Saturday, September 8, 2012

How I Healed My Knees, In One Phrase

This blog, in aggregate, is a lot of words.

Me talking about stretching. About structuralists. About glucosamine. About hope, despair, and all sorts of feelings in between.

Sometimes I like to cut through the verbiage and get back to the simplest, most basic question a first-time visitor will have about my recovery from chronic knee pain.

How did you do it?

My shortest answer is that I followed this prescription:

The proper amount of appropriate motion.

Now here’s the unpack of that phrase, starting at the backend.

Motion means moving. It doesn’t necessarily mean exercising. “Exercising” is a loaded word that conjures up images of buff fitness freaks. It also suggests vigorous activities that may not be good for weak knees.

“Appropriate” is a significant modifier because there are lots of activities that I don’t think are suitable for people with weak knees. They include many low-repetition exercises aimed at strengthening the quadriceps muscles in the front of the thigh. My knees weren’t strong enough for such exercises (in some cases, where the knee pain isn’t too bad, your joints may be able to handle them).

To get enough “appropriate” motion, I considered three options: (1) something in the water (2) easy cycling (3) easy walking. Why those three in particular? They’re all gentle on the joints and good for doing high repetitions.

(1) was out -- water simply wasn’t convenient enough, plus I had some knee problems while moving about in a swimming pool. (2) didn’t work either -- I had messed up my knees cycling and they protested when I tried even easy spinning. That left (3). I built a recovery plan around appropriate motion that my knees liked: walking.

Now, what about those two words, “proper amount”? Why are they important?

Because there will be a sweet spot of the right amount of motion for your knees -- not so much that they get worse, but not so little that they fail to improve. Determining where that sweet spot is will be a difficult thing -- no sugarcoating here -- unless you’re working with a smart physical therapist who actually believes in measuring what kind of load your knee can tolerate (as Sports Center in Austin does) and who designs a program around that.

Warning: I’m aware of very, very few physical therapists that do such a measurement, in a scientific and quantitative manner. This is one reason why I think, for chronic knee pain, we’re still in the Dark Ages.

Further complicating matters, that “sweet spot” of motion is somewhat of a moving target. You must occasionally push your knees to meet more demanding tasks, to ensure they keep getting stronger. Figuring out how much, and how often, to push is yet another challenge.

All these challenges demand a sustained, concentrated effort at healing. Use tools that help you monitor progress and maintain consistency, such as a knee journal and pedometer. And be prepared to experiment, in a smart way. All of this I did -- and I got better, even after a doctor told me I never would.


  1. Great post!

    It seems so simple, but to master it for long periods of time is challenging.

    I think a big challenge is the mental one. It seems like you're almost not doing anything, and that you don't "really" have a serious issue. It's hard to explain to people that what you're doing is hard and has very little room for mistakes even though it looks like a regular day at the park to others...

    Others say "is that all you're doing?" as if only going to "serious" treatments is the way to really do something for your knees.

    I try to just think for myself and do what seems to be working for me.

  2. HI Richard,
    I've read all your posts and you've given me hope that I might come back one day from a 2 year battle w/ chronic knee pain.

    I've read your thoughts about glucosamine, but what is your opinion on the other supplements Doug Kelsey recommends?

    What are your thoughts on omega three's and SAM-e?


    1. Good question. I'll probably write more in depth on this later.

      I'm not a big believer in supplements. I didn't try SAM-e, so I can't speak personally on that one. I take flaxseed oil, but not for my knees. The only particular supplement I have a strong opinion about is glucosamine, because I did a lot of research on it: basically, it's most likely worthless (or its value derives from the placebo effect).

      My feeling is that, by far, the most important thing to get right is the physics part of the equation: determining the right amount of movement and load (assuming your diet is okay and you're not deficient in anything important) for your ailing joints.

      Of course I could be wrong. :)

  3. Hi Richard,
    I know you credit a lot of your success to walking, and in your book you started off with padding around barefoot in your apartment.

    Have you done research into "proper walking technique"? I spend some time today poking around YouTube about "correct walking stride" and gait training and knee pain.

