Someone reached out to me recently, asking (basically) the question above.
It’s a very good one. After I got better, my brother said that if he were me, he wouldn’t go back to the intense cycling I enjoy so much. Yet I did. And so far, my knees have been fine.
Was I foolish to do so?
I don’t think so. Here’s why:
* You should never go back to doing exactly what you were doing that caused the knee injury. That seems kind of stupid. For instance, if you decide to train by jumping off the roof of your shed, then springing up and running three miles, and you hurt your knees one day jumping off the shed -- why the heck would you keep doing that after your knees healed? :)
Or, in my case: I was cycling up steep hills, doing short sprints on those climbs, all while dehydrated -- and doing this back-to-back on Saturday and Sunday mornings. Would I do that again? Nope. I wouldn’t sprint uphill. I would carry more water. I wouldn’t do a max effort on Saturday and try to do a max effort again on Sunday.
* You have to get smarter in general. I still ride really, really hard. But I’m smarter about making sure I warm up properly. And in temperatures below 55 degrees, I always put on knee warmers (sleeves that cover the knees and a bit of the legs). Always.
Being smarter doesn’t mean I can’t charge up the hill with the rest of the pack on a ride. It does mean that I’m more careful about exercising in a knee-friendly way.
* I still listen carefully to my knees. There isn’t much to listen to now, thankfully. But I’m ever alert to early warning signs. If my joints started getting really noisy and crunchy again, you better believe I’d modify my behavior.
Knowing how to listen to your knees is especially important if you return to the activity that injured them in the first place. You don’t want to be grounded with chronic knee pain again. One reason you may not be is because you know what the danger signs are that you ignored the first time around. The key is not to do so the second time.
Yes, but what about those of us who did not overdo anything. Where did that come from . For 42 years I had no problems with my knees and then suddenly everything collapsed like a house of cards. There must be something systemic involved. I'm not satisfied with "wear and tear" theory.
ReplyDeleteThe only thing that makes sense is that the knees require constant movement. Neither too little nor too much. Just a optimal amount of movement. In my case, there was a lack of movement.
This is an interesting point. What happens when my knee suddenly implodes seemingly overnight and I'm not physically active? Or, if I am physically active, what if it implodes overnight but I haven't done anything unusual? (In other words, I'm just following my normal workout regimen).
DeleteI did way too much thinking about knees when mine were hurt. Some of that thinking went into a couple of blog posts entitled "Of Breakdown Points and Discontinuities in Healing." The idea was that accumulated stresses can very rapidly turn a normal situation into a nightmare (and yes, inactivity and too much sitting will lead to accumulated stresses, in my opinion). Anyway, they are here:
http://savingmyknees.blogspot.com/2012/03/of-breakdown-points-and-discontinuities.html
http://savingmyknees.blogspot.com/2012/04/of-breakdown-points-and-discontinuities.html
My knees are finally healing; and feeling quite good (thanks to walking). However, both ankles are falling apart (due to walking). Has anyone else experienced this? If so, what did you do to heal ankles? Thanks in advance, this blog has been a wonderful forum of information, thoughts, and opinions!
ReplyDeletefirst step, get good shoes. I am hypermobile (my joints are like playdough, bendy and strechy) and I need good support shoes or else my ankles flip flop. I am wearing Ecco shoes with some arch support as my feet are very high arched. I also do a ankle strengthening exercise: stand on one foot (holding to something) and do a very slow rise on that foot, hold 3 seconds then slowly go down. To be repeated several times. It may be worth checking with an osteopath too, as sometimes a shift in your gait can affect other parts of your body, including the back and neck
DeleteHi Deloupy,
DeleteThank you for your response. It is interesting as I have good shoes but I have very flat feet and orthotics to support my feet (honestly; I think they are useless but I'm used to them and find them comfy so I keep wearing them). I just started doing to heel raises this week and definitely notice an increase in ankle pain after my daily walks, ah! My knees aren't ready for easy cycling yet so trying to find the knee vs ankle balance.
