Friday, November 11, 2011

What Angers Me About a News Article I Largely Agree With

The Salt Lake Tribune ran an article recently about how important it is not to sit around moldering on the couch when you have arthritis.

"Remaining sedentary actually increases the risk of injury and pain," the author writes. Through movement, a woman by the name of Margaret Crowell was apparently able to reverse symptoms of osteoarthritis in her thumbs and hands. She now leads a class in modified yoga and tai chi moves.

"Great, wonderful," I'm thinking -- this is the right message. Heal through motion! It's one of the key themes in Saving My Knees.

And then I got angry.

Because this isn't the first article I've read espousing gentle motion for arthritis pain sufferers. So the arthritis experts are figuring this out, that lots of easy movement is a good thing, but ...

Once you have arthritis, your joint (knee, finger, whatever) has undergone significant changes, some of which aren't reversible (such as bone spurs). You're already fairly damaged.

However, no one wakes up one morning with osteoarthritis (I'll limit myself to this common wear-and-tear form of the disease), completely taken by surprise ("What! Last night when I went to bed I felt fine!"). For example, if you have osteoarthritis of the knee, you've already spent a fair bit of time -- years, most likely -- coping with and complaining about your joint pain. And, getting back to the original point, this is what made me mad.

There is a wonderful window for intervention early on with knee pain! You can heal, even if your cartilage crackles every time you bend down to pick up your slippers. I know you can because I did (and because medical studies show the tissue can heal, and because a very smart physical therapist by the name of Doug Kelsey has shown at his Austin practice that patients with knee pain can get better).

But what typically happens early on, with the first onset of knee pain? You flail around for a while on your own. Maybe you see a doctor, who just shrugs if your knee moves normally and advises you (if you're a sporting type) to take it easy for a while. Or you see a physical therapist who recommends stretching and quad strengthening (the first of which doesn't help fix the underlying problem, and the second may make it worse).

Gradually, you resign yourself to your bleak fate (and your cartilage breaks down some more, and osteophytes form and get larger, and your range of movement becomes restricted, and ...)

Crazy! Because what those arthritis patients are doing at age 65 when their joints are trashed is what they should've been doing at age 45 when their joints were starting to give them problems! Lots and lots of gentle movement is a great prescription, but it's coming too late.

That's what infuriates me -- that knee pain isn't being treated seriously, systematically and properly early in the disease cycle of arthritis.

Seriously means doctors should stop shrugging helplessly and saying there's nothing they can do yet for hurting knees and should start focusing on early intervention to stave off arthritis.

Systematically means the design of a user-specific movement program aimed at gradually strengthening the bad knee.

Properly means the right kind of motion -- not high-load, low-repetition (quad strengthening) but low-load, high-repetition (knee strengthening).


  1. I am 40 yrs old with two young kids. I have been diagnosed with Chondromalacia Patella and some damage to cartilage in both of my knees. I have been in severe pain for the last 5 months and have met 6 Orthopedic surgeons and 2 PTs. Nothing helped because PTs focused on quads strengthening and Doctors focused on surgery - Arthroscopy now or a future knee replacement. In my research for alternatives, I have been doing exercises with Egoscue method for last 2 months (some improvement initially and then downhill every week) and now have started Acupuncture (for pain relief) - so far no improvement in pain while I am getting depressed with doctors' attitudes all around me. It seems every one is giving up on me and my chances of getting better. And of course, my health in general is going down because I haven't been able to do much exercise except for 1-1.5 hrs of physiotherapy exercises daily.

    I bought your book this week and have now changed my office hours to accommodate 1-2 hours of walking in my schedule. I am also purchasing a small bike to keep under my desk - all in the hope that this strategy of high repetition exercise may work for me too. I have recently started taking swim lessons too since that's the only exercise all doctors are recommending to me.

    Please let me know if your experience can add some more value (or acceleration) to my recovery and search for answers. There are many simple things such as going up and down the stairs, bending down, squats, any weight-lifting (including my younger kid) have become impossible to do now!

    I look forward to any more suggestions that you may have for me from your experience.

    1. Hi Anu
      I am a recovering from Chondromalacia Patella too. I had similar experience with by doctors and physical therapist. My healing did not start until I started walking a lot, but within my Goldie locks zone(to much sets you back to little does not heal). My big mistake was pushing myself to hard and setting me back, over achiever syndrome :). I'm a runner and had to give it up over a 2 years ago. Progress for me did not start until I started walking and then it was learning process at what hurts and make the knee feel good. The Saving My Knees Book. The hard part was for me was that I would not know until the next day when those feeling happened, a delayed response. I realized less and more gradual for me was better when it came to leg strengthening. Its hard for me not to go all out. My Goldie locks zone started out as a very small window, it was frustrating. As time went by that window opened up very very slowly. Yesterday I XC skied 6 miles, walked/ran 2 miles, did 3 sets of squats and was on my knees carpeting for 4 hours. Today I feel pretty good but I think I might have went above the zone a little. There is no way 6 months ago I could come close to doing the above. Low repetitive movements is the key and when able to leg strengthening which for me was months later. Richard's book is great. I question weather most of us are as disciplined enough to do what Richard did though. I was able to. Another good book is the Runner's Knee Bible. Which the author concurs on low load repetitive movements. Good luck you are on the right path.

  2. Anu, I wish you much luck! It's a tough road, I know. The under-desk bike sounds like a great idea, if your knees tolerate cycling well. Also swimming -- just be careful with thrashing and kicking strokes, I'd say. It sounds like you're doing a lot of good things, so you may want to be careful about the "bad" things that can set you back or slow healing -- such as too much stair climbing or lifting heavy objects, if your knees don't tolerate either very well. I might even consider avoiding the stairs for a while -- but I'm not your physical therapist; try to get a good one! Cheers.

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