9+ Knee Tendonitis, Can't Walk? Reddit Fixes & Tips!


9+ Knee Tendonitis, Can't Walk? Reddit Fixes & Tips!

The inability to ambulate due to knee tendonitis, frequently discussed on platforms like Reddit, suggests a significant inflammatory condition affecting the tendons around the knee joint. This condition causes pain and restricted movement, potentially rendering walking difficult or impossible. The severity can vary, but the presence of such limitations usually indicates a substantial level of tendon irritation and swelling. As an example, individuals experiencing this might describe an intense, localized pain that increases with weight-bearing activities, preventing normal gait patterns.

Addressing the underlying issues causing the ambulation difficulty is of paramount importance to regain mobility and alleviate pain. Early intervention through conservative treatments, like rest, ice, compression, and elevation (RICE), alongside physical therapy, often yields positive outcomes. The benefits of proactively managing knee tendonitis extend beyond pain relief, encompassing the prevention of chronic pain, functional limitations, and potential compensatory mechanisms that can lead to problems in other joints. Historically, remedies for tendonitis included bracing to reduce stress on the knee, but modern approaches emphasize active rehabilitation to strengthen supporting musculature and restore function.

The subsequent discussion will delve into diagnostic procedures used to confirm the presence and extent of tendonitis. Further emphasis will be placed on comprehensive therapeutic strategies and preventative measures aimed at minimizing the risk of recurrence and promoting sustained recovery. These strategies range from pharmaceutical interventions to regenerative therapies.

1. Inflammation Severity

The severity of inflammation plays a pivotal role in determining the extent to which knee tendonitis impedes the ability to walk. When inflammation surrounding the affected tendon is acute and substantial, it directly exacerbates pain upon weight-bearing, limiting range of motion and functional use of the leg. The resulting discomfort can be so intense that it is impossible to maintain a normal gait, or to ambulate at all. Individuals discussing experiences on platforms like Reddit often cite the cyclical relationship: increased activity provokes further inflammation, which, in turn, intensifies the pain and restriction, creating a barrier to movement.

Consider an athlete who strains a patellar tendon during training. If the resulting inflammation is mild, they might experience discomfort during strenuous activity, but can still manage day-to-day walking with minimal difficulty. Conversely, a severe inflammatory response, characterized by significant swelling, heat, and tenderness, can make even short, level walks unbearable. This directly translates to a situation where the individual “can’t walk,” necessitating crutches or complete rest to manage the pain. This example illustrates how varying degrees of inflammation serve as a primary determinant of functional capacity in individuals with knee tendonitis. Recognizing and addressing the inflammation severity is a crucial early step in effective treatment and rehabilitation.

In summary, the inflammation level is a critical factor in understanding the link between knee tendonitis and the inability to walk. Effectively managing and reducing inflammation is essential for restoring function and enabling individuals to resume ambulation. While addressing the pain is important, focusing on diminishing the inflammatory response provides a more sustainable and potentially long-term resolution to mobility limitations associated with the condition.

2. Pain management

Pain management is a critical component in addressing the inability to walk caused by knee tendonitis, as evidenced by discussions on platforms like Reddit. The intensity of pain directly correlates with functional limitations. When pain is severe, ambulation becomes difficult, if not impossible. Effective pain management strategies can alleviate this pain, improving the individual’s ability to walk and participate in daily activities. For instance, individuals experiencing intense pain due to patellar tendonitis may find walking challenging, limiting their ability to perform basic tasks. Adequate pain management, through methods such as medication or physical therapy, can reduce pain levels, facilitating improved mobility and function.

The approach to pain management often involves a multi-modal strategy. This includes pharmacological interventions, such as non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics, physical therapy modalities like ultrasound or electrical stimulation, and lifestyle modifications. A person suffering from quadriceps tendonitis preventing them from walking without significant discomfort might benefit from a combination of pain medication to reduce acute pain, and targeted exercises prescribed by a physical therapist to strengthen the surrounding muscles and improve joint stability. Furthermore, activity modification, such as avoiding high-impact exercises, is crucial in reducing stress on the affected tendon and promoting healing.