Ah.... I'm sorry to hear that this is making your ankle worse. Unfortunately, that's the message in Richard's book: what works for someone may not work for someone else. Do not do anything that increases your pain. I used to get sore ankles and the heel raises worked for me, but as I said I'm hypermobile so definitively need to strengthen the ankles or they go very loose. Have you seen an osteopath? I recently injured my back and my right knee started acting up (it's usually not painful at all). I knew that because my pelvis was locked - I walked with straight hips due to the pain in the lower back - it would affect the rest too. As soon as he put me back together, the pain went away (sadly, not in the left knee.... that's a long term pain that can't be fixed so easily)
DeleteI'm glad to hear you found relief with an ostepath. I myself have not been to one but my massage therapist did suggest it. I brushed it off as she made it sound like they focus more on low back pain and my understanding is in Canada; osteopaths are not regulated by the gov so I wasn't sure how "qualified" they were. I plan on continuing with the heel raises and see how I feel as I just started those. I definitely want to get back to walking since that is what helps the knee pain the most. Thank you for your advice!
DeleteI´m sorry to hear that, Anonymous. As if a pair of bad knees wasn´t bad enough...
DeleteI find it amazing how could easy walking wreak havoc with your ankles. Perhaps they were so unused, so unfit, that even easy walking became too much. Have you tried walking without the orthotics? Despite the good intention in them, they could be to blame. I would recommend walking without the orthotics to see how your ankles (and knees) respond to that. I think you could also experiment with another pair of shoes or even barefoot walking. Although your shoes are good (aka expensive), it doesn´t necessarily mean they are good for all your necessities. They might not be good at all. Consider also walking on softer surfaces than concrete. Sometimes small changes can go a long way, even though they sound counterintuitive at first, and experimentating is usually the only way to know.
Hi Richard, your blogs and book have been very enlightening and giving hope, I cant thank you enough! Please give your valuable suggestions for my condition..
ReplyDeleteMy ortho doctor says that I have slight bow leggedness, patellofemoral problem (patellar maltracking) and initial stages of chondromalacia (MRI normal). The knee starts to swell up and subsequently hurts if I do jogging/running/ sitting down cross legged/ some yoga postures etc. There is pain on the lateral border of patella and a loose band of tissue has developed over the years that hurt if I flex and extend the knee. I can walk upto half an hour.
Reading your book, I have started walking, gentle cycling and isometric quad exercises. Kindly suggest what could be done more to heal the lateral patellar area..? What could be that loose band thats attached to lateral patella?
Would you suggest me to buy the 'Runners knee bible', since it costs a bit, I would buy if it will be really useful.. ? Does it contain exercises that I can do or it requires costly equipments?
Thanks once again for your help!
Yes, "Runners knee bible" is a good book. It contains exercises for chondromalacia, and no,it was not helpful, at least not for me.
DeleteThanks gcoza.
DeleteAs Doug Kelsey says, swelling generally indicates that you're subjecting the joint to more load than it can handle. So it's good to get away from activities that prompt swelling, Anonymous. I'm not sure exactly which exercises may target the lateral patellar area, and honestly, if I were you, I wouldn't get that focused. I'd just try to get my knees feeling better overall. Is Kelsey's book a bit expensive? Yeah. Is it a good buy? I think so, especially as he shows you a lot of exercises. Maybe the best option would be to find a physical therapist who's worked with Kelsey or believes in his philosophy and to work directly with that person.
DeleteThanks for the time Richard! Iam Sairam (sairamisha@gmail.com) from India, working with an NGO. I will definitely buy Mr. Kelseys book, as I cant meet him in person and there are a few of my friends whom might also benefit. Already there are fans for your book in my circle.
DeleteAs you say swelling is an indication of knee crying, I didnt think much in those terms because pain was less and vague.
Please let us know if you come across any information about bow leggedness and its surgery free correction..
My best wishes for your good work.
Hi Iam,
DeleteI purchased Kelsey's book and I personally believe it is worth the money. He has lots of good information, exercises, etc. That combined with a walking program is what I believe is key to healing bad knees. Best of luck!
Thank you very much!
DeleteHey Koolaid! How embarrassing...
DeleteAlso can the slight bowleggedness be responsible for this patellofemoral knee problem? Is it worth considering any specific exercises for that, because when I stand straight I find more tightness on the lateral side of knee than medial side..
ReplyDeleteWould really appreciate if somebody can throw light on this as it is a chronic frustrating issue...
Hi Richard, can you please clarify this doubt..
ReplyDeleteYou had written in your book that isometric quadriceps exercises with less load and high repetitions are good for the knee, instead of conventional high load and low repetition. The exercise that I do is keeping the legs stretched and pressing the knee down by contracting the quads.
So does this mean that I should do it with less contraction force (and do 10 counts) and repeat many times, instead of contracting the muscle strongly..?
Thank you..
