I got this comment -- a story really -- and it's a long one, so I've edited it down. You can find the full comment here. I've underlined some parts that I found interesting.
I am a 28 year old female, very active, but unfortunately twisted my knee 3 years ago getting ready to take off for a run on wet grass. The sharp pain was horrendous, as my leg twisted my knee tensed and it felt like I had torn everything in there. I carried on stupidly as I was in a bootcamp and embarrassed to highlight myself as injured!! As a 25 year old healthy girl at the time, I assumed it would fix itself and carried on about my life ignoring the niggle up the stairs and when hiking. I initially went to a doctor who told me I had patellofemoral pain syndrome and to get back in the gym.
I never had pain squatting or lunging with weights, it was only the act of load bearing with my knee over my foot where I got the sharp pain. Similarly to a few previous comments I have read on your blog, the pain when I work out seemed to disappear and even after prolonged weights I found improvements in my knee and could run up the stairs no problem! Well I think all of this was not allowing it to heal properly as the pain always came back when I didn’t work out for some time.
I think the strength on the other areas were maybe masking the knee problem short term, who knows! But I certainly didn’t do it any favours getting back lifting weights. Pain started to feel a little more prominent this past year. I can walk totally fine. Hiking is my passion and something I haven’t been able to give up. But this causes me a lot of pain the next day and is hard on the joint coming down.
All of this led me to pay for an MRI to see what was going on. It showed I have a ‘punched out lesion within the cartilage of the patella in a central position. There is thinning of the trochlear cartilage in association with this. No reactionary oedema but evidence of a dominant lateral trochlear facet which is slightly dysplastic. Grade 3 chondromalacia’
The specialist said I could require arthroplasty in the distant future, but I should focus on swimming and cycling to manage it and avoid impact activities. He said there is no way to treat it and it will continue to get worse with age. Sure enough I left feeling very upset, hopeless and frustrated.
My strength PT said we should be still focusing on strengthening quads, glutes, calves core and hips etc but he has me still load bearing with some weight which I don’t feel is the best option for healing after reading through the blog! Would you agree? I have a lot of range of motion and don’t get any pain walking but when bent with pressure I’m getting the sharp pain. I have only just recently the past two weeks started to feel a burning sensation in that knee after movement. Is this a worrying sign that it is getting worse?
Desperate to find a way to combat the pain and make sure I am not doing further damage. I am due to go traveling to Canada (I’m from the UK) in a matter of months, a trip I have planned for a long time when my knee wasn’t causing me these problems) to do a lot of hiking which is so important to the trip. I don’t want to miss out on life because of this, but also do you think I could progress my grade 3 into grade 4 if I hike?
The magic question I suppose is, do you think it is possible to turn grade 3 chondromalacia around and live pain free!? I have an unbelievably healthy lifestyle, my passion is fruits and veg and I am 5ft8 and 51kg so I have this in my favour!
For starters, congrats on the healthy lifestyle and the ideal weight! You're young, eating well, and not carrying around a lot of extra pounds (or kilos). That seems like a good way to start a healing journey.
Next, I avoid giving advice. I'm not a medical professional, and even if I were, I've never seen you (or your knees). But I will share some things to think about.
I half-like the specialist. He said to focus on swimming and cycling and avoid impact activities. That strikes me as quite sensible, at least early on. Once your knees are in better shape, maybe you can do impact activities. For now, swimming and cycling, as long as your knees tolerate the activities well and you are careful not to push too hard, are two of my favorite "knee rehab" exercises (along with slow walking).
But I only half-like him. He also said there is no way to treat your condition and it will continue to get worse with age. Boy, he's a real cheery fellow, huh? I know nothing about your knee, but I think his dire prognosis is probably crap. One of the best things I read, early on during my struggle, was from Doug Kelsey, who was responding in his head to a doctor who had just told a patient that he'd never get better. And Kelsey's reaction was terrific, along the lines of: That's ridiculous, absolutely ridiculous.
Hope is so, so, so important. Orthopedic doctors should be smart enough to know that at least some knees do heal, without surgery. Mine did!
