Saturday, March 12, 2016

Open Comment Forum, Dive In!

Today I’m going to do something different. Today I’m going to turn the mike around, so to speak. I’m going to let all of you “talk amongst yourselves” (I’m sure some of you remember the original context for that phrase!)

A while ago, someone suggested doing this, so people could share and help each other. It made perfect sense to me.

Before we begin, I think there are four things we all share:

(1) We believe there is good reason to be optimistic about the prospect of damaged cartilage healing, or at least improving.

(2) We accept this will probably take a long time (maybe years).

(3) We believe that getting better requires movement.

(4) We believe “envelope of function” is the best framework for understanding and dealing with knee pain.

Okay, that’s it. You can start talking now. Since it might be useful to have a subject, I’ll throw one out there (but feel free to ignore or modify): What are some things you’ve done that have helped you with your knee pain?


  1. So what have you guys all tried for "envelope of function" rehab?

    I've ultimately settled on a manual treadmill after trying many things. I'm lucky to be relatively high functioning and I don't think that walking alone provides enough stress. It's on the easy side of the envelope of function. So I prefer walking uphill. And the manual treadmill has an added bonus, which is that you have to active push on it to make it go. So it's actually pushing a shopping cart up a 10% incline. I also do one more thing, which is that I walk backwards for the last two minutes.

    Ideally I'd do two 14 minute sessions per day, but I usually only get in one. Even so, my progress has been rapid.

    1. If manual treadmill works for you then its fine. In my case using manual treadmill actually worsened my knees. Manual treadmill workout increases the load on the knees. I realised it too late when the damage had already been done.

  2. I have been suferring with chondromalacia patella since two years. I am a Physical therapist tried all sorts of physical therapy for myself without any improvement. Now I have quit my job 5 months back as I could no longer tolerate this pain in both my knees , right being more severe. I am not to use stairs any more. Richards book 'Saving my knees " is the only one that gave me a ray of hope when I was devastated reading all the blogs on this condition. Initially I was not even able to walk more than 5 minutes without hurting my knees. Since I quit my job i started with 2 to 3 minute walk sessions spread through out the day may be around 7 to8 times. Apart from this I could not do anything else. Any exercises I tried only increased the pain. I continued my walking alone and now I can walk 20 minutes slow walk two to three times a day with running shoes on which gives comfort and avoids stress on knees. I cannot still do any quad sets as they hurt more on the right knee.But I do mild exercises like straight leg raising for activating quads atleast at the minimum, also some mild strengthening exercises for the hip abductors, internal and external rotators. I cannot even stretch quads as bending my knee hurts badly but to compensate I try to trigger release the quads muscles thinking it would provide some help though not much.

    I lost my sleep due to pain and was on medications for sleep, now I am trying to slowly come down on it by using knee straps at night.
    I really never expected I could land up in this situation quitting my job even as it involved long standing and other activities that increased stress on knees.

    This is how it had been for me until now. By Gods grace I hope to get better atleast in activities like standing from a chair and other day to day activities.This is the only blog thats keeps me going with confidence when I read that cartilage healing does takes place.

  3. Using the McConnell taping technique, keeping a knee diary and daily walking have all helped my knees. The daily walks are the only solution I've found for improving my envelope of function. Amy

  4. I've said all this before on here, but to summarise for those who don't want to go back searching for it:
    - Was a 48yo long course triathlete
    - Had some chondromalacia problems in R knee for years, but nothing that put me out of action for more than a few days. Rest and wearing a Thermoskin knee brace always saw rapid improvement.
    - Tore medial menicus in L knee in April 2012, had to have it trimmed.
    - Within a month had chronic burning/aching/pain/stiffness/loss of function in BOTH knees
    - Tried all the mainstream stuff (physiotherapy, doctors, sports doctors, pain specialists, trainers, witchdoctors you name it)
    - Most of their exercises made me worse - esp loaded exercises with high degree (>70deg) of knee flexion
    - Had PRP injections x3 in each knee which helped a bit
    - By now had quit all triathlon, just walking (20-30mins per day) my knees could handle this, swimming with pull bouy and ankes strapped together (no kicking as it aggravated) and some upper body weights.
    - Did a lot of my own research including this blog, met some great people and followed their advice (shout out for Crazy Ed from California on the other side of the world who has been such an inspiration and emailed me his exercise bands all the way to Australia - thanks mate).
    - Was treated for CRPS with Lyrica (did not really work).
    - Slowly, ever so slowly over nearly 4 yrs have improved by doing my own thing (i.e. avoiding things I know aggravate - took a long time to figure out).
    - Recently went on anti anxiety/depression meds which have helped with mental side of chronic knee pain.
    - Can now do quite heavy leg weights (50kg deadlifts, 20kg kettlebell swings) and 3x40 sec skipping, 16 mins of treadmill jogging, 30mins on MTB with short steep hills.
    - Have learned too much knee flexion (>70 deg)with repetition is worse for me than heavy loads with less reps (hence weights and jogging are OK but not too much cycling, deep squats, seated leg extensions etc)
    - Pain down 70-80%, functionality up 50+%.
    - Still not out of the woods, but looking promising.
    - There were times I never thought I'd have even this much improvement, so stay patient people (I wasn't which is why I'm still 4 yrs into the journey).

