This will be a two-parter because there’s so much to say.
First, anyone who’s read Saving My Knees knows that I openly acknowledge a huge debt to Doug Kelsey, a very smart physical therapist who heads a clinic in Austin. His writing showed me (1) Bad knees can get better; don’t listen to any doctor who says they can’t (2) The right kind of exercise to rehab a bad knee joint is low load, high repetition.
At some later point, I found Paul Ingraham on the Internet. Ingraham, a former massage therapist in Vancouver, wrote long essays that were sharply reasoned and easy to read, often debunking things that 99 percent of his colleagues believe. He showed me that (1) stretching probably isn’t of much use at all (2) physical therapy’s obsession with “crookedness” has led the profession down a questionable path.
So I had managed to stumble across, quite fortuitously, two therapists whose insights possessed great appeal. All that was missing, really, was a doctor to provide a more formal framework for the right way to understand chronic knee pain.
Enter Scott F. Dye.
I’ve been aware of some of his ideas (such as the “envelope of function” and the importance of tissue homeostasis) for a while, but only recently (because of a reader comment) was prompted to look into them more deeply. And I’m glad I did.
The idea of the “envelope of function” is the cornerstone of his thinking on nagging knee pain. He describes it as “the range of painless loading compatible with tissue homeostasis of a joint without causing structural or physiologic injury.”
In other words, there’s an optimal range of load-bearing activity for your bad knee, within which healing can occur. If you drift outside of this range, or envelope -- either by pushing your knee too hard or not placing any demands on it at all, which leads to its own problems -- you’ll thwart that healing process.
Simple, and spot on, from my own experience.
Dye identifies a problem many of us face after hurting our knees:
The envelope of function, or the safe range of painless loading, frequently diminishes after an episode of injury to the level where many activities of daily living that previously were well tolerated become symptomatic, leading to the prolongation of symptoms.Huge.
This is exactly the issue for so many people, but they don’t modify their behavior in response. The above quote brings to mind a wince-inducing comment I recall reading once from someone who couldn’t climb stairs without pain. His solution? “I just pop a couple of Advil.”
And people like that wonder why their knees never heal?
So if you want to fix your bad knees, it’s important to determine your own “envelope of function” and faithfully stay within it, healing slowly and steadily. Of course that does raise a bunch of interesting questions about the therapeutic implications of an “envelope of function” approach to beating knee pain.
Next week I’ll look at some of those.