Is Water Therapy Good for Your Knees?

I recently came across the question above in the comment section.

My answer is scattered all over this blog, but I don’t think I’ve dedicated an entire post to the subject.

So here’s my opinion:

Absolutely.

In fact, if I were to suggest a “Holy Trinity” of the most excellent knee exercises -- those where you can get in lots of nourishing high repetition movement with little strain on the joint -- it would look like this (in no particular order):

(1) easy walking (initially stay on flats, take breaks every 20 minutes or so, and don’t let your legs slam down -- ever)

(2) easy cycling (a stationary bike though more boring is better as it’s easier to control the force you exert; cycle backwards if your knees are really weak)

(3) easy water movement (careful -- swimming may be a very bad idea if you’re kicking vigorously with your legs; you’ll need exercises designed for people with tender knee joints)

The right kind of water exercises can be a great way to heal bad knees. Water provides gentle resistance and support when you're moving about. Of course just jumping in and doing the overhead crawl from one end of the pool to the other usually won’t be a smart idea.

Where do you find good exercises?

Heal Your Knees is a book that contains many water exercises designed for those with hurt knees. A frequent commenter here likes The Complete Waterpower Workout Book (both books share an author, who evidently has made water therapy a key part of her physical therapy treatments).

My biggest reservation about telling people to try to heal through water therapy:

Most of us simply aren’t close enough to pools, or can’t afford pool memberships, or can’t align our schedules with pool hours, to make this a really practical option. A nice thing about a walking regimen is that walking can be done anywhere, anytime.

The other thing to note: Water therapy may not be the best treatment plan for you, regardless of whether there's a convenient pool nearby. I did try it for a while and had some good results. But then I had a setback and found I wasn’t getting the same benefits as before, so I changed to a walking-centered program.

More From Last Week's Success Story

Last week, I posted a great story of recovery from knee pain, as told by “Luis” about his wife. The story was so long (even after being edited for length) that I decided to dispense with any of my own comments. Also, I trimmed out a couple of sections.

This week I wanted to quickly comment on a few things, then include the sections I omitted last time.

One thing that struck me as interesting about his wife’s pain early on:

The doctors found nothing wrong.

MRI fine. Bloodwork fine. Alignment fine.

This, I imagine, is very common. It was my situation as well.

So what did doctors diagnose her with?

That terrible, kitchen sink, pseudo-diagnosis of “patellofemoral pain syndrome”.

I wish more patients who were told they had PFPS would gently challenge their doctors by saying, “Right, but what’s causing my knee pain?” Because the PFPS “diagnosis” neatly evades that answer.

Here’s another thing that resonated about his wife’s story: she noticed that walking uphill was okay, but downhill was painful.

When I was engaged in my recovery, I remember striding uphill, but descending very, very gingerly. Uphill is good for you, downhill is poison. Going uphill, your legs are working hard and gravity is slowing you and minimizing the pounding your knees are taking. Downhill, just the opposite: no muscle benefit and a lot of joint abuse.

Now back to Luis.

In the original telling of his story, he described how he developed a classification system to identify where his wife was in her recovery. When I saw this, and the level of detail, I knew Luis and I were kindred spirits. :) Anyway, I include it here because it shows that to heal from knee pain, you often have to really get involved in your own treatment and it helps to be a bit analytical and even anal (the first four letters of “analytical” -- hmmm, coincidence?)

We tried to identified the percentage of recovery.
    STAGE 1. 0-20% - When she couldn't even walk a couple of steps on flat surfaces.
    STAGE 2. 20-40% When she was able to walk continuously for at least 50-100 m without starting to feel pain, on flat surfaces.
    STAGE 3. 40-60% When she was able to walk continuously with discomfort, but no more than 300 m (600 steps), on flat surfaces.
    STAGE 4. 60-80% When she was able to walk continuously with a bit of discomfort on uneven surfaces for 2-2.5 km (4000-5000 steps) (avoiding downhills or with assistance going down)
    STAGE 5. 80-90% When she was able to walk continuously without discomfort on uneven surfaces for 4-5 km (8000-10,000 steps) (avoiding downhills or with assistance going down)
    STAGE 6. 90-95% When she was able to walk continuously pain free on uneven surfaces for 5-8 km (10,000-16,000 steps) (avoiding downhills or with assistance going down)
    STAGE 7. > 95% When she was able to walk continuously pain free on uneven surfaces for 8 to "X" km (till her body started to feel tired instead of her knees)

Last, here is the advice that Luis gave to others.

    1) Read to understand, not to find a magical cure.
    2) Develop an achievable plan depending on your observations, reward yourself and feel proud about it.
    3) If you are overweight, there are no excuses nowadays not to reach an ideal weight. Just go for it with a balanced diet.
    4) Walk every day. If you were able to walk before, is there a reason why you can’t do it now?
    5) Find the cause. In the case of my wife, she spent 2 years almost doing nothing. The biggest impact was when we returned from the mountain that we jogged-hiked in June 2012. If we have known that this could have happened, we should have focused on a minimum of 6 months covering 10,000 steps per day before even starting running.
    6) Use shoes that suit you and don't use different shoes when walking, stick to the ones that suit you.
    7) At the beginning if you have to use braces, but once you get into a more comfortable point try not to.
    8) Does this only help for PFS? I'll say that it can work with any other knee problem, just like for me it worked as well.
    9) Don't let anyone tell you that there is no hope, because there is.
    10) Listen to your knees and avoid what they don't like. Do not jump, do not run, go slowly when going down stairs. If there is a handrail, use it and put most of your weight on it. Plan your walking routes and walk only flat and slightly uphill, avoid stiff hills, do not fully stretch your quads until STAGE 3.