This is my end-of-the-year shout out to everyone who visits regularly, semi-regularly, or even who's dropping in for the first time.
Thanks for coming by, and best wishes for your knees in 2020. If you've been on a program, whether designed by you or someone else, year-end is a good time to reflect on how well it's working. Beating knee pain can involve a frustrating amount of experimentation. Sometimes you have to look at what you're doing, in a very clear-eyed way, and say, "Hey, I'm not getting better."
That's different of course -- very different -- from "Hey, I'm getting better, but it's taking soooo long." That unfortunately is par for the course.
My knees this year have been very, very good. I think I sprained a ligament on the inside of my left knee, and because I stubbornly refuse to curtail my cycling much, it has become a bit of a nuisance injury. Still, I plan to shut things down for about a month this winter, and hopefully that will take care of it for good.
What about all of you? Anyone out there want to share the progress you've made this year? What are you resolving to do more of/less of in the new year? Leave your comments below.
Cheers, and best to all!
Friday, December 27, 2019
Saturday, December 14, 2019
A Thinking Man’s Guide to Writing a Book About Knee Pain
After a Washington Post reporter wrote an article quoting me about my recovery from knee pain, I saw a predictable bump in sales of Saving My Knees.
A lot of people were motivated to buy the book, it turns out. A small number returned it, realizing it wasn’t quite what they wanted. (In the front, I now explicitly warn people that it’s NOT a book full of exercises, but rather my personal story.)
By the way, I love Amazon’s no-hassle policy on returns. I think it keeps merchants honest and careful about quality control. I’ve used it many times myself. I don’t have a problem if someone buys Saving My Knees, then decides, “Eh, it’s not really what I was looking for” and returns it.
Some people do find the book annoying, because it’s a story, as opposed to a pared-down, just-the-basics manual on fixing bad knees. This is something I didn’t initially realize would be an issue. Rather naively, I thought, “People will want to read the whole story, because the outcome is incredible, and this is a book I myself would’ve paid $100 for.”
I suppose every author is self-delusional to some degree. Otherwise, why go to all the effort of writing, rewriting, rewriting again, and rewriting some more, when for all you know your book may sell all of 20 copies? It’s a rather masochistic exercise that does little but feed the ravenous ego, I suppose.
So anyway, I remember at first being surprised by comments in reviews about people skimming through it to get to the "good parts," or complaining it was full of “filler.” But I understand now. If you have bad knees, you just want to know, “What should I do? Tell me. My knees are hurting, dammit.”
You probably don’t care about some of the little details I dropped in there about my own life, or my athletic life before I had bad knees. In my mind, I was telling a story that had a dramatic arc, and a character (me), and I wanted to flesh these things out. But in actuality, I totally understand the mindset of that impatient reader: “How did you do it? Hurry up!”
I’ve sometimes wondered if maybe a better title would have been something like, A Thinking Man’s Guide to Beating Knee Pain.
But I do think there are some advantages to telling a fuller story, and this is partly what I wanted to convey today:
(1) Those little setbacks I had – whether from carrying a fan up a few flights of stairs, or a full backpack for a fairly short distance – may seem unrelated, but they’re very ordinary, everyday events, and every knee pain sufferer will have to recognize that these things will happen, and be prepared to deal with them.
(2) I know I’ve said this before, but negativity takes a big toll on you. And there was a period in Hong Kong, nursing my bad knees, when I was just a ball of intense negativity. So all those little things I mentioned that got me depressed, yes, I did blow them out of proportion, but this is what it’s like being in such a negative state. You do tend to hold a lot of one-person pity parties. And to get on the healing track, you need to move beyond that.
(3) I wanted to show the frustration leading up to the discovery of what eventually healed my knees. I wanted to because so many people go through this prolonged state of trying so many things, with one thing after another failing. This is part of the experience, committing mistakes and chasing dead ends, but still trying again and again.
(4) I wanted to explain what I learned about how knees work, because this helps explain why the solution I came upon makes sense. Again, I’m a logical, rational guy. I don’t want for someone to just tell me something works. I want to know why it works.
(5) And then – I like learning stuff! And I wanted to share the many things I learned. I suppose that’s the inner journalist in me talking.
What if I wrote the book really short? I suppose the ultimate condensation would be something like:
I hurt my knees.
I walked a lot.
I got better.
But that only scratches the surface of the story that was important to tell. So I told that story. But no, I don’t disagree with any reader who thinks the book does include a bunch of non-knee detail (especially at the beginning, where I’m setting a scene). Feel free to fast-forward!
Cheers, and I hope everyone's enjoying the approach of Christmas. Less than two weeks away!
A lot of people were motivated to buy the book, it turns out. A small number returned it, realizing it wasn’t quite what they wanted. (In the front, I now explicitly warn people that it’s NOT a book full of exercises, but rather my personal story.)
By the way, I love Amazon’s no-hassle policy on returns. I think it keeps merchants honest and careful about quality control. I’ve used it many times myself. I don’t have a problem if someone buys Saving My Knees, then decides, “Eh, it’s not really what I was looking for” and returns it.
Some people do find the book annoying, because it’s a story, as opposed to a pared-down, just-the-basics manual on fixing bad knees. This is something I didn’t initially realize would be an issue. Rather naively, I thought, “People will want to read the whole story, because the outcome is incredible, and this is a book I myself would’ve paid $100 for.”
I suppose every author is self-delusional to some degree. Otherwise, why go to all the effort of writing, rewriting, rewriting again, and rewriting some more, when for all you know your book may sell all of 20 copies? It’s a rather masochistic exercise that does little but feed the ravenous ego, I suppose.
So anyway, I remember at first being surprised by comments in reviews about people skimming through it to get to the "good parts," or complaining it was full of “filler.” But I understand now. If you have bad knees, you just want to know, “What should I do? Tell me. My knees are hurting, dammit.”
You probably don’t care about some of the little details I dropped in there about my own life, or my athletic life before I had bad knees. In my mind, I was telling a story that had a dramatic arc, and a character (me), and I wanted to flesh these things out. But in actuality, I totally understand the mindset of that impatient reader: “How did you do it? Hurry up!”
I’ve sometimes wondered if maybe a better title would have been something like, A Thinking Man’s Guide to Beating Knee Pain.
But I do think there are some advantages to telling a fuller story, and this is partly what I wanted to convey today:
(1) Those little setbacks I had – whether from carrying a fan up a few flights of stairs, or a full backpack for a fairly short distance – may seem unrelated, but they’re very ordinary, everyday events, and every knee pain sufferer will have to recognize that these things will happen, and be prepared to deal with them.
(2) I know I’ve said this before, but negativity takes a big toll on you. And there was a period in Hong Kong, nursing my bad knees, when I was just a ball of intense negativity. So all those little things I mentioned that got me depressed, yes, I did blow them out of proportion, but this is what it’s like being in such a negative state. You do tend to hold a lot of one-person pity parties. And to get on the healing track, you need to move beyond that.
(3) I wanted to show the frustration leading up to the discovery of what eventually healed my knees. I wanted to because so many people go through this prolonged state of trying so many things, with one thing after another failing. This is part of the experience, committing mistakes and chasing dead ends, but still trying again and again.
(4) I wanted to explain what I learned about how knees work, because this helps explain why the solution I came upon makes sense. Again, I’m a logical, rational guy. I don’t want for someone to just tell me something works. I want to know why it works.
(5) And then – I like learning stuff! And I wanted to share the many things I learned. I suppose that’s the inner journalist in me talking.
What if I wrote the book really short? I suppose the ultimate condensation would be something like:
I hurt my knees.
I walked a lot.
I got better.
But that only scratches the surface of the story that was important to tell. So I told that story. But no, I don’t disagree with any reader who thinks the book does include a bunch of non-knee detail (especially at the beginning, where I’m setting a scene). Feel free to fast-forward!
Cheers, and I hope everyone's enjoying the approach of Christmas. Less than two weeks away!
Friday, November 29, 2019
Yes, You Can Avoid Knee Surgery. Read About it in the Washington Post!
The Washington Post ran a wonderful article a couple of weeks ago about alternatives to knee surgery.
I was flattered that the reporter, Sally Squires, saw fit to include a condensed version of my story. We talked a couple of times. As a journalist myself, I know that good reporters conduct a lot of interviews, and not everyone they speak with makes the final cut.
When interviewing me, Squires was quite careful and thorough. As she explained in the article, she has been suffering from her own travails with knee pain, so I imagine that the research she did had a special resonance.
She gives a great overview of the dimensions of the problem our country has with sore knees: one in four adults have chronic knee pain, and the number of sufferers has jumped 65% in four decades. About 680,000 total knee replacements were performed in 2014.
Can you imagine that? That’s about one in 500 Americans – in just a single year. What’s more, when adjusted for population, that rate doubled from 1991 to 2010. As her article notes, the number of knee replacements is outpacing operations for coronary artery bypass surgery.
This country has a crisis of bad knees, it seems.
Squires also quotes someone about the delayed onset of symptoms with knee pain. This is critically important, and I don’t remember reading much if anything about this when I undertook my own journey to save my knees.
It means that the activity you do now may seem pain free, but your knees might protest hours later. And if you don’t connect the dots between pain now and something dumb you did yesterday, your knees may never get better because you’ll never try to modify your behavior! I talk about this at some length in my book; it was a key revelation for me.
Finally, one small thing: she did mention that I still notice some burning in my knees when sitting. Honestly, I did suffer occasional spells of burning in my knees (when sitting) during the “post-recovery” period after I healed enough to go back to work.
But the problem with burning under my kneecaps lessened over time. I haven’t had any issues for (I think) two years now. I have to put “I think” in parentheses simply because it’s been a while, and I no longer track every little sensation from my knee joints.
But she’s correct that I did have this problem, and it took a while to shake. And it’s not like my knees never complain. I really beat them up sometimes (like in a very intense Thanksgiving bicycle ride this week). I still like to play hard.
And I’m glad that I can again!
If you haven’t read the excellent article that Squires wrote, please check it out here.
I was flattered that the reporter, Sally Squires, saw fit to include a condensed version of my story. We talked a couple of times. As a journalist myself, I know that good reporters conduct a lot of interviews, and not everyone they speak with makes the final cut.
When interviewing me, Squires was quite careful and thorough. As she explained in the article, she has been suffering from her own travails with knee pain, so I imagine that the research she did had a special resonance.
She gives a great overview of the dimensions of the problem our country has with sore knees: one in four adults have chronic knee pain, and the number of sufferers has jumped 65% in four decades. About 680,000 total knee replacements were performed in 2014.
Can you imagine that? That’s about one in 500 Americans – in just a single year. What’s more, when adjusted for population, that rate doubled from 1991 to 2010. As her article notes, the number of knee replacements is outpacing operations for coronary artery bypass surgery.
This country has a crisis of bad knees, it seems.
Squires also quotes someone about the delayed onset of symptoms with knee pain. This is critically important, and I don’t remember reading much if anything about this when I undertook my own journey to save my knees.
It means that the activity you do now may seem pain free, but your knees might protest hours later. And if you don’t connect the dots between pain now and something dumb you did yesterday, your knees may never get better because you’ll never try to modify your behavior! I talk about this at some length in my book; it was a key revelation for me.
Finally, one small thing: she did mention that I still notice some burning in my knees when sitting. Honestly, I did suffer occasional spells of burning in my knees (when sitting) during the “post-recovery” period after I healed enough to go back to work.
But the problem with burning under my kneecaps lessened over time. I haven’t had any issues for (I think) two years now. I have to put “I think” in parentheses simply because it’s been a while, and I no longer track every little sensation from my knee joints.
But she’s correct that I did have this problem, and it took a while to shake. And it’s not like my knees never complain. I really beat them up sometimes (like in a very intense Thanksgiving bicycle ride this week). I still like to play hard.
And I’m glad that I can again!
If you haven’t read the excellent article that Squires wrote, please check it out here.
Saturday, November 16, 2019
Humans, Salamanders, and the Ability of Cartilage to Heal
Get a load of this: a scientific study is confirming that cartilage does have the capacity to regrow. Hooray!
Of course some of us have believed that for a while.
The reporting on this discovery has a kind of breathless tone of disbelief. The researchers who did the study call this ability we possess a “salamander-like” regenerative capacity. Salamanders, of course, can regrow limbs and parts of major organs.
As I’ve said a number of times, at least two studies done a decade or so ago have discovered that deep holes in cartilage can fill in naturally, at least part of the way, over a few years. (For more, see here and here.) That doesn’t surprise me at all.
From an evolutionary biology standpoint, it just makes sense.
The cartilage in our knees takes a banging over the course of decades. It’s hard to believe that it would be designed so that it just wears out, like the tread on an overused car tire. Cartilage should have some natural regenerative capacity. Indeed, evidence has been found that, when damaged, it does try to repair itself.
The problem is, cartilage changes slowly. Defects in the tissue can easily get worse if too much pressure is applied to the knee joint. So getting better isn’t quick, or easy.
Anyway, more details on the study:
Researchers at Duke Health found that molecules called microRNA oversee the regeneration process. These molecules are more active in animals that are known to efficiently mend their own damaged limbs or fins, such as salamanders or zebrafish.
The research team thinks the microRNA could be used in treatments that could possibly reverse arthritis.
