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.
After 2 stints at physical therapy since my car accident over a year ago damaged cartilage in both knees, I can attest that my physical therapy did little and sometimes made things worse. When I began going, it did help - BUT that's because he started with me with super easy REPETITIVE motions. After spending a bunch of money and after 3 months, starting to feel it was hurting me more than helping me, I finally stopped going. I am now just trying to live healthy and pay attention to the signals and am "piddling" around the house and outside a bit when I can be at home. When I work, I go backwards....so it's a step forward/ a step backward all the time. However, so many people screamed physical therapy at me and I did everything they told me - best PT patient ever and made no real progress.
ReplyDeleteWow this is good to read!
ReplyDeleteI agree that low load / high rep was key for my own slow recovery from knee pain.
Whenever I tried to "strengthen my quads," it would cause a knee pain flare up and thus a setback. Then I had to wait for that to calm down before I could try again. This was very frustrating.
I'll also put in a plug for being very patient with my knee. I made a "rule" for myself which was after I did something that I considered "risky" in terms of it might cause a knee pain flare up, then I had to wait 72 hours before even thinking about doing anything that might be risky. During those 72 hours, I did still need to get in some gentle knee movement like go for a mellow walk on flat. It's important to not just "be still." But anyway, waiting 72 hours would allow me to see if my knee was going to be tempted to flare up or not. In this way, I could reduce the number and severity of setbacks! (In Richard's book, he refers to this as delayed pain onset.)
It's so important to reduce the number of setbacks because otherwise i would go one step forward and then have a setback and go one step back -- never making any real progress. Whereas if I could wait and BE PATIENT and see how my knee responds over 72 hours, I could reduce the number and severity of setbacks and go 4 steps forward and only 1 step back. Net gain of 3 steps forward!
Getting actual progress was very important to help buoy my spirits as well. Although... this could also be dangerous because i would start to get excited and want to go faster and push harder....which would cause a setback. Argh. So. Being consistently patient over a long long long period of time was also very important for me.