    1. That should say Ed MAILED me his exercise bands. Bit hard to send those through cyberspace. Have been using them as part of my intense 20-30min upper and lower body gym routine to build leg strength without too much loaded knee flexion.

    2. Congratulations!!
      I am on this journey too and at the moment hard to imagine myself doing weights or walking more than 5 min with no pain.
      I go to the pool every other day and exercese there, swimming backwards, walking and doing biking moves.

      Today I walked on irregular path and that made my knee hurt.

      Could you please share some of the band exercises?

      Any advice on supplements?

    3. Amaia, I've done two types of band exercises:

      1. Sideways crab-walk with a thera band around my calves. This works your hips/glutes (and quads a little). You can also put the band around your feet, bend forward about 30deg and do it which isolates the glutes more. There are plenty of vids on the net which show these exercises.
      2. Using the bands Ed sent me - which are completely different to a thera band. They are rubber cords, one end attached to a solid unmoveable object in the gym at knee height, the other to a velcro strap just below my kneecap on one leg and I do sort of forward and sideways 'lifts' or 'kicks' which works the quads, hips, glutes without too much knee load - though there is a fair load on the other standing knee which is not being lifted. It can be quite hard to balance too.

      Supplements - I can't say anything worked definitely. I still take 3x cod liver oil tabs a day for general joint health. I've stopped taking the gelatin for now as I suspect my digestive system did not like it much, but will try it again soon.

  5. TriAgain, my experience has been similar. Triathlon to joint pain. Except mine started with my hips and the other important difference I have to say I've sadly had no progress. What I find works best for me is flow. By which I mean if I get into a state where I am completely and utterly absorbed by whatever I'm doing and am happy then the pain seems to resolve to some extent. I'm not sure if this is the body's endogenous pain killers - endomorphine and endocannabinoid pathways or something else. It would kind of make sense as it seems to last for a while afterwards. Its not just a case of being diverted. It lasts longer than the diversion. I have been increasingly speculating that being stressed and focussed on the pain not just amplifies the pain which I think is pretty well established in the academic literature but causes actual joint damage. I've actually found a serious academic paper which kind of makes this leap. The nervous system goes two ways. You sensory receptors send signals to the brain. The brain interprets them and sends signals back to the joint. That signal back to the joint can change what happens in the joint. Sometimes my attempts to understand cause and effect seem to be pointless. Yesterday I got up and felt great and had a go on the stationary bike for 10mins very easy hardly any resistance. It was a lovely day I was outside. Sunday. My right hip became significantly more painful afterwards. Today I got up and felt not great walked my son to school then had to cycle to school and back because I'd forgotten something he needed. No effect - in fact I feel better. Is a real bike better than a stationary one?! I can imagine that cycling on the road is more varied in how it stresses the body - like trail running. But would it really make any difference. Perplexing... Currently there are clearly ups and downs but the overall trend is generally not quite in the right direction!

    1. Yes, flow worked/s for me too CRM - especially fly-fishing in NZ, wading about in cool water, absorbed in trying to spot and catch trout in stunning natural surroundings. I'd be on my feet for hours, often walking over very uneven terrain. Pretty much no pain. And like you, even afterwards the pain was less.

      I fully agree there are interactions between pain, neural pathways, and more (or less) pain. This was why the pain specialist said I was bordering on CRPS and tried Lyrica. Once I started getting into some more intense gym work and one day randomly threw in light deadlifts in an attempt to maintain at least some leg strength, I started to see some real gains in pain reduction and improved function.

      I think two things were happening here:

      1. Through 2 yrs of gentle movement my cartilage had recovered enough that I could start to edge things a bit.
      2. The deadlifts etc helped re-wire my neural pathways. My brain started to say "look, you can do this stuff and your knees don't snap in half" (which is what they felt like they would do at times).

