrifuge produces solution which is much more concentrated (70 or 80% if I recall correctly, but don’t quote me), so the platelets are right there when you need them.

Of course, after a while, the platelets will be distributed through the blood stream. So prolotherapy that is doing the real work. The PRP just provides a percentage improvement on the prolo treatment. But PRP works well in joints, where blood flow is minimal. (In general, the lack of blood flow inhibits healing. But in a form of medical judo, the PRP technique takes advantage of that fact to put a concentrated solution of platelets where they’re needed.)

Mechanism of Action

Readers familiar with my philosophy know that I am a big fan of what I call the “mechanism of action”. To my mind, understanding how and why some procedure works is the key to choosing wisely — whether you’re talking about a medical procedure or one of the many alternatives.
Learn more: Using Medical Practitioners Wisely

Here, in summary, is what you need to know about Prolotherapy:

“”Prolotherapy works by causing a temporary, low grade inflammation at the site of ligament or tendon weaknes (fibro-osseous junction) thus “tricking” the body into initialing a new healing cascade.

“Inflammation activates fibroblasts to the area, which synthesize precursors to mature collagen, and thereby reinforcing connective tissue.

“This inflammatory stimulus raises the level of growth factors to resume or initiate a new connective tissue repair sequence to complete one which had prematurely aborted or never started.

“Animal biopsy studies show ligament thickening, enlargement of the tendinosseous junction, and strengthening of the tendon or ligament after prolotherapy injections.
Prolotherapy for Musculoskeletal Pain

“Clinical evidence exists that prolotherapy can help to stimulate cartilage regeneration, although no specific controlled studies have yet been done to confirm this. Laboratory studies have demonstrated that cartilage cells respond to injury (inflammation) by changing into chondroblasts, cells capable of cell proliferation, growth, and healing.
Prolotherapy for Knee Pain

Note:
For a complete description of the biochemical mechanism of action, see this article:
Treatment of Tendon and Muscle Using Platelet-Rich Plasma

The Word on the Street

–no studies
–No one is going to make billion dollars from selling a drug, so no one has a million dollars lying around to fund a study. (The government used to to do such things, but it has been so starved for cash by corporate loopholes that it has all but totally abdicated its responsibility for doing such fundamental research.)
Bottom line: There are no studies that “prove” its effectiveness. But then, too many studies are falsified (the temptation not to is too large, when there are billions at stake).

In addition, studies can only be taken as a guide for investigation and understanding. Remember the study that said children who listen to Mozart as children get better grades? That’s an interesting study. But before everyone rushes out to get Mozart recordings, maybe we should find out whether the result was due to genetics or other environmental factors! If the parents are playing Mozart a lot, odds are they’re pretty well educated. So they’re reasonably smart. In addition, they know how to study and have a strong “study ethic”. Those attributes will tend to produce good grades, with or without the Mozart. So it could be that Mozart was the determining influence, but there a lot of other factors to take into account — and it takes a particularly good study to account for all of the possible factors.

So while studies are useful, they are most useful as an indication of areas that need to be investigated and understood. The result of that investigation will inevitably be — you guessed it, I hope — and understanding of the mechanism of action. Once you have that, you have everything you really need to know. And for PRP Prolotherapy, that mechanism is quite well understood.

–Tiger Woods, other athletes

–“life changer”

Letter to Hemwall Medical

Let me start by expressing my gratitude for the articles you sent. They gave me the one thing I value most:  Clear understanding of the mechanism of  action. (That kind of understanding has been the one and only infallible guide for choosing wisely. Everything else is just voodoo and witch doctor-y, with consequently haphazard results — whether the procedure was recommended by a medical professional or an alternative practitioner.)

I am especially grateful for that information, because all I can find on the web are “no studies”, or “inconclusive studies”. (Before those articles, I was motivated by anecdotal evidence and sheer desperation.)

“No studies” is understandable. With no expensive drugs to sell, the drug industry that funds nearly all of the research has no interest in this procedure. “Inconclusive studies” was more disingenous. It said the procedure was “no more effective than a saline injection”–a procedure which engenders a similar healing modality, according to your articles! So they were highly informative.

