Saturday, December 20, 2014

On Writing a Book and a Blog, and Learning Humility

After I finished writing (and rewriting) Saving My Knees -- and extensively fact-checking the entire manuscript -- I felt kind of giddy. This was a unique book, I felt. It was a first-person, well-documented story of how someone failed -- then succeeded -- in fixing bad knees his doctor said would never get better. My story vividly demonstrated the shortcomings in the traditional approach to treating chronic knee pain (of the sort sometimes caused by osteoarthritis, but sometimes not).

Bestseller lists, here I come!

Then reality bit down. Hard.

The book has sold well, all things considered, but never got close to being a bestseller. Reviews trickled in -- many positive, but others sour and dismissive.

The most humbling experience though has been writing this blog and coming into contact with so many people with knee pain who are really struggling -- and who appear to be doing many of the right things too. They’re desperately seeking the path to healing, just as I was. And they’re discovering that’s not an easy path to find.

Ah. Theories are neat; reality is messy. I still believe that switching from high load/low repetition activities to low load/high repetition makes much more sense for fixing achy knee joints. But I also recognize that while this may be necessary for some people to get better, it may not be sufficient. Big difference.

The problem is, there are different causes of knee pain (in need of different solutions), as well as various mysteries about what’s really going on in the first place. For instance, is there something weird and systemic that sets in when you have chronic knee pain that goes on week after week? I had a doctor tell me unequivocally “no.” But I’m not sure I believe him.

Sometimes I had the sense there was a poltergeist of inflammation loose in my body, and while it may have first appeared in my knees, later it began to roam at will. Apparently it wasn’t just me either who felt this way. I’ve been surprised at the number of people with symptoms similar to mine who went so far as to be tested for rheumatoid arthritis (just as I did).

So what was all that systemic stuff? I honestly don’t know. But, even though it’s gone today, I think it was real.

So yes, there are lots of mysteries about knee pain, as you’re all finding out. It’s good to stay humble -- even if you succeed in beating knee pain -- because no one has all the right answers.


  1. Hi Richard,
    First I want to thank you for writing the book. It gave me hope and also some results :) I don't mind it isn't bestseller, I am just happy I found it.

    When you mention systemic inflammation. I experienced similar symptoms with my knees. When mine started to hurt really bad after longer bike ride in cool weather and over steep hills (without much training before, I am stupid I know), soon there were other problems. Toes and one ankle started to hurt. Then even thumb on my right hand hurt to the point that I was not able to open bottle or peel a banana. I too got tested on rheumatoid arthritis, gout, lyme and other stuff.. but all came back negative. My doctor told me she rarely see such clean blood-work. Then orthopedic doctor told me I am just getting old (I'm 27 by the way) and that I should eat some joint supplements, which did totally nothing. But eventually I managed to get rid of all the little pains except for the knees.

    I started walking regularly in September, at first only around 1000 steps 3-4 times a day. Now I am able to walk 2000 steps 3 times a day without problems, occasionally I can afford 3000 step walk. So it's getting better, but very very slowly. Much slower then I expected. But at least it's getting better. With 6 months of physical therapy and listening doctor's advice it was just getting worse.

    In your book you write that you also did 3 or so shorter walks per day in the beginning. But later in the diary you mention usually one long walk. Did you get better results with one longer walk than with several shorter ones? How did you transfer to it? So far it seems logical to me to keep more shorter walks to spread out the load and move regularly.

    Best regards,

  2. Shame on your doctor for telling a 27-year-old "you're just getting old"! Ugh.

    Yes it is extremely slow, getting better. I like to tell people that when I embarked on healing, those at my workplace figured it would be slow. But I was smarter than that: I thought it would be VERY slow. In reality, even I was wrong. It turned out to be VERY, VERY slow.

    If you have time to do shorter, more frequent walking, that's great. Yes, it probably does spread out the load. It's a good strategy early on (and most likely later as well). Eventually, you'll want to push your knees harder, so it's not a bad thing, trying to build up to occasional longer walks. I wouldn't say it's a matter of which I had more success with; it's more a matter of when is the best time for going short more frequently and when are you ready to go long.

    No rush at all though. That's the key thing. Your approach sounds pretty good to me.


