Saturday, September 12, 2015

On the Virtues of Going Slooooowwwww

My contributions to this blog will soon become less frequent. Honestly, I just don’t have as much left to say. I don’t want to become like that tiresome grandparent who’s always telling the same story, as if you haven’t heard it eight times before.

Of course, I’ll always be monitoring the comments. And the best way to reach out to me, as I’ve said before, is to leave a comment.

Occasionally, when thinking up ideas for blog posts, I ask myself which messages are worth repeating -- what have I said that should be said again and underscored, with a few exclamation points added at the end? One such message, I believe, is lose weight.

Another is this: you won’t believe how slow healing a pair of bad knees is.

No, really. You. Have. No. Idea.

Now some of you, whose knees aren’t too bad, will be on the comeback trail in a few weeks and may be much better after a month or two. If so, congratulations and utter a small prayer of thanks. Because you got off really easily.

Most of you won’t be so lucky. You’ll spend months tinkering with a recovery program, changing diets, exercises, and all sorts of variables. You will wonder if you’re making progress. Self-doubt will sometimes become intense.

The problem is, often it can be hard to tell if you’re moving forward or running in place, going nowhere. I think this is especially true for people with really bad knees, who most likely need to spend a few years just to get them to improve from terrible to bad.

I know there are a lot of mysteries about how healing occurs. But I think it can. That, to me, is a tremendously inspiring message.

But it’s always good to keep in mind that slow, gradual progress -- even slower than you think is slow -- is the best way to go.


  1. Thank You for creating this blog and for writing the book , I read it few days ago. Thanks for the information. I am 36 years old, use to be a very active runner and cyclist. I am struggling with the Left knee pain for the past 4 years. I was unwise and had 3 arthroscopies which did not solve the problem. I have chondromalacia and had a defect of a medial femoral condyle. I tried everything I could, pills, physio, specialists, surgery (arthroscopy) had microfracture done. I think most of my sympotms come from the chondromalacia. Over the past 2 years I also developed terrible ankle pain as a result of probably altered gait. There are good days, bad days and nightmare days. I will try to develop a plan of action/diary to come up with a solution to heal my knees. I am a family physician myself and work full time, sadly medicine has no answers for me. I do believe that you are right in saying that knees can heal if you give them time. I hope to recover in the next several years. I do believe you are correct, cartilage will take a loooooooong time to heal. I will take that change thought. Thank YOu so much again for the book you wrote.

  2. A quick update.

    3.5 years into the journey now, pain down by 70-90% (varies a bit), function up by about 50%.

    Can now do a little 30min boxing-weights-core circuit in the gym which includes 4x6x35-40kg deadlifts 2x/week

    Also up to about 22mins on spinbike, with some segments where HR gets to 130-140, plus some 1min bursts at 150-160 (though I'm not sure those are wise) 2x/week

    Still walk 20-30mins every morning and sometimes another 10-15 on treadmill @ lunch.

    Day-to-day living/tasks much better.

    I do think prolonged sitting was a major factor in my demise.

  3. My quick update:

    2 years of pain.
    Constant pain down by 50-70%, also varies from day to day, and morning to afternoon.
    Function better 50%.
    I can squat, run(although carefully), ride a bike, do stairs. All the things I could not before two years.
    Daily tasks also much better. I'm still not ready for cinema, but, most importantly I can drive long distances and do my job.

    And, yes, too much sitting was the cause to blame.

  4. Thanks Richard for writing this blog. I wouldn't be where I am today without your advice.
    Two years on, I am much better, although it's difficult to put a figure on it like TriAgain and Gcoza. Some days I can feel my knees crackle, pop, and go into spasms. Some days, I almost forget they are even there. I went on a 2 hours hike, not a knee friendly one with lots of hight steps to go up and down. I took a few breaks, but generally kept up with the others. The following days, my knees were fine. I danced two nights ago, and my knees still seem ok. I'm trying new things one at a time and see how I tolerate them
    My right knee is weird: it was always the strongest one, but now that the burning in both knees has abated, this knee keeps jerking and getting weird fleeting pains in the surrounding ligaments and muscles. Last week, out of the blue, the quad had a spasm and the whole knee jerked, it was so painful. A minute later, the pain was gone. Weird or what....

