Sunday, November 22, 2020

'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. 

4 comments:

  1. I would like to tell you 2 things only: being 18 is defenitely on your side, you will be fine. like Richard Said, try something lighter to the knee like swimming or cycling.the second thing is,emotions can play a role too, you already understand that because you mentioned the difficult stuff going on when it started. now you know that, work on that and then move on, that is my honest advice to you!

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  2. As a chronic knee pain sufferer (and 3.5 years later knee-pain-defeater) I would definitely say move as much as you can, stop if it hurts >7, keep up with physio and don't let anyone tell you to just get over it and this is the new you. I've seen close to 15 different physios and surgeons in my journey. This summer I started crossfit (or whatever we call it now) but if you had said this to me when I was barely able to climb stairs I would have thrown an ice pack in anger! Keep pushing for answers - PFPS is not a diagnosis but a result of something that needs addressing. I had bilateral plica syndrome & hoffas impingement syndrome which had lead to grumbly cartilage and knees that would swell ALL the time. I have a long way to go but at the age of 29 my final words of knee wisdom are: you can show your knees who is boss - knees take ages to heal but they CAN heal!

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  3. Hi I'm the (admittedly slightly neurotic) 18 year old who wrote that comment. Not going to lie, when I wrote the comment, I was in quite a bit of pain which was affecting my life, hence the anxiety and definitely a lot of doom and gloom.

    First of all I'd like to thank the commentors for their well wishes and the reminder to keep my chin up. Will keep those words in mind.

    Secondly, as you mention, life is imperfect and over the past couple of weeks I have accepted that (very difficult not to, to be fair). It has gotten a lot better, definitely I have noticed some things that absolutely do not jive with my knees and things that seem to be okay or at least don't cause any disproportionate pain. For example, taking stairs two at a time is out of the question for some time now because it seems to have the same pain impact as going on a 10km walk (and one is obviously more worth it than the other). So I guess I will just continue going about my daily life and trying not to unnecessarily piss my knees off.

    Speaking of exercise, I'm definitely thinking of getting into cycling/swimming/gym work but that'll have to be when I get onto a uni campus (can't afford it otherwise and I don't have a bike). Maybe I'll try a bike rental thing around a park or something like that and see if it blows anything up.

    Like I said things have gotten better since I wrote the comment. I guess part of that is resting and natural body healing (like you all pointed out, I am 18). I've also been very very liberally using ice if I do anything very out of the ordinary (for instance I went out last week and somehow ended up clocking 10km in walk time. got home and instantly put ice on and that seems to have prevented a complete meltdown). I guess the most frustrating part of this is how bloody long it takes lol, took about 8 weeks until I stopped feeling really sharp stabbing pains so I suspect this is going to be a multi-month thing. Irritating especially at this age but I'll keep at it, thanks for the support everyone.

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  4. This is off topic. The only way I know how to ask a question.

    Two years now since I had my skiing accident. Tibial Fracture. Ruptured inside ligament and meniscal tear. I am in my 3rd episode of discomfort and having to rest and am experiencing despair. Resting seems counter intuitive because I feel my joints are getting weaker and weaker as the years go on. Have just been reading Doug Kelsey's book and he talks about Fascial tears which can require strapping and also an injection of Platelet Rich Plasma. I wonder if this is something they do in the UK. I'll contact him in the States and see if I can get a consultation with his clinic.

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