"What to do About Weak Knees?" Revisited

This was a popular blog post. A commenter had complained of “weak knees” -- no pain, no instability -- just general weakness. I went out on a limb and surmised that this person was overweight and inactive. Showing that I have no future as a carnival weight guesser, the commenter wrote again to say that he/she was five-ten and 135 pounds (which may qualify as underweight, if anything) and likes to ride a bicycle and ski cross-country. Okay, zero for two -- hey, it happens ... :)

Today I thought I’d return to this odd case once more, seeing if any readers have insights or suggestions. First I’ll give you all three comments this anonymous person has left (settle in, because they're long):

Have you or anyone had just "weak knees?" For over 7 years, I have had this issue and have seen a variety of doctors, multitude of tests, physical therapy and still...same old..same old thing. I was wearing a rocker type shoe from Kmart for about 6 months and my weakness went away, but...then my feet started to tingle and get sore from them. It became too much...so...I tried the Sketcher brand and the weakness came back. So now, I am back to a good pair of running shoes with good support wit weak knees. I am considering on seeking out another orthopedic surgeon's thoughts, but...because I am not in pain they feel nothing is wrong. If I wear knee supports the feeling goes away, but in several days, I get tingling in my feet. One doctor thought that since my knees are OK with supports that by realigning and tightening the knee cap, the problem would be solved. I should be happy that I don't have pain...but...a weakness all day can be just as brutal. No medication works on weakness...so...I manage through the day. When I relax at home on the couch, the feeling will go away in about an hour and then the problem starts all over again the next day.

... I am the one with this strange condition. I could type you a long story...but I will be brief. Prior to this condition, I have been physically active (road by bicycle, cross-county skiing and such. I am 5'10 and weigh about 130 lbs. This weak knee condition slowing emerged about 10 years ago. Initially I was instructed to do circuit training at my gym and such. It seemed to help...but...as the months/years crept up, this weakness was more constant. The feeling in the knees are exactly that...a weakness within the knee area. They never feel like they are going to give out...just a darn feeling of weakness. I could be sitting at work and have that annoyance. Have tried pain meds, but..it's not pain, so nothing helps. And, I am not overweight, was physically active and have mystified doctors. As these years have transpired, I noticed that the rocker shoe removed this condition. I did have tingling in the feet with these shoes and was told that my shoe size 8 1/2 or 9 which was the wrong size, thus creating a tight foot-bed. Once I went up to a size 10 1/2 with an orthotic, the tingling subsided. Would bore you with more details, but had to resort to a normal shoe style. Recently, I had to adjust my new orthotics with my shoes due to smaller toe box and foot soreness. So,they reduced the arch material so my foot would not hit the seems within the shoe. Two days after the adjustments, the weakness in my knees came back. Two days ago, I purchased a shoe with a wider foot-bed and they built up the arch support and fingers crossed in day 2, the weakness in my knees are dissipating. So as you can see, their is a connection between the angle/alignment of the foot and my knees. I believe that my knees are slightly misaligned, thus creating the condition. Several summers ago, I rode my bicycle to and from work. It seemed to keep things in check, but as soon as the weather changed and I had to resort to driving...the weakness reappeared. In the past, the 3 P.T.'s were always mystified during the sessions and how my weakness would disappear and reappear. From all the orthopedic surgeons I have visited, only 1 suggested that I wear knee supports. During this 1 month trial, my weakness went away. Due to this, he had a plan of operating on the knees that would essential tighten the knee cap and properly re-align them for support. It's difficult to reach that decision, since other doctors said my knees are fine, but...the weak knee symptoms are quite debilitating. Through these years of experimentation, I now know there is a link between the alignment of my feet and my knees. So...I hope this addresses your logic. If anyone know of a good knee specialist in Ohio that has dealt with this condition I would appreciate a response.

