When a Bad Knee Just Gets Worse

I came across this tale recently. It begins with our protagonist limping a little.

A few Tuesdays ago, I noticed Joel limping a bit, dragging his right leg. I asked him what was the matter. “Knee’s a little sore. Don’t know what I did,” was his response.

“Maybe you should rest it,” I suggested. “Do you need some ice?” 

“No, I don’t need ice. Good grief. Geesh. You think I’m a weakling?” he grumped.

Now what happens?

This is an interesting juncture for someone who has just developed knee pain seemingly out of the blue. The sudden, unexplained onset of knee pain can be frightening. It’s one thing if you bang your knee hard against something and then it becomes sore. A simple line can be drawn between cause and effect.

But if you can’t even recall what you did? Yikes. That’s not a good sign.

Well, Joel decides his leg needs more exercise. He chooses to walk downtown to run errands instead of drive. The next morning? Yup, you guessed it:

The knee is swollen. The limping is worse.

So he drags himself around the house for a while. He rests on the couch, an ice pack over the hurting joint. He starts wearing shorts, because his jeans won’t slide up over his swollen knee. His wife (narrating all this) gets exasperated with him.

Finally he breaks down and sees a doctor. An MRI is done. The report comes back with a lot of impressive-sounding jargon like:

“Large joint effusion,” “periarticular fluid signal and edema, greatest in the popliteal fossa and lateral soft tissues,” “subcutaneous edema in the prepatellar region, complex cystic structure along the later [sic?] popliteal fossa, adjacent to the lateral head of gastrocnemius.”

Of course the effusion and edema just mean that Joel has swelling. His doctor tells him the test confirms that his knees are getting old and orders medication for swelling and pain. And that is pretty much where the story ends.

But after reading this, I found myself thinking: Where did things go wrong for Joel, and why?

Things really went wrong when he decided he needed more exercise. So think about this in terms that have become familiar to visitors to this website: Joel’s envelope of function had narrowed. His knee joint hurt. It was less capable of handling stress.

So what does he do? He goes out and stresses it more than he would during a normal day when it wasn’t hurting!

Where the heck is the logic in that? What could have possessed the poor guy?

Here we can only speculate, but:

What’s the message you hear constantly from physical therapists trying to rehab bad joints? You need to strengthen your legs to protect the joint! Build up your leg muscles!

One can just imagine poor Joel Googling around for answers for his condition, landing on this message repeatedly – strong muscles protect weak joints! – and deciding, by God, he was going to strengthen those leg muscles and banish that knee pain!

Building up leg strength is a great idea ... before you have bad knees. Once you do, you need to move much, much more carefully. This is something that Joel has now presumably learned. That, and an MRI often isn’t really very useful. :)