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.