Ask DK

question_mark_dkWant to ask me a question?

I  love helping people find answers to questions about how to move better, feel better and get more out of life.

But….

I cannot answer specific, personal health or injury related questions.

If you have a quick question that I can answer easily in a few sentences, feel free to ask in the comments box below and I’ll try to get to it as soon as I can.

I often answer questions in my blog (but I change any personal identifying information).

PLEASE, DO NOT ASK ME FOR ADVICE REGARDING  A HEALTH OR INJURY RELATED PROBLEM.

If you do, I won’t respond. I don’t mean to be harsh. This isn’t the venue. You can email my colleague, Laurie Kertz for more personal assistance.

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DD Kelsey says

Hi Barb –

When you have enough exposed bone, you won’t have enough cartilage to create a healing response. In some cases of a very small, focal area a microfracture technique can help but it sounds like you may have a larger area of exposed bone.

And, no, sorry, I don’t know of any therapists in Illinois.

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Barb says

Have you heard of any physical therapists with your philosphy on healing knee cartilage in central IL? I’ve been told I need knee replacements for both knees as I am “bone on bone” in both. Trying to rebuild cartilage before going that route (57 yrs young) but need some help. The surgeons, PT’s and trainers I have been to tell me it is impossible. Thank you so much for your informative posts.

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Lynn Bjorklund says

Have you heard of the slack line as a fun way to try to improve balance? Do you think it might be a good tool?
These folks in this video have really mastered the art of balance: http://www.youtube.com/watch?v=3MdDobR65Oo
I suspect they would have no trouble standing on one foot for a minute or even do the Tree Pose to Superman!
Lynn

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    DD Kelsey says

    Yes I am aware of a slack line and it’s a more advanced form of balance training.

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DD Kelsey says

Naomi – yes, I can say something about exercising in the Austin heat. It’s awful.

Having said that, make sure you’re well hydrated before you start, drink plenty of fluids both during and after. I train in my garage mostly or outside and typically drink at least 1 liter of water within a session – for example. Feeling drained later is often dehydration but could also be not eating enough of the right things so look at that as well. And yes, there’s an adaptation to training environments (heat, cold, wind, elevation, etc) but unless you must exercise in the heat, I would opt for more tolerable conditions.

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    Naomi says

    Thank you!N

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Naomi says

Is there something you can say about exercising in the Austin heat? I find it puts a real dent in what I can do and not feel really drained later in the day. Is withstanding the heat part of conditioning? I do start early and drink much water along with electro-mix.

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Jola says

I got 286 copies of Will Eating More Fat Make Me Fat? in my inbox this morning.
Sorry, I know this is not the right forum for this question, but I didn’t know how else to reach you.
j

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JONATHAN hALL says

I found your article on back pain in the morning (‘flexibility is my friend’) very interesting. I have similar problems for about 5 years now, my doctor has examined my back and I have had an X ray scan of the back, there seems to be nothing wrong with the basic bone structure of the back. I believe the problems are with the muscles supporting the back The problems come early in the morning after 6 hours sleep. It seems that my back cannot take lying in the same position for that length of time. The muscles supporting the back then start to ache, and I am missing out on some sleep. The pain is not severe, its just enough to wake me up and then stop me from falling back to sleep again. During the day my back is fine, I feel no pain. My doctor says there is nothing more he can do for me here, he cannot explaiun why I am feeling pain early in the morning. I feel conventional medicine has failed me. I would like to get a referral to a sleep unit here in the UK, but to do so I would need to be referred by my doctor. But would a sleep unit be able to help me here? Are the problems best dealt with by a Physiotherapist or Chiropractor? Any advice considered!

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    DD Kelsey says

    Jonathon – from your description, it sounds like a Physiotherapist or Chiropractor would be the best choice. They might be able to assess sleep positions, sleep surfaces, your biomechanics. Another thing to consider that seems to affect some people is gluten. Some people are sensitive to gluten in their diet which causes a low grade inflammation. You could remove gluten from your diet for 6-8 weeks to see if there was any difference in your sleep quality / quantity.

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Patrick says

Doug–

What are your thoughts on a rope machine? I’ve been using a Marpo Vmx at the gym, and at home just 20 feet of heavy rope (not too heavy), which I use to strengthen my upper body and burn some calories. Since my knees are slowly healing, what I like is the ability to stand up and sit down, even walk around while I manipulate the ropes. so far it seems to be a good way to combine exercise forms and also to be able to work out at home outside while the weather is still good. Thoughts?

