Friday, August 17, 2012

The Importance of Setting Realistic Goals

Not long ago, a colleague at work turned to me and said, “I’m going to lose 20 pounds by July.”

I had a pretty good idea what was going on.

Most of us employees had signed up for free, company-provided health screenings. These consisted of a finger-prick blood test for cholesterol and glucose levels, a blood pressure check, and a weighing.

His weighing showed that a sedentary desk job and a fondness for pistachios had caught up with him. (Note: If you want to gain weight, just eat in front of your computer while working. You’ll enjoy the food less and eat more. I guarantee it.)

Losing a few pounds is certainly a laudable goal, especially when you find yourself on the wrong side of your ideal weight. But in his case, he had given himself two months to achieve something that most people would find extremely difficult to accomplish in six.

I remember expressing skepticism that he could lose so much weight so fast. Inside though, I was thinking something more like, “If you do lose 20 pounds in two months, I’ll eat my keyboard.”

About a week later, it was clear my keyboad would remain intact. I spied him gobbling pistachios again, the weight-loss resolution apparently a dim memory already.

When you set an unrealistic goal, I think you’re basically setting yourself up for failure. Further, failing at something is no fun, and just erodes your self-confidence.

With overcoming knee pain, this issue is particularly acute. That’s because the key bit of traditional advice for beating knee pain -- “strengthen your quads” -- mentally conditions you to expect a recovery on the wrong time scale.

Muscles strengthen relatively quickly. Knee joints don’t.

So, not knowing any better, you think: “I have chronic knee pain. If I strengthen my quad muscles, I can escape it. I’ll devote myself to a two- to three-month quad-strengthening routine. Then I’ll feel fine again!”

My bet is you won’t though. My bet is (if you really have chronic knee pain that’s been troublesome for a while), you’ll need six months. 9 months. 12 months. A year and a half. Two years.

But suppose you proceed with this unrealistic goal of healing in two or three months. After a month, when you realize you’re nowhere near being halfway healed, you may despair and think, “That’s it. There’s no way my bad knees can be fixed.”

So you give up, having decided you can’t reach a goal that was never realistic to begin with.

Of course your problems are really twofold. Your larger problem is arguably that you’re following the wrong path (focusing on strengthening muscles instead of the joint). Still, even if you get on the right path, chances are good you’ll flub your recovery if you begin with the promise of unrealistic expectations.


  1. When improvement is fast then I think it is easy to be excited about it or even take it for granted.  When improvement is very slow, it can be hard to see or remember that there as been any progress -- and that can be discouraging.

    As a chronic and long time knee pain sufferer who is now finally on track to success, something that helped me was measuring myself against very small benchmarks. Then if there was any improvement then I'd be able to see it and realize.... Hey! I'm actually better! 

    For example, one benchmark was: I would lie on my back with my thigh perpendicular with the floor and my lower leg parallel to the floor, so my knee is at 90. Then I try to straighten my leg so my whole leg is perpendicular to the floor and my knee would be at 180.  At first I could only get to about 165. So i would write that down in my knee pain & progress journal. Then , over time I'd keep trying and then write down the result. Slowly slowly it did improve. Eventually I was able to straighten it fully without pain.  Wow! But another interesting thing I noticed was that on the mornings I did my little benchmark test, my knee  seemed to feel better afterwards. I made note in my journal. And if I made multiple slow attempts (for example try it 5 -10 times in a row) then my last attempt was usually better and less painful. So, that was helpful.  I wrote it down. So even if my knee was not noticeably different in the world at large, these mini benchmarks combined with the journaling helped me pay attention and gave me solid encouragement that I was getting better. 

  2. Hello Richard,
    Thanks for your post. I had two questions for you and I'll be glad if you could answer them.

    1. Did you try to stay in a completely "pain-free" zone for as long as you could? Or did you look for the point of little pain that marks the edge of your ability so that you push it further? (not sure if I wrote that clearly enough)

    2. Could you share some of the exercises you did that worked (beside walking)?

    Thanks a lot!

  3. On #1, I understand what you're trying to say. In my case I tried to stay pain-free as much as possible. I think that's the best strategy, as long as you're not in constant waking pain. I don't believe you need pain as a sign that you're edging your training. (The less pain when you edge your training, the better, I think.)

    Other exercises: I did a few, but honestly, I think the walking contributed most to my recovery. But I also did unloaded knee bends and side-to-side "crabwalks." I'll probably go into this more in a future post; it's a good question though I'm convinced the walking helped me the most, by far.

  4. The parts in the book that emphasize the time frame for knee healing combined with my own long drawn out experience with debilitating knee pain make this blog topic of "setting realistic goals" and the need for patience of special relevance to me.

    I know Richard already compared cartilage healing time to watching paint dry. Here is my own analogy based on 6 years of debilitating knee pain and "periods of getting better" followed by heartbreaking setbacks.... although I think I've finally got it beat (I hope I hope I hope).

    For me, patience has been a HUGE challenge and also a huge key, so, I'm writing this in case it can help anyone.

    Let's say you are painting 4 white walls of a room.

    For regular healing cases, you can use dark blue paint and a big paint roller. Maybe it takes a day to do one wall. So then when you come back the next day you feel very encouraged because you can immediately see your progress and that the job is already 1/4 done. You move ahead with wall #2 with enthusiasm, etc. It only takes you four days to paint the room.

    But with chronic knee pain, it's more like you are painting the room with a 1 inch brush.... And it's not dark blue paint but only an offwhite. It's tedious and you wonder if it is really making a difference. After 1 day you only have 1/16 of one wall painted. When you walk back into the room the next day you can't even see which part of the which wall you had worked on. Could feel discouraging, right?!

    But if you shine a bright light and really pay attention, then you can see, ah yes, the lower right corner of the north wall is now offwhite. So, you get back to work.

    Since the progress is slow, it's easy to get discouraged or even bored, but it's important not to give up. A few friendly tips:
    1) do not focus on the vastness of the room.... Just put on some music or chat to a friend on your hands-free phone while you are painting.
    2) take notes to help you remember where you've already painted and help you see how far you've come.
    3) do NOT compare your own progress to the person painting with blue paint and the big roller -- they have a different healing problem so, it's apples and oranges.

    So, day in and day out keep with the program and Slowly slowly you finish wall #1.

    When you start on wall #2, then maybe you'll find you can use a slightly bigger brush and a light yellow paint. The improvement start coming faster and you can notice more of an impact. Wall #3 you can start using an even bigger brush and orange paint. But, don't carry the big fan down the hill! Don't reach for the blue paint or the big paint roller yet! Keep focused.


    August marked my 6 year anniversary of having debilitating knee pain. I think for the first 5.5 years I either used the wrong color paint or kept upgrading to a bigger paintbrush size too soon causing setback after setback after setback.

    Now since about March 2012 I've been implementing what feels like a Herculean quantity of focused patience and I think it is paying off. I'm still cautious because of my history of repeated ups and downs, ... I am very very hopeful.