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.
I feel it may be a good idea to give an update to encourage others and also provide time perspective from my story.
ReplyDeleteI continue to get better&stronger and, as it stands right now, it seems likely I have a good chance to go all the way in the coming years.
It took me more than 2,5 years just to stop the disease and then to slowly begin to reverse it. And this despite good shape of cartilage and other major structures. During these couple of years there was very very limited EoF and a great deal of disability.
Consequently, all I can say to people in similar long term dire situations is that it was essential for me to train stress management and somehow manage to shield my mind from depression&despair in order to give the body a chance to start moving towards balance again.
Good luck to everyone!
Hi Richard,
ReplyDeleteDid you run for your recovery? If you did, when did you start and how long did you run daily? I feel quite strong my legs when i walk or cycle, but after all i cant still climb up and down the stairs. I mean do you recommend to run for recovery? Thank you
Read his book. It will answer many of your questions about his personal knee journey. I'm grateful he's still ministering to us.
DeleteI never ran at all while I was trying to recover from knee pain. It seems like a stressful activity for hurting knees. That's my take anyway.
ReplyDeleteHi, Richard. I just came across your site. It's very interesting stuff.
ReplyDeleteCould you comment some of my considerations?
1) I've read some of your posts where you rebuke 'structuralist' approach. Your arguments obviously make sense for those, starting to have knee pain in their 30-s\40-s. But what about young knee-pain-sufferers? For example, I'm 23 now, mild knee pain, gone when having rest and wearing knee brace. I definitely have significantly weaker and lazier quads on my affected leg. So maybe to some extent, 'structuralist' approach is applicable to some of us? And it is worth doing some motor control work along with joint strengthening?
2) I find your strategy of low load-high reps similar to the approach of overcoming degenerative tendonopathy (e.g. described here http://stevenlow.org/overcoming-tendonitis/). Don't know whether you knew this fact, but it's pretty interesting coincidence on how we should treat different parts of our body differently.
Anyway, greetings from Russia :)
Best regards,
Mikhail
Does a structuralist approach make sense for some people? Does it make sense for younger people as opposed to older? I think that at the extremes a structuralist diagnosis makes sense. For example, if your left leg is two inches shorter than your right, yeah, that's going to be a problem. But that kind of discrepancy doesn't apply to many people. In general, I'm skeptical of the structuralist framework. As for whether it makes more sense for the young as opposed to the old, I don't see why it would.
DeleteBut -- if a structuralist gives you a bunch of exercises, and they work well for you, then it makes sense to keep doing them as long as you're not doing harm to your knees. Different knees respond best to different things. I'm a lot more open-minded on that than I was before!
It seems to me a lot of the problems the structuralist finds are a result of knee pain, not the cause. Others may exacerbate knee pain, but were not a problem before the injury.
DeleteFor example, on a variable incline plane (like the total gym), I can squat 60%+ per leg, which should allow me to do full body weight squats, but I can't. What's the difference, various muscles needed to stabilize me when doing a real squat (hip adductors, etc).
From Doug Kelsey:
"Most knee joint pain is caused by tissues that cannot withstand the force they are exposed to. The patellar mechanics
can make that worse but keep in mind that there are plenty of people walking and running around with less than optimal
mechanics who have no symptoms (Of course, there are situations, such as arthrofibrosis, adhesions of the patella to the
tendon, patella fracture , subluxation, dislocation, among others that can create knee pain)."
At least in my experience, the toughest thing about recovery is figuring out when to increase the level of exercise and by how much.
ReplyDeleteToo much to fast is bad, but without progressing the level of exercise, I don't see how recovery will progress.
JK,
DeleteA couple questions if you don't mind. At what % of body weight did you start on the VIP? Are these full single leg squats or eccentric? How long did it take you to progress to 60% and how often did you perform the exercises? I seem to remember seeing a comment from you before that you are working with Laurie, I am as well. I started with 15% and have gotten up to 35/40% eccentric squats in about 5-6 months. I can progress about 5% per month if there are limited setback. I know everyone is different, but I was just curious. Thanks and best of luck.
In my experience, structuralism was very damaging for me, along with the diagnosis of chondromalacia which in my opinion is a poor working diagnosis for knee pain. Oftentimes weak quads are a result of knee pain and not the cause. However, most therapists which will follow the norm.
ReplyDeleteEnvelope of function has been the key to getting healing going, despite some bad setbacks I have tried to keep going, and hopefully one day I can report my story in full on here as I think the things I've learned can really help others.
Good luck everyone!