Saturday, February 25, 2017

Your Bad Knees Are Someone's Market Opportunity

This article recently caught my attention, with its lead:
The global knee cartilage repair market had a valuation of US$1.6 billion in 2014. The market’s valuation is expected to rise to US$2.7 billion by 2023, indicating a [compound annual growth rate] of 5.8% between 2015 and 2023.
That $1.6 billion actually sounds low to me, but still: It’s a considerable chunk of change. The estimate is from a market intelligence company that blames our increasingly sedentary lifestyle for our knee woes. Still, this isn’t an exhort-couch-potatoes-to-get-moving article.

It’s identifying a market opportunity. Yup, that’s right, your bad knees are a market opportunity. So let that sink in a little, what it means to be a market opportunity. That means there’s gold in them thar joints.

Maybe not golden outcomes unfortunately, but gold for the guy who’s wielding the scalpel and for the company that made the artificial knee joint, or that developed a process to grow cartilage cells in a lab dish, or that makes arthritis medication.

So just keep that in mind when you ask your orthopedic doctor: What should I do about these bad knees?

Most doctors are very conscientious, very ethical people, but be aware there’s a little conflict of interest tugging at even the best among them. They have become vested in surgical procedures. What would you think if you had spent many hours perfecting cartilage-trimming operations, investing in equipment for the same, receiving sizable paychecks for surgery – then someone said, “Hey, you know, clinical studies show doing that’s usually a waste of time.”

I bet on some level you’re going to resist that conclusion.

Also, all these companies that have developed drugs and procedures, they have something at stake – maybe stock prices, impatient investors, shiny new facilities. The drug makers employ pretty young representatives (my brother was married to one) who smile their way into the office of your crusty old physician, who takes some samples and maybe later writes a few ‘scrips – and that attractive young woman, she’ll know exactly how many Doctor X wrote, believe me, and she’ll be back later, trying to induce him to write a few more.

So, as a patient, you just need to remember there’s gold in your bad joints -- $2.7 billion by 2023, it appears – and that when there’s money to be made if you do thing X (surgery/medication) but no money if you do thing Y (try to heal on your own or through physical therapy), you have to be aware of that and weigh your options wisely.


  1. Spot on Richard. And thankfully I worked this out before I was tempted to try the highly dubious 'knee cleanup' surgery which even my OS suggested I stay clear of.

    The other one which peeves me is 'you are just getting old' without really considering your history. I went from smashing out a pretty fast half-ironman race to hobbling like a 90yo with chronic stiff/sore/burning knees within 3mths.

    All the medicos thought cartilage wear & tear, and while no doubt I have some, it felt like all my cartilage had just vanished in that 3mth period. Intuitively, I knew this was impossible, and finally after reading Dr Scott Dyes material, I figured out what was going on (chronic inflammation of synovial lining & other things in my knees).

    As per Dr Dyes protocols, I got on anti-inflammatories for 4-5mths and avoided aggravating activities (though not always very well), but found some things I could still do to maintain fitness and some leg strength.

    I've not been off the anti-inflams for a month now and things are going well.

    Y'day I was out on the MTB around a very challenging track for 90mins with feet clipped in. While my knees are not 'normal' and I have to be careful not to over-do it, I've come a very long way. I'm also doing some running over 4-5kms as 2min walk/3min run.

    The key was knocking out that inflammation to allow the knee tissue to regain some homeostasis. I also think chronic knee inflammation can lead to cartilage degeneration, so getting on top of the inflammation is critical.

  2. Hey Triagain, could you share which anti inflammatories youbwere taking? Beside the medicine what else did you try to knock out inflammation. Thanks in advance.

    1. Hi Superman
      Celebrex 200mg, 1 tablet each morning for about 4-5mths. Been off it almost a month now.
      I tried natural anti-inflams first (Rosehip with GoPo) but it was not sufficient. I needed the heavier drugs!
      I also started doing a little icing when I'd overdone things, but not more than about 10-15mins a day in one session as I think over-icing can cause CRPS-like symptoms.
      I found some gym exercises that did not stir things up too much, but improved my leg strength which in turn I think took some load off my knee joints (sissy squats body weight only using hands against a frame for a little support/balance, deadlifts up to 50kg, kettlebell swings up to 20kg). Also did upper-body work during these sessions - basically a 20-25min intense whole-body workout with little rest. Good for endorphins and your head. Found I could also skip for 30-50secs without trouble.
      I eased back into a little running & cycling, but nothing like I used to do, and did not take it too seriously, just happy to be out there doing a little.
      Recovery is not linear. General trend is upward and gradually doing more, but I still have times when I go backwards a bit. That's mostly when I do a little icing in the evenings.

    2. Thanks a lot for the detailed response TriAgain.
      My recovery is not linear either. I was doing pretty well for about 8 months and then I overdid squats this past month and I can feel that weird soreness in my knees again which I remember from last year.

