Friday, May 3, 2013

How I Saved My Knees (in Dialogue Format)

From time to time, I like to talk to the impatient first-time visitor to this blog, who’s thinking, “Okay, you saved your knees. Great. So just cut to the chase and tell me: What did you do?”

Below, I’m going to make another attempt to answer that, using a different approach: a make-believe dialogue between me and a slightly grumpy reader who has just read my book.

Because, unfortunately, a number of people have finished it without being able to figure out how I got better. I’ll take the blame for my unclear writing (but, believe me, I wasn’t trying to be mysterious).

Okay, here’s the imaginary exchange:

Reader: Okay, your frustrations with doctors and physical therapists in the book were interesting. But I reached the end and felt kind of cheated. Exactly how did you beat your knee pain? There aren’t a lot of details on what you did.

Me: Sorry! I thought I made clear what I did. But maybe not. Part of the problem, it wasn’t too exciting.

Reader: So what did you do?

Me: Basically, I walked a lot.

Reader: That’s it? Jeez, that’s a letdown. So I just need to go out and walk a lot and my knees will get better?

Me: Nope. Part of my message is that what worked for me may not work for you. But it is important to find a high-repetition, joint-friendly activity that your knees like. For me that was walking.

Reader: I don’t mean to be captious, but you could’ve written a much shorter book saying that.

Me: True, but the message isn’t simply to walk a lot. As I recount in the book, at first I tried walking a lot when I was allowed to work half-time in Hong Kong. And it didn’t help. My knees got worse!

Reader: Because you walked too much.

Me: Right. So there’s a delicate balance. That’s part of what makes healing so tricky. Especially if your knees are really bad, because the balance is even more delicate, and you can’t even do the ordinary things (like walking up a couple of flights of stairs) that most of us take for granted, without suffering pain and setbacks.

Reader: But again, your secret to how you saved your knees is by walking a lot.

Me: Well, yes and no. If that was my entire experience -- I had bad knees, I decided I would walk a lot, and my knees got better -- I never would have bothered writing a book. I also spent a lot of time studying how knees worked and why the traditional methods to treat knee pain failed me (and probably fail many others). That’s an important part of the story.

Reader: Okay, but I’m interested in solutions for my bad knees. And you’re saying that if my knees like walking, I can go out and walk a lot and my knees will improve.

Me: Again, not quite. You have to walk the right amount -- not too much, not too little. And, periodically, you have to increase that amount of activity -- you have to push your knees harder -- and gradually strengthen them so the joints can tolerate more.

Reader: And that’s it?

Me: Actually, at some point, you’ll be able to graduate to “sweating” activity -- such as walking uphill, hard. This will be a great advance and will hasten the healing of the soft tissues in your joints -- at least that was my experience.

Reader: But again, that’s all you did -- walking?

Me: There were other exercises, more typical of “muscle strengthening”. But honestly, they constituted a small part of my program, and I don’t think they did much for my knees, so I didn’t spend time in the book on them.

Reader: Were there other things that you think were important?

Me: I also consumed high-protein drinks, to make sure that my injured tissues had the basic ingredients they needed to mend. I made sure I got enough sleep. And I learned to listen to my knees, on a really deep level.

Reader: Okay then. So what should I do?

Me: I don’t like giving advice. But I’d look for a good physical therapist who believes the right things about healing bad joints (that they indeed can heal, and that patients should be doing exercises that are more joint focused, as opposed to muscle focused). Then, from that, I think good things will follow. Good luck!


  1. well as per my underdtanding short intermittent walk is working very well for me and i thank you for that

  2. I read your book and understood it, but that is a good summary and a good reminder for me.

    What screws my recovery up is all the day to day things I have to do - like now we are moving house, so lots of moving about packing.

    Add to that my impatience (e.g. I did 2 short bike rides and the knees felt good, so went on to do 4 rides in 8 days = big mistake). Or I can walk 30mins on fairly flat ground OK, but then I want to make it more aerobic so throw in a walk with 10mins uphill = mistake.

    But after we get moved, I should have the opportunity to really take it a bit easier for a few months which will be good.

    Strangely, the best type of movement for me was 2-3 hours of fly-fishing in New Zealand, just gently wandering along, often in knee-deep (cold!) water, casting.....or it could have just been the positive vibes from being on holidays & catching beautiful big trout in spectacular scenery....and forgetting all about my knees for hours!


    1. That doesn't surprise me that slow wandering through the water would have a beneficial effect. It appears to combine the best of water therapy and gentle movement. Reminds me a bit of my trip to Tibet, and all the slow strolling I did, and how my knees felt pretty good.

