Saturday, December 4, 2010

I Followed Your Advice, So Why Aren't My Knees Getting Better?

Sometimes I imagine this question, in a slightly querulous tone, coming from someone who has read either my entry here about what I did to save my knees, or this loonnnggg thread here, on Knee Guru's bulletin boards, that also reveals how I got better. (Quick disclaimer: I steer away from giving advice, so I took some poetic license with the title of this post.)

At Knee Guru, several smart people greeted me by peppering me with questions, curious about my "exercise regimen." How did I do this, how did I do that, what did I mean by this, what did I mean by that? And then, I have no doubt, they tried what worked for me: lots of easy, joint-friendly motion (for example, I did "walkarounds" in my apartment, where a wind-up timer would go off every 15 minutes, to alert me I needed to get up and walk a little, about 70 steps. Cleaving to that routine kept dosing my knees with movement).

After a few days of copying everything I did, I'm guessing many of them gave up in frustration, because their knees felt about the same.

So let me take a moment to make a few more in-depth observations about how I healed.

First, and it's hard to overstate the importance of this: recovering from a slow-healing injury isn't linear. What that means: you don't feel 15 units of healthy today, 16 units of healthy tomorrow, 17 units the day after that, and so on until you're at 100 percent again. If only healing were like a smoothly ascending straight line on a sheet of graph paper! Because then, as soon as you discovered the proper solution to getting better, you would know immediately that you'd found it because you would begin feeling an improvement every day forward.

Unfortunately, on the long road to saving my knees, there were ups and downs. Over a single month, I might happen to feel worse on the 22nd than on the 5th -- even though I was getting better over the entire month. So I learned that what I really needed to focus on was the trend line of healing. I had to be patient and squint hard to see that line. It only becomes clear over the course of some time.

Which brings me to point two: whatever path you choose to heal, it will probably take many months to bring you to your destination. For me, it took the better part of two years. This too has enormous implications, because early on (if you're like I was), you're casting about in frustration and desperation for a solution, any solution. So you try different things, in the same manner that a clotheshorse swaps out hats -- okay this guy says if I eat asparagus, that's good for the joints, I'll do that, wait this guy says I need to squeeze a beach ball between my knees, okay let's see if that works, now this guy says ...

Essentially you're a butterfly in the garden of healing, flitting from flower to flower, never committing to anything. Will you get better this way? I doubt it. You need to find a path, stick with it for a while (to verify that it's the right one), and then persist to the end.

Last observation on healing: the worse off you are, the longer it will take to make a few small gains. This too is critical to know. If your knees are really bad, it could take five or six months to make them just a little better. During this time, sadly, you may be tempted to just give up, thinking, "If it takes this long to go a little way, it will take me 20 years to get better!"

But what I observed about healing: it starts going faster as your knees get stronger.

I quit my job right at the end of April 2008. I had to; I couldn't sit in one place, with my knees bent normally, without a lot of uncomfortable burning, and my joints were going downhill fast. As soon as I quit, I devoted myself to a program of gentle motion, in amounts that my knees could tolerate. I focused like a laser on my goal.

Four and a half months later, I felt a little better, but not much. I began to have serious doubts. Would I really be able to beat this thing? What I didn't know was that my dedication to slow and steady motion was already helping my knees prepare for the next level of my program -- that November, I started walking on hilly trails, very carefully at first. Had I not spent the summer building up my knees, I don't think they could have withstood the rigor of that kind of exercise.

So if you're wondering why you're not getting better, even though you think you're doing what you should be, just consider these points above. Healing isn't linear. It's not swift. And, early on, it can be really, really slow. This is all important to know to win the battle.


  1. Hi Richard,
    Thanks so much for sharing your experience. Reading your blog has given me a bit of hope. Would really appreciate if you could give me any advice or connect me with someone who could help. I hope you understand how important this is for me as being so young this has affected me professionally and personally. I don’t know your email address so I have written in detail my situation and hope you get to read this...
    my email is

    I am a 25 year old female. For me,it started in February 2010 I used to (rarely) get pain if I traveled for 4 hours continuously on badly constructed roads, but it would go if I stretched my legs once. April 2010 end, I had swelling with no pain in my left leg following a week later in my right leg. A week after both my legs were swollen I felt uneasiness and clicking while sitting and walking. I met a doctor who said nothing was wrong, I was just working too much and dehydrating myself (have a desk job with many hours or random 3-5 days with lots of travel in car/plane). He also said it is because I put on weight and don’t exercise (I have always been going on yo-yo diets since I was a teen; weight changing from 53-65kgs and back). One day pain started in my left leg following my right leg a week later. 2 weeks later pain was so much I couldn’t travel. From there it was downhill till I had soo much pain I couldn’t even sleep at night and had to stop working like you. To move, I had be pushed in wheelchair. No doctor knew what was wrong because my X-rays, MRI, blood test were all perfect except that I had a severe Vit D deficiency (i used to be in upstate NY, currently in Asia for past 2 years). Everyone said you have a low pain threshold and its nothing. Which I doubted because I had stitches before without anesthesia on my chin :)
    Finally, my current doctor diagnosed me with condromalacia patella 1st week of Aug. Since then I have tried everything such as RICE method, machines such as glucose amine-MSM tablets, collagen drinks, gels/ointments, SWD, IFD, taping, exercises to strengthen quads etc. My Vit D deficiency is corrected. I am personally trying to lose weight to reduce pressure. But I have improved only 30% till date... a very very slow rate as per my ortho doctor and physiotherapist. Now, with the taping on 24/7, I am now able to with very less pain, sit on the bed with legs straight and walk slowly at home (on leveled/smooth marbled ground). They are telling me to have an arthroscopy done and have my lateral muscle released. I don’t want to do this as I am too young. Please please let me know if you have any ideas on what more I can do (different types of exercise, therapies etc) to avoid surgery and/or to solve this problem. Looking forward to hearing from you. Thanks in advance!

  2. Hi, glad you stopped by! First, let me be clear about something: I avoid e-mail correspondence with people about their specific knee problems. I don't mean to seem rude! It's just I'm not a doctor, not a physio, and I want to avoid any appearance of seeming like one. So my blog is totally open, and the comment section too, and hopefully I (or someone else, perhaps even with medical training), can give you some good ideas with the provision that nothing substitutes for an in-person examination by a qualified medical professional.

    Here are a few thoughts for you:

    * In a chapter in my book, I list four golden rules for bad knees. Simple stuff, but number four: Lose weight! Don't know how much you weigh, but losing weight is the closest thing to a "get out of jail free" card for knee pain that I know of. You may not immediately feel better -- these things take time -- but being heavy is the best predictor I'm aware of for destructive osteoarthritis of the knee.

    * I don't know your situation of course, but I would be wary of surgery too. If I were you, I would try to see another doctor or two and see what they think. Most doctors advise against knee surgery for someone who is so young unless there's a compelling reason. Also the "lateral release" (I think I know the operation you're referring to) has a spotty history. Please see the KneeGuru forums and ask some questions there; you'll see.

    * Exercise is good. Sweating exercise is better! If you are relatively inactive, you should look at a way to ease into an exercise program. Benefits won't come overnight. But if you start it, and stick with it, you'll have a lifelong habit that will do your body more good than just about anything else you can do for it.