    1. Richard,

      I always wondered how did you stumble across Doug Kelsey? Thanks to this blog I found DK's book, principles, and am now working with one of his coaches via Skype and I'm finally seeing improvements after 2 years of things only getting worse; to the point where I could barely walk.

      As for my fellow knee pain suffers, I know everyone is different but I would love to hear what activities are helping you beat knee pain if you feel like sharing!

      Take care everyone,

    2. Alex,

      First up, I haven't beaten this thing yet, but have made good progress.

      Second, it is as much about what activities I avoided as what I did. Things that made me worse were running, cycling, kicking while swimming, heavy lifting, stairs, squatting/crouching, ladders, almost every exercise prescribed by a mainstream physio/doctor plus others I've forgotten, any thing that combined frequency with even quite moderate load.

      Third, in terms of activities that worked, I'd say moderate walking (100-120 steps/minute) on mostly flat ground, improving diet to keep weight down, swimming but with no kicking using a pull buoy and ankle band, upper body weights in gym to maintain some strength, sitting at a desk with my legs out straight propped up on a box (no prolonged bent-knee sitting), wandering around slowly fly-fishing (strangely, I could do that for hours over some pretty uneven terrain).

      Also a determination to beat or at least improve my situation, despite some advice to the contrary (e.g. the psychologist saying "you can't beat nature"). Thankfully, most other medicos were far more positive, though none understood what a long process it is.

      My approach was somewhere in-between Paul Ingrahams book on PFPS and DKs book the 90 Day Arthritis Remedy (I found DKs exercises too much).

      I've recently delved into Dr Shane Dye's papers (thanks R-X for the link), and am pretty sure my problem was loss of knee tissue homeostasis, started by pre-existing patella chondromalacia, inappropriate triathlon training, meniscus surgery followed by very poor OS advice about return to training after surgery = tipping me over the edge. There was also a pre-CRPS element to it (probably triggered by arthroscopic surgery - quite common).

      Here's some summaries I put together for another purpose:



    3. Alex, water physio was the only thing that broke the cycle of pain and less movement thus more pain thus less movement... When I started, I was walking 10-20 min max with a stick, couldn't stand for long, couldn't sit for long, etc. After 3 months, I picked up the courage to let go of the stick. After 9 months I started cycling (albeit very little and slow) and hikking. I still do it, on my own, once or twice a week, 45 min solid of all body exercises. I have days when I run in the water, and days were I take it more slowly. It's also beneficial for my back, which had jammed a few times, since I couldn't bend using my knee, the back was doing all the work.
      I also did an awful lot of pilates, targeting my hips and pelvis

    4. My links above from Photobucket don't work in the blog but if you remove the [IMG] from either end of the code then paste the remaining into your browser address bar the images should appear. I'd edit the post but have no idea now when just using this blog with a name (TriAgain) to make posts.

    5. TriAgain, did you write or compiled that, or? If that is so, I'm impressed.

    6. gcoza, it is part of a very long and self-indulgent story I wrote in chapters on a triathlon forum I used to hang out on - almost another e-book in itself!

      It was sort of a cathartic thing, and spurred on by reading some of Dr Shane Dyes papers. It helped me get my thoughts together on what happened. It was also in response to a large number of knee problem posts appearing on that forum.

      You can read it here if you have the patience (beware, it has some coarse language!) -

    7. Thanks to all of you for the comments and especially the updates! Fascinating ... my journey I thought was long, but I can see that others are in the middle of even longer journeys. I hope everyone sticks around and is able to update in another six months, a year, whatever. In response to the question about how I found Doug Kelsey: I was just Googling all over the place, as I imagine most of you have done, trying to figure out my condition and a solution, and found a blog Doug was writing. At first I kind of shrugged off his advice -- it was running counter to everything else I was reading -- but then I started really reading him closely and was amazed at how much sense his observations made.

