Saturday, August 29, 2015

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.


  1. Good point, Richard.

    What are your thoughts on trying to denervate (remove the nerves of) the kneecap? Do you think this would help with pfps?

    1. Eh, I'm not keen on that. Nerves are there for a reason. If they are overactive without good reason, maybe try neural blockers (after consulting with a doctor of course)? When you shut down nerves, you risk doing damage that you no longer can detect.

  2. Hey Guys, I just wanted to share my story.

    My name is Kevin. Although I am in the very beginning of my story, I still want to share it. This blog and Richard's book has given me hope, and I cannot stop reading the information, I have read the "saving my knees" book and am currently going through the blog. I wanted to share my story right now. I am a 23 male 5'8 165 lbs, not overweight - I have a high bmi because of my muscle mass. I was powerlifting and running on concrete regularly for the past 3 years and have never had a problem until recently.

    I have been struggling with knee pain (in both knees) for a little over 2 months now. Symptoms include dull aching pain on a regular basis and having to pop my knee regularly. I stopped powerlifting and running after realizing that it kept digging me into a deeper whole with my pain. Even activities that I thought were low stress (sand volleyball) made me worse. I tried to bring my knees back with other things like strengthening VMO, strengthening hip abductors, glucosamine, foam rolling, stretching, nothing worked. Went to the doctors and they took xrays, doctors said it is patellofemoral pain syndrome and did not know what the problem was. They suggested I stretched it out, and in a month if I did not get better we could talk about an arthroscopy. I work as a therapy tech and am on my feet a lot, my duties also include squating and lifting things fairly often - this was making my pain worse. So as hard as it was, I asked for time off of work, may have to quit my jobs upon realizing how long this recovery may take. But, I will do whatever it takes to allow my knees to heal. It was not until a week ago that I found this book and started really "resting." My knee joint is weak to the point where even quad sets cause some discomfort later in the day and the next day. I set myself back Monday when I was at my chiropractors office (have been getting treatment for the past 2 months for a car accident too -unrelated). She took a look at my knees and had me do some leg extensions, stupid move on my part, I should have known. Later that day my knees were all stiff. Now my rest is even more defined. I am implementing what I have learned from you and "save yourself from patellofemoral pain syndrome."

    The past 3 days I have been pretty much bedridden. I have been doing six 2 minute walks a day. My toughest thing right now is showering. I have a tub shower, and standing too long starts to make me uncomfortable. So, thinking that my knees are freshest in the mornings, right when I wake up I go straight for the shower. I shower and then go back in bed and allow my knees to rest before doing anything else. I started propping my knees upon realizing that sitting was what was causing a large part of my pain. However, propping my knees started causing my back, neck, and elbow to start hurt (coping strategies), but I am trying to make it as comfortable as possible because I know in the end it will be worth it. I am getting up with my upper body, and have not been very careful to not flex my legs at all. I am fortunate that my brother is home half of the time, he has been helping me with cooking, washing dishes, and laundry. This is tough, but I know I will persevere. I will very slowly build up on "cartilage time." I feel at least I have a sense of direction. Anyone who has been suffering with Patellofemoral knee pain for a while needs to check out Richard's stuff. I really believe the material Richard gathers is decades ahead of our medical care's view on knee pain.

    I will keep everyone updated on my progress.

    1. Hi Keving,

      I'm sorry you too have PFPS, but at least you got in the right track early on. I wasn't that lucky and have been struggling with this problem for 9 years, since I was 18, with no success yet.
      Just a heads-up: be really careful with your diet. You were very active before, so you will gain weight massively if you don't reduce your calories intake. You seem to be a smart guy and I believe you are already aware of this, but better safe than sorry. ;)

  3. Hi Kevin, welcome!
    Thanks for sharing your story.
    I had the same problem when showering! It was so frustrating...During that time I had the fastest showers ever, trying to finish in 5 min max!
    See you around here!

  4. HI Kevin,

    Sorry to hear about your knee pain. I too have had elbow pain since injuring my knees! Super frustrating. When doing quad sets have you tried propping a pillow underneath your knees for support? As well as squeezing glutes first? It helped me, best of luck!