For PRP, the articles suggest that inflammation will be most intense for the first two days. (I don’t take aspirin, so that won’t be a temptation,
fortunately. Again, I’m indebted to the articles for explaining how important inflammation is for healing.)

After the first two days, the platelets will be recruiting fibroblasts and initiating the release of growth factors for another 5-8 days (a total of
7-10 days), with full recovery anticipated in 3 to 6 weeks.

How it Works

–multiple injections
–first an anaesthetic, then the solution
–a sharp, but brief pain when the needle goes in
–possible stiffness and lingering soreness for days or weeks afterward
–a bit of pain will come and go

My Healing Protocol

After the PRP / Prolotherapy procedure, it is important to give the body the right amount of exercise to stimulate growth — not too much, not too little, and definitely nothing painful. That’s something you have to work out with your doctor, but the general advice is avoid things that have been known to cause pain in the past, and to start small and ramp up slowly. After that, it is important to give the body the nutritional elements it needs to re-grow cartilage.

It turns out that cartilage is composed of amino acids! (Who knew? More details later.) So a high-protein diet is a big part of my healing protocol. In addition, I take a supplement recommended by Dr. Alderman (Ligagenix) which provides trace minerals needed for cartilage growth that are in short supply in the average diet (in particular, silicon — plus boron, molybdenum, potassium, manganeze, magnesium, copper, and zinc). And I maximize intake of Vitamin C and MSM, both of which are needed to create healthy, flexible tissue.

Here are the details of the recovery protocol I used.

–morning Amino Cocktail
–MSM lotion after shower
–protein and fiber breakfast
–coffee w/coconut oil & butter (plus optional lecithin, chia seeds, honey, whipped cream)
–morning vitamins with breakfast
–protein bar & applesauce for mid-afternoon snack, if hungry
–optional additional MSM lotion
–evening vitamins with dinner
–protein bar & applesause and/or jello for dessert
–late night protein shake

Amino Acids and Cartilage Formation

Methionine, Arginine, and Tuarine

According to this site, methionine is an important cartilage-forming substance. It’s also an essential amino acid (it cannot be produced by the body, so it must be consumed in the diet).

That site goes on to say that “Joint cartilage principally requires one thing for its creation: sulphur…. the cartilage in healthy individuals contains around three times more sulphur than in patients who suffer from arthritis”. So intake of __MSM__ (the only bioavailable form of sulphur) and use of MSM lotion is a very good thing!

The site goes on to say that the amino acid methionine is well suited as a source of sulphur, “as it can be used to create almost every sulphurous compound, especially in combination with the B vitamins”.

That site also says that arginine supports the production of collagen-a protein which is the basic component of connective tissues such as cartilage. This body-building site, meanwhile, points out that arginine also aids in the release of growth hormone.

The body-building site also mentons that Tarurine is another sulfir-based amino acid that is the second most abundant amino acid found in the body (glutamine is the first). So it makes sense for taurine to be in good supply, if only to ensure that the arginine available in the diet isn’t redirected for other purposes.

Glycine and Proline

This Wikipedia article says that cartilage is composed of cells that produce collagen fibers, while this one points out that glycine and proline are essential for collagen formation.

The “Essential” Amino Acids

This Wikipedia article lists the essential amino acids (must be found in the diet), as well as those that are conditionally essential (can be formed internally, but more may be needed in some circumstances). Given that cartilage formation is an important healing process, I think we can agree that any “condionally” essential amino acid that participates in cartilage formation is essential, to promote healing after a PRP/prolotherapy treatment. So a good protein supplement makes a lot of sense to help with the healing process, to provide:

  • Methionine – essential
  • Arginine – conditionally essential
  • Taurine – coniditionally essential
  • Glycine – conditionally essential
  • Proline – conditionally essential

Note:
“Taurine is a derivative of cysteine (a conditionally essential amino acid).”
” In the strict sense, it is not an amino acid…but it is often called one, even in scientific literature”
http://en.wikipedia.org/wiki/Taurine

Vitamins and Minerals

Vitamin C, B6, and magnesium are also important for the joints. While calcium and magnesium are important for the bones. (Vitamin D, meanwhile, is necessary to utilize calcium.)