Successful pain management not only reduces discomfort but also facilitates active participation in rehabilitation, a crucial step towards restoring full function. Failure to effectively manage pain can lead to a cycle of inactivity, muscle weakness, and prolonged recovery. Therefore, the integration of appropriate pain management techniques is paramount in enabling individuals with knee tendonitis to regain the ability to walk and improve their overall quality of life. Ultimately, the degree to which pain is managed dictates the pace and success of the recovery process, impacting the individual’s ability to resume normal activities.

3. Limited mobility

Limited mobility is a direct consequence of knee tendonitis and a central reason for the experiences shared on platforms like Reddit concerning the inability to walk. When the tendons around the knee joint become inflamed and painful, the range of motion is significantly restricted. This restriction arises from both the pain itself and the body’s protective mechanisms, such as muscle guarding, which further limit joint movement. Individuals with patellar or quadriceps tendonitis often experience difficulty fully extending or flexing the knee, hindering the normal biomechanics required for walking. The reduced mobility directly impacts the ability to initiate, maintain, and complete a normal gait cycle. The more significant the mobility restriction, the greater the difficulty in walking.

Consider the case of an individual with chronic quadriceps tendonitis. The persistent inflammation and pain lead to decreased muscle flexibility and joint stiffness. This stiffness restricts the knee’s ability to bend fully during the swing phase of walking and limits the power generated during push-off. The result is an altered gait pattern, characterized by shortened strides, reduced walking speed, and increased energy expenditure. In more severe cases, individuals may rely on assistive devices such as crutches or walkers to compensate for the reduced stability and support caused by the limited mobility. This highlights that restricted movement is not merely a symptom of knee tendonitis but a critical factor contributing to functional impairment.

In summary, limited mobility is a primary driver of the inability to walk associated with knee tendonitis. The restricted range of motion, combined with pain and protective muscle responses, disrupts normal gait mechanics, making walking difficult or impossible. Addressing mobility limitations through targeted interventions like stretching, strengthening, and pain management is crucial for restoring function and enabling individuals to return to ambulation. Effective management of limited mobility is therefore a cornerstone of rehabilitation strategies aimed at improving the walking ability of individuals affected by knee tendonitis.

4. Functional impact

Functional impact refers to the extent to which knee tendonitis affects an individual’s ability to perform daily activities, a frequent topic of discussion on platforms like Reddit when individuals describe an inability to walk. The severity of this impact varies depending on factors such as the degree of tendon inflammation, pain levels, and the individual’s physical demands.

  • Activities of Daily Living (ADL)

    Knee tendonitis can significantly impede the performance of basic self-care tasks. Walking, standing, and squatting are often necessary for activities like bathing, dressing, and using the toilet. When knee tendonitis prevents walking, individuals may require assistance with these fundamental activities, leading to a loss of independence and reduced quality of life. For example, an individual unable to walk might struggle to prepare meals, requiring reliance on others for basic sustenance.

  • Occupational Demands

    The functional impact of knee tendonitis extends to vocational capabilities. Occupations requiring prolonged standing, walking, or repetitive knee movements can become untenable. Construction workers, nurses, and teachers are examples of professionals whose livelihoods may be jeopardized by the condition. The inability to perform essential job functions can lead to decreased productivity, absenteeism, and, in some cases, job loss, resulting in financial strain and reduced psychological well-being.

  • Recreational Activities

    Participation in leisure pursuits is often limited by knee tendonitis. Activities such as hiking, running, and playing sports become painful or impossible, leading to social isolation and diminished physical fitness. The inability to engage in preferred hobbies can contribute to feelings of frustration, depression, and a reduced sense of overall life satisfaction. For instance, a previously active individual might find themselves unable to participate in social sports leagues or outdoor adventures.

  • Social Interactions

    The restriction in mobility imposed by knee tendonitis can impede social engagement. Difficulty walking or standing for extended periods can limit the ability to attend social events, visit friends and family, or participate in community activities. This isolation can lead to feelings of loneliness, anxiety, and decreased social support, further exacerbating the psychological impact of the condition. An individual unable to walk comfortably might avoid social gatherings to minimize pain and embarrassment.

These facets demonstrate the profound functional impact of knee tendonitis that manifests as an inability to walk, often discussed on social platforms like Reddit. It underscores the importance of early diagnosis, effective management, and comprehensive rehabilitation to minimize functional limitations and improve the overall well-being of affected individuals. Addressing the functional impact requires a holistic approach that considers not only the physical symptoms but also the psychological and social consequences of the condition.

