Saturday, June 4, 2016

Welcome to the Blog! A Few Things …

I thought it was about time to do one of these posts, following a recent complaint I got about "commercial marketing" on this site (I'm assuming in the comments section).

There are very few ground rules here for people who want to leave comments/ask questions, but for anyone curious:

* Spam comments will be deleted.

These by the way have become harder to detect. At first spam comments were along the lines of “Great post!” with the commenter embedding a url in their profile name. The url generally led the clicker to some clinic that had most likely paid the spammer to drive up its traffic count.

Once the spammers figured out they were getting deleted this way, the tactics evolved. So now they sort of pretend to be engaging with the post for a couple of lines, often in a fairly transparent and superficial way. And of course, the url is still buried in there somewhere.

Again, I don’t mind at all if you link to a web site, an essay that helped you, a book, whatever – as long as you’re here to participate in the dialogue. If you’re a drive-by spammer, who is just looking for a way to staple an advertising flier to the nearest utility pole then move on, that’s different.

I check the comments weekly and try to clean up the ones that don’t contribute to the dialogue. As I said, advertisers are getting more sophisticated. But be forewarned: if you’re a first-time commenter and include a short comment and a prominent url, you will be looked upon with suspicion.

* The best way to ask me a question is in the comments section.

I get a lot of requests for advice/consultations, and many make me more than a bit uncomfortable. I wrote a book to tell my story, thinking it would help a lot of people with similar problems and also, as much as anything, offer hope when all seems hopeless. To me there was huge value in just documenting well the story of someone who beat knee pain when he was told he couldn’t and exposing all the untruths out there, about everything from “damaged cartilage can never get better” to “you need to focus on strengthening your quads.” Pernicious myths abound when it comes to knee pain.

Also (and I’m not exactly proud of this), I was full of anger about the way I was treated as a knee pain patient, and I’m sure others can speak of a similar experience: shrugging doctors who can’t recall what your issue is from one visit to the next, bouncy physical therapists who have never suffered a day of knee pain in their lives and all work from the same tired playbook, an industry of snake-oil supplements that has sprung up that studies have shown have no clinical efficacy, a roster of more serious drugs to keep the pain at bay and the knee pain sufferer on a dazed eventual walk toward surgery, which is where you wind up when you don’t take charge of a program to get better.

But I never claimed to be a doctor or a physical therapist myself, so I try to avoid giving advice. I try to avoid suggesting much in the way of exercises, except for the most simple ones. In fact, I got better doing an extremely simple exercise: walking, in slow, measured doses, with breaks, always listening to my knees.

So when you come to me and want to share your story via e-mail, my inclination is naturally to shrink away. It’s very flattering, but I’m not the guy you want. Doug Kelsey’s clinic has coaches who are very well-equipped to counsel and advise, and they work by phone now I understand. That’s really who you want. This is why I say “no” when people want to e-mail me with long descriptions of their problems. If they offered to pay me by the hour, I wouldn’t say “no,” I would say “hell no.” Because that would be even more wrong.

So what should you do? Leave your comments below a recent post. A lot of smart people now are regular visitors to this blog. A community has developed here of people who look out for each other, share what has been working/not working, and in many cases, have thoughts/insights that I would not have or that would simply be more appropriate or helpful for you. So share, by all means. But let’s keep the dialogue open and public (you can remain anonymous behind a screen name; that’s fine). You might be surprised at the volume of excellent suggestions (and all the support) you get from others on this site. Plus, I’ll see your comment too, of course, and might have some ideas as well.

Last, let me close on a positive note: Thank you all for reading. Honestly, I figured I’d have shuttered this blog by now. I don’t contribute to it as regularly anymore. But it always gives me pleasure to see all the people chatting below the posts, and I know I’ve created a kind of valuable if small ecosystem on the vast Internet, where intelligent people can talk about knee pain and feel free to shred some of the myths that hold us back from healing – and talk about the difficulties of their personal struggles too.