  6. I had a partially torn PCL when I was a kid. It never bothered me much until 10 years later. One summer, after riding a smaller bicycle for a week, I developed the first signs of Patellafemoral pain. I went to several PT's who had their own suggestions as to what I should try. Some things worked but the knee pain always came back. My latest PT told me to do leg press with increasing amount of weights. That seem to have caused way too much joint damage. A few months ago I read Richard's book and the "Runners knee bible". I was at a stage where walking for more than 10 mins started causing weird pain in both knees. Now, I walk in the pool and I can easily walk for 30 mins with not much pain afterwards. I keep a journal tracking number of steps and pain scores in the morning/evening. Walking in the pool helps to stay within the "envelope" which is critical.

    Also, I agree with CartilageRepairMan's comment about "flow". When I am a few hours into my work I normally forget that my knees are hurting. Especially when they are properly supported under the desk. Ash

  7. I wanted to share something I've just read on NSAIDs which I think everyone should be aware of. Richard has written that drugs that mask pain from damage are bad news because we are ignoring the signals from our body that are warning us of damage. In fact it's worse than that. NSAIDs have been shown to be hypertrophic for cartilage. They are directly damaging for cartilage not indirectly because we start skipping around as they block the pain signals. Delve a little deeper and it's complicated because it seems that some NSAIDs are worse than others depending on their mode of action. It would appear that Naproxen is the worst. On top of this we know that NSAIDs can cause long term problems such as intestinal bleeding and heart problems. However there are positive aspects to anti-inflammatory drugs in that inflammation is part of the joint degenerative process. The paper you could read here raves about a new drug that combines the traditional COX pathway inhibition of conventional NSAIDs and LOX pathway inhibition called Licofelone.
    They say "Considering the importance of NSAIDs as the most prescribed antipain medication for patients with OA, the results from the present study point toward caution that needs to be exercised, while suggesting the use of these drugs. This is particularly true for drugs like Naproxen that target only COX and those with similar molecular action. One can speculate that drugs such as licofelone that show dual inhibition of COX and LOX pathways are more likely to have better beneficial effects in preventing inflammatory responses than the COX inhibitors. In fact, it has recently been reported in a 2-year clinical trial with 161 knee OA patients that the total knee replacements were much higher in patients receiving Naproxen than in patients given licofelone,46,47 indicating the beneficial significance of choosing a COX/LOX inhibitor over COXonly inhibitor in OA patients". So if you're going to take an anti inflammatory then it would appear you want licofelone. The problem is that its not available yet as far as I can tell. However what is the 5-Lox pathway? It turns out that you can already get an off the shelf supplement which works along this pathway - derived from Frankincense. It's been shown to be effective in various clinical trials for osteoarthritis. Having looked at a few studies it seems that a derivative which is marketed under the trade name ApresFlex is the most effective.
    The whole area of inflammation is complex because inflammation is good and bad. It's an intrinsic part of the healing and adaptation process but it's also part of the cartilage damage process. Personally I haven't quite figured it all yet and I'm not sure the scientists have either. I'm not a doctor so make your own choices but it looks like the 5-lox inhibition is good news for cartilage conservation, whereas traditional NSAIDS, some more than others, are not.

    1. I found this very interesting after reading the passage "What's Wrong With Aspirin?" that can be found here: It seems aspirin is implicated in cartilage degeneration also. - Amy

  8. Hi Richard, I got your book, then I got Doug's book, a Total Trainer DLX III, the Gray Cook Bands, and now I'm at a loss. I can't figure out my load tolerance, and whether doing these exercises is supposed to hurt after the fact of not. I got in touch with the therapist Doug suggests in his book (he appears to be retired) but I can't afford to pay her $ 350.00 an hour. How can I figure out load tolerance? Your help would be highly appreciated. By the way: I'm writing here because the email address you've got in your book doesn't work. Sincerely, David (

    1. Hi David. I appreciate that you may be on a budget (didn't realize Doug's therapists were billing at $350 an hour -- other readers who have used them, does that sound correct? -- but if that's the case, I trust that's the prevailing rate). How do you find out your load tolerance? Well, I never did, so I'm probably not the best person to ask. :) (Maybe Athenea has a suggestion?) Generally though, my feeling is your knees are not supposed to hurt after exercise. But the complex issue is, sometimes it's hard to sort out "hurts" from "feels weird/different." On that score, you probably just have to do some experimenting.

