Category Archives: My Fitness

Paul Ingraham Cured My Patello-Femoral Pain Syndrome (PFPS)

…and Paul’s not even a physician or physical therapist. But he’s a smart guy, writer, and former massage therapist. Click for his article on patello-femoral pain syndrome if interested. I paid about $20 USD for the full article, and it was well worth it. Full disclosure: I don’t know Paul and earn no commission or other compensation for this endorsement.

Photo credit: Steven Paul Parker II

The key to my cure was probably radical rest, or what Paul calls profound rest.

If you have PFPS, I hope you find something useful here.

Regular readers here know I’m a huge proponent of exercise. Unfortunately, exercise can be risky. You can injure yourself. I did that a few years ago when I was getting in shape to climb Humphreys Peak. I accelerated my training program too rapidly and developed patell0-femoral pain syndrome (PFPS).

This is how my right knee felt in 2017:

I’ve developed over the last month some bothersome pain in my right knee. It’s not interfered much with my actual hiking, but I pay for it over the subsequent day or two. I’m starting to think this may put the kibosh on my Humphries Peak trek next month.

The pain is mostly anterior (front part of the knee) and is most noticeable after I’ve been sitting for a while with the bent knee, then get up to walk. The pain improves greatly after walking for a minute or less. It also hurts a bit when I step up on something using my right leg. If I sit with my knee straight (in full extension), it doesn’t hurt when I get up. The joint is neither unusually warm nor swollen. Ibuprofen doesn’t seem to help it.

That episode resolved after I stopped hiking for 3-4 months. But in 2018 I had recurrence of similar pains in my left knee, with no clear precipitant this time. I continued my usual weight-training program and expected another spontaneous resolution. Six months passed…no improvement. That’s when I found Paul Ingraham’s article.

By the way, I’m the one who diagnosed my PFPS. It’s been said that a doctor who diagnoses and treats himself has a fool for a patient. He can’t be adequately objective.

Alternative diagnoses would include patello-femoral osteoarthritis and degenerative meniscus, due to my age (over 60). Diagnosis of the osteoarthritis could be facilitated by knee X-rays: weight-bearing posterior-anterior imaging, weight-bearing lateral view, and sunrise view.

This was my treatment plan for PFPS in early Feb 2019, based on Paul Ingraham’s recommendations. Paul explains how to do various specific exercises below in his article.

  1. Avoid all activities that stress the patella-femoral joint or aggravate pain for at least two weeks, if not longer (2–3 months). Paul calls it “profound rest.” I started this Feb 17. No knee-loading exercise (e.g., leg presses, any kind of squat, deep knee bends) until pain is truly in remission from rest. I quit my usual squats, Bulgarian split-squats, and single-leg Romanian deadlifts.
  2. Consider Motrin (ibuprofen) 400-600 mg three times daily for two weeks (I did 600 mg 3x/day) but usually no help
  3. Consider cold-packs (10–20 mins) when it flares up but usually no help. (I never did this because I couldn’t find my WalMart cold-pack.)
  4. Find a substitute for the squats? E.g., stationary bike? No bike for now: too much stress on patello-femoral joint at this time
  5. Paul’s not big on stretching (quadriceps and hamstring stretches routinely recommended by others). I didn’t stretch.
  6. While recovering, keep leg straight most of the time, even when sitting. Sit less. (I didn’t sit less but did make a huge effort to keep my  affected led fully extended, or at least not bent more that 20 degrees at any time. This necessitated sitting on the edge of my seat at work, and/or lowering the height of the seat. At home relaxing, I’d keep my leg fully extended. I think this was extremely important for my healing. I considered getting a standing desk for home or work but didn’t.)
  7. Start with exercises that keep knees straight. Exercise both lower extremities. As condition improves, can start to add other exercises, very slowly, that allow bent knees. Single-leg RDLs may be a good start (started in Sept 2019). Restart squats, deep knee bends, and leg presses (cycling?) only very late into recovery. Rehab must progress VERY SLOWLY. If an exercise causes more knee pain, back off and work the hips first. Exercise 2–3 times/week. Walking on the flat in moderation is usually OK. Strengthening hip abductors may be helpful.
  8. Hamstring curls via machine or therabands. Curl to 60 degrees, not 120. (I curled to 90 degrees using therabands).
  9. Quadricep setting. (I didn’t do this. Straight-leg raises on your back seem to be similar, which I did.)
  10. Straight-leg raises, on back and side-lying. (Done: 3 sets of 10 reps each side.)
  11. Clam shells. (Done: 3 sets of 10 reps each side.)
  12. Knee lifts? (don’t know what that is; not done).
  13. Consider the following although not from Paul: Hip abductor strengthening: “monster walks” (lateral steps with elastic band around (just proximal to) knees: 1 min x 3 sets. Hip hikes (what’s this?): 2 sets of 20 reps each side.
  14. Consider the following although not from Paul: Quad strengthening: terminal knee extensions with elastic band, 3 sets of 15 reps; leg presses?; semi squat, 3 sets of 10 reps (also recumbent bike?). Also consider stork stance TKE (terminal knee extensions) as alternative to standard TKE.
  15. Paul likes trekking poles for hikers. (I’ve been using these for years; Leki brand.)
  16. Not from Paul: Home physical therapy for six weeks
  17. Not from Paul: Turkish get-ups now or later? Much further into recovery!