I'm not crazy about the strength physical therapist. I see the word "strength" and I wince. One thing I've come to realize about many physical therapists: they're young, frightfully fit, and haven't had any personal experience of whatever they're giving you advice about treating.
And they love strengthening muscles: because their playbook is full of strengthening exercises (and stretches). Stronger quads are great, but not if the effort to strengthen the muscle is greater than what the knee can tolerate. Unfortunately, you don't always realize that until the next day.
You might think, "Well, working out with weights helped my knees before, didn't it?" Okay, maybe it did. But maybe your knees aren't in the same place anymore. They could be worse, or more sensitive to the heavy loads and the bending.
Last, will going on this planned hike cause your knees to worsen? Maybe yes, maybe no. It depends on a lot of variables. How many miles a day? How many miles a day can your knees tolerate? How fast? How much climbing and descending? How many breaks? And you have to ask yourself: If this hiking trip isn't working out, is there a Plan B that you're confident enough to execute? Or do you just plan to suffer through?
Some thoughts. And one parting thought: If you bought Doug Kelsey's book, then you made a smart move. His book should be an invaluable guide on your journey. Doug really, really knows his stuff.
I don't really understand the PT thing. I've been pushed to do things that are difficult and make me hurt, which would all be fine and good if it helped me walk better - but it doesn't. Yet they will keep pushing and I walk the same after 3 1/2 mos of therapy as I did before I started. (And I am poorer.)
ReplyDeleteHello! This is "Knee Pain" checking in! I saw the above reference to HIKING and so I wanted to share my latest update with this knee community. (For those of you who are not familiar with my long long long knee pain journey, I will post a short summary at the end of this post.)
ReplyDeleteMy latest update is that my knee is doing so well now that I'm living my lifelong dream of going backpacking! And, yes! I mean carrying my tent and food and sleeping bad and everything in a backpack on my back! I completed my first trip (2 nights) in Nov 2020 and my second trip (3 nights) in April 2021. Just last month! And.... the amazing thing.... my right knee is not hurting at all. Not even a yellow warning flag. Not even a small whimper! Wow!
Last weekend I did my most vigorous backpack training hike EVER which was hike up a mountain with 2300 elevation gain up in 5 miles carrying 32 pounds. Which is pretty steep! And then I carried it back down the hill. (And as you all know, downhill is harder for knees than uphill.) And, my right knee did not hurt or ache or anything. Wow. So... I'm absolutely thrilled that my right knee is doing so well after decades of pain where at times I could barely walk. Literally.
Well......The unfortunate news is that my LEFT knee is now giving me some pain! Ack! I did see a doctor about my left knee and it was NOT diagnosed as chondromalicia or PFPS at this point. So, I am monitoring the situation and I do think it is improving. I'm also experimenting with different knee supports for the downhill parts.
The main thing I think I should do for my left knee is... GET BACK INTO THE WATER! I strongly believe that my right knee joint was healed by me doing gentle leg movements in water and then slowly building up. So! I feel that I should get back into the water to see if it can help my left knee. (I stopped swimming in the Winter 2020 due to the situation with the pandemic and haven't got back to it yet.)
Anyway! And, I hope this can be an encouragement to folks because I know it is so frustrating (and painful) to have knee pain. And, I hope it's helpful for people to that some fellow knee pain sufferers have not only found relief from the knee pain .....but built up enough knee-health to do pretty intense activities without knee pain.
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ReplyDeleteSHORT BACKGROUND OF MY KNEE PAIN HISTORY AND MY THOUGHTS ON HOW I ACHIEVED SUCCESS
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I have a long long long saga of debilitating knee pain (in the right knee). Diagnosed as chrondromalcia patella in the 90's and then later as Patella Femural Pain Syndrome. So painful that at times I used canes and even a wheelchair.
I started writing on this blog in 2012 after I read Richard's book -- which was very helpful. I found the low-load / high rep approach worked for me. Another helpful thing for me was to wait 48 - 72 hours after any knee intense activity to "wait and see" if I was going to have the delay pain onset that Richard talks about in the book. That's one reason i would have so many setbacks is because it would try to do too much too soon. Sigh. Anyway... it took me YEARS and a lot of ups and downs to finally "get it right."