  3. I liked this summary. When I read the book the first time, I started off being the grumpy reader saying "just tell me the answer!" But, as I was reading I ended up really appreciating all the details!

    1) it was very validating to read someone else's experience struggling through all the similar ups and downs. I mean, previous to this I felt I was only person who couldn't just "get better" like people generally do.

    2) great to get all the info about why there is a delayed pain response and the studies about why movement is do key as compared to rest.

    I agree with TriAgain that patience is really the hardest thing and finding the Goldilocks Zone. Despite a previous post were I stated how I was going to take it easy and not push it... I went out and did a Big Old' Papa Bear in the form trying to bike outdoors on flat instead of sticking to the stationary bike. I thought I was ready! But, I was not.

    My favorite phrase from these blogs was when Richard wrote something ablut how it is hard to
    Solve this knee problem. The sentence was something like "it's not hard like pushing a boulder up a hill is hard. It's hard because it's staying engaged every day and every moment."

  4. Hi:

    I don't know if you've mentioned this in an earlier post but I found that walking with a pedometer can help gauge how much effort you are putting into your recovery. Some of the more sophisticated ones can include altitude and so can track things like how high you are climing (stairs, hills). For $100 it can be a lot cheaper than multiple visits to the PT clinic, and you have clear data you can track in something like a pain journal--they can transmit data wirelessly to your computer. It's a lot less complicated than it might sound. Thanks for the website and keep up the good work--

    1. Yes, I'm a big fan of pedometers. For one, they help you quantify the loads that you're putting on your joints each day. Good suggestion, and it sounds like the newer models can do a lot of neat things.

  5. I have been reading your blog. I committed to effortless pedaling for a half an hour every day then icing my knee after walking 6 miles outside at work. Well the snow and ice melted. In the morning I began to feel this tremendous aching. I got busy and quit therapy for a couple days then I fell while running to the bus and bruised my hip and limped for a few days. Well I walked slower at work because I was sore and my knee stopped hurting. My guess is that I got everything lined up with my pedaling and then my knee just needed a rest. Thank you for your blog. Its been an education learning the ins and outs

    1. Thanks for dropping by and sharing! It certainly is an education, true.

  6. Richard

    Are your knees entirely pain-free now?

    Can you cycle with the same intensity/volume as before your knees went bung?

    cheers, TriAgain

    1. My knees are fine now. This marks the fourth year that I've been cycling hard (as hard as I did before, which is to say, to the point where I feel like my lungs are going to burst or my legs are going to burn up with fatigue from the effort). I don't necessarily recommend what I did -- which is get back into intense cycling after two years. Probably smarter to ease into it a bit more, but I was excited about being back in a cycling group, and riding hard again.

    2. Something doesn't make sense. How can you be treating your knees the same as you did prior to them being injured, but this time around they remain healed? What changed? Something has to be different or else you're just going to injure them again!

    3. Well, of course there are differences. I may be dense at times, but I'm not that dense. :)

      The big one: I no longer live in mountainous Hong Kong; I live in western Long Island. No more hard cycling up long stretches of mountain road (it's all flat or small hills here). Also I'm not riding really hard on back-to-back days on the weekend (I have a family and don't have that kind of time anymore anyway). And during the workweek, my training consists of easy cycling. But that one day a week (usually Saturday) when I ride hard, I ride as hard as I ever did.

    4. Thx. So the answer to TriAgain's question = "No, I do not cycle with the same volume as I did before".

    5. I'd say Richard is training much smarter now, which is important once you get into your late 40's.

      I used to ride 4-6 days a week (age 44-48), and I'd say none of my sessions were 'easy'. They were moderate (av speed 27-29kmh for 1-5 hrs) or hard (hard 45min intervals on windtrainer or 100km+ time trials @ 30-34kmh solo, so no drafting benefit where I'd nearly collapse afterwards.....and sometimes do do a 20min run off the bike).

      I now realise many of my rides should have been much easier.

      Also, where I live in Australia is reasonably hilly which added to the stress on my knees.


    6. Yes, TriAgain, basically you're right. Anonymous at 11:41 p.m., I ride close to the same number of miles here (volume) as I did in Hong Kong, only most are at a gentler pace.

      What does all this prove? That my knees can't handle the same volume as before? No, it proves that I'm no longer a single man who has all the time in the world to tool about on his bicycle. I could ride 1,000 miles a week if I didn't have a job and a wife and a 3-year-old, and I'm sure my knees would be fine.

      Does this prove my knees can't handle back-to-back days of intense riding? Honestly, I don't know. I am happy with a day of hard riding each week. So why risk getting injured again, even if I had the time, which I don't.

    7. Great to hear how well your doing. That's quite amazing you had this debilitating pain and it healed more or less spontaneously with this high-rep, low-weight exercise.

