A Case Presentation: Coping with Pains in the Knees

    After about 20 years, when I used to walk every day to my office and back, one day I felt severe pains in my two knees, especially in the right one. After stopping for a rest, I continued walking very slowly home. Instead of 20 minutes, the usual time, it took me almost an hour. Since that day, my wife has had to drive me back and forth, since I was not able to walk more then 100 yards.

    After a thorough orthopedic examination and x-rays of my two knees, the diagnosis was osteoarthritis. My orthopedist explained to me that osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and eventually, the cartilage begins to degenerate by flaking or forming tiny crevasses. He recommended arthroscopy for my right knee, since it was in a worse condition. He further explained that arthroscopy is a surgical technique, whereby a doctor inserts a viewing tube into the joint space, in order to detect and repair abnormalities of and damage to the cartilage and ligaments. I was scheduled for operation in two weeks.

    When I came home, I had a long discussion with a good friend, who recommended reading the book: "Healing Back Pain. The Mind-Body Connection" written by Dr. Sarno, who is an orthopedic surgeon. Dr. Sarno claimed that he performed arthroscopies on hundreds of patients who suffered from severe pains in their knees, due to osteoarthritis. Their x-rays showed severe "wear and tear." To his astonishment, he found out in a study, that people of a similar age, who did not complain of pains in their knees, their x-ray showed the same degree of "wear and tear." His conclusion was that x-rays that show "wear and tear" cannot predict pains. Dr. Sarno consulted a psychiatrist, who suggested that such pains may be the outcome of stress. When a person is stressed, his muscles contract in order to prepare him for Fight or Flight. When the stress lingers, the pressure on the knees, which has a "wear and tear" condition, may cause severe pain. Since people who suffer from osteoarthritis may experience long periods of freedom from pains, followed by periods of severe pains, the explanation made sense. Dr. Sarno decided to recommend patients who suffer from pain due to osteoarthritis, to explore the mind - body connection, and to learn relaxation techniques before performing an arthroscopy.

    As I finished reading the book, I canceled my operation and I started musing on the question: Was I stressed more lately then usually? Unfortunately, I could not identify particular issue that stressed me. A few days later, I met my younger brother Joel, who is a psychology professor at Hebrew University in Jerusalem. I shared with him my issue and he suggested to me that I close my eyes and view any changes, positive or negative that have occurred prior to the onset of the pains in my knees. After a few minutes, I opened my eyes and said: "I am sorry but I can not identify any important event that could explain the pains in my knee."
    Joel thought for a few seconds and then he asked me: "Didn't you have your birthday around that time?"
    "Yes, I turned 60," I answered.
    "How did you feel about becoming 60? Did you like it?"
    Suddenly I experienced what psychologists refer to as an "Aha" experience and I answered. "I hated it. I thought about our father who died at the age of 72. When he passed away, I felt young and I thought that he was an old man. Now I am getting too close to the age he died. It scared me?"
    "Could it be that the thought about our father's death made you feel weak in your knees?"
    I was shocked for a few seconds. I had to admit to him and to myself that I felt helpless coping with the fact that I am getting older.

    No question in my mind, that the few minutes talking to Joel gave me insight to the onset of my symptoms. The same day, I stated working on a few different directions. I had discussions between the child part in me, that was afraid of growing older and the adult part in me, who kept convincing me that 60 years old is not that old and the fact that my father passed away at the age of 72 does not mean that I am going to have the same fate. I started a daily practice of a variety of relaxation techniques. My wife volunteered every evening, to put her palm on my right knee, for a few minutes. She asked me to visualize that the heat of her palm was penetrating my knee and healing it. I also took once a day doses of Glucosamine & Chondroitin, although my orthopedist claimed that it might help somewhat my left knee but, for sure, not my right one.

    After about a week, I started feeling positive changes. Gradually, I was able to walk to my office, with minimum pains. Since then, I have skied many times downhill, I have walked up and down on the Great Wall of China, and I climbed the steep mountain trails in Machu Picchu, Peru. I did all that without experiencing any pain in my knees.