Saturday, September 1, 2012

A Reader Writes: Is It Best to Stay in a Completely “Pain-Free” Zone?

Someone posed these questions recently.
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)? 
I’ve answered these questions in places before, but from time to time, I like revisiting certain subjects, figuring some people have arrived at this blog for the first time.

On #1 -- Is there such a thing as good, or at least acceptable, pain? Should you expect to live with a certain amount of pain to “edge your training,” so to speak, in recovery? And how to figure out where to draw the lines?

Great, tough questions. What’s somewhat surprising: I’ve yet to find much in the way of answers either, in my wanderings on the Internet. What follows are my opinions, based on my own research and experience.

If you have a “pain-free” window each day, try to enlarge that window.

Which generally means: Stay in the “pain-free zone” as much as possible. So, very short bursts of walking may be better than long walks at first. Gradually re-introduce your bad knees to the rigors of daily living (long periods of sitting, climbing stairs).

What’s a pain-free window?

Well, if you’re lucky (as I was), you do wake up each morning with your knees feeling better. Someone once described this as “It’s like I wake up with a brand new set of knees each morning.”

But you really don’t because those knees wear down all too quickly -- in an hour, two hours, three -- because they’re not that strong.

Anyway, that pain-free window, of a few hours or however long it is, is what you want to try to enlarge, in my opinion.

If you don’t have a pain-free window, you want to work toward getting one.

If you’re always in pain, a good plan for recovery becomes more complicated (see here). In that case, if you’re too focused on avoiding all pain, your tendency is to move less -- which isn’t good. So you have to very very very slowly work on healing those knees: using some experimentation, quite possibly creativity -- and lots of patience.

Swelling is pretty much always bad.

That’s my opinion anyway. Swelling seems to me to be your angry joint screaming, “You overdid it, doofus. Now I hurt and can’t move through my normal range of motion!” If, however, the swelling isn’t mechanically induced, but caused by say an autoimmune disorder, the analysis about how to prevent it changes -- because it’s much less clear to me how you deal with that kind of problem, unfortunately.

You don’t necessarily need pain to “edge your training” when healing bad knees.

Again: my opinion. But joints aren’t muscles. After a hard run, during your preparation for the local 5k, maybe your muscles burn, in a good way that signifies you’re getting stronger. That same “burn” in your joints after a hard hike, because you’re trying to strengthen them, isn’t a good thing. In my opinion.

I got better by pushing my knees to do more, sure. But I pushed slowly, and carefully. To me, the ideal recovery is one in which you improve, and steadily push your knees to do more, while experiencing as little pain as possible.

As for that second question, about what other exercises I did: I have spent little time talking about them because, honestly, I don’t think they mattered much in my recovery. But here are my three favorites:

The “monster walk” (I call it the “crab walk,” which is think is more descriptive.) Knot the ends of a Theraband together, roll the loop up over your ankles, then walk side to side, against the band’s resistance. This exercise didn’t put much strain on my knees, I found.

Unloaded forward knee bends (Doug Kelsey describes these here.)

Unloaded squats (I invented one particular variety, using bungee cords and a rock-climbing harness -- more details here.)

UPDATE: There's a great comment below by "Knee Pain" that I urge everyone to read. It adds a lot to the discussion.


  1. Thanks so much for another GREAT encouraging article that addresses questions I'm sure we all have!

  2. I asked the questions. Thanks a lot for your detailed answers.

  3. Maybe my skin and bones are thinner than most, but I found the Theraband really uncomfortable for my monster walks-- it seemed to dig into my skin too much and it made me hate doing monster walks. If anyone else has this same problem, I recommend "ankle cuff resistance tubing." (If you google it you can see pictures.) I tried it and it is MUCH more comfortable.

  4. In regards to the "edging the pain" question, I think a tricky thing about knee pain recovery is the "delayed pain effect." Richard talks about this delayed pain effect in his book... such the episode where he carried a heavy fan and his knees didn't hurt during the activity, but then much later his knees were extremely painful. I have my own version of that scene where I carried an ancient, heavy computer monitor down three flights of stairs. Did not hurt at all at the time... but, caused a huge painful setback. Sigh! The pain delay can be 8, 24, 32, 48 hours later.

    I found this to be very frustrating because pain is our signal to stop doing something that is causing damage -- but with the "delayed pain effect" I could be doing damage to my knee but have no clue because it's not hurting at all in the moment. If it would just TELL ME that I was damaging it I would stop! But instead, I'm blithely doing the activity, not knowing that I'm setting myself up for a 1-4 week setback.

    So my concern about the "edging the pain" question is that even without feeling any pain, the activity could be causing damage. So trying to push towards "edging the pain" in an attempt to make sure you are getting a good workout could be causing even more damage.

    For people trained to push ourselves to improve (like straining to get in just one more bench press to strengthen those muscles), it feels unsatisfactory to work out without having a sense of "edging the pain" which proves to ourselves we are doing our very best. But it seems like with chronic knee pain, the key is more about patience and an incremental careful increase in exercise..... with the key of "not over-doing-it" which causes setback after setback after setback.

    On the other hand, I guess there are different kinds of pain. Some pain is an immediate stab telling me "don't do that."

    Also, maybe in the knee healing process, there comes a point where this "delayed knee effect" is less of a problem because the knee is well enough to tolerate the exercise without causing damage. So, in that case "edging the pain" is not causing damage but is moving the healing to the next level.

    Listening to one's own body's response to the activity is key. Richard kept a knee journal to track progress and seek correlations between activity and pain including where the sneaky delayed pain effect plays its hand.

  5. Very nice and thorough comment, Knee Pain! All I can say is "Amen." You covered a lot of good ground. Thanks!

  6. After writing the above, I read Doug Kelsey's website (everyone reading this blog knows Ricchard is a fan of Doug's work, right?)

    Guess what?

    Doug does talk about edging the pain! Wow!

    But, the "edging the pain" technique comes into play in "stage 3"

    His stages are

    Stage 1: recovery

    Stage 2: restoration.

    Stage 3: re-train (this is where " edging the pain" comes in)

    You can read about it yourself at and scroll to the bottom.

    I think I'm somewhere between stage 2&3 at this point. but I'm not sure. I'm tempted to get the book to help me continue my progress.