  3. Hello!
    I am EXTREMELY grateful I found your book and blog. There are very few resources for Chondromalacia Patella sufferers so your book is a God send. Thnak you!That being said I could use a little advice. I seem to have fallen into a very deep hole.
    I am 35 years old. I weigh 135 and am 5’7”. I’ve always been active. I had my knees act up (typical Chondromalacia symptoms) moderately after my first pregnancy (I am sure it was the weight) and decided to go to physical therapy. THe exercises she recommended trashed my knees to the point where I could barely walk. Many many tests and doc visits confirmed I had “mild chondromalacia patella.” Mild yet I can barely walk. I was inspired when I read your book and immediately “bathed my knees in movement” with exercises recommended by Doug Kelsey. My knees reacted badly. they swelled the next day and I fell “down a another chute.” I realized I must have overdid it so I rested a few days until my knees calmed down and tried again. Same thing. Tried again. Same thing. Tried again. Same thing. Tried again. Same thing. Each time I did less and less movement or tried a different type of movement and each time my knees went crazy with stiffness/swelling/pain (always the next day). Over the last few months I have fallen down so many chutes that I cannot even manage to walk 1500 steps a day TOTAL without my knees swelling. It seems my knees are happiest when I don’t move at all but I know I need to move them to heal. I am so confused and frustrated and not sure how to proceed. I was hoping you could advise. I keep rereading the sections of your book that talk about what you did when you first started trying to heal. I am shocked that you were able to walk. Walking is almost unbearable for me. It doesn’t hurt at the time but the next day I pay. I look back at my knee journal and it has been a gradual decline over the last three months. I can’t figure out how to stop it and I can’t seem to find an exercise my knees will tolerate. I am contemplating going on total bed rest (because at this point the walking required to live seems to be too much for my knees) and maybe just starting out with what Doug Kelsey describes as “quad sizzlers” and gradually trying to build up from there. Even though I am slender I am still planning on losing more weight too. Any feedback would be most welcome. I value your opinion much more than any doctor (why are they all so clueless?) on the subject.
    Thanks again, Jenny

    1. Sounds rough, Jenny. My heart goes out to you. I wish I had some insight to share that would change your life and get you on the right track. All I can give you is a few things to think about: (1) Is it possible to find any easy movement that your knees like? Cycling backwards, Kelsey's "tail gaters", very gentle movement in a pool, or some other thing? Walking may not be best recovery activity for you, I'm guessing. And I think you need to find some activity that your knees like/don't react badly to. (2) Are you sure you know what's causing your pain? Have you been tested for rheumatoid arthritis or has any other cause of your pain been investigated? It's hard to believe that mild cartilage damage is causing problems that extreme. My symptoms were not nearly that bad, honestly. Anyway, I'm hoping you find some relief; life sounds quite difficult for you right now. Hang in there!

    2. Thanks so much for your thoughts and encouragement. 1) I am ever experimenting to find things my knees will like. I have not found a solution yet but I am still searching and am not one to give up. However, I am taking the experiments SLOWLY. For me that seems to be more important than the exercises themselves. 2) Yes the Chondromalacia Patella diagnosis seems definitive. I have been to several doctors including Rheumatologists. It has been surprising to me as well at how little my knees tolerate compared to others. I think that was why I had so many set backs. It took me a long time to get it through my thick skull that my knees could not handle the same movement that you and others could. Sigh. Oh well, I am wiser now at least.

  4. Jenny, if you can not walk, that's the problem. I walk up to 6 miles per day, with no change in symptoms next day. My pain is constant.In the morning, the pain is weaker, stronger in the afternoon. Every day is more or less the same, for a year and a half already. I think that in this condition the muscles can not be strengthened only maintain.
    In Richard's book, you will not find a solution to your problem, which he wrote several times.You'll find only his detailed experience about chondromalacia.Try blood injections.It's the only thing that helped me.


