Sunday, October 28, 2012

Beating Knee Pain: Do You Have a Plan?

A while ago, while working out at the gym, I heard a canned announcement over the PA system designed to sell the services of the on-site trainers.

“Do you have a plan to get fit?” a pleasant voice asked.

At the time, it struck me as deeply ironic.

We accept the need for a plan to build muscle strength and improve cardiovascular fitness. But that’s child’s play compared with managing knee pain, with an eye toward actually getting better. If the former requires a half-page plan, the latter demands something like three pages of detailed notes.

Yet how many knee pain sufferers are there who just muddle along, day to day, and never try to plot a path toward healing?

Broadly, what should go into a plan for beating knee pain?

I think it helps to start with a realistic appraisal of your condition. And be willing to be humbled. You may want to start out walking three miles a day; your knees may quickly tell you that they can only do half that much comfortably.  

Also, of course, you have to decide what your regimen will consist of, day to day, in terms of walking/cycling/swimming/other joint-friendly activities, and how much of each.

Not too hard so far -- rather like designing a workout program in fact. Here’s where it gets tough. You need to be able to adjust on the fly, and play medical detective.

Example: You wake up one morning during week five and your bad knee is really stiff. Oh no! What do you do? You have to be able to ease off for a few days -- or even a few weeks, if needed. Also you need to try to figure out what may have caused the stiffness, so you can avoid doing that again.

So you want to keep some kind of knee journal, to make sure your plan is working and help guide you in revising your plan as your knee gets stronger (yay!) -- and also help you figure out what went wrong when your knee gets worse (ugh!).

To beat knee pain, I’m convinced you need a thorough, though flexible, plan. It may sound challenging. But the rewards are great if you succeed!


  1. By the way, do we know what causes our PFPS and Chondromalacia in the first place so we can avoid a relapse? I had debilitating knee pain in the 90's but from around 2000-2006 I managed to heal and I could hike 10 miles and bike up long steep inclines i the hills and mountains and dance dance dance....but then I had a terrible flare up in 2006 and it took me 6 yearrs until i finally was able to make significant healing progress starrting March 2012. (And although I'm have a setback right now, I do think I'm still way better off than last year, for example.)

    So. What causes PFPS & chrondromalcia in some people but not others? And, once we reach a certain level of knee health, is there something dependable we can do to avoid a relapse like my 2006 debacle?

    Also, what's the relationship between PFPS and patella tendinitis?

    Thanks for any insights.

    1. Interesting -- I may do a blog post soon on "What causes PFPS and chondromalacia?" Good questions that have no short answers!

    2. Great! I look forward to hearing your thoughts! After going through it in the 90's and then healing.... And then having a giant relapse in 2006 and which I'm still working on recovering from...... I am very curious!

  2. Hey Richard. Thanks for the inspiring post.

    I have a plan i want to do. I feel it can work. But it seems like the "outside world" is pushing me to do more than what I know is good for my knee, and as a result I push myself to do too much. For now I can still try to navigate around it but I feel like it is closing in on me, to a point where I feel I might carry this thing for years or for good in a downward spiral. Sorry for the negative talk, but I feel like only people in here understand what I'm going through and how hard it can get. Do you have any tips on how to deal with the feeling that the world is "walking on" while you are counting steps?

    1. I will do what I can to get my knee better - no matter what is going around me, for as long as it takes. There's simply no other way.
      I might have reached a low point, but I have already had big improvements before and setbacks(though smaller than this one). With patience I believe I can climb my way out of it, or at least give it my best. this time I will have a clear written plan so my chances should be bigger.

      Does anyone know about the treatment Kobe Bryant did, Regenokine?


    2. If it helps, Anonymous, know that you're not alone. I ended up quitting my job to try to save my knees. I'm sure everyone thought I was crazy (including my fiance -- now wife -- even though she never said as much). A doctor, the best of the four I'd seen, said my knees would never get better.

      They did heal. But it required a lot of patience and discipline and determination. Luckily I WAS crazy -- crazy enough to believe in myself, and the path to healing I was pretty sure I had found, even when no one else did. :)

    3. Hi Anonymous,

      When I was cautiously experimenting with water therapy on my own in the public pool, I wore a neoprene knee bracesleeve as a gentle support device. A woman at the pool swam overr to me and told me that she didn't think I should be wearing the knee brace. She thought it would be better for my knee if I didn't wear the knee brace.

      I was floored that this total strangerr would be giving me medical advice! She has NO idea of what's wrong with my knee, nor my 5.5 year history of debilitating knee pain, nor my terror that this water therapy attempt might give me a setback.

      Not wanting to make waves (pun intended), I just smiled and said that I was keeping the brace on. Period. And then I just went about my own business.

      My point is to give an extreme example of someone who is well-meaning and yet meddling and giving advice where they are ccompletely off base.

      Maybe if the people pressuring you are family it can be more tough. But, if you show them your carefully devised plan, maybe they will realize that you are working on it deliberately. Also, if you track your pain n progress, you can show them.... Yes, I know you think I should do squats, but, look here.... 2 weeks ago when I did squats It resulted in pain level 7 and i was unable to walk without pain for 8 days and in fact I'm still recovering from that. So. Slow and steady wins the race in this case. But if you insist that I need to do Exercise X and then that causes me to have another setback..... Then I expct you to take on the responsibility to help me in my recovery including driving me to work everyday, do my laundry, and go grocery shopping for me until I recover to walk without pain.

      My point is..... It is easy for someone else to throw around advice when they do not have to deal with the consequences!!

      For me At this point, sadly, all my friends and family know how easily I can have a flare up and are terrified on my behalf when I want to try something where I'm pushing myself a little. "no no!!! Don't n do it!! We don't want to see you revert back to using a cane orr having stabbing pains when just crossing th room." so..... That becomes yet another cchallenge when I think I'm ready to try something and everyone around me is scared on my behalf and it makes me scared and doubt myself. But.... At the same time I have to try! Otherwise I'll never make any progress!

  3. Hi Knee Pain. When you just started healing your knees did you have pain when walking? It seems that I can't walk more than 50 steps at time without going into more pain, and in the evening it's even worse.