Saturday, August 4, 2012

Handling Setbacks on the Long Road to Healing

The question of how to deal with setbacks came up recently in the comments section. It’s a great question because I doubt even the smartest, most patient person can navigate a healing process that spans many months without a single setback.

First, why are setbacks so bad, when it comes to overcoming chronic knee pain?

They’re depressing. Really depressing. It’s not like you were healing that fast to begin with, right? So you feel a little better after two months of doing all the right things, then do something wrong -- you may not even be sure what -- and suddenly you hurt as much as you did before.

Argh. Bad knees are forever, you start thinking to yourself. At this point, you’re particularly prone to negativity, self-pity, and a bunch of other bad feelings.

Also, at this point, you’re prone to abandoning what works. After all, you tried to improve your joints very, very slowly, you were feeling somewhat better, then an ill-advised hike/long walk/sprint to catch the bus set you back.

Maybe you start thinking: “This program can’t be working -- it’s too slow and if my joints are getting stronger, how can a little x (whatever the offending activity was) cause such problems? Ah, forget it. It’s time for surgery/pain medication/a life of doing whatever I want because it doesn’t matter anyway.”

You feel lost, not knowing how far you were set back. To me, this is a big issue, especially when you’re measuring hard-fought gains in inches, figuratively speaking.

Obviously, you want to get back on track. But do you take a few easy days? An easy week? Should you return to your program of three weeks before, when you were taking 20 percent fewer steps each day? Or do you need to hit the reset button more dramatically, and go back three months, maybe to when you weren’t even taking long walks yet?

These are frustrating, demoralizing questions to deal with. You’ll want to downplay the significance of the setback. You’ll want to act as if you were less affected than you really were -- which raises the risk of doing more damage to your joints.

Okay, that’s why setbacks are bad, in my opinion. Now, how to deal with them?

Make sure they don’t happen.

No, that’s not meant to be a “d’oh” statement. Because I believe you really need to be thinking hard about not pushing your knees too much.

So this means (1) Err on the conservative side with activity. (2) Monitor your knees very closely. (3) Learn as much as you can from whatever setbacks you do have. Failures are never wasted when they’re recycled into knowledge (that in turn prevents future similar failures).

Recognize and accept the setback.

The worst thing, I think, is pretending it never happened and just merrily going on with your existing program, not changing a thing, not reflecting on how and why you screwed up. Because then your knees may just get worse and you’ll be no smarter for what you just went through.

Instead, my advice is to face it head on. You may be lucky -- maybe you just need to take an easy day or two and you’re right back on track. If not, you’ll probably have to experiment a little to figure out what level/type of activity your suffering knees are now happy with.

Know you’re in good company.

I had setbacks. And I bet that almost everyone whose knees healed over a 12-month-plus timeframe had at least one setback. They happen. So it’s good to be philosophical about something that’s practically inevitable.

Some years ago, I remember getting very angry at myself for losing/misplacing something. How could I be so stupid? Then I decided to take a larger view of the situation, and it relaxed me somewhat. The larger view was this: Over the course of anyone’s life, that person will lose or misplace a certain number of things. So, unless I lose personal items at an extraordinarily high rate (suggesting say Alzheimer’s), the occasional object that goes missing is just me filling my cosmic quota. :) No big whoop.

Cry if you need to.

Throw something across the room. Curse the unforgiving God of Bad Knees for not cutting you a break.

After all that, figure out how to get back on that slow path going forward. Because that’s the only way to go, isn’t it, if you want to win back your old life?


  1. I say "Yes, yes, yes" to Richard's  post about setbacks.   

    One thing I think is interesting about healing knee pain vs  improving ourselves in other parts of our lives is that in most things if you want to improve you need to Push Yourself. For example if you are doing strength training you typically keep pushing yourself to do one more rep even when your arms are shaking. If you are studying for an exam you need to keep pushing yourself to memorize more and more.

    We are trained in life how to push, strive, achieve... But that backfires for healing our type of chronic knee pain! Biking an extra 5 minutes can cause  a huge setback. Pushing myself to "not be a wimp" and add weight on the leg press could cause actual damage to my knee...even though I won't know it until 24 hours later.

     The skill set for healing knees is totally different! What we need to learn is focused and consistent patience. I need to do my gentle exercises and then stop, even if I feel like could do 50 more. We need good "listening skills." If I have scheduled time to exercise but my knee is irritated,  the temptation might be to "tough it out" but actually I need to listen to that irritation and maybe make a different decision. In this joint healing stage if I'm doing some exercise and my knee seems unhappy, instead of pushing through it I might need to adjust my leg or foot position...or stop.   And no cramming! If I miss an exercise session then I can't try to make up for it by doing twice as much in the next session. Nope! 

    The skill set to heal chronic knee pain is  like the consistent patience  for growing a plant. Careful monitoring every day. Adjust the amount sunlight or shade as needed. Modify the amount of water. You can't push a plant. Read up on that type of plant and talk to others. On the other hand, you can check in on a plant twice a day and walk away, but your knee is with you 24 hours a day and anything you do can help it or hurt it all day long.