5. Rehabilitation strategies

Rehabilitation strategies are fundamental in addressing the inability to walk resulting from knee tendonitis, a situation frequently discussed on platforms like Reddit. These strategies aim to reduce pain, restore function, and facilitate a safe return to activity, thereby mitigating the limitations imposed by the condition.

  • Pain and Inflammation Management

    Initial rehabilitation efforts focus on controlling pain and inflammation through methods such as rest, ice, compression, and elevation (RICE protocol). Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce inflammation and pain. A person experiencing acute patellar tendonitis might use ice packs several times a day and take over-the-counter pain relievers to manage symptoms before progressing to more active therapies. Effective pain and inflammation control is essential for enabling participation in subsequent rehabilitation exercises.

  • Strengthening Exercises

    Strengthening exercises are designed to restore strength and stability to the knee joint. These typically begin with isometric exercises (muscle contractions without movement) and progress to isotonic exercises (muscle contractions with movement) as pain decreases. Examples include quadriceps sets, hamstring curls, and calf raises. An individual recovering from quadriceps tendonitis might start with isometric quadriceps contractions and gradually progress to bodyweight squats and eventually weighted exercises as their strength improves. Strengthening the muscles around the knee helps support the joint and reduce stress on the affected tendon.

  • Range of Motion and Flexibility Exercises

    Restoring full range of motion is crucial for regaining normal walking mechanics. Flexibility exercises, such as hamstring stretches and calf stretches, help improve joint flexibility and reduce stiffness. An individual with restricted knee extension might perform heel slides or towel stretches to gradually increase their range of motion. Improved range of motion allows for a more efficient and pain-free gait pattern, contributing to the ability to walk normally.

  • Proprioceptive Training

    Proprioception, or joint position sense, is often impaired in individuals with knee tendonitis. Proprioceptive training exercises, such as balance board exercises and single-leg stance activities, help restore balance and coordination. Someone recovering from patellar tendonitis might use a wobble board to improve their balance and stability, reducing the risk of re-injury. Enhanced proprioception contributes to improved joint stability and control, minimizing the likelihood of falls and promoting confidence during walking.

In conclusion, structured rehabilitation strategies are indispensable for addressing the walking difficulties associated with knee tendonitis. By targeting pain and inflammation, restoring strength and range of motion, and improving proprioception, these interventions enable individuals to regain functional independence and return to their desired activities. The integration of these facets is critical to successful rehabilitation, allowing individuals to overcome the limitations and experiences discussed within forums like Reddit and achieve sustained recovery and improved quality of life.

6. Underlying causes

Understanding the factors contributing to knee tendonitis, often discussed on platforms like Reddit when users describe difficulty walking, is crucial for effective treatment and prevention. Identifying and addressing these underlying causes is essential to mitigating symptoms and restoring function, rather than merely managing the immediate pain and mobility issues. The subsequent points detail significant etiological factors.

  • Biomechanical Imbalances

    Biomechanical imbalances, such as improper foot alignment, leg length discrepancies, or muscular imbalances around the hip and knee, can contribute to uneven stress distribution on the knee tendons. For example, overpronation of the foot can alter the alignment of the lower limb, placing excessive strain on the patellar tendon. These imbalances, if uncorrected, perpetuate the inflammation and pain associated with tendonitis, ultimately hindering the ability to walk. Addressing these imbalances through orthotics, physical therapy, or other interventions is critical to alleviating the stress on the affected tendons.

  • Overuse and Training Errors

    Repetitive activities or sudden increases in training intensity or volume can overload the knee tendons, leading to micro-trauma and inflammation. For instance, a runner who abruptly increases their mileage without adequate conditioning may develop patellar tendonitis due to the repetitive stress on the tendon. Such overuse injuries can render walking extremely painful or impossible. Proper training techniques, including gradual progression and adequate rest, are necessary to prevent tendonitis arising from overuse.

