Saturday, February 23, 2013

Try To Be Optimistic Because How You Feel Affects What You Feel

Here’s a knee pain finding with a message well-worth heeding.

A South Korean study of 660 men and women, all older than 65, found that being depressed can make symptoms of knee osteoarthritis feel worse.

Researchers used X-rays to measure how severe each subject’s osteoarthritis was. Naturally, those with the most damage reported the most pain. However, some of the subjects with mild to moderate arthritis also reported severe pain.

Now, setting aside limitations of X-ray measurements (and there are many, for conditions that involve soft tissues), what can we learn here?

An Arthritis Today article about this study quotes Jon T. Giles, an assistant professor of medicine at Columbia University:
“Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors.”
Now here are a few of my thoughts.

And if you have knee pain, you’ll be relieved to know that none equates to “Don’t worry, be happy.”

Because chronic knee pain stinks.

Of course there’s a good chance you’re depressed. If you’re anything like I was, you’re depressed because you have discomfort and pain most of the time. You’re depressed because merely climbing a set of stairs or carrying your toddler across the room causes a flare-up in your joints. You’re depressed because you know that almost everything you want to do in your life will involve your knees, and you’re doubtful that they’ll ever be normal again.

In short, you have a lot of very good reasons for feeling depressed.


Negativity levies a real tax on your body. That’s an inescapable truth. So even though you may be perfectly justified in your anger/bitterness/sadness, you have to realize you’re paying a price for it.

What to do? Here are a couple of ideas.

First, consider a de-stressing activity, such as meditation. I did it for a while, during my knee pain recovery (this was a period, by the way, when it wasn’t just my knees giving me problems). I found it useful.

Second, get into a long-term program that has one objective: healing your knees. This will restore something that is essential to getting better: hope.

This brings me to a closing rant.

In the Arthritis Today article, reactions to the study above included this suggestion: that care providers such as doctors screen patients for conditions such as depression and refer them for treatment (drugs, etc.) when needed.

I can imagine, upon hearing this, a gathering of doctors murmuring in approving tones, “Yes, yes, that sounds like an excellent idea.”


Here’s what irks me about that seemingly sensible suggestion. One major reason that knee pain patients suffer depression is because no one shows them a path to escaping knee pain. In this regard, doctors are the worst, from my experience.

In many cases, I suspect (again drawing from my experience), patients bounce around among doctors who just kind of shrug and say “You have knee pain, but I wouldn’t advise surgery just yet.” Further, patients are diagnosed with unhelpful, baffling terms such as “patellofemoral pain syndrome” that don’t tell them, in clear, specific terms, what’s wrong with their knees.

And then they’re found to be depressed. Well, no kidding.

Before doctors go about blithely prescribing pills for depression related to knee pain, they might want to ask themselves if they’ve done everything possible for their patients in terms of finding a good, long-term plan for eventually escaping that pain.


  1. Ran into your website a few weeks ago. I'm a 26 year old female and I was diagnosed with this unfortunate disease when I was 19. I was pretty fit at the time, but after my knees I became very inactive. The Ortho I went to at the time wasn't very happy at all. He just prescribed some physical therapy and when that didn't work he said there was nothing I could do. Honestly he didn't even suggest taping or anything else! I was really young at the time and my parents weren't supportive so I just reluctantly accepted this condition. 7 years later, I am really really tired of being inactive and am finally trying to find ways to help myself. I'm planning to use some taping and go to an ortho again to assess my condition. My condition hasn't been assessed since I was first diagnosed. Your website helped me to find some courage to try and look for something that works for me. Thanks.

    1. The original anonymous here from the last thread - I'll sign my posts as 'Tri Again' from now on, because getting back to triathlon one day is my vain hope.

      To the 26yo anonymous above - have you thought about swimming? That's all I can do at present, along with very moderate paced walking & upper body gym weights (no leg weights). I swim (freestyle) with a pull buoy between my legs & my ankles strapped together with a loop of old bicycle tube. This stops me kicking (it aggravates my knees).

      It is a far cry from what I was doing in Feb 2012 when I did my last long-course race (2km swim, 80km cycle, 20km run), but it (sort of) keeps me active and sane, and I'm wary about not putting on too much weight which will put more pressure on my knees (so far I've only gained 1-2kg from race weight).

