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:

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.

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

 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.

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.

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:

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.
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?

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.

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!

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.