Syringe nearly full of synovial fluid aspirated from the knee

DUROLANE® Karate Knees

DUROLANE® Karate Knees

An ongoing blog post to track knee progression of regression

By Johnpaul Williams

November 2022 – So after years of abusing my legs and knees, last November during a dinner after a karate seminar in Los Angeles, I was called to receive certificate that I tested for a few months earlier while in Japan, however for the moment I couldn’t stand. During the time I was seated, my knee had simply frozen and when I could move it the initial pain was agonizing. After a short massage I managed to muster up the strength to limp my way to the front table for a photo opportunity, which did help loosen the ligaments, and wobble my way back to my table.

May 2022 – 6 months later the pain would return, and the typical knee osteoarthritis symptoms would appear. Swelling in the leg above the injured knee, joint pain and tightness, locking or difficulty walking, painful to bend at the knee and near impossible to kneel down.

I’ve been “strongly urged” to schedule an an immediate doctor’s appointment after having fallen twice for my knee giving out. I’m sure this is parsley due to the stress I put on my writing me at work. However, I wouldn’t discount the years of karate training, track and field and judo may have contributed to the initial wear and tear.

After my first appointment my doctor recommended that I see a specialist and also revert me to physical therapy. The physical therapy actually makes no sense to me. If I can’t walk on it or bend it then what uses physical therapy going to do. That’s not going to fix a problem. If anything, it’s probably going to irritate it. I’m wondering if Kaiser is more interested in treatment as if this is a situation of pain or resolve and  solution…



May 31st 2023 – This morning I met with Dr Hayano at Kaiser Santa Clara. He was already onboard to remove the build-up of synovial fluid from my leg today and injecting the knee with a Hyaluronic Acid gel that has a lifespan use approximately 6 months. I, however, had to be at work and on duty no later than 9:30 am. and it was already 8 am so this would have to wait for two more days until Friday.

Syringe nearly full of synovial fluid aspirated from the knee

Syringe nearly full of synovial fluid aspirated from the knee

June 2nd 2023 – My good Dr. Hayano (OD) aspirated the joint capsule this morning and I was on duty by 9:30 am. , Dr. Hayano removed approximately 60 ml of synovial fluid from my leg and injected a combination of Cortisone and Durolane into the knee capsule. A little about the product from their website is below. Hope this works because I’m training in Japan next month for 6 hours for 8 of 13 days.

DUROLANE is a single-injection hyaluronic acid treatment for knee osteoarthritis

  • Longer lasting than Synvisc-One® and steroids.‡11,25,33
  • Chosen by more than a million doctors and patients worldwide, DUROLANE is a single-injection hyaluronic acid treatment that’s been clinically proven to match the power of 5-injection therapies for pain relief, while significantly improving the quality of life for knee osteoarthritis patients as early as 2 weeks after injection.
Knee Injection

Knee Injection

June 5th 2023 – It’s Monday, the first day back to training. Although yesterday I went on a very short bicycle ride, today I feel my leg and knee is much better, even though there are some strange pains. I’m not sure when this is supposed to go away, if ever, or minimally. I’ll write to the doctor for a bit of clarification.

June 9th 2023 – I can clearly feel and see the muscular atrophy in my right leg, which occurred over the past months having had had limped for miles and hours on end. I had my 1st physical therapy on Wednesday the 7th and another follow up next week. Being a life karate guy. I may have overdone it with training already. A (slow) 4-mile bike ride last Sunday and several hundred kicks on Wednesday during training. It’s like using muscles I never knew I had before because I couldn’t use them for months.

July 16th 2023 – I read that “Generally, the effect of Durolane starts within four weeks of an injection. However, some studies suggest an impact occurs as early as two weeks.” Well, this is the two-week mark, and I can tell you that although I can bear weight on my right leg without a problem it still feels like the linkage to the rear axle is about to fall off. This isn’t because of the treatment; this is because of muscular atrophy. I’ve been staying on top of my knee health since April now having a better understanding of how dependent we are on various parts of our body.

August 2nd 2023 – We are one month out from the Durolane injection treatment and I must honestly say, the swelling has finally subsided. Not completely, however obviously. I still tend to favor using the strength of my left knee over my right knee for various pivots and shifts so this is something I must mentally work on. The ligament chain which felt like an axle near breaking now feels significantly sturdier. Next week’s training in Japan will be the real test as that is approximately 5 weeks out from the initial procedure. If the knee holds up when it comes time the left knee will follow the same life-path as however it’s not too far behind in needing the same treatment as the right knee.

August 6th 2023 – Tonight I went by the pharmacy to pick up a pair of those custom sole inserts by Dr. Scholls. I had to stand on a computerized pressure sensor which measured my feet and logged a few details, some I knew of and others I had no idea….. But the recommendation from Dr. Scholls is Custom ID440….. For people over 200lbs with fleet feet. Tomorrow I’m on the plane back to Japan for training. Although I don’t have any tests or grading this year, I still expect to participate as much as I possibly can, just as I expect everyone else attending to commit to doing the same.