      One thought from me: You might want to start out at what you think is "ridiculously easy" on the total trainer. Like take what's really easy and divide it by half, and start there. A thought, but someone else who's worked on a total trainer may have a better suggestion.

      On the e-mail address -- yeah, turned out there was a typo in the address. But since then, I've discouraged people from e-mailing me anyway, because I just get too many people reaching out for personal advice (and I'm not a doctor and frankly, have a lot of time burdens too, plus if you post a question on the blog it can help everyone!).


    2. Thanks Richard,

      I appreciate your kind reply - so what is it that you did in your recovery process other than walking? You don't mention anything in the book.

      Did you follow all of Doug Kelsey's advice or did you add other drills to that particular training regimen?

      Take Care, David

    3. ps: I suppose Athenea is another person reading your posts on this blog?

    4. Hi David,
      You can figure out your load tolerance by doing single leg squats. Place the total trainer on level 5 and do 5 single leg squats with your good leg. Then do another 5 with your injured leg. Does it hurt? If yes, go down one level and repeat. If not, go up one level and repeat. Once you find the level where it doesn't hurt, that is your load tolerance. Now, you don't train on that level, it's too hard, you start training on a level below, and then progress from there. So if you did 5 single leg squats on level 5 (example) and it did not hurt, you will start doing your training (DK book exercises) on level 4.

      Hope this helps,

    5. Hi Athenea,

      I appreciate your kind reply.

      That's exactly what I did - I have the DLXIII and I was following DK's instructions, but I can't figure it out!!!

      I did double legs squats on level 4 for 20 minutes 2 weeks ago, result: I hurt for like a week (but only after the fact).

      By the way: I have problems with both knees (though a bit more on my left) which makes hte whole thing even more of an angst producer...every other day I feel like braking down and crying.

      Kind Regards, David

    6. David, mostly what helped me heal was the walking. It was almost that simple (and difficult, because you have to carefully monitor your progress and be careful not to do too-strenuous walking at first). In addition, I did a few exercises with a Theraband, such as sideways crab-walking. I didn't talk about these exercises in the book because I really don't think they helped much. Also I did some unloaded squats, but that was pretty late in my recovery.

    7. I second Richard's advice on walking. I couldnt walk on normal ground more than 1km without my knees hurting. So I started walking in the pool. Now I can walk in the pool for 45-60 mins without hurting. And I am slowly adding steps outside the pool as well.

    8. Hey David,
      I also had pain in both knees. To find out your load tolerance you need to test using only one leg, not both.
      Treat them separately, I mean, you can train one leg on level 4 and the other on level 5 depending on your load tolerance.
      What I did at the very beginning, before any single leg squats, but after testing my load tolerance, was 3 weeks of bilateral squats. You want to do 6 or 7 minutes twice a day, don't do more than that. This helps to lubricate the knees and prepare them for loading later on.
      I did have symptoms (pain) afterwards, specially during the first week, but then they improved a bit. I also did quad sets, aim for 100 per day.

      Do this for 3 weeks and see how it goes!


    9. Hi Athenea,

      I basically overloaded my knees in a repeated deep squat position that I've held for a while (the tipping point was in September 2015). Had I known the kind of damage I was doing to my knees I would have not done that. But I felt invincible, not realizing that at 40 I can't push myself like I were 20.

      After a couple of months of pain (and not much swelling from altered synovial fluid) things got better. But then some demon possessed me to do some quad stretches while pulling my feet up to my butt, and that's when things started to get really bad.

      Both knees are sore, but the left one more, where the pain radiates into the tibia on the medial compartment.

      This past Saturday i was on the road (traveling by train and standing a lot and going up and down a hill) needless to say that was too much.

      Then this past Monday I spread the following exercises over the day: 90 quad sets, 8 min of tailgaters with the light Gray Cook Band, and 6 minutes of bilateral squats on the Total Trainer at Level 2 (without knowing my load tolerance).

      My knees (especially my left one) did not like the bilateral squats at Level 2 on the TT. I've not even tried the single leg squat.

      Needless to say that right now things are going badly.

      I have no idea how not to overload my knees, after all I need to do some day to day stuff like keeping my house clean and shopping for some food - never mind work - I am not working right now as I'm more or less falling apart mentally and emotionally, I feel like my life's about over - every other day I feel like I want to cry like a small child.

      Walking stairs is at this time not good.

