Saturday, April 6, 2013

Why Is My Story Relevant If Your Knee Pain Differs From Mine?

Sometimes I get a reaction like this to my book:

Interesting story, but it doesn’t really apply to me. The author hurt his knees cycling, while my knee pain is due to nothing related to sports/no identifiable cause/insert something else here. Also, the author struggled with knee pain for about a year, while I’ve had problems for 2 years/5 years/insert some other length of time here. And the author’s symptoms were burning sensations around the kneecaps and difficulty sitting while mine are problems walking/swelling/insert some other symptoms here.

First, don’t misconstrue what I’m about to say as a marketing pitch (Step right up and buy this book! A panacea for all your knee woes, of any kind, of any severity!) Clearly my story isn’t relevant for certain types of knee problems (e.g., a torn ligament). It’s also not useful for a certain kind of person who mainly wants details on specific exercises to do or who seeks an “other” directed solution to his problems.

But for those suffering from that mysterious condition called patellofemoral pain syndrome, or who have been told they have chondromalacia, or who have chronic knee achiness, diffuse burning, pain of unclear origin -- and for those who believe they themselves must be very involved in fixing their problems -- I think it can be of great benefit. Here’s why:

(1) “All happy knees are alike; all unhappy knees are unhappy in their own way” isn’t quite true. (Apologies to Tolstoy.) Which is to say, I think there are a lot of similarities among knees afflicted with patellofemoral pain syndrome, chondromalacia or osteoarthritis.

For example, many problems will relate to damaged cartilage, and they’ll be frustrating to deal with, because cartilage has no nerve endings. This was a major frustration that I faced certainly.

The upshot: What unites us may be more significant than what separates us.

(2) Some good practices are just universal, regardless of your particular symptom set -- for example, the importance of movement or weight loss (or weight control at least, if you’re thin already).

It’s hard for me to imagine a chronic knee pain patient for whom these good practices aren’t relevant. In the book (and on this blog), I’ve supplied more context -- from medical studies, from my own experience, from examples drawing on common sense -- for why they matter so much.

(3) You need the right kind of optimism to succeed, if you’re going to triumph over knee pain.

More specifically, you need optimism grounded in reality. It’s not the optimism of the terminal cancer patient who, with a 1 in a million chance of a cure, stubbornly vows, “I’m going to get better.” It’s the optimism of a reasonable, intelligent person who thinks he or she can get better because there’s plenty of evidence supporting that belief.

The book is largely about providing the proper context for such optimism. You can get better because I did is part of the message. But you can get better because defects in bad knees can heal -- that’s a bigger, universal message worth shouting from the rooftops. And scientific evidence for that assertion is in the the book (and on this blog).

I believe my story does have a wider relevance than here’s-one-thing-that-worked-for-one-guy. My hope is that others will have their own success stories, following similar principles, and together we can force doctors and physical therapists to rethink how they treat chronic knee pain.


  1. Hi Richard
    I am one of your graduates and you are spot on with the knees. It is sad that it will take years for the so called experts and people struggling with knee pain to accept that happy knees are those in motion. It may be easier to convince people you played cards with bigfoot:) My runners knee came back again after sitting long periods at work and running the same day. It was bad combo and what caused it in the first place for me. I am almost 100 percent again. I have been very careful not to jump to conclusions and a great opportunity to know what healed the knee the first time around. Number 1 walking for a minimum of 2 miles a day. Number 2 when ready do a walk and run on forefoot for 2 miles. I would and am still run slowly on my forefoot for about 300 feet and then walk 600 and repeat. When running on the balls of your feet the knee cap surrounding muscles are fully engaged pumping blood and stimulating the whole area. Walking with running is and was synergy for healing my knee. Afterward and the next day a remarkable healing feeling in my knees would and still happens. Number 3 when ready the SAME DAY as the walk/run do knee bends, lunges low weight high reps. Again there is for me a synergy in my knees going on again if done the same day. My body weight is all I used. Chairs can be used in the early stages to lesson the weight. I can sit a work for long periods now without a problem but I need to continue the walk/run daily for that to happen. Try the walk/run Richard and let me know what you feel. It put me on the fast track to recovery. I did not realize it was such a big player in healing process the first time around.
    As a side note once the knee is healed if you don't keep doing what cured the knee it will come back faster than it did the first time. It did for me anyway.

    Cute blog on how a runner cured his runners knee by accident.

    1. I read the blog that Ron W suggested and it turns out the author's answer is to take smaller steps. I don't know quite what to think of that as his entire solution, but, anyway, it did get me thinking about shorter stride vs. longer stride. As my knee improves I do tend to take longer strides and then I've noticed that tends to put more stress on my knee joint as well as increases the chance that I will hyperextend my knee which always leads to bad things. So. I will keep it in mind to try to not take large strides. On the other hand, he is talking about running which is totally out of the question for me. I'm just talking about walking.

    2. Smaller steps and not getting your leg out in front of you. Landing below your center of gravity. Bare foot running forces you to do this. You can do it in shoes, just land on the balls of your feet. The natural way our ancestors did you would think would be the best. That's what our bodies have learned to adjust and heal to. It forces you to run on the balls of your feet which in turn engages the knee muscles which I would think help the patella track better too. I have no doubt it healed my knee. For most people who don't want to run or use there knees heavily walking may be enough therapy for them.

