Knee pain? Here’s something to think about.

To begin, a brief medical history. And I’ll try to make this as non-tedious as possible. A few years back, I began having some really annoying pain. . .in my knee. This is a dreaded Ashtanga Vinyasa Yoga phenomenon. I’d discovered that under the right (or wrong, depending on how you look at it) conditions, my knees would sublux, and until I put them right again, the pain would stay.

It would be particularly hard to get them back into place after: a strong janushirshasana C adjustment, after a particularly strong bhekasana adjustment, or after a particularly strong kapotasana adjustment. (Noticing a pattern here? Like an idiot, l didn’t.)

Then, after some fierce kapotasana one day, my tibia went one way, my femur another, and I felt the knee pop. I finished practice, and as I limped out of the practice room with Steve, I said to him, “I just blew out my knee.”

Verdict: Torn medial meniscus.

Over the couple of years that I’d been having the knee pain, I consulted a lot of my fellow practitioners. I discovered Ashtanga practitioners are particularly wary of surgery. I knew people who had practiced two, three, four years and more, living with a known tear, refusing the surgery.

Me, I was not so shy. I had a labrum tear in my left shoulder repaired, and that surgery had allowed me to do backbends for the first time in my life. I was not afraid. “Do it,” I said to my surgeon at USC, “How soon can you fit me in?”

Now, a new Finnish study is suggesting that a placebo version of this commonly performed surgery is as effective as the real repair. From the New York Times:

“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”

Does this mean I regret my surgery? The answer here is also no. For this reason:

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

I realized from my shoulder surgery experience that MRI’s are remarkably uninformative. I had two MRI’s on my shoulder. The second showed no labrum tear. The surgeon disagreed, and I went ahead and had the repair. Once he was in there, what had shown as a tear on the first MRI was scar tissue. The real tear was in a totally different spot. It was very confusing. But I knew, after four years of pain, there was a tear in the joint–I could feel it. In the end, it’s up to the patient to understand what’s going on in the joint, how it tore, and what the chances are of it healing correctly. Even what you hope to achieve by having or not having it fixed.

When it came to my knee, I argued with my surgeon, actually, about doing the surgery sooner rather than later. “You should try physical therapy first,” he said, “That may get the pain to a manageable level.” “If what I already do hasn’t helped,” I said, “it’s very unlikely that PT could.” It’s been my experience that doctors don’t have a firm grasp of what we do in Ashtanga.

Turns out my meniscus was so shredded, it had to be partially removed. “You were right,” the he said in my post-surgery appointment, “That never would’ve healed on its own.”

But my sister had the same surgery when she was about my age. She was totally inactive, unlikely to become active, and had never really done anything to create the tear. Should she have had the surgery? Probably not.

After my surgery, I went to my friend and Rolfer Russ Pfeiffer for recovery help. He told me then that evidence was mounting that people do just as well without meniscus repair as with it, and that placebo surgery was just as effective, “But something tells me a placebo probably wouldn’t have worked for you.” I think, like all things, it depends on how seriously you take those words emblazoned over the door of the Oracle of Apollo in ancient Delphi: “Know thyself.”

Posted by Bobbie

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Two Ashtangis write about their practice and their teachers.

3 thoughts on “Knee pain? Here’s something to think about.”

  1. Bobby could you tell me if your knee hurt all the time or only during Ashtanga? I’m afraid I have a tear- my knee pops out more as time goes on and I’m unable to do many poses now without pain. But no pain when I’m off the mat!

  2. This type of surgery is a real money maker for surgeons as it’s so quick. The study basically states that doctors are performing this surgery on patients with arthritis and other natural aging processes of which there is no cure for only management options. These studies state the obvious regarding more severe knee problems and when actually surgery is needed like locked knees etc. Surgeons need to do surgery this is how they make money and many will do it whether you need it or not ( just look at the amount of woman getting C sections now compared to 20 years ago its staggering). I suggest reading a book entitled “How Doctors Think” by Dr. Jerome Groopman I’m sure that many of the people that received the placebo surgery fared well because the surgeon gave them orders to rest which gave their knee time to heal. This is the part of the study i can’t seem to find what was the down time for post op and did rest from physical activity give the body time to heal?

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