  5. I want to echo the physician's "thanks" Richard for writing the book. I also read the book a couple days ago, and now am reading Doug Kelsey's Runner's Knee Bible.. I am 42 and have had left knee pain for 7 years.. I had one arthroscopic which did nothing and was a bad experience to boot. I have managed to exercise some and mountain bike on trails (find it easier on knee to bike on trails than on pavement) but I always pay the price.. I can't do any exercise without serious ice and elevation for hours afterwards. Recently I think I reinjured the knee and the pain has grown worse over the last month (I did a 10 mile bike.. most of it on paved roads with a big hill).. It is an awful feeling when you can't do anything with legs without paying the price. I have hope and a better understanding what I'm up against now. Thanks for writing the book and happy journeys.. I am still down about the situation but hope to come up with a long term plan soon..

  6. Richard I have over 10yrs because I am determined to not have knee replacement surgery at least until my sixties. My orthopedic surgeon said I would definitely have to have surgery sometime in future. So, I have lots of time, but I will need a plan to develop a new lifestyle. This knee pain is a great motivator. You're right about it being a devastating

  7. Hi guys! Nice to see you are making progress! Yes we can! :)
    Thank you Richard for the blog, I totally understand what you say about writing less frequently... But I hope we can all still come back here and support and advice each other! This blog has been of massive help for me. And I also found DK through you, so thank you so much :)

    I also have some improvements to share: My right knee can now stand 80% of my body weight. YES!!!! I have almost no symptoms, I can squat and even though I am still avoiding stairs just in case... It feels so good!!!! Now, I'm not gonna stop until it reaches 100%. Maybe I'll have a setback, or two, but I don't mind. I trust my knee and I trust that it is healing!

    My left knee has also improved. It is now on 65% body weight, which is not bad. My left quad is really weak (I mentioned before I have some atrophy) so things will go slower with this one but still, I am happy :)

    Keep going everyone! Always forward :)

    In 2 days, I will be celebrating my birthday, 30 years old.
    It is also my "knees anniversary" as it all started around those days last year.

    This year, I won't go to the pub and drink like crazy as I used to. I've actually given up on drinking. Not a single drop of alcohol in a year. Well done me :P
    This year,I am celebrating that I have become a more resilient woman, and that thanks to my injury, I have learned that I have no control over certain things happening, but that I can take action and choose how they affect me. Still working on it though, it is hard to manage your emotions. But without my injury I would still be the same woman with no empathy that I used to be. Now I have compassion, empathy and faith. It has changed me. I am a better person now.

    So thank you very much chondromalacia and patellar tendonitis for all the lessons you have taught me :)

    See you around everyone


    1. You are so young. Maybe that is the reason for your faster healing.

    2. Hi Athenea,

      I won't bore you with my knee story. I just read that you have been talking with one of DK's PT. How awesome. How did you get in contact with them. I am assuming you are not from the US like me. Please advice!!


  8. hi Dear Richard
    im Nastaran 30 years old from Iran.
    i have chondromalacia since last year.
    it ruined my not happy and im lossing my husband .i cant climb stairs i cnt live as anorml person
    i Search a lot and i fond your book due to sanction i could not buy your book
    i know it is a lot to ask but i need your book
    the money i have paid for MRI pic ,PT and Glucosamineis very much than your book price and if i could i will pay for that .
    i know how much is hard to write a book
    but it will be nice of you to do me this favor .
    if it is not possible i completely understand please
    just tell me about the main exercise
    this is my email.


    1. Sorry to hear of your troubles, Nastaran. Unfortunately, the book isn't available in a hard copy that I could send to you -- but honestly, if you're looking for exercises, my book probably won't be the best thing for you anyway. I would recommend that you (1) Take a look around the blog, because I share a lot of my thinking here, and explain what helped me (and it's all free) (2) Try to find a way to buy Doug Kelsey's book, if you want exercises. Honestly, if I were you, this is the book I would move heaven and earth to get a copy of:

  9. ok dear Richard thanks for your reply.