  • Muscle Weakness or Tightness

    Weakness in the quadriceps, hamstrings, or gluteal muscles can impair the biomechanics of the knee joint, leading to increased stress on the tendons. Similarly, tightness in these muscle groups can restrict joint movement and contribute to tendon irritation. An individual with weak quadriceps muscles may rely more heavily on the patellar tendon during activities such as walking or stair climbing, increasing the risk of tendonitis. Strengthening weak muscles and stretching tight muscles are essential components of rehabilitation to reduce stress on the tendons.

  • Poor Footwear or Equipment

    Inadequate footwear or improperly fitted equipment can contribute to knee tendonitis by altering biomechanics or increasing stress on the knee joint. For instance, wearing shoes with insufficient support or cushioning during high-impact activities can increase the load on the patellar tendon. Similarly, using improperly adjusted bicycle seats or pedal cleats can place excessive stress on the tendons during cycling. Choosing appropriate footwear and ensuring proper equipment fit are crucial for preventing tendonitis related to these factors.

In summary, addressing the underlying causes of knee tendonitis is crucial to resolving the ambulation difficulties reported on platforms like Reddit. These factors are interconnected and often require a multifaceted approach to treatment. By identifying and correcting biomechanical imbalances, avoiding overuse, addressing muscle weakness or tightness, and ensuring proper footwear and equipment, individuals can reduce their risk of developing tendonitis and improve their ability to walk without pain.

7. Recovery timeline

The “cant walk from tendonitis in knee reddit” phenomenon underscores the significant impact of knee tendonitis on mobility. The recovery timeline, in this context, represents the duration required to restore ambulation. This timeline is highly variable, influenced by factors such as the severity of the tendonitis, individual physiological responses, adherence to treatment protocols, and pre-existing conditions. An incomplete understanding or disregard for the recovery timeline can lead to premature resumption of activity, exacerbating the condition and potentially resulting in chronic pain or further functional limitations. Real-life examples encountered on Reddit frequently involve individuals who, in an attempt to expedite recovery, return to weight-bearing activities too soon, leading to setbacks and prolonged periods of immobility. The recovery timeline is therefore a critical determinant of long-term outcomes and functional restoration.

The management of knee tendonitis and subsequent return to walking necessitate a phased approach, guided by the recovery timeline. Initial interventions often involve reducing inflammation and pain, followed by a gradual introduction of strengthening and flexibility exercises. The progression through these phases is dictated by the individual’s response to treatment, monitored through pain levels, range of motion assessments, and functional tests. For example, an individual might initially be unable to bear weight without pain, requiring crutches for ambulation. As the pain subsides and strength improves, the individual gradually transitions to weight-bearing exercises and eventually to walking without assistance. However, deviations from this timeline, driven by impatience or misjudgment of healing progress, can compromise the tendon’s recovery and prolong the period of immobility. Individual accounts shared on Reddit often highlight the frustration and setbacks experienced when recovery timelines are ignored or misunderstood.

In summary, the recovery timeline is a crucial element in addressing “cant walk from tendonitis in knee reddit.” Its adherence ensures a structured and safe return to ambulation. Ignoring this timeline can lead to reinjury and chronic disability. Understanding that each case is unique and requires a personalized recovery timeline, informed by medical guidance and vigilant self-assessment, is essential. The goal is to not only restore the ability to walk but also to prevent future recurrence of knee tendonitis and its associated functional limitations, thereby ensuring a long-term improvement in mobility and quality of life.

8. Lifestyle adjustments

The inability to ambulate, a predicament frequently voiced within the “cant walk from tendonitis in knee reddit” discourse, often stems directly from lifestyle factors. Repetitive strain injuries, such as knee tendonitis, are markedly influenced by activity levels, exercise routines, and even dietary choices. The causal link between these habits and tendon inflammation is well-established. A sedentary lifestyle can lead to weakened musculature around the knee, placing undue stress on the tendons, while conversely, high-impact activities without proper conditioning can overload the tendons, leading to micro-tears and inflammation. Dietary choices impacting inflammation, such as diets high in processed foods or lacking in essential nutrients, can exacerbate the condition. Thus, lifestyle adjustments are not merely ancillary recommendations but a fundamental component of addressing the root causes of impaired mobility related to knee tendonitis. For example, a desk-bound worker who spends hours seated with poor posture may develop weakened leg muscles, which subsequently contribute to tendonitis when they engage in infrequent, strenuous physical activity. This emphasizes the need for regular, low-impact exercises and ergonomic considerations within daily routines.