My Experience with PRP

Going in, I had three problem areas:

  • The right knee, which was the first joint to be subjected to arthroscopy, and which had the most cartilage removed.
  • The right ankle, which had degenerated as a result of taking the strain the knee used to absorb.
    (In the morning, rotating it would produce a very loud crack-ing sound.)
  • The left knee, which was just about as bad as the right ankle, but not as bad as the right knee.

First Treatment

Dr. Alderman decided to do the right knee and ankle, and let the left knee go for a bit — mostly so I’d have one usable leg, I’m sure.

The ultra sound showed a huge empty pocket in the knee where cartilage should be. That is pocket that accumulates fluid when the knee is under stress, producing a lump behind the knee about as big as a baseball. (Not a problem when standing, but it made it pretty much impossible to sit on my heels for a while after any sort of exercise or stretching. We took 50 cc’s of fluid out, before we even started.

Note:
We also saw some “arthritic lesions”. (Well, Dr. Alderman saw them anyway. I’m not sure what the heck I was looking at.) But right at that moment, I appreciated her perspective. I regular medico would probably have said I have arthritis.
She just said that I have “some lesions”. In my book, if I stop moving, those lesions will join up with each other and I’ll
really have arthritis. So I plan to keep moving… for a good, long time.

For the first couple of days after the procedure, the leg was super stiff. It slowly loosed up over the next several days. Right at the 10 day mark, the knee and ankle began to feel substantially the same as they felt before the procedure. Going up the stairs at Whole Foods at lunch, for example, I felt a twinge at the inside corner of the knee, and at the top of the ankle — same as before the procedure.

On the other hand, there have been moments that the right knee feels better than the left, when walking normally. Most unusual. And at one point last week, I felt a twinge at the outside of the knee. (I’ve never felt that before in my entire life — which suggests to me that some tissue may have been laid down on the inside that is shifting weight to the outside. That would be terrific.)

Then too, I felt a bit of pain in the right knee on Friday, without having done anything — but that was probably due to a weather front. (As confirmed by the Hemwall staff. The good news is that there was much less pain than I experienced from a weather front a few week’s earlier.

Did an hour of wicked-easy cycling Saturday. No pain from that, a bit of an ache later in the day. Then rested completely on Sunday, and did mild elliptical for a few minutes on Monday morning.

Note:
After reporting this progress, the folks at Hemwall Medical told me that the rate of progress sounds normal, and that it is typically the second or third treatment where progress is really noticeable. They also mentioned that it takes about 6 weeks to lay down new cartilage, so scheduling appointments at 6 to 8 weeks apart is the right way to go.

After two and a half weeks, I walked a short 9 holes on a par 3 golf course. The left knee hurt more than right! Yay! (I started the day taking short swings with with the short clubs, gradually working up to the long ones to see if anything hurt. None of the swings affected the right knee in the least. I did feel a bit of stress in the left knee, though. So when we start treating that one, it will be short game only for a while — pitches and and chips that do not involve any turning.)

I feel definite pressure on the inside of the right knee when I walk. That’s a very good thing.

Had a small bit of cracking in my ankle, when I rotated it one morning — only one, and relatively mild. It’s the first cracking I’ve heard since the procedure. (I had another time or two subsequently — but always a couple of weeks apart, at a minimum, and always very mild. That’s a big change from the major gunshots I used to hear every single morning.

Coming up on the second appointment, the right knee now feels better than the left when walking. For the first time, I understood what they meant when ask if the knee feels “stable”. With both knees being a bit dicey, I had no point of reference. But now, when I stepped on the right knee, it felt like there was a cushion holding my upper leg in place — it didn’t want to go anywhere. But on the left, the upper leg felt as though as it could slide away in any direction, so muscular effort was required to keep it in place. (Needless to say, that makes a Yoga tree pose rarther more difficult! Balancing should be easier, in future.)

Going up and down steps, the “hip lift” I used to do to avoid pain in the knee has all but disappeared.

I have felt a brand new pain I’ve never felt before, just above the knee cap. The pain at the inside corner has all but disappeared, and the “pressure” sensation is dwindling as the stiff tissue that was put down converts to cartilage.

Second Treatment

This time, we only took 30 cc’s of fluid out of the knee. I would have been ecstatic with 35 cc’s. Thirty was beyond my expectations.