By the way, the researchers also looked at the age of cartilage in different locations in the body. It happens to be “young” in the ankle, “middle-aged” in the knee, and “old” in the hip. That, they suggest, could be why arthritis occurs more often in hips and knees.
So there you go. As you focus on gentle, low-load movement to heal your knees, you may be awakening your inner salamander!
Of course some of us have believed that for a while.
The reporting on this discovery has a kind of breathless tone of disbelief. The researchers who did the study call this ability we possess a “salamander-like” regenerative capacity. Salamanders, of course, can regrow limbs and parts of major organs.
As I’ve said a number of times, at least two studies done a decade or so ago have discovered that deep holes in cartilage can fill in naturally, at least part of the way, over a few years. (For more, see here and here.) That doesn’t surprise me at all.
From an evolutionary biology standpoint, it just makes sense.
The cartilage in our knees takes a banging over the course of decades. It’s hard to believe that it would be designed so that it just wears out, like the tread on an overused car tire. Cartilage should have some natural regenerative capacity. Indeed, evidence has been found that, when damaged, it does try to repair itself.
The problem is, cartilage changes slowly. Defects in the tissue can easily get worse if too much pressure is applied to the knee joint. So getting better isn’t quick, or easy.
Anyway, more details on the study:
Researchers at Duke Health found that molecules called microRNA oversee the regeneration process. These molecules are more active in animals that are known to efficiently mend their own damaged limbs or fins, such as salamanders or zebrafish.
The research team thinks the microRNA could be used in treatments that could possibly reverse arthritis.
By the way, the researchers also looked at the age of cartilage in different locations in the body. It happens to be “young” in the ankle, “middle-aged” in the knee, and “old” in the hip. That, they suggest, could be why arthritis occurs more often in hips and knees.
So there you go. As you focus on gentle, low-load movement to heal your knees, you may be awakening your inner salamander!
Saturday, November 2, 2019
The Dangerous Shift by Orthopedists to 'Symptom Control'
I’m feeling a bit sour. This kind of irked me:
The lead author on the study, which was published last month in Arthritis Care & Research, rightly says we need to shift our thinking away from taking care of the immediate pain and toward preventing a further decline in physical health.
Well, yeah. Short-term fixes for hard-to-solve, long-term problems aren’t a good idea. It’s like using zip ties to hold your car’s battery cables together (I’d link to the YouTube video where I saw this “fix,” if I could only remember where – I discovered the video when I had to replace my own battery cables.) Short-term fixes are sometimes necessary of course because you need some way to get your car home, or in the case of your knees, to manage pain that's reached unbearable levels.
But, once the pain abates, you should start thinking of a long-term plan to take care of the problem.
Below are more details from the study, which I found mildly horrifying. The researchers discovered that:
* In the 2007-2009 period, orthopedic doctors referred patients to physical therapy 15.8% of the time. Less than a decade later, in 2013-2015, that figure dropped almost by half, to 8.6%.
* Many of these doctors also abandoned “lifestyle counseling” (e.g., exercise recommendations, advice about managing weight). Specifically, lifestyle counseling fell from 18.4% of all visits to less than half of that, or 8.8%.
So what were these poor patients leaving with, if not referrals to physical therapy or good advice about the importance of controlling their weight? You guessed it: little pieces of paper for their local pharmacy.
The number of prescriptions written by orthopedic specialists for nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubled, from 132 per 1,000 visits to 278 per 1,000, and tripled for narcotics, going from 77 per 1,000 to 236 per 1,000.
Personally, I think what many of these orthopedic doctors are doing is shameful. I’m not sure how much of it is because of the long-legged twentysomething drug reps showing up every few weeks with new pills and free goodies to shower on power prescribers, but I think there’s a better way.
True, it’s a harder way, a longer way. Still, if you minimize the pills, and stick to a careful regimen, you can actually improve the health of your bad knees. This isn’t just my story anymore, but the story of a fair number of other people who are regular visitors to this blog!
A new review of how specialists and primary care doctors treat knee osteoarthritis (OA) finds that the use of pain-relieving prescriptions has risen dramatically, while lifestyle recommendations and physical therapy (PT) referrals have dropped.The next sentence provided needed context: doctors appear to be increasingly concerned with “symptom control” rather than treating the underlying issue. The analysis was based on data collected from national surveys conducted by the Centers for Disease Control and Prevention.
The lead author on the study, which was published last month in Arthritis Care & Research, rightly says we need to shift our thinking away from taking care of the immediate pain and toward preventing a further decline in physical health.
Well, yeah. Short-term fixes for hard-to-solve, long-term problems aren’t a good idea. It’s like using zip ties to hold your car’s battery cables together (I’d link to the YouTube video where I saw this “fix,” if I could only remember where – I discovered the video when I had to replace my own battery cables.) Short-term fixes are sometimes necessary of course because you need some way to get your car home, or in the case of your knees, to manage pain that's reached unbearable levels.
But, once the pain abates, you should start thinking of a long-term plan to take care of the problem.
Below are more details from the study, which I found mildly horrifying. The researchers discovered that:
* In the 2007-2009 period, orthopedic doctors referred patients to physical therapy 15.8% of the time. Less than a decade later, in 2013-2015, that figure dropped almost by half, to 8.6%.
* Many of these doctors also abandoned “lifestyle counseling” (e.g., exercise recommendations, advice about managing weight). Specifically, lifestyle counseling fell from 18.4% of all visits to less than half of that, or 8.8%.
So what were these poor patients leaving with, if not referrals to physical therapy or good advice about the importance of controlling their weight? You guessed it: little pieces of paper for their local pharmacy.
The number of prescriptions written by orthopedic specialists for nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubled, from 132 per 1,000 visits to 278 per 1,000, and tripled for narcotics, going from 77 per 1,000 to 236 per 1,000.
Personally, I think what many of these orthopedic doctors are doing is shameful. I’m not sure how much of it is because of the long-legged twentysomething drug reps showing up every few weeks with new pills and free goodies to shower on power prescribers, but I think there’s a better way.
True, it’s a harder way, a longer way. Still, if you minimize the pills, and stick to a careful regimen, you can actually improve the health of your bad knees. This isn’t just my story anymore, but the story of a fair number of other people who are regular visitors to this blog!
Saturday, October 19, 2019
On Quads Sets and Easy Passive Motion
Okay, so here’s a comment I received (lightly edited):
This sounds like you have a real muscle-first kind of guy. In other words, a typical physical therapist. As I see it, the trouble with “wall sits” (put your back against the wall and slide down, until it looks like you’re sitting on an invisible chair) and “one-legged squats” (squat down on one leg, then straighten up) is that they’re great for people with good knees (or knees that aren’t too bad) but can be disastrous for people with tender, easily upset joints.
When I had chronic knee pain, both of those activities bothered my knees. Eventually I simply said, “no more.”
Now, as for the isometric quad sets: Right, a study showed subjects who did them had thicker viscosity of their synovial fluid. How does that work, when there’s no motion? You know, that’s a good question. I’ve wondered it myself. How the hell does that work?
In any event, I have to confess: I’m not a huge fan of isometric quad sets. I guess they could be a useful way to build up your quads without irritating the joint (though sometimes they do irritate it, oddly enough). I have wondered if perhaps the thicker synovial fluid that researchers found was due to something else.
Then again, maybe quad sets are a good idea, which is my way of saying, “You might want to try them and see if they’re useful for you.” In any event, the bottom line for me is they didn’t factor in my recovery.
On the rabbits and passive motion: Yeah, no load. That’s my understanding. Like when your physical therapist grabs your leg, and moves it through a range of motion, and you just lie there on your back and watch.
So would lying on your back and pedaling in the air be the equivalent? Uh, I’m not sure about that. I just got on my back and went through some “air pedaling” motions, and it was harder than I expected. It certainly wasn’t easy peasy passive motion. However, you can always try it – I’m usually quick to point out that I don’t have advice or answers necessarily, but just like to share my thoughts on things.
I think it’s easier to replicate near-passive motion on a stationary bike. Set the resistance to zero, for instance. Or try to pedal backwards. Still, if your knees get cranky doing that, maybe this isn’t the best activity for you. One other option, if you really think you need to go back to square one, are what Doug Kelsey calls “sliders.” You basically put your feet on something like a dolly, and move your legs back and forth using its smooth rolling motion (I think).
I would definitely find out how Doug advises the exercises be done.
You might think about starting there, and build up to something harder later: easy cycling, or walking, or whatever.
One last note for everyone out there: I talked to the Washington Post reporter again, and she says that the article that she’s writing got delayed, but it’s planned now for early November. I’ll keep you all posted!
I am a little worried right now, as unfortunately, I experience pain when walking. I also experienced it while biking. I am not sure yet what low-rep activities to pursue at this point, and I can't take off work to devote my time to laying with my legs up. Sometimes the pain comes on directly during physical activity, and other times will just appear as I'm resting, even laying down, usually at night. I also have an adorable 20-lb. daughter that I have to carry around quite a bit... unfortunately I think it is causing a toll.
Question: Some studies you mention say isometric quad sets improve, thicken viscosity of the synovial fluid. So I'm thinking about keeping some of those exercises and abandoning the wall sits, one-legged squats my PT had me do. Any thoughts? Also wondering how this works, as it doesn't seem like there is any motion involved with these exercises.
Another question: it appears that bearing appropriately light load and motion is the best combo. In the study with the rabbits, did it seem that they were bearing load when they were attached to the passive motion machine? It seemed to indicate that motion, no load, allowed regrowth of cartilage only when a hole had reached the cartilage. I am considering whether or not bicycling in the air, while laying on my back, would be a smart way to get more motion without overloading and damaging the cartilage.First, on this: “I'm thinking about keeping some of those exercises and abandoning the wall sits, one-legged squats my PT had me do.”
This sounds like you have a real muscle-first kind of guy. In other words, a typical physical therapist. As I see it, the trouble with “wall sits” (put your back against the wall and slide down, until it looks like you’re sitting on an invisible chair) and “one-legged squats” (squat down on one leg, then straighten up) is that they’re great for people with good knees (or knees that aren’t too bad) but can be disastrous for people with tender, easily upset joints.
When I had chronic knee pain, both of those activities bothered my knees. Eventually I simply said, “no more.”
Now, as for the isometric quad sets: Right, a study showed subjects who did them had thicker viscosity of their synovial fluid. How does that work, when there’s no motion? You know, that’s a good question. I’ve wondered it myself. How the hell does that work?
In any event, I have to confess: I’m not a huge fan of isometric quad sets. I guess they could be a useful way to build up your quads without irritating the joint (though sometimes they do irritate it, oddly enough). I have wondered if perhaps the thicker synovial fluid that researchers found was due to something else.
Then again, maybe quad sets are a good idea, which is my way of saying, “You might want to try them and see if they’re useful for you.” In any event, the bottom line for me is they didn’t factor in my recovery.
On the rabbits and passive motion: Yeah, no load. That’s my understanding. Like when your physical therapist grabs your leg, and moves it through a range of motion, and you just lie there on your back and watch.
So would lying on your back and pedaling in the air be the equivalent? Uh, I’m not sure about that. I just got on my back and went through some “air pedaling” motions, and it was harder than I expected. It certainly wasn’t easy peasy passive motion. However, you can always try it – I’m usually quick to point out that I don’t have advice or answers necessarily, but just like to share my thoughts on things.
I think it’s easier to replicate near-passive motion on a stationary bike. Set the resistance to zero, for instance. Or try to pedal backwards. Still, if your knees get cranky doing that, maybe this isn’t the best activity for you. One other option, if you really think you need to go back to square one, are what Doug Kelsey calls “sliders.” You basically put your feet on something like a dolly, and move your legs back and forth using its smooth rolling motion (I think).
I would definitely find out how Doug advises the exercises be done.
You might think about starting there, and build up to something harder later: easy cycling, or walking, or whatever.
One last note for everyone out there: I talked to the Washington Post reporter again, and she says that the article that she’s writing got delayed, but it’s planned now for early November. I’ll keep you all posted!
Sunday, October 6, 2019
Any More Success Stories Out There?
From time to time, I like to encourage people to send in their success stories, or even updates about what they're doing that's working well.
The small community that we have here benefits greatly from hearing voices other than mine talking about what works (and what doesn't) when it comes to knee pain.
So consider the comment section open to success stories or updates! Some of you have been visiting this blog for years, and have years of struggling with knee pain before that. You have long stories to tell that make mine seem quite short by comparison.
Anyway, that's all from me! Not a lot to report on my end ... I don't really think about my knees too much anymore, and that's kind of a nice place to be.
Cheers!
The small community that we have here benefits greatly from hearing voices other than mine talking about what works (and what doesn't) when it comes to knee pain.
So consider the comment section open to success stories or updates! Some of you have been visiting this blog for years, and have years of struggling with knee pain before that. You have long stories to tell that make mine seem quite short by comparison.
Anyway, that's all from me! Not a lot to report on my end ... I don't really think about my knees too much anymore, and that's kind of a nice place to be.
Cheers!
Saturday, September 21, 2019
We're Losing One of the Good People ...
