Finding the Numbers to Your Combination Lock

I went on a 103-mile bike ride yesterday -- phew! Some say it's not the heat ... but yes, it's the heat! It's hard to stay properly hydrated when the temps climb into the upper 80s. This morning I'll be in the basement, riding the stationary bike, trying to make up for the fact that yesterday's ride burned up most of my day.

Now then, here's a reader comment that put me in mind of something Dr. Scott Dye once said:

I have no idea what is the matter with my knees, have had no diagnosis and have kind of given up on that front, though I'm convinced it started mentally as i was suffering from chronic stress at the time, I also have a raised vein or nerve in leg so could be that WHO KNOWS. They do improve a lot with motion though, and lately on my walks ive just had the urge to start gently jogging, its like my body wants to take off, whats your advise on that? I havent jogged but i really want to.

Here's what Dr. Dye said that I found to be very true, though curious coming from a physician. It concerns the difficulty of finding the right program to heal a person's bad knees:

“It is not unlike trying to find the numbers to a combination lock.”

We tend to naturally attribute shaman-like qualities to our doctors, believing they have an almost magical power to heal us. How strange it is, then, to hear a doctor compare what he's doing to cracking a safe. It's perhaps a bit unsettling. Aren't doctors supposed to be supremely confident in their diagnoses?

But I think Dye's observation is quite perspicacious. He nails it. The fact is, there is no manual on healing knees that will work equally well on all knees. A certain amount of experimentation is in order.

Partly I have come to that realization from listening to all of you while writing this blog. As I've said before, I wrote my book naively assuming that what I did would be useful to the same degree for everyone. I still think the book has enormous value, and broadly the approach is the correct one, but I've also tempered my position somewhat, so that now I'm closer to Dye's thinking:

Healing your knees will involve finding a solution that will probably be, to some degree, unique to your particular knees.

So why does this reader comment put me in mind of Dr. Dye?

Because here's someone who has bad knees, it appears, but who wants to "start gently jogging." How could that be a good idea?

But suppose this person is right: that stress contributed to the knee issue in the first place. Maybe a little gentle jogging, getting the heart pumping and the body sweating, would help lower his stress levels -- and it might not be harmful to his knees too.

Maybe?

I am opposed to giving advice, but if I were this person, I might try an experiment: maybe try a short jog, very slow, maybe up a hill as that's less stress on the joints, and then monitor my knees for a couple of days. Do they feel better or worse?

If they feel better, maybe try it again, for a little longer, being careful of course and not pounding down hills.

Do I think this would have helped with my own knee pain? No, not really. But then again, if we are all trying to find the numbers to our personal combination locks, when it comes to beating knee pain, we have to be open to trying different things.    

A Goldilocks Theory of Cartilage Damage

Here’s a study I can’t access (without paying for), but I found the main conclusions interesting. The researchers decided to look at the following:

Knee cartilage damage is often linked to mechanical overloading. However, cartilage requires mechanical load to remain healthy, suggesting that underloading may be detrimental.

So there you have it. Essentially, they’re testing what we’ve talked about repeatedly here: trying to find a motion “sweet spot,” if you will. If you subject your knees to too much load, they will get worse. If you don’t subject your knees to any load, they will get worse too.

The key is finding that elusive “sweet spot” where they can handle the proper amount of load, which can be gradually increased over time. However, of course, this is no simple thing.

So what did the study consist of?

The researchers looked at how the load on a person’s knees correlated with worsening cartilage damage over a two-year period. There were 964 subjects, including 62% women. The average age was 66.9 years old, and the average BMI 29.7 (this borders on obese and roughly equates to weighing 220 lbs. for someone who is six feet tall).

People who walked a moderate or high number of steps each day (at least 6,000) and who had a high BMI (more than 31) had a greater risk of worsening damage of the cartilage in the medial part of their tibiofemoral joint, compared with those who were thinner.

But people who walked less than 6,000 steps a day and who had a low BMI were at higher risk of worse damage in both the medial part of the tibiofemoral joint and lateral (outside) part of their patellofemoral joint (where the kneecap meets the femur). They were compared to a group that also had a low BMI but walked more steps.

Clearly, one takeaway is that weight has a big influence on how much walking you can safely do.

But the results also do suggest that there is an optimal level of motion: too much will cause further damage, and not enough is harmful too.

The trick is finding that proper balance. What’s scary for people with bad knees is that finding that balance becomes a really hard task when your knees don’t seem to like to move much at all.

It will frustrate you endlessly, I guarantee. But when you do figure out the right balance, you are suddenly in a position to get better, slowly but surely.

And that's a great feeling, when you realize you're starting to make progress toward healing.