Dr. Alderman did one of the injections at the pain point just above the knee cap. (That pain point disappeared completely, as a result.)

The knee was much less stiff after the procedure. (I thought it was because I sat in a chair, rather than lying down for the first 24 hours, but I later found out that those two factors probably aren’t related. The stiffness is just one of those things that might or might not occur.)

The knee seemed to hurt more than it did after the first time, probably because I did not have the inflammation and swelling that made a natural “cast”.

The slight, intermittent pain notwithstanding, I am about as active a week later as I was 4 weeks after the initial procedure. (I cycled to work and back after a week, for a total of 15 miles.)

While cycling, I noticed that my right leg was delivering as much power as the right. (Which made me aware that I had been favoring it, previously.)

The other day, I took a shopping cart on my way in to the grocery store, as I always do — partly to save the crew some effort, since I’m going that way anyhow, and partly because it makes a nice “rolling cane” to lean on while walking. On this occasion, I noticed that I did not need to lean on it. That made me aware of how much I used to lean on it, only a couple of months ago.

While taking a walk, I noticed a “bounce” in my right leg. It was noteworthy, because I had totally forgotten what that feels like. In addition, I noticed that the bounce made my left knee more painful. (Which suggests that the left knee should be getting some attention, sometime soon!)

After a couple of weeks, cycling to work a few more times, I went out for a decent pedal. It was now, three and a half weeks after the treatment, I went out for what turned out to be a 25-mile ride. Man, I felt strong! It seemed that I had been cycling mostly with my left leg for many, many years. Now I was pedaling with just as much power — or more — with my right. It felt good.

Third Treatment

We treated the right knee and right ankle once more. Only 20 cc’s were taken from the knee, this time. Feels like good progress. (The knee certainly feels more normal without all that swelling — but then I’m not really stressing it they way I would have prior to the procedure. We’ll see what happens down the road, when I get back to using it more normally for Yoga, weight lifting, and elliptical running.)

This time, the knee was not stiff or sore at all after the treatment! (The ankle was a little stiff, but really not very much at all.)

Dr. Alderman, being prescient, told me during this particular treatment that it isn’t necessary for stiffness or soreness to occur. Some people never experience it — but the healing still takes place. She went on to say that the healing for continues for months after the treatment stops. The initial tissue is laid down during the 6 weeks following a treatment, but that tissue gets harder and stronger with time. Additional tissue is created, as well, so the good news just keeps coming!

Another thing Dr. Alderman told me was that I would just naturally start walking for longer periods of time, when I was no longer thinking about the knee — and to just let it happen in that manner. (I can’t wait. I’m really hoping I can get back to some light running, one day.)

After having the procedure on a Wednesday, felt good enough to go out for a light 14 miles of cycling on Saturday. It was surprising how good it felt.

Sunday: Had a nice walk as part of an earthquake emergency-response drill. Didn’t even think about the knees. Later that night, the left one hurt. Apparently the right was strong enough that it put pressure on the left to keep up! Nice. Will definitely be doing the left knee, next time.

Week 2: There have been small amounts of pain, here and there, even when I’m not doing anything. That’s the prolo solution, doing it’s job, and stimulating the healing. But it keeps making me wonder if I’ve overdone it. There’s no real difference between the kind of pain I experience. I guess that’s why you can’t let pain be your guide for activities. You just have to avoid anything that has caused pain in the past.

While walking, there’s a small amount of pain at the inside front corner of the knee. That’s about it! Wow. That’s terrific. After this treatment, or the next, the only way we’ll have to know when we’re done is how much fluid we take out! That’s pretty cool. (It will be great to see that keep going down, too.)

Week 3: I was late for a continuing ed class in music theory at Stanford. So I was walking rapidly. Got out of breath pretty rapidly. And afterwards, muscles deep in the abdomen were sore. The bad news is that it’s an indication of just how far out of shape I have become. The good news is that I was able to walk rapidly enough to have that effect! Muscle soreness and being out of breath are things I can improve. And improving them will be very good for me! That’s a world different from having to walk slow to prevent joint pain!