Sadly, it appears Dr. Scott F. Dye is retiring. "Silvertongued" posted this in the comment section the other day:
Years later though, I came across his "envelope of function" framework for how to understand and recover from knee pain. This was something completely new for me. Intrigued, I read a few of his scholarly articles. It soon become clear that he belonged to the smart set when it comes to knee pain: he made a lot of common sense suggestions, debunked some myths, and analyzed diffuse, chronic knee pain in a way that was completely logical.
I then looked up some of his videos on YouTube. He is an, um, refreshingly direct and original speaker, not shy about his disdain for certain wrongheaded beliefs. I urge you to look him up on YouTube, as he really is entertaining.
So in honor of the retiring Dr. Dye, I am listing below some of my posts about him and his beliefs. If you're a new visitor, still trying to figure out your knee pain, I urge you to take a look. It's good stuff.
Why You Need to Know About the “Envelope of Function”
What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?
Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)
Update: A commenter below actually says Dye is not retiring, just "limiting future office visits to once a month." So if you're interested in seeing him, it would be worth placing a call, it appears.
I've been seeing Dr. Dye since last year. I'm lucky enough to live driving distance to his office. He's been instrumental to my recovery. He's a great doctor and very compassionate, as we have been sharing over the years in this forum. He told me last visit that he'll be retiring at the end of this year.As some of you know, I discovered Dye rather late, during my post-recovery. True, during my recovery, I did happen to come across his name in a magazine article. He seemed a bit odd though. What stuck in my mind from the article was a certain incident, when he wanted to better understand the source of patellofemoral pain:
He noted that many patients who had arthroscopic surgery for other reasons had fibrillated cartilage in their patellofemoral joint, but did not have patellofemoral pain. Meanwhile, patients with presumed patellofemoral pain might have pristine cartilage in their knee at the time of arthroscopy. This led him to ask the question, “What anatomic structures in the knee can really feel pain?”And so (it would have been interesting to be a fly on the wall during this experiment):
Dye asked a colleague to perform knee arthroscopy on his knee without anesthetic. During the arthroscopy, the surgeon would probe different anatomic structures, and Dye would report what he felt. ... He discovered that he had almost no pain with palpation of the patellofemoral joint, while probing of the anterior fat pad and anterior joint capsule was exquisitely painful.I can just about hear him scream when that probe touched his synovium. All in the name of science, I suppose, but at the time I remember thinking he was a bit eccentric.
Years later though, I came across his "envelope of function" framework for how to understand and recover from knee pain. This was something completely new for me. Intrigued, I read a few of his scholarly articles. It soon become clear that he belonged to the smart set when it comes to knee pain: he made a lot of common sense suggestions, debunked some myths, and analyzed diffuse, chronic knee pain in a way that was completely logical.
I then looked up some of his videos on YouTube. He is an, um, refreshingly direct and original speaker, not shy about his disdain for certain wrongheaded beliefs. I urge you to look him up on YouTube, as he really is entertaining.
So in honor of the retiring Dr. Dye, I am listing below some of my posts about him and his beliefs. If you're a new visitor, still trying to figure out your knee pain, I urge you to take a look. It's good stuff.
Why You Need to Know About the “Envelope of Function”
What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?
Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)
Update: A commenter below actually says Dye is not retiring, just "limiting future office visits to once a month." So if you're interested in seeing him, it would be worth placing a call, it appears.
Saturday, September 7, 2019
A Musing on My Occasional Knee Recklessness
I may not be the best role model for someone trying to figure out how to manage the post-recovery period after beating knee pain.
This occurred to me a couple of months ago. I was struggling with a little pain at the side of my left knee.
What happened: As some of you may remember, I broke my hand in two places while cycling on Aug. 11 of last year. That left me in the basement, racking up miles cycling in the virtual reality world of Zwift, and sometimes badly disobeying my doctor’s orders to minimize sweating under my cast.
Eventually the cast came off and I was cleared for cycling again, but by then it was late in the season and I figured I’d just stay inside, logging miles on Zwift, until April.
Now normally, I take off a month or two during the winter and only do easy stationary bike cycling. I figure it’s good to give my knees a little break. Not this year though. Frustrated about the broken hand, and trying to preserve some semblance of conditioning, I did long rides and races on Zwift, pushing myself hard. My best ride, I averaged 251 watts for 51 minutes, which I thought was respectable.
But, during a race on Zwift, I pushed down hard with my left leg to go up a sudden steep climb and got a sharp pain on the inside (medial) of my left knee. It kind of lingered for months. Every time I thought it was gone, I’d move my leg/knee a certain way – and bam – there it was again.
I think it was a ligament sprain. In any event, intense cycling wasn’t helping any. So early in July, I finally went into knee conservation mode. I began cheating on pedaling, putting more stress on my right leg. I backed off sprints. I went out on more rides alone.
It took about a month, but the knee got better and I’m fine now.
But the experience did make me think: Wow, I managed to heal my knees and then dove right back into the kind of crazy cycling I’ve always loved to do. Which is great on one level: I did succeed in returning to doing exactly the same intense physical activity I had grown to love.
However: a more sensible me might have toned things down a bit. I probably could have avoided some of the little burning-under-the-kneecap episodes I’ve had since 2011, when I published the book. I’ve talked about those before, and they never lasted more than a few weeks or a month, but I think they came about because, well, I like to ride my bike really damn hard.
If I had just wanted the most trouble-free knees, I would have adopted a moderate riding program, not the cycle-til-you-want-to-collapse riding that I often do. So maybe this isn’t the most sensible way to handle your post recovery. Still, I will say that I’m always careful now to monitor symptoms. When I feel as if a knee-related problem is starting to spiral out of control, I modify my behavior and nip it in the bud.
The takeaway here is that I’m not encouraging anyone to do what I’m doing. It’s rather hardcore. But I’m also saying with my example that, if you bring your knees back from a painful state, and do it carefully, that there’s a good chance you can return to doing whatever you want. Just take small steps to get there. :)
This occurred to me a couple of months ago. I was struggling with a little pain at the side of my left knee.
What happened: As some of you may remember, I broke my hand in two places while cycling on Aug. 11 of last year. That left me in the basement, racking up miles cycling in the virtual reality world of Zwift, and sometimes badly disobeying my doctor’s orders to minimize sweating under my cast.
Eventually the cast came off and I was cleared for cycling again, but by then it was late in the season and I figured I’d just stay inside, logging miles on Zwift, until April.
Now normally, I take off a month or two during the winter and only do easy stationary bike cycling. I figure it’s good to give my knees a little break. Not this year though. Frustrated about the broken hand, and trying to preserve some semblance of conditioning, I did long rides and races on Zwift, pushing myself hard. My best ride, I averaged 251 watts for 51 minutes, which I thought was respectable.
But, during a race on Zwift, I pushed down hard with my left leg to go up a sudden steep climb and got a sharp pain on the inside (medial) of my left knee. It kind of lingered for months. Every time I thought it was gone, I’d move my leg/knee a certain way – and bam – there it was again.
I think it was a ligament sprain. In any event, intense cycling wasn’t helping any. So early in July, I finally went into knee conservation mode. I began cheating on pedaling, putting more stress on my right leg. I backed off sprints. I went out on more rides alone.
It took about a month, but the knee got better and I’m fine now.
But the experience did make me think: Wow, I managed to heal my knees and then dove right back into the kind of crazy cycling I’ve always loved to do. Which is great on one level: I did succeed in returning to doing exactly the same intense physical activity I had grown to love.
However: a more sensible me might have toned things down a bit. I probably could have avoided some of the little burning-under-the-kneecap episodes I’ve had since 2011, when I published the book. I’ve talked about those before, and they never lasted more than a few weeks or a month, but I think they came about because, well, I like to ride my bike really damn hard.
If I had just wanted the most trouble-free knees, I would have adopted a moderate riding program, not the cycle-til-you-want-to-collapse riding that I often do. So maybe this isn’t the most sensible way to handle your post recovery. Still, I will say that I’m always careful now to monitor symptoms. When I feel as if a knee-related problem is starting to spiral out of control, I modify my behavior and nip it in the bud.
The takeaway here is that I’m not encouraging anyone to do what I’m doing. It’s rather hardcore. But I’m also saying with my example that, if you bring your knees back from a painful state, and do it carefully, that there’s a good chance you can return to doing whatever you want. Just take small steps to get there. :)
Saturday, August 10, 2019
Are You Mentally Ready to Beat Knee Pain?
I was pondering this question recently, because it occurred to me that beating knee pain depends first of all on being in the right mental state. Specifically, there are four traits you need.
(1) You need to be receptive to the right message.
I’m not even saying, arrogantly, that it’s necessarily my message. I’d like to think that my message makes a lot of sense. But maybe you disagree. Or maybe you like parts of what I have to say about understanding and healing from knee pain and dislike others.
Nevertheless, you can’t shut yourself off from being receptive that the right message will come along. If regular physical therapy doesn’t work for you (as it didn’t for me), giving up shouldn’t be the default option. The default option should be to study other types of treatments and thoughtfully evaluate them, and keep pushing forward.
(2) You can’t be consumed with negativity.
This seems obvious, but it’s easier said than done. Most people who have tried a lot of things to overcome knee pain, failing many times along the way, become deeply discouraged. That’s not surprising. When something new is suggested, they might think, “Might as well try it, because everything else has failed.”
That heavy negativity weighs you down and prevents you from giving a new treatment a fair chance. Negative people tend to flit from one cure to the next, in manic depressive style, and never stick long enough with something to learn anything useful from it. How many successes do “I can’t do it” people have versus those who embark on new programs with hopefulness, even when things seem bleak?
(3) You have to be prepared to think “outside the box.”
Thinking “inside the box” has failed a lot of knee pain patients over the last few decades. The conventional prescription of muscle strengthening around the joint doesn’t work well for those with really weak knees. It just trashes your joints. And you figure that out quickly, unfortunately.
So what do you replace it with? You should be ready to look at creative, sensible alternatives that maybe aren’t part of a typical physical therapist’s playbook. Discoveries aren’t made by people entranced by the status quo; they’re made by those who dare to think differently.
(4) You need to possess a certain stubbornness, patience and will to persevere.
Healing from knee pain can take a long, long, long time. That’s what I learned. Luckily for me, when I set my sights on a goal, I pursue it with a steady, single-minded determination. And there are other people whose stories appear on this blog, who have shown an even greater singularity of purpose along with complete devotion to doing whatever it takes to get better. And they make the time it took for my recovery, over more than a year, seem downright fast.
Sure, even if you have these four traits, there's a lot of other things you need to do. But I think being in the right frame of mind is where you have to start.
(1) You need to be receptive to the right message.
I’m not even saying, arrogantly, that it’s necessarily my message. I’d like to think that my message makes a lot of sense. But maybe you disagree. Or maybe you like parts of what I have to say about understanding and healing from knee pain and dislike others.
Nevertheless, you can’t shut yourself off from being receptive that the right message will come along. If regular physical therapy doesn’t work for you (as it didn’t for me), giving up shouldn’t be the default option. The default option should be to study other types of treatments and thoughtfully evaluate them, and keep pushing forward.
(2) You can’t be consumed with negativity.
This seems obvious, but it’s easier said than done. Most people who have tried a lot of things to overcome knee pain, failing many times along the way, become deeply discouraged. That’s not surprising. When something new is suggested, they might think, “Might as well try it, because everything else has failed.”
That heavy negativity weighs you down and prevents you from giving a new treatment a fair chance. Negative people tend to flit from one cure to the next, in manic depressive style, and never stick long enough with something to learn anything useful from it. How many successes do “I can’t do it” people have versus those who embark on new programs with hopefulness, even when things seem bleak?
(3) You have to be prepared to think “outside the box.”
Thinking “inside the box” has failed a lot of knee pain patients over the last few decades. The conventional prescription of muscle strengthening around the joint doesn’t work well for those with really weak knees. It just trashes your joints. And you figure that out quickly, unfortunately.
So what do you replace it with? You should be ready to look at creative, sensible alternatives that maybe aren’t part of a typical physical therapist’s playbook. Discoveries aren’t made by people entranced by the status quo; they’re made by those who dare to think differently.
(4) You need to possess a certain stubbornness, patience and will to persevere.
Healing from knee pain can take a long, long, long time. That’s what I learned. Luckily for me, when I set my sights on a goal, I pursue it with a steady, single-minded determination. And there are other people whose stories appear on this blog, who have shown an even greater singularity of purpose along with complete devotion to doing whatever it takes to get better. And they make the time it took for my recovery, over more than a year, seem downright fast.
Sure, even if you have these four traits, there's a lot of other things you need to do. But I think being in the right frame of mind is where you have to start.
Saturday, July 27, 2019
Once More: Proper Exercise Won’t Damage Your Knees
One thing that exasperates me is the all-too-common belief that, once you develop chronic knee pain, you have to stop exercising completely or else the condition will get worse.
So I’m always happy to hold up a study (or in this case even better: many studies) that disprove this wrongheaded attitude.
Here is the opening paragraph of a summary of the research:
The two main findings: (1) Therapeutic exercise doesn’t damage the articular cartilage in the knee joint. (2) Also, that kind of exercise doesn’t increase inflammation.
All great results, and they should give knee pain suffers confidence to embark on an exercise program.
Now, what’s important to remember though: therapeutic exercise is good. Any old exercise may not be. Even if you think you've found the perfect exercise that's not too stressful on the knee, you have to be careful and monitor any symptoms closely.