The practical application of lifestyle adjustments in managing knee tendonitis involves a comprehensive assessment of an individual’s daily habits and targeted modifications. This may include altering exercise routines to incorporate low-impact activities like swimming or cycling, implementing regular stretching and strengthening exercises to support the knee joint, adopting an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids, and making ergonomic adjustments to workspaces or recreational settings. For instance, a runner experiencing patellar tendonitis might benefit from shortening their stride length, increasing their cadence, and incorporating cross-training activities to reduce stress on the knee joint. Furthermore, weight management, if applicable, can significantly reduce the load on the knee tendons, alleviating inflammation and improving mobility. Adherence to these lifestyle adjustments requires a sustained commitment, often involving behavioral changes and integration into daily routines. Practical support can be obtained through physical therapy, nutritional counseling, and engagement with peer support groups, some of which may be found on platforms like Reddit.

In conclusion, the connection between lifestyle adjustments and the inability to walk due to knee tendonitis is direct and significant. Addressing modifiable lifestyle factors is crucial for both preventing and managing the condition. Challenges in implementing these adjustments often involve overcoming ingrained habits and maintaining motivation for long-term adherence. Recognizing lifestyle adjustments as a primary intervention strategy, rather than an afterthought, is essential for mitigating the functional limitations associated with knee tendonitis and promoting sustained improvements in mobility and overall well-being.

9. Return to activity

The phrase “cant walk from tendonitis in knee reddit” represents a shared experience of functional limitation. The prospect of a return to activity becomes a primary focus for those impacted. Premature or poorly managed resumption of physical exertion stands as a frequent cause of symptom exacerbation, prolonging the period of immobility. The information shared on platforms like Reddit often highlights this, with individuals recounting instances where overzealous attempts to return to pre-injury activity levels led to setbacks and renewed pain. Successful rehabilitation, therefore, hinges on a carefully graded approach to activity resumption.

The importance of “Return to activity” as a component of recovery from knee tendonitis manifests in restoring not only mobility but also overall quality of life. A structured program, typically guided by a physical therapist, aims to gradually increase the load and impact on the affected tendon, allowing it to adapt and strengthen over time. For example, an individual recovering from patellar tendonitis might begin with low-impact exercises like swimming or cycling before progressing to walking and eventually running. Pain monitoring is crucial during this phase; an increase in pain often signals that the activity level is too high and needs to be reduced. Reddit threads frequently detail specific exercises and progression strategies that have proven effective for others, providing a valuable, though not medically validated, source of information.

In summary, the connection between restricted ambulation due to knee tendonitis and the return to activity emphasizes a need for caution and structured rehabilitation. The absence of a carefully managed approach to “Return to activity” significantly contributes to the persistence of the “cant walk from tendonitis in knee reddit” situation. Successful recovery necessitates a gradual progression, diligent pain monitoring, and adherence to medical guidance, enabling individuals to regain function and prevent recurrence.

Frequently Asked Questions About Knee Tendonitis and Ambulation Difficulties

The following addresses common inquiries regarding the condition preventing walking due to knee tendonitis, often discussed on platforms like Reddit.

Question 1: What factors typically contribute to the inability to walk when experiencing knee tendonitis?

Significant inflammation, intense pain, and limited range of motion are primary factors contributing to the impaired ability to ambulate. These elements directly affect the functionality of the knee joint.

Question 2: Are there specific activities that should be avoided to prevent exacerbating knee tendonitis and further limiting ambulation?

High-impact activities, such as running, jumping, and prolonged standing, should be avoided. These activities increase stress on the affected tendon.

Question 3: What conservative treatments are typically recommended to improve walking ability in individuals with knee tendonitis?

Rest, ice, compression, and elevation (RICE) protocol, along with pain medication and physical therapy exercises designed to strengthen supporting muscles, are often recommended.

Question 4: How can rehabilitation exercises improve the ability to walk when affected by knee tendonitis?

Rehabilitation exercises aim to reduce pain, increase range of motion, strengthen surrounding muscles, and improve balance and proprioception, all of which contribute to a more stable and functional knee joint.

Question 5: When is medical intervention beyond conservative treatment warranted for knee tendonitis?

