Sunday, January 3, 2016

Sometimes It Pays to Keep Things Simple

I recently had Internet issues that reminded me of my old battle with knee pain.

My desktop PC connects wirelessly to our home router through an adapter that plugs into a USB port. The week before Christmas, my Internet browser started to hang after anywhere from three to ten minutes. This happened repeatedly. However, my laptop computer could still connect wirelessly.

Hmm, I thought. What the heck can be causing that?

I’m fairly good with computers, so I used Google to help me try to figure out what was going on. But my sleuthing proved frustrating. Possible causes abounded. Every time I eliminated one, another two or three would pop up.

The list of suspects was all over the map. Could it be a virus? A software conflict with my antivirus software? A power saver setting? An update from Windows that created issues? And on and on.

Then, while pinging websites from the command prompt, I discovered a significant amount of packet loss. That led me to connect the PC by cable. The Internet worked fine.

Ah hah.

I went to the back of my computer, where a wireless adapter smaller than my thumb, poking out of a spare USB port, should have been grabbing the Internet signal. I suspected it wasn’t – or at least not reliably.

So I replaced it, and everything was okay again.

What I realized later was it took me a long time to get to the solution. I should have investigated the faulty hardware as a culprit early on. I got that little device from the company that provides our Internet service; the installer handed it to me as if it were some throwaway lagniappe when I asked about connecting wirelessly.

That should have been a clue that it didn’t have much of a lifespan.

Instead of zeroing in on the adapter though, I chased a lot of other theories around, some a bit wild. I didn’t look at the simple thing first: namely, something that wasn’t built well in the first place just failed and needed to be replaced.

Similarly, when I had chronic knee pain, I remember Googling my symptoms a lot. I bet that anyone reading this right now will recognize themselves in that sentence. We all do it, desperate to find answers. In my book, I even mention getting tested for rheumatoid arthritis, wondering if I had some autoimmune disorder.

But Google can be more curse than blessing. It can lead you in a thousand different directions, none of them profitable. It will convince you that you have some extremely rare disease.

The simple thing to consider when you have grumbly, achy knees and medical tests don’t turn up a clear culprit, like a tear in a ligament, is that you simply have a damaged, weakened joint that can no longer tolerate the burden placed upon it.

In that scenario, you have to modify activity, scale back activity – but stay active somehow. You let go of all the weird little symptoms that don’t make much sense. You focus on bringing back your knee joint, little by little. It will take a long time. There will be more ups and downs than a world-class rollercoaster.

For a lot of us though, I think the simple approach makes a lot of sense. And, at least in my case, when I got better the weird little symptoms that made me suspect some systemic disorder went away anyway.


  1. Hi Richard,

    Reading your blog gives me hope. I am 31 and had 2 meniscus tears in my Left knee (Lateral Compartment). Injured it while playing soccer both times. I have also had one meniscus tear in my right knee and also in the lateral compartment. Injured it while running.

    My recent meniscus repair surgery for in Sept 2015. The surgeon called me for a post op check up and informed me that i had fibrilated cartilage in the tibial plateau. Grade 2 chondromalacia. All other compartments (media and patellar) looked good.

    He has said that i should not run anymore and just bike/swim. He also said the cartilage wont heal and i should try wearing an ossur unloader one brace when walking/hiking long distances.

    I was very active before my surgery and now i am scared to over use it and cause any more wear and tear.

    I also have grinding noise coming from both my knees. I am going to read your book and see if walking (low load high rep) or related activity will help me.

    My main question right now is that did your hyaline cartilage regrow or was it the fibrocartilage. Would a MRI be able to tell the difference?

    Vancouver, BC

    1. Hi Rish,

      I don't know exactly what regrew/changed in my knees, to be perfectly honest. What I know is my knees feel fine now and they certainly didn't before. I don't think an MRI could tell the difference between hyaline and fibrocartilage -- I think you'd have to take a tissue sample and examine the cells under a microscope. But I wouldn't worry overmuch on that point -- I think the fibrocartilage after a while takes on characteristics of hyaline.

      As for the doctor's opinion that the cartilage won't heal: maybe he's right, maybe he's not. In any event, you'd probably be smart to take up a sport like cycling for a while and try to rehab your knees. Someday maybe you can get back to soccer. I'd forget about that for a while though -- maybe a long while. An unloader sounds like a smart suggestion too. Good luck.

    2. Wow, nice total non answer. Go sell some (e)books douche.

    3. I believe there were only two questions in there. Did hyaline cartilage or fibrocartilage regrow in my knees? And the only truthful answer is I don't know -- and no one could know -- without taking a tissue sample from my joints, which they're not going to do because my knees feel fine now. As to the second question, no, I don't think an MRI could tell the difference.

