Sunday, September 19, 2010

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.


  1. Hi Rihard,

    I saw a date mistake on your book pdf.
    "April 5, 2008, Sunday (I’m in month twelve...)"

    It has to be 2009 :)

  2. Sharp eye! (And I thought no one was reading the appendix ...) Yes, you're quite correct. The last entry should be April 5, 2009, in the "My Year of Recovery" appendix. Sorry about that, folks!

  3. Does this mean I can refund my book purchase since it contains faulty information? Lol.

    Just curious, does Mr Kelsey know how much publicity you're giving him? Have you ever communicated with him?

    I'm having a hard time coughing up 70 bones for his book. You recommend it, or should I simply cruise his blog first?

    Thanks Richard, -Erik

  4. I've never read Doug Kelsey's book, but I have a lot of respect for his thinking. I would cruise his (free) blog first. His book, I understand, does have good exercises for bad knees, if you need some.

  5. Thanks for this info. I'm a fairly active 40 something who was trying to get back into running most recently, but struggling with shin splints right off the bat. Then a few weeks ago, I noticed that anytime I would squat, it was becoming harder and harder for me to stand back up...and as the mother of a 5 year old, not squatting is not an option. So I'm panicking a little. I've seen it coming, the bad knees, I mean. They've always popped going up and down stairs, and crawling around on the floor was absolutely "crunchy" - to steal your perfect description. I knew exactly what you meant when I read that. So looks like I am on the right track: more walking. Seriously, thank you for taking the time to write about this. I feel much less stress having read of your success. I wish you continued improvement!

  6. Thanks for the good thoughts! No need to wish for continued improvement; I'm already healed and don't expect future problems (knock on wood).

  7. I am staying from Singapore and wanted to order your ebook, Saving My Knees" from Amazone. But this book is not selling to asia countries because of publisher not licence in these countries. Can you do something on this. So that more people benefit from your experience. Thank you.

    1. Thanks for your interest, Anonymous from Singapore. A few things: (1) The book is selling through Amazon in Japan (2) Amazon is adding new countries all the time (so who knows -- Singapore could be next!) (3) A lot of my experience (and beliefs about what's needed to heal from chronic knee pain) are scattered all over this blog, so you can find a lot of good info by searching right here ... plus it's free! ;)

    2. Thank you for your info. I am still reading through your blog.
      Just some sharing, while looking for knees cure, I found this website using another method, quite interesting also.
      Again, I am from Singapore, so cannot really check on their course.

  8. i was depressed when i knew i got bad knee..
    i have gain some confidence thru your blog...i m going to buy your book ....
    i wish my uncle saw your blog before he went for knee replacement..

  9. Dear Richard, your story relates very much to what I am passing through right now. 4 surgeons and 2 therapists all same recommendation strengthen the muscles. As you say this was causing more harm. Cycling was a no no too for me not even gentle cycling for five minutes. Then my husband was planning a weekend break for me to distract myself (had become sad and unhappy) as I could not accept this injury. To my surprise I managed to walk a lot during the weekend break with coffee stops in between. my knee felt good for the first time away from therapists and all. So your book encouraged me a lot to follow your steps and have hope that one day I will be able to return to the active person I once was. Like you I want to feel the sweat coming down my face once again. But I know it is a long way and to learn above all to have patience.

    1. It sounds like you're harboring no illusions about the size of the challenge! But it's all one step at a time, and if you're improving, that creates a positive momentum and energy. Check back in the future and let us all know how you're doing.

  10. Hi Richard, your book is encouraging. But my condition is little different. I have been diagnosed with mild Chondromalacia. I squatted 6 months ago and sensed some pain and discomfort when I got up. Ignoring my pain, I did some impact exercises including jogging which made my knee problem worse. I stopped exercises but continued walking as part of my routine activities and this repeated use of my knee and leg made my condition worse to the extent that I was limbing and finally could not put any weight on my knee and leg. Nothing shows up on MRI and doctors suggested PT and then cortisone shot. With cortisone I started improving but as soon as it wore off, my condition again deteriorated. I can barely walk and doctors don't have any idea what is wrong. They say probably my patella is biologically placed in such a way that it grinds and causes irritation. Everyday, I improve a bit, but that bit is very minute. Do you have any suggestions on my kind of condition?

  11. Interesting. I'm not a big fan of cortisone shots/steroids for knee inflammation (just search the blog and you'll see). Also that lame "mistracking patella" reason for your pain is usually not the real reason (just search the blog for mistracking or maltracking). If you're improving every day, well, that's a good sign! Patience is a virtue with knee pain. It can take many months or years to escape it. If you search the blog for "envelope of function," you'll find some discussion of Scott Dye's theory of rehabbing bad knees, and his framework may be appropriate for you. Good luck!