I'm not quite sure what exercise you're doing, but generally, yes, I believe you want low load, high repetition. If you're doing isometric exercises, however, the issue of overtaxing the joint may not be as serious, as you're not moving the joint. Still, I'm not completely sure on that -- your best bet is to work closely with a physical therapist who believes in low load/high repetition. Or read some of Doug Kelsey's writings on good exercises to do for knee pain.
DeleteJust got the book, thanks Richard..
DeleteHi Richard, Iam grateful for introducing Dougs Runners knee bible book..
ReplyDeleteHow can I do the bilateral and single leg squats that are mentioned in it if I dont have the Total Trainer and leg press machine.. is there any way out? Can I just do normal squat exercise in standing posture by guessing the load tolerance for the knee..
Is there any means to contact Doug by the way, I didnt find any mail id in his website..please guide me
I don't think Doug distributes a private e-mail. Not that he strikes me as an unfriendly guy, but I can imagine he would be inundated by people seeking advice. I can certainly understand his reluctance. Your best bet may be trying to set up a phone consult with someone at his Sports Center clinic in Austin, Texas.
ReplyDeleteIf you don't have a total trainer, next best thing may be trying to jerryrig a way of doing unloaded squats. I mention one setup I used here:
http://savingmyknees.blogspot.com/2011/05/three-interesting-things-i-left-out-of.html
I was wondering what could be the root cause of knee swelling in patellofemoral syndrome, since thats the main issue for me, vague pain only follows the swelling. Please correct me if Iam wrong..
Deletedamaged /unhealthy cartilage leads to irritated synovium leads to swelling and vague pain. This is what I understood from your book savingmyknees. So the swelling should come down once I do proper cartilage strengthening measures which would heal the synovium..is it not?
About keeping the knees elevated for swelling reduction- is this only a symptomatic relief or it will help in long term healing..?
Thanks for the time Richard..I have started a regimen based on your and Doug's inputs with ups and downs, hoping for the best. Thank you very much.
I think the easiest way to think about swelling is that it occurs when the load placed upon the joint is more than it can tolerate. So if you're getting a lot of swelling, you're overstressing your bad joints.
DeleteI don't think that reducing swelling is just symptomatic relief. You want the knee clear of swelling/inflammation so that the joint can move properly and isn't subject to damaging inflammatory processes. Anyway, that's my take on things, as a non-doctor.
Yes that seems right..thanks Richard
DeleteThats a great idea for unloaded squats..thanks Richard
ReplyDeleteThanks for all your support Richard. Small doubts when cleared bring big relief. This has been persistently nagging since few days.. my knees are bad (swell up by walking even for a km) and Iam doing the low load high repetition exercises. When to start the unloaded squats? right now or after one or two months of knee friendly activities so that knee becomes better further..? If it doesnt hurt, should I start right away..
ReplyDeleteMany thanks for your time.
It's hard for me to know. You may be the best judge of that (or a good PT if you can work with one). If you're having swelling, you may want to wait. You also may want to think about doing movement shorter than a kilometer. At one point in my recovery (early), I just walked around a swimming pool every ten minutes. That was it. I really scaled back. Movement is critical, but it's a delicate balancing act between enough and too much, I believe.
DeleteOk, I think I should wait and just do low load activities for some more time so that swelling goes down fully, hopefully..
DeleteI feel this kind of information (this blog and the book) is a must for every ortho, physio doctor because patients rely on them totally and just advising some quad exercises is taking them nowhere..thanks Richard
Hi Richard,
ReplyDeleteIam 33 and have bilateral chondromalacia patella, for the past 15 months. MRI shows thinning of cartilage in both knees with more on the right knee. I am a Physical therapist and have pain even on standing, walking and transition in standing from a chair or sitting down and also dificulty while climbing down stairs.I had completely avoided floor activities but still continue to use stairs as I reside in apartment on second floor with no elevator. My orthopedist had strictly warned me against using stairs.
I purchased your book, Saving my knees....and found some relief to know cartilage heals. My three weeks off work did not help me in any way out of the pain. I still have pain and swelling in both my knees especially in my right knee. I wanted to purchase Doug kesley book, but am confused if I have to go with the first or the second one though there is overlap.
Will I be recover my cartilage completely and continue my profession as a Physical therapist, which is my greater concern. Is there anything to do to cope up with stairs atleast until I can shift to a lower floor which will still take some time.
I think you should buy the runners knee bible. The second book is for osteoarthritis of the articular cartilage of knee, someone correct me if Iam wrong..I use my hands on the railing so that it takes much of the knee burden while climbing stairs.
ReplyDelete