Sunday, September 12, 2010

What's Your Knee Pain Personality?

While writing my book about recovering from chronic knee pain, I had a flash of insight: There are two dominant "knee pain personalities," if you will. They are both extreme, in their own fashion. Each personality type presented an obstacle to healing.

I call them the "Humpty Dumpty" and the "Warrior" (other colorful nicknames can be devised; these are the two that I happened to like best).

Humpty Dumpty types manage the long-running knee pain battle by being ultra-conscious of their fragility. These people have suffered enough setbacks to adopt caution as a byword. If they make a dash for the bus, and their knee swells/aches that day or the next, the lesson they take away is not to run for any more buses. Which at first seems sensible.

Notice though that they don't think, "How can I strengthen my knees so that they can tolerate an occasional sprint to catch a bus?" Instead they pencil "running for bus" on their mental list of "things that people with knee pain like mine shouldn't do." Over time it becomes a long list. A Humpty Dumpty is, in fact, prone to falling into the "bad knee death spiral":

Do less physical activity and --> your knees become weaker and --> your weak knees hurt more and --> because your knees are weak and hurt you do less physical activity and --> your kness become weaker and --> on and on and on ... until you've got a pair of really bad knees.

A Humpty Dumpty probably believes that knees are sort of like that brand-new car that, once rolled out of the showroom, has only so many miles on it. After time, knees simply wear out, as that car does, and there's not really anything that can be done about it. So a Humpty Dumpty is an interesting mix of prudence and resigned pessimism.

Ah, you may think: I'm not one of those! I know I have bad knees, but I'm still running/playing volleyball/hiking mountains/participating in the weekend touch football tournaments.

You may be the other extreme: a Warrior. That probably described my personality early in my battle with chronic knee pain.

Warriors have sporting lives full of props, and I'm not talking about running shoes or tennis raquets. Ice, that's a prop they like. (Over time, my bags of ice melted to the inverse shape of my knees as I stubbornly tried to continue my cycling-in-the-mountains routine.) Ice will quiet inflamed joints (until you remove it, I discovered). Or aspirin, or Advil -- those are good props that let you exercise through the pain (or help you through the post-exercise pain). Knee braces: yet another prop.

They accept their knee pain. They're tough.

And their knees don't get better either. Just as Humpty Dumpty's don't.

When I finally recovered, it was by cleaving to the middle path. I looked for ways to be active, but through gentle motion, and not too much at once. That was anathema to the Warrior in me -- I remember laughing scornfully at my doctor the first time he suggested that I cut back my cycling to ten minutes a session for a while, because my body was conditioned to going out hard for up to two and a half hours.

But later, when I began to learn more about what I needed to do to get better, in a real and lasting way, I realized I couldn't be a Humpty Dumpty and sit back and rest and do nothing and hope my knees would somehow improve on their own. And I knew that Warrior behavior was destructive too. By working out through knee pain, all I'd ever get would be a life sentence of more knee pain.

Those are big realizations to make. If you've got problem knees and are trying to chart a way forward, figure out your knee pain personality. Then ask yourself: Is my personality working against my long-term goal to get better?

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