      Keep inspiring!!!

    8. Hmm. "More or less spontaneously" conveys the sense my knees just happened to heal after I did a bunch of walking. Unfortunately, healing was a long, difficult process (a year and a half or so) that required a lot of attention at many times. I wouldn't call it "spontaneous."

  7. Hi Richard,

    I LOVED your book!!!! I really felt your pain and frustration and cheered for you when your knees got better. I, too, wanted a plan that I could follow, but of course each person needs to develop their own. The hardest part is knowing whether what I'm doing is working or not. Your book and this blog have truly been a lifesaver and I always look forward to your weekly dose of encouragement. I love this summary and it's perfect to show my husband and others.


    1. Thanks! That's a really nice comment. Yes, you're absolutely right that the hardest part is knowing whether what you're doing is working or not. If it makes you feel any better, I wondered that a lot too ... during the time that, as it turned out, I happened to be healing.

  8. This conservative mumbo-jumbo is inapplicable in most cases. If people have major joint damage it's very unlikely physical therapy will fix much. It could smooth out the joint I guess and get unphysical people active. But how it could actually cure cartilage damage is beyond me. Maybe the natural stimulation process would get activated by some of this activity although it seems unlikely this wouldn't happen in daily activities.

    When we walk around we fire all these muscles and are doing low-repetition rep exercises. You could say cleaning one's house or room is equivalent to going to a Pilates class.

    The argument that surgery is obsolete is wrong. It's probably considered maybe more often than it should but often by the time individuals visit a doctor they have exhausted most conservative options.

    I do believe that there are new age methods that will be superior to most options today. But a lot of your results are skewed. It only takes some searching for non knee injury sites to find a general sample of people that underwent knee surgery. Examples include running sites, bodybuilding sites and just general discussion sites. Most people have positive outcomes--the same positive outcomes that are reported in most literature.

    I believe this site has a role for people who have had bad outcomes or trouble persistent knee pain because everyone needs moral support.

    But I would bet against physical therapy and your low-rep exercises as solving their problems.

    I think up-and-coming methods such as HGH injections into the joint (, PRP injections into the joint, Stem cells (, the Bio-Joint by Kevin Stone ( and generalistic cartilage repair procedures (MX, ACI, OATS, SC Paste, OCA) have more hope than physical therapy and low-rep physical exercise.

    I think it has a place in the rehabilitation process but if someone pursues this method for 1 year and has no improvement? Then they would have to consider surgery. Surgery has mostly good outcomes but shouldn't be taken lightly.

    I appreciate and follow your blog. Some of my favorite posts include your coverage of cartilage healing spontaneously (Australian study I believe) and also the possibility that this high-rep exercise could lead to a decrease in knee pain.

    1. Anonymous, I think you're creating a straw man here. I don't know who you think is saying surgery is obsolete; it's no one I know of -- certainly not me. I think there's probably too much surgery -- that's an entirely different thing.

      And major structural joint damage will always be a significant impediment to getting better. I've said that before (I even mention in my book that people with bone spurs had a much lower rate of cartilage defects improving in one study.)

      Of course knee pain sufferers should look at all their options. The purpose of my blog is to point out that a more conservative option -- especially with early-stage knee pain -- may be the best one. It sure was for me.

  9. Hi Richard,

    I have been scrolling through your entire blog for the day and reading all of your posts. I even bought your book! I'm a 20 year old female who led a VERY active life. I underwent a bilateral knee athroscopy to obtain a final diagnosis of my knee problems AND fix any issues that are able to be fixed.

    The surgeon removed a medial plica, a piece of cartilage the size of a pinkie nail that was floating around the knee joint and another piece of cartilage that was flapping around inside the knee joint from my left knee. However, I was diagnosed with softening of the articular cartilage behind my RIGHT kneecap (chondromalacia patella).

    My father (who is a GP) told me it will get better if I do light exercise (e.g. walking to the toilet) at regular intervals throughout the day (e.g. every 30 minutes). I had also undergone physio for several months but this exacerbated the problem. After reading your blog, it has given me new hope in healing the cartilage in my right knee.

    The only thing that I'm unsure of, is how do you know when and how much to increase light activity. I understand there is no magic answer, everyone is different. But did you increase your activity slightly when the pain had remained relatively stable or did you slightly increase your activity when the pain had improved slightly? After you had increased your activity slightly, would there be a few days where you experienced a little more pain than usual and persisted for a few days before determining whether to decrease or maintain the new level of activity.

    Sorry for the load of questions!

    1. Correction** Walking had proven fine when I was just doing that. My knee even felt better at times! It was when I began physio therapy my knee became worse