For me, the thing that seemed to help the most was doing gentle leg movements in water (low load, high rep movement to thicken the synovial fluid) ... and then I was able to build up to doing more vigorout leg movements in water ........ and then I was able to eventually start doing activities on land again.
Even though I read Richard's book in 2012, it wasn't until 2016 that I really made headway AND not have any major setbacks. I kept getting better and better (and avoiding setbacks) and was able to build up to be able to straighten my leg without pain and walk without pain and walk down stairs without pain (major major accomplishment!) ......and..... in 2019 I started SWING DANCING again. I love swing dancing so much, but I was not able to swing dance since around 2003-2005. In 2020 I started doing road biking again which is also something I love but I could not do for years and years.)
I would very much like to correspond with you some. After a car accident almost 2 years ago I have been on crutches for 21 months. I've had a hard time finding anybody who's had so much trouble for so long but I think you might be someone that has. I do not know if you will see this so I will wait and see if you respond. I'm extremely discouraged at this point, no longer working at least temporarily. I'm in physical therapy but to me I feel no difference. I did have surgery four weeks ago and have not progressed as I hoped I would.
DeleteUpon re-reading the original post from the woman in the UK who said "I am a 28 year old female, very active, but unfortunately twisted my knee 3 years ago..." and whose specialist said "no way to treat it and it will continue to get worse with age...."
ReplyDeletePlease do not give up hope.
Of course I don't know your condition, but, I can say that I had a long history of severe (sometimes screaming) knee pain from chondromalicia patella and..... now I'm much older and that same knee is doing AMAZING and I can hike and swing dance and bike and even backpack up and down slopes carrying 32 pounds (15 kg).
So.... please try to be patient with yourself and with your knee and try to not give up hope. Best wishes.
Wow!! This is so fantastic to read, thank you so much for sharing your journey! Sometimes you get caught up in the negative online and it feels like there may be no hope so hearing stories like this really lifts your spirit! I have learnt the hard way that sometimes you have to go back to basics to try and heal, I always wanted to do more and faster thinking this was the best way, I’m so glad I came across Richard’s book and this community and now know it is certainly not!
DeleteThat is incredible to feel no pain after such an intense hike uphill! I imagine the best feeling in the world (fingers crossed the left feels better!) I would love to know more about the exercising you did in the water. What are your go to exercises in the water? Did you navigate this yourself and follow a particular exercise program? How did you know when it was strong enough to work on outside the water? It is difficult with mine because it always hurts when bent so hard to know if I have pushed it too hard or not enough because pain is always around the same, which makes it hard to find the line. Did either of you find this starting out?
Lastly did you take any particular supplements alongside this that helped at all? I’ve been doing a lot of research into the mineral, boron!
DeleteThank you again for sharing and giving me a positive outlook, I really do appreciate it!
Tara
Hi Tara! I'm glad to hear that you found my comments and my journey encouraging!
DeleteFor the water therapy, i found a book called "The Complete Waterpower Workout Book: Programs for Fitness, Injury Prevention, and Healing" by Lynda Huey and Robert Forster. It gives photos for movement in water for people with all sorts of pain including bad knees. I use the word "movement" instead of "exercise" because the word "exercise" sounds too rigorous! I just started out doing gentle movements such as standing in chest high water and bending the heel up behind me and then lowering it back down. I def focused on the "healing" section and not on the "fitness" section!
Initially I couldn't do all the different knee movements, I marked them with different colors. blue was pretty safe... yellow were ones I did with caution... red were the ones that I couldn't do at first but I was just gentle and patient and over time I was able to do more and more of them and with greater vigor.
Initially I wore a neoprene knee brace, but over time I took it off -- which was scary. I had to regress a bit and be very careful.
I was doing so well that i also started doing road biking. And, I was so confident that I gave my cane away thinking I would never need it again.
And....then I guess i got too confident and i over-did-it and had a huge setback.
