Saturday, September 28, 2013

On Hope, and One Reason I Write This Blog

I got a really neat comment recently (edited a tad for length etc.):
I stumbled upon your book whilst spending hours online searching for advice on chronic knee pain. You have given me a sense of hope I had all but lost. I have recently been told I have irreversibly damaged the cartilage in my knees, told there is nothing I can really do, advised to take glucosamine and to strengthen my quads with exercises I cannot possibly contemplate at the moment. It seems such a relief to hear your story.

I am in the depressed, downward spiral of thinking that, at the age of 41, is this it? How am I going to live like this when even climbing a set of stairs is a challenge? I used to thrive on exercise and being active. To have this unwelcome change in my lifestyle has been extremely difficult to cope with, especially as I have two young children and a wonderful husband I want to be enjoying life with. I just want to thank you for taking the time and effort to share your story. You have given me a glimpse of a hope I had all but lost and well-balanced, well-researched advice I am going to attempt to follow. I know the road is very long with many likely falls along the way but to hear that it can be done inspires me in a way I haven't been for some time. Thank you.
Wow. Thank you.

Sometimes, I confess, I feel a bit remote from this blog. Namely: I had chronic knee pain. But I managed to fix it. And the memory of the hole I was in has started to recede.

Then, every once in a while, I get an uplifting, heartwarming comment like this that says to me:

There are millions of people out there who are going through what you once did. They’re scared too, trying to figure out what to do. Some are over 40, as you were, and maybe they too were essentially told, “Ah, you’re just getting old; learn to live with the pain.” Many are getting the same bad advice you did (such as to focus on “strenghtening the quads” when, as Doug Kelsey of Sports Center notes, “having stronger muscles is helpful but weak muscles are not the primary problem”). So don’t stop spreading a message of hope!

I still recall a phone conversation I had with my father, back when I was living in Hong Kong, trying like hell to heal my bad knees -- and succeeding.

My voice was shaking with anger. I was talking about my experience with my knee doctors. I was most upset with them because, after a physical exam would reveal no major structural problems, each would more or less shrug when asked what could be done about my knee pain.

Of course one said that sometimes patients with knee pain get better, sometimes they don’t. So I followed up with what seemed like a logical question: Why do some get better? But he wouldn’t answer.

Later, thinking about that scene, I got irritated. Hell, if I was a knee doctor, and my mission was to heal, and some of my patients improved while others got worse, I’d be lying awake in bed every night, thinking:

Why? What are the ones who heal doing differently? Or what’s different about them?

One of the most inspiring messages I got from Doug Kelsey early on was this response to an imaginary comment from a doctor:
"Well, you have arthritis. Your knees are just wearing out and there's really not much you can do about it."

Hogwash. Hooey. Balderdash. It's just nonsense.
Kelsey's rejection of the gloomy fatalism that bad knees will be bad knees, and only get worse if anything, was for me very encouraging. It helped convince me that I could heal. And I did.

Taking away hope, wrongly, from a suffering patient is a terrible thing to do.


  1. Your book and the additional info you find and post in this blog have been a HUGE source of inspiration for me. I hold onto it like a lifeline of hope.

    Thank you!

  2. As a 22 year old male who until a few months ago was living a fast paced and active life you could say that I am walking( though not very well) proof that chronic knee pain can strike at any age, and without major precipitating injury. I'm so thin and lean I don't know my weight, 5'8, cycled everywhere, ran long distance and cross country throughout my teens. I like to climb and I like to hike. I think that my problems stem from cycling too hard on the wrong gears or up hills. However, without a period of inactivity which acted as the catalyst for chronic knee pain I believe the damage I was causing my joint wouldn't never have become so obvious, and so in a roundabout way I am thankful for that.

    It began with a relatively minor lateral meniscus tear inflicted during a solo hike in west wales, which through utter ignorance I let develop when I got back home to London into a debilitating tear. I won't go into the details of how stupid I was, but lets just say I didn't know a thing about joints and cartilage and treated this like any other scrape or strain I'd ever had, rested for a few days and got back to cycling, running up stairs, and so on. At some point I obviously aggravated the tear and things got stiff and swollen...

