Saturday, December 31, 2011

Are Your Knees So Bad They’re Beyond Hope?

The idea for this post comes from a recent comment that went like this: “My doctor is negative about my knees, talking about bone on bone and osteoarthritis. Can I still benefit from your experience and methods and heal my knees?”

In other words, is there realistically any hope for knees that feel lousy pretty much all the time, that are missing a lot of cartilage, that are already osteoarthritic?


First, a quick rant (some of you know this one by now).

I doubt that terrible, crippling knee pain (short of that caused by a traumatic accident) just steals into your joints in the middle of the night. It’s generally preceded by annoying, persistent knee pain. That in turn is preceded by occasional, nagging knee pain. And so on.

That means that, with knee pain that has steadily worsened over many years, opportunities have been squandered. Why do people waste good chances to get better early on? For many reasons, I suspect, but partly because of a grim fatalism that nothing can be done, that knees “just wear out.”

Of course that’s not true. You can reclaim a pair of bad knees (as I did), but it helps to act sooner, not later. You may have to swim upstream against the prevailing advice (with its focus on strengthening your quads, stretching your ITB, etc.). But you can do it.

Still, if you didn’t seize that optimal window to heal early on, are you doomed? I don’t think so.


While struggling with my own recovery, I thought a lot about knees (way more than any human being should), and about how the body heals, and grappled with tough questions. For example: If damaged knees can heal (I firmly believe they can, after mine did), why don’t people who have really bad knees ever seem to get better?


If you believe that knees “just wear out,” it’s no mystery. The really bad knees never get better because that’s the immutable law of the universe, for them to get worse and worse, just as gravity exerts a pull that can’t be denied, no matter what your belief system. Case closed!

But if you’re an optimist on the subject, like me, the answer turns out to be more complex. I think people with really bad knees don’t heal for a variety of reasons: They become mired in pessimism. Their knees have changed permanently (bone spurs, for example) in ways that complicate or thwart healing. Or they’re not patient enough, radical enough, or creative enough.

The third reason (by the way -- that list above is not meant to be exhaustive, just a sampling of reasons) is the one I want to explore (the meaning of the other two, after all, is kind of obvious).


Patient enough means girding yourself for a long process to heal. It took me the better part of two years. For someone with severe chondromalacia, I’m guessing it may take 4, 5, 6 years. And the hardest part would be the first year or two, I would bet.

That’s because the worse your knees are, the slower your gains. That was my experience. Early on, there were weeks, even months, when I wasn’t convinced I was really making significant progress. After about seven or eight months though, I could tell my plan was definitely working, and my rate of improvement was faster too.

Radical enough means you may have to make big life changes. I quit my job -- I know, not many people can afford to do that -- but sitting at my desk was contributing to the chronic inflammation that kept my knees weak. I couldn’t convince my doctors of that, but by then it was okay: I had done the research and felt confident that I was right. For other people, radical enough may mean giving up that second-floor bedroom for a while if your knees aren’t strong enough to climb and descend stairs.

Finally, creative enough is all about finding innovative solutions to vexing problems. You want to find a way to lighten the load on your knees? One commenter recently described how, for a while, he decided to use crutches. And he used a Bosu Ball at work to get in regular flexing of his bad knee. That’s creative!

When I wanted to move my knees a lot, but couldn’t do so without discomfort, I thought of making a poor man’s continuous passive motion machine (and went so far as to sketch out designs on paper). I never did try to construct it, but did create a rock-climbing-harness-and-bungee-cord setup in my mother’s garage that allowed me to do hundreds of deep-knee bends at a time, with little strain on my recovering joints.


Finally, if your knees are really bad, I would develop a long-term plan -- you’ll need it, because there aren’t any short-term fixes (short of surgery, which may or may not work). And I’d seek out a good physical therapist, someone who believes what Doug Kelsey and others at Sports Center in Austin believe -- that you can get better -- and knows the right path to take too.

For some more thoughts, check out this blog post. It’s my most popular ever, so it must’ve struck a chord with a few people. It will give you hope about cartilage repairing itself, even when you’re down to the bone.

One last observation: Even for the very worst knees, I’d be surprised if some improvements couldn’t be made. Even if your ceiling isn’t full healing, but rather living with 50 percent less pain, that’s an improvement!


  1. Hey Richard - we might know each other perhaps as I raced for many years (still ride), working in ePublishing and also live in NYC. I too am having chronic knee issues - very frustrating and just got your eBook. Started to read it and do hope to find valuable information there that will perhaps help.

    It would be great to catch a ride with you one day soon. Though of late, I am pretty slow.

    Ray Alba

  2. Thanks for writing, Ray. I generally go out with the Triangle Park cyclists in Little Neck these days (the 8 o'clock group, not the 8:30 racers, though I have joined the faster guys a few times). Good luck with the knee issues -- I'm sure you've already checked out the obvious stuff, such as seat height.