      I was planning to move into another apartment (which has an internal swimming pool, a relatively small but very well equipped gym and a sauna). The thing that scares me right now about this prospect is that there are 8-10 steps into the house and 8-10 steps into the swimming pool room. The stairs are not very tough, but right now I look at stairs like the devil looks at holy water. I truly don't know what to make of that? Do I not go into that apartment because of a few steps?

      Today (it's noon in Switzerland) I've done 40 quad sets and 2min taligaters on both legs. Both knees are full with fluid (the left one being worse).

      I've sent my MRI (which show patello-femoral degeneration (light on the left and very light on the right) but there is also a thinning of the medial compartment (both sides) and that I can feel particularly in my left leg as it radiates into the tibia.

      I just got a Bathroom Scale (arrived by mail a few minutes ago) so at 6 foot 3 I'm currently 206 lbs - the goal is to get myself down to 180 - 183 lbs - which undoubtedly will help my knees immensely.

      I 4 Iontophoresis sessions at my physical therapist's (Tora-Dol Ketorolacum trometamolum 30mg/1ml injectable solution) - it works with electrical induction - I'm not sure I want to like that approach as it apparently numbs the pain but then you don't have load feedback, which is not good.

      I think I will end this post now - but I'm really worried about my knees, I am on the edge of breakdown every other day.

      So I have to slow down and see what goes, I think I will do some more tailgaters now...with the GC band, but again, given that my knees are filled with fluid I don't know how much is too much...that's what freaks me out the most about the whole thing.

      Cheers to you all and thanks for your thoughts.

    10. Hi David, Iam in a similar state as you. But i really cannot do quad sets and what i can manage now is only3 -4 minutes of slow walk frequently through out the day. I was walking half an hour until two weeks back. And my knee worsened as I tried to stretch my quads and external rotators of hip. Biggest mistake in my case. Trying hard to recover.

      I actually feel in your case you are pushing your knees too hard. May be you can stop with quad sets and squats for now and concentrate on walking within pain limits and do tailgaters frequently that does not load your knees much. When it improves not to hurry before you can start quad sets. Once quad sets are not hurting then slowly one can try on with squats according to load tolerance. This is what i feel in my opinion.

      Stairs had been the worst part in my case with both knees affected and I can hardly use it anymore. I think we should try and avoid stairs as much as possible especially going down the stairs.

      Its really hard even to get up from a chair without hurting my knees. One technique that I use to avoid hurting is I try to take weight in my hand while simultaneously tightening the muscles in lower limb when getting up.

      an apartment without stairs is much better than looking for a pool.


    11. I was thinking exactly the same thing PR. David, I think you are pushing too hard too soon. For the first 1-2years of my bilateral knee pain, all I could do without making it worse was easy walking for 15-20mins and swimming freestyle but with a pull buoy and my ankles strapped together so I didn't kick.

      I also think stairs were a problem for me - they may have even been the final straw which broke the camels back as I moved to a new job into an office where I had to go up and down 20 stairs a few times a day. Now in a new office without stairs.

      I too know that feeling of despair - it feels like your life is over and you'll forever be in pain/disabled, but you can get better. I'm about 80% better (still have ups and downs) but that has taken 4yrs. Hang in there.

  9. Hi Richard,
    I am 24 and have had aching knees on/off for years now (if I had a day going out, walking). In the last 2 months I have had constant aching on the insides of my knees. I have also had clicking in most of my joints but I always assumed it was because I was weak due to lack of exercise and food intake. I have seen a physio and they gave a general answer, that I need to get more muscle round my kneecaps (which I'm sure is true). I am a lightweight 65kg guy. I want to become strong and healthy, and my passions are cycling and dancing (have a strong dislike for cars - I want to cycle everywhere). Do you think I should pursue a more thorough diagnosis, or should I continue with strength exercises and more muscle? I haven't got any help out of doctors, they only seem to want me out the door as quickly as possible.
    Thanks and will scour your blog for tips and answers,

    1. Maybe I should mention the hunch I have had - that my knees have always had a 'knock' appearance, and it would seem like that would create an uneven distribution of weight across the knee - hence the aching on only one side. So could it just be a biomechanical issue?

    2. I tend to be somewhat skeptical of biomechanical factors, as they tend to be over-emphasized. Still, if your biomechanics are bad enough, that definitely will have an effect. On whether you should pursue a more thorough diagnosis: I don't know (and I really try to avoid giving advice anyway). Are the strength exercises helping you? If they're not -- or if they're not enough -- you may want to look for a PT who believes in the "Doug Kelsey" approach to healing bad knees (which is not as aggressive and strength-oriented as other approaches). That's what I'd do anyway.

