Knee pain is often a strange, baffling thing.
I tried to figure it out. I eventually healed my own hurting knees, and learned enough that I was motivated to write a book about my experience.
But at the same time I knew there was a whole lot I didn’t understand (and neither did the smart people out there who study the origins and treatment of knee pain).
One thing I always tried to do: draw lines between cause and effect, especially when I had a setback on the long road to getting better. For me, setbacks were like small teaching moments: my body teaching me something, very important, about how I should go about healing.
Sometimes it’s easy to draw that line. If you carry a heavy backpack up six flights of stairs, then have knee pain the next day, or a couple of days later, what caused it isn’t much of a mystery.
But what’s frustrating are those setbacks when you can’t point to a likely culprit. What then do you do? What if your knees hurt worse then ever, out of the blue, and you can’t figure out why?
These are the good, hard questions. I’ve thought about them more since I started the blog, as a stream of readers have confronted me with issues that weren’t always ones I had to deal with, but that usually made me think.
My gut feeling – and this may work for you, or may not – is to hit the reset button and scale back your activity significantly. Maybe try returning to your activity level from a couple of months before?
But I would be reluctant to go “full couch potato.” I’m not saying it doesn’t work for some people, because apparently it does. But I’d rather find a way to get in some motion, even if I’m seated and resting my feet on a wheeled dolly that I slide back and forth, back and forth.
It can be maddening to be racking up small wins over three or four months then have a weird, sudden, inexplicable setback. But they happen. I think there is a reason for all setbacks, because I’m that kind of logical “things happen for a reason” kind of guy.
But let’s face it: the human body is a very complex stew of chemicals and cellular processes, all interacting in complex ways. It shouldn’t surprise us that the results of some of these interactions are close to unknowable. And some of them probably lead to unpleasant knee pain symptoms.
So, even if you can’t figure out what caused your setback, carry on. Don’t get too discouraged. Try to figure out what you can, but I think there will always be mysteries.
Here is an interesting approach to think chronic pain that I found lately
ReplyDeletehttps://www.bettermovement.org/blog/2014/a-systems-perspective-on-chronic-pain?rq=dorsal%20horn
The blog is quite good in general so I share and hopefully someone else can also benefit from it.
Good luck, everyone!
I had a weird one last week. After my swim session I decided to do 20-30 squats in the waist deep water - so not even full body weight, but knees going past 90 deg bend. Next day, for the first time in months I felt the old ache/burn symptoms coming back. Couldn't believe it as my knees have been pretty good for 6-12mths now & I'm back to regular hard cycling of up to 90mins, some solid leg weights in the gym 2x/week & even a little running (4kms of 2min run/2min walk).
ReplyDeleteThankfully, those symptoms only lasted 2 days, and I didn't even back off with my other exercise.
Just shows my synovial lining is still twitchy.
I'm also sure that 5yrs of chronic knee pain/inflammation did my cartilage no favours. While the constant burning/aching/stiffness has gone, my knees feel 'older' than when all this crap started, but it feels more like weary cartilage than anything else.
Hey guys, this is all extremely interesting, thanks Sveto for sharing! I think its a most significant article. I recommend looking into it, and maybe its even something Richard could take up in one of his posts.
ReplyDeleteOver the past years I found myself getting ‘obsessed with the idea’ that my cartilage is damaged/dysfunctional/gone (whatever), or then later that the synovium is inflamed or the bone changed, causing the discomfort. I was so happy when I found Richards book, yes, finally a ‘solution’. But at least for me, and probably for many others, ‘making only 2-3000 steps a day’ is not the only thing thats needed (and I believe it wasn’t for Richard either). I am more and more realising how neurological pathway changes can cause regime shifts in the system. After months in a chronic condition you find yourself developing sensitivities to things that never bothered you before, and especially for very sensitive people (like me), everything can become a threatening stimulus to feed the negative pain circle. More pain, more threat, more pain, etc. Richard, with his strong mind, quitting his job and focussing on things he liked, cut out or minimised all his stressors, and eventually came right. The pain went, and the cartilage probably grew back. But the stressors can be anything (physical, environmental, emotional), and they can be massively different for different people. Its really complex, and identifying the stressors takes a high level of self-observation. This is nothing a doctor can give or teach you, and as Richard says, in the complexity the cause-effect connection is not necessarily clear. What I like about the Systems Perspective of Chronic Pain-article is that it illuminates the many useful principles of the savingmyknees-community from a different angle.
