If nothing else, I hope one message in my book is crystal clear: You have to get involved in fixing your knees.
Why? Here are three reasons: (1) Your particular problem has a particular solution; what worked perfectly for me (or someone else) probably won’t be exactly what you need. (2) A doctor or other medical professional trying to advise you will never gain as complete an understanding of your symptoms as you have, even if he spent five hours with you. You ultimately know better what you can and can’t do. (3) You need to be able to monitor and adjust your rehabilitation program in real time and your orthopedic doctor won’t be on call, 24/7, for every small question you have.
Part of getting more involved in fixing your knees means honing your skills at playing medical detective. Think of your evolving symptoms as a nonstop “Who dunnit?” (or “What dunnit?” may be more apt). If you want to avoid pain/flare-ups of symptoms, avoid doing the thing that triggers them. (Note: Believe me, I realize sorting out cause and effect isn’t always easy, especially when there are renegade inflammatory processes in the mix.)
The good thing is, once you develop “medical detective” skills, they’ll come in handy. In my case, they helped me solve (and heal) a couple of mysterious injuries in the past few years.
The Case of the Sore Index Finger:
This was a strange injury that kind of crept up on me. Quite simply, I began noticing my left index finger was sore, in the joint nearest the fingernail. Whenever I I pressed down on something with my fingertip, the joint would hurt.
What the heck? Was I just getting old, I wondered. Maybe starting to develop some arthritis?
But then I started thinking. “Hmm. Why is this joint -- and only this joint -- sore?” My right index finger was fine. Then I discovered something: The joint was being strangled twice a day. And I was responsible!
What I figured out was that, for my twice-a-day flossing, I was wrapping one end of the string around -- you guessed it -- the last joint of my index finger. I didn’t notice any pain or discomfort while flossing, but the soreness was evident later.
After realizing this, I started wrapping the floss away from the joint. Today my index finger is perfectly fine again.
The Case of the Sore Thumb
More recently, I had a problem with soreness around the base of my thumb joint. It was a nagging minor pain. As with the index finger, I couldn’t recall precisely when the pain began, or an injury that may have precipitated it.
Again I wondered: What’s going on? Is this age-related?
Well, I knew age hadn’t been the issue with my index finger, so once more, I began paying close attention to the unnatural forces on that thumb. And I found one -- but it was so minor I couldn’t believe it was the culprit.
I wear a backpack to work -- except usually it’s not on my back. I sling it over my right shoulder. And I caught myself, more than once, absent-mindedly pressing my thumb against the strap, stretching the digit back.
That can’t be what’s to blame, I thought. How can a little thing like that cause a problem? Still, I made myself stop pressing my thumb against that strap when I walked with my backpack.
And the pain went away.
The funny thing is, had I gone to a doctor for either of these problems, I probably would not have gotten a helpful analysis or solution. It’s not his fault; I wasn’t doing anything obvious that was causing either of these two joints to be sore. Further, a doctor might have put me in that “old guy” box (“You’re on the wrong side of 50; it’s just some inflammation that may eventually become arthritis; if it really bothers you, I can write a prescription for some pills.”)
But the cool thing is, I managed to figure it out by myself. And I got better. I’ll take that outcome any time.
Update: Oops, I see that this post is open to misinterpretation. My fault. To be clear: I don’t mean to imply that you don’t need doctors or physical therapists at all. I don’t mean to imply that you’re your own best doctor (in the end, you may be, but please don’t start out with that assumption).
I do believe that you need to get involved in helping solve the mystery of your knee pain. In other words, don’t go to a professional when you have chronic, hard-to-treat pain and expect to be handed a perfect solution on a silver platter. This goes to the heart of one of my beefs with people today: I think they look too often to the quick, easy, other-provided solution: a pill, a surgical operation, 35 leg lifts at dawn every other day, etc.
Here is why I would always start my knee pain journey with doctors and physical therapists: (1) They’re usually pretty smart people and good, careful thinkers. (2) They have extensive training and a broad understanding of a human body’s biomechanics that I’m betting you don’t have. (3) They have experience treating bad knees just like yours. (4) They (doctors anyway) have access to diagnostic equipment that can help shed light on what’s going on with your bad knee(s).
The first step to fixing a bad knee is figuring out what’s wrong with it!
Ah, but what if they don’t find anything? This is where things get more complex. If your doctor shrugs and basically says, “You’re getting old and your knees are just wearing out” -- well, that’s not too helpful. So here are my main complaints about many doctors and physical therapists: (1) They’re too fixated (physical therapists especially) on this idea that if your knees hurt, the underlying cause must be an imbalance/crookedness. (2) They’re too pessimistic (doctors) about the prospects of your knees getting better. (3) The exercise routines they prescribe (physical therapists) are usually too hard because they focus on muscles when they need to focus on joints. (4) They don’t work hard enough to help you craft a sensible, go-slow program to improve.
But -- and here comes a huge but -- this isn’t always true. Celebrate when you find a good physical therapist (I believe they can save you; a doctor’s usefulness tends to be limited after he shrugs and says “I can’t find anything wrong, so just try not to aggravate the joint.") A smart, patient, dedicated physical therapist is worth his or her weight in gold. I said that in the book, because I really believe it’s true. Just be careful: A bad physical therapist can mess up your knees really, really fast.
Finally: a nod to Doug Kelsey who is hands down the best physical therapist I know of (disclosure: I base that solely on his writings; I’ve never been a patient of his). He wrote a great book here. If you want good insight into chronic knee pain and illustrated exercises that will help you get better, check it out.