Sunday, May 15, 2011

Three Interesting Things I Left Out of "Saving My Knees"

Well, one of them I didn't leave out of Saving My Knees. I just underplayed it, I think.

Here they are:

1. Getting proper sleep is important.

I mentioned in the book that during my recovery I was always careful to drink lots of water (cartilage is largely composed of water) and to get plenty of protein (which contains the building blocks for repairing injured tissue).

What I neglected to include: I was also diligent about getting enough sleep. When my knees were in a fragile state, they often reacted badly to a lot of seemingly minor or unrelated things, such as a change in the weather or a bit of emotional stress.

In fact, the extreme sensitivity of my knees led me to investigate whether I might have a systemic condition, such as rheumatoid arthritis. It turns out I didn't, thankfully. But I realized that, to improve my chances of healing, I had to do as many things right as I could.

Getting enough sleep was critical. A full, restful night's sleep (that's about 7 1/2 hours for me) helped me in several ways: (1) My whole body felt better, including my knees (they gave me negative feedback when I got too little sleep) (2) Sleep is downtime that your body needs to rest and repair itself (3) The sleep position -- relaxed body, legs extended -- was also good for not stressing my joints.

2. I did do certain exercises that appeared more "quadriceps focused" than just walking about.

Readers of my book, if asked to distill the message of how I recovered, might say, "Go slow and walk a lot." Of course that's a vast oversimplification. Still, the truth is, I did walk a lot -- and I think this high-repetition, low-load activity did much toward helping me heal.

But I also did some lower-repetition activities that seem rather close to the quad-strengthening exercises that I regularly disparage. Here are the three main ones: (1) the "monster walk" (or what I call the "crab walk") -- you put a looped Theraband around both ankles and, pushing against the resistance, walk side to side. (2) unloaded knee bends (I'll return to these in a moment) (3) unloaded squats (using bungee cords and a mountain-climbing harness, I did squats -- the bungee cords effectively reduced my weight significantly, so it was as if I was doing squats in a low-gravity environment).

The unloaded knee bends I did one knee at a time. I would do a fairly deep bend while being partly supported by a "giant rubber band," if you will. The exercise was a poor man's adaptation of something Doug Kelsey recommended on his Web site. What I did: I pounded a heavy nail on top of a tall bookcase. I took an old bike tube tire (stretchy but tough) and attached one end to the nail and the other to a belt tightly cinched around my waist). The tube was at a right angle to my position as I did the knee bends. (Picture a "T" -- I'm the top bar of the T; the long bar is the bicycle tube).

Why didn't I mention these exercises in the book (actually I did mention two of them, but fleetingly)? Several reasons: I didn't do them consistently; I didn't think they contributed all that much to my getting better; also the key thing with two of them is that they're unloaded -- so they're really joint-focused, not quad-focused.

But -- having said all that -- I considered the unloaded exercises, at least, a good idea. Why? Because I believe you have to train your joints to move through the range they will need for day-to-day activities. An exercise program consisting only of walking doesn't move your knees through the deeper range of bending (that you need for getting in and out of ordinary chairs, for example). So if you can find a (gentle, unloaded) way of doing high-repetition deep knee bends, I think that's a good thing.

3. Sweating is really, REALLY important.

I touched on this in my recovery chapter, but I may have undersold it. If I had bad knees, one of my objectives would be to get my joints/body strong enough to do sweating exercise. My strong suspicion is that it helps your body heal faster. (Doug Kelsey delves into this somewhat on his blog and refers to "perfusion rates," but I never really explored the subject). Personally, I noticed a real jump in improvement once I reached the point where I could walk up hills and work up a sweat.

How do you get there if your knees hurt all the time? Partly I think it's a matter of patience. Rome wasn't built in a day, as that tired cliché goes. But don't discount creativity either. At one point I considered buying one of those arm-pedal bicycles.

I've often thought that, if I were more the inventor type, I would devise a kind of "taffy" exercise device for people with bad joints. The exerciser would be somehow ensconced in a web of Theraband and could work his good joints vigorously (the bad joints could remain still, or would be used only lightly). The objective: to get that person sweating and moving, even if the bad joints don't move that much. In my mind, it would be a sort of resistance-based tai chi if you will. Or it would kind of mimic the gentle resistance that water provides when swimming.


  1. Great blog, great post. Touching on #2 - first I would imagine that walking would be great for strengthening the knee cartilage. Dr. Stu McGill, one of the top spinal mechanics experts recommends walking to strengthen the bone and cartilage of the spine for those with back problems. Though the lumbar spine should not be flexed or rotated to a great degree (+15degrees,) the gentle side to side movement on the spine from walking has a very positive effect on spinal tissue. It would make sense that the knee might experience the same positive effect from normal, easy, walking. Also, as a personal trainer, I warm up nearly all my clients with " band monster walks" and "band side steps."
    The sideways steps are done with the feet being lifted high - not shuffled along the ground as many trainers teach, with emphasis that the trailing leg lift as high as the leading leg. Very important in my mind. These band walks not only work the quads, but really work the glut complex hard. I firmly believe the gluts are the key to an efficient body. Weak or strained gluts can cause both back and knee pain. The strained glut-medius can manifest pain in the knee without there being any damage to the knee itself. Further, if the hips are weak or inflexible, the body will call on other areas, such as the lower back or knees, to do the job of the hips. The hips are for flexibility. The knees are for stability. Forcing them to flex in ways they were not designed to will damage them. Cure the hips and you increase your chances of recovering your knees greatly.
    I like the idea of the unloaded knee bends. Thanks. I know I'll use that in the future.
    I don't know if what I've said here has been stated in your book as I haven't read it yet, but it will be on my list now.

  2. Can you please post pictures of your two partial-weight assisted devices? You mention you "needed a little padding here and there (pieces of foam I shaped to my purpose)". Nobody knows what you're talking about here, at least I don't. Also, how did you attach the bungee cord to the mountain harness. Picture of the harness too? How about the tire tube apparatus, a photo of that too. Thanks!

  3. Richard, you need to read this site (it is interesting!) and do a post on it