What I've Learned About My Knees This Year

It's December, another year drawing to a close, and I'm grateful to be the owner of two well-functioning knees. I now know the danger of taking them for granted, of exercising through the warning signs of injury.

At this point I have normal, or probably better than normal, knees. But that doesn't mean there aren't some issues that pop up here and there.

I am a bit fanatical about getting in my exercise, and I like to do it intensely. That's great for my cardiovascular system, but as I get older, it can be a bit taxing on my joints.

I can give you an example that involves my favorite indoor cycling activity, "Zwifting." Zwift is a "game" where a stationary bike on a smart trainer is connected to, say, an iPad and the cyclist can see himself (or herself) on the screen, riding through video game-like courses alongside other riders.

The faster you pedal in real life, the faster you go in the game.

The only trouble with Zwift is, unlike cycling in the real world, you never have to stop. No red lights. No crashes. No flat tires. No pulling over to the side of the road so someone can photograph a sunset.

It's just pedal, pedal, pedal, pedal, and this can be rather intense for long rides. I started riding 100-mile centuries in Zwift. I did one yesterday: 4 hours, 20 minutes. Phew!

However, I've noticed my left knee bothers me sometimes after these long rides. I can't tell if it's because of the bike fit on the trainer, or just pushing so hard for so long, without a break. I never have a similar pain riding in the real world.

So I've tried to troubleshoot this, and this year I'm experimenting with ramping up more slowly to the long, really hard rides. Not sure how well it's working, as I always have to fight my natural inclination to zoom off with the fast riders; it's hard to hang back and take it easy in the beginning.

Other than that, my knees are good. I walk half a mile to catch the train when I commute to work; when I work from home, I take two breaks during the day and walk almost 40 minutes during each. Motion is good. Sitting too long is bad.

What I've learned about my knees this year, I suppose, is that taking good care of them is a lifelong project. I don't need the same constant focus as when I lived in Hong Kong and battled chronic knee pain, but I am still alert to little aches, or feelings of instability, and I try to modify my behavior a bit before things get worse.

What about all of you out there? Anyone have any good lessons from this year to share?

In the meantime, happy holidays to all, and if I were a drinker (which I'm really not), I would make a toast to your good knee health in 2024!

What to Do About Intermittent Knee Pain/Swelling?

 Dipping into the mailbag (well, "comment bag"):

What would you do about intermittent and unpredictable pain? Mine started after a mild injury last winter. I got a clean bill of health from a doctor and got on with physio, which helped enough.

But recently I've been getting bouts of pain and swelling, which your blog has helped me to recognize are probably delayed onset pain from activities. I like walking and swimming anyway so I decided to follow your methods. The issue I'm having is that a walk of, say 5km, can be fine one week and agonizing the next. I'm struggling to develop and keep to any plan because it all just feels so unpredictable.

This is a great question, because it's a hard one, and also so common (especially for people who are desperately seeking to remain active).

So, in a nutshell, if you're an active person struggling to overcome knee pain, the situation can look something like this:

One day, you notice you have knee pain. Over the next few weeks, you try to ignore it. But it doesn't go away. Frustrated, you finally decide to curtail your activities. You settle on something like "I'll walk 5,000 steps a day. That's nothing! I'm used to doing so, so much more! But I'll just do the 5,000 steps for a while, build up my knees and maybe leg muscles too, then increase my walking. And then, after some months, I'll be healed!"

But then: Ugh. You do your 5,000 steps each day and the results are decidedly mixed. You have some good days. But there are bad days mixed in, and you're not quite sure why. You flounder about, growing more frustrated. What's going on? You know you're fit enough. You should be able to walk 10,000 steps a day, no problem. Gradually, you start to lose hope ...

In this case, "Intermittent Pain" is getting "pain and swelling" ... and the results of walking some distance can be fine one week and "agonizing the next."

So here are some thoughts (and again, not advice, but things to consider):

1. A couple of scary words in Intermittent Pain's account are "swelling" and "agonizing." This sounds like what would be expected from someone with a weak joint who is doing too much.