    3. Hi Ron,

      Do you think that taking a shorter stride while walking would also have less impact on knee joint? Or is the concept only for running?

    4. By the way, someone told me today about "Chi Walking" which can be used for rehab. Most people apparently do "chi running" which on the website sounds like a forefoot type if running for lower impact.

      Anyway, I'll read the website in chi walking and watch the YouTube videos on it to learn more about it. I'm always curious about anything that might have a positive effect... Especially if it is a free or low coat thing to try.

      Maybe in my case I can learn to walk with lower impact to my knee joint so that it help my knee joint heal.

    5. Hi KP
      I can only tell you my opinion based on my experience. I am just another person like Richard who has had to figure the knee out. Richard is the master and most educated in this field by far. Without him I don't think I would have cured my knee.
      Me I strongly believe the body has evolved to repair its self through natural means.(so reverse engineer it) Walking is what man has done the most of so it would stand to reason the more you walk the more repair/rebuild is going on and vise versa. How that happens exactly we can only theorize. Our ancestors walked bare foot or little padding on our feet. That way I would think is the best which tends to use the balls of your feet more and heels less. Walking in ordinary tennis shoes worked for me although so did using my barefoot shoes. Running with padded tennis shoes is fairly new as of the late sixties I believe. A lot of bare foot people out there blame a lot of foot problems on padded shoes. The first time I cured my knee I would run a little during my walks not because I thought it helped, I just wanted to run again. What I found was I could run on the balls of my feet OK but when I would heel strike the knee problems came back. Running up hills works real good for landing on the balls of your feet. So I stumbled across what really cured me fast by mistake. The run/walk can be any ratio that you can handle. If your knees are weak walking may be your only choice for now. For me I need to do about 45min to a hour of walking to feel it helped. The more the better as long as there is no or little pain. Some of my running is just shuffling on the balls of my feet slowly never extending my legs and keeping the knee area bent and knee area flexed so there is very little impact. I don't no about chi running. What you need to understand is that only you can tell weather something is working or not working by the feeling created in your knees. When you know what that feeling is you follow that as a guide post.

    6. I've learned more about chi running and it sounds exactly like the technique you are talking about.

      I bought a used copy of "chi walking" to see if maybe I can adjust my stride or posture for even more effective knee rehab.

      I'm open to trying new things as long as it doesn't hurt. As you mentioned, it's important to self monitor and cease or modify activities which aggregate the knee joint. I'm pretty good at self monitoring at this point -- my main problem is I get excited when I start to get better and then I over-do-it and have a flare up.

    7. Ron, thanks for pointing out that (rather humorous) essay on how one man cured his runner's knee. It inspired me to begin work on a couple of related blog posts (coming, sometime in the near future).

      In brief, I'm somewhat skeptical that "forefoot striking" is necessarily the proper way to run (though I understand it's helped you a lot). But I very much like this idea of "smaller steps" -- both literally and figuratively.

    8. Richard
      The article about running through the tree roots using smaller steps meant to me that he was landing on the balls of his feet and that’s the reason for his healing not the smaller steps. When you land on the balls of your feet the surrounding knee muscle tighten. Which I would think helps the patella track and improves circulation in that area. Did you try the walk/run for 2 miles? And if so did you feel the after effects?
      Man has been running/walking with little to no cushioning on his feet for 1,000’s if not millions of years. Which automatically means a forefoot strike for him. The cushioned tennis shoes came out in the late sixties, early seventies which can allow a flat foot or heal strike. To wonder if the forefoot strike is better or not seems like a no brainer to me.

      Just trying to share and help you and the people out there with what I have learned through the healing my knee twice.

      Looking forward to your next blog.


    9. I can't run, but I did look watch this YouTube video which talks about how to walk so that you are not putting as much pressure on your knee, hips, and lower back. He first demos walking incorrectly and shows how people who walk that way tend to take strides with their leg out in front of their body and how they lock their knee or put a lot of force into their knee joint. Then he slightly modifies his posture and stride to keep his knee more bent and more under his body. Also his stride is smaller.

      To see this video google "Chi Walking 100 Days Lesson 3".

      Given that it is lesson 3, you can guess that yes there are several more in the series. But I think the lesson 3 was the most poignant about putting less stress on the knees just from walking.

      I'm definitely going to pay more attention to how I walk and see if my usual walk is putting extra strain in my knee joint and if I can modify my posture & technique to reduce strain on my knee joint.

  2. Anyway, Richard's original blog post for this week about how the book applies to people with different kinds of knee pain was interesting because that is exactly my situation. I do have the same dreaded PFPS / Chondromalcia diagnosis, but, the type of pain is very different. And yet, I do think that the things in his book still relate to me.

    Richard describes his as a severe ache or burning feeling -- even when he was just sitting and not moving. So bad that he could not even sit in a chair and had to quit his job! That is pretty awful.

    I don't have those symptoms.