Does the quote from the last section sound familiar? “That means getting better is often a question of moving two steps forward and one step back. In the short term, this makes it difficult to discern positive change. But over a larger timeframe, a pattern of progress may become clear. It's good to keep these patterns in perspective so that short-term setbacks do not cause abandonment of a winning game plan.”
Hi everyone , I’m unfortunately new to this pain. Just a month. But damn, you all are scaring me that I’ll maybe feel like this forever. I’m 29 and active. I hurt my knee in a basketball game and it never healed. I rested it, it got better, then would go out and do something active on it (couldn’t run, more like hiking or yoga) and would reinjure it again and again for 3 months. Finally, after a walk and two doses of yoga, it flared to a point where I am now (5-7/10 burning pain at all times in the knee; standing, sitting, lying in bed, etc.). It’s been a month post the big flare up, thankfully I live near Dr Dye in SF so I’ve begun seeing him (he thinks he can help but I’m an Uber skeptic of any doctors, mentally I’ve also convinced myself there’s little hope). I’m on crutches now but I’m seeing no sight of any envelope of function (ie. I have pain all day, from when I wake to when I go to bed no matter what I do, even if I rest it up all day, pain is burning at rest and sharpish when I walk around, which is nearly never now).
ReplyDeleteSo my questions!
1) Does anyone have any evidence of someone in my position, someone with NO envelope of function (meaning intense pain at all times, no matter what they do) recover from this? Even a little?
2) Dr Dye said that if I wasn’t getting better in the next 6 months he’d potentially go in arthoscopically and cut out inflamed synovial cells. Has anyone had this surgery? Any evidence it works?
3) Do I stand a better chance as a younger person?
4) Anyone live in SF? I need a hug in a big way.
5) Has anyone who’s had this chronically for a long time been able to build a happy life? Obviously one with struggle and strife, but one where you could make it out the other end mentally and get yourself out of bed every morning? One where you maintained a stable job and just learned to live with it?
6) Would a TKR help me?
-Ben
Hi Ben. I've had daily pain in my left knee for three years. It's some kind of over-use injury related to running (which I stopped when I developed symptoms, but by then I guess it was too late). The pain came on a little at a time, so the type of injury I have may be different from yours, but I can tell you about my experience with an arthroscopic synovectomy. I had it about a year ago and it really helped with range of motion and reducing the burning pain from sitting with my knee bent. Thickened synovial tissue was getting pinched whenever I bent my knee. I couldn't bend my knee very far, and getting comfortable at rest was almost impossible. I am now able to sit at my desk for much long periods, watch movies at the theater, and go for multi-hour car rides and airplane flights. I still have pain though during or after any weight-bearing activities that aren't slow walking on even surfaces. The docs keep telling me that will resolve with physical therapy aimed at strengthening the leg and hip muscles. I haven't seen any improvement yet though, which is discouraging. Anyway, in your case, if osteoarthritis, meniscus, tear, tendonitis, stress fracture, etc. have all been ruled out, a conservative synovectomy might help. It may not cure your problem, but it might help eliminate some of your symptoms, as it did for me.
DeleteDid any doctor diagnosed you with synovitis before the surgery or did they do arthroscopy to see what was going on and then performed synovectomy?
DeleteHow long did it take you after the surgery to start walking again without crutches, driving etc.?
Hi Ben
DeleteWas it Dr Dye that suggested to go on crutches? Did he prescribe you something else?
Hi Mante. To answer your questions: Physical examination, x-rays and MRI failed to reveal an obvious cause of my pain. Five months of physical therapy did nothing to help. At that point my doctor suggested an arthroscopy to get a better idea of what was going on. Some things can only be seen from the inside. The surgeon suspected he would find frayed or loose cartilage under the kneecap, which he'd clean up. He didn't find that though. He said my cartilage was a little soft but otherwise was in good shape and all there. So he didn't touch my cartilage; he just removed the abnormally-thickened parts of the synovium. Afterward I walked on crutches for a couple of days. I didn't need them after that. But my knee was sore for a while and so I was gentle with it. I don't drive, so I can't tell you about my experience with that.
DeleteCheers,
Pax
Thanks for the reply Pax. Where did you have the surgery?
DeleteAre you still doing physical therapy for your knee?
