Saturday, March 25, 2017

Does Your Doctor Really Understand Your Level of "Physical Activity"?

I came across a study recently that came to a not-very-surprising conclusion: that a high level of leisure-time physical activity is good for your knee cartilage.

That’s nice to hear (again), but it’s hardly stop-the-presses news. Nor is it necessarily true without qualifiers. There is an appropriate amount of physical activity that’s good for knee cartilage, but you to make sure you get that amount right for you, especially if you have a difficult case of knee pain. Too much and you’ll further damage your knees.

What I found more interesting was this idea of “physical activity,” taken in its broadest sense. The study focused more on activities such as walking and Nordic walking, but “activity” can be almost anything: it’s crossing the room, kneeling to scrub the floor, walking to the mailbox, carrying your little niece on your shoulders. It’s all of that and much more.

This study got me thinking about something doctors and physical therapists usually don’t do: they don’t take anything resembling a comprehensive inventory of how you use your knees each day. Example: You have really bad knees and your doctor asks what sports you do. You say you don’t run or play basketball, but get in a few miles of slow walking each day.

Sounds great, right? So maybe your doctor writes down, “Sporting activity appropriate.” But what if you’re also lugging your two-year-old around all the time? That could be doing as much damage to your knees as playing basketball a few times a week.

In my book, I went into a lengthy criticism of a knee study that seemed to me to be a bit of a mess. One flaw concerned giving too much weight to how much time your knees spend in a certain kind of physical activity, like running or walking. That’s part of the picture, but it seems to me everything you do from the moment you wake up until you hit the sack at night is part of the picture. And if you’re not being asked about how you use your knees outside of sport, your health-care provider (or therapist) isn’t looking at the whole picture, but only at what might be a small piece.

One point I like to make about conquering knee pain is personal involvement in finding a solution. The experts are good, but they are limited: they only have a short time to spend with you, and there’s no way they can crawl inside your body and feel how your knees feel, and live with those joints for a few days to see how they’re being used, and how they’re irritated, and to what degree.

So I think it falls to everyone with knee pain to do this analysis themselves. Ask yourself, “How do I use my knees each day?” What knee-unfriendly things do I do? How much squatting, lifting, kneeling, carrying, walking? You may find activities in there you’re doing that you shouldn’t be – at least not until your knees are stronger.


  1. Richard, you make some great points. I thought I was onto something by leaving work 6 months ago to rest, and I did manage to identify a lot of triggers I never suspected in that time (such as lifting the mattress a bit to make the bed each morning!) but unfortunately I have not improved simply by avoiding certain activities. My comprehensive knee diary isn't revealing any clear patterns at this point either. Interestingly, Coeliac Disease is looking increasingly likely in my case, as is the potential for my synovitis of the knees to be autoimmune in nature due to reacts to certain foods. Perhaps a change of diet will help.

    1. Hi Amy,

      I looked into my diet as well as I didn't feel my activity levels were strenuous enough to warrant bilateral knee pain. I didn't find any allergy or intolerances however. It seems the only definite way to figure out food allergies is a complete juice fast and reintroduce foods slowly one by one. Barbara Allens book 'Conquering Arthritis' is worth a look at. She outlines that type of fast and also lists hidden food allergies in items such as toothpaste, medicines etc. I just replied to your post in the forum in March too if you want to take a look.

      Hope you make some progress soon.

    2. Hi Ellie,

      Thanks for your response! A juice fast isn't suitable for me because I react to the salicylates and amines in fruits and vegetables (among many other things). I have been through the Royal Prince Alfred Hospital (RPAH) Elimination Diet, also known as the FAILSAFE diet, under the guidance of a Dietitian and that process has been very enlightening!

  2. Ellie, I went back and found your comment to me in March but I don't seem to be able to respond to comments there - I am getting an error message. Thanks so much for the recommendation. I found the blog you mentioned and have located some references to Dr Dye and Ali's knee surgery; however, it appears Ali has not been active on her blog since 2012. I have left a message asking her to contact me just in case.

  3. S.A. - If you are still visiting here, I would be very grateful to you for any details about your recovery from surgery as this is looking like the only option open to me now. I hope you are doing well with your recovery.