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    DD Kelsey says

    Patrick –
    I’ve not used a Marpo Vmx so I can’t help you much there. The heavy rope drill can be a very demanding drill on the shoulders and trunk. It’s a function of the length and weight of the ropes. Since I don’t know the exact issue with your knees, it’s hard for me to say whether that exercise is one that could indirectly overload your knees. There is a reactive force from stabilizing the body – question is whether that force is too much or not.

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Anne says

I noticed that in your knee bible book you include the bird dog as part of the evaluation. Isn’t kneeling totally contraindicated for damaged knees? Thanks, Anne

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    DD Kelsey says

    Hi Anne – thanks for your question.

    The Bird Dog is part of a Priming sequence (I don’t believe it’s part of the assessment). Kneeling is not a contraindication but is a precaution. If kneeling is painful, by adding sufficient padding, you can relieve the discomfort. If your knee pain as from, for example, bursitis, then kneeling might be too painful to do but the book primarily addresses runner’s knee syndrome and kneeling is often tolerated.

    I hope that is helpful to you.

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Lori says

Hi Doug- After many years of running five miles a day, I was diagnosed with chondrosis in my left knee and tendonitis in my right knee. I went through five months of physical therapy to strengthen my quads and hips and the therapy only made the pain worse. I had supartz injections in my left knee which had to be stopped after the second injection because I could no longer bend my knee without pain (I didn’t have that problem before the injection). I live in New Jersey and wanted to know if there are any therapists here who are familiar with your way of treating these problems (I can travel to New York City for one session as well). If not, do you have any reference materials that you provide to other therapists? Thank you.

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    DD Kelsey says

    Hi Lori –

    I don’t know of anyone in the NJ / NYC area unfortunately. I know therapists who have purchased my book – The Runners Knee Bible (http://runnerskneebible.com) have told me that it was helpful in explaining the principles and concepts around joint related problems. You could also contact Christine Springer – look under the ABOUT tab on this site. She may be able to help you.

    I hope this is helpful to you.

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Mary beth pace says

Please post the how to fix your toe video…saw it once now can’t find it. Thanks

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Naomi says

What would be the “legal” pause between sets of any exercise? How many seconds?

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    DD Kelsey says

    Naomi –

    For the Elements, there is no “legal” or “illegal” pause. You rest as needed while aiming for shorter rest periods over time.

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DD Kelsey says

Hi Regina –

Without knowing exactly what was done surgically it’s hard to say what the cause is for your symptoms re: the sensation of something slipping. It may be that you have adhesions in the area which come into play when the knee is at certain angles. This could interfere with efforts to strengthen your joint since cartilage requires a very high volume of motion at low loads. The repetitive motion could irritate other tissue in your knee since the movement will not be smooth and unimpaired. I’ve sent people with complex knee issues to the Steadman Clinic in Vail, CO. They have a lot of experience with situations like yours.

I hope this is helpful to you and things improve soon.

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Regina Clarke says

Hi–

I just did an Internet search to find out the best way to strengthen my quads because I had knee pain. The first article that jumped out astonished me–by Richard Bedard–refuting the very idea of doing that and describing the advice he got from you. My story parallels his so much in terms of what doctors have told me that I just assumed quad work was necessary–I had to do something! Always active, I nevertheless had four knee surgeries–two on each knee–once in my teens to add wood screws to hold the kneecap in place, and then in my forties to have the nails removed. The second op seems to have accelerated arthritis, which I had not known prior to it (not felt). For 12 years now it has been up and down. But I just assumed the cartilage would stay as it was–the MRIs showed marked deterioration when I had them filmed in Austin–where I lived a few years in 2003-2005. Just hearing the revelation that cartilage can repair itself–never having heard that ever before–is enlightening–for now that is how I will “talk” to my legs and knees–with awareness they have inner healing capacity–I am a believer in whole body and mind interconnection.

My question is in light of this last surgery when I had the nails removed. The doctor was a sports doctor in CA. He said it was a casual op. But it wasn’t. He added three inches to the scar on the right knee that was already long enough. And advised no physical therapy after the operations on both knees (done at the same time). I saw the wood screws–astonished they looked like screws for cabinetry! And he told me after the surgery ( with irritation) that he had a devil of a time getting the tendons or ligaments back in place. He said something about pulling them around. Now, years later, one thing I feel every time I get up from having my legs straight out or after sleep, and try to bend my knees, is first a kind of motion inside around the knee as if the ligament or tendon is sliding over into a new location. As if it settled almost on the knee cap and then moved aside. It wasn’t until recently I even remembered his saying he had done that. So could this fact affect healing, too? is there anything I can do about it while approaching the cartilage healing Mr. Bedard has presented from your advice?

I guess even to know what it is the doctor did, based on his description, would help. And whether it might have accelerated the apparent atrophy that has slightly bowed the legs.