Update of Progress on April 4, 2019:

Knee definitely feeling better, probably due to profound rest as above.  On Feb 23, I aggravated knee mildly by sledding in snow with Paul in Care Free – no regrets! Around Feb 26, Sunny got me started on Platinum’s Ortho-Chon Plus, 3 caps twice daily. Per 3 caps: glucosamine sulfate 800 mg, turmeric 380 mg, methylsulfonylmethane 350 mg, berberine HCL 145 mg, Boswellia serrata extract 140 mg, hyaluronic acid 50 mg, cat’s claw 10 mg, total cetylated fatty acids 3 mg. Not sure if these did any good at all; I’m skeptical. Started feeling less pain around Feb 29.

I am not healed or in remission yet. Doing hip exercises twice or once/wk with Therabands: clamshells, straight leg raises, side-lying straight leg raises, hamstring curls.

I had to put hip exercises on hold temporarily on March 28 due to a right low back muscle strain either from the exercises or weed pulling.

Update on Nov 25, 2019:

The PFPS is in remission and has been since July or so. For the last couple months I’ve been doing single-leg Romanian deadlifts and “walking” on elliptical-type aerobic machines at Anytime Fitness—some machines also work the upper limbs, others don’t—which are very easy on my knees. Avoiding treadmill since I have a palpable click in one knee, and treadmill aggravates my degenerative joint disease (DJD in both knees but predominantly left knee).

Next step is to slowly re-introduce exercises that load the knees (particularly the patell0-femoral joint). This is scary but must be done. My quads have atrophied somewhat. Squats? Lunges? Bulgarian split squats?

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

OMG I’ve Got PFP

My daughter and I at Tom’s Thumb on June 3. She got her good looks from her mom, obviously.

I posted this here a couple weeks ago:

I’ve developed over the last month some bothersome pain in my right knee. It’s not interfered much with my actual hiking, but I pay for it over the subsequent day or two. I’m starting to think this may put the kibosh on my Humphries Peak trek next month.

The pain is mostly anterior (front part of the knee) and is most noticeable after I’ve been sitting for a while with the bent knee, then get up to walk. The pain improves greatly after walking for a minute or less. It also hurts a bit when I step up on something using my right leg. If I sit with my knee straight (in full extension), it doesn’t hurt when I get up. The joint is neither unusually warm nor swollen. Ibuprofen doesn’t seem to help it. These pain characteristics seem classic for something, but I don’t know what, yet….My twice weekly hikes always include a fair amount of elevation gain. I suspect an over-use syndrome, basically a training error. I plan to take an entire week off from hiking and Bulgarian Split Squats, and taking ibuprofen 600 mg three times a day.

The view looking south from the base of Tom’s Thumb

I did some research in the literature and think I’ve got patellofemoral pain, aka PFP or PFP Syndrome. Can’t say I’d heard of it before. Sounds more like a description than a diagnosis. Like saying someone has fever.

This guy posed for my daughter

I got most of my info on PFP from UpToDate.com, but you probably don’t have access to that. You healthcare professionals, click for a 2007 article at American Family Physician. Mayo Clinic has info for muggles. So does American Academy of Orthopaedic Surgeons.