    3. The strength exercises aren't helping. I suspect they were targeting the wrong areas anyway. I am going to PT again to get some more advice, and will follow this up with a doctor's visit. I have inflammation everyday now. Whether I ride my bike or not.

  10. To David and everyone else in the same situation,

    When I started my own journey to save my knees for over a year ago I was in pretty bad shape. I had burn out, severe anxiety, (most likely) fat pad impingement in my right knee and constant burning sensation in both of them. MRI:s were clean, however, so nobody knows whether my pains came from physical injuries or solely from my nervous system that was completely freaked out. My active life as a keen cyclist, as my whole life for that matter, seemed to be over. I'm in much better place right now but I still have a long way go. I hope I'll be able to share my story with you later on but unfortunately I don't have the energy to do that yet.

    However, what I want to say to all of you who struggle in the beginning of your journeys. You may need to start with exercises that are RIDICULOUSLY easy. When I started, I could not have imagined doing anything with my total trainer (besides Richards book I read also Kelseys Runner's Knee Bible). Instead, I laid on the floor holding in my hands light resistance bands attached to my feet and bent and straightened my knees for 2 minutes at a time, four times a day. I slowly worked the time up to 10 minutes at a time, then started with the total trainer at some very low level. Without going to the details and all ups and downs, I say this: it has been an INCREDIBELY slow process to heal the eventual physical injuries in my knees and fight the pain syndrome. Kelsey's advise on edging your training has worked for me but I have needed to moderate the pace. I make the changes very gradually and over much longer time than he suggests.

    Be patient, go slow, keep moving and don't be afraid of taking things easy. Believe me, I know it is hard.

    Best of luck,
    Honey blush

    1. I agree Honey Blush. I am working with one of Dk's coaches and we are going much much slooooower than what DK recommends. Unfortunately, we had to find out the hard coach pushed my knees multiple times into BRUTAL setbacks and I finally said - okay, we are on the right track with the exercises (high repetition/low load) but we need to go much, much slower.

      That is my only criticism of DK's book and method - yes, it works BUT DK makes it sound much easier than what it is, and it takes years (not 90 days as he suggests) to heal.

      Quick update: I am finally doing much better now that my coach slowed down the pace of edging. But I have a long, long ways to go. I'm expecting another year of healing but I am on the right track to take over myself and don't feel as though I need to rely on my coach for help.

      Take care!

    2. Alex,

      Glad to hear things are back on the upswing for you. You definitely sounded like you were in quite a rough patch there for a while. Glad you're seeing some light at the end of the tunnel.

      I agree with everything that Honeyblush and you have said as well. The importance of being patient cannot be stressed enough.

      I think with the Runner's Knee Bible, one of the critiques I have that I'm not sure people pick up on is that there are points in the book where he states something like "the goal is..." in terms of number of reps. I immediately took that as do this amount right off the bat. In reality, you'd probably want to start with something much less than that, and over the course of a maybe a few weeks work up to the goal reps. My two cents from my experiences with and without a coach thus far. So for David, the gentlemen who spent 20 minutes on a Total Trainer at level 4...bad, bad idea unless you've worked up to it (again, this is my opinion). My coach didn't even have me doing bilateral squats until a few weeks ago, and I've been working with her since December 2015.

      My personal update:
      -Doing single squats at level 10 on a total trainer currently.
      -Also doing some assisted squats with a band, squatting down to a chair.

      So...I'm progressing, but my legs/knees are constantly in a state of up/down. It usually takes a couple of days to recover from a session, and then I'm starting another one. I have symptoms...lately I've been getting some random bouts of knees that are hot to the touch, as well as red, which is pretty concerning. Other than that a lot of things I was experiencing have been reduced - random muscle twitching in my thighs, crampy aches in my lower quads, elbow/shoulder/back pain.

      Overall I'm in a better place as well, but have a very long ways to go.


    3. Hi Brandon,

      I appreciate your reply (thanks to all the other people that have replied to me as well).

      I don't know how bad your injuries have been, but you seem to be advancing rather quickly - 4 months and already single leg squats at Level 10 on the TT?

      By the way: I did work on Level 2 on the TT the other week...the Level 4 thing was further in the way I'll do that again - as a matter of fact, I don't think I can take any work with the TT at this time, which begs the question: what do I do?

      I wish I could pay for a coach... .