So I’m always happy to hold up a study (or in this case even better: many studies) that disprove this wrongheaded attitude.
Here is the opening paragraph of a summary of the research:
A study by scientists has discovered that therapeutic exercise does not harm articular cartilage of the knee in people with osteoarthritis, a leading cause of disability worldwide associated with pain, impaired mobility and quality of life. It may, in fact, benefit articular cartilage.It turns out that this conclusion was reached by a research fellow at the University of Aberdeen's Institute of Medical Sciences. He didn’t examine a single study either, but rather 21 of them that were conducted in countries from China and Holland to Turkey.
The two main findings: (1) Therapeutic exercise doesn’t damage the articular cartilage in the knee joint. (2) Also, that kind of exercise doesn’t increase inflammation.
All great results, and they should give knee pain suffers confidence to embark on an exercise program.
Now, what’s important to remember though: therapeutic exercise is good. Any old exercise may not be. Even if you think you've found the perfect exercise that's not too stressful on the knee, you have to be careful and monitor any symptoms closely.
Sunday, July 14, 2019
On Stretching and Knee Pain
I was thinking about stretching recently. My mother was in town for a few weeks. She’s edging toward her late 70s, is in great shape, and was talking about her yoga class.
She mentioned all the stretching she does for class, and I just kind of nodded absently.
It’s no secret I’m not a big fan of stretching. Most of my life, I never bothered to stretch, and I was fine. Then, when I developed knee pain, a physical therapist advised that I stretch, and at that point, hell, I was willing to try anything. I even thought to myself, “Of course. Stretching. Never did it and look where I am now. Stretching is what I need to do!”
I learned a stretch for my quads that brought me some temporary relief, but the knee pain would soon come back. What’s more, I never got the sense that my knees were really getting better on account of the stretching. So I started to look into stretching, and what I found went into Saving My Knees and also became this five-part series below:
To Stretch or Not to Stretch, Part I
Can Stretching Really Help Fix What Ails Your Knee?
Stretching, Part III: A Critical Look at the Biggest Pro-Stretching Claims
On the Real Benefits of Stretching If You Have Knee Pain
Why Is Stretching So Darn Popular, If Its Benefits Have Been Greatly Oversold?
Still, a lot of people love stretching. It’s like this unquestioned, ingrained thing, and the belief in stretching is really hard to dislodge. Frankly, I doubt it’s worth arguing about. I think you could cite clinical studies that disprove the benefits of stretching until you’re blue in the face, and any diehard stretcher would listen impassively, then go off and start doing some stretches.
I think it’s almost reached the level of religious belief. But that’s not necessarily a bad thing. It’s good to take a benign view on such matters. I’m sure some of the things I do now, that I think are helping me in some way, actually aren’t making any difference at all.
My thinking now is, if stretching helps with your knee pain, great, keep doing it. I’d say the same about taking glucosamine (unless you’re diabetic of course).
I’m not sure stretching does any good. But most stretching – if done gently enough, without any strange, hard, twisting forces being put on joints – seems harmless enough.
So if you want to stretch, go for it. Me, I just prefer to warm up. I think that works better.
She mentioned all the stretching she does for class, and I just kind of nodded absently.
It’s no secret I’m not a big fan of stretching. Most of my life, I never bothered to stretch, and I was fine. Then, when I developed knee pain, a physical therapist advised that I stretch, and at that point, hell, I was willing to try anything. I even thought to myself, “Of course. Stretching. Never did it and look where I am now. Stretching is what I need to do!”
I learned a stretch for my quads that brought me some temporary relief, but the knee pain would soon come back. What’s more, I never got the sense that my knees were really getting better on account of the stretching. So I started to look into stretching, and what I found went into Saving My Knees and also became this five-part series below:
To Stretch or Not to Stretch, Part I
Can Stretching Really Help Fix What Ails Your Knee?
Stretching, Part III: A Critical Look at the Biggest Pro-Stretching Claims
On the Real Benefits of Stretching If You Have Knee Pain
Why Is Stretching So Darn Popular, If Its Benefits Have Been Greatly Oversold?
Still, a lot of people love stretching. It’s like this unquestioned, ingrained thing, and the belief in stretching is really hard to dislodge. Frankly, I doubt it’s worth arguing about. I think you could cite clinical studies that disprove the benefits of stretching until you’re blue in the face, and any diehard stretcher would listen impassively, then go off and start doing some stretches.
I think it’s almost reached the level of religious belief. But that’s not necessarily a bad thing. It’s good to take a benign view on such matters. I’m sure some of the things I do now, that I think are helping me in some way, actually aren’t making any difference at all.
My thinking now is, if stretching helps with your knee pain, great, keep doing it. I’d say the same about taking glucosamine (unless you’re diabetic of course).
I’m not sure stretching does any good. But most stretching – if done gently enough, without any strange, hard, twisting forces being put on joints – seems harmless enough.
So if you want to stretch, go for it. Me, I just prefer to warm up. I think that works better.
Saturday, June 29, 2019
Whoops, I Got Better, Then Overdid It. Now What?
I figured I’d hoist one more story out of the comment section. I think almost everyone with long-term knee pain can identify with the mistake in this one:
It’s discouraging as hell. There’s no way to put a pretty gloss on a bad setback. It stinks, and it’s going to take some time to get through.
But here are some notes of comfort:
* Virtually everybody trying to recover from knee pain has setbacks. Some are severe. And often, yes, they’re caused by something stupid you did. So you have to make your peace with this. Yes, you did something dumb. But yes, many others (including me) have done the same. Don’t be too hard on yourself. Remember, too much negativity extracts a price when it comes to healing.
* Okay, so now you know something you shouldn’t do. You’ve learned something. Learning is valuable. The setbacks that are most frustrating are those where you can’t identify what you did wrong. That’s not what you went through. You know you made a mistake; now you have to try again, being more careful.
* Finally, will you recover again? Obviously, I don’t know this for sure, and neither does anyone else. However, I’m betting that the chances are pretty good. That’s partly because there are a lot of people who have gone through bad setbacks, and not just one, but multiple, and who have gotten better.
So before you get too discouraged, check out this story that “Knee Pain” left recently (that’s her moniker on this site, and she’s been here just about since I started blogging). Her knee pain came roaring back multiple times, and she just kept patiently working on healing, and at last she seems to be – fingers crossed – getting back to all the activities she used to love.
Four years ago, I had a knee injury and an MRI revealed chondromalacia, grade 3. Feeling depressed that my life would never be the same again, I came across your book. Following your strategies I managed to have four good years without pain. My workouts included indoor bicycle, walking on treadmill, swimming and rowing.Ah yes. That old, familiar burst of misplaced confidence. Who hasn’t felt it? After a good week, or a good month, or a good three or months, you think, “I must be healed now, right?” Then you go back to your previous favorite sport or exercise and, after some vigorous workouts, you backslide. You have a bad relapse.
Feeling good, I was tempted to go back to my usual training, meaning squats, lunges etc. and light jogging for short bursts, 30 seconds, rest and repeat. I was doing this routine for a month and was feeling OK when all of a sudden it took a bad turn. I have bad pain in my knee for three days. I am feeling discouraged and angry with myself. I am now worried that I am back to where I started. Is there hope that I will recover again? Isabelle
It’s discouraging as hell. There’s no way to put a pretty gloss on a bad setback. It stinks, and it’s going to take some time to get through.
But here are some notes of comfort:
* Virtually everybody trying to recover from knee pain has setbacks. Some are severe. And often, yes, they’re caused by something stupid you did. So you have to make your peace with this. Yes, you did something dumb. But yes, many others (including me) have done the same. Don’t be too hard on yourself. Remember, too much negativity extracts a price when it comes to healing.
* Okay, so now you know something you shouldn’t do. You’ve learned something. Learning is valuable. The setbacks that are most frustrating are those where you can’t identify what you did wrong. That’s not what you went through. You know you made a mistake; now you have to try again, being more careful.
* Finally, will you recover again? Obviously, I don’t know this for sure, and neither does anyone else. However, I’m betting that the chances are pretty good. That’s partly because there are a lot of people who have gone through bad setbacks, and not just one, but multiple, and who have gotten better.
So before you get too discouraged, check out this story that “Knee Pain” left recently (that’s her moniker on this site, and she’s been here just about since I started blogging). Her knee pain came roaring back multiple times, and she just kept patiently working on healing, and at last she seems to be – fingers crossed – getting back to all the activities she used to love.
Sunday, June 16, 2019
Will Knee Pain When Climbing Stairs Ever Get Better?
Okay, today we’re off to my equivalent of the mailbag, the comment section.
I got this one recently:
Second, congratulations! You may not think so, but you’ve made good progress in one year. You can run eight kilometers (about five miles for those of us in the U.S.), you can walk considerable distances apparently, and your knees handle cycling well. This is all very, very positive. I know, sometimes in the midst of what can be a long healing process, it’s easy to get discouraged. But you should take a moment and feel good about how far you’ve come.
Now, what comes next? This is always difficult, especially when it feels like you’ve reached a plateau. You don’t want to accidentally overstress your knees and move backwards. If you just continue to do the same things, but ramp up the intensity a little, will your knees heal to the point where you can feel comfortable on stairs again?
Maybe. Maybe not. The truth is, it’s just about impossible for me, or anyone, to guess based on the information you’ve supplied. Patellofemoral pain syndrome, I’m convinced, is a bogus, non-diagnosis. It doesn’t describe whatever is ailing your joints. It’s just your doctor’s fancy way of saying, “You have general knee pain that has no clear underlying cause.”
So what might you consider doing?
Well, you could stay on your current course, but start to slowly build up the intensity, especially of the cycling. Cycling builds strong leg muscles, which may be useful for navigating those stairs. Also it may thicken the cartilage under the kneecap; triathletes were found in a study to have thicker cartilage under the patella. I think cycling is the most likely reason (pure conjecture on my part, but I doubt it’s because of the swimming, and am skeptical about running having that effect either).
Or you might consider trying to do leg exercises, but in a completely different way. I wouldn’t do full-load squats if they bothered my knees. No way! But if you can get access to a Total Trainer, it allows you to do exercises at less-than-full body weight. That could enable you to build up your ability to better handle squatting (and stair climbing), but slowly. And, as I’ve written, with a little creativity, you can rig up something that will let you do squats in a way that doesn’t stress your knees too much. I did! See here.
Best of luck!
I got this one recently:
I have been dealing with patellofemoral pain syndrome for nearly 1 year. At the beginning I could not walk more than 2-3 km, I needed to rest to go on, could not run, and was scared to cycle. Now 1 year later there is no limited walking for me, I can run 8 km and there’s no problem with cycling but stairs are still a serious problem.First of all, I try to avoid suggesting things or giving advice. I’m not a doctor or physical therapist. But I can give you a few things to think about, and perhaps others on this site may want to chime in as well. I’m fortunate to have a pretty smart readership.
At the beginning I was doing squat, quad exercises etc. and these exercises were terrible for my knees and I stopped doing these. I started to walk 10-15 thousand steps every day and cycle 30 minutes 3-4 times a week as you said. When I use the stairs I feel pain.
So my knees feel okay now and I wonder whether I am gonna feel exactly normal in the future maybe 1 more year later. I mean, do I need to follow the same path further or could you suggest anything else for me?
Second, congratulations! You may not think so, but you’ve made good progress in one year. You can run eight kilometers (about five miles for those of us in the U.S.), you can walk considerable distances apparently, and your knees handle cycling well. This is all very, very positive. I know, sometimes in the midst of what can be a long healing process, it’s easy to get discouraged. But you should take a moment and feel good about how far you’ve come.
Now, what comes next? This is always difficult, especially when it feels like you’ve reached a plateau. You don’t want to accidentally overstress your knees and move backwards. If you just continue to do the same things, but ramp up the intensity a little, will your knees heal to the point where you can feel comfortable on stairs again?
Maybe. Maybe not. The truth is, it’s just about impossible for me, or anyone, to guess based on the information you’ve supplied. Patellofemoral pain syndrome, I’m convinced, is a bogus, non-diagnosis. It doesn’t describe whatever is ailing your joints. It’s just your doctor’s fancy way of saying, “You have general knee pain that has no clear underlying cause.”
So what might you consider doing?
Well, you could stay on your current course, but start to slowly build up the intensity, especially of the cycling. Cycling builds strong leg muscles, which may be useful for navigating those stairs. Also it may thicken the cartilage under the kneecap; triathletes were found in a study to have thicker cartilage under the patella. I think cycling is the most likely reason (pure conjecture on my part, but I doubt it’s because of the swimming, and am skeptical about running having that effect either).
Or you might consider trying to do leg exercises, but in a completely different way. I wouldn’t do full-load squats if they bothered my knees. No way! But if you can get access to a Total Trainer, it allows you to do exercises at less-than-full body weight. That could enable you to build up your ability to better handle squatting (and stair climbing), but slowly. And, as I’ve written, with a little creativity, you can rig up something that will let you do squats in a way that doesn’t stress your knees too much. I did! See here.
Best of luck!
Saturday, June 1, 2019
Why It’s Dangerous to Have Long-Term Inflammation
Knee pain sufferers often struggle with inflammation and try various methods to subdue it.
What’s now becoming clear is that subduing it, by some means, is absolutely imperative.
