What I Did to Save My Knees

That's an ambitious title for a post -- too ambitious really (that's why I wrote a book) -- but I just realized that, through several months of entries, I haven't been very clear about how I saved a pair of knees that my doctors said would never get better. At the time I was in my 40s with chronic pain that one doc even diagnosed as arthritis.

Here's my short answer: Joint-friendly motion. A lot of it.

When I realized my hurting knees had to move, and had to move a lot, the first thing I did was jettison all the advice of my physical therapist. Because he wanted to improve my knees by strengthening the muscles around the joint. Anyone who's done exercises to build up muscles knows that they respond best to low repetitions of high force.

For a while, I struggled with my physical therapist's recommended exercise program, wondering why I wasn't getting better. My muscles weren't getting stronger; my weak joints sabotaged my attempts to bulk them up. Then, as I researched the science of joints more deeply, I realized: damn, this guy has been giving me lousy advice.

Strengthen the quads is the wrong prescription. Strengthen the joints is the right one.

My first invaluable insight into restoring bad knee joints came via Doug Kelsey, who is by far the smartest guy I've read on rehabbing injuries. He suggested that a soft tissue like cartilage (which is often implicated in knee joint pain and mine was definitely damaged) responds best, in a positive, adaptive way, to high repetitions of low force. High repetitions = thousands of times.

So that got me thinking. Hmm. What exercise gets you high repetition, low force? You may think: well, there's lifting a really light weight. Unh unh. Tried that. You'd be surprised how heavy a five-lb. weight becomes after you extend it with your bent leg 100 times. There really aren't many activities that are high repetition, low force. Two however came to mind: flat-stage, easy walking (for me, 2,000 steps equals about a mile) and gentle cycling.

Cycling was out. I hurt my knees cycling hard up mountains, and my knees got irritated and inflamed with even easy cycling on a stationary bike. I suspect this was because of the peculiar cartilage damage pattern (it was worst under the kneecaps and I think mirrored the contact points of my cartilage for the pedal stroke). Walking though was different: I had retained a decent ability to walk.

So I kept a knee journal as I began walking and increased my step counts, from week to week. It was slow. There were setbacks. But eventually I could hike for five miles in the mountains. Then a full thirteen months after I seriously began my rehabilitation, I climbed back on a bicycle. My back felt stiff and I was wobbly, like an old man, not like the guy who took second place in his age category two years running in a time trial series in South Florida just five years previous.

That return to the bike came 15 months ago. Now, finally, I'm back cycling at full intensity. My knees feel really good. They also make less-crunchy noises (indicating the cartilage has probably healed somewhat).

So why was I convinced that motion was so important for knees (I think it is the single most important thing, by far, to effect healing)? I did much, much research -- which is what I'll get into in future entries. And what do you do when your knees hurt too much to walk a few miles a day? Ah, I've been there. There are answers. When my joints were really weak, I used to walk around a pool, 101 steps, every 10 minutes, just to give them periodic "dosed" motion.

The key thing is to get on the right path to healing. That path, I'm convinced, involves just the right amount (and right kind) of motion. Moving is how you win the battle.