Week 4: Cycled to work on Tuesday. Some pain at top of knee and instep. Felt fine the next day. Might have been pressure I’m not used to. Also the weather was pre-storm like. That tends to make things ache. Felt fine the next day. Thursday, I walked around Stanford for half an hour. (Fun place. You always stumble across something new. This time it was a dry lake bed the size of two city blocks that I never knew was there!) Felt fine throughout the walk. (Still some minor twinging, but nothing serious.) The next morning, the left knee hurt, but not the right. Yay! Time to work on the left knee.

Week 5: Walking around the grocery store for 10 minutes, I was almost done when I became aware of a twinge in the knee. That’s progress. I remember when I was acutely aware of my knees the moment I got out of the car.

Tried some hill repeats. there’s a trail with a 30-degree slope near work, maybe 100 yards long. Running uphill is easier on the knees, and I figured I would walk down. Planned to run the hill maybe three times. Instead, it took three 15-second repeats to get to the top, with about 45-seconds of recovery time between them. Man! I remember when I used to go run for 2 or 3 hours! But with a 100 extra lbs, and quads nowhere near as strong as they used to be, there was basically zero spring in the legs. When I slowed the pace, I found a tiny little bit. It’s something to build on, at least.

I had to be careful, because the twinging escalated to exactly the degree that the quads weren’t taking the strain. But all in all, it felt good to be out there. That 45 minutes of running (plus a 5 minute walk to get there, and another 5 to get back), had about the same aerobic impact as an hour of cycling!

The next morning, my left knee hurt a bit. But the right knee hurt not at all! Cycling to work the next day, I felt the right knee a bit. But legs felt strong! And afterward, I felt zero swelling behing the knee, where accumulated fluid tends to bulge it out. With any luck, the amount of water drawn from knee will be very small, this go ’round. When I started for home, I noticed my left knee hurt a bit. My right? Not a bit. And about halfway through the ride, I realized that I was pedaling harder with my right leg, than with my left. What a turn around!

After running earlier in the week, as little as it was, I felt great. I broke a sweat in no time, had the breath going, and slept well that night. For the next two days, abs felt tight and I felt strong as an ox (a good sign that both HGH and testosterone had been released). So I gave it another shot later in the week. This time, knowing that I only had about 15-seconds of effort in me, I found a steeper hill that had two sections of just about the right length. Did 6 repeats, this time.

Week 6: It had been rainy and cold all day, and I had been feeling a twinge in the top of the right knee, but on Friday I ran anyway. As I ran, the right knee hurt not a bit! The left knee hurt a bit, though. Same when I played golf a few days later. I was in cart, but there was still a fair amount of walking. Right knee fine, left hurting a bit. (The right knee did hurt a bit the day after running, though. The hills many have been just a little too steep. We’ll see what happens going forward.

Come Monday, both knees were hurting a bit, but I think it was mostly the weather. Did six 20-second repeats on the shallower hill (about 60 steps), with 40-seconds of rest between. Good workout. I wanted to do more, but with so little spring in the quads, the legs became Pogo sticks after 50 steps or so. Had to stop there to save the knees.

Fourth Treatment

The running caused a small fluid build-up in the right knee. (I could feel it as a soft lump behind the knee.) I hadn’t felt it before yesterday, so Monday’s run was a just bit too much, it seems. But it was a good experiment.

The ultrasound showed only a small opening where there used to be a gaping hole. We were only able to draw about 5cc’s of fluid out of the knee — and it took a bit of work to get that. So the progression from treatment to treatment was 50cc, then 30, 20, and 5. That’s pretty amazing progress.

We figure the right knee is pretty close to a plateau. We gave it one more treatment, but if more is needed, we may go to the adipose-tissue stem cell procedure (where they take a teaspoon of abdominal fat, isolate the stem cells, and inject them). It’s more expensive, though, and there is a bit more risk, so we’ll go there only if needed.

The right ankle might take one more treatment, too. But since the left knee is now pretty much the limiting factor in my activities, we hit that one, along with the right. (Just finished the treatment. It’s aching like crazy. Yay! Good things are happening.)

The treatment was at 11:00 on Wednesday. Pain peaked about 2:00 — but was never bad enough to even think about a Tylenol, much less a Vicodin. By 5:00, the little pain I was experiencing had abated. Both legs felt fine the next day, although they were a little stiff.

