Saturday, February 22, 2014

Thinking About Knee Design

Why were knees “designed” the way they were? Why does articular cartilage lack a blood supply and nerve endings -- the former, if present, would facilitate healing and the latter would warn us away from activities that are causing further damage?

I often pondered such questions during the year I spent in Hong Kong without a job, when I was concentrating full time on healing my bad knees. My focus had turned completely to all things knee.

At first when your knees hurt, and they prove stubbornly resistant to getting better, your inclination is to think, “Stupid knees! These dumb joints always wear out. Why couldn’t they be better designed?” But then, as I took a closer look at the inner workings of the human knee, I was surprised at how ingenious the design actually is.

Some of this I captured in Saving My Knees, in a chapter I’m sure half of readers skipped over, eyes glazed. It was the chapter that took a sort of Fantastic Journey through knee cartilage and introduced proteoglycans, chondrocytes and glycosaminoglycans. While writing it, I tried to keep a sense of wonder at how well all of articular cartilage’s adaptations actually worked.

But no nerves, no blood vessels -- how could this be a good thing? As I thought this over, an answer began to take shape: Of course it could be.

Imagine you’re designing a very tough cushion, to insert in a joint, that can withstand big impacts. Would you want to lace this tissue with delicate blood vessels and sensitive nerves? Or would that make a simple stroll across the room feel like walking on broken glass -- a refrain of “ouch, ouch, ouch” with each step?

I don’t know, but it’s something interesting to ponder.

To me, the real fatal design flaw in knees would have been if they had no capacity to self-repair, considering all the abuse they take. Happily, as I found out during my recovery from chronic knee pain, this is not the case.


  1. Hi Richard,

    You alredy know my story of meniscus tear. The story became more complex as why I am still bedridden from last 2 month finding out that I also have Chondromalacia in left knee (where I have meniscus tear). I have moderate Chondromalacia with bone nerrow. Feeling very low and try to fighting hard just reading your book every day. My only treasure is 1 min. walk in every 30 min. , that too from just last one week in last 2 month of being bedridden. With that much, my knee cap inflammation goes 7-9 (10 being most) by evening.. My right knee also started showing some burning arund kneecap , may be it is not being used..

    I remember your tips and try to get up and walk around since tht is the only thing my knee can bear, but even that is not possible other than few steps to bathroom.. stuck in a rut.

    My right elbow also started showing some burning from last one week. Not sure why Chondromalacia is happening in all joints.

    Do you still think I have hope to recover and get mobile?
    In your case, you were lucky enough to walk to heal your knee.. I don't have that either.. Not sure what step to take.

    Do you thinkg moderate Chondromalacia can heal too (just in one knee)?

    Do you have any recommendation for elbow Chondromalacia? any exercise or tips? does this help too?

    Feeling very low with my body showing all this symptoms and at the verge of loosing my job.

    Any word of encouragement and suggestion would be big help.

    Best Regards,

  2. Saroj, have you seen your doctor again? It may be something else and you would need to have more tests done, maybe?
    There is a story of a guy on this blog, can't remember where exactly, he went from not being to walk without crutches to running in 6 months. My advice, for what it's worth, is to get yourself crutches, and practice walking with them. Your knees are so weak even your body weight might be too much for them. I sometimes use a cane when I go for longer walks, to ensure that I don't put too much stress on my bad knee.
    Have you tried a small pedaller? It's available on Amazon for about 30$.
    You also need to consider that your muscles would be very weak after two months of bed rest. You need to start exercising your legs in a way that doesn't put any stress on your knees. I find mat pilates the best exercises, skip the pelvic rolls and anything that calls for leg support. I recommend the Pilates TV dvd 'focus on buttocks', it's great to strenghten your glutes and thights and very low impact. I got it on Amazon too. I think Doug Kelsey has good exercises on his blog, you can access them for free if you register
    But above all, visit your GP again to rule out any other condition. And good luck!

    1. Crutches might be a good idea if walking is very hard. Or there are even milder exercises -- Doug Kelsey has described one where you sit down and put your feet on something like a furniture slider, then move your legs back and forth, bending your knees. Strange joint pains migrating through the body when you have knee pain is not unusual, I suspect -- I had weird problems as I mention in the book.

      Anyway, the smartest thing may be to go back to that doctor and make sure you don't have a different problem (blood test could help there perhaps?) and press him to get you into some physical therapy that makes sense. You may need some close-up personal attention.

    2. Hi Deloupy , Richard,

      Thank for your reply. I haven't seen doctor again. I thought it is similar symptom so it could be Chondromalacia every where.

      I am though starting physicla therypy from next week.

      My right knee cap burn so much that I cannot do furniture slide exercise even for few seconds..

      I have been having severe pain in my shoulder and upper arm in last one year. Have developed some weakness in that area.. and now I got this symptom of elbow burning.. Not sure if my should and upper arm weakness crated something in my joint.

      My plan was to keep my right kneecap burining little low and then go for PRP for my meniscus .
      I feel lot of burning behind my knee cap too which could be due to meniscus tear.

      But with symptom starting in my right knee (good one) burning around kneecap and in my elbow, I feel like I am loosing battle.

      Thank you for your support. looking forward to stay in touch with you.


  3. Hi Deloupy,

    Can you please send me link or name of that Pilates TV dvd to buy from Amazon.


  4. Hi Saroj, I got the DVD on the UK site, can't see it on the US site:
    I'm sure you can find other ones, it just happens to be the one I use.
    If you've never done pilates before, you'd benefit from a couple of sessions with an instructor, or a beginners DVD
    However, make sure you only do the exercises that you feel comfortable with. Do not attempt to do any that call for leg support (pelvic roll, front support, etc) before you are strong enough

    I'd personnally visit a GP for blood tests before starting physio again (or even pilates). If the issue is a general inflamation in your body, then physio is likely to aggravate it

  5. Thanks deloupy. Yes, it is inflammation around my kneecap and behind my knee. It's been 2:30 month for me in Bed.

    How long I can keep lying in bed due to this inflamation, not sure.

    From last one week, I just started waling for 1-2 min, in every 30 min. that is the only treasure I have.

    Started PT session from today in Stanford. Today they just asked me do do 15 min. seated bike and then some dance step move holding a rod and some high step walk arond some stones sitting on floor.
    They told me that I will have rollar coaster ride with PT, but their ultimate goal is to make progress.

    Regarding Meniscus tear, they don't believe in surgery or any other treatment. MY PT Told today that you need to get this thing out from your head that it is your minscus tear causing burning behind your knee.
    It could be knee capsule or synovial fluid. what if you go for surgery and still have same issue. He said I have seen ppl with bigger tear than you and having normal life.

    Where as palo alto foundation dr. was ready to throw me on surgery table for menisucs tear.

    My biggest problem right now is burning behind my kneecap and behnd knee.. Praying to God and going slowly for recovery and to have my life back.

    Tried doing some streatchs and strenghting exercise for 2 days (spine, quaard, hip, glutus) and my knee burning went up 8 out of 10 (hightest). stopped yesterday.. full day in bed.. took pain killer.. went for PT today.

    Richard , deloupy, please keep posted me suggestion , tips to keep burning down and make some progress.

    Thanks for all help