Even though some weeks are "fine," my inclination would be to worry I'm playing around a little too close to the edge of what my knee can tolerate. This reminds me of when I got a leave from my job in Hong Kong because of my bad knees and, convinced that they really needed movement, proceeded to drown them in easy movement. And I got worse.

My real "ah hah" moment came on realizing my knees were a lot weaker than I initially thought. That's when I scaled way, way back on my walking. This can be very, very hard to do for active people who are used to biking or running or hiking for hours and hours every week. But when I scaled way, way back, I was able to find a new baseline, then start to improve from that.

2. Another thing that can be useful is trying to keep notes on what's happening on the bad knee days. Do they typically fall on days when you have to sit a lot the day before? Do they come after you eat certain foods? In certain weather? I would hoover up details, jot them down, and see if I can detect patterns. 

3. I don't know what the mild injury you sustained was, but might it be worth going back to the doctor (or seeing another doctor) to make sure there's no lingering issue (or new issue) that could be causing problems? There always could be something structurally wrong that needs attention.

4. You mention you like swimming. That's wonderful (and typically a great activity for bad knees). If I were you, I might think about spending as much time in the pool as I can, and as little time walking about on land as possible, when it comes to getting my exercise in.

That's all from me! Readers of this blog may have other thoughts. Good luck! 

On Crepitus, 'Normal'-Looking Cartilage, and 'Real Pain'

I've received a few good questions in the comment section, and am a bit dry on blog posting material, so I thought: why not use these? The first one (edited lightly): 

I noticed crepitus in one knee about two years ago, but brushed it off. I had no other symptoms until I pulled my calf during running, and after that developed a baker's cyst. I rehabbed the cyst, but I was asking the physical therapist about the crepitus, and he said the same thing: unless there is pain, just ignore it.

I returned to life as normal without pain, but when I started training for a half and working on my squats I noticed the same posterior knee pain, but now on both knees. I took it easy for a while since it seemed everything I was doing was causing pain. Once I got back to running, I noticed tightness in the front of the knees although still only crepitus on one side.

I went back to the PT, who did an ultrasound and found no issues. I asked if he could examine the cartilage with other methods and he said that with just the ultrasound it's showing the cartilage is thick and healthy, so there is no need for other exams. I am trying to get a second opinion, but now I am in the trap of, "What am I really feeling? Do I feel real knee pain or is it only mental/psychological?"

I have also started having back pain, which I never really had before. I keep pretty active with cycling almost every day to work, but I have dropped running. I am afraid everything I am doing is destroying my joints, but am also afraid doing nothing is destroying my joints. Did you have issues of navigating this in terms of knowing what is real pain versus normal sensations your body is interpreting as pain? How do you navigate that? Also, how does one get your book if they live in a country where the Amazon site there does not offer it?

First, on finding my book if you live in a country where they don't offer it: it is also available on Smashwords. If you can't get it through Smashwords, no big deal. What I say in the book is scattered all over this blog. It's not like I'm holding anything back with the promise, "This secret is in the book!"

Lots of things to react to in this story (and readers may wish to chime in with their own thoughts). A few things to think about:

* Once I got back to running, I noticed tightness in the front of the knees although still only crepitus on one side.

"Tightness" can be swelling. As Doug Kelsey once observed, it doesn't take much swelling at all for the joint to tighten up. And swelling means you're pushing the knee too hard. What happened? I know very little about your situation but I can almost imagine:

Baker's cyst diagnosis. Stop/reduce running, focus on rehab, then when the "all clear" signal is given, ramp up running, perhaps too quickly. Problems then ensue.

* I went back to the PT, who did an ultrasound and found no issues at all with the knees. I asked if he could examine the cartilage with other methods and he said that with just the ultrasound it's showing that the cartilage is thick and healthy ...

Um, color me a little skeptical here. I think ultrasound might show the cartilage is of normal thickness. But I'm not sure how it can see whether it's "healthy" exactly. Also, remember: people with normal-looking cartilage can have lots of knee pain. Or people with rough-looking cartilage can have no knee pain. I do think there is a correlation between the amount of knee pain and how much cartilage you have and how it appears on an imaging test, but that's not a perfect correlation at all.

