Saturday, September 10, 2011

An Update on Where I Am, Post-Recovery

Just back from vacation! Joelle's American relatives finally got to meet our funny, special, high-energy little daughter. The occasion was Jo's two-year birthday party. We visited the Maine beaches a few times and I ate way too many chocolate chip cookies that my mother baked ...

This week's entry will be an update on where I am, post-recovery. Occasionally I interject some comments on this blog about what I'm doing, physically, to maintain good knee health going forward. Sometimes I mention a little problem, then forget to close the circle and let everyone know how it was resolved.

On March 27, for example, I mentioned on the blog taking a few extra weeks to "break in" my knees for a new cycling season, after feeling a few twinges and tinglings when I ramped up my stationary bike workouts a bit too fast. And I sort of left that storyline dangling (which I only realized some time later, when someone who wrote to me about a knee problem added the question, "So how did all that work out?")

Well, today I rode my bike, quite hard, and felt great. I've been riding every Saturday since late April. Same group, same intensity, and same punishing workout I remembered from last year. Right now is the toughest time, because everyone's strength is peaking, as this is about the end of the racing season up here.

How are the knees holding up? Really well. Even better than last season, when my left knee felt like it was getting a little sore at times during the long rides. Apart from riding, my knees seem to be making less noise too. Everything is pointing in the right direction at the moment. Life is good.

Besides the Saturday ride, what else do I do for my knees each week?

Sunday: 60 minutes on a stationary bike, easy pedaling.

Tuesday and Thursday: 45 minutes each day on a stationary bike that includes 10 easy minutes of warm up, then 35 minutes of slightly harder but still not intense riding. (So each week I ride hard only once -- Saturday -- which usually features about 40 fast miles, then 20 or so miles at an easy pace.)

Other than that, each workday morning I walk not to the closest subway station, but to the next-next closest stop, which (when added to the walking I do to get to work), gives me roughly one mile (or two miles each day). I make a point of doing this, every day, because I have one of those dreadful desk jobs that keeps me in front of a computer screen for a good 10 hours.

Where I'm at right now is basically where I should be at if everything in Saving My Knees -- everything that I felt more and more convinced was true, during those grueling days of my slow recovery -- really was true. I hope there are others out there who are finding relief for their bad knees through a motion-based program that gradually increases in intensity. It's worked really great for me.


  1. I was wondering what would happen if you stopped doing the maintenance parts, i.e. the stationary bike. Have you tried that?

  2. I suspect nothing much would happen, because my knees have recovered. Why don't I try it? Three reasons at least (1) What I'm doing is working -- when I changed things during my recovery, it was because they weren't working. My philosophy is stick with what works! (2) The stationary bike helps me maintain my aerobic fitness for the hard weekend cycling that I do. (3) I still have a little crunching noise from my knees and am curious whether, if I continue to cycle (especially on the stationary bike, which is steady and not too intense) the noise will pretty much go away in several years. This is my experiment to see if I can "sandpaper" the roughness out of my cartilage. We'll see!

  3. I hear that: if it is working, don't change it!

    My knees (this is Asheville Jenni) are slightly better. I am so close to being able to do a full squat without pain. This is huge. Much better than several months ago. I have been focusing on quad sets (DK recommends these bigtime) and short walks/swims until I see the Sportscenter people *this week.* I am happy that I'm going down there.

  4. Good to hear from you, Jenni. Please fill us in on how the trip to Austin goes. That sounds exciting. I'm a bit surprised that Doug is a big supporter of quad sets, as he once said this on his blog:

    "The classic exercises (quad sets, short arc or limited knee extension, straight leg raises) fail to improve the quality of the joint surface sufficiently to permit pain free exercise on their feet. We use quad sets in our programs since a quad set has been shown to improve the quality of synovial fluid in the joint but it is a small component. Our emphasis is pain free, weight bearing exercise to promote improved joint health prior to entering any muscle training."

    I think I know the study he's referring to, when he says quad sets have been shown to improve synovial fluid (I cite it in SMK). The problem I have with that study is that while it shows that isometric exercises do improve the synovial fluid, it doesn't attempt to match them against other activities that may work even better (my hunch is that light walking, in the right amount, would lead to even superior results).

  5. Hm. I have to say that they do help a lot. After even a few of them, I can get up off the floor with less/no knee pain. I think that since synovial fluid feeds the cartilage, making it higher quality will make the motion exercises (walking) count for more. Anyway-- they have definitely helped me, so I'm a fan.

    A small component?? He says to do 100 a day! Craziness! I have never, EVER been able to complete 100 in a day. We'll see what Christine says... I won't be seeing Doug unfortunately, but I spoke to Christine on the phone and she sounded like a Doug clone... very knowledgeable.

  6. Yeah, I think this is the Miyaguchi et al. study. The thing is, the researchers say: "The purpose of this study was to analyze the biochemical changes in the joint fluid, and pain relief resulting from isometric quadriceps exercise in patients with osteoarthritis of the knee."

    So, in other words, what you could have (in a larger study, and I'm simplifying here of course): Leg presses improve synovial fluid 8%, isometrics quad exercises (such as quad sets) improve synovial fluid 18%, easy walking or gentle cycling improves synovial fluid 33%. However the researchers looked at exercises narrowly (isometric quad exercises), so we don't know the possible beneficial effects of other forms of exercise.

    Still, having said that, I will note: If it works, great, keep doing it! Whatever makes the knees happy! :)

  7. Oh wow... what is that study? Or all you compiling stuff from different studies?

    I have noticed that some gentle walking seems okay, but that right now things like the total gym seem better. Maybe I'll work up to the point where walking is good. The thing is, I (probably) have softening of the cartilage between the tibia and femur... perhaps that is why walking isn't the thing just yet.

    Anyway... let me know what that study is if you think about it. (I'm sure it's cited in your book, I just don't know which it is.)

  8. The study I think his advice is based on is this one (though if you search for it on the Net, it's behind a paywall):

    Miyaguchi, Masatsugu, “Biochemical Change in Joint Fluid After Isometric Quadriceps Exercise for Patients with Osteoarthritis of the Knee.” Osteoarthritis and Cartilage, July 2003.