Friday, February 17, 2012

Arthritic Knees Are in Constant State of Repair, Study Finds

Just call this "Good News February."

A couple of weeks ago, I ran a success story from Ron, who credited his recovery to the same approach that helped me heal.

Of course, much of the medical profession still seems to doubt that bad knees can repair themselves. This pessimism, not surprisingly, has resulted in a prevailing treatment regimen that emphasizes stretching and strengthening muscles, to prevent bad knees from getting worse. Oddly absent from the protocol: activities designed specifically to strengthen the knee.

But what if bad knees can repair themselves? Ah, then the game changes completely (as I've said many times). Then you probably need a plan that, at least broadly, resembles what I did to heal.

Well, check this out, hot off the press (my bold):
Researchers at Duke University Medical Center used new tools they developed to analyze knees and hips and discovered that osteoarthritic knee joints are in a constant state of repair, while hip joints are not.

"This suggests the knee has capacity for repair we didn't know about and the main treatment strategy probably would need to focus on turning off the breakdown of knee tissue," said Virginia Kraus, MD, PhD, professor of Rheumatology and Immunology at Duke. "I was hugely surprised to find this."
Maybe Kraus was hugely surprised. I'm not at all. This is the driving idea behind Saving My Knees -- your knees stand a good chance of healing if you do the right things and are very patient -- and there are medical studies over the last decade that show why (which Kraus may be unfamiliar with, but others of us know about).

The article on the Duke University web site goes on to note:
Perhaps the natural repair response would be sufficient to lead to a reversal or halting of the disease process in the knee if the joint breakdown could be halted, Kraus said.
Note the language is carefully couched -- "perhaps ... would be sufficient ... reversal or halting of the disease process." But I can assure you, from having parsed plenty of medical studies, that all researchers speak with this same abundance of caution. My own experience was that "the natural repair response is sufficient to lead to a reversal of the disease process in the knee" -- because my conviction is that I was in the early stages of a bad disease process that I managed to turn around.

All in all, I was happy with this article, except for this part:
The knee is very accessible for injections, so it would make sense to inject the knee with agents that could turn off the degradative processes, and these could be delivered periodically with close monitoring, Kraus said. "That seems like a very viable strategy."
Argh. (That sound you hear is me banging my head against a wall.)

Somehow we've gone from "the knee has a naturally robust repair response" to "what artificial agents can we inject into the joint?" What's frightening is I don't think Kraus even realizes the irony. Maybe, on a deeper level, her strategy of choice just reflects the times we live in -- when there's a problem, we immediately seek to harness our superior technological knowledge in service of a solution.

But do we really need to inject foreign substances into our knees to "turn off the degradative processes," as if these processes are biochemical toggle switches waiting for the right substance to float by to trigger a shutdown?

I really don't think so (and to explain in depth why I think this is a flawed approach would take another blog-length entry). Let me just observe: I had destructive chronic inflammation in both my knees. I managed to turn it off without jabbing a needle into the joint capsule.

How? The simple version: I focused on stopping activities that my knees didn't like, and weren't strong enough for (such as periods of bent-leg sitting) and starting activities that my joints craved (lots of gentle motion), and on strengthening my knees over time.

And guess what? My body apparently figured out how to flip that biochemical toggle switch on its own. Which is really the best way to go, if you ask me.


  1. This is an awesome post. I'm so happy to hear this. I'm still at the relative beginning of my knee repair journey, so any positive stuff I can read is helpful. I suffer from frequent bouts of doubting and exhaustion (bad knees is not the only major health issue I am battling!). And this seems like the most positive "scientific" information in quite awhile. Good to know! Thanks, as always, for keeping us going, Richard!

  2. Hi Richard!
    Nice news! Now that you got back to cycling, do still have to avoid ascending and descending tracks?

    About a month ago, I think I had the same reaction you had on this article, my Doctor told me it would be helpfull to try injecting hyaluronic acid (Singex one). It seems perfect if you don't belive in self healing, but if you do, then this artificial fluid certainly won't have the biological stuff to help the joint to rebuild the cartilage.

    I'm having condhromalacia for something like 6 months now, seems to be gettind a little better, but still can't climb the stairs with one of the knees.

    I am almost feeling safe to try cycling avoiding ascending and descending tracks. Any tips on this?

    For now, just walking, sleeping well (which seems to help to diminish inflamatory processes in the body), using nike full air to avoid much impact, taking condroitin and glucosamin even not beliving in much difference and having a lot patience...

    See you!
    Henrique Carlo Farina

  3. Thanks for writing. As for your question, I'm back to cycling and I don't have any limitations on ascending or descending, whether riding a bike or traveling by foot. I really did recover, thank God.

    Getting enough sleep is a great idea. As for cycling, I think that's also a great sport for bad knees. I made sure, when I resumed cycling, that I eased back in. Also my early days back on the bike I was careful not to climb any steep hills and keep my rate of spin high and my effort fairly low. Sometimes it's easier to just ride a stationary bike (though boring), to make certain you don't over-exert. (Personally I favor outdoors cycling but using caution, as the exercise bikes are dull and my knees didn't like them as much either).