Wait... what? A set-back? No instant success story? Nope. I've had so so so so so many ups and then setbacks. Up. Down. Up up up. Down. down down down. up. down down. up up up... down. It's been a long road! And... I got discouraged sometimes, for sure!
I tried other things. I developed other interests and hobbies that did not involve knees.
But, over time I tried again and I went back to the water...and I slowly got better.... and.... as you know, wow now I'm doing so well!
So, I think a key learning for me was learning patience -- and, that was also one of the hardest things! Because of course I wanted to push and get better faster. But. That would cause a setback. And it can take a while to recover from a setback. So.... I had to really focus on patience patience patience. And... patience can be pretty boring, right? It's like painting just one tiny square inch of a wall in a big room .....and then sitting there and watching the paint dry before painting the next tiny square inch of wall. This is very hard to do when your spirit wants to make sweeping strokes and paint the whole wall in one go!
Oh! I wanted to add:
DeleteYou had mentioned that you can't put weight on a bent knee. I was exactly the same! That would cause a horrible stabbing pain and was just completely impossible. Actually, at one point it would even cause a stabbing pain to straighten my leg from 90 degree to 180 degrees while seated. I literally trained myself to never jump, never run and to never put weight on that knee. I went up and down stairs in such a way to not bend my right knee. (After my knee finally finally finally got better, I had to re-train myself on how to walk down stairs using both legs equally AND to not have a death-grip on the railing. Even now... years later... i notice that when I'm really tried I revert to my old way of going down stairs with my right knee straight and the left knee doing all the work of the weight bearing. No wonder my left knee is starting to give me problems!)
As for supplements, I tried omega-3 and I tried Glucosamine With Chondroitin. But, sorry to say I didn't feel any results from that -- even though other people had said it had helped them. So, I guess you never know.
I'll look into boron. I haven't heard of that. Maybe it can help my left knee!
My left knee does seem to be doing better, by the way. And... I'm such a huge believer in the water movement that I did indeed force myself to get out into the water and do some knee movements today!
I'll just add that water movement wasn't the only thing that helped my knee. Years before I discovered the water movement, I had tried taping my knee (taught to me by a physical therapist) and doing very gentle bike rides. And... that seemed to be going well and so I kept slowly increasing the difficulty... sometimes a little further..... sometimes going up a slightly steeper slope. Trying hard to not over-do-it. That worked. My knee got better! I was able to be more and more active. I increased my biking. And, that's when I first took swing dance lessons. So fun! And, I was also getting into hiking and .... then..... I'm not sure exactly what happened but, I had a catastrophic knee setback. I am guessing it was caused because I had moved to a new home and I stopped doing biking and the other physical activities... and I took my knee for granted and then that led to my knee setback after a night of dancing.
But... my point was... i don't think the water movement is the ONLY way. And in fact, from all the success stories that Richard has posted, I may be the only one who found success through this water movement method. I believe it was the light load / high rep movements that were the key combined with being consistently cautious and patience and not causing a setback.
Hello! Thank you for checking in again! And for all this great info, it is so encouraging hearing that you also have been through what I am and are on the other side! I am glad your left knee is feeling better, and yes I’ve heard great things about boron, it’s quite unspoken about but a natural mineral which builds strong bones and can help osteoarthritis (nutrition and holistic health is where I start to nerd out!)
DeleteI actually also have the stabbing pain when I straighten my leg when sat from 90 to 180. And for the last few weeks I have been doing the one step at a time on the stairs with my left leg doing all the work! Very frustrating when I’m in a rush and I just want to dart up the stairs 2 at a time (for now I have to accept those days are somewhat gone). I am definitely a run before I can walk kinda gal so I need desperately to learn the patience part. Is it best for healing to carry on not using that leg doing anything that causes a pain (I.e the stairs) I was worried I would weaken it more not using it?
Sometimes when I’m disheartened I lack motivation to do any knee workouts because they frustrate me but hope if I keep doing little movements each day it will get better. Hearing this worked for you gives me great confidence and motivation, the kick up the bum I needed!! I went on a bike for the first time and cycled flat for an hour or so and once I had adjusted the seat (the crepitus in my knee is a bit wild right now!) it felt very comfortable and I had no knee pain and it also felt fine the next couple of days (still a stab on the stairs but nothing more than usual). Perhaps if I stick to the one at a time I wouldn’t even notice that but then I am unsure how to mark my pain and assess if things are getting better.