      I have to admit that I'm a bit lost at this time...I'm really unsure of how much movement I can take without overdoing knees have been swollen for months now and as such I'm really worried, and that is why I've just created a forum which I've also embedded into a weebly site:

      Naked forum:
      In weebly site:

      I hope Richard doesn't mind that I've called it that - due credits are on there, as well as links to Richard's Book + Blog, as well as to Doug's site and Book.

      I encourage everyone to sign up and to post on there, I'd like to hear about your experience in as much detail as you feel comfortable sharing.

      Kind Regards, David

  11. Hi David,

    I'll try to be as concise as possible here (but I make no promises, my posts always tend to be long :P )...

    I've been dealing with my knee pain since last June (at least that's when the real significant symptoms began - in retrospect I think my knees were telling me something long before that). I started working with a coach December 9. So it will be 4 months in about a week.

    Some things to bear in mind about my state:
    1. I'm at level 10 on a DLX-III total trainer, but that doesn't mean it's pain free. In addition, that's an eccentric squat (slowly lowering down on one leg, and then up with both legs). I'm doing some standing squats right now as well, with the assistance of the Grey Cook band, but I get a fair amount of pain on those two (kind of borderline as far as whether I should do a full set or stop short) and I also get a lot of what I hope is just some kind of a benign crepitus, and not arthritis (when I'm standing out of my squat my right knee crackles almost the whole way up - I actually caught it on video with my phone and youtube'd it to show my coach to get her opinion on it)

    2. I still have concerns that maybe we're going a bit fast, and I plan on discussing this with my coach at my next appointment. I'm seeing stuff now that I didn't really see before - knees that get warm/hot to the touch and red, it seems like I can walk less and less distances before I need to stop or feel heavier pin prick sensations around my kneecaps. I can't stand for more than a few minutes most of the time. There's a crackling in my right knee (that comes and goes during certain movements, but is more consistent with others). Hot burning sensations internally (even during those times that my knees aren't hot to the touch).

    If you can't handle the Total Trainer, then my knee jerk reaction is you need even gentler movement and will have to build up to even that. Walking, or pool walking, Have you tried doing a slider? If not, try this (it's in the Runner's Knee Bible, if you have that book, and there's a video of it):

    a. If the surface you're going to be doing this on is carpeted, buy some plastic furniture sliders (the big ones, has to be big enough to fit your heel, mine are 4inch x 6inch-ish, I suppose. Maybe even bigger than that). If you're doing it on a vinyl/wood/hard surface, a sock might work. You could even get by with a paper plate if needed. Basically whatever you're using to slide your foot has to be fairly low friction on the flooring surface you're working on.

    b. If you have the Grey cook band (light resistance, it's pink), attach the strap on the center foam piece to the top of a door and close it, or attach it to some other sturdy point of attachment.

    c. Pull the band through so it's all on one side of the center foam piece.

    d. Lay down on the ground, a few feet from the point of attachment at the door. (For me my head ended up being at least 4 or 5 feet from the door). This is where I was first making a mistake. For weeks before I went back and reviewed the video in the RKB, I was laying down so close to the door that my head was touching the door, and eventually I hated doing sliders so much I dreaded it. Get far enough away from the point of attachment so that with very little effort it will bring your foot back and bend your knee.

    Continued in next post...

    1. f. Continue to bend and straighten your leg. Do whatever range of motion you can tolerate (don't push it). It should be fairly easy to do with the help from the resistance band. I had eventually found a point where the band was tight enough so that it would really help me flex my knee with very little effort from me, yet I could almost completely relax my leg and have it straighten back out.

      If you're goign to try it, I'd start small. Try maybe a couple of minutes per injured knee, 3 times a day or so. Do that for two or three days, then add a minute (so three minutes 3 times a day, then 4 minutes, etc), until you're up to 10 minutes or so. Stay at 10 minutes for a few weeks, then maybe try working in some very light total trainer stuff. When you start the total trainer squats, ease into that too, don't just switch from sliders to total trainer. Take a similar concept that you did with the sliders - replace a minute or two of sliders with a minute or two of squats. Eventually you'll just be doing ten minutes of squats. If you are having problems with both knees, this effectively cuts the time for this in half, because for every minute of sliders for each leg you are replacing it with one minute of bilateral squats.

      As far as strengthening and stuff goes, that sounds like it's a little ways out. Take it slow, especially right away, and when you make a change, do it for at least a couple of days, and see how it goes. If you're still having problems after like 3 or 4 days, chances are what you did was too much.

