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.