Saturday, February 8, 2014

Comment Corner: A Torn Meniscus and the Dangers of ‘Quadriphilia’

I thought this week I’d do a “Comment Corner,” using a story that a reader shared. “Quadriphilia” is a neologism -- or not exactly a neologism, as the word already exists, it turns out, but I’m adding a new meaning for it.

Quadriphilia: An irrational obsession with strengthening one’s quadriceps to overcome knee pain.

Now, on to the story (slightly edited for length etc.):
I am a 47-year-old female, had an injury seven months ago in the gym working out on the elliptical machine, and ever since my life has stopped.

The MRI result says that I have a complex tear of the posterior horn of the medial meniscus. Tear of the free edge of the body of the lateral meniscus.

I was able to resume walking and some normal routine work after being bedridden for the first three months.

I had two flare ups in between which got better in one week of rest.

But I had a recent setback just two weeks ago. I thought I could start doing my quad exercise which doctors gave me five months ago. Did two minutes of single leg quads exercise and felt some burning after that. Next day, I went for my normal walk, and some Christmas shopping.

On Dec. 20th, I felt horrible burning and weakness in my knee and in bed since then. It's been two weeks, not much difference. Keeping leg straight and elevated in bed only helps me.

Right now, I cannot do even 5 min walk due to burning in my knee and weakness. It is not able to bear my weight.

Do you think this kind of flare up is something normal and it takes a few weeks to get better in order to even do a slow walk? Why I became so bad in 2 min of single exercise, and then keeping up with my normal one hour walk and 2 hour shopping? Why did I get so much burning?

I wonder why my knee is taking so much time to even reach a point where I can do a little walk without burning?

Do you think this kind of setback is common and it does not have any pattern in terms of how long it will last?

Every morning I get up thinking today my burning will go away and I will resume my life. But it is not happening even after resting (most of the time) for the last two weeks. :(

I am feeling very low and I guess looking for some word of comfort to stay positive. Seeing a doctor is no good since they did not do anything when I had this injury first time other than giving me a print out of a few quad exercises and an IT band stretch.

I would highly appreciate if you can please provide some insight and advice.

First, some quick thoughts on the questions raised. (By the way: usual disclaimer that I’m not a doctor or physical therapist, plus I’ve never had a torn meniscus.)

Why did the knee become so bad after two minutes of exercise, followed the next day by a normal one-hour walk and two hours of shopping?

Hard to say for sure -- but I’m guessing the normal walk wasn’t to blame. My bet is the two minutes of exercise coupled with the two hours of shopping the next day overloaded a still-weak joint.

Is two minutes of exercise really long enough to cause a serious problem? Sure. Just think about the original injury -- it may have occurred in the space of mere seconds. Remember, this wasn’t two minutes of exercise with a healthy knee; this was two minutes of exercise with a recently injured and still healing knee.

Are such setbacks common?

My experience: incredibly common. As common as sea shells on the sea shore.

How long will the pain last?

That, unfortunately, is more of a mystery, I imagine, as it depends a lot on what kind of further damage you did.

Should it take a few weeks to reach the point where you can do a slow walk?

Maybe. It could take a few months, or longer, depending on what’s going on inside your knee. But if the question’s intent is more along the lines of, “Does this mean I can’t get better and should consider surgery?” -- that is a decision it seems you’ll want to make with a qualified doctor’s input.

Now here’s the part of the story that grabbed my eye (and why I really wanted to do this blog post):
I thought I could start doing my quad exercise which doctors gave me five months ago. Did two minutes of single leg quads exercise and felt some burning after that ... On Dec. 20th, I felt horrible burning and weakness in my knee and in bed since then.
This, to me, is classic “quadriphilia.” The patient shouldn’t be blamed for it either, but rather the doctors who apparently carelessly prescribed quad strengthening for a weak, damaged knee.

I can fully empathize with this part of her story because I went through almost exactly the same thing. My physical therapist too believed I should strengthen my quads. So, once my knees were feeling relatively good, that’s what I tried to do. And I almost succeeded in ruining them.

Why is “quadriphilia” an irrational obsession?

Here’s one way to answer that:

For your knees to work properly, and assist you in any number of different movements (take walking e.g.), there’s an interlocking chain of muscles and tissues that have to be able to function correctly. For example, if I remove your quadriceps, you won’t be able to walk anywhere, no matter how strong your knee is. Similarly, other structures -- other muscles, tendons, ligaments, cartilage -- play their role in making activities such as walking possible.

One way of looking at knee pain is this: The weak link in that complex chain has become your knee(s). With that in mind, here’s why I think “quadriphilia” is crazy.

Most exercises that strengthen your quad muscles will overwhelm your weak knees. (I first came across this logical observation in the writings of Doug Kelsey, who astutely notes about treating knee pain: “having stronger muscles is helpful but weak muscles are not the primary problem”). You can find other, milder movement that will nourish the joint without taxing it too much (like the walking that Saroj was doing, that her knees apparently liked.)

Yet “quadriphilia” persists.

It persists partly because, in my opinion, a whole bunch of studies have been done showing strong quads protect weak knees, but few people have thought deeply enough (“Why That Study About Quad Strength Doesn’t Mean What You Think It Does”) about what these studies are really saying -- and what that implies for treating already injured knees (NOT healthy knees you’re trying to prevent from becoming injured -- big difference).


  1. Quads strengthening SEEMS to work. Until you realise they are just the tree that conceals the wood. I went to a PT who gave me the '95% of PFPS cases are resolved through a quads strengthening programme' lecture. I had read your book before and was thus rather skeptical that it would work, yet after 6 weeks I could run (alternate 1 min walking with 3 min running for 30mn). I thought may be I was one of the lucky few. Then a week after the PT had given me the all clear, bam, it happened again. That's when I realised what quads strengthening really did: they support your knees so that the knees won't take the force of the strike when you walk, run or climb. But they don't FIX the knees. It's akin to add some supporting braces to a crumbling wall. Take the braces away and the wall will eventually crumble further. I never went back to the PT, so I guess he counts me in his 95% rate of success. I then devised my own programme through trial and errors (a lot of...) and after a few weeks my knees are getting better. HOWEVER, I can feel how weak they are and I think in Saroj's case the 2 hours of shopping were too taxing. Every time I do some shopping, my knees burn the next day, it could be because I'm not walking, rather 'stamping' the ground in queues, or because I'm carrying bags, or pushing a trolley, or going up and down to pick up stuff on the shelves. Online shopping from now on!

  2. Hi, Am changing the subject, sorry but thought this might be of interest. In a book about a 90 year old athlete, Olga Kotelko, they mention the term interoception. And reminded me very much of Your approach - listening to body. Here is the excerpt from What Makes Olga Run by Bruce Grierson.

    Excerpt from online excerpt:

    "There is a name for this faculty of superattunement for
    what’s going on inside your body. It’s called interoception. To

    be interoceptive is like being introspective, but to sensations
    rather than emotions or thoughts. page 110

    There is an NyTimes article about this athlete and an excerpt of the book is on-line:

    Seeking the Keys to Longevity in ‘What Makes Olga Run?

    Thought this would be of interest. You perhaps mention this concept in your book, but can't remember

    1. Thanks for sharing this. "Interoception" seems like an interesting concept, but I wouldn't think it rare; I imagine you just have to listen hard enough to what your body is saying :) Anyway, I found this line had a lot of resonance: "Among the potential anti-aging elixirs Mr. Grierson explores, exercise appears most potent."