    Actually, the skill set to heal chronic knee pain is more  like losing weight.  You have to monitor what you are eating all day long. You make  very slow progress no one else can see. You must resist sooo many temptations all day long, day after day after day. Must resist cake and French fries even when everyone else are eating them.  On the knee healing journey you must resist taking the stairs just because you are feeling a little better that day or because you are with a group and everyone is taking the stairs.   Just One Indulgence or one instance of over-doing-it can undo a week or more of progress!  And in both the weight loss journey and the knee joint healing's not fun! It's not exciting!  It's very slow and even dull.  

    Despite being slow and dull, I must make it a constant focus and priority in order to get back to an active life. I've been keeping a knee journal in which I write down everything about my knee: any tiny progress, my setbacks, my fears, what exercise I did and when, how it felt during, how it felt after, how it felt 24 hours after, what shoes I'm wearing, etc.  In one journal entry I sort of laugh at how BORING it is! And yet, that's what it takes. I use the journal writing as a way to keep focused on my knee pain and progress. I celebrate any progress and berate my failings. I need to make this knee healing journey fascinating to myself so I can be focused on it every day, all day, day after day after day. 

  2. This is great-thanks! As a 44 yr old gal who is trying to keep her rear in gear, I had a major setback when doing some glute exercises. I kept my knees in mind and was very careful but bam, major setback. However, this is how I came across your lifesaving book and blog, so it was truly a blessing in disguise. Still, I have been extremely depressed and this blog is a good one and very much appreciated. Thanks! Theresa

  3. Hi Knee Pain. Can you share with your injury, and any progress you've made? I think many of us on here are always looking for that rarely shared success story as encouragement. And thank you for your post...I needed to read that as my setbacks are killing me.

    Tahera, are you spamming us?


  4. Sorry Knee Pain, I just read your story on the previous post. My bad, and thank you so much for sharing. Please do keep is updated on your progress, I'm very interested to apply your findings to my own recovery. -Erik

  5. Hi Erik. My condition has been diagnosed as patella femur pain syndrome and also chrondromalcia. My symptoms are/were different from Richard, though. He had pain even sitting! Awful! Luckily I avoided that symptom. My pain only happened when I bent my knee... Ranging from wincing pain to screaming stabs and at one point I also developed a lovely knee lock symptom which literally made me fall down on the sidewalk first time it happened. Fun. I've been slowly back tracking through Richards post and making comments on topics I personally relate to such as patience, setbacks, weight loss, patella alignment, structuralism, Synvisc type injections, quad strengthening too soon, etc. After the knee lock symptom developed, I did undergo arthroscopy to smooth the cartilage -- this solved the knee lock problem and one other symptom (pressing on knee cap with leg extended was extremely painful). So, I do think that definitely helped my particular situation. But even up tp two years after the surgery i was still suffering from original problem and could not retun to an active life.

    But after starting another focused attempt in March 2012 I have finally finally had success... and Im starting to even think I can trust my knee to go on a vacation that requires walking. But. Patience. Last year I also went on a vacation where I walked around some and I was fine, but one month later I had a huge setback. Again. However, THIS time does feel different. I think it's really stronger and healthier. For example at this point I've built up to biking 20 miles -- whereas last year I could walk but my knee was not healthy enough to bike. So. Day by day.

    Looks like you are able to bike now, too? I so far biking feels very key in my recovery. But, it was important not to do too much too soon. Force myself to be patient.

    Patience can feel suspiciously like an excuse not to push myself. I worried... "Am I being too soft on myself? Am I using "patience" as a disguise for not trying hard enough? Surely I could bike 5 more miles?" For me the answer is Nope! Been there, done that -- over and over until FINALLY i think i've learned to trust patience. Someday I WILL be able to push myself to do just one more hill or just one more staircase... But I'll never get there if I do that now. Patience patience patience.

    1. PS. I re-read my above post. I did not mean to imply that I think my vacation during which I did some walking caused a setback a month later. What I meant is there have been times where I was doing pretty well ( such as a vacation where I was able to do some walking ) ...and then I'd start overestimating what I can do and start getting too ambitious with my activities..... And then in my enthusiasm I would "over do it" and cause a setback.

      So. This time even though I am doing well, I'm trying hard to not over estimate my abilities hold myself back from overdoing it. For example, I wanted to sign up for a bhangra dancing lesson which looks really fun! However.... Bhangra dancing requires some bouncing motions and even hops or skips. And, given that I cant even stand here and do one hop or one skip, how could I possible make it through a whole lesson??? So, I was able to talk myself out of it. However, now I'm more motivated to build up my bouncing, hopping abilities so that I WILL be able to take a Bhangra dancing lesson. My Active Release Thearpist suggests I try out hopping / jumping in shoulder high water and slowly build up. After I've built up in water, I can graduate to land. Then on land I'll see if I can hop from foot to foot laterally (high risk!) to increase my knee stability un a controlled environment. Then after I can do that it seems safe to sign up for a Bhangra dance lesson. Long road. Patience. Patience patience. Overkill? Maybe or maybe not. buT my priority is to avoid another setback and the only downside is that I'm delaying taking a dance class. It can wait.