Just consider a rather lengthy article in the latest issue of Harvard Magazine that took a look at recent research into inflammation and chronic disease.
Here are some takeaways:
• A 2007 study sought to understand why physical activity works so well at reducing cardiovascular disease. Researchers learned it was because of reduced inflammation over the long term (note: exercise does temporarily increase inflammation).
• Evidence is emerging that constant, low-grade inflammation triggers a host of conditions, from Alzheimer’s, cancer, arthritis and gout to anemia and Parkinson’s disease.
• Curiously enough, inflammation has an evolutionary basis. In other words, it benefited our animal skin-wearing forebears!
Half of them were felled by disease before the age of five, so a hyperactive immune system turned out to be a good thing. Insulin resistance, or a tendency to store calories as fat (and the presence of fat is pro-inflammatory) made it more likely our early ancestors would survive food shortages. And blood that was quicker to coagulate made it less likely that a woman would bleed to death in childbirth or a hunter would die after tangling with a saber-toothed tiger.
• Inflammation may appear to be a symptom of disease, not a cause. But one scientist says in unambiguous language: “Chronic inflammation is uniformly damaging and is absolutely causal to the process, because if you interfere with it, you can reverse the pathology.” For instance, if you make a fruit fly diabetic, then block its inflammatory response, you can cure the diabetes.
• Excess body fat is a risk factor for inflammation! No big surprise here. Overeating places a lot of metabolic stress on the body. (By the way, fun fact: the oldest cellular system is metabolism, or energy management, and the next oldest is the ability to defend, or the immune system).
To process large quantities of food, cells undergo a lot of stress, rapidly storing away useful nutrients and disposing of harmful substances. The pancreas secretes as much as 500 milliliters of enzymes each day to deal with the meals we eat. Excess food accumulates as body fat, which happens to have a lot of immune cells.
Anyway, the most important message to remember is that, just as many of us with knee pain suspected, giving inflammation a nice, comfortable place to live for too long is just inviting the worst of home wreckers in for an extended stay. The longer inflammation is on the prowl in your body, the more mischief it can wreak – and the more diseases it can help spawn.
What’s now becoming clear is that subduing it, by some means, is absolutely imperative.
Just consider a rather lengthy article in the latest issue of Harvard Magazine that took a look at recent research into inflammation and chronic disease.
Here are some takeaways:
• A 2007 study sought to understand why physical activity works so well at reducing cardiovascular disease. Researchers learned it was because of reduced inflammation over the long term (note: exercise does temporarily increase inflammation).
• Evidence is emerging that constant, low-grade inflammation triggers a host of conditions, from Alzheimer’s, cancer, arthritis and gout to anemia and Parkinson’s disease.
• Curiously enough, inflammation has an evolutionary basis. In other words, it benefited our animal skin-wearing forebears!
Half of them were felled by disease before the age of five, so a hyperactive immune system turned out to be a good thing. Insulin resistance, or a tendency to store calories as fat (and the presence of fat is pro-inflammatory) made it more likely our early ancestors would survive food shortages. And blood that was quicker to coagulate made it less likely that a woman would bleed to death in childbirth or a hunter would die after tangling with a saber-toothed tiger.
• Inflammation may appear to be a symptom of disease, not a cause. But one scientist says in unambiguous language: “Chronic inflammation is uniformly damaging and is absolutely causal to the process, because if you interfere with it, you can reverse the pathology.” For instance, if you make a fruit fly diabetic, then block its inflammatory response, you can cure the diabetes.
• Excess body fat is a risk factor for inflammation! No big surprise here. Overeating places a lot of metabolic stress on the body. (By the way, fun fact: the oldest cellular system is metabolism, or energy management, and the next oldest is the ability to defend, or the immune system).
To process large quantities of food, cells undergo a lot of stress, rapidly storing away useful nutrients and disposing of harmful substances. The pancreas secretes as much as 500 milliliters of enzymes each day to deal with the meals we eat. Excess food accumulates as body fat, which happens to have a lot of immune cells.
Anyway, the most important message to remember is that, just as many of us with knee pain suspected, giving inflammation a nice, comfortable place to live for too long is just inviting the worst of home wreckers in for an extended stay. The longer inflammation is on the prowl in your body, the more mischief it can wreak – and the more diseases it can help spawn.
Saturday, May 18, 2019
A Knee Pain Lesson From the World of Diabetes
A recent British study caught my eye. It wasn’t about knees, but diabetes. But there’s a lesson in there for knee pain sufferers, I believe.
Researchers split into two groups 300 people with type 2 diabetes, formerly known as adult-onset diabetes. All were ages 20 to 65 and had been diagnosed with diabetes within six years.
The control group followed regular treatment guidelines.
The second group stopped taking their diabetes drugs and were put on an 825-calorie-a-day diet of shakes and soups for three to five months. After losing weight, they returned to other food and received monthly counseling to keep the pounds off.
Two years later, 36% of those in the second group, but only 3% in the control group, had blood sugar that had fallen out of the diabetes range without taking drugs.
Weight loss turned out to be the critical factor, not surprisingly. Losing weight is a great idea to help with many problems, including knee pain.
But one takeaway I found quite interesting: one of the study’s authors said the results show that type 2 diabetes isn’t an “inevitably progressive disease.”
Osteoarthritis, which is what many knee pain sufferers are diagnosed with, is often portrayed too as an “inevitably progressive disease.” Knee pain in general is similarly thrown into the basket of hopeless causes.
But I think there’s a lot that people with hurting knees and even osteoarthritis can do to arrest the downhill slide, and even begin to get better.
The first thing is to reject the dismal pessimism of the phrase “inevitably progressive disease.” I mean, have you ever heard anything so depressing? There is absolutely no light at the end of that tunnel.
I think there’s ample reason to reject that dour thinking. Some of us with knee pain who were written off have gotten better. And then you have this latest study of people with diabetes, who modified their diet, shed weight, and managed to escape a lifelong regimen of drugs.
Researchers split into two groups 300 people with type 2 diabetes, formerly known as adult-onset diabetes. All were ages 20 to 65 and had been diagnosed with diabetes within six years.
The control group followed regular treatment guidelines.
The second group stopped taking their diabetes drugs and were put on an 825-calorie-a-day diet of shakes and soups for three to five months. After losing weight, they returned to other food and received monthly counseling to keep the pounds off.
Two years later, 36% of those in the second group, but only 3% in the control group, had blood sugar that had fallen out of the diabetes range without taking drugs.
Weight loss turned out to be the critical factor, not surprisingly. Losing weight is a great idea to help with many problems, including knee pain.
But one takeaway I found quite interesting: one of the study’s authors said the results show that type 2 diabetes isn’t an “inevitably progressive disease.”
Osteoarthritis, which is what many knee pain sufferers are diagnosed with, is often portrayed too as an “inevitably progressive disease.” Knee pain in general is similarly thrown into the basket of hopeless causes.
But I think there’s a lot that people with hurting knees and even osteoarthritis can do to arrest the downhill slide, and even begin to get better.
The first thing is to reject the dismal pessimism of the phrase “inevitably progressive disease.” I mean, have you ever heard anything so depressing? There is absolutely no light at the end of that tunnel.
I think there’s ample reason to reject that dour thinking. Some of us with knee pain who were written off have gotten better. And then you have this latest study of people with diabetes, who modified their diet, shed weight, and managed to escape a lifelong regimen of drugs.
Saturday, May 4, 2019
Open Comment Forum: What Are Your Goals This Summer?
I figured today I'd throw the comment section open to whatever people want to discuss.
If you don't have a better subject, you can take a crack at this one: What are your knee goals this summer? When the weather turns warmer, hiking up mountains and cycling down by the beach become attractive (but potentially risky) activities. (Apologies by the way to our friends down under, as they're not moving into summer, but winter!)
So how do you take advantage of the pleasant, warmer weather without overstressing your knees? What are your plans?
Of course the usual rules apply: Feel free to talk about whatever you want to below. You don't have to discuss the headline question. Share your problems if you're seeking insight. There are a lot of smart people who hang out at this blog who are generous about sharing their experiences with the struggle to beat knee pain.
I hope all are having a good month of May so far!
Saturday, April 20, 2019
Will You Ever Be Able to Return to Your Favorite Sport Someday?
I found this in the comment section. I’m pulling it out because one of these questions in particular is worth addressing:
Wear knee braces or not?
I’m somewhat skeptical. The ones that probably do make a difference in terms of knee support are expensive and make you look like a cyborg. The ones you can buy at Walmart (or even some high-end stores) aren’t doing anything to reduce the load on your knees.
However ... as always, your mileage may vary. You may get a placebo effect. Or, as I mention in this post, there could be a different beneficial effect. Neoprene sleeves are thought to help by aiding proprioception. That big word describes your body’s sense of how it’s positioned in space. Better proprioception might mean better balance, which could improve knee stability.
Which books to buy?
Scott Dye has no book on envelope of function that I know of. However, you can probably find some of his papers online. Still, I wouldn’t even bother chasing down one of those. You’ll get an adequate sense of envelope of function by searching this blog or from Doug Kelsey’s “90 Day Knee Arthritis Remedy” at Doug’s website.
Will I be able to play football again?
This is the question I wanted to address.
The answer is a definite maybe. That’s the best anyone can tell you. Anyone who says otherwise is probably a charlatan or a fool.
I wanted to pull out this question because many active people ask it. They want to know, “Will I ever be able to dance/bicycle/rock climb/whatever again?” For me, it was ride my bicycle, of course.
I tried hard to get back on that bike as soon as I could. I got back on the bike before my knees were ready. I tried biking, failed, tried biking, failed.
To get better, I think you have to move beyond that question of “Will I ever be able to participate in my favorite sport/activity again?” You have to accept that the answer might be “no.” You have to look for new physical activities that won’t stress your knees that you can do in the interim.
I gave up on biking for a while, after even easy cycling disturbed my knee joints. So I decided not to even think about it. Pushed it out of my mind. I told myself I could be happy just being able to go for long walks. Once I made my peace with that, I no longer was focused on, “When will I be able to get back on my bike?”
Before then, I had been rather obsessive about cycling. But sometimes you have be prepared to move on. I did, and then when I got better, many months later, I rolled the bike out of the driveway, took a deep breath, climbed on the saddle, and slowly off I went.
So maybe you can play football again (which I assume is what we Americans would call soccer). But for now, you might want to think about pushing that thought far out of your mind. That tends to make things easier during what can be a long recovery.
Do you think I will be able to play football again? It gave me purpose and a social circle. I am desperate to play again. I understand it is a long recovery process, and I am willing to be completely disciplined and dedicated to that. Whilst in recovery, would you recommend wearing knee braces? My last question: out of the three books recommended in 'Saving My Knees,' which are: Scott Dye's Envelope of function, The Doug Kelsey book and 'There Is A Cure For Arthritis', is it important I buy all of them? And which book should I read first?Okay, the easy stuff first:
Wear knee braces or not?
I’m somewhat skeptical. The ones that probably do make a difference in terms of knee support are expensive and make you look like a cyborg. The ones you can buy at Walmart (or even some high-end stores) aren’t doing anything to reduce the load on your knees.
However ... as always, your mileage may vary. You may get a placebo effect. Or, as I mention in this post, there could be a different beneficial effect. Neoprene sleeves are thought to help by aiding proprioception. That big word describes your body’s sense of how it’s positioned in space. Better proprioception might mean better balance, which could improve knee stability.
Which books to buy?
Scott Dye has no book on envelope of function that I know of. However, you can probably find some of his papers online. Still, I wouldn’t even bother chasing down one of those. You’ll get an adequate sense of envelope of function by searching this blog or from Doug Kelsey’s “90 Day Knee Arthritis Remedy” at Doug’s website.
Will I be able to play football again?
This is the question I wanted to address.
The answer is a definite maybe. That’s the best anyone can tell you. Anyone who says otherwise is probably a charlatan or a fool.
I wanted to pull out this question because many active people ask it. They want to know, “Will I ever be able to dance/bicycle/rock climb/whatever again?” For me, it was ride my bicycle, of course.
I tried hard to get back on that bike as soon as I could. I got back on the bike before my knees were ready. I tried biking, failed, tried biking, failed.
To get better, I think you have to move beyond that question of “Will I ever be able to participate in my favorite sport/activity again?” You have to accept that the answer might be “no.” You have to look for new physical activities that won’t stress your knees that you can do in the interim.
I gave up on biking for a while, after even easy cycling disturbed my knee joints. So I decided not to even think about it. Pushed it out of my mind. I told myself I could be happy just being able to go for long walks. Once I made my peace with that, I no longer was focused on, “When will I be able to get back on my bike?”
Before then, I had been rather obsessive about cycling. But sometimes you have be prepared to move on. I did, and then when I got better, many months later, I rolled the bike out of the driveway, took a deep breath, climbed on the saddle, and slowly off I went.
So maybe you can play football again (which I assume is what we Americans would call soccer). But for now, you might want to think about pushing that thought far out of your mind. That tends to make things easier during what can be a long recovery.
Sunday, April 7, 2019
A Cautionary Tale From the Big Medical Business of Knee Pain
Knee pain is a big, big business, not surprisingly.
Here’s an alert from Seeking Alpha, a website covering news on publicly traded companies, that shows starkly what small companies have at stake with cartilage restoration technologies.