I wanted to ask if you were foam rolling throughout your journey as well? I had been told by various physios to keep foam rolling every day. On my quads, it band and also a hockey ball on the hips and glutes to loosen the tight tissue.
I am actually leaving for my trip to Canada in 1 week so the nerves are setting in on whether I have everything to support my knee! (Probably also because I am leaving home for possibly the next 2 years which terrifies me!) I have been researching the best knee braces for my problem and there is so many out there. It’s new to me, having worn one I assume you felt was comfortable and helped, could you offer some advice on what might work well?
Again thank you ‘knee pain’! Your support is so appreciated :) And yes I tried kayaking once and loved it, haven’t since my knee but an activity I will definitely give a go while I am out there!
Hi Tara! Wow, good luck on your trip to Canada. I hope you are able to find a good balance of doing some activities you love but not making your knee worse.
DeleteI think you may be the only other person on this blog who also has/had the stabbing pain when sitting and attempting to straighten knee from 90 to 180 or bend knee from 180 to 90.
I did try foam rolling... but I'm not sure that actually helped me.
I did try a slew of knee braces and not sure that helped -- except for when I wore a neoprene brace when doing the water activities. Maybe it wasn't really "needed" but it gave me emotional comfort that I was doing everything I could to protect it.
Wow an hour biking is quite good. If biking is working for you, hopefully you can slowly build on that by incrementally adding difficulty such as a small slope, etc.
My personal strategy was that I did not too much weight bearing on land (i.e. stairs) because that would just stress it out. I would save any shreds of knee health for doing the light load / high rep things and try very hard to NOT OVER DO IT. In others words... try very hard to be patient. I had to try a little something. And then wait 48-72 hours to make sure my knee wasn't going to have a painful flare up. And then try a little something more.
In my head I developed my own personal "knee health scale" which goes from negative 10 to positive 10. Anything Below 0 means I don't even attempt to do any "strengthening." Below zero is when the pain can flare up pretty easily into a setback and send me even further down the scale. Zero meant I felt my "knee joint health" was pretty stable. The smallest mistake doesn't flare it up. From Zero...I could start doing a little more and a little more.
In my head, I visualize "below zero" was like being in a well -- a well with straight, slippery sides. Any upward progress was very difficult and was very easy to slide back down. Getting to Zero was like reaching the top of the well: ground level! So, then could start doing more things. for example when I was at a positive 1 I would try to put weight on my bad knee to go up a few stairs. And... when I was at a positive 3 I would try putting weight on my bad knee to go down a few stairs. But.. even when out of the well, I still had to be careful so I don't slide back into the well. For example, I would still wait 72 hours after doing anything kind of risky to see if it would cause any sort of setback.
Anyway! I hope your trip to Canada goes well!
Richard thank you so much for posting this and sharing your views, it really is great to get some more perspective and to hear other people’s stories as well so I thank you again! The doctor certainly put me in a terrible mind set, he looked at me like I was crazy when I asked if there was a way I could work on reversing it and regenerating the cartilage. I have since abandoned his view that there is no hope!
ReplyDeleteYou are right in saying my knee quite possibly can’t handle the heavy load bearing any more, and funnily enough, these few weeks I’ve been taking a more restful approach and just sticking to walking, and it feels marginally better!
There is absolutely a plan B for my trip, Canada is a beautiful place and if my knee can’t handle the hikes I certainly won’t make it worse, I shall find new things I love until I make progress. Thank you for your insight and I am excited to learn more about your journey when I am on the plane reading the book!
Tara
Hi Tara. Have you tried kayaking? The focus is on upper body and you can still explore nature. However, sitting in a kayak with knees slightly bent can also be a strain of sorts on knees. Argh.
DeleteSo... if you try it, be sure to get out of the kayak every so often and get in some light knee movement.