Three Reasons Why “Let Pain Be Your Guide” Can Be Bad Advice

At first I was going to title this “Three Reasons Why ‘Let Pain be Your Guide’ Is Bad Advice.” But, although provocative, that title is rather misleading. You do need to listen to those pain signals coming from your knees and react smartly to them.

So what am I objecting to now? This, in a nutshell: The all-too-hasty examination of a bad knee (or knees) by a medical professional, who concludes with some breezy advice to be careful and “let pain be your guide.”

What’s wrong with that?

* If pain is all you know, it’s probably dead-end advice.

Think about it. Your knees always hurt. You try to minimize the pain (“Let pain be your guide”) by using them less. Before you know it, you’re caught in a death spiral.

The death spiral goes like this: 1. Your knees hurt so you move them less. 2. Because you move them less, over time, they hurt even more.

Now, go back to #1 and repeat the cycle, ad nauseam, until you have a pair of completely wrecked joints.

What can you do if you do hurt all the time? There are ways to move a lot without over-stressing your knees, as I discuss here.

* The advice needs to be more nuanced, to account for the delayed symptom effect.

Knee cartilage has no nerves. When I discovered this, I remember thinking, “Wow. That’s huge.” Indeed, it’s very, very significant for a number of reasons.

One of them: You can overstress and damage knee cartilage and not even know it until sometime later.

Here’s a real-life example (from my own experience): You move a heavy object, such as a pedestal fan, down a couple of flights of stairs. Your knees feel okay at the time. Two days later, you’re out casually strolling and you notice one of your knees is aching.

“Let pain be your guide” suggests that the casual strolling is the activity that should be curtailed (to be fair, you probably do want to take it easy on your walk, even if it didn’t cause the problem). You felt no pain while carrying that fan down the stairs, right?

But when you have bad cartilage, and it’s overstressed, symptoms can take a day or even two to appear.

So, in this example, you run the risk of learning the wrong lesson. Instead of resolving not to carry heavy objects on the stairs until your knees get stronger, you decide your joints can’t handle easy walking.

* The advice needs to be more nuanced, to make more-subtle distinctions.

One thing I learned from battling knee pain: your joints will throw off lots of different sensations. Sure, there’s outright pain, but you need to be able to parse all the sub-pain signals, because some of them indicate that pain, while not present, will be soon if you don’t change what you’re doing.

So, instead of “Let pain be your guide,” I’d suggest “Let sensations from your knees be your guide.” I can imagine someone reading that sentence and rolling his or her eyes. How is that any more helpful?

Well, it isn’t and it is.

Because the next step involves doing some work. You need to figure out what various signals from your particular knees mean. There’s only so much you can learn by studying medical articles about how the knee works and how pain and discomfort arise from damage to cartilage and soft tissue.

Those are general guides. You have a pair of specific knees, with specific problems that will result in an array of weird tinglings and sensations. You need to understand what they all mean. You have to learn the language of “knee,” as it applies to your knees.

If you really do follow “Let pain be your guide,” in a simple way, you’ll probably make the same unfortunate discovery I did. By the time you’re in pain, it’s already too late. You screwed up. You went backward. You need to figure out how to gradually work your way out of pain -- and then, once there, stay there.