Friday: Walking on the left knee at the store felt as comfortable as can be! May not even a second treatment on that one.

Monday: Walking from parking lot to office again felt very comfortable on left knee. Right knee felt a bit of pain at very front, below the dimple that’s under the kneecap. Not even sure if that’s related to the knee. Everything else feels good.

Week 1: Went to a running store to buy shoes. “Ran” at a minimal pace, in minimalist shoes (which promote a toe landing, rather than heel). After doing it several times for a couple of minutes each, knees felt it a little, but it wasn’t bad. Walked 5 minutes later in the day. It was close to being comfortable! (Minor twinges in knees and right ankle still, but not a lot.)

End of week 1 (Tuesday): Walking is almost totally pain free! Was out for 8 minutes and felt pretty darn good. Left knee is very close to perfect, with one minor pain point at top of kneecap, slightly to the outside. (Feels like a tendon there.) Right knee still has a pain point at front inner corner. (Nowhere near as severe as it used to be, but still there.)

Week 3: Darn it. Chiropractor spent two much time using thumper/vibrator on left knee. Afterwards, it hurt so bad I was limping. By later that evening it was better, but not as good as it had been. Going into week 4, it’s better than it was before the treatment, but nowhere near the perfection I was experiencing immediately afterward.

I’ve built up the walking by a minute or two each day. Now going 10-12 minutes with little discomfort. The pain points are medial join of left knee, medial join of right knee (slightly forward), and right instep (outer part, at the tendons).

Week 4: Joined a club and did 300 yards of swimming. Need to improve my technique so I launch off the wall in “chair” position. I was doing it with too much bend in the knees, so I was feeling it in the knees the next day. Next day, I went to a spin class. Things were fine at high RPMs, but during the “mashing” segments (50-60 RPM in a high gear), it felt too much like doing lunges. So that hurt a little, too. Lessons learned: Develop good turn technique for the swim, and make 70 RPM my minimum in the spin class. Despite all that, walking the next day felt better than it had in weeks. Nearly pain-free for 12 minutes or so. After that, felt several pain points: Under the front of left knee (towards the outside), top of left knee, under front of right knee (towards the inside), inside corner of right knee. I was at my farthest point right about then, so it was 25 minutes in all, before I got back. Still. I’m pleased. Real progress!

Week 5: Went late to an event where I wound up standing around on a hard floor. After an hour, I noticed that my knees weren’t hurting! After an hour and half, there were minor pings at top of right knee and inner front corner. But they weren’t bad, and shifting my position made them go away. When chairs opened up, I remained standing just to see how long I’d be comfortable. After a couple of hours, my calves began to ache! (Haven’t a felt a muscle pain there in forever.) Finally left after 3-1/2 hours! It used to be that 15 minutes was a very long time. After 10, I’d be looking for a chair. So good things have definitely happened, even if I did short-circuit the results a bit with the chiropractor’s massage-machine and the spin class. (Right knee was stiff and sore the next day, though, so I guess I overdid it.)

Fifth Treatment

Instructions were clear: Remain as still as possible the first 24 hours (trips to kitchen and bathroom ok). No exercise for first week (normal activity ok). Then start with minimal exercise (10 min. walking), and build gradually.

Week 1: Held myself to minimal activity for several days, then got a sinus infection that had me bedridden for two solid weeks. So I was held to minimal activity by external forces the entire time, with only occasional trips to the store during the later half of the second week.

Week 3: Starting to feel like myself again by mid-way through the week. Short walks felt comfortable at first, but slightly painful after 6 minutes or so. Even so, the pain in corner of the right knee was like, 50% of what it was before. Major improvement. On the second day of walking, I twisted the right knee slightly as I took my first step (a step to the left). That was seriously painful, and stayed painful for a couple of days.

Week 4: A slow walk for 10 minutes felt good in the right knee. Left knee still feels a little “dicey”, with a pain point somewhere in the middle of knee, down the center line. Not sure what’s going on, but it doesn’t feel as solid or stable as the right knee. Right knee is comfortable, though, as long as I walk slowly and focus on straight-ahead movement with no twisting.

