Why Hot Showers Help With Knee Pain and Stress Hurts

I was reading comments on this blog a while back and came across a knee pain sufferer parsing his symptoms for meaning. One thing that helped with the pain, he noted, were hot showers.

Yup. Makes sense.

But why?

Well, I thought I’d share my analysis of this phenomenon (“The Hot Shower Effect”), as others have no doubt noticed the same thing. Of course, my standard disclaimer: I’m not a doctor (nor do I play one on TV).

Anyway, I think hot showers confer a similar feel-good benefit as light stretching (which made my bad knees feel better). Namely, they loosen the muscles in the leg, so that when you sit, for example, your kneecap isn’t pushed so tightly against the damaged cartilage in your joint.

Stress would naturally work in the opposite direction, by tightening the muscles and placing the joint under more irritating force.

Of course there’s most likely an additional effect at work that has to do with mood and brain chemicals. Stress correlates with unhappiness, anger, frustration, anxiety -- all negative emotions. A hot shower is tranquil and relaxing.

Having a bad knee is a difficult, depressing experience. Whatever can get you out of that zone even for a little while -- taking a hot shower, meditating, laughing at the antics of some squirrel on YouTube -- should be helpful, even if it there’s more you need to do eventually to address the root cause of your pain.

The Dangers of Our Little Delusions

A couple of months ago, I got a really fancy bike computer that syncs up with a satellite in space somewhere, to monitor everything from distance traveled to speed. It can capture dozens of bits of data, including heartrate.

I ride hard once a week and easy three other days, so I assumed my aerobic conditioning would be between very good and excellent.

Boy, was I wrong. I wore the monitor one day on a challenging Saturday ride. I was alarmed at how quickly my heartrate jumped beyond my aerobic threshold. Even at what felt like low levels of exertion, my heart was beating about 145 times a minute.

It turned out that my “easy” rides had been too easy. I was riding a stationary bike in my basement and rarely clearing a pulse of 100. So I started going on long, easy rides outside, wearing the monitor and watching it like a hawk, keeping my heartrate from 120-135.

Now my aerobic conditioning is improving, and I’m riding better.

Still, I had really misjudged my conditioning. It reminded me of when I had bad knees, and I did something similar.

My legs were strong. I liked to walk. I knew movement nourished sick knee joints.

So I walked and walked and walked. Slowly. No uphills. And with some interspersed sitting. Still, my knees got worse.

It turned out that I had fallen victim to what is surely one of the most common delusions among knee pain sufferers:

Many people think their knees are stronger than they actually are.

I can remember becoming incredibly frustrated, because I was moving, which I knew was the right thing to do, and I was moving slowly and carefully, and I was taking occasional breaks too. But I wasn’t getting better.

That’s when I had a radical rethink of how strong my knees were. That’s when I came up what I thought was a program so simple and easy that my knees could not possibly be bothered.

I started going to the swimming pool, walking around the pool, then sitting backwards on a pool chair, with my legs elevated in a position that reduced the burning I experienced constantly. I’d repeat this endlessly -- walk around pool, rest with legs elevated, walk around pool, etc.

I did that for weeks. Boring as hell. But my knees actually began to feel better.

I talk about this in the book. An experience like that is both encouraging and depressing. Encouraging, because you see progress at last. Depressing, because you see what a deep hole you’re in.

But sometimes you have to come to grips with your little delusions in order to find a better way forward.

On Wearing Supports for Knee Pain

I enjoy the Ask Well column at the New York Times website. It’s well-written and does a nice job of summarizing important research/studies and doesn’t blindly follow the fad of the day. I was intrigued when the idea of knee supports came up for discussion.

My completely unresearched position is that knee supports could make sense. After all, one challenge for a patient is unloading the joint. Wouldn’t a good support do just that?

So I was curious about what this (rather short) column found.

First, the most common, cheaper supports, the elastic sleeves that you tug over your aching joints, probably don’t provide meaningful mechanical support. Which means they don’t work? Not necessarily.

Neoprene sleeves are thought to help by aiding proprioception, according to   Dr. Robert A. Gallo, an associate professor of orthopedic sports medicine. Proprioception is the body’s sense of where it’s positioned in space (interestingly, this ability appears to decay among knee pain sufferers).

We are told:

In theory, improved proprioception around the knee joint could augment knee stability by improving your balance.

Of course there’s another reason why they might work: the placebo effect. The placebo effect can be very powerful. I think it’s behind a lot of glucosamine’s perceived benefits, for example. I’m very skeptical of the glucosamine story, after the supplement did absolutely nothing for me and my research uncovered no reasons why it should have.

But back to knee supports: So let’s say neoprene doesn’t mechanically unload the joint (which isn’t surprising, if you think about it -- that a small piece of synthetic rubber could significantly alter the alignment or movement of a joint that regularly handles loads of your body’s weight plus; it would be kind of like expecting a reed of straw to hold up a brick). What then would help?

What could be useful, Ask Well says, are bulkier braces that really do unload the joint. These are more complex (and expensive) and sort of make you look like a cyborg. These braces have been shown in studies to help people with knee arthritis.

Me, I never used a brace/support. I did try patellar taping. Once that seemed to work really well. And on other occasions it didn’t work at all.

Oh well. Maybe that was the placebo effect too.