Ignoring a nagging, chronic pre-injury is a risky proposition, especially in a weight bearing joint. That is because once you are feeling pain in your precious knee, hip or ankle lots of damage may have already been done.

Cartilage, the miracle substance that lines the articulating surface of joints and allows bones to move pain-free, has no nerve endings. It will suffer in silence, allowing itself to be worn away, eaten alive by misguided inflammation or other wise destroyed and not utter a peep. Think of chronic inflammation and swelling like cartilage dissolving acid. As it attempts to clear out other foreign bodies in the joint it will also eat your joint cushions for lunch. Pain is not usually felt until the bone and nerves below are exposed. Things you should not ignore or tough-out:

• An old injury to a major joint that is chronically swollen. For a good rule of thumb compare the size of the battle ax joint to the more innocent one.
• Decreased range of motion in a major joint.
• Pain that is minor and tolerable, but chronic.

Wait too long to have an old injury looked at and you may find yourself like me, forced to undergo surgery and endure a long, psychically painful rehab. I spend most of my time on my couch with my leg elevated making conversation with my monkey slippers and praying to the bone gods that the seeds planted in my cartilage lesions will grow. Pay attention to that that amazing body of yours before its too late, good advice from the bone gods, right monkey slipper, left monkey slipper and me.

Someone burgles your house; breaks a window, comes in, makes a royal mess and helps themselves to whatever they like. So you do what anyone would do: call the police, and if it’s really bad, some professionals to help you deal with the mess. But what if after a day or two none of them wanted to leave? What if the cops ended up on your couch asking how many cable TV channels you get and if anyone in your neighborhood delivers donuts? What if they started helping themselves to whatever was in the fridge, borrowing your clothes and sleeping in your bed (on your side no less). What if the cleaning crew just kept scrubbing, through the paint on the walls, the finishes on the furniture and the porcelain on the bathroom fixtures? What if they turned out to be obsessive monster’s who seemed to gain super human strength from the inhalation of toxic clearing fumes and wouldn’t ever stop no matter how sweetly you asked?

This scenario is a crazy shut-in’s dramatization of what happens to your body when it sustains an injury, also known as the inflammatory response and what happens when that response goes awry. Shut in because I just had a second knee surgery to try and get the damn cops and cleaners out of my knee for good.

The inflammatory process sets in motion a cascade of chemical reactions. At the site of invasion cops called mast cells get the ball rolling by releasing the chemical histamine. As any allergy suffer knows histamine causes things to leak and on cue plasma seeps out of nearby cells in order to slow down invading bacteria. This is one cause of inflammation’s tell tale swelling. Then ass kicking cops without pot bellies called macrophages begin terrorizing unwelcome germs, parasites and viruses. When macrophages get busy they release a chemical called cytokines, which sends a signal back to headquarters that reinforcements are needed. Soon the site is jammed with cop like immunity cells bent on the destruction of unwanted invaders. The cleaning crew is right behind to dissolve any thugs or unwanted materials in their wake. This well orchestrated immunity response prevents infection and destroys any unwanted bodily invaders.

But sometimes the process doesn’t shut down in order to allow healing to begin. For whatever reason, and there are many, the cops and cleaning crews don’t leave and chronic inflammation sets in. When this happens the processes that were designed to keep the body safe eventually begin to destroy it, as healthy tissue is irritated and destroyed by the ever vigilant immunity cells.

I had chronic inflammation in my right knee and the cops and cleaners took a bunch of my cartilage, the smooth surface on your leg bones that allows your knee to move pain free, before I finally had my swollen knee looked at. There had been a battle going on in my knee for years, ever since I had had my original ACL replacement surgery, and I had chosen to ignore it. The inflammation had caused some stiffness and warmth, but it had never been (too) painful. I had chosen to ignore it because I didn’t want to be told that I couldn’t do all the things that I loved to do. This was a mistake.

Chronic swelling and inflammation in a joint is a sign that something is really wrong. The bodies healing mechanisms are being overwhelmed and may be turning on the healthy tissues as they attempt to heal the perceived (or real) injury. So if you have chronic swelling in any joint, even if it is not painful, get it looked at by a good orthopedic doctor. If it helps to motivate you imagine a crazed housekeeper scrubbing your joint with a piece of iron wool. Call now my swollen friends, call now.

I am currently reading Guns, Germs and Steal (by Jared Diamond) which is both a blessing and curse for those in my close proximity. The book does a damn good job of covering the history of the human race with an emphasis on who won, who lost and why. One of the reoccurring themes is that cultures that adopt or invent useful new technologies often use them to prosper and overrun their less innovative neighbors. The most obvious example of this is guns. Another interesting observation is that sometimes societies adopt something useful and then drop it, like the Aboriginal Australians who for some reason gave up on the bow and arrow.
It is my own, and not Mr. Diamond’s, observation that many modern urban humans have given up two of their most important advantages, pack animals and wheels. In a time when cars are becoming less and less practical who among us would not appreciate a loyal llama or mule to carry about our daily necessities? Without a car, the modern day pack animal, we are forced to hump our own belongings like old school nomads. This method is impractical, often uncomfortable and can be down right dangerous to the health and longevity of our backs.
Until recently I too was an urban mule of an increasingly sway backed variety. Each day I would jam my giant backpack full of clothes, food, books, equipment and all sorts of stuff I might need for the day. Consequently my pack was a hernia waiting to happen and often caused my back to ache. Recently I was diagnosed with a knee condition that forced me to take a critical look at my daily life and I realized the havoc my pack was wreaking. My bad habit was subjecting my body to the equivalent of being 25 pounds overweight for several thousand steps over the course of each day. I was also ignoring one of the most brilliant of human inventions all because I didn’t want to be seen as dorky.
Let’s face if you are not at or going to or from an airport wheelie, carry-on style bags are not suave. In fact, if you have the audacity to pull one around behind you (because its hell to get a llama permit in the city) people will regularly ask you about your destination. If you say nowhere special they will look confused and then commence to tease you about your dorky wheelie-bag (especially likely if they are saddled with a hip, urban messenger bag or backpack).
I say don’t listen to these soon to be obsolete human pack mules. Do they think penicillin and agriculture are dorky too? If harnessing the power of the wheel to save the delicate vertebrae of my back and the cartilage that lines my hips and knees is wrong, I don’t want to be right.
After a couple of days of pulling around my wheelie bag I can’t believe the difference. I feel much lighter, less worn down, my back doesn’t hurt one bit and I’ve taken some pressure off my ailing knee. I will never go back to being a human mule again and you shouldn’t either!
I dare you to take the wheelie bag challenge. Exchange your usual method of stuff transport for a roller bag for one week and experience the difference.
Roll on my dorky comrades, roll on!