In this case, Histogenics apparently developed a treatment called NeoCart. It’s described as a “cell-therapy based implant designed to help restore and heal knee cartilage through the use of a patient's own cells.”
I’ve written here and here about autologous chondrocyte implantation. I’m not sure how NeoCart works exactly, but it sounds a lot like ACI.
Alas, the NeoCart story may have a sour ending. I’ve been skeptical about ACI; I’m doubtful that it will lead to a result better than an old-fashioned microfracture. And sure enough, here are the findings of a study that sent the shares of Histogenics into a nosedive:
Back in September, the CEO of the company hastened to assure investors that the results weren’t as bad as they looked.
If you believed that, if you held on to your stock, thinking “It’s going to rebound now” – and investor psychology shows people do tend to cling to their losers, hoping they’ll recover at least somewhat – you’re in even worse shape now.
Its latest stock price is 11 cents, or about one-fifth of its value in September. Right now it’s trading in the basement of the penny stock dungeon, jerking up and down on vapors and wisps of news.
What’s the upshot here?
Well, if you’ve got money to blow out your, um, ears, you should realize that investing in small companies whose fortunes are riding on unproven medical technologies is always going to be high risk. So caveat investor.
But for me, it’s at least as significant to ponder that maybe surgeons like Scott Dye have it right when they espouse a belief in doing as little surgically to heal bad knees as possible. If you can mend your bad knees without any kind of surgery, so much the better.
But if you’re going to do something to restore lost cartilage, maybe the simpler, less-invasive microfracture, which aims to stimulate your body to heal itself, beats this fancy, complex technology where your cartilage cells are grown in a lab then sutured back into your joints.
Something to ponder.
Here’s an alert from Seeking Alpha, a website covering news on publicly traded companies, that shows starkly what small companies have at stake with cartilage restoration technologies.
In this case, Histogenics apparently developed a treatment called NeoCart. It’s described as a “cell-therapy based implant designed to help restore and heal knee cartilage through the use of a patient's own cells.”
I’ve written here and here about autologous chondrocyte implantation. I’m not sure how NeoCart works exactly, but it sounds a lot like ACI.
Alas, the NeoCart story may have a sour ending. I’ve been skeptical about ACI; I’m doubtful that it will lead to a result better than an old-fashioned microfracture. And sure enough, here are the findings of a study that sent the shares of Histogenics into a nosedive:
NeoCart, when compared to microfracture, was unable to demonstrate a statistically significant improvement in function and pain.When the news came out, back in September, the stock abruptly plunged more than 75%, to about 60 cents a share. Think of that. If you had invested $100,000 in this company, overnight you wound up with less than $25,000.
Back in September, the CEO of the company hastened to assure investors that the results weren’t as bad as they looked.
If you believed that, if you held on to your stock, thinking “It’s going to rebound now” – and investor psychology shows people do tend to cling to their losers, hoping they’ll recover at least somewhat – you’re in even worse shape now.
Its latest stock price is 11 cents, or about one-fifth of its value in September. Right now it’s trading in the basement of the penny stock dungeon, jerking up and down on vapors and wisps of news.
What’s the upshot here?
Well, if you’ve got money to blow out your, um, ears, you should realize that investing in small companies whose fortunes are riding on unproven medical technologies is always going to be high risk. So caveat investor.
But for me, it’s at least as significant to ponder that maybe surgeons like Scott Dye have it right when they espouse a belief in doing as little surgically to heal bad knees as possible. If you can mend your bad knees without any kind of surgery, so much the better.
But if you’re going to do something to restore lost cartilage, maybe the simpler, less-invasive microfracture, which aims to stimulate your body to heal itself, beats this fancy, complex technology where your cartilage cells are grown in a lab then sutured back into your joints.
Something to ponder.
Saturday, March 23, 2019
Pro Tip: How to Navigate This Site
So, some news first: I had an interview recently with a freelance writer for the Washington Post. Her topic (a very good one) was how to avoid knee replacement surgery. Well, that’s something I’m not bashful about talking about. If my knees had continued going downhill, I have little doubt that right now I’d be sitting in an orthopedist’s office, and the subject of knee replacement would be front and center.
She asked me how my knees were. That was the icebreaker question. I told her they weren’t normal. I think her breath caught slightly on the other end of the line. I could almost hear her thinking, “A relapse? Did I pick the wrong person to talk to?”
Then I explained that my knees are much better than normal. That’s the crazy thing. I emerged from this knee pain saga with knees that are probably in the top 5% for my age. Honestly, I do not have knee pain, and can chase my kids through the snow without problems, and so I feel very, very fortunate!
I will let you all know once the story runs, assuming she lets me know (or if she doesn’t, one of you can let me know, and I’ll provide a link to it). Of course there’s no guarantee my voice will be in the final story – I’m in the journalism business, and I know a good journalist leaves a lot of material on the cutting room floor – but I think there’s a decent chance.
Now for today’s subject: pro tips on searching this blog.
I realize I’ve been posting here now since June 14, 2010. Wow. Almost nine years.
Since then I’ve covered a lot of territory. So here’s how you can find some things if you’re new and are seeking help:
* If you search the blog for “success story,” you’ll find some detailed stories from people who have overcome knee pain (or are making great progress in overcoming it). I love success stories. Some of these stories you may relate to better than my own.
* If you search the blog for “Scott Dye,” you’ll find more about Scott F. Dye and his concept of the “envelope of function,” which for my money is the smartest framework for understanding and devising a plan to heal from knee pain.
* If you search on “glucosamine,” you’ll find plenty of material on why I think the supplement is basically a waste. But of course, if you think it works, go for it. The only damaged party will be your wallet (unless you’re diabetic).
* If you like reading me being philosophical, puzzling over unusual things, try these:
Of Breakdown Points and Discontinuities in Healing, Part I
Of Breakdown Points and Discontinuities in Healing, Part II
* If you want to read about debunking bad structuralism, go here:
The Odd Tale of the HQ Ratio
* And, last, one reason I’m so optimistic about the ability of cartilage to heal:
Why I’m So Optimistic About Cartilage Healing
Why I’m So Optimistic About Cartilage Healing, Take 2
She asked me how my knees were. That was the icebreaker question. I told her they weren’t normal. I think her breath caught slightly on the other end of the line. I could almost hear her thinking, “A relapse? Did I pick the wrong person to talk to?”
Then I explained that my knees are much better than normal. That’s the crazy thing. I emerged from this knee pain saga with knees that are probably in the top 5% for my age. Honestly, I do not have knee pain, and can chase my kids through the snow without problems, and so I feel very, very fortunate!
I will let you all know once the story runs, assuming she lets me know (or if she doesn’t, one of you can let me know, and I’ll provide a link to it). Of course there’s no guarantee my voice will be in the final story – I’m in the journalism business, and I know a good journalist leaves a lot of material on the cutting room floor – but I think there’s a decent chance.
Now for today’s subject: pro tips on searching this blog.
I realize I’ve been posting here now since June 14, 2010. Wow. Almost nine years.
Since then I’ve covered a lot of territory. So here’s how you can find some things if you’re new and are seeking help:
* If you search the blog for “success story,” you’ll find some detailed stories from people who have overcome knee pain (or are making great progress in overcoming it). I love success stories. Some of these stories you may relate to better than my own.
* If you search the blog for “Scott Dye,” you’ll find more about Scott F. Dye and his concept of the “envelope of function,” which for my money is the smartest framework for understanding and devising a plan to heal from knee pain.
* If you search on “glucosamine,” you’ll find plenty of material on why I think the supplement is basically a waste. But of course, if you think it works, go for it. The only damaged party will be your wallet (unless you’re diabetic).
* If you like reading me being philosophical, puzzling over unusual things, try these:
Of Breakdown Points and Discontinuities in Healing, Part I
Of Breakdown Points and Discontinuities in Healing, Part II
* If you want to read about debunking bad structuralism, go here:
The Odd Tale of the HQ Ratio
* And, last, one reason I’m so optimistic about the ability of cartilage to heal:
Why I’m So Optimistic About Cartilage Healing
Why I’m So Optimistic About Cartilage Healing, Take 2
Sunday, March 10, 2019
The World Needs More 60-Year-Old Physical Therapists
Seriously.
I was thinking yesterday about why physical therapy latched on to its muscle fixation, when it comes to treating bad knee joints. You know the tired old song: Strengthen the quads to overcome the pain from ailing, balky knees!
Of course (as so many here can testify), the quad exercises end up further hurting the knee, which isn’t healthy enough to tolerate the force needed to strengthen the muscles. I had this frustrating experience myself and only started getting better when I rejected such catastrophic advice.
But where did the advice come from in the first place, and why did it prove so popular?
I can’t testify to its origins, but one thing I have noticed about physical therapists: they tend to be young, perky, athletic people. They like to stretch too. They eagerly acquire new stretches.
And it seems none of them have had the chronic knee pain that they are advising you on.
Is experience of a thing a necessary condition for advising on that thing? We don’t require a medical doctor to have lived through every problem he’s giving recommendations on, certainly. Nor should we.
But a certain humility and awareness of mortality and open-mindedness to alternative solutions comes with age, at least in the realm of physical ailments. This, I think, is a good thing when faced with the intractable problem of chronic knee pain. As a patient, I wouldn’t mind a little genuine empathy – if not with my knee pain, then perhaps with the fact that the body does betray its owner sometimes in mysterious ways, and can bring any of us low with pain that has no clear source and no clear solution.
That’s why I’d welcome more 60-year-old physical therapists who have had bad knees, bad elbows, bad feet – who have fought the good fight for months with a condition only to have it recur, then to subdue it, again and again, and finally win in the end. I’m not saying all physical therapists have to be mature adults, with hair shot with steely gray, but wouldn’t it be nice if a few more of them were?
I was thinking yesterday about why physical therapy latched on to its muscle fixation, when it comes to treating bad knee joints. You know the tired old song: Strengthen the quads to overcome the pain from ailing, balky knees!
Of course (as so many here can testify), the quad exercises end up further hurting the knee, which isn’t healthy enough to tolerate the force needed to strengthen the muscles. I had this frustrating experience myself and only started getting better when I rejected such catastrophic advice.
But where did the advice come from in the first place, and why did it prove so popular?
I can’t testify to its origins, but one thing I have noticed about physical therapists: they tend to be young, perky, athletic people. They like to stretch too. They eagerly acquire new stretches.
And it seems none of them have had the chronic knee pain that they are advising you on.
Is experience of a thing a necessary condition for advising on that thing? We don’t require a medical doctor to have lived through every problem he’s giving recommendations on, certainly. Nor should we.
But a certain humility and awareness of mortality and open-mindedness to alternative solutions comes with age, at least in the realm of physical ailments. This, I think, is a good thing when faced with the intractable problem of chronic knee pain. As a patient, I wouldn’t mind a little genuine empathy – if not with my knee pain, then perhaps with the fact that the body does betray its owner sometimes in mysterious ways, and can bring any of us low with pain that has no clear source and no clear solution.
That’s why I’d welcome more 60-year-old physical therapists who have had bad knees, bad elbows, bad feet – who have fought the good fight for months with a condition only to have it recur, then to subdue it, again and again, and finally win in the end. I’m not saying all physical therapists have to be mature adults, with hair shot with steely gray, but wouldn’t it be nice if a few more of them were?
Sunday, February 24, 2019
Open Comment Forum: What Does Your Knee Like Best?
I'm going to keep this short, as I'm really tired this weekend. The usual rules apply: you can choose to answer the question I pose, or you can talk about whatever you want to.
It's an open comment forum. All of you are driving the bus.
Anyway, I thought it might be useful to start with this question: What does your knee like the most? Is it half an hour in the sauna, a short and slow walk, a massage, a meditation session, or what?
By sharing what personally works and what doesn't, I think we can all help each other.
All fine with my knees by the way (no, I don't say that to gloat, but rather as a perfunctory update, as sometimes people do ask how much knee pain I still have). Both knees feel good. It's like a rebirth!
Cheers.
It's an open comment forum. All of you are driving the bus.
Anyway, I thought it might be useful to start with this question: What does your knee like the most? Is it half an hour in the sauna, a short and slow walk, a massage, a meditation session, or what?
By sharing what personally works and what doesn't, I think we can all help each other.
All fine with my knees by the way (no, I don't say that to gloat, but rather as a perfunctory update, as sometimes people do ask how much knee pain I still have). Both knees feel good. It's like a rebirth!
Cheers.
Saturday, February 9, 2019
How Long Will It Take for You to Heal?
I received a comment recently, the first part of which went:
So if we continue to walk for 2-3 miles a day and bicycle 20-30 minutes every day, are we going to heal in 2-3 years?
First of all, if I could answer this question, I would not be wasting my time with a blog. I would be making billions of dollars trading stocks and futures contracts.
The truth is, I can’t answer this question. Neither can anyone else.
If you are in the presence of someone who tells you, with great conviction and vehemence, that he can answer this question, I would advise you (and God knows, I try not to give advice) to check to make sure that your wallet is still on your person, and intact, then to make your way quickly toward the closest exit.
Knee pain can be a terrible place of fear and uncertainty. And part of that uncertainty, sadly, revolves around how long it will take to get better. Honestly, I can’t even tell you for sure that if you do all the right things, you will emerge from this nightmare with pain-free knees.