  5. Luiz- Yeah I am definitely eating less now, thank you!!

    Athenea- Hahah yeah you definitely learn how to be creative with things...Everything has its pros and cons, with my faster showers I have noticed there are times where I go too fast and put too much pressure on my foot while rushing or losing balance, so I still have to be very careful while speeding it up. Sitting down in the shower floor feels better, but then the matter of getting back to my feet may set my upper body or knees back further whenever I do a movement wrong. Lots of trial and error, but I am learning!

    Alex- I will try the quad sets like that thanks!

    Update- I have been resting for about 2 and a half weeks now. My step count is 2200-3000 total each day. I have had 2 major setbacks during this time. I just had my second setback yesterday, when I messed up getting up from the shower floor (used too much of a squat up with my left leg). I am just going to go back to standing in the showers again from now on and rush it. I was just starting to see progress too, my knee joints had just started feeling stronger with the little activity that I was doing. Overall, I am feeling better than I was a week ago though. I still have my legs propped up and elevated all the time. I am walking 70-100 steps every 30 minutes throughout the day. I am beating this thing!!

    Anyone have advice on the elbow pain? It is still a pretty new injury, so I think it could go away with rest and low activity. However, after seeing the way my knee is after all the overuse, I am definitely going to be more cautious about this body part and try rehab/strengthen it.I think Richard mentioned slow eccentric bicep curls in his book?

    1. Yeah eccentric exercises work well if you have tendonitis but if you suspect it may be cartilage problem maybe get it checked first... I'm not sure if eccentric will work for cartilage so I can't say for sure.
      Congratulations on your little progress! Remember that even small progress is still progress so always look forward and accept that setbacks are part of the process :)
      I don't recommend you sit on the floor while showering ... it can take a lot of effort to stand back up and it can also be pretty slippery so be careful :)

    2. By the way at the beginning of my injury I also had elbow pain. I couldn't figure out why. Until I started to pay attention to what I was doing with my arms. Eventually I realized that the pain was coming from the extra effort I was doing with my arms when going upstairs. As I didn't want to use my legs, I was basically using my arms to lift me up on every step... I stopped doing that and the pain went away. It was pretty scary at that time as I was freaking out with joints in general haha, but it turns out that was the cause for me! Maybe you really have something in there so better have it checked but also see if you are doing something that may be causing the pain.
      Good luck!

    3. Hi Kevin, when you said you were "resting," initially you had me worried that you might not be moving much at all. The key, I think, is to move as much as possible, but early on, to do so mostly in short bursts. Anyway, it sounds like you're doing that (70-100 steps every 30 minutes). Please keep us updated on how things go. There is no magic recipe; you'll go through periods where you'll try things, make mistakes, then start trying different things.

      As you can tell, there's a readership of smart, curious people here who can lend advice/support. In fact, they can share what's helped them. The hive mind has gotten a lot smarter than me alone. ;)

      Also, I got your question about what to do about medial epicondylitis. It's funny, that's exactly what I was prescribed with. The eccentric bicep curls that I described doing in the book were what worked for me. I find it very odd that a number of us who have/had knee pain had this same problem of weird pain popping up in other joints. Hmm.

  6. I also second the request for advice to heal elbow pain! My elbow stabs like my knees so I assume it's cartilage.


  7. It's insane, I'm 32 and a soldier. I'm currently going through the medical discharge process for grade 3 cartilage damage of my right knee. I'm applying the 'joint first' approach from your book to repair my cartilage.

    Just a note but walking and gentle cycling works for me so I'm planning to keep it up until I can hike again. Hoping that in a year or so I'll be repaired and strting a new career somewhere.

    However recently I have started to have pain on my right inner elbow. (It's my right knee that's damaged) It just seems strange. I have been an extremely fit person for years and now I feel like I'm breaking all over.

    Your book was an inspiration to me and I understand the theory of how we can aid our bodies to heal themselves through high repetition of the correctly loaded exercises.

    I just wanted to point out that I am too having elbow paiN, hoping eccentric loading bicep curls at high reps sort this out quickly. Not being able to run was ok while I could hit the gym but now I can't do either.

    Thank you so much.

    1. Sam, thanks for dropping by. Check back later when (I hope) you'll have some good news to share about your progress.

      The "migrating" joint pain phenomenon is very odd indeed. I remember a doctor pretty much telling me, in absolute terms, that there's no way that my elbow pain was connected to my knee issues. Yet you are far from the first person who has commented here who said they wound up with pain in their elbow joint (just like me).

      I'm glad you tolerate walking and gentle cycling well. Those are two very good activities. Good luck.