  2. I am trying to remember this every day - take things slow and keep it simple. I was a semi-professional dancer until patellofemoral pain syndrome sidelined me completely - it's been over 12 months since I've been able to take stairs, walk up or down hills, carry things, or sit with knees bent long enough to take a long drive. Pretty bad for a 32-year-old! Amy

  3. Doctor google almost sent me into depression when I started having pain ... (well, it was me who did all the searches so nobody else to blame...). I started to follow a blog about RA because I was sure my symptoms were the same as the ones people with RA were describing. I did blood tests 3 times in different hospitals, all of them turned out fine. No RA for me or other inflammatory diseases. Still, my mind didn't believe it 100%. Hard times for me.
    After a while I started to forget about those thoughts, but it's hard not to believe the scary stories your mind tells you in "dangerous" situations.

    So today I did 15 full body weight single leg squats with my right knee. No pain. Kept my balance well. Left knee "only" 7 squats. Then the tendon started to hurt.
    Pretty awesome.
    (Sorry but this last part is not entirely related with the post but I dont really have other place where I can share my progress and people really understand what it means! If I tell my friends hey today I did a bunch of single leg squats! they are not going to fully understand what it means for someone who have had knee pain)

    Sorry for the long comment.

    Athenea xx

    1. Athenea, updates are always welcome, so I've certainly got no problem with your posting them (and I think you've got a few followers here now too). Congrats on the single-leg squats! Those are really tough. If you can do seven with the not-as-good knee, you're coming along pretty well.

    2. Thank you Athenea for posting,
      I would like to know how you got there,

  4. Hi Richard,

    I have a request for you. I know you've largely told your story, but your website has become the focal point of the "envelope of function to regrow cartilage" community, such as it is. Could you make a weekly or monthly open thread for the rest of us to talk about our stories and rehab?

    1. So here's where I am.

      I'm relatively high functioning (which probably means I'm not as tough as you or triagain). I play squash and got a case patellar tendonosis. But I also get pain under my knee cap. I saw an orthopedist and he did an MRI which showed a perfectly normal patellar tendon and mild wear on the cartilage. So much for the MRI giving you a good window into your knee.

      The standard rehab for patellar tendonosis is eccentric single leg squats on a slant board. I've done a bunch of them but they didn't help. I've since come to realize that there is a big gap in intensity between a slow and controlled decline squat (even with added weight) and violent stops and starts playing sports. I gave up on the single leg squats in frustration, but knee has since regressed so I'm back to doing them again.

      This is all about tendinosis but another thing that I've learned is that the patellar tendon is not particularly vascular so it too needs a lot of movement. I hate cardio so I spent a good year where I'd faithfully do my rehab exercises, but otherwise be completely sedentary.

      Throw in the fact that I've also got pain under the kneecap (PFPS) and I think I need to do a couple things:

      1. Get in at least one 20 minute cardio session that fully warms up my knee.
      2. Continue to do the single leg squats.

      I want the cardio sessions to be progressive on how much they stress the knee. I alternate between two main types of cardio - walking (some of it backwards) and cycling.

      Cycling. Right now I can do 20 minutes on the stationary bike set to level 4 (about 120 watts if you can trust the display). I want to start doing intervals at level 5 and gradually build up. The goal: to do about 30-45 second intervals with a good 3 minutes of rest and not have that hurt my knee.

      Walking. I have a manual treadmill which is on a 10 degree incline. I walk for 10 minutes to warm up the knee and then walk 5 minutes backwards. That backwards motion is almost exactly like the way you decelerate from a run and I think that's how I overcooked my knee. I'd like to build up to 10 minutes but it hurts my knee (at a completely different spot) if I do too much. The joy of being in your 40's is that you have to ease into new types of exercise instead of just diving in. So I've backed off to 5 minutes of uphill walking and will add one minute per month.

      The goal is to do a good easy run for ten minutes uphill followed up with 10 minutes of hard backwards walking uphill.

      Once that's done I may pay out the big bucks for a NordicTrac incline treadmill. It does a negative 6 degree decline. I figure that doing 10-20 minutes of forwards easy running uphill to warm up followed by ten minutes walking at a 6 degree decline will be the acid test.

      At the same time, I'm still doing squash drills once a week. The nice thing about drilling is that if my opponent hits a good shot I just let it go, so I never get those violent stresses on my knee. Like I said earlier, I'm lucky that I'm pretty high functioning compared to many people.

    2. One followup point about drilling in squash. It also makes a good real world test of where my knee is. Back when I was good doing the single leg squats I felt so good that I played a round robin. My knee was sore for two weeks. That's when I threw out the single leg squats (bad move). Now doing the easier drills is uncomfortable so I'm trying to get back to where I was two months ago.

    3. This is a good point Anonymous about starting an open thread for people to talk about their progress/issues. I could do that maybe once a month or so and put a short post on top, inviting people to share in the comments section.

  5. Does someone have a story to share on how they improved their knees with cartilage damage and prior menisectomy?

    I have has a lateral meniscus surgery. They trimmed my meniscus for the second time in my life and the doctor also found a grade 2 wear in the cartilage on the tibia.

    I have pain in the joint line and also feel unstable when walking. I feel weak in the knee which had the surgery.