I have a large, abiding faith that many bad knees can be healed, over a time period that can vary greatly by individual. I base this partly on my own experience – my knees that a doctor told me sternly would never get better (what I’m sure he thought was a necessary bit of truth-telling) did in fact improve – so much so that today they feel normal or even better than normal, considering my age.
I also base my optimism on much research that I did, which I detail in Saving My Knees.
But to offer blanket reassurance that anyone can heal within a tight time frame by doing a fixed amount of walking and cycling? You may get better in 12 months on that regimen. Or it may take nine or 10 years. Or you may never get better, because that program is too much for your particular knees.
The time frame for healing is not a really knowable thing at the beginning. I know: more fear, more uncertainty, more doubt. Not what anyone wants. But the alternative is dishonesty.
I think the best thing is to think of this as a purposeful journey. You are not wandering, lost, in the desert. You have an objective. You are experimenting. Your aim is, at the end of each year, to have knees that are at least a little improved from where they were at the year’s beginning.
And think about it: if your knees never get back to 100%, but they get a little better each year, and you have a positive outlook, because you’re actually executing a plan, and you have some control over your future, isn’t that something good? Isn’t that a victory of sorts?
Part of the reason my initial experience with bad knees was so miserable was the helplessness, the belief that nothing could be done. There is at least a solution to that. Keep in mind that others have healed, that all is not lost, and push forward with purpose. There’s an excellent chance that good things will happen.
So if we continue to walk for 2-3 miles a day and bicycle 20-30 minutes every day, are we going to heal in 2-3 years?
First of all, if I could answer this question, I would not be wasting my time with a blog. I would be making billions of dollars trading stocks and futures contracts.
The truth is, I can’t answer this question. Neither can anyone else.
If you are in the presence of someone who tells you, with great conviction and vehemence, that he can answer this question, I would advise you (and God knows, I try not to give advice) to check to make sure that your wallet is still on your person, and intact, then to make your way quickly toward the closest exit.
Knee pain can be a terrible place of fear and uncertainty. And part of that uncertainty, sadly, revolves around how long it will take to get better. Honestly, I can’t even tell you for sure that if you do all the right things, you will emerge from this nightmare with pain-free knees.
I have a large, abiding faith that many bad knees can be healed, over a time period that can vary greatly by individual. I base this partly on my own experience – my knees that a doctor told me sternly would never get better (what I’m sure he thought was a necessary bit of truth-telling) did in fact improve – so much so that today they feel normal or even better than normal, considering my age.
I also base my optimism on much research that I did, which I detail in Saving My Knees.
But to offer blanket reassurance that anyone can heal within a tight time frame by doing a fixed amount of walking and cycling? You may get better in 12 months on that regimen. Or it may take nine or 10 years. Or you may never get better, because that program is too much for your particular knees.
The time frame for healing is not a really knowable thing at the beginning. I know: more fear, more uncertainty, more doubt. Not what anyone wants. But the alternative is dishonesty.
I think the best thing is to think of this as a purposeful journey. You are not wandering, lost, in the desert. You have an objective. You are experimenting. Your aim is, at the end of each year, to have knees that are at least a little improved from where they were at the year’s beginning.
And think about it: if your knees never get back to 100%, but they get a little better each year, and you have a positive outlook, because you’re actually executing a plan, and you have some control over your future, isn’t that something good? Isn’t that a victory of sorts?
Part of the reason my initial experience with bad knees was so miserable was the helplessness, the belief that nothing could be done. There is at least a solution to that. Keep in mind that others have healed, that all is not lost, and push forward with purpose. There’s an excellent chance that good things will happen.
Saturday, January 26, 2019
Could I Have Healed My Knees Without Quitting My Job? (And Other Questions Answered)
I recently came across a comment loaded with questions and thought, “Why not just do a post answering these?” They came from someone in his late twenties who hurt himself skiing last February and is now struggling with knee pain. He’s tried a number of things to fix the problem, has many questions, and I invite all of you out there to help me with the answers if you’d like.
Q: Do you believe you could have still recovered in the office setting (which, I assume, means had I not quit my job and continued to work sitting at a desk)?
A: I honestly don’t know with certainty. I know it would have been harder, for sure. The act of sitting was causing me problems, and I had a job that required a lot of sitting (a standing desk would not have helped either, because at that point I couldn’t stand in one place for very long either).
Q: Your story somewhat ends abruptly, in the second year of recovery. Did you slowly increase your activities on the same rigid scientific approach? At some point did it feel like you came out of the rehab stage?
A: Yes, others have made the same complaint about the book, so that’s probably my fault for moving too quickly through the narrative of the latter stages of my recovery. But to me, it simply wasn’t as interesting. That’s because I began making steadier progress, suffering fewer setbacks. Yes, I was still careful about how fast I increased my step counts, etc.
Apart from that, I’m not sure that there was a clear line of demarcation where I “came out of the rehab stage.” I was pretty much healed when I rejoined Bloomberg in the last part of December 2009. Still, I had days at Bloomberg where my knees felt a little cranky. That minor discomfort did go away eventually, but that just goes to show healing is long and gradual.
Q: Does research suggest a cortisone shot prevents cartilage from healing?
A: I’m not a fan. And yes, the research on cortisone shots is not good. Just do a search on this blog for “steroid.” You’ll see.
Q: How did you explain your injury to outsiders?
A: I don’t recall this being a big issue. I mostly just said I had knee pain. If you come up with a short spiel that goes, “I have knee pain and I’m working to resolve it,” that seems to satisfy most people. They don’t particularly want to hear that much about your injuries anyway.
Q: Does research suggest age playing a factor in the speed of cartilage recovery?
A: I’ve seen at least one that shows an age-related effect, yes. But it’s significantly smaller than most people would guess. So you probably do have an edge, being in your late twenties, but I don’t think it’s a huge edge.
Q: I’ve seen your comments on diet, that you think it did not play a significant part in your recovery but losing weight is one of your 4 keys to rehab. Have you done any research on the claims that low carb/keto type diets can help arthritis patients?
A: Unloading the knee by shedding a few pounds is always a good idea for pudgy people; for thinner people the benefits may be much smaller (because there’s less fat to lose). I’m ignorant and agnostic on the effect of special diets on knee pain. Usually, diet didn’t affect my knee pain.
However, when I loaded up on fatty foods, I did seem to feel a bit worse. So it’s probably smart to try to eat as healthy as possible, and look for anti-inflammatory foods. (One other important note on diet: my experience is by no means representative; if you comb through comments on this blog, you’ll find a number of people who say changing their diet was absolutely important in getting their knee pain under control.)
Q: Do you think weightlifting, upper body type workouts, are safe to resume?
A: I would think so, but I would still carefully monitor my knees. This seems minor, but some of those exercises cause unrelated muscles to tense up, and that could cause irritation for bad knees. Also, be prepared: if you have knee pain long enough, you may find other mysterious joint issues popping up, such as with your elbows or shoulders, when you’re lifting weights.
Generally though, I think it’s good to engage in activities that get your heart pumping and get you perspiring.
Q: Any other exercising activities you came across that don’t overload the knee joints? I think my knee is responding OK to low-watt biking.
A: My favorite ideas remain walking slowly, pool exercises, and easy cycling. If your knee does well with low-watt biking, congratulations. That may be your ticket out of this mess.
Q: Do you believe you could have still recovered in the office setting (which, I assume, means had I not quit my job and continued to work sitting at a desk)?
A: I honestly don’t know with certainty. I know it would have been harder, for sure. The act of sitting was causing me problems, and I had a job that required a lot of sitting (a standing desk would not have helped either, because at that point I couldn’t stand in one place for very long either).
Q: Your story somewhat ends abruptly, in the second year of recovery. Did you slowly increase your activities on the same rigid scientific approach? At some point did it feel like you came out of the rehab stage?
A: Yes, others have made the same complaint about the book, so that’s probably my fault for moving too quickly through the narrative of the latter stages of my recovery. But to me, it simply wasn’t as interesting. That’s because I began making steadier progress, suffering fewer setbacks. Yes, I was still careful about how fast I increased my step counts, etc.
Apart from that, I’m not sure that there was a clear line of demarcation where I “came out of the rehab stage.” I was pretty much healed when I rejoined Bloomberg in the last part of December 2009. Still, I had days at Bloomberg where my knees felt a little cranky. That minor discomfort did go away eventually, but that just goes to show healing is long and gradual.
Q: Does research suggest a cortisone shot prevents cartilage from healing?
A: I’m not a fan. And yes, the research on cortisone shots is not good. Just do a search on this blog for “steroid.” You’ll see.
Q: How did you explain your injury to outsiders?
A: I don’t recall this being a big issue. I mostly just said I had knee pain. If you come up with a short spiel that goes, “I have knee pain and I’m working to resolve it,” that seems to satisfy most people. They don’t particularly want to hear that much about your injuries anyway.
Q: Does research suggest age playing a factor in the speed of cartilage recovery?
A: I’ve seen at least one that shows an age-related effect, yes. But it’s significantly smaller than most people would guess. So you probably do have an edge, being in your late twenties, but I don’t think it’s a huge edge.
Q: I’ve seen your comments on diet, that you think it did not play a significant part in your recovery but losing weight is one of your 4 keys to rehab. Have you done any research on the claims that low carb/keto type diets can help arthritis patients?
A: Unloading the knee by shedding a few pounds is always a good idea for pudgy people; for thinner people the benefits may be much smaller (because there’s less fat to lose). I’m ignorant and agnostic on the effect of special diets on knee pain. Usually, diet didn’t affect my knee pain.
However, when I loaded up on fatty foods, I did seem to feel a bit worse. So it’s probably smart to try to eat as healthy as possible, and look for anti-inflammatory foods. (One other important note on diet: my experience is by no means representative; if you comb through comments on this blog, you’ll find a number of people who say changing their diet was absolutely important in getting their knee pain under control.)
Q: Do you think weightlifting, upper body type workouts, are safe to resume?
A: I would think so, but I would still carefully monitor my knees. This seems minor, but some of those exercises cause unrelated muscles to tense up, and that could cause irritation for bad knees. Also, be prepared: if you have knee pain long enough, you may find other mysterious joint issues popping up, such as with your elbows or shoulders, when you’re lifting weights.
Generally though, I think it’s good to engage in activities that get your heart pumping and get you perspiring.
Q: Any other exercising activities you came across that don’t overload the knee joints? I think my knee is responding OK to low-watt biking.
A: My favorite ideas remain walking slowly, pool exercises, and easy cycling. If your knee does well with low-watt biking, congratulations. That may be your ticket out of this mess.
Saturday, January 12, 2019
A Success Story of Overcoming Knee Pain After Devastating Setbacks
As I’ve said, I love success stories. Mine, of course, is one. But someone who can't relate to mine may be able to relate to someone else’s, so the more success stories I can share the better.
In the early days of this blog (that takes me back!), a frequent visitor was a woman who went by the simple moniker “Knee Pain.” She was one of the people I was rooting especially hard for, as I could feel her complete determination to beat this curse of knee pain in virtually everything she wrote.
Well, she checked in late last year and told her story in the comment section. And she had made some very good progress, I was pleased to learn. Because I love success stories, I kept meaning to pull out all the bits and give them a proper home inside one of these posts.
Finally I’m getting around to that.
Here’s her story, with my editing as usual. If you want to see her full comments, go here.
Also, Knee Pain, if you're out there reading this, you're welcome to update us on your progress and field questions in the comment section below. I know it's been four months since you posted the story below.
"I was diagnosed with chondromalacia patella in 1993. In later years, it's also been diagnosed as PFPS (patellofemoral pain syndrome). Doctors say that the kneecap is not tracking properly and the cartilage has worn down too much. There's no signs of knee arthritis.
My pain is in my right knee. My bad knee doesn't swell or turn red or other colors. It seems to look exactly like my good knee -- even when it's at its most painful.
I don't have the "burning and aching.” Instead, when my knee is irritated/flared up, I get stabbing pain when I bend my knee. The severity of the pain can range from a just a dull stab to a gut-wrenching pain. (It feels like a flying elf is hovering over my knee with a long knife and gleefully plunges it into my knee.) I only get these stabs when I move my knee. Not at rest.
I didn't quit my job. As long as I am sitting perfectly still, it doesn't hurt while I'm sitting. My type of work uses a computer, so I can still type with my fingers without moving my knee. I went on 2 business trips with the help of a wheelchair when the pain was just too bad and I couldn't walk very far. I've also used a cane.
I've trained myself to never run or jump. Ever. That would cause a flare up. I don't even move quickly. Stairs are a constant nemesis (especially walking down stairs), but I can conquer them one at a time, making my good knee take on all the burden. As for household chores, kneeling or squatting are not a possibility. I sit on the floor or in a chair.
I've had soooo many ups and downs since 1993.
For the most part my doctors recommended physical therapy in the form of strengthening the quads and the vastus medialis. I really don't think that worked for me. Even before reading Richard’s book, I had the gut-feeling sense that trying to strengthen the quads flares up the knee joint itself, sooooo.... instead of helping me, it kind of sets me back. It was only after reading Richard's book (in 2012) that I felt like my gut-feeling was validated!
