Saturday, October 24, 2020

Some Good News About Cartilage's Ability to Rebuild Itself

I’ve said before that there won’t be a third edition of Saving My Knees because I expect that what lies between the covers will eventually no longer seem that radical and will become widely accepted.

And, happily, along comes a New York Times article to underscore that very point.

To recap, what I’ve said (in the book and on this blog):

The cartilage in your knees doesn’t simply “wear out.” It’s not like the tires on your car. It has an underappreciated ability to adapt and even repair itself (though very slowly).

To be clear, these insights don’t originate with me.

Doug Kelsey, an Austin physical therapist and author, was the first person to really awaken hope in me when I was struggling with a pair of bad knees while living in Hong Kong.

The gist of what he said: Don’t believe pessimistic doctors who say bad knees never get better. They certainly can.

I also uncovered scientific studies showing natural changes in cartilage that indicated the tissue, over a period of several years, showed signs of getting worse, yes, but also of healing. Places in the knee joint that were bone-on-bone often had cartilage filling in the holes when examined by MRI a few years later.

Okay, that’s a bit of a long windup for this New York Times article. The Times was looking at  running and the hoary myth that running is bad for your knees (to be clear, it can be, if you run when injured or don’t train properly).

Ross Miller, an associate professor of kinesiology at the University of Maryland, was involved in a study to try to figure out a puzzle: why, if running pounds knees so hard, don’t more runners develop conditions like osteoarthritis?

He knew that some recent studies with animals intimated that cartilage might be more resilient than researchers previously had believed ... animals that ran tended to have thicker, healthier knee cartilage than comparable tissues from sedentary animals.

The study looked at what would theoretically happen to the healthy knee cartilage of two groups: one would walk six kilometers (roughly 3.7 miles) a day for years, the other instead would walk for three kilometers and run for three.

It’s admittedly a bit confusing to follow what was going on: volunteers were going around a track that had embedded force plates, which measured the impact of running and walking. The collected data was fed into complex computer simulations, that drew on lots of other data too.

Now, here’s the really interesting part, and the Times explanation is a bit confusing, so I'm going to simplify.

There are three possible scenarios for cartilage and how it responds to running:

(1) The cartilage can’t change to adapt to the harsh forces (and therefore would be expected to deteriorate over time).

(2) The cartilage can slightly repair itself after repeated minor damage.

(3) The cartilage can remodel itself and adapt to the intense forces, growing thicker and stronger, just as exercise builds up muscles.

If you were to poll most orthopedists, I bet their beliefs would fall mainly into scenario (1) and (2), but certainly not (3).

Surprise.

If you assume (1) is true, runners have a 98% chance of developing arthritis in their knee joints, the study found. Even if you assume (2), the slight repair taking place isn’t enough to counter the frequent running, and their chances of arthritis decline only a bit, to 95%.

But if you assume (3), they have a 13% chance of eventually suffering from arthritis, which is the same as for the people who were walkers only. This does seem to match up with evidence that the incidence of arthritis among dedicated runners isn’t higher, and may be lower, than for the rest of the population.

The article concludes:

What these results suggest is that cartilage is malleable, Dr. Ross says. It must be able to sense the strains and slight damage from running and rebuild itself, becoming stronger. In this scenario, running bolsters cartilage health.

I can’t say this would surprise me.

I just hope orthopedic doctors see this article too.

5 comments:

  1. Amazing!

    "I just hope orthopedic doctors see this article too.".
    Now, this would be huge! Hope that this really happens.

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  2. Hello Richard Bedard,

    First of all, thank you for writing 'Saving My Knees' and sharing your experience with the world, and for continuing to keep this blog updated for so long. I can say that I have found hope and solidarity through reading the book and the blog (as well as Paul Ingraham's book and many papers that I've seen quoted in these texts).