August 8th 2023 – Tuesday evening we land at Narita Airport Japan and boy are my arms tired….. I’m a dork so what!?!? I’m wearing the shoe inserts in a pair of sandals, by Dockers, at the moment. If you’ve ever been in the lines for international customs, you know just how aggravating you can get and if you are uncomfortable and in pain, making the situation much worse. So far, I’ve managed to get through customs, to the railway office, and all the way to the Shinkansen for Tokyo and these shoe inserts are working great! The Durolane is a thing of science as well. Combined, I could put in some mileage, however how about I stick to getting the muscle network rebuilt and strengthened. Lots of walking ahead for me in the next few days.

August 9th 2023 – Wednesday and day one of training in Akita Japan. Suprise suprise, I can kick but I can’t. Training today in northern Japan opened with back movements and the application of hip rotation to generate power. My knee did just fine! After lunch a heat advisory was issued, and we slowed down significantly but still performed kata and I am accustomed to making my kata explosive however when I attempted to do so, my leg said “hahaha good luck there buddy,” and refused to pick up the speed. Upon inspection, it seems there is significant swelling around the knee and some pooling around the ankls. I’ll use my physical therapy roller tonight to work on this and sleep with my legs elevated tonight.

August 11th 2023 – Friday the Japan National Champions train with us.

August 12th 2023 – Saturday

Knee swelling with Synovial fluid to 18.5" when it is normally 16.5"

Knee swelling with Synovial fluid (???) to 18.5″ when it is normally 16.5″

August 16th 2023 – Wednesday is generally the travel day for our annual karate adventure from out headquarters dojo hometown (Daisen near Akita Japan)  to the host city (Osaka) for the national convention (taikai) and competition (shiai).

August 18th 2023 – Friday

Tomorrow is competition day and with some luck there will not be some swelling.

August 19th 2023 – Saturday: As written in a different blog post today was proving day. I didn’t try t oover-do anything and took an easy route performing a kata with no kicking and with the Durolane injection I was very capable of making my show stopping deep shiko dachi (square stance) thus walking away with a 9th place our of a pool of 32. Being a giant in Japan, that is an excellent score and as can be seen in the video based on the height of our heads I can go just as low as a 5′ 2″ local.

August 21st 2023 – Monday the return home stateside. My posterior and anterior crucuate ligaments as well as my paternal ligament (connects the patella to the shin) and calve muscles are much less sore than before leaving to Japan. Although not 100% I can clearly feel that the treatment works and did the job of getting me through the Japan training.

There continues to be a necessary routine to stretching and strengthening required for maintenance and rebuilding however so far so good.

September – October – November – I actually forgot for some time to update this blog as I nearly forgot that I had the injection since there have been only minor issues with my knee which I have long dealt with. Particularly in October and November there were times where I have completely forgotten there was ever a problem at all. This included training and teaching Kumite footwork and participating in a kumite seminar.

December – Now that the California weather is officially changing, I can feel that something is not optimal with my knee however looking at the barometer there may simply be a different type of pressure occurring so this is a wait and see moment.

January 11 – I’ve just written the following message to Dr. Hayano at Kaiser. “Over the New Year’s weekend it seemed as if the injection was finally wearing off and as of late last week, I could clearly tell that it was time for the procedure again. How would I go about scheduling a follow-up injection? I’m at a point right now where the limping is starting again and when laying down on my chest and bending my knee I can hear and feel the joints rubbing together.”

Over the Christmas and New Year holiday, the temperatures outdoor dropped significantly here in the Silicon Valley. Looking over this blog posts beginning I quickly calculated that the initial injection has now been over the six (6) month prescribed duration so it only makes sense that the treatment has worn off or is wearing off.

Less than 6 hours after writing to the Orthopedic department, I received a message back from Dr. Hayano’s office that my next appointment is the morning of January 23. Updates to follow on or after the 23rd of January.

After a 12 hour shift on duty wearing a compression knee brace on the right knee, both swelling and pain decreases.

After a 12 hour shift on duty wearing a compression knee brace on the right knee, both swelling and pain decreases.

January 13 – Since receiving the response and appointment from Kaiser my knee pain increased (7/10) significantly and last night I wore a light compression sleeve over my knee to bed then followed with another knee compression and support (tape style) device to get through my 12 hour shift at work. By the end of the day, upon returning home there was minimal pain (3/10 with help from a combination of Motrin and Acetaminophen) and the swelling was gone however there remained that noticeable feeling that my knee was going to fall off. The same feeling back in May of last year. As a side note, my left knee now feels as my right knee felt back in 2022 so my be due for the same treatment towards the end of the year. Getting old totally sucks!