Monday, May 23, 2011

Why Do Bad Knees Rarely Heal, If They Can?

This weekend I was in full problem-solving mode. I needed to sink anchors into concrete to hang a bicycle rack on the kitchen wall, set up a wireless router for my computer, and replace the (broken) deadbolt lock on my apartment door. Phew!

Each job could have been relatively easy. As (bad) luck would have it, none was. I finished all three, but only after briefly staring into the abyss of failure on each one. The deadbolt lock -- surely this task has to be easy, I thought, after struggling mightily with the router and with anchors that kept sliding out of their holes -- proved to be my last challenge, and tricky in its own way.

In the end, I replaced the deadbolt key cylinder but wound up retaining the old lock mechanism (the new lock wouldn't marry up with the existing strike plate that was embedded in the door frame). Keeping the old lock was an ironic twist, as it was the source of the original problem. Basically, the sliding bolt didn't turn.

So how did I fix a broken lock? I took it completely apart. I got up close and personal with the innards of a deadbolt lock, for the first time. I stared hard at it, made it move (with difficulty), tried to figure out why it didn't like to move, then set about jiggering and oiling and ... well, now it moves like butter. Knock on wood.

So now I can sleep at night without that nightmare that someone is breaking into my apartment. :)

Solving these three problems put me in a somewhat reflective mood (and gave me a gigantic headache, if you want to know the full truth). Because these problems, as difficult as they were, pale in comparison with the greatest challenge of my life: fixing my bad knees. And I began to think: Why do so many people try so hard, but yet fail to fix their knees?

I look at this question in Saving My Knees, but I think it's such a good one -- if you're a "knee optimist," as I am -- that it deserves a full-fledged blog entry.

So here's why I think the failure rate is so high.


Traditional physical therapy encourages knee pain sufferers to strengthen muscles to beat knee pain. This can be a prescription for disaster (in my book, I recount my own failed experience).

The correct prescription is strengthening the joint first. Otherwise, if you have bad-enough knees, the muscle strengthening will simply put you on a carousel ride of frustration. Sometimes you feel a little better, sometimes a little worse, and you never make sustained progress. That's because your joints are too weak for muscle strengthening to be effective.


Okay, you believe in high-repetition, low-load activity to strengthen the joints. So far, so good. Where do you start?

Do you go 3,000 steps on a long walk twice a day? Or 4,000 steps once a day, then 2,000 steps on "off" days? Should the terrain be flat? Or can it be mildly hilly? How long do you wait until increasing the number of steps? Or should you not be walking but riding a bike instead to get high-repetition motion that way?

This is where I think good physical therapists will become invaluable. They can help you figure out where to start with the right plan. It's important to stay within the envelope of function, if you will, that your knees can tolerate -- but then, gradually push that envelope. Or as Doug Kelsey of Sports Center says, "edge the training."

Sadly, most physical therapists aren't as enlightened as Doug. But if my knees were bad, and I was mired in despair, I would consider relocating to Austin, Texas, (home of Sports Center) to work with someone there. I think their approach is that good. They can help you to figure out where to start and guide you on the way.


You have to develop a plan. You have to count your steps, the way other people count their calories. And then you have to execute that plan, over the course of many months. You won't notice a huge difference immediately. It takes time. In fact, the worse your knees are, the longer it will take to climb out of the hole you're in.


I've come to appreciate that the right plan alone doesn't always suffice. Sometimes there are structural obstacles. They can be bone spurs. Or they can be scar tissue, inflamed fat pads, or that something, whatever it is, that causes a clicking or popping each time you bend the joint.

In some cases, if you're patient and diligent, and don't try to rush your recovery, the problem will go away. (I had a band that seemed to slide over something in my bad left knee ... while it alarmed me at the time, today I think it's largely gone or has subsided or whatever).

Other times, the structural problem will be a real, ongoing issue.


Unfortunately, there are lots of doctors who don't believe bad knees can heal. They don't know of the studies (I can cite three) that show cartilage can heal naturally over time. These doctors tend to shrug when faced with a set of bad knees, not offering much advice beyond, "If you feel pain, don't do whatever you're doing, but try to keep moving."

Gee. Thanks a lot.

When doctors are pessimistic, their patients not surprisingly become so. And so a ceiling of expectation is put in place. I went through the ceiling. I refused to believe my doctors. But I bet many others are trapped below the ceiling of what they're told is the best-case scenario for their ailing knees.


  1. Richard - I just emailed Doug the following and was curious if you had any input. Could not find your email on this site.

    Hi Doug!
    I found your site through

    I have knee/leg problems including chrondromalacia patella, weak VMO, tight ITB. I used to run in college but since then have spent most of my life sitting down. I attribute my problems to the sitting, not the running.

    After having no improvement with PT (leg lifts, quad strengthening, stretching, partial squats, balancing, patellar taping) I got synvisc in one knee in January. Wow, it worked!
    Since I felt much better (down to 2-4 extra strength ibuprofen a day) I figured I had a window to get my legs stronger before the synvisc wears off. So I did bodyweight squats and 20 pound goblet squats, one-sided calf raises, lots of stretching, and some very light jogging. I also tried walking around in vibram "5 fingers" barefoot shoes to give my feet and ankles exercise.

    Now my leg muscles are all noticeably bigger and stronger - but my knee joints themselves HURT much more!

    My guess is I made my quads and calves too strong and now they are yanking more on my patella causing cartilage damage. I also have some muscle soreness on my anterior thighs right above where VMO meets my knee joint. I don't know if that means my VMO is weak compared to my other quads or too tight or what. I also get ankle pain now!

    My question is - how can I get my legs back into alignment? Should I avoid strength exercises and let the quads weaken? I have been taking it easy but still have joint and muscle pain.

    I saw you recommend low load high rep for knees, does that advice apply even when I have pretty strong legs that might be causing the problem?

    Also, I am considering getting an angled exercise machine to do help me do high rep low load squats. I can do 2 legged bodyweight squats with support from a desk or table but without support it hurts. 1 legged is more painful.
    Do you have any experience with the Weider machine? It is MUCH cheaper than total body I saw you recommend


  2. One of the primary problems or limitations is that people can not actually fix their knees. Like I cannot currently cut open my knees (I guess I could...haha!) and try to operate on them. I just can't do it.

    You have to trust a doctor and then have them do a good job. You can try everthing you can--seeking out the best possible doctor with established techniques that you think is the best option. But then you are just victim to the probability curve.

    Did the surgeon sleep well the night before? Did he have a piece of steak in his tooth (from the prior night...) when he opened your knee, he slipped and missed and cuts a piece of cartilage out of your thing you wake up with a microfracture!

    It's pretty unpredictable. Like with all things, I guess you just try until you either a) solve it or b) don't. Then repeat. You might eventually die. You could become hopeless and a pain-pill addict.

    I don't know. It's a mess. But hopefully one day I will be A-Okay.

    -Another Bum Knees Guy :)