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.