Can Stretching Really Help Fix What Ails Your Knee?

A brief update on last week's post: I had a few twinges and tinglings in my knees after my spirited workout (I got up to 349 watts while doing intervals on the stationary bike). That was probably to be expected, after three months of indoor cycling at a leisurely Sunday-at-the-park pace. Maybe it wasn't so bright to ramp up to time-trial intensity so fast. :) So I'm going to take a few more weeks to "break in" my knees for the 2011 cycling season. Who wants to ride in the cold anyway?

Now for the discussion on stretching, resumed:

WHAT'S WRONG WITH YOUR KNEES AND HOW DOES STRETCHING FIX IT?

Okay, I'm going to start with what was wrong with my knees, because my problem was fairly common -- and I have to start somewhere.

I had cartilage damage in my knee joints. That can cause pain mainly in two ways (as I explain in Saving My Knees): (1) tiny pieces of the soft and damaged cartilage flake off -- which you don't feel because the tissue has no nerves. They float in the synovial fluid and then migrate out to the synovium (the lining of the joint capsule) -- which you do feel, because the synovium is nerve rich. (2) cartilage that is thin or damaged fails to adequately cushion the underlying bone from pressure (such as from bent-knee sitting or walking). Bone endings also have plenty of nerves, unfortunately.

So my primary challenge (and the challenge of millions of others with pain from chondromalacia and osteoarthritis) is as simple and complicated as this:

How can bad cartilage be fixed?

This is where some doctors head for the exits, claiming it simply can't be done. That's just not true though. Even if you can't restore cartilage perfectly to its original state, you certainly can strengthen it and, if you do all the right things and are patient, even regrow it, I'm convinced. (NOTE: natural regeneration of cartilage has been shown through at least three scientific studies; I discuss the subject more here and here).

So then, how can the cartilage be fixed? Through a program of stretching?

This makes no sense at all. Just think about it. How would that even work? Would you stretch the cartilage? Of course not -- you'd stretch tissues around it, primarily muscles. But if you stretch your quadriceps, or your hamstring, how does that help repair or strengthen your damaged cartilage?

It doesn't. To change the health of the cartilage, I strongly believe you need to adopt a program of appropriate motion, that gradually intensifies over time. That's what succeeded for me.

MY IMAGINARY CRITIC LASHES OUT: "TALK ABOUT A 'STRAW MAN' ARGUMENT! WHO SAYS STRETCHING HELPS CARTILAGE! IT HELPS OTHER THINGS!"

Later we'll look at that: specifically, what's the rationale behind stretching for sufferers of chronic knee pain? For now though, it's important to start with the simple essence of the matter. Which is: If your problem is damaged cartilage, you need to improve the condition of that tissue. And stretching doesn't do that. How could it?

A more sophisticated rebuttal (from Mr. Imaginary Critic) might be that stretching helps you do the things that will fix the cartilage (such as engaging in lots of not-too-strenuous motion). Or that stretching redresses imbalances that are causing the damage in the first place (notice that, in this second scenario, stretching still doesn't claim to repair the tissue -- only prevent it from being chewed up more).

I'm skeptical about both assertions in the preceding paragraph, but that's for an upcoming post.

MY IMAGINARY CRITIC AGAIN: "YOU WANT SIMPLE, WHAT ABOUT THIS? I HAVE A BAD KNEE. MY BAD KNEE MAKES THE JOINT AND NEARBY MUSCLES FEEL TIGHT. STRETCHING HELPS ME LOOSEN UP AND FEEL BETTER."

The logic certainly seems straightforward. Stretching is about getting loose. Having bad knees is usually about feeling tight -- whether it's a "knot" in the joint, or tight muscles around it, or just an inability to move a knee through a normal range of motion. So isn't getting loose just common sense, in order to feel better?

That depends. What's the source of the tightness? And does stretching help take care of that?

It doesn't appear so.

Listen to Doug Kelsey, chief therapist of Sports Center, a guy who's much smarter than me:

If the muscle is tight from irritation of the joint (which is almost always the case), stretching proves to be exceptionally frustrating. You're flexible right after the stretching but within hours or days, you're just as tight as before the stretch.

That tightness or fullness can be caused by swelling in the joint. Kelsey says that "as little as 20 milliliters of extra fluid in the knee [the equivalent of half a shot glass, he says] will intimidate the quadriceps muscle into near total inactivity." That swelling may not even be that visible.

So how effective is stretching in reducing swelling? Not very. Stretching may be effective in inducing swelling -- causing more swelling, when you overstretch -- but it doesn't relieve it. (As Kelsey notes, stretching may make you feel temporarily more flexible, but soon you tighten up again, especially if there's swelling in the joint. That was my experience exactly.)

How can you beat the swelling, and begin to eliminate the tightness, in a real, significant way? Kelsey suggests (1) elevating the leg and (2) light exercise, such as slowly spinning on a bicycle or walking in a pool. My opinion: that is what you need to focus on, not stretching.

(By the way, after quoting Doug Kelsey at some length, I should be gracious and point out that he has produced The Runner's Knee Bible, which contains many photos and videos and I'm sure is terrific.)

NEXT TIME: What are the arguments for how stretching benefits someone with bad knees?