I had the surgery in Oregon. Afterward, I did physical therapy on and off (mostly on) for the greater part of a year. I recently quit because I just wasn't seeing any improvement, plus my prescribed routine involved using weight machines at a gym, and this was inconvenient for me for a number of reasons. My doctor and physical therapist kept telling me that in order to improve the pain, I had to rebuild the muscles around my knee, which had significantly shrunk over the three years since my injury. But the exercises they were having me do often aggravated the pain and actually made it harder for me to do day-to-day activities. That's the big dilemma of patellofemoral pain syndrome--how to take pressure off your patellofemoral joint by strengthening the muscles but without constantly irritating sensitive tissues in the process. Nobody seems to have an effective solution for this, which is why Richard's story of success through simple walking therapy has felt so revelatory for so many people. I myself have found that my knee seems to like lots of slow walking on even surfaces. But it hasn't cured my problem, and it does nothing to help the soreness I experience during and after ascending or descending stairs. If I remember correctly from Richard's book and posts, this last symptom was never a major problem for him. Plus, he feels that his problem was cartilage degeneration, which I know I don't have. So it's important to remember that everyone's situation is different. "Patellofemoral pain syndrome" is not a diagnosis. It's just a phrase that means "you have chronic pain in the front of your knee with no obvious cause." As for "synovitis," it too is poorly understood and is usually a symptom secondary to some other condition, like rheumatoid arthritis. Or if you have some kind of biomechanical problem, like one leg is shorter than the other, your synovitis is going to persist until you resolve the asymmetry. I'm at the point where I'm ready to move away from orthopedics to start consulting other kinds of medical professionals like chiropractors to see if I have some kind of hip, back, or foot problem that's been overlooked. Sorry if this was long-winded but I hope what I have experienced and learned can be helpful to others.
DeleteCheers,
Pax
Thanks Pax, your experience is really helpful.
DeleteI have been having PFPS since one year. Most days I feel this relentless burning on both knees, and had just a few days virtually painless. Even though I stopped running and any other sport, it's the activities of daily living that flare my knees up. I cannot afford living as a recluse at home, resting the whole day, or quitting my job, and neither I want as both things would make me become even more depressed than what I am already.
That's why I am starting to ponder arthroscopic investigation and potentially synovectomy. But the thought of ending up worse than before, because of the trauma and irritation inflicted to the knees, scares me. Besides, I have PFPS in both knees and I guess they cannot do synovectomy in both knees at the same time, but first one then after several months the other, is that right?
I don't know how they do synovectomy when both knees are affected. I understand your reservation about surgery though. Hopefully you have access to good medical care and can consult with an experienced knee expert about the potential risks and benefits of surgery. Arthroscopy itself is a pretty minor, low-risk procedure. It's just making a small incision and looking around with a camera. It's what they do while they're in there (if anything) that you need to be concerned with.
DeleteHi
DeleteI am a 29 year old female and had been suffering from knee burning for the last 1 year and 10 months before I discovered 'Saving my knees'and '90 day knee arthritis remedy'. My knees pained very occasionally, mainly when I overuse them by walking upto 15000 steps, dancing etc. '90 day knee arthritis' has given description about some of the exercises that may help alleviate your pain. I have been doing just one, moving the leg while sitting on the edge of a chair, while taking a high dose protein (since I am a vegetarian my diet doesn't contain a lot of protein).
And within 2 months, my knees have started feeling a lot stronger. I can see the difference. There was once a time when I had almost stopped going out with friends as you never know when the knees start getting irritated. Thankfully, that's not the case anymore. Btw, I am software developer by profession, so my job forces me to sit for long hours but thankfully the floor in my office is covered with carpet, so I can do this exercise while sitting and working too. I have never been this positive about curing my condition as I am now after reading these books. Moving your knees in a sub-gravity condition is the key here. It has helped me, it will help you too. So don't loose hope my friend. :)
Hi Ben. My answers:
ReplyDelete1) Yes
2) Don't know, but Dr Dye is your best bet by far
3) Yes
4) No - Australia! But sanding you best wished. 1 month is a very very very short time if your main problem is synovial inflammation. Took me 5yrs to get on top of it.
5) Yes, me. 80-90% improved now, back to a fair amount of sport (mostly cycling, gym, swim, a little running)
6) Forget it - too young and way too early in your journey to consider TKR. Besides, TKR limits what you can do.
cheers
Thanks Tri,
ReplyDeleteA few other follow up questions that may be helpful to others if anyone has answers...
7) I've been crutching around for 2 weeks (and I suspect will need to do it for many more weeks) but my other knee (R) is now flaring up itself. Any advice?