I hope she thinks of this hike when she sees Tom’s Thumb from Hwy 101

I may have some age-related osteoarthritis in both knees, but that’s not causing this pain.

My PFP was caused by over-use. Too much hiking with elevation gain and  accelerating my program too rapidly. Also, prior experience taught me that using trekking poles helped take strain off my knees, and I have not been using them.

The newest resident at the Parker Compound. He’s eight weeks old.

I took a week off from hiking while taking ibuprofen 600 mg three times a day, when I could remember it. The combo helped, probably the rest more than the NSAID. Then I did two six-mile walks on the flat without much trouble. On June 3, I hiked Tom’s Thumb trail with my trekking poles, 4 miles round trip, and only had mild discomfort. Most importantly, I learned that I get relief from icing down the knee for 30-45 minutes after I get home.

I’m disappointed I can’t climb Thompson Peak in preparation for Humphries Peak. It would probably kill my chance to summit Humphries (right now I put those odds at 50:50).

Steve Parker, M.D.

 

 

Hike: Marcus Landslide Trail at McDowell Sonoran Preserve

FullSizeRender-3

Yesterday I started my training in preparation to tackle Arizona’ Mount Humphries in June. I and about 20 people from my son’s Boy Scout troop hiked the Marcus Landslide Trail. Near the end of that trail we created a loop by hitting the Boulder Trail, Pemberton Trail, and Rock Knob Trail. Total hike was 5.8 miles in 60-68° F weather.

It’s a mostly flat course and an easy walk. It was no physical strain at all at the time. But I had some muscle cramps in bed last night and some soreness around my hips and thighs today. The soreness is a good sign. I’m embarrassed I’m not in better shape.

The scouts are doing a 20-mile hike in March for the Hiking merit badge. I’ll be right there with them, Lord willing.

Steve Parker, M.D.

Cholla cactus

Cholla cactus

That vertical rock formation in the center is called a mushroom

That vertical rock formation in the center is called a mushroom

Testing Your Fitness When You’re Hungover is a Bad Idea

"Good job, maggot!"

“You can do better, Parker!”

It’s been 23 months since I last tested my fitness level in February, 2013. So on New Years’ Day I re-tested. My standard is the Army Physical Fitness Test, which is required for U.S. Army soldiers to pass every six months. I’ve never served in the military. The other military branches probably have their own fitness standards, but my dad was in the Army, so that’s what I use.

Unlike 23 months ago, I didn’t pass this time. I don’t like to exercise but I’ve been pretty good about doing it for 60–70 minutes a week, a combination of weight training and HIIT on a stationary bicycle.

My performance:

  • 2-mile run: 21 mins, 16 secs (FAIL; need 19 mins, 54 secs to pass)
  • military sit-ups: 25 (FAIL: need 27 to pass)
  • push-ups: 31 PASS
  • chip-ups: 7 (not part of the Army test but something I monitor)

My run, if you can call it that, was pitiful. I know I gave it my best effort because my thighs were sore for 48 hours thereafter. At one point I wondered if I could “speed walk” just as fast as I was jogging.

Military sit-ups are done with hands behind your head or neck. Doing sit-ups with my arms folded over my chest, I can do 30.

Yes, I’m disappointed. Why did I fail? I’m almost two years older, probably six pounds (2.7 kg) heavier (at 176 lb or 80 kg), and missed too many workouts.

My remedial plan to pass: Miss fewer workouts and lose six pounds of fat, then re-test. I don’t know if it’ll work.

Steve Parker, M.D.

PS: Just kidding; I wasn’t hungover.

How to Prevent Macular Degeneration

Remember...peanuts aren't nuts, they're legumes

Remember…peanuts aren’t nuts, they’re legumes

I saw an optometrist recently for a new eyeglass prescription and mentioned that age-related macular degeneration (ARMD or AMD) runs in my family. ARMD is the leading cause of adult blindness in the West. Thank God, I don’t have it….yet.

The optometrist suggested I start taking eye vitamins to help prevent ARMD. Popular eye vitamin preparations around here are Ocuvite and I-Caps. He said a multivitamin like Centrum might be just as effective.

UpToDate.com, a source I trust, says that supplements for prevention probably don’t work and are not recommended. Which means Centrum would be just as effective: i.e., none of them work.

Instead, UpToDate recommends regular exercise, not smoking, and relatively high consumption of leafy green vegetables, fruits, fish and nuts. Although they didn’t mention it by name, the traditional Mediterranean diet provides all of those.

