Stubborn knee pain

January 14, 2019Chronic pain, Pain, Pain Coach, Pain Education, Sports Injuriesanterior knee pain, chronic pain, Joint pain, Knee pain, pain, patellar pain, patellofemoral painrichmondstace

Running in the sunlight

Knee pain is a common problem across the population. The people who come to see me have been suffering stubborn knee pain, sometimes for years prior to starting The Pain Coach Programme.

Currently I am writing a book chapter focusing on the psychological factors. To illustrate some of the key points, I will be using case studies such as those below. These brief stories are in the words of the patients of course. The reality is that there are no psychological factors, or physical factors, or indeed social factors in the sense that they are distinct dimensions. There is only the lived experience, or first person perspective, all of which is grounded in biology — everything has a biology.

This is one of the most important points I will make in the book chapter: ‘you are more than a knee’. In fact, this was the title of the talk I gave at the ESSKA Congress (2018) last year to a good few hundred orthopaedic surgeons. The purpose was to expand the thinking to take on board that it is the person who feels pain and not the knee itself. This leads on quite naturally to the requirement that is knowing the person as much as, if not more than, the condition. This is a phrase coined by the great Oliver Sacks who continues to be a magnificent influence upon my approach to pain.

“Know the person as much as the condition”

Persistent knee pain always necessitates an understanding of the person, their experiences to date, their lifestyle and their unique way of ‘doing’ life, amongst other things. The problem is embedded within the person’s life, and of course embodied. This latter fact is an important one to understand. Another useful way to think about this, is that the body keeps the score. Each thought, feeling and sensation is experienced with a body. The brain needs a body (Karl Friston). So, despite talk of emotions, thinking, perceptions and conscious experience abound in the pain world, the pain itself is always felt in the confines of the body (even if the body part does not exist as in phantom limb pain). In other words, pain is always real and is ‘what the person says it is’.

Here is what three people had to say about their experiences of overcoming stubborn knee pain:

Back to exercising after more than 2 years of knee pain

I had injured my knee playing netball and scans indicated damage to ligaments but repairable without operation. After what became nearly two years of NHS and then private physio and more consultants, I was suffering great pain still in my knee and unable to exercise. Later scans couldn’t identify any damage and I couldn’t obtain and answer on why I was feeling constant pain.

The pain was affecting me physically (I was unable to undertake many of my usual exercises at the gym and I couldn’t play netball), even just walking I could feel the pain. It was also affecting me mentally in that I was so frustrated I couldn’t exercise, couldn’t get any answers as to what I was feeling and couldn’t get myself better. I tried everything with the physio and bought a machine to try and engage muscles in isolation that I was unable to engage through exercises when others would be able to. Nothing worked.

My physio said there was nothing else she could do to help and suggested that I see either the pain management team (putting me on medication to ease pain which I didn’t feel was right) or see Richmond. In all honesty, I’m not someone who usually buys into the concepts that Richmond initially discussed with me, and would be very sceptical that such a pain could be anything other than physical damage that still existed. However, I forced myself to give it a go as I had tried everything else and it was really my last resort.

I tried to tell myself that I wasn’t injured and I did the exercises that Richmond discussed with me. Having a professional tell me to try running on the treadmill just for a minute or two after a while gave me the confidence to do that when I would have been too scared to have done that before. As soon as I started to do that it was a quick spiral where I learned even if I felt slight pain then, it wasn’t any worse the next day. The pain then subsidised each time and my confidence was building quickly.

It only took me three sessions (quite spaced out and with contact with Richmond over email) to put on me in a position I was confident enough to take it forwards on my own.

I am now back to exercising as I wish – impact sport and running. I am confident and happy. I am very grateful for the help Richmond provided and I feel as though I would have been stuck in that rut for a long time otherwise. Although I was sceptical initially, I was quickly proven wrong and it was an invaluable experience.

AM, London 2019

Overcoming knee pain and learning skills for life

I first saw Richmond in December 2015 in regards to a chronic pain in my knee that I had been suffering from for 8 months. I had seen various physios and had been on an extensive course of rehab but was in almost constant pain and unable to carry out many of the everyday activities I so wished let alone play sport or, as a 22 year old, go on nights out at University. I knew from my very first meeting with Richmond that I would be able to overcome my pain. He explained the concept of pain to me like no one had done before. I saw Richmond once a week for a month and in that time I went from having constant pain to being able to run with no pain at all. Two months later and I was running six miles every other day and as I write this in May I have had no pain since.

I also worked with Richmond in regards to on-going digestive issues and chronic pain in my abdominal area. Having not eaten gluten, dairy or alcohol for three years, Richmond gave me the belief that through controlling my thoughts and using the mind/body connection I would be able to do so. I am now eating and drinking what and when I want.

I can’t thank or recommend Richmond enough for what he has done for me. Not only has he helped me overcome obstacles which seemed to high to climb at the time, but he has taught me truly invaluable lessons which I will use for the rest of my life.

JD, May 2016

Back to sport after 6 years of debilitating knee pain

For 6 years I went through debilitating knee pain that led to me giving up every sport that I enjoyed and eventually resulted in me missing work and avoiding social events. Despite being less active, the more I changed my routine the worse the pain became.

Having seen multiple physios, osteos, podiatrists and doctors it became obvious that there was no simple exercise plan, soft tissue work or operation that could cure the pain, and medication caused a host of other problems. I reached a point where it felt like there was nobody who could help.

Finding Richmond six months ago was the start of a journey that has gotten me back doing the things I love and most importantly, feeling myself, something which I didn’t think would be possible.

Pain no longer defines who I am. I’m back to playing sports and living my life in the way that I want to. While flare ups still happen from time to time, I’m now equipped with the skills and understanding to deal with them.

SA, London 2016