Further, crepitus can be a sign of early cartilage damage and thin synovial fluid. I had a lot of crepitus, but a relatively clean MRI.

* I have also started having back pain, which I never really had before.

Yup, sounds familiar. It could be a compensation injury (i.e., you're using your back in ways you never did before, to compensate somehow for the knee injury). Or, it could be what I call the ol' "poltergeist loose in the house, that keeps popping up in random rooms." Chronic inflammation can cause strange joint problems all over the body -- at least that's what I believe.

* I am afraid everything I am doing is destroying my joints, but also afraid doing nothing is destroying my joints. Did you have issues of navigating this in terms of knowing what is real pain versus normal sensations your body is interpreting as pain?

Doing nothing is definitely bad, but you may also need to scale back your activity somewhat. This can be a hard balance to achieve. Does the biking bother you? If not, then maybe become a casual cyclist for a few years (ramping up intensity over time if you can). Forget about running. Shove it right out of your mind. Maybe someday you can return to it; maybe not. Make your peace with that.

As for knowing what is real pain versus what are normal sensations masquerading as pain ... my default would be to assume it's all real pain of some kind, and to treat it carefully. Personally, I aimed for the least amount of pain possible. Even if it was all in my head, it felt real enough, and when I ignored the pain, it seemed to come back with greater force, so my approach worked for me.

However, TriAgain (who fought and overcome knee pain and often visits here) might have a somewhat different perspective. He took medication for a while to get on top of inflammation that was limiting him severely, and doing so was key to his recovery, so he might have thoughts on the mental aspect.

Best of luck and hang in there!

Saving My Knees: the Elevator Pitch

Recently I was thinking about the "elevator pitch" for my book (which is basically what I learned about healing bad knees). The elevator pitch, as most people know, is the 30-second speech encapsulating something that can be fairly complex. It's supposed to be an idea condensed to the amount of time one might spend riding an elevator in a high-rise.

What put me in mind of elevator speeches was a conversation I had a few weeks ago with someone about what I did to heal my knees. Generally, I try to avoid the subject. There's so much that could be said; I feel sort of talked out on the matter; many people don't respond well to the book's core message anyway.

But occasionally I find myself engaged again in a dialogue on the topic, and my thoughts skip through a whole bunch of things and I get kind of excited until in the end I figure I've either made a convert to my way of thinking or my interlocutor thinks I'm crazy.

So I started thinking, once again, about the essence of my message. I guess it would go something like this:

You can heal your bad knees. The pessimistic doctors are wrong: knees don't just "wear out." But be careful: many physical therapists urge strengthening muscles around the joint, and that can further damage your knees. Broadly, the best way to heal involves lots of easy movement and very, very slow progress that can be maddening, with disheartening setbacks. More narrowly, you'll have to experiment some to find out what works best for your particular knees.

I think that's the essence of what I have to say. My particular story is what the book is all about. But, once again, no one needs to buy the book. The message is here on the website ... look around for a while and see whether or not what I'm saying makes sense to you. Everything I learned is here. Plus, on the website you benefit from getting to read some cool success stories about how others conquered their knee pain!

Don't Discount the Placebo Effect

This was a strange story. A 60-year-old man, who lives out in the country, is suffering from knee pain. He consults with a neighbor, who advises him to try ...

WD-40.

As most of you probably know, WD-40 is a lubricant. I own some myself. It's good for freeing rusted machinery parts, stuck bolts, that kind of thing.

What happens when you apply it to your knee, repeatedly? Well, this man showed up at his doctor's office, complaining of his knee pain. The doctor noticed that the skin around his knees was "rough, reddish." It turns out he had been using the spray for months at that point.

You might think this is just a titillating story about something that a reasonable person would have the common sense not to do. But there's more to it than that.

The doctor told the man, of course, to stop spraying WD-40 on his knees, immediately. But what's interesting is that the patient reports that, when he first tried the lubricant, he "felt some relief," so he continued using it.