Another way I could describe the sensation is that when I bend my knees even slightly to get up, it’s like there is a rope blocking the bone that eventually a few seconds later slips to the side.

Thanks for any comment, indeed.

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Des says

Hi Doug
I watched a BBC Horizon documentary recently (no, not the Fast diet) about the human body clock. One aspect of this they talked about was the best time of the day to exercise (as I recall this was mostly in reference to “cardio” exercise.) Something that interested and worried me was the claim that cardio in the morning not only had no benefit on blood pressure but was also dangerous. Your blood pressure is naturally higher in the morning and putting more pressure on the heart at this time is asking for a heart attack. I usually prefer to run in the mornings and now that I live in Houston, if I want to run outdoors, the morning is the only sensible option. I’d be interested in your opinion on this subject.

Thanks,
Des

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    DD Kelsey says

    Des –

    There was a study done a few years ago that suggested early morning exercise was potentially detrimental to people who had hypertension or cardiovascular risk factors. If you’re otherwise healthy, there’s this more recent study that shows early morning exercise is beneficial: http://www.news.appstate.edu/2011/06/13/early-morning-exercise/

    Reply
DD Kelsey says

Curt – I removed your contact info.

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Curt Miller says

Doug: Thanks again for the help! Dale has an office in Southlake and I look forward to meeting him shortly.
(Didn’t know this was a public access. Could my contact info in the first message be removed before Google harvests it? Thanks)

Lacey: I want a non-surgical solution and I’m very much willing to cruise down to Austin if this doesn’t work out locally. Thanks for the feedback. I’m looking forward to my own success story!

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Lacey says

Hey Curt,
I drove to Sport Center from Altanta. It’s worth it. Really, it is. I would do it again without hesitation.

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Curt Miller says

Hi Doug:
I called your office today to ask for a physical therapy referral in the Dallas Ft Worth area. I’m in Bedford. The office said the closest was Oklahoma. I wondering if there is someone in my area with a similar mindset as you?

I suffered a right ankle inversion dislocation from a ladder fall two and half years ago. I’ve developed PF and more recently for the last three months or so routine peroneal tendon pain. The young orthopedic doctor a recently saw has just put me back in my air boot for four weeks with an rx for physical therapy. He want’s to do do an MRI if not improved in 30 days. I have this feeling we are off on the wrong track. I am hopeful that I can rehab these issues with some effort on my part. I successfully self-rehabbed the same leg after a total knee replacement several years ago with good direction from my knee surgeon. I do know how to follow directions.

So, is there someone that can get me started in the right direction locally or can I do this on my own with remote direction from Austin? Since it’s kind of a tough commute to Austin.

Thanks for any help,
(65 y.o. that still wants to be active. Not riding the bike anymore and only light duty on the indoor recumbent till I have a plan in place)

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    DD Kelsey says

    You should see Marty Stajduhar – he’s in Bedford I believe at : http://www.texashealth.org/MeettheStaffbh
    I’ve known Marty a long time. Smart guy, great skills and has an extensive background. Tell him I sent you.

    Reply
      Curt Miller says

      Thanks for the quick reply! Marty no longer has an active number in Bedford and is not at Texas Health any longer….. Anyone else? Thanks in advance!

      Reply
        DD Kelsey says

        I would try Dale Smith, PT. I believe he’s in Dallas – Greenville Ave last I knew.

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Bill says

Hi Doug,

Any advice on how to heal from patella tendonitis. I look forward to following you on your new blog.

I am a 51 year old runner who wants to be able to run.

Thanks in advance,

Bill

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    DD Kelsey says

    Hi Bill –

    Thanks for your question. Tackling something like patellar tendonitis is a broad subject and it wouldn’t be proper for me to give you specifics via this venue. I can give you some general guidelines that might help though.

    There are a number of disorders that can cause anterior knee pain so you to be sure you have tendonitis and not something else like tendonosis, bursitis, or patellofemoral syndrome or referred pain. But assuming you have a tendon injury, you have a couple of options.

    Tendons heal from applied physical stress – either a low load over a long duration or a higher load and fewer reps. If you have symptoms at rest or soon after starting an activity, then you’ll need to go the low load, high rep path.

    Biomechanics come into play too – adequate range of motion of the hip and ankle, enough strength in the hip to prevent too much rotation at the knee, etc but these these have to be evaluated by a health practitioner.

    There are some good taping techniques that seem to help with symptoms and sometimes improve mechanics – you can look into kinesiotaping and probably find a practitioner near you.

    I go into more detail about the knee and running in my book – The Runner’s Knee Bible at http://www.runnerskneebible.com

    I hope this helps and good luck on your quest.

    Reply
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