      I would agree that 10-15 mins icing in one session is the limit as I notice some pain after that point as well.

      From my reading, sissy squats are some of the worst exercise you can do for your knee joints since they put all of the load on the patella. However, its interesting to see that you have seen improvements after doing it.

      I am curious how you got back into running. I think of running as a high impact activity on the knees. I am looking to get back into running as I think its one of the best exercises for cardiovascular fitness.

    3. Hi Superman

      I decided to trial sissy squats after another poster on here wrote about how a medico asked him if he had ever tested his pain barrier, which he did using sissy squats and found after a certain number of reps, things started to get better.

      I found similar. The first set of 10, under my patella was not happy, but it improved with the next 2 sets of 10, and the quad workout was most pleasing.

      AS for running, I started with 2min walking, 1 min run for 20-30mins and over the course of a year or so have got it 2/3 for 30mins. I have run a couple of straight 4 & 5kms non-stop at about 5:30-40km pace, but paid for those a little, so went back to the 2/3 for now.

      My theory is that with my type of PFPS issue, degree and number of reps of knee flexion under load is more of a problem than impact at lower knee flexion. Hence the small number of reps I do (e.g. sissy squats, not more than 90 deg flexion) or running (less knee flexion than cycling)are less of a problem. But if I did enough of either, it would push me past my limit.

    4. TriAgain,

      Do you suspect a chronic pain disorder is also to blame for your pain. I have always thought that and my physician finally confirmed it. Started on some medication for nerve pain/fibromyalgia and have noticed a significant reduction in pain after about 4 months when the meds kicked in.

      Also notice a reduction in pain after cutting out dairy.


    5. I should clarify the chronic pain disorder was TRIGGERED by a knee injury that further deteriorated after the crap standard physical therapy receipe.


    6. Alex

      This is a tough one. I've often wondered if I had a fibromyalgia type condition, because I got sore elsewhere as well (though nothing like the intense persistent knee pain).

      I went to a pain specialist who put me on lyrica (a nerve-pain med) for my knees, but it did not do much.

      As my knees have recovered, I've noticed sensations in them that I vaguely recall while running BEFORE my L meniscus tore, a subsequent surgery, and within 2mths wicked PFPS in BOTH knees.

      So I think I was headed for PFPS anyway, surgery for an unrelated knee issue hastened the demise, and PFPS morphed into a more systemic issue (both mental & physical).

      I should add, as well as anti-inflams for 4-5mths, I've been on anti-anxiety/depression meds for more than 12mths. These have helped me so much I can't believe, and a more positive outlook probably aided knee healing. But I still think the key to PFPS is getting on top of the inflammation.

    7. TriAgain,

      That is very interesting! Chronic pain disorders are primarily treated with antidepressants so I'm glad they have help to you. I take gabapentin which is Lyrica's sister drug and it took about 6 months to kick in and it did decrease the burning in my knees. I went off of it as I didn't like the side effects and I wasn't convinced it was doing anything and that daily burn in the kneecaps is back so I'm going to go back on it.

      I am taking an antidepressant as well and I've had a lot of pain relief from it, but again took a long time for it to kick in. A few months ago I went on a holiday where I was averaging 25,000 steps per day and I had no pain now that I'm off my nerve pain med at 7000 steps I'm hurting. So for me prescription drugs are worth it as they've given me my life back and I just have to put up with the side effects.

      I'll give a quick update I'm no longer working with DK's coach, she help me immensely I can maneuver stairs, squat, etc. and the medications are needed to tackle the nerve pain. I believe that my bad knees were injured and inflamed for so long that it got to the point where it inflamed and compromised the nerves.

      Knowing what I know now in the beginning of my injury I would probably opt for ONE Cortizone injection to tackle the inflammation and focus on an anti-inflammatory diet; I can't take anti-inflammatory drugs because I am highly allergic to them..... and the most important piece of all would be to stay the hell away from standard physical therapy!


    8. Alex - on this point:

      " I believe that my bad knees were injured and inflamed for so long that it got to the point where it inflamed and compromised the nerves. "

      I agree. Despite a massive improvement in my knees, they do not feel entirely normal and I still have to be careful. I think the 4-5yrs of chronic inflammation of my synovial lining (and other structures?) caused some long-term changes in my knees, which may take many more years to reverse (or maybe it can't be). I know for sure my patella cartilage is now softer/weaker and it is far asier for me to flare up my chrondro-like pain (which is different to the PFPS pain).

      Luckily for me, I had no side-effects at all from 4-5mths on Celebrex.

      And as for this:

      "and the most important piece of all would be to stay the hell away from standard physical therapy!"

      You are 100% correct. I'm almost tempted to ask the Australian Associations of Orthopedic Surgeons and Physiotherapists if I can present at their next annual conference, to tell them how dangerous their rehab protocols are for people with true long as they cover my costs.