Felt some relief? From a smelly, petroleum-based chemical that's meant for things like lawnmower parts, not human skin (and what lies underneath)?

To me, this strongly suggests some kind of placebo effect. What's more, I'm convinced that there are a lot of suggested solutions for knee pain that involve the placebo effect.

I've never been convinced of the efficacy of glucosamine or chondroitin. Yet people swear by them. The placebo effect? I think that there's a high chance that's involved here.

I'm not sure the placebo effect is necessarily bad. If someone said to me, "On days, when I wake up and rub the belly of my lucky Buddha statuette, I have less knee pain," my response would be, "Keep rubbing the belly of your lucky Buddha."

Why not? A certain amount of pain is what we perceive on a subjective level. If we can somehow "trick" our brains into thinking there is less pain there, that doesn't seem like such a bad thing. But of course, the placebo effect works better on some than others. Sadly, I don't think it would help me much because of the way I am.

For others though, if something helps with your knee pain, and it's not doing harm to your body (or to your pocketbook, or at least not excessively), why not keep doing it?

Just don't spray WD-40 on your knees. Please.

Exercise, the Anti-Aging Drug

The Wall Street Journal ran a good article last week. The premise was a simple one that I heartily agree with:

Longevity researchers have spent decades hunting for a magic pill to slow the aging process. But the best solution--at least for now--may be the simplest one: Move more.

The author points out that exercise stimulates muscle and bone growth that helps lessen fatigue and, for older adults, protect against bad falls. It can reduce the risk of certain diseases, such as cancer, diabetes and heart disease.

In addition, exercise improves memory. It helps us learn better. It reduces inflammation.

And on and on and on.

All this talk of exercise may seem frustrating on a blog devoted to people with damaged knees. But it's good to know why it's so important to get better: because living a long, happy, healthy life involves being able to do things like play a game of tennis, walk up a mountain or even toss a frisbee back and forth.

What I like most about the opening to this article is that it doesn't say, "Go out and run a half marathon." Rather, the advice is much more basic: "Move more."

People suffering from knee pain won't be able to do the ambitious activities that others engage in. But, no matter how much your knees hurt, there are usually ways to move more without making your condition worse.

I'm reminded of the simple exercise where someone can sit in a chair, place their feet on a low, rolling platform, then just roll it back and forth. This shows that if it hurts to walk, it's possible to start with something really, really easy. I think everyone can find some way to move more.

So that's what's on my mind today. How's everyone doing out there? Any success stories to share?

Rethinking Osteoarthritis Pain (a Recent Presentation Now on Video)

Here is a video that a reader found quite valuable. The title apparently was "Rethinking Osteoarthritis – Is It More Than Just The Joint?"

The speaker has that kind of irrepressible, smart-sounding Ted Talk energy, paired with a collection of visuals that are meant to be accessible, not intimidating. Even when some of the terminology gets technical, the talk is fairly easy to follow.

I'd say the speaker's thinking pretty much lines up with mine (and that of Doug Kelsey, and of course Dr. Scott Dye, who are really the people who deserve the credit for first bucking conventional wisdom on this subject, or should I say, conventional pessimism).

Some key points she makes that are terrific:

(1) Let's get away from the gloomy "wear and tear" language when it comes to bad knees. We should prefer "wear and repair." We can all heal, no matter our age.

(2) Bad knees are about more than the knee. Chronic inflammation kicks off a process where pain signals being sent to the brain are intensified, and at the same time the ability of the brain to repress such signals is damped.

(3) Cartilage loves loading and can adapt. Amen! That's the "Saving My Knees" message in a nutshell.

(4) Just because your knees looks bad on an MRI/X-ray, that doesn't mean you have knee pain.

Excellent points. So why would I be reluctant to wholeheartedly endorse her message?

(1) She makes a point about "weight doesn't matter the way you think it does" that I think is kind of trivial and possibly dangerous, because I think weight does matter a lot, and a careless listener might be prone to interpreting her statements as "weight doesn't matter that much." It is certainly true that there are different kinds of weight (fat vs. muscle e.g.) and that excess bad weight brings inflammation.