      Frankly I really miss cycling & running (swimming pool laps is pretty boring), but it helps mentally when you finish a session and feel a little exerted. I do 3 sessions a week of 35-75 mins, and mix it up (some involve fast short intervals, some longer slower intervals with rests between).

      On an issue in the last 'Structuralist' thread, one of the exercises my Sports Dr wanted me to do to strengthen hips/glutes was one-leg bouncing on a mini-tramp. I'd just had 2 pretty good days with my knees, spend 30 secs bouncing on each leg and whammo - burning knees again.

      PFS really is a hit and miss affair with the medical professions! I'm starting to back my own judgement more and more.

      cheers, Tri Again

    2. The first Anonymous: glad you're finding the courage to try again. Don't give up! This problem can be beaten. "Tri Again" has some good suggestions on swimming. Water activities are usually a winner for people with knee pain; the tricky thing can be finding a pool that's conveniently nearby and affordable.

  2. @Tri Again

    I guess I'll sign as "HP." Yea I am starting to get into swimming. I know how to swim only a little so I got some personal training at my gym for 2 sessions to help my technique. He said that when you swim doing freestyle, you are supposed to keep your legs stiff and use your thighs/glutes to kick and not bend your legs and kick. If you do it that way, it might provide some relief and give you some leg work out at the same time. And I know what you mean about no leg weights. But I think it's safe for us to use the weight machines where you just work out your inner and outer thighs. Long ago I used to be a decent runner but now I'd be totally happy if I could use the ellipticals without too much discomfort. I'm wondering if the tape could really help with that..And PFS seems to be mostly a miss with the medical professions. Ugh!


    1. @HP

      Yes, you are supposed to kick from your hips, but I always find I get a little knee action too, which causes problems.

      I hadn't thought about the inner/outer thigh machine - must try that.

      I tried taping, made mine worse! Might help you though.

      What exactly is your diagnosis? Mine started with a medial meniscus tear in the L knee (the torn bit was cut out), which rapidly progressed to pain in both knees from degeneration of cartilage on the back of both kneecaps (called patella chondromalacea) - they think! I already knew I had a chondro in the R knee, but for some unknown reason, it really started to cause probs in both knees after surgery on just the L knee (go figure!).

      PFS seems to have many causes, so yours may be different to mine.

      cheers, Tri Again

  3. @Tri Again
    Well for me what happened was that I was running a lot and lifting a lot of weights which included front and back squats. When I did these squats I would squat very deep. After doing my weight lifting, I would go on the treadmill. Extreme impact on my knees I know, but I figured so many people lift weights and run so knee problems didn't even cross my mind. The first time I felt a sharp pain on my left knee, but I kind of ignored it and it went away. The next week it happened again and it wouldn't go away. They couldn't really provide a detailed diagnosis for me because my x-rays and mri looked just fine at the time. After 7 years, I wonder how they look now?? It's time to find out. And some how, the pain transferred over to the right side as well. I honestly wish I did more about it 7 years ago but I had never heard of this condition and I was just flabbergasted...Did you ever try reading the OPs book and his techniques? I haven't yet, but I'm planning to look into it next month. When did you develop PFS?


  4. @HP

    I have bought Richards book but am only 3 weeks into following his advice. I think I've had some better days since, but also some bad days when I do something which stirs things up. I'm also thinking of getting Doug Kelseys book 'Runner Bible'.

    Your situation sounds a bit like mine in that I ended up with PFS in both knees! I'm 49 now & have had some chondromalacia symptoms esp in my R knee for at least a decade, but it never stopped me for more than a few days. An MRI in 2008 showed I had it in my R knee and an MRI in 2012 showed it had worsened to 'high grade'.

    When the OS did my L meniscus in 2012, he said everything else in there looked good, but within a month, I had PFS badly in both knees ????

    BTW I could never do squats as they have always hurt my knees. I suspect what did my damage was hard cycling (not running), just like Richard. I used to do very hard interval sessions on a windtrainer. They really improved my cycling....until my knees imploded!

    Tri Again

  5. Had knee pain due to bad shoes and running style. Fortunately the knees healed after 6 months of rest, new shoes and easing back into running slowly.