    I have been experiencing patellofemoral pain (as well as achy quads and calves, and some sharp medial pain that comes and goes a bit too much for me to fully attribute to a meniscus tear) for 7 weeks now. I understand that in knee pain terms this is a very short time and that perhaps I am being too hasty. However, here is my background. I am only 18 years old, was previously fairly active on a day-to-day basis, and a runner and casual player of many sports. I can work out why my pain (probably) started - a sudden fitness obsession after months of a mainly sedentary lifestyle brought on by the pandemic and moving from a relatively flat area to a rather hilly one (where I have to walk both uphill *and* downhill to get from public transportation to where I live. I can work out why the pain hasn't stopped yet - I sit at a desk (admittedly with legs less bent under the table now) for most of my day and I have to do all the chores around the house, grocery shopping etc as I live alone. I have technically gone into 'recovery' four times already in the past 7 months, only to invariably exacerbate it back to pain as bad as when it all started by jumping (twice!), going on a long walk and then trying to skateboard (and I didn't even skateboard before knee pain so I'm not sure why I thought that would go well), and going for another long walk (this was last week and has given me pain that only recently lessened significantly in the last two days).

    After reading your book and Paul Ingraham's, I have some questions. Firstly, I know that both of you encourage rest and many doses of light exercise to slowly build up joint strength. This seems reasonable to me. But what did you do (or what do you recommend) when you were *not* able to rest and *had* to push that envelope of function? Does this mean constant setbacks, or is it possible to push it a bit and then rest/light exercise for a longer period of time? I don't *want* to do that, I'm aware that runners like myself are our own worst enemies, but at the moment I cannot grocery shop or run errands (or even walk for 10 minutes outside) without first traversing some slopes and a few kilometers of walking, which are unavoidable but might also be pushing my envelope of function.

    Secondly, do I have a chance of this not lasting as long as your pain and the pain of some others in this blog, as I am starting my attempt at recovery (hopefully) early and because of my age?

    Thirdly and finally, what advice do you have about the emotional side of pain? I was very depressed and anxious for over a week after one of the remissions (the long walk + skateboard episode), and I am now grimly aware that this recovery may be a long, non-linear process and I may never get back to running or competitive sport again. How did you or other readers cope mentally with this?

    Thank you so much for writing the blog and the book.

    P.S. I used to live in Hong Kong myself, and reading your descriptions of places in Hong Kong has made me horribly and beautifully nostalgic for those times.

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  3. One more thing (I am the 18 year old above): I am due to go to university in 4 months time, and I'm worried that I won't recover fast enough or that I'll 'relapse' into pain again with the increased exercise that I'll undoubtedly end up getting walking to classes etc every day. My plan is to rest and slowly strengthen the joints for the next 4 months in the hope that, at least while walking normal distances on mostly flat land, I will be pain-free and then I can continue to strengthen when I'm at school (hopefully somewhat naturally as my activity load will probably be similar to how it was pre-pandemic). I realize that I cannot just give my joints a 'deadline' and make them recover in time, but does anyone have experience with a similar big lifestyle change during their recovery and how that impacted them?

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  4. Hi 18 year old,

    Responding to this sentence "I'm worried that I won't recover fast enough or that...". From experience I can tell you that worry is your greatest enemy right now. Make the decision to drop worry and anxiety immediately; the what ifs, the pictures of doom your mind has the potential to create. You are incredibly young, there is really no physiological reason for you not to have perfect knee health in the future (if not even already plus age irrelevant anyhow - it's how you treat and respect your body that counts) and thrive. Slow things down, take the pressure off yourself and your knees. My advice is to use this time to take up a meditation/mindfulness practice and get your mind on your side. Your mind can either be your biggest asset or greatest enemy in this scenario. Get to know it. Maybe take up some embodied movement practice like Qigong or yoga. It'll pay dividends to your running when you return to it and you WILL get back there when your body is ready. Be patient and use this pain and setback as a period of growth. Reframe this whole experience. That's where you power is. Wishing you all the best. Ellie x

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  5. For the 18 year old,
    I see myself so so so much in you - 6 months of waitressing before studying medicine as a mature student took its toll. 2 weeks after getting my place (and 5 months before starting my degree) my chronic pain journey started and my knees told me that they had had enough. I was going to defer and take a year out to recover but my dad said that life doesn't stop. You may take this problem to university and have to juggle physio, time-out-days, mental wobbles with the demands of being a student, but you will get better. Lean on good people and create your life with bad knees for a while - it feels like a monkey on your shoulder you have to take EVERYWHERE, no one realises how tough it can be. It will make you a stronger and more insightful human being. Good luck and please don't give up - sending good-knee-vibes. G x

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