  10. Hello everyone, I'm new to the site and I’m grateful for the blog and the comments of others and plan to read the entire blog soon. My journey starts about 15 months ago where I went for examination of my right knee as it felt as if there was water at the back of it and the knees being a bit sore all around. I had been doing a bit of home renovation for a few months and the pain wouldn’t heal, so I wanted to confirm it wasn’t something traumatic. Up until this time I've only had crepitus in both knees for many years. This particular doctor referred me for MRI's of both knees and prior to seeing the doctor I had no significant issues with my knees and in fact I was a moderate cyclist and jogger. I was shocked when he told me I had chondromalacia patella Grade III in one knee and Grade III/IV in the other. He subsequently sent me to PT and told me there was nothing that could be done for me; at 42 I was far too young for a TKR and needed to stick it out for the next 15-20 years ideally. Of course I was devastated by the news, I did the rounds of PT ordered by the doctor only to pick up more pain in my mid/upper quad on my right leg (which I still fight today and no one can figure out). I ended up leaving PT after about 2 months, my knees were so painful and irritated, I opted to just have them rest...but things never really returned to normal. It just seems strange that I had zero issues with my knees up until someday 15 months ago and they were to never be the same…you would think that I would have had some early pain years back. I have daily discomfort of various levels, some days are better than others; fortunately I haven’t been in the situation where I can’t walk or climb stairs yet (although I fear that is to come). I work with computers primarily and sit for long periods and now have developed significant pain on the knees and quads when sitting and must keep my legs out relatively straight during the work day (which in itself is an unnatural way to sit and causes problems). I've recently converted my office desk to a sit-stand configuration and spend about half the day standing while I work at my computer which seems to help. For cardio workouts, I have found that using a Gazelle glider machine works really well for getting the heart-rate up without pain; although it is limited in ability it doesn't require you to bend your knees. I've completely stopped cycling and primarily only perform upper body workouts now and the glider machine (although I will be looking into the Total Trainer, kettle bells, and introducing new exercises that I read in the comment section). Honestly, the past 12 months have been tough to deal with mentally, as I seem to dwell on the fact that life will not be the same and that a TKR will most likely have to occur at a young age. I’ve spent the last 10 months in a depression which only spurred further health issues…somehow my body responded with fibromyalgia type symptoms for about 6-7 months… it was really strange stuff going on for a while and my wife thought I had turned into a hypochondriac, lol! Only after forcing myself to change my mental outlook and start working out again I was able to gain back about 80-90% of myself. It was a big help to read in the comments that others feel the way I do and that it is a very slow process, but doable. My goal is to develop a long term plan and I would like to revisit a competent PT to help develop this plan, but I fear that the PT won’t be a qualified and I’ll end up worse. Someone mentioned in the comment section about a knee coach of sorts, I would be curious to know where you find such a person? I’d also be curious to know if anyone has had success with supplements or doing stem-cell injections (similar to what Regennex offers) to spur cartilage regrowth? With respect to Doug Kelsey’s books, it appears he has two books which do you recommend for someone with my condition? Again, thanks to Richard for creating the blog and those that comment here, your input in appreciated.

    1. Hi, Hal. Sorry to hear of your struggles. Hopefully some other people will chime in here. By all means, check out other posts on the blog. A few thoughts: (1) You may want to look into a desk cycle; you can find them on Amazon for example. They'd give your knees some motion while sitting -- but if cycling produces symptoms, no matter how easy, that may not be a good idea. (2) Doug's "90 Day Knee Arthritis Remedy" should be a fine book for your condition (and it's his latest). (3) The coaches that readers have had good success with are at Sports Center in Austin. Just Google for the phone number. Sports Center does offer phone consultations; one reader here has been working with a coach long distance. (4) Try dropping some comments under a more recent blog entry (say from January); people more often are scanning those, not the older posts.

      By the way, on this element of "the pain came out of nowhere," several years ago I did a post on breakdown points after I got thinking about some of those same issues: