Clinical Notes: Patient with Knee Pain

knee03 August 2015

White, middle-aged male patient visited me today for two year checkup. Patient originally visited me in July 2013 for pain in both knees. Patient had a case history of being physically active, including repetitive squats with weights, outdoor running, basketball, sprints, and climbing stairs. I noticed the patient had bowed legs, putting him at higher risk for uneven cartilage wear, and thus knee pain.

In 2013, I learned from the patient that the pain had started about two years prior and had become gradually worse, such that on certain days, it was hard not to walk without a slight limp, or without favoring a knee on stairs. He said it was bad enough that on certain days, he would decline to work out until the following day.

I did not x-ray the patient. There was no reason for a thin thirty-something to consider knee replacement, so there was no need to damage his DNA with x-rays for what would amount to no difference in outcome.

I asked the patient which of his physical activities he felt was causing the knee pain. He said the squatting with weights, but then caught himself, saying it couldn’t be, because the weights would only build up his knees. I let him talk, though I disagreed.

I strictly forbade him from any prescription drugs. Anti-inflammatory drugs would halt natural benelle healing, and painkillers would encourage him never to become aware of the root cause of the pain, thus never to change his habits.

I asked him to please discontinue squatting but continue all other exercises as normal, and visit me again in two weeks. In two weeks, he reported that his knees felt much better, hurting only mildly at times after doing a plethora of stairs, or after he took a long run on pavement. I asked him to take no more than a single big run on pavement per week, and see me again in six months.

After six months, he was happy with the cure. Knee pain only came at times, generally after taking many flights of stairs. I told him to continue and see me again in two years, which brings us to current.

Patient claims not to have any knee pain now, even when he does lots of stair stepping in a day. He never has to favor a leg the day following an outdoor jog. I asked if he had done any squatting in these two years; he had not. I asked if there was anything that hurt his knees at all. He identified sprinting at the park would result in two days of knee pain; thus he had permanently discontinued it, succumbing to the hurt ego of his daughter being faster than him. He indicated he does light duty exercise 6 to 7 days a week.

I praised him for identifying sprinting as a problem and having discontinued it. I reminded him that I had not cured him at all; he had identified his own irritation. Furthermore, he had the strength of good habit to make changes and carry through. In the end, his benelles healed themselves and I could take no credit at all. I instructed him to continue in his exact path, always listen to his benelles, and that he need not see me again.

Final analysis:  I have seen many times where a patient already knows what is doing harm and simply needs a doctor to ask him to make a small lifestyle change. This fit the mold of this patient, too logical to heed his own common sense. His pattern also matches what I have seen in other patients; slowly digging a deep hole over years until hitting a chronic apex; followed by reclamation of health after two weeks of employing a good habit. If the patient possesses willpower, max health seems to return after about two years.

This patient may have knee pain again later in life, however his daily light-duty exercise is not prompting knee pain, thus he may go another 20 years without pain, at which point he may need to accept a lower level of max health. No benelles are immortal, and such is the aging process for us all.