Week 5: 10 minutes of nearly pain-free walking. The right knee feels pretty darn good (as long as I don’t twist it). The left knee has one pain point at the inner front corner, and some clicking behind the knee. (Sometimes, it “goes out”, too.) But all in all, this is better than I have felt in decades. Can actually begin to believe that one day I’ll be doing an hour of walking!

I’m not trying to walk any faster. Nevertheless, I’ve had to increase the distance of my route by 20% just to get 10 minutes in. So I’m still walking for 10 minutes — just for a longer distance. (At the 9-minute mark, I notice that my breathing is deeper. So I’ve I go longer I’ll probably begin to get an aerobic effect.)
Right knee feels about 95%, left knee about 85%. Will probably need to schedule the next appointment 4-6 months out, to build up savings and get the adipose stem cell procedure. (The last ultrasound showed that the deposit of stem cells in the right knee has been just about emptied. That’s probably the result of attempting to repair the arthroscopy damage. So replacing that reserve makes sense.)

Week 6: Decided to try the treadmill for a bit. Set up a 4-degree incline to reduce stress on the knee, and went at the uber-slow speed of 2.5 mph (slower than walking! 24 minutes a mile). Went for about 5 minutes. Knees hurt a bit at 2-1/2 minutes, but focused on adjusting my landing to minimize it until I got to 5. Next day: Knees still hurt a bit, but not much. Should be able to do this once a week until my next treatment. (At the moment, I’m thinking one more PRP treatment for the knees, then wait until September and do the full adipose stem cell treatment.)

The next day, right knee felt even a little bit better than it did before. Left knee felt a little worse, alas. But all in all it was a good experiment. (The treadmill at the gym turned out to be less cushioned than the one in the running shoe store. I love that one!)

Week 7: Things have normalized. The left knee, meanwhile, still has a little pain at the inside corner — but it’s almost non-existent. It does “go out” from time to time, though. (Not enough cartilage there, as yet.) There is also pain at the inside corner of the right knee, but half what it was. A bit of fluid still accumulating in the back of the knee, but a fraction of what it used to be. I know I need the adipose stem cell procedure on that knee especially, in order to replace what’s missing and “future proof” against further wear and tear. But that will have to be much later in the year. The left knee, meanwhile is probably one or two procedures away from being complete. One lesson learned: Next to no activity for 2 or 3 weeks! That seems to be the best protocol for me.

Summary: (Convert all of the above sections to a single paragraph, like this one.)
Got sick a week or so after the treatment, so I wound up being comatose for a little over two weeks. That turned out to be quite helpful. Felt like I made more progress after this treatment than most.

Walking is pretty darn comfortable. The pain point I used to feel at inside corner of right knee is a fraction of its former self. (One more should do it, for walking.) Had one pain point while cycling one day (top left, right knee) but it was gone the next day I cycled. The left knee doesn’t feel fully stable, but it doesn’t have any real pain points. (I’m hoping that only one more is needed for it, although it may take two.)

Rather than walking, I’m shooting hoops these days — not playing a game, just shooting by myself. I do “jump shots” (hop shots really, with my current one-inch vertical jump capability), but those are building a bit of “spring” in the muscles. Occasionally, too, I need to run after the ball — just a few steps, but enough to get my heart pumping after a few minutes. After 10 or 15 minutes, I’ve had a good (though minimal), fast-twitch fiber workout that builds muscle and burns fat.

Note:
In those short runs, I notice that I am “pogo-sticking” on my right leg. There is a total lack of spring in that leg, after a couple of decades of dis-use. So I know those short bursts are good for me.
Question: When can I start shooting hoops again after my next treatment? After six weeks, certainly. Probably not after two weeks. After four? Sooner? Later?

The one disappointment in my progress came when I needed to sit cross-legged to play ukulele. All the chairs were taken, and I was sitting maybe six inches above the ground. There was a lot of pain at the inside corner of the right knee, when it was placed in that position, so I had to keep it straight. I’d love for that to be fixed with the next treatment, but will understand if it has to wait for the adipose stem-cell procedure.