Healing bad knees isn’t easy. But I’m convinced it can be done. I did it. :)


  1. Richard, I've meant to ask you.... I know you are not a fan of structuralists, but how were you sure that your knee pain really came from your knees?
    I mean, some people have massive cartilage loss and no pain, and some people have massive pain with little cartilage loss. I know the pain was IN the knee, but could it have originated from somewhere else?
    I have noticed that every time my knee pain starts, it's preceded by a few days of pain in the tendons / ligaments / muscles around. Usually the ITB, sometimes the quads and the adductors. If I press my finger, even slightly, on these I can feel an intense pain that always radiates to my knee. And sure enough, the knee starts hurting a few days later and it feels inflamed, full (but it's not visibly swollen), etc. Usually, the pains in the surrounding structures will calm down way before the knee does. If I stretch and massage (I know you are not convinced there either!), it definitively helps, maybe because I can walk better so that it doesn't put more stress on the knee.
    I don't think the structuralists' approach to treating knee pain is safe or even sound. But I think they might have some point that sometimes the knee pain is a referred one. Only it needs to be treated with your approach of high rep low load. My point is that I don't think this approach helps so much with my cartilage (as far as I know I have no visible damage), but more with the overall mechanism of the knee which needs to be retrained. I'm not sure I'm very clear?

  2. " some people have massive cartilage loss and no pain, and some people have massive pain with little cartilage loss." yes one of my doctors also told me this. I wonder why. In fact my father in law claims he had all knee cartilage removed decades ago from injury, and he also has RA, barely has knee problem as much as I do. He can't run, but everything else seems totally fine.

  3. Ree, deloupo, as I've suggested before, it could be systemic inflammation where the major symptom is knee pain. The more I research, the more I think that might be my problem (at least in part). Ed from California got me looking into this possibility. I've never been offered any tests for this though, despite mentioning to medicos the possibility of RE or synovial inflammation.

    Richard - I too am angry with my treatment as a knee pain patient and I don't lose any sleep over it. Mostly 10-15min consultations, "weak quad/VMO, do these strengthening exercises, that'll be $70-$160 thanks, come back in a few months if you are still having problems". After several of these I eventually found a Sports Dr who videoed my knees in action and concluded my quads/VMOs were working fine (who'd have thought it in someone cycling 200+kms/week!).

    Like you, my job involves research and analysis before suggesting conclusions and I got the distinct impression most of my medicos were bloody lazy on that score, particularly given what they charge per hour. They just got fixed on the knee pain. None asked me about pain in other joints or any other symptoms. They just leapt straight to "triathlete, does lots of hard leg work, he's stuffed his knees". So I have no qualms making sure I get my money's worth when I see my GP now. Most of the time, I'm suggesting things to him which he is agreeing to - things I learned from sites like yours. Scary stuff!

  4. Yes, I also have a friend who has severe osteoarthritis according to MRI findings.
    But, he does not have any particular problems except little pain in a deep squat.
    He does not have constant pain at all!!!!!!!!!!
    Regarding my other symptoms, I also have problems with the lower back or hip(no one knows), left leg ankle, fatigue, dizziness and sometime irregular heart beat, and lately, tinnitus in my ears.
    What about lyme disease?
    Main symptom is knee pain:

    1. When I first went to my PCP he immediately suggested lyme disease, but later he ruled that out with blood tests. My problems are in knees, lower back, shoulders, right ankle and arch, fingers, toes, eyes, teeth, and I too have irregular heart beat, tinnitus in my ears, as well as eczema. All of them appeared within 6 weeks after my baby delivery. Lately I start to have some skin problem on my hands, not quite as in your pictures. I still don't know if they are systematic. I did quite a few blood tests to rule them out but test might be false negative or the disease sub-clinical. At some point I thought I had EDS or ALS, but now I think they are unlikely.

  5. I forgot to mention peeling my hands, diagnosed as contact dermatitis (probably wrong). After comparing the images and listed symptoms from Internet with my palms it seems like Exfoliative keratolysis:
    Another symptom of lyme disease.

  6. Dear Richard,
    I accidentally found your blog and e-book after I got a phone call from the hospital that I have a worned down cartilage in both knees. They offered me the shot which will preserv my cartilage but they expressed the fact that this injection won't build back my cartilages. I always doubd doctors and I earned my master degree in "Univeristy of Google" so I found you and your story. I wish to ask you a simple question, what do you think about this injection? I havent read your e-book since I just purchaed it but I need to go to get my first shot on Monday and I wish to know what is your advise.
    I appreciate your help.

    Thank you,



  7. Compulsory viewing from Dr Scott Dye. He is a bit of a character!

    1. Indeed! I want to watch this all the way through later, when I have about 56 minutes to spare (it's not short, I noticed). Thanks for the link.