The Times Helps Repudiate the Belief in Muscle Strengthening for Bad Knees

It’s great to see another news article, this one in the New York Times, ratifying the central message of my book, which of course is drawn from my personal experience beating knee pain.

The article begins simply enough, with a familiar bit of received knee pain "wisdom":

The idea made so much sense that it was rarely questioned: exercise to strengthen muscles around the knee helps patients with osteoarthritis, making it easier and less painful to move the inflamed joint.

So a professor of biomechanics, Stephen Messier, decided to test this belief. He ran an 18-month clinical trial with 377 people. One group lifted heavy weights three times a week, while another did moderate strength training, and the third was simply counseled on “healthy living.”

If strengthening muscles around the knee joint is the solution to chronic knee pain, the group lifting the heavy weights should have seen the most improvement. It did not. Instead, the knees for all three groups got slightly better.

I find it kind of humorous, seeing learned experts scratching their heads in utter bafflement over something that, if they thought about it on a common sense level, would make perfect sense:

Lifting heavy weights can be an utter disaster for weak joints. Personally, I’ve been there. And a lot of other people who read this blog have been too.

At the end of this article, we learn that Messier may still be, uh, dispensing dangerous advice:  

Despite the new, unexpected results, Dr. Messier still urges patients to exercise, saying it can stave off an inevitable decline in muscle strength and mobility. But now it seems clear there is no particular advantage to strength training with heavy weights instead of a moderate-intensity routine with more repetitions and lighter weights.

He's right to advocate "movement" (not sure I'd promote "exercise" per se, as that usually connotes people jumping about). But he's still hung up on weight training (sigh). At least he’s getting nudged closer to the truth. Maybe after another 10 years, two or three more studies? :)

Low intensity, high rep. Not a hard formula ... it worked well for me, and for many others.

Some Thoughts About the Delayed Onset of Knee Pain

There was an interesting story posted on the latest open comment forum. I want to focus on one piece of it (bolded). I've edited the entire story down for space:

I have been dealing with a knee issue since mid 2017 when I felt something "tweak" while doing "sissy squats" as part of a strength training program. Since this incident this knee has bothered me off and on and several orthos have diagnosed it as patellofemoral syndrome or PFS.

Running and cycling both aggravate it. I've tried the following methods for relief/cure:

- Rest from running/cycling. I had a 4-5 month period of rest from running/biking when I had a minor hip surgery. As soon as I got back to running/biking the pain came right back.

- Strength training, particularly those described as targeted for relieving PFS (quad strengthening). Step ups, and wall sits can really aggravate it although after a few reps the pain lessens during the activity (just as it does with running/biking), it comes back after as if I've damaged something.

- Robin Mckenzie "treat your own knee" regimen - Mostly the isometric holds that he recommends. I've gotten relief from this, but not a cure.

- Stretching and tissue work that supposedly helps PFS - Mostly foam rolling the quads and IT band and similarly stretching these areas. Similar to Mckenzie's regimen, this helps but does not cure.

- Treating my symptoms as Dr Sarno's "TMS". While this treatment has worked with other chronic pain I've experienced, this knee pain has not responded to that methodology at all.

- NSAIDs/Anti-inflammatories - Naproxen/Ibuprofen will knock the pain out altogether after a few days of steady use, but this isn't a long-term solution.

This part in bold sounded so familiar I had to separate it out. I remember, during my disastrous attempt at weightlifting to strengthen my quads (because that was what the physical therapist said I was supposed to do, once my knees were strong enough!), there would initially be a little discomfort that would then become more tolerable after a few repetitions.

But -- and here's that giant, ten-foot "but" -- later my knees would become more uncomfortable. At first I chose to ignore what was obvious after a week or so of this weightlifting program: my knees were getting worse. I was backsliding. When I realized that, I got upset and briefly depressed.

Even so, this terrible experiment turned out to be valuable: it got me thinking more deeply about the whole phenomenon of "delayed onset" knee pain.

I don't think it's unusual at all for a pair of bad knees to "warm into" an activity. This is why I hate that glib line from doctors about how to treat knee pain: "If it hurts your knees, don't do it." That's far too simplistic. Your knees may feel okay during the activity, after a little initial discomfort.

The key is how they feel later. "Later" can be immediately afterwards. But I discovered "later" can also be a day or even two after the offending activity. That makes it undeniably difficult to sort out cause and effect with bad knees. Still, it's very important to know about delayed pain, I think.

Recognizing this gets you to a higher, more sophisticated level of being able to "listen to your knee pain." And that's where I think you have to be to heal effectively.