    Well I went to my parents house in the country to recover, but having done that, having gotten medical attention, an x-ray, fresh air, having everything done for me and so on there was still a problem. As the meniscus injury seemed to improve steadily it was seemingly replaced with a sneakier on-and-off pain occurring around both kneecaps, especially the left. When I squatted deeply the left knee would crunch painlessly, and sounded like a zombie eating Doritos.

    Well until I found your book I made the mistake of doing nothing. For almost a month. This caused the 'death spiral'.Eventually there was always burning, when sitting, when standing, when bathing. Having then read the book I began a loose regimen of very light walking and increased the distance slowly, and yes my walking improved. I also saw an osteopath a couple of times who had a very gentle approach which helped.

    Right now I'm back in London but still unable to live a normal life, to work, or cycle. My joint(s) have definitely got far stronger but it's certainly not straightforward and some days I realise how I pushed too far the day before and I get down. I am constantly tweaking my plan and becoming basically more of a nerd about it. I've had serious anxiety issues around this, which meditation has helped somewhat. But it's still a challenge to keep the spirits up when faced with such a sneaky adversary, through perhaps seeing it as my adversary is the problem.

    My dream right now is to be able to cycle around my city and visit museums and walk up hills with my girlfriend and have a normal life again. I don't know when that will be but your book and blog have been invaluable in the journey so far.

    Thanks, Oscar

    1. "A zombie eating Doritos" ... I wasn't sure what to make of that description, but thanks for the grin. Yup, once you injure yourself, the whole equation changes ... people are often slow to realize that, especially hardcore athletes, but you just can't keep doing what you were doing before. Hope you keep getting better; I know it's slooooow.

  3. I am an avid reader of your blog since having followed your advice since January of this year looking for encouragement and entertainment during the long road back. Thank you.

  4. Very familiar stories here, particularly the 41 year old reader in your blog post & Oscar's story. Oscar, your situation is very similar to mine (meniscal tear - surgery on one knee - a period of lower activity post surgery - pain and burning in BOTH knees followed).

    The other benefits I got from Richards book is a Plan B and an experience against which I can measure/temper the advice of the numerous medicos I've seen. If their Plan A is not working, I quickly shift back to Plan B.....though this may may ultimately pro-long the process.

    I'm currently trying something my medico has suggested which I'm a bit concerned about, but thanks to following a Richard-type Plan B for the past 8 or so months, I can now more readily gauge if the medico plan is taking me backwards or forwards, and respond accordingly.

    Otherwise I'd likely blunder on ignoring the pain and make things worse.

    My Doc does seem more switched on than many though - probably because he also suffers from patella-femoral syndrome (though I suspect his is the type which mostly causes problems when hew runs - classic runners knee - not the type of permanent discomfort I get & which Oscar also describes). He did say fixing this issue is not a straight-line heading up at a 45 deg angle to success, and that the line will dip back down at times.

    cheers, TriAgain

  5. An update.

    Went back to my GP today and it seems most likely I have a (mercifully mild) form of CRPS (now called RDS), triggered by my meniscus surgery, and perhaps also by some kneecap cartilage damage (which I know is present from old MRIs). But my knee x-rays show no osteoarthritis, which he said is remarkable in a 49 yo (though you could probably classify damage to the cartilage on the back of the kneecap as a form of osteoarthritis - what he means is no large damage to the cartilage on the ends on the femur & tibia).

    And the remedy for this is very much like Richards remedy - gradually increasing movement, but very carefully, to re-train/de-sensitise the sympathetic nervous system).

    He's had me doing very shallow single-leg knee bends (stop before any pain, so about 30 degree max) and light 'running' (8x 30 secs shuffle, 90 secs walk). I can't tell you how good it feels to be 'running' even a little, albeit at half my old pace.

    I've also discovered boxing on a bag & speedball is a fairly knee-friendly exercise that gives you a good aerobic workout. Just don't try and dance like Ali, keep your feet planted.

    After 3 weeks of this, this morning I scored my knee pain at zero for the first time in about 18mths. But I can tell it could easily come crashing down if I don't progress slowly. Even the knee bends & shuffling bring on very mild tingling/burning, but the constant deep aching and stiffness is all but gone.