Sixth Treatment

This one didn’t seem to have much of an effect — in fact, I barely even felt it. That’s actually a good sign. It means that a lot of healing has occurred. The doctor’s assistant used this analogy: Salt in an open wound is very painful. But salt on bare skin you don’t even feel. The point being that early treatments were painful precisely because there was so much damage to heal.

When I played a round of golf with a friend, though, (riding in a cart), I noticed midway through the round that while my back and shoulders were aching (as they usually do), my leg muscles weren’t aching at all. That was most unusual. It occurred to me that, previously, I had been unconsciously protecting my knees by being in small “squat” virtually all of time on the golf course, whether I was swinging, standing, or walking. So halfway through the round, the muscles were sore. But this time, I wasn’t doing that. I wasn’t conscious of doing anything different, but even at the end of the round my legs felt fine — as though they had never been used! That was a far cry from my experience in the last several years. (On the other hand, every other muscle in my body was begging for mercy!)

But there was still slight pain walking in the right knee, and after a rainstorm the left knee ached incredibly. So it was time to get more aggressive.

Seventh Treatment — STEM CELLs

For this treatment, the extracted a small amount of fat from body, isolated the stem cells in it, and mixed it with the PRP solution to make even more of a good thing. (Stem cells can become cartilage and ligament tissue. If they don’t do anything else, they become fat cells — which will give my knees that much more of a cushion!

They warned me to expect a lot of pain for 24 hours or so, so I filled the Vicodin prescription and took it every 4 hours for 12. Then I let it wear off. What do you know? A lot of stiffness — especially in the left knee, where they did most of the work. But no pain to speak of. Wonderful! And the Vicodin did not make me drowsy — although I was home resting, just in case. More important, it does interfere with the inflammation that is the first step in the healing process!

Fortunately, the doctor was wise enough to focus most of the attention on one knee (the left, in this case). That left me one leg that was working well enough to hobble to the bathroom, during the first couple of days.

The stiffness began to subside after a few days, so I began to follow my planned rehab procedure: Walk 5 days a week after work, starting with 5 minutes a day and adding 5 minutes a week until I got to 20 or 30 minutes.

It worked well for the first couple of weeks. The third week, I was up to 15 minutes a day when I pulled my right hamstring — while walking, no less. But during the 2 or 3 weeks it took recover, I realized that it was a good thing. My right leg had shortened by at least an inch, due to the lack of cartilage and the the near-constant bending of the knee I had been doing to minimize pain even to get from grocery store parking lot to the front door. But now it was beginning to stretch out — and the hamstring that had tightened up so much during that 3-decade process had to tear a bit, in order to lengthen.

So I gave it lots of MSM lotion (see Why You Want MSM) and massaged it a lot. After 3 weeks or so, I was ready to resume a decent activity schedule.

The plan now was to engage in some form of activity 5 days a week: A run/walk, followed by an evening of billiards on Mondays, cycling on Tuesdays, interval training on the elliptical machine Wednesdays, golf practice on Thursdays, and swimming on Fridays. Then at least one day each weekend would be devoted to a short round of “executive golf”, or cycling.

It’s been two weeks so far, and the weekend activity has been a couple of hours of golf on a short “executive course”–all par 3’s, except for two par 4’s. (The plan was also do to do strength training for 10-15 minutes each morning, four days a week — Mon, Tue, Thu, and Fri.) So far, Mon/Tue have been consistent. Thu/Fri, not so much.)

After two weeks, it’s the run/walk day that is giving me the best measurement of my improvement:

  • Week 1: Run 10 seconds (20 steps), walk 50, for 15 minutes.
    Felt a bit of pain after 20 steps (10 with each leg), so I backed off. That turned out to be almost exactly 10 seconds.
  • Week 2: Run 15 seconds (32 steps), walk 45, for 20 minutes.
    Fifty percent more running time, slightly more than 50% more steps. Legs felt like they were beginning to get some “spring” back.Note:
    While running, I felt heat at the inside corner of the right knee. I love that sensation! It feels like inflammation, which is of course the first step in the healing process!

Resources

Articles
These highly informative articles are available at the Hemwall medical site (http://www.prolotherapy.com/Articles.php):

These related articles come from the TreeLight Health site:

Other articles:

Books
These books contain a wealth of information:

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