8) Let's call the place I'm in now Knee Pain Purgatory (KPP, we'll keep it short and fun!). In KPP, there is no time you don't feel absolute pain and therefore you technically have 0 envelope of function, no load of any frequency can be handled w/o pain. My question for the larger group is this - during absolute rest in KPP, did you try to begin to do small walks (like <2 min)? Something just to keep the cartilage engaged (Richard suggests movement is key to healthy cartilage). Or did you hide in a completely non-weight-bearing hibernation until you couldn't feel pain standing up and walking around a bit? Just curious to hear how it works. My guess is it's not black and white and you need to start to walk with pain before you can get to walking without pain.
9) I need to be on planes for work. Is that going to screw up my KPP absolute rest?
Ben
My left knee sharp pain went away in six months.Burning diminished over the course of five years. From 5-8/10 to 1-3/10. I am 47 years old now.
ReplyDeleteHave you been able to resume most activities?
DeleteI can walk long distances and do stairs. I am satisfied with that. I am aware that my knees would never be like before.
DeleteBurning is the worst thing and, like I said,burning pain diminished progressivily over the years and now is tolerable.
7) Yes both my knees went into KPP, after surgery on the left one, but I suspect both were heading that way before the surgery. It is common for synovial inflammation to be bilateral.
ReplyDelete8) I pretty much had pain all the time for years except when sleeping. I never went non-weight bearing. I agree, some easy walking is probably the way to go.
9) I had stuff to do which definitely did not help & slowed down recovery(going on hols with families, lugging heavy cases about). Hard to avoid unless you can do what Richard did (quit work).
Dear Richard, I have same, chondromalacia .from 4 states I have 2nd state. I am a 21yrs old dancer and knees mean everything to me.I am planning to read your book but until then can you tell me have you got back to your activities normally? I am not in big pain, but ocassional. Is it possible to run a sports / dancer life with chondromalacia?? Also, have you been in touch with feldenkrais method?
ReplyDeleteYes, I'm back to cycling very intensely (as anyone who follows me on Strava can attest to!) I don't see why people can't return to an active lifestyle -- dancing, sports, whatever -- after healing their knees, but you do have to go slow and be careful (my experience anyway).
DeleteI'm not familiar with the "feldenkrais method," sorry!
I haven't read your book yet, but am interested if I am not expiriencing big pain, only little and ocassional with chondromalacia, is it neccesary to quit sports activities While recoverying as described in your book?
ReplyDeleteNot sure if you have to quit entirely. It may be a good idea, but it depends on the condition of your knee. If you have just occasional, minor pain, perhaps you can continue but modify the activities. But be careful: minor pain may be a precursor to more serious problems if you don't take some kind of action now.
DeleteHi Richard. I have similar symptoms as you had. I've been training martial arts for a few years, during which I damaged both my knee cartilages.Over the last few yers I had a several sessions of electro and magnetic therapies (which of course helped only temporarily).And today after finishing the last therapy, when I told my psychiatrist that my knee pain isnt improving and is infact starting to get worse, esoecialy while standing and putting full weight on the left knee, his answer was "Well... avoid standing, goodbye". The more I read warious claims that cartilage cant get better the more depressed i became, and after hearing him saying that I didnt know how to react or what to do anymore.But accidentaly stumbling on your book really gave me courage and motivation,wil buy your book and give it my all. By the way Im 28 years old, and hoping to retun to active life and martial arts.
ReplyDeleteHow do you know damaged cartilage is your main problem? It could be synovial inflammation (Google Dr Dye PFPS). I think saying goodbye to your therapist is a good idea, does not sound like he can help you. And even if it is damaged cartilage, there is evidence it can heal.
DeleteWhether cartilage or synovial inflam. it is a long tricky road but you can make big gains with care, patience & time. Hang in there!
Hi Richard
ReplyDeleteI m from istanbul, Turkey. I suffer from pfps with 2 months. All doctors and PTs say the same things and i am fully depressed in 2 months. Your book is my the biggest hope! But due to some local restrictions i could not buy it. Is there only electronic version of the book, because if there is printed version i will be able to buy through the contractual publisher in turkey. Thank you very much Richard, bye
I'm sorry Ibrahim, but there isn't a printed version -- I never went that route. I'm not sure what your restrictions are, but the book is available on both Amazon and Smashwords and can be read in a variety of ways (you don't need a Kindle for example).
DeleteIn any event, the book is the full A-Z story, but everything that I believe in is on this blog, and the blog is free -- so you may want to spend some time just looking around. Also, you'll find some very good insights from other people who have healed in the comments section. Best of luck!