  5. Thank you for your advice Gordon. Congrats! Six miles a day is amazing. I cannot wait till I can do that again. What do you mean by blood injections? Do you mean platelet rich plasma injections? If you don't mind me asking, how did you feel before and after? How many did you have to get? What was your diagnosis? Was it for a tendon, ligament, or bad cartilage? How much did they cost? I hope those questions are not too personal.
    I actually can walk but it is difficult for me to find the correct amount that I should walk. Right now I walk about 150 steps per day and spend the rest of the time in a wheel chair. I discovered that this is the amount that my knees will allow without swelling or going stiff the next day. The steps that I take are gentle, small and very delicate. I bought a counter. Every time I take a step I click and count. My hope is to increase these steps so slowly that my body doesn't even know I am doing it. I think I'd rather watch paint peel.
    My original questions stemmed from a fear that somehow I was missing something. What I was trying to describe earlier was that often I would wake up in the morning with a stiff or swollen knee (my right seems to be worse than my left). So naturally I would try to decrease my activity even further and the rest seemed to make my knee happy. Then once feeling better I would naturally do a little more and wake up with a swollen knee again the next day. Each time this happened my capability decreased in the sense that my knee tolerated less movement before swelling again. I wondered if this was the death spiral that Richard referred to. I wondered if I was overdoing it and correct to listen to my knees and decrease activity. But I also wondered if I was underdoing it and being overly sensitive to my symptoms and not giving my knees the motion required to heal. This is especially true now that my activity is a big joke. 150 steps a day is hardly activity yet that is all I can truly handle without swelling. It’s very confusing finding this balance and knowing if I'm helping or hurting myself.
    I truly apologize for two very long winded posts. I guess I'm just a bit desperate to get answers.
    Thank you, Jenny

  6. My experience described in detail is here:
    I have not received plateled rich plasma injections, but orthokin injections globally known as Kobe Bryant treatment. They cost 1000 Euros for 6 weekly shots.

    Goran, not Gordon, like tenis player Goran Ivanisevic

    1. Wow. I've never heard of that before. I've been reading up on it this week but still feel like I have lots to learn. It sounds promising. From what I read it is a potent natural anti inflammatory. I've avoided other anti inflammatories because they can make you feel so good that they carry the risk that you may cause more damage to the area without knowing it. For this reason I've always considered the pain signals as my friends. I wonder if this has ever been an issue with this treatment. It doesn't seem like it since it can keep people feeling better for years apparently. It would be interesting to see a long term study on its effect on cartilage.
      I truly apologize for misspelling your name. I read it quickly and substituted it with an American name I was more familiar with. Blush.
      Again, thanks for sharing this information. Its nice to know that I do have some back up options--even if it does mean draining my savings account.

    2. I just found that long term study I wanted. Thought I would share.
      Very impressive.

    3. Orthokine treatment sounds interesting. (One caveat: the page you linked to is not a journalistic article but a modified press release, thus explaining some of the non-objective phraseology such as "The results of a two-year representative study of osteoarthritis of the knee, published in the internationally renowned journal "Osteoarthritis and Cartilage", confirm the safety and effectiveness of Orthokine therapy"). I haven't really looked into this or PRP therapy (the one Doug Kelsey espouses), but I like the idea behind both. Re: Orthokine, chronic inflammation is definitely a problem for long-term knee pain sufferers. "Good" inflammation tends to morph into purely destructive inflammation over time, so fighting the inflammation in a natural way (and allowing the patient to get back into a more active lifestyle) seems on the surface like a pretty good thing.

  7. Jenny, I see that you are interested in details about orthokine. First of all do not expect too much from it. Orthokine will not repair cartilage, especially in a short time. This I mention not to think that I advertise treatment. I have real personal experience with orthokine injections.
    My left knee patella has cartilage lesion 12x9mm on the medial side. The degree is not defined but I had a sharp pain when walking up and down stairs, My right knee started to hurt after two months from the left one as a result of overloading, and it does not hurt on stairs, but in right knee I have constant pain for 15 months.
    I had 4 injections in left and 5 in right knee. Orthokine did nothing to the left knee, but, on the other side, right knee instantly (after first shot) felt better(70% better).
    In fact, orthopedist who gave them to me said that these are like a natural corticosteroids that help speed up the healing process. That's the real truth!!!
    Now, as I write this I do not feel pain in the right knee. I know it will be back in the afternoon but when I think of what it was a year ago this is real progress.


  8. My left knee is also much better. Now I can run upstairs. Sharp pain is almost gone. But I still have long way to recovery.