      That right now is the best advice I can give you as far as using the Total Trainer goes. I can tell you from my experience I was doing bilateral squats immediately. I started single leg squats at level 3, and I wasn't doing bilateral squats until I was at like 8 or 9 on single leg squats, and for bilateral squats right now I'm at level 6.

      Here's some other stuff that's helped me that might help you:

      1. Avoiding stairs - Unfortunately my home is a split-entry home, so when you walk in you are in an entryway, with half a dozen stairs up or down. I'm able to manage getting up my stairs well enough by pulling myself up and keeping my legs fairly straight (I call it Frankensteining up the stairs). There's no way I could possible walk down the stairs forward however. What works for me for going down the stairs is to go down backwards. Obviously you need to be careful and make sure your path is clear, but it makes them significantly more manageable. One day I'll be able to walk stairs properly, but until that time, I avoid them and if I need to go down them, I go backwards, no matter how silly it looks. It's really not much different that backing down a step stool or ladder. I still use the railings to take some weight off of my joints, but it works.

      2. Get a step counter of some kind - phone, fitness band, etc.

      3. Be patient, and don't give up.

      4. Remember that everybody is different, and don't let someone else's successes or failures discourage you.

      Best of luck to you, David. If you need clarification on anything I said, please feel free to reply.


  12. I recently got my kids a trampoline and I have been bouncing on it for 10-15 minutes per day. At first my sore knee was a little tender but a few weeks in I have noticed a significant improvement in lack of pain in the knee and an overall strengthening of the core with no back pain. I am close to 50 and played soccer most of my life and have suffered knee pain in one leg for about 2 years. The pain is finally subsiding but I though I would share with the group my experience with this low impact alternative.

  13. Hello from Singapore!

    Thanks for this site Richard. It provides so much hope and advice and encouragement for so many knee-pain sufferers, and that's really a big part of the battle, to just hang in there.

    I landed on this site after a Google search, of course. The first time I visited this site was in 2012-2013 but at that time, my knee-pain was fairly new, I thought it would go away, and I lacked the patience to go through everything in here. I did register that walking would help the knees. But I didn't focus on that as I didn't think my problem would worsen.

    But in some ways it has worsened, and in some ways things are better. However, now I plan to get serious, and so I've been visiting this site often. I need to make a knee-recovery plan along with a knee journal. Am hopeful, thanks to you and others here, but far from where I need to be.

    Anyway, I wanted to request you to make a fresh, new post and collate everyone's knee-recovery stories out there.

    for eg. TriAgain has been so kind to re-post his story and recovery plan in many posts. Others have done the same.

    But it would be great if you could make a post, with all these recovery stories under *one* post... so that anyone who wanted to refer to this site for the specifics of any other person's recovery, could immediately head straight to that post.

    Do you think it makes sense?

    Looking forward ... Thanks!

    1. An actual forum would make sense, this is a blog.

    2. Easiest thing to do is search the blog for "success story." I often use that term when I write about how people have beaten knee pain. At some point I may do a post full of links to previous posts that feature "success stories." That'll probably be the extent of it, as unfortunately my time is increasingly limited to spend on this blog. Cheers, and best of luck.

    3. david: My request was made to Richard. Besides, in many ways this has already become a forum and a community in substance. The blog is just a platform.

    4. Richard: thanks for your reply. Yes, a post with links would make a lot of sense.

      In the mean time, 'success stories' should work. My concern was that there are many comments and suggestions by other readers, and usually these have been made in the Comments section of your posts, so these would not show up in the search for "success stories".

      Even so, let me see if I can collate those links and comments and send them across to you.

    5. Sure, if you want to take that on Sherry, and put them all together, I'll be happy to do a post featuring comments and links. I agree there would be a lot of interest.

  14. hey guys, I dont have any problem in the knees but in the IP Joint of the big toe. I am wondering, if I move the toe with my hand, is it the same? Because if I move it too much it hurts the next day so if I move it with my hand it is easier to adjust it to move it just a little bit and hopefully increase little by little in the future. Thanks!

  15. To treat runners knee pain you can also use apple cider vinegar as it contains anti-inflammatory property. Because of this feature, it helps in reducing the pain and swelling by eliminating accumulated toxins from the joints and connective tissues.

    Prepare a mixture by adding ACV and warm water in equal amount.
    Take a clean towel and soak it in a mixture and remove excess water.
    Then apply the towel directly to the affected area for minutes.
    Repeat this home remedy for chondromalacia patellae twice a day.