Saturday, December 18, 2010

Beating Knee Pain: The Attitude Re-Alignment

As I said here, I'm not at all convinced that issues of physical misalignment (the patella incorrectly tracking) usually explain knee pain. However, another kind of misalignment can be a big obstacle to getting better.

This kind of "misalignment" I came face to face with on one of the message boards I now frequent, where knee pain sufferers gather to share stories, advice, and from time to time, a little encouragement. Someone recently posted asking to hear from others who had "end-stage chondromalacia."

That phrasing intrigued me. Think about it for a moment. If you have "end-stage" anything, you're pretty much finished, right? If I came to you and said, "I have end-stage skin cancer," your reaction would probably be to clutch my hand, quietly murmur "I'm so sorry," then wait for me to disclose how much time I had left on this earth.

Well, it turns out there is no such thing as "end-stage chondromalacia." Or at least I've never heard of it, or read of it. I Google'd the phrase as well. Not a single hit. I doubt that a physician ever said to anyone, "You have end-stage chondromalacia."

However, I don't doubt that this person is in a lot of pain and missing a lot of knee cartilage. He or she is thinking: "My cartilage will just keep wearing down. It's not coming back. I'll just have to wait for a total knee replacement. Things won't get better."

Once you're convinced you have an end-stage condition, what does your life become? Answer: a matter of dreading the inevitable. Forget about hope. Negative thoughts dominate. Bad days are expected. Good days (or good moments) are explained away as flukes; they don't really matter because you're on a one-way street called Misery Lane.

I've been there. Early on, I was determined to beat knee pain. But I couldn't, even following my physical therapist's advice to the letter. A doctor told me my knees would never get better. And, not unexpectedly, my attitude -- little by little -- reset on me. Eventually I became an intensely negative ball of energy.

Part of healing meant doing an attitude re-alignment. It's not easy. It's hard as hell. Especially for someone like me -- I'm not by nature anything resembling a blithe optimist. But I realized my mind was working against me, and that wasn't good, so I began meditating. I just wanted to find some quiet interior space where I didn't hurt and wasn't angry all the time.

Of course meditating alone doesn't do it. You also need a plan -- a really good one if you've got "end-stage chondromalacia." You have a small margin of error.

What would I do if I were in that position?

I would seriously think about getting on crutches for a while and getting access to a continuous passive motion machine. Robert B. Salter did an incredible experiment in the early 1980s that showed an astounding rate of healing of full-thickness cartilage defects (yup, that's right down to the bone) among rabbits that were hooked up to a continuous passive motion device.

But here's the rub: at the same time, you'd probably have to go non-weight-bearing on those knees for a while, then gently introduce weight-bearing activities. I don't know exactly how this plan would be carried out. Right now this is just me musing aloud, trying to find a solution. Because trying to find a solution is positive at least.

I hope this knee pain sufferer can connect with a really smart physical therapist, someone like Doug Kelsey at Sports Center. If I were this person, I would even consider moving to Austin, Texas (where the clinic is). As I say in my book, a good physical therapist is worth his (or her) weight in gold.

That's because the best way to kill a negative attitude is with a plan that shows there is a path to getting better. Who cares if it's a long one? As long as you can see the light, and see the way to move toward it, you have some hope. And that's really important.


  1. I'm just so thankful to have found your blog. Thank you SO much for sharing your well-researched information and methods. I am working diligently to get my knees back!

  2. I just found your site today!! I'm excited.

    I have the same old story... knee pain, ortho dr, pt, no impromprovement, post-pt recommendations made me worse. I went from one knee with pain to both knees, a hip and a few sprains in my back from compensating.

    And then I went to Austin for a week to get a plan from Sports Center :) I lived in Atlanta. It was so worth the trip. They gave me an at home plan and some equipment to buy. About 10 months later I slowly started running again. Pain free :) Oh my gosh were the set backs tough to take!

    Now I am applying what I know about joints to rehab my dog's elbow...he's got some nasty looking cartilage, looks like confetti. It's been about a month and he was actually jogging for 90 seconds, walking 3 minutes, for 30 min total - which of course is fantastic! And then my husband let him jump out of the car... back to square one, or pre-square one. Ugh.

    Finding your site was the encouragement I needed today. Thanks so much!

    Did you notice proprioception deficits caused from knee pain? Did your foot drag or did you trip or misjudge the steepness of steps??

  3. Interesting comment about the proprioceptive deficits ... I consider myself fairly observant, but did not notice this in particular. However, to be fair, there was a certain amount of poor functioning of my legs while walking that I attributed to having weak muscles/hurt knees ... but it could have been something else.

  4. One second to vent pls - I know you get it.

    Dog and I are in the midst of yet another set back and I'm PISSED. So angry I can hardly stand it! Recovered beautifully from the last one - speed, distance and proprioception were improving nicely and then in a split second he hurt that elbow again. Argh! I know it isn't square one, more than likely. Why is it so infuriating???

    Both my knees and one of my hips was damaged and I remember misjudging the step-down from curb to street and landing too hard. It hurt!!! I know I had spacial deficits.

    Proprioception deficits are how I am judging progress/setbacks with dog. After too great a speed or distance or impact he fails to pick up his foot/leg high enough so sometimes his nails drag - I can hear it. If they drag hard enough it trips him. Ex: Yesturday morning he could walk on the treadmill for 25 min at 1.9 mph w/o trouble. Today, after a fall late yesturday, he walks at 1.2 mph for 15 min with frequent drags. I dont' know if it is also stiffness or pain- either way, it is a sign of a problem.