"What Should I Do If I Have 'Weak' Knees?"

As I promised a while back, occasionally I'll lift a "story" from the comment section and turn it into a blog post. Today is the first installment of that occasional series. For the umpteenth time, I'm not a doctor or physical therapist, so I'll just offer "things to think about" and "observations from my own experience beating knee pain and researching knee injuries." Other readers with insights (which may be much better than mine) are welcome to chime in (my comments section is completely open).

I strongly believe in patients becoming smarter about their knees and pain symptoms so that they are equipped to ask good, incisive, challenging questions of the medical professionals that examine them. That's what I'd like to help people with: getting smart enough to ask some good questions.

So without further ado, here is Anonymous complaining of "weak knees":

Have you or anyone had just "weak knees?" For over 7 years, I have had this issue and have seen a variety of doctors, multitude of tests, physical therapy and still...same old..same old thing. I was wearing a rocker type shoe from Kmart for about 6 months and my weakness went away, but...then my feet started to tingle and get sore from them. It became too much...so...I tried the Sketcher brand and the weakness came back. So now, I am back to a good pair of running shoes with good support wit weak knees. I am considering on seeking out another orthopedic surgeon's thoughts, but...because I am not in pain they feel nothing is wrong. If I wear knee supports the feeling goes away, but in several days, I get tingling in my feet. One doctor thought that since my knees are OK with supports that by realigning and tightening the knee cap, the problem would be solved. I should be happy that I don't have pain...but...a weakness all day can be just as brutal. No medication works on weakness...so...I manage through the day. When I relax at home on the couch, the feeling will go away in about an hour and then the problem starts all over again the next day.

I found this case interesting mainly because of the vagueness of the complaint: "weak" knees. Notice as well the comment "because I am not in pain they (doctors) feel nothing is wrong."

First, I'm going to go out on a limb here and say that, even though nothing is currently wrong, I bet Weak Knees (Anonymous, this is your moniker for the rest of this post :)) isn't that far away from having problems. The fact that something in your body feels amiss is often a softly blinking red warning light. Before my knee issues flared up, I was having twinges in my right knee while cycling uphill. I would adjust my stroke briefly, easing up, then the sensation would go away. So I continued to ride as hard as before, thinking (wrongly) that the problem would eventually just fix itself.

Second, I'm going to put on my swami hat and surmise a few things about Weak Knees. I could be wrong about all three speculations, but let me list them and explain my thinking:

1. There is a good chance Weak Knees is overweight.
2. There is a good chance Weak Knees leads an inactive lifestyle.
3. The physical therapy that Weak Knees did was directed at muscle-strengthening and not at improving aerobic capacity.

Again, I could be completely wrong about all three points, especially because there is so little information given about what "weak knees" means exactly. Do the knees feel like they are about to give way? Do the knees feel like they offer poor support for ordinary daily activities, such as squatting or kneeling? Do they ache at all? Or after climbing a few flights of stairs, does Weak Knees just not feel that good?

The vagueness of this self-diagnosis intrigues me, however. Much of my life I have enjoyed a sporting lifestyle. That means I have spent a lot of time with people who enjoy a similar lifestyle.

And when they have pain in one of their joints, such as the knee or spine, they describe it in a variety of manners, but "weak" is generally not one of them.

Symptoms of diffuse weakness I associate with people who tend to be overweight and out of shape. Excess weight is probably the worst thing I can think of for someone seeking to recover from knee pain or avoid it in the future. That extra fat means your knees have to work much harder to move your body around. That weight discourages you from moving in general. And, I think on some level, being overweight makes people more susceptible to "general malaise" type of disorders.

The best kind of exercise, I'm convinced at the grand age of 49, is something that gets your heart beating without your body taking a beating. That isn't meant to dismiss the benefits of running. I don't believe the myths that knees just wear out from all the pounding of running and inevitably become arthritic, though that may be true for runners who don't watch their weight or who run carelessly (e.g., who take off four months, then try to resume at the level they were at previously without building up their training). But if you've got knee joint issues, cycling (or swimming, or walking) may be a more suitable activity.

If I were Weak Knees, knowing that my joints were just weak and not hurting, I'd first drop onto my weak knees and praise the Lord I've got some time to sort out any issues before the curtain of pain descends :). Then I would talk to my doctor about what aerobic activity might be good for me that would help strengthen the knee joint and improve my cardiovascular fitness. You'd have to start slow, if you've been inactive, but exercise -- SWEATING exercise -- does a body much, much good. It's like acquiring a protective invisible force field against future knee damage (and I have yet to meet a cyclist who's complained of weak knees). I wouldn't waste a minute looking into this.

One last note: if my analysis above is anywhere close to correct, I would NOT have surgery to try to correct this condition. Surgery is generally best considered a last resort for non-specific knee pain. But again, Anonymous, talk to a qualified doctor about this.