Sunday, June 17, 2012

Some Thoughts on Moving Your Knees: How Much Is Enough?

The other day I got this comment from “An”:
I’m a 25 year old woman who has never been an athlete (to be sincere, just the opposite), but I’m determined to beat this knee pain as it’s keeping me apart from my life, my career, my friends and even daily life activities. I don’t have another option, anyway. It’s this pain or me. And it’s gonna be me, definitely.

I have some doubts about your healing program. Those short walks you did every ten minutes around your apartment… did you do them only the first month of your program (when you were not prepared to walk a lot) or did you keep doing them when you were building distance? Did you do them ALL day? Didn’t that irritate your knees?

Sorry for asking such personal and specific questions but I can’t walk as much as you did at the beginning of your plan. I can only walk less than a mile daily without pain, after many moths (I started with 200 metres per day), and sometimes I feel as if I wasn’t doing enough (type A way of thinking, I guess). I walk a few steps around my home every two hours or so.
First of all, not to worry -- that information isn’t what I consider personal (unlike, say, what color underwear I have on). Also, you may not be an athlete physically, An, but you appear to have some of the essential mental attributes. For one, you’re determined and focused on a goal: beating this condition!

To answer your questions: (1) As I recall, I did my “walkarounds” (which involved setting a timer to go off every 10 or 15 minutes, then taking 70 or so steps around my apartment) for the first few months of my recovery -- more in the beginning and less as my knees got stronger. By the six-month point, for example, I wasn’t really doing them, and was focusing on taking longer, more challenging walks. (2) Maybe I didn’t do them all day, but most of the day, yes. So you see: I’m very disciplined (and maybe a little crazy). Also, remember I had no job then. I had embarked on a one-year experiment to save my knees. Healing was my No. 1 focus, constantly. (3) Doing walkarounds didn’t irritate my knees. But if it bothers yours, then maybe you need to do them less frequently, or take fewer steps, or find some substitute activity.

So those are my answers.

But here’s the postscript, which you all can probably see coming.

Doing exactly what I did almost surely won’t be the right thing for your particular knees. Your knees may need to do some variety of walkarounds for a week, a month, a year -- or not at all. Maybe another activity suits them better. I liked walkarounds because they got me moving in short, manageable bursts and got me moving in an activity that was useful (in other words, my knees were making adaptations in order to walk more -- and walking is something we need to do all the time, as opposed to say leaning against a wall as if sitting in an invisible chair).

In my opinion, that’s the bigger picture (which I think An already recognizes). The really big picture requires stepping back and thinking about what walkarounds and other similar activities are meant to accomplish.

And sometimes it’s good to look at the really big picture.

I started doing walkarounds because (1) I knew motion was critical to healing bad knees (2) my bad knees thwarted my attempts to move as much as I wanted to (3) my knees responded well to short bursts of walking.

For me, these were the main ideas to keep in mind, as I fashioned a program to get moving.

Finally, to An: congratulations! You can now walk less than a mile a day without knee pain, up from 200 meters. I know what you’re thinking: Yeah, but that’s after many months! True, but you’re in the middle of a loooooong process. It’s hard to overemphasize, in fact, how long this type of healing takes.

The good news is, the stronger your knees get, the faster it goes (and the more tolerant your joints become of the mistakes you invariably will make along the way). That was my experience anyway.

Good luck!


  1. Recently I had to make the difficult decision to quit my job after a year of sick leave due to my knee problem, in order to focus even more on my recovery without the pressure of a deadline. Therefore I’m feeling a bit down and overwhelmed with this whole situation.
    Thank you sooo much for your answers and positive evaluation of my progress, Richard! They are truly appreciated!!
    Hopefully you'll have another success story to tell in some time. :)

  2. Hi Richard!

    I'm so thankful for your wonderful book and I'm reading through your blogs now. I'm 44, weigh 115 lbs, and hurt my knees running marathons 6 yrs ago. I was diagnosed as having patellofemoral pain syndrome and PT also made me MUCH worse. Thank you so much for helping the rest of us!

    I feel lost as to how to proceed and would like a plan of action. How did you know how and when to increase your steps? Would you suggest increasing a certain amt or % every week, for example? How do we know how to push the envelope without risking further cartilage damage? Should we wait for the knees to feel better before progressing?

    I just don't know where to even start and then how to progress. You've also mentioned that it may take a couple of months to notice improvement, so that makes it hard to know.

    I understand we need to listen to our own knees and that you can't tell us specifics, but knowing what you did will help.

    Also, did you always sit or recline while you weren't walking, even in later months?

    Thanks for any advice and especially for giving us HOPE!!!

    I felt your misery while reading your book and I'm so happy you recovered!


  3. Hi Richard
    I am also thankful for your wonderful book.
    I tore my Left MCL and it has since healed. The physio had me doing "wall slides" "clams" and some swimming and bike riding to strengthen my knees. This was painful and difficult and took almost 2 yrs to
    feel normal and not sore.
    I had finally healed 100%
    (I should also say that I work 12 hour shifts full time on my feet all the time walking on hard surface floors.)
    About a year ago I started to have an occasional
    twinge in my "good" knee.
    and one bad episode difficult to walk at all. (It only
    lasted a couple of hours.)
    I was terrified of another torn MCL situation so saw my doctor and had proper Xray and MRI done. It showed narrowing and severe osteoarthritis deteriorated meniscus.
    I have now been told by an orthopedic surgeon I will need a knee replacement in about 5 years time.
    I was shocked. I am 59 years old and quite
    I am working at getting my weight to within normal range.
    I also plan to retire from full time work because I think it is not healthy to work shift work on my feet for 12 hours at a go when I am pushing 60.
    I am not sure where to start with exercise now.
    I do golf weekly
    and walk my dogs daily, I also do kettle bell swings
    because they don't seem to hurt my knee at all and I can get my heart rate up quickly (tabata type protocol)
    In the winter I swim a couple of times a month.
    What exercise would you add or take away??

  4. These sound like good exercises (but don't listen to me -- what do your knees say?). I'm not sure about golf, but if it's fun and your knees don't object, that could be fine too.

    So maybe your biggest challenge right now isn't the exercises you're doing; I'm guessing it's your weight. That would be a primary focus for me if I were you. "Quite overweight" sounds like it's taxing your joints a lot. Losing weight is a long-term project, but it pays a LOT of dividends in the end (not just for your knees).