I am that person with weak knees. I am 5'10' and weigh about 135 lbs. I was always been active...riding my bicycle, cross-country ski, enjoyed working out in the yard...and 8 or so years ago, I started to feel a weakness in both knees. Started to workout and it seemed to help a bit. But...as time transpired, nothing seemed to work. As the day progresses, my knees start to feel weak. Through these years, I have seen 3 different P.T.'s and they are uncertain about my condition. When I work Kmart rocker shoes, by weakness went away..but still had tingling in the feet. Went to a shoe store and was told that my 8 1/2 shoes should be 11 B. So....I went that direction and tingling went away, but...they had me wear their shoe orthotic over the insole to take up room. I started to supinate and ended up with nerve pain. So...I had to get orthotics and scrap the rocker shoes. I have tried several orthotics and have not found one yet that has helped me. While I was being fitted with one...they were trying to fit the orthotic with the shoe vs. my foot. And, during that course, I first had no weak knees, but by the time the removed much of the original support, the weakness returned in my knees. If I go home and crash out for an hour or so, the weakness will go away. When I wake up, I am OK..but..then the day starts all over again.

Here are a few of my thoughts, in no particular order:

(1) Someone who has weak knees and accompanying pain might say there’s a word for people like Anonymous: lucky. :) I too had weak knees. But I also had burning, aching, and even some swelling in the joints.

Have other people out there had “just weak knees” that don’t seem unstable (remember, they don’t feel as if they are “going to give out”)? If so, what exactly do they feel like? Because my second observation is:

(2) You say to-may-to, I say to-mah-to.

What does “weak” mean in this context? “Weak”, by itself, can be a hard descriptor to parse. For example: You’re sitting. Your knees feel weak. What exactly is that sensation? When I’m sitting nowadays, I either (a) don’t feel any sensation from my knees or (b) feel a slight sensation, such as an occasional tingle.

My hunch is that 10 people who had the same sensation in their knees as Anonymous would find different ways to describe it besides “weak.” It’s not that I distrust Anonymous, it’s just that (to get philosophical for a moment) words are imperfect vessels to contain our thoughts and impressions, and I suspect that this feeling of weakness is a bit more complex or nuanced.

(3) Could this be a neural issue? Or something systemic? I’m just throwing out ideas here, because of the odd and strangely asymptomatic nature of the problem. Or perhaps it is an imbalance issue, though I tend to be skeptical of misalignment as a cause of knee pain, as I think this reason is cited too frequently and doesn't answer the question of "Why now?" In other words, why does alignment suddenly become a problem -- unless you were say in a car crash and your body got knocked out of alignment?

(4) Has Anonymous tried building up to intense physical activity of the sweating variety? By that I mean really working out aerobically (I can’t tell how intense the bike riding and cross country skiing were). I’m a believer in vigorous physical activity banishing all sorts of strange little aches (if it’s the right joint-friendly activity -- say swimming or cycling). And the intensity should be increased gradually.

(5) At one point in the narrative, Anonymous claims to have been wearing size 8 1/2 shoes on size 11 feet. Hmm. I can usually tell immediately if I’m off by only one shoe size. So Anonymous, this leads me to a final thought:

(6) The power of self-awareness, creativity and a commitment to problem solving.

The power of self-awareness, if you’re Anonymous, is to pay special attention to your environment and what may be causing issues. Keep a knee journal. It's not just shoes that can contribute to the onset of symptoms.

Creativity is using the ol’ noodle to solve problems -- biking was helping Anonymous with the weak knees, then the weather got cold, and that was that. ??? Gyms have stationary bikes. Buying a bike roller or a trainer allows you to ride indoors. Heck, with under-the-desk pedal exercisers, you can ride at work! So a change of seasons doesn’t qualify as a reason to stop doing what your knees like.

And the commitment to problem-solving is the determination to get this right yourself, if need be. The docs don’t know what’s wrong and can’t help. Now you need to help yourself.

Experiment. See what works. And, if you're Anonymous, say a little prayer of thanks that at least you’re not in pain yet. :)

P.S. One other thing I would be remiss not to note. The observation by Anonymous that "When I wake up, I am OK..but..then the day starts all over again" could have just as easily been made by me a few years ago. Each morning, when I awoke, it was like I started the day with a set of brand new knees, that gradually wore out as the day went on -- by mid-morning on a bad day, by mid-afternoon on a good day. This I believe is a classic symptom of knees that aren't strong enough to endure what is required of them -- i.e., the normal sitting and walking and standing that we do, day to day.

So Anonymous, you may not be as alone as you think.