On the other hand, if you already have macular degeneration (wet or dry), UpToDate recommends these supplements (probably based on the AREDS-2 study):

  • vitamin C 500 mg/day
  • vitamin E 400 mg/day
  • lutein 10 mg/day
  • zeaxanthin 1 mg/day
  • zinc 80 mg/day (as zinc oxide)
  • copper 2 mg/day (as cupric oxide)

An reasonable alternative for non-smokers and never-smokers is the standard AREDS formula. It’s the same as above except it substitutes beta carotene for lutein or zeaxanthin. You can buy both formulations over-the-counter in the U.S. pre-mixed so you don’t have to swallow a handful of pills, just one.

I was in a supermarket yesterday checking out eye vitamins and noted that Bausch and Lomb’s AREDS-2 formula costs about $10/month.

I haven’t decided yet whether I’ll take the optometrist’s supplement advice. Probably not. But I’ll go the diet, exercise, and non-smoking route.

Steve Parker, M.D.

I’m Still As Fit As a U.S. Army Soldier

"Good job, maggot!"

“Good job, maggot!”

I took the Army Physical Fitness Test last week, and passed.  I’m only working out for 35 minutes twice a week, with a combination of weight training and high intensity interval training on a stationary bicycle.  (The weight training is much like this program.)

U.S. soldiers, at least those in the Army, have to pass a physical fitness test twice a year.  I wondered how I, at 58-years-old, stacked up so I self-administered the three fitness components.  I didn’t run in army boots, nor carry a rifle or backpack!  Soldiers need to score a minimum of 60 points on each exercise.

The Army Physical Fitness Test (APFT) performance requirements are adjusted for age and sex.

My Results

  • two-mile run: 19 minutes, 20 seconds (65 points)
  • consecutive military sit-ups: 41 (75 points)
  • consecutive push-ups: 32 (76 points)

Compared to my performance in August 2012, my run took 102 seconds longer, I increased my sit-ups by 9, and my push-ups held steady.

I purposefully “held back” on running because I remembered how bad I felt after the run last August.  Even this time I had a little hamstring strain.  Nevertheless, I suspect my aerobic endurance is truly less now since I’m riding the stationary bike instead of running the treadmill.  The bike exercise is more enjoyable.  My knees will thank me over the long-run.

I’m satisfied with this level of fitness.  It’s a good base for some strenuous hiking I’ll be doing over the next few months.  With a little luck, I’ll be hiking the Grand Canyon rim-to-rim with my son’s Boy Scout troop in May.

—Steve

Fitness Experiment No. 4: Results

For the last six weeks I’ve been working out twice weekly.  Twenty minutes of man-makers alternating with Turkish get-ups, followed by 15 minutes of high intensity intervals on the stationary bike.  So 70 minutes a week.  Click for details.

I re-tested my fitness today and compared with my numbers of July and August:

  • weight: no change (170 lb or 77.3 kg)
  • maximum consecutive push-ups: 36 before, 28 after
  • maximum consecutive pull-ups: 9 before, 8 after
  • maximum consecutive sit-ups: 34 before, 39 after
  • time for one-mile walk/run: 9 minutes and 30 seconds in August, down to 8 minutes and 30 seconds now
  • vertical jump (highest point above ground I can jump and touch): 276 cm in July, 277 cm now
  • toe touch (wearing shoes, stand and lock knees, bend over at waist to touch toes: 22 cm in July, 20 cm now

lessons learned

It’s not fun.  I’m glad it’s over.  It’s harder than Experiment No. 3.  The program significantly improved my 1-mile run time, but I did just as well with the more enjoyable Hillfit plus treadmill intervals (Experiment No. 2).  Total work-out time per week is about the same for all three programs.

I do sit-ups with my arms folded across my chest, hands on my shoulders

I’m disappointed in my big drop in total push-ups.  The increase in sit-up performance is cold comfort.

I’m enjoying the intervals on the bike more than the treadmill, and they’re probably easier on my lower limbs.

Although I can’t see myself doing this regimen long-term, I can imagine going back to it periodically just to mix things up, to avoid boredom.

Working harder doesn’t necessarily mean you’ll get better results.  Work smarter, not harder.

Steve Parker, M.D.