    My take-aways so far are:
    -- the way someone walks can affect their knee and contribute to knee pain
    -- the way people walk in shoes is often different than the way they walk barefoot.
    -- where the foot A) hits the ground and b) rolls and c) pushes off are things to consider
    -- the length of stride is something to pay attention to
    -- how the hips move while you walk is something to consider
    -- the position of the upper body and the head while walking is something to look at

    I'm goin to be paying attention to how i walk this week and see if I can apply any of these techniques.

    But my question for you is: have you done research about the connection between how a person walks and knee pain?

    1. I haven't really looked into this, no. I'm a bit skeptical that it's that important for most people.

      One thing I discovered when I began looking into knee pain was that the physical therapy part of the medical community had interpreted its causes in the most complex ways possible (namely, the structuralist paradigms). It seems like physical therapists spend an inordinate amount of time poking and prodding various muscles groups, looking for imbalances that often don't exist, or aren't that significant if they do.

      I remember a late revelation for me was this study (that I mention here: that basically said that mistracking kneecaps don't have much correlation with knee pain. And, honestly, our physical geometries are all a little different, all a bit irregular.

      Similarly, I think there are people who walk a bit oddly who have no knee pain, and others whose gait is perfectly fine (as mine pretty much was) who have knee pain.

      Of course, again, I could be wrong. :)

  4. Ok. Just curious. As you know, we knee pain sufferers will look into anything if it might help! :)

    And, yes, that was a great post about Structuralism.

  5. Hi, I just finished your book and I beg you to post a photograph of the setup you have at home or in your garage for doing partial-weight (assisted) squats, where you used a 2x4, mountain climbing harness, etc. Can you itemize the parts in the setup? Describe the exercises in detail. that was the only weak part of the whole book, you covered that way too fast (at least in the Kindle version).

    By the way, I have extensive research on non-surgical treatment of knee problems at my google profile, focusing on Prolotherapy, Regeneration Injection Therapy, using either Standard injection fluids that go back to 1955, or Platelet Rich Plasma (PRP) or Adult (your own) stem cells. My issue is a complex torn knee meniscus. I was about 90% pre-injury healed and was able to do a 27 day mountain hike on the John Muir Trail this summer but on the last day, I should have taken two days to descend from Mt. Whitney, and instead I think I suffered a knee bone bruise having been too hard on my knees (16 miles, 25 pound pack, 6,000 feet descent (over those last 11 miles)). I'm continuing with PRP Prolotherapy treatments and want to add to it your exercise approach (plus some I'm already doing). Thanks for such a wonderful book and optimistic outlook on taking control of your knees.

    1. Hi, Roleigh -- you asked about the two unloaded exercises I did. One was an adaptation of a Doug Kelsey exercise that he details much better than I, if you go here:

      I just did a poor man's version, using a tire tube and ordinary belt and a nail that I pounded into the top of a bookcase (which is what I wrapped the end of the tire tube around). But if you follow his directions, you can probably come up with something more elegant.

      On the unloaded squats, I don't have photos on hand and the mountain climbing harness is in deep storage at the moment, but I may try to photo-illustrate it later (one problem is that I no longer live in Mom's apartment; she had the garage that I used). It's actually fairly simple, assuming you have a sturdy overhead beam you can toss bungee cords over. The bungee cords need to be fairly thick (I got heavy-duty ones from a marine supply store). You just put on the mountain climbing harness, hook a bungee cord end to a free loop (see this image, showing loops:, toss the other end over the beam, and grab it out of the air and attach it to that same loop (as I recall). You'll probably need 2 or 3 bungee cords on your left and right sides. As for the foam: once you do your first squat, I think the pinching sensations will show you where to put that. ;)

    2. You can get used total gyms on ebay for very little! I think I paid something like $200 for mine! It works great!

  6. Hi Richard,

    just stumbled across your blog and wow! Some great great stuff here, I'm really glad to have found it.

    Thank you for posting all this info. I especially like the advice about strenghtening cartilage first and then proceeding to regain muscles.

    Thanks and keep up the good work. Book order coming.