Saturday, January 22, 2011

Am I Really Some Crazy Guy Who Doesn't Believe in Strong Quads?

Okay, the book is out, so it's time to get back to the regular business of the blog ...

One thing I realized recently: someone not familiar with the story of my recovery might stumble upon bits of my writing, specifically my dismissal of quadriceps strengthening to heal bad knees, and say, "Well, this idiot clearly doesn't know anything."

EVERYBODY says that to cure patellofemoral pain syndrome (a.k.a. runner's knee, chondromalacia patella), you have to focus on strengthening the quads, or those large muscles in the front of your thigh. By everybody, I mean doctors, physical therapists, your grandma from Dubuque ...

And I think this advice is wrong -- sometimes dangerously so, as when following it leads you to injure yourself even further.

So does this mean I don't think quad strength matters? Strong quads, weak quads ... whatever.

Not at all.

Having strong quads is GREAT. They do help preserve your knees. My quads are quite strong right now. I spent the summer chasing aerobically fit, young (mostly) cyclists along flats and up hills in western Long Island. Some Saturdays I was in the saddle for almost 70 miles. The rides were intense. We would start with 40 to 50 cyclists. At the finish, there might be five or six of us.

But my own recovery taught me that, when your knees hurt, it's absolutely wrong to FOCUS on strengthening your quads first. Ironically, this conclusion turns out to be simple common sense and "strengthen your quads to beat knee pain" turns out to be baffling advice -- when you stop to really think about it.

Because: Your focus should be on what hurts, on the weak link in the chain. When you have bad knees and walk half a mile, or climb two flights of steps, and then have pain -- it's not your quads that are grumbling, but your knee joints. Your quads may be weak, average, or even strong (I happened to have fairly strong quads at the time I developed chronic knee pain). But one thing is certain: your knees are weak.

So you gotta strengthen your knees first. And what I discovered works best for that, as I outline in my book, is a program that focuses on easy motion that over time increases in intensity and duration. And by "over time," I mean months, not days. I fashioned a plan to heal that centered on walking and pretty much walked my way to stronger, healthier knees. THEN I got back on my bike and really started building up my quads.

I know I've blogged on this subject before. But it's so important I wanted to hit it fresh, with a new year upon us. That quad-strengthening approach is hardly ever questioned ... which is what I find truly crazy, because it really doesn't make sense. The cart has been put before the horse. Why don't physical therapists see this?

Well, one does. I'm going to cite Doug Kelsey again. If you put the two of us in a room, we might not agree on absolutely everything about healing knees (he once advocated taking glucosamine; my research led me to believe it's probably worthless), but Doug is the smartest PT, by a long shot, that I've come across anywhere.

Here he answers a reader's question about a program to heal patellofemoral pain syndrome (abbreviated below as PFS). The bold is mine:
Almost every exercise program that you find for PFS targets muscle (quadriceps strengthening, stretching of the hamstrings, etc.) and having stronger muscles is helpful but weak muscles are not the primary problem. The muscular weakness is in response to the changes in the joint. Some clinicians argue that cartilage does not respond to exercise; that it is biologically inert. However, there is ample scientific evidence proving that cartilage does respond like other biologic tissues of the body (muscle, tendon, ligament, bone) as long as the motion-force combination is within a certain range.
So you need to strengthen the joints. And you can. I'm living proof.

P.S. I'm going to start a new (occasional) feature where I lift some of the cases from the comments section and devote posts to them. One thing I know (from my own experience): people with hurt knees have an insatiable desire for knowledge, and they're eager to tell their stories, hoping someone can provide a glimmer of insight. As I've made clear (I hope), I'm NOT a physical therapist or a doctor, just someone who did a lot of reading and experimenting who saved a pair of bad knees that doctors said would never get better. So I won't offer any advice, more like "things to think about and discuss with a medical professional." We'll see how it goes.

1 comment:

  1. I know you said you wouldnt, so Im not gonna ask for advice.. but Ill ask for some insight as it seems you've done a lot of research, as Ive tried to do.

    I have some worn out cartilage, or a meniscus tear from playing too much football ( soccer ) .. Im desperate for help. I went to my doc, and he said dont run or do anything for weeks and take these antiflams. So I did. I also added glucosamine to my supplements. Result? Got fatter from lack of exercise and once I got back into it, pain was still there. My knee doesnt hurt when I walk or run, but when I squat it does. Its that type of motion that hurts the most, when i squat, or kneel.. when i want to get into a car, or out of my chair. I only turned 20 about a month ago, so you can imagine my frustration. I cant play football to the best of my abilities due to this injury and I cant practice bodybuilding to the fullest ( I cant work out my quads coz any exercise causes knee pain !! )

    Ive tried resting it, and ive tried taking glucosamine.. and it hasnt worked. IS there anything else I can do? Really looking forward to your reply. I dont want to quit my sports at such a young age, and thats why i push thru the pain sometimes, but also i dont want to risk further injury that might cause me problems in the future.