    My knee pain is just in one knee and is the form of a stabbing pain. The pain ranges from being just a warning twinge to being a sharp stabbing pain -- as if a knife has been plunged into my knee. I know "a knife" is a boring and overused analogy, but, I really can't think of anything that seems more accurate. A nail gun, maybe?

    Whereas Richard's knees hurt and ached and burned even when just sitting and not moving, my knee ONLY hurts when I move. So, when I'm sitting still (or even standing still) I have no pain -- which makes my knee condition quite computer-friendly.

    But, despite the type of pain being very very different, my experience is similar in terms of what helps and what makes it worse.

    my experience has been that movement is very important. So... for me when the pain is ultra acute like the chef's knife level of stabbing, then, ok I do need to let it rest and calm down. But, then the tendency might be to just want to rest rest rest until it gets all better, right? But, NO! After it has calmed down a bit I need to get it moving. Resting further just makes it worse. Also, if it gets a little worse, that is OK. but, at some points when it gets a little too worse, then, I need to back off and let it calm down.

    Also, the issue about the quad exericses is very interesting. I totally agree that doing certain exercises to strengthen the quads just ended up flaring up my knee and making it worse. So, I have to be more patient and only doing exercises that do not aggrevate the joint. Then, over time, slowly I can add in quad exercises that involve the knee joint.

    I don't know if it is a coincidence or not, but, last year when I had so much success with my knee recovery... it was also after I lost 30 pounds. So, I went from being on the very high end of the range for "normal" way way way down to the low end of the range for "normal."

    This issue drove me crazy! I could do something and not have any pain while I was doing it ... but, then 24-48 hours later my knee would hurt or maybe even be absolutely killing me. And, I really suspected it was from the activity I did 1-2 days previously, but, I could not understand why the pain took so long to manifest. For example... the bus is just pulling up to the busstop and I'm 1/2 block away, so I would trot up to make sure I woudl catch the bus. No pain at all. But, then, 24-48 hours later I'm stuck with screamingly bad stabs in my knee. Richard's book explains that it's because the cartiledge does not have nerve endings, so, I don't get the pain signals until later. This is very helpful to at least understand what is going on.

    It is encouraging to have found this blog and hear about other people'struggles and celerations and read Richard's continuing research on hip exercises, Vitamin D, Synvisc shots, glucosamine, and all these things. Also, to feel like I am NOT crazy for rejecting certain exercises which I am certain aggravate my knee (such as squats!) and to focus on doing exercises that get my leg and knee moving but without aggrevating the knee joint. Also, that I need to be even more patient than I have been in the past, which already felt like a Heculean level of patience and yet was not enough.

  3. Hi there:

    I stumbled on your website (as I suppose most do) after much reading and researching about knee pain. My came from overuse of a stationary bike at the gym, basically "mashing" on the pedals as I sought to go faster and faster. I did tons of research, tried different exercises, kept a pain journal. Symptoms have slowly retreated after a couple of months. But perhaps the most interesting bit that resonates with this blog--I had a trip planned to Egypt which I was very concerned about. How would I spend hours on my feet, especially a day long walking tour I had scheduled? But contrary to expectations my time there was perhaps some of the least painful in weeks. I would say that doing a lot of self-massage with a tennis ball around my knees helped as well, but I just kept thinking about this blog and the idea that movement--not the crazy PT stuff suggested--can be the key to getting back in order. So thank you for the insight!

    1. That's interesting, Anonymous. Thanks for sharing the story!

    2. hi richard,
      i am ashish male 26 years from india and suffering from the same problem.I have recently read your book.And i am very much impressed."Movement is the key which doesnt hurt".I have one doubt in my mind as i do desk job with hours of sitting .Can you suggest some ways or may be a post through which people doing desk job can benefit.Thanks in advance :-)

  4. Good question, Ashish. Desk jobs are bad for knees (actually they're bad for backs, necks, and other things too). Here are a few thoughts: (1) For lunch break, I eat a quick meal, then spend most of the time outside walking. I can cover the better part of a mile. (2) During shorter breaks (coffee breaks essentially), I eat snacks while strolling around. (3) Every hour, or couple of hours, it's good to get up and walk about -- I try to do that. (4) If you want to do some easy exercise at your desk, go to Amazon and search for "under desk bicycle." I personally haven't used one of these (maybe someone who has can chime in), but they give you an opportunity to spin right there while doing work and they're not too expensive.

  5. @Richard ThankYou very much for your help. Your doing a very noble deed.Keep up the good work.:) :)

  6. I read your book in November 2012 after a year of not really being able to run due to knee pain. It inspired me to take responsibility for my knees, and not trust or rely on the medical profession for a solution. After lots of research and failure, I've finally figured out my problem was that my glutes weren't firing, which led to very strong quads, with lazy glutes and hamstrings, which pulled my knees out of alignment, causing the pain. This is a frequent problem in people who dramatically increase their running or biking over a period of time, instead of gradually increasing. You'll find the blog of a woman who did the right things to fix her "broken butt" here:

    and note that Running Times recently recognized it as a serious problem as well:

    So, thanks for the inspiration.