'I'm Only 18. I Have Knee Pain. What Now?'

Recently, an 18-year old suffering from knee pain left some questions in the comment section.

A brief synopsis of this case:

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 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.

Then, the person asked:

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. 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?

This reminds me of something that of course should be quite obvious: We live imperfect lives in an imperfect world when it comes to developing programs to heal. We have to sit too long at desks at work. We have to climb hills sometimes to get to the commuter train station. We have small children who insist on being carried around.

What's the answer to all these knee-unfriendly obstacles that are part of everyday living?

I wish I knew. Luckily, when I lived in Hong Kong, I was largely able to control my healing program. But I quit my job and had no family at the time! This enabled me to conduct a scientific-like experiment, and not many have that luxury.

My best thoughts on this are that people should control what they can, closely monitor what they can't, and try to learn from mistakes. So for instance, if I know that I have to walk up a couple of hills just to get to my train station (which I can't control), then maybe I don't take a long walk at lunch and instead do something less intense (which I can control).

Also, if I'm doing something that turns out to really bother my knee (in other words, I made a mistake), I should try to learn from that. But what if it's something I can't control, like walking up those hills? Well, humans are quite ingenious and can often solve difficult-seeming problems.

So maybe I try walking up the hills much more slowly. Or I hitch a ride with someone. Or?  

And then this question:

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?

I think your age is definitely a positive factor, being only 18. And if you've only had your knee pain for seven weeks, and you're already serious about fixing it, you should be in very good shape indeed.

Try to be positive! Which leads us to:

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 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.

Well, heck, that sounds grim! I already sense a lot of negativity here. So I would tell myself:

I'm only 18. I haven't had knee pain that long. I have a great chance of beating this, and I will.

What I might do, if I were you, as you seem to like to be very active: Figure out a new knee-friendly sport to throw yourself into (well, ease yourself into may be a better phrasing). I think cycling, if you can tolerate it, can do wonders for bad knees. Some people like swimming, or exercising in the pool.

Again, try to be positive! I've read a lot of very tough, hard-luck cases in the years doing this blog. And yours, be thankful, isn't one of them. You seem like a great candidate for figuring this out and being able to do a lot of the activities that you did before this pain crept into your life.

Good luck!

If anyone else has any thoughts, please chime in below, thanks. 

When Knee Pain Comes With Golfer's Elbow

 I got this comment recently:

Hey Richard, funnily enough I have now developed that elbow pain you were talking about in your book. Has yours healed now? Any tips?

That "elbow pain," for me anyway, was "medial epicondylitis," also known as golfer's elbow.

Some context: I had had the knee pain for a while. The golfer's elbow just came out of the blue. There were no identifiable triggers for it. None at all.

Of course, as many of you know, this led to a lot of musing on my part about the ghost of inflammation loose in the haunted mansion of the body (if you want to ladle on those Halloween metaphors).

In other words, once inflammation takes up shop somewhere, in a matter of time you can develop other weird, seemingly unrelated problems in distant areas of your body. And I think the problems may be connected.

I have not seen a lot of science on this, so I could easily be wrong here. But I find it very odd that, as my knee pain deepened and persisted, various other ailments began to plague me, from the golfer's elbow to back pain (though that had a proximate cause, because I was sitting in an unnatural position).

Anyway, to the question: what to do?

I had terrific success with eccentric bicep curls (look them up on YouTube; you'll find lots of videos).

We're all accustomed to regular bicep curls, where the effort is expended in curling the weight up. For the eccentric version, the emphasis is on slowly releasing the raised weight back down to the starting position.

Over time, I really think this rebuilt the chaotic tendon fibers. My tendons went from being painful and dry and crackly feeling (they were almost like parched sticks, it seemed) to normal. I have no problems today and there's no reduced tendon strength as far as I can tell.

Be patient though. It does take time.

That's my experience, at least. Anyone else with any other ideas?