If conservative treatments fail to provide sufficient relief after several weeks or if symptoms worsen, medical intervention, such as corticosteroid injections or, in rare cases, surgery, may be considered.

Question 6: What lifestyle modifications can help prevent recurrence of knee tendonitis and maintain walking ability?

Maintaining a healthy weight, using proper footwear, avoiding overuse, gradually increasing activity levels, and addressing biomechanical imbalances can help prevent recurrence.

These FAQs are intended to provide a general overview of ambulation difficulty due to knee tendonitis. Individual experiences and treatment outcomes may vary, therefore, consultation with healthcare professionals is recommended for personalized guidance.

The subsequent article section will explore detailed approaches on diagnosis and managements.

Navigating Knee Tendonitis

Individuals experiencing ambulation difficulties due to knee tendonitis, often expressed as “cant walk from tendonitis in knee reddit,” may benefit from targeted strategies. The following provides actionable recommendations.

Tip 1: Prioritize Rest and Activity Modification: The initial phase necessitates minimizing stress on the affected tendon. Refrain from activities that exacerbate pain. Consider alternative, low-impact exercises such as swimming or stationary cycling to maintain cardiovascular fitness without overloading the knee.

Tip 2: Implement the RICE Protocol Consistently: Adhere to Rest, Ice, Compression, and Elevation. Apply ice packs for 15-20 minutes several times daily. Utilize a compression bandage to minimize swelling, and keep the affected leg elevated above the heart. Consistency is critical for reducing inflammation and facilitating healing.

Tip 3: Engage in Targeted Stretching and Strengthening Exercises: Gentle stretching exercises, such as hamstring and quadriceps stretches, can improve flexibility. Strengthening exercises, including isometric quadriceps contractions and calf raises, enhance support around the knee joint. Proper form and gradual progression are essential to avoid re-injury.

Tip 4: Evaluate Footwear and Biomechanics: Ensure appropriate footwear that provides adequate support and cushioning. Consider consulting a podiatrist or physical therapist to assess biomechanics and identify potential imbalances that contribute to tendon stress. Orthotics may be beneficial in correcting foot alignment issues.

Tip 5: Optimize Nutritional Intake: Consume an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids. Avoid processed foods, sugary drinks, and excessive saturated fats, as these can exacerbate inflammation. Adequate hydration is also essential for tendon health.

Tip 6: Consider Assistive Devices for Short-Term Support: During periods of acute pain and limited mobility, assistive devices such as crutches or a knee brace can provide added support and reduce stress on the knee joint, facilitating limited ambulation when necessary.

Tip 7: Gradual Return to Activity: When pain subsides and function improves, implement a gradual return to activity plan under the guidance of a physical therapist. Increase activity levels incrementally, paying close attention to any signs of pain or inflammation. Avoid sudden increases in intensity or duration.

Adherence to these strategies promotes reduced pain, improved function, and a safer return to activity. Consistent application of these tips should allow individuals to more effectively manage knee tendonitis.

The subsequent section will summarize and conclude findings to address such issue effectively.

Concluding Remarks

The discussions surrounding the inability to ambulate stemming from knee tendonitis, as observed across platforms like Reddit, underscore the substantial impact this condition can have on an individual’s functional capacity. The preceding exploration has highlighted key contributing factors, including inflammation severity, pain management strategies, limitations in mobility, the broader functional impact on daily living, and the necessity of structured rehabilitation protocols. Additionally, underlying causes such as biomechanical imbalances, overuse, muscle weakness, and inappropriate footwear have been emphasized as critical areas for attention. Further considerations have included the variable recovery timeline and the importance of integrating appropriate lifestyle adjustments to both manage existing symptoms and prevent recurrence.

Effective management of knee tendonitis requires a comprehensive approach that integrates these multiple facets, moving beyond symptom mitigation toward addressing underlying causes and promoting long-term joint health. The information presented is intended to provide a foundation for informed decision-making, but it cannot replace the expertise of qualified healthcare professionals. Individuals experiencing persistent ambulation difficulties are encouraged to seek personalized medical assessment and guidance to ensure optimal recovery and prevent chronic functional impairment. The prospect of sustained mobility necessitates proactive engagement with treatment strategies and a commitment to lifestyle modifications that support tendon health, thereby mitigating the risk of recurrent episodes that impede daily life.