Saturday, January 17, 2015

Did My Knees Really Get Better Or Do They Just Feel Better (And Does It Matter)?

A long title but I couldn’t think of a good shorter one.

After reading my story, some people say something like this:

Why don’t you get another MRI (or some other test) that shows whether your knees really healed? That would prove whether your program really worked.

To be sure, this kind of comment has never been phrased in a hostile way. There’s no implication I’m a liar or fraud. Rather, people have a deep curiosity -- the same as I do actually -- about what changes physically occurred in my knee joints between the worst days of my condition (when I was suffering each day in Hong Kong) and now.

If I could do such a test (for cheap), and it could measure such a thing, I’d do it in a heartbeat. Hell, I’d love to know. Armed with the test results, I could probably sell five times more books. ;)

But it’s not possible. Here’s why.

(1) Simply having an MRI done would cost a lot; I’m guessing at least $1,000. And my health insurance company isn’t going to pay for a “there’s nothing wrong but I’m curious about what my knees look like” MRI.

(2) I don’t have an ideal MRI to compare it against anyway. True, I had images taken in Hong Kong in early September 2007, but that was before my disastrous experiment with weightlifting to strengthen my quads (which really trashed my knees). An MRI done in November or December of 2007 might have shown more damage.

But here’s the big reason:

(3) My original MRI exam was only somewhat useful in identifying my problem and determining the extent of it. Actually, “somewhat useful” may be a too-kind phrasing. My MRI basically said I had changes consistent with mild chondromalacia. So it found no giant potholes in my cartilage that a subsequent exam might show had healed.

My suspicion is that if a surgeon had cut open my knee, he would have spotted some kind of more obvious cartilage damage not detected by the MRI. But I never went that route (thank God). So, like many knee pain sufferers, I don’t have a good baseline test that says, “Wow, your cartilage is really messed up!” I suspect I was on the verge of going downhill fast, but I was fortunate to fix my knee pain in the relatively early stages.

So how do I know there was damage in the first place and I didn’t just suffer from some weird neurological ailment?

Well, as I relate in the book, there was a lot of noise from my knees when I dropped into a squat (as if I were about to sit in an invisible chair). My knees were so loud that my doctor felt compelled to be blunt and opine that the joints would never get better. Also, when I went into a deep crouch -- which was hard to do and uncomfortable -- and then straightened up, there was a loud, ugly “ripping” noise.

But now those disconcerting sounds, whatever they indicated, are either gone or much quieter (I can still hear a little crunchiness in my knees, but it’s not painful at all). I’m back on the bicyle, riding as hard as ever. I can sit at my desk again through a long 10-hour-plus day without issues.

Do I have a before/after set of tests that shows the improvement? No. But even if I did, would it matter? I’m not so sure it would. Just from the way I feel, I know something in my bad knees sure as hell healed/improved significantly. And I’m pretty confident of that, whether or not those changes could be detected by an MRI or some other test.


  1. Actually this is something I have thought about. If I recover, hopefully I will, sooner or later, I want to get another MRI to confirm if my cartilage has healed or not. But actually now that I read your post maybe the MRI doesn't matter that much... If I feel good and can return to sports... That's what matters. I know people who are almost bone to bone and feel better than me with 'mild chondromalacia'.
    You can always cheat and tell your doctor you have knee pain again to get the MRI referral if you really wanted it checked again. Of course if your insurance can cover the cost or if you can afford it. I would be curious to see the results .

  2. Love your work. It has meant so much to me. Bedrock for me. I have tried to comment several times but get locked out somehow technically.

  3. Hooray! I finally got through. Thank you husband. I have read & retread your book so many times. I overdid the daily steps too much at first. After I got my knees comfortable but not strengthened, I got a cheap total trainer & tried the Doug Kelsey program. Too many repetitions caused a big set back for me. There is no information in the book about how to fit the training into the amount of time you are on your feet during the day. After my second go at the program, I had a holiday period where I was on my feet far too much each day. I blew all my walking progress. I am in my mid 60's. So I am back to walk arounds of 100 every half hour. I use the trainer at a much reduced rate on alternate evenings. My version of Doug Kelsey's tailgaters is to sit & do half way round pedals on my exercise bike( so that my sore knee never goes beyond 90 degrees.) it has always helped me to sit on a platform edge waist deep in a pool and bend my legs slowly from nearly straight to just under 90 degrees. Once again the tailgaters idea of low load repetitive motion.
    I am looking forward to this sore stiffness disappearing as it has twice before.
    The gradually increasing doses of walking that you recommend have been my bedrock.
    I am so grateful you published your book & I found it 18 months ago.

    1. Great to hear from you, Ozjan. Happy that you're finding some success -- but progress is slow and difficult, with various setbacks, as I see you're also finding. Best of luck, and check back here in the future to let us know how you're doing. Cheers!

  4. I'm getting through a very 'interesting' patch. When I first felt pain, 18 months ago, it was in both knees. Gradually, the right one improved so much that I never felt pain.
    Two weeks ago, I was looking after a friend's toddler, a 2.5 stone little man who can't climb stairs so I had to carry him up. That evening, my right leg (which, being my strongest, I use to haul myself up the steps) was very sore on the ITB. The next day, it was worse. By Monday, the knee was painful. And so I made this discovery: the reason why my MRI didn't show any damage to the cartilage is because there is none, or very little. I am convinced of this. Looking back, my knees were always painful first on the side, and progressively the pain moved to the front.
    At the moment, after a week of careful conditioning on my ITB, the pain has greatly improved and I can't really feel much in the right knee. The left one, however, having had to work that little bit more in the last few days, has gone worse. But only on the side of the knee, and when I press on the ligaments over it. right where the ITB runs, it is very, very sore (I don't know about you, but when I have pain somewhere, I can't help poking at it!). I know it will settle. It is also hugely positive for me to understand my pain (s). At the end of the day, the walking programme seems to help that kind of pain too, so I'll keep going!

  5. Doctors have told me that MRI's are not that accurate at showing the state of your cartilage.