In 2010, I had the synvisc injection. That made it worse. My knee got a brand-new symptom which was that it would catch and lock up, which was horribly painful.
In 2010, I had arthroscopic surgery to smooth out the cartilage in the knee. The result was that it definitely helped with the knee locking problem! But I kept having irritation and flare-ups.
I asked my doctor if she thought I should next try the total knee replacement? She felt very confident that I should be able to get well with just physical therapy. So I kept trying to use natural methods to get better. But .... not very successfully ....until I tried water therapy starting in March 2012. More on that later. :)
My knees are doing very well right now and I'm grateful every day.
Currently I can swim, bike (up to 10 miles with small slopes), and play a court sport (running around after a ball on a court -- including jumping!!) I can walk up and down stairs without pain.
I'm still scared I could have a setback, but I keep trying to move cautiously forward.
This is the THIRD TIME I've gotten to this "happy golden knee health level" with my knee. I think that the thing that seems consistent with how I've achieved the "happy golden knee health level" is the low-load/high rep that Richard talks about in his book.
The first "happy golden era of knee health" was approximately 2000-Sept. 2006. This started by me taping my kneecap into the "correct spot" (what I learned from a physical therapist) and then gently biking. I started off with just very short and easy. Flat. I would walk my bike up any slopes. Over time, I built up and was able to bike further and with tiny slopes. Then, over the course of months and years, I built up more and more and I could bike really tough routes. I danced. I learned the Lindyhop. I hiked. I learned to windsurf!
But in 2006 I had a catastrophic relapse. Why? I'm not totally sure, but I SUSPECT it's because i had a lifestyle change in which I wasn't as physically active. I stopped biking as much. More sitting. Less moving. And then, after a night of very intense waltzing ... boom. That was it. Back to all the pain. It was devastating.
In March 2012-October 2012 I had my second happy golden era of knee health.
I got the idea of doing water therapy! I got a book called "the complete waterpower workout book" because it has suggestions for people with bad knees (and all sorts of other injuries). I wore my neoprene knee brace to start.
Some exercises involved standing in chest high water and doing movement like moving my leg in a circle. Some involved wearing a floatation waist belt in deep water and moving my legs in different ways.
I also learned I have to listen to my knee because it didn't like all the leg exercises -- even the ones to help with "bad knees." For example .... swinging my leg forward with a straight leg -- as I recall -- was too intense for my knee initially.
After about a month I took off my knee brace. I did have a little trouble. But I was able to work through that by just going slower and more carefully.
In July 2012, I got Richard's Saving My Knees book and read it in one sitting.
I learned about high-rep/low load.
I learned about delayed onset pain.
I started posting on this blog about how I was improving.
Then after my knees were starting to feel better I started gently biking again. And I could go up and down stairs without hurting. Amazing!! And then I started biking more and I started biking more.
I thought I was CURED!!
But no!!!
I "overdid it" on one of my bike rides and BOOM that was it. Another catastrophic relapse.
My big takeaways from Happy Golden Era #2 in combo with what I learned from Richard's book were:
1) I'm a believer in low-load/high-rep, thicken the synovial fluid. I saw it work two times for myself -- even though I didn't know it was called that or that the biking and the water therapy were essentially doing the same thing.
2) I definitely agree with the idea of not even attempting to strengthen the quad muscles until after I've got the knee joint itself feeling calm and stable.
3) I was so glad to learn that Delayed Pain Onset is a real thing. Not my imagination. It helped give me the courage to believe in my own hypothesis that maybe when I'm doing something, only days later I will feel the negative result. So I need to be patient and "let the dust settle" after doing knee activities and make sure I'm OK.
4) Patience. Patience patience patience patience. I promised myself 100 times that if I ever got the chance to get to another "happy golden era" again, then I would be a lot more patient.
Starting 2016, I used all this knowledge to try to make another big (but slow and gentle) push for a third "happy golden knee era."
It worked!! (So far!)
-- I can go up and down stairs without pain.
-- I've walked without knee pain for up to 5 miles
-- I can bike up to about 10 miles with small slopes
-- I can swim for up to 90 minutes
-- I'm playing a court sport (running around a court after a ball -- including occasional jumping)
How I got to this point was once again using the water activity.
However, this time I did my water activities in cold water. (BTW: I was learning on another post that maybe being in cold water helped reduce inflammation and that might've helped with my success this time.)
I did once again start with essentially wearing a thick knee brace. Once again, not "swimming" but more like gentle leg motions. (When I did opt for "swimming" then I just dragged my legs.)
By July 2017 I built up to swimming a mile! But still, I wasn't supplementing this with land activities.
Then in 2018 I really realized wow my knees are feeling pretty great.
So then I started experimenting with land activities such as walking up to 5 miles.
And I was doing really well so I invested in buying a road bike in April 2018. I started super cautiously riding short easy distance on flat. 4-5 miles. Then wait at least 72 hours. See how my knees feel. Bike another 4-5 miles on flat. Then wait at least 72 hours. See how my knees feel.
Then I decided to try a court sport running around after a ball. The court sport did stress my knees some. I did get a few SMALL sharp stabbing pains within the 72 hour waiting period. So that was kind of scary. I decided to try again and just be cautious. After a couple sessions, the small stabbing pains went away. Now it's been two months of trying the court sport and I'm not having any stabbing pains anymore.
Anyway!
This is where I am now.
But.
I know I have to remain cautious.
I need to remain patient.
And it's really hard to be careful and patient because I'm feeling very excited that I can once again do all these different kinds of activities!! I feel like my life possibilities are opening up again!"
In the early days of this blog (that takes me back!), a frequent visitor was a woman who went by the simple moniker “Knee Pain.” She was one of the people I was rooting especially hard for, as I could feel her complete determination to beat this curse of knee pain in virtually everything she wrote.
Well, she checked in late last year and told her story in the comment section. And she had made some very good progress, I was pleased to learn. Because I love success stories, I kept meaning to pull out all the bits and give them a proper home inside one of these posts.
Finally I’m getting around to that.
Here’s her story, with my editing as usual. If you want to see her full comments, go here.
Also, Knee Pain, if you're out there reading this, you're welcome to update us on your progress and field questions in the comment section below. I know it's been four months since you posted the story below.
"I was diagnosed with chondromalacia patella in 1993. In later years, it's also been diagnosed as PFPS (patellofemoral pain syndrome). Doctors say that the kneecap is not tracking properly and the cartilage has worn down too much. There's no signs of knee arthritis.
My pain is in my right knee. My bad knee doesn't swell or turn red or other colors. It seems to look exactly like my good knee -- even when it's at its most painful.
I don't have the "burning and aching.” Instead, when my knee is irritated/flared up, I get stabbing pain when I bend my knee. The severity of the pain can range from a just a dull stab to a gut-wrenching pain. (It feels like a flying elf is hovering over my knee with a long knife and gleefully plunges it into my knee.) I only get these stabs when I move my knee. Not at rest.
I didn't quit my job. As long as I am sitting perfectly still, it doesn't hurt while I'm sitting. My type of work uses a computer, so I can still type with my fingers without moving my knee. I went on 2 business trips with the help of a wheelchair when the pain was just too bad and I couldn't walk very far. I've also used a cane.
I've trained myself to never run or jump. Ever. That would cause a flare up. I don't even move quickly. Stairs are a constant nemesis (especially walking down stairs), but I can conquer them one at a time, making my good knee take on all the burden. As for household chores, kneeling or squatting are not a possibility. I sit on the floor or in a chair.
I've had soooo many ups and downs since 1993.
For the most part my doctors recommended physical therapy in the form of strengthening the quads and the vastus medialis. I really don't think that worked for me. Even before reading Richard’s book, I had the gut-feeling sense that trying to strengthen the quads flares up the knee joint itself, sooooo.... instead of helping me, it kind of sets me back. It was only after reading Richard's book (in 2012) that I felt like my gut-feeling was validated!
In 2010, I had the synvisc injection. That made it worse. My knee got a brand-new symptom which was that it would catch and lock up, which was horribly painful.
In 2010, I had arthroscopic surgery to smooth out the cartilage in the knee. The result was that it definitely helped with the knee locking problem! But I kept having irritation and flare-ups.
I asked my doctor if she thought I should next try the total knee replacement? She felt very confident that I should be able to get well with just physical therapy. So I kept trying to use natural methods to get better. But .... not very successfully ....until I tried water therapy starting in March 2012. More on that later. :)
My knees are doing very well right now and I'm grateful every day.
Currently I can swim, bike (up to 10 miles with small slopes), and play a court sport (running around after a ball on a court -- including jumping!!) I can walk up and down stairs without pain.
I'm still scared I could have a setback, but I keep trying to move cautiously forward.
This is the THIRD TIME I've gotten to this "happy golden knee health level" with my knee. I think that the thing that seems consistent with how I've achieved the "happy golden knee health level" is the low-load/high rep that Richard talks about in his book.
The first "happy golden era of knee health" was approximately 2000-Sept. 2006. This started by me taping my kneecap into the "correct spot" (what I learned from a physical therapist) and then gently biking. I started off with just very short and easy. Flat. I would walk my bike up any slopes. Over time, I built up and was able to bike further and with tiny slopes. Then, over the course of months and years, I built up more and more and I could bike really tough routes. I danced. I learned the Lindyhop. I hiked. I learned to windsurf!
But in 2006 I had a catastrophic relapse. Why? I'm not totally sure, but I SUSPECT it's because i had a lifestyle change in which I wasn't as physically active. I stopped biking as much. More sitting. Less moving. And then, after a night of very intense waltzing ... boom. That was it. Back to all the pain. It was devastating.
In March 2012-October 2012 I had my second happy golden era of knee health.
I got the idea of doing water therapy! I got a book called "the complete waterpower workout book" because it has suggestions for people with bad knees (and all sorts of other injuries). I wore my neoprene knee brace to start.
Some exercises involved standing in chest high water and doing movement like moving my leg in a circle. Some involved wearing a floatation waist belt in deep water and moving my legs in different ways.
I also learned I have to listen to my knee because it didn't like all the leg exercises -- even the ones to help with "bad knees." For example .... swinging my leg forward with a straight leg -- as I recall -- was too intense for my knee initially.
After about a month I took off my knee brace. I did have a little trouble. But I was able to work through that by just going slower and more carefully.
In July 2012, I got Richard's Saving My Knees book and read it in one sitting.
I learned about high-rep/low load.
I learned about delayed onset pain.
I started posting on this blog about how I was improving.
Then after my knees were starting to feel better I started gently biking again. And I could go up and down stairs without hurting. Amazing!! And then I started biking more and I started biking more.
I thought I was CURED!!
But no!!!
I "overdid it" on one of my bike rides and BOOM that was it. Another catastrophic relapse.
My big takeaways from Happy Golden Era #2 in combo with what I learned from Richard's book were:
1) I'm a believer in low-load/high-rep, thicken the synovial fluid. I saw it work two times for myself -- even though I didn't know it was called that or that the biking and the water therapy were essentially doing the same thing.
2) I definitely agree with the idea of not even attempting to strengthen the quad muscles until after I've got the knee joint itself feeling calm and stable.
3) I was so glad to learn that Delayed Pain Onset is a real thing. Not my imagination. It helped give me the courage to believe in my own hypothesis that maybe when I'm doing something, only days later I will feel the negative result. So I need to be patient and "let the dust settle" after doing knee activities and make sure I'm OK.
4) Patience. Patience patience patience patience. I promised myself 100 times that if I ever got the chance to get to another "happy golden era" again, then I would be a lot more patient.
Starting 2016, I used all this knowledge to try to make another big (but slow and gentle) push for a third "happy golden knee era."
It worked!! (So far!)
-- I can go up and down stairs without pain.
-- I've walked without knee pain for up to 5 miles
-- I can bike up to about 10 miles with small slopes
-- I can swim for up to 90 minutes
-- I'm playing a court sport (running around a court after a ball -- including occasional jumping)
How I got to this point was once again using the water activity.
However, this time I did my water activities in cold water. (BTW: I was learning on another post that maybe being in cold water helped reduce inflammation and that might've helped with my success this time.)
I did once again start with essentially wearing a thick knee brace. Once again, not "swimming" but more like gentle leg motions. (When I did opt for "swimming" then I just dragged my legs.)
By July 2017 I built up to swimming a mile! But still, I wasn't supplementing this with land activities.
Then in 2018 I really realized wow my knees are feeling pretty great.
So then I started experimenting with land activities such as walking up to 5 miles.
And I was doing really well so I invested in buying a road bike in April 2018. I started super cautiously riding short easy distance on flat. 4-5 miles. Then wait at least 72 hours. See how my knees feel. Bike another 4-5 miles on flat. Then wait at least 72 hours. See how my knees feel.
Then I decided to try a court sport running around after a ball. The court sport did stress my knees some. I did get a few SMALL sharp stabbing pains within the 72 hour waiting period. So that was kind of scary. I decided to try again and just be cautious. After a couple sessions, the small stabbing pains went away. Now it's been two months of trying the court sport and I'm not having any stabbing pains anymore.
Anyway!
This is where I am now.
But.
I know I have to remain cautious.
I need to remain patient.
And it's really hard to be careful and patient because I'm feeling very excited that I can once again do all these different kinds of activities!! I feel like my life possibilities are opening up again!"
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