(2) It worries me when people stray a bit too much down that road of "it's not just the joint," even though this is undeniably true. One problem can be that, if you think it's just the "pain signal," you can take drugs to reduce that, and you could do further damage to the joint while exercising. So I think you have to be careful not to focus too much on the pain signal and lose track of the joint, which is presumably in some state of disequilibrium.

(3) It's true that knees pockmarked with cartilage lesions can be pain free, and knees with no signs of damage can hurt. But this is another argument I would be hesitant to take too far because of correlation. If MRIs of 100 knees show multiple grade 4 lesions, and MRIs of 100 other knees look fine, I am willing to bet with high confidence there are more knee pain sufferers in the first group than the second, even if a few people in the first group have no pain and a few in the second group have a lot of pain.

I suppose I'm not quite as skeptical about the usefulness of these tests as she is.

Still, this is a really good, and watchable presentation, that was only posted on YouTube 7 months ago, so it seems fresh. Enjoy!

Anyone Have Thoughts About Going Barefoot?

I'm lifting this straight from the comments on my last post.

hello, what do you think about barefoot? I find it easier for my very damaged knees compare to Nike carbon (Alphafly) which are better when it comes to cushioning but foot and knee feels unstable

I never tried going barefoot to see if that would put less stress on my knees (well, except around my Hong Kong apartment, I suppose).

As I recall, I tended to look for as much cushioning in a sneaker as I could find. That was basically my footwear strategy.

In the book, I do mention a special pair of shoes I bought that were supposed to reduce stress on my knee joints. The manual in the box sounded very promising. I was very excited about trying them out.

But once I started walking around in these new (and rather expensive) shoes, I soon discovered they were a disaster. My knees felt worse. I quickly abandoned that experiment.

Still, healing knees is like running a series of experiments where you try things and toss aside what doesn't work, and keep trying. There's no magic one-size-fits-all formula. What works for me may not work for you, and that includes our choice of footwear.

Since I broached the subject, if anyone has experience with going barefoot, please weigh in below. Did it help or hurt your knees? I wonder sometimes about activities such as walking barefoot in loose sand, for someone who has knee pain, as that would seem to risk exacerbating instability in the joint.

 

Calling All Readers! Any Questions Out There?

I'm throwing this post wide open, inviting any of you to contribute. I know I usually run these posts with the heading "Open Comment Forum," but in this case, I want to see how many readers are left out there (I know some have drifted to the exits over the years, hopefully as their knees have gotten better).

For years, I've talked about stepping back from this blog (I'm kind of talked out, and my knees aren't a problem anymore, so "Saving My Knees" is becoming more like a receding bad memory). I have cut down on the frequency of posts, but every time I'm ready to take a hiatus, it seems, there's a little flurry of book orders, and I think to myself, "Maybe those people will come here, looking for a place to turn, and find an abandoned storefront! That wouldn't be good!"

At this point I'm mainly interested in posting about three things:

(1) Success stories. If you have one, and haven't shared it yet and would like to, please post it below! It doesn't have to be, "Your book changed my life!" I'm not fishing for plaudits. Rather, I think everyone out there with hurting knees benefits from reading success stories. They're all a little different, and I think that's good, because knee pain, and the best ways to treat it, are all a little different. I like to turn success stories into posts.

(2) Questions from readers. People are often struggling with things, and I like to post the questions, as people who follow this blog may have answers. Of course I don't always. For example, if the question is "Has anyone had a bad experience with hyaluronic acid injections?" I'm not going to be much help, because I've never had the procedure. But others can chime in.

(3) New science/medical studies/research. I'm always watching to see if something new and interesting crosses the wire, as we say in the news business. So far, most of what I've seen over the last few years just reinforces the findings and the message in "Saving My Knees." And that's a good feeling.

So how about it? Any questions or untold success stories out there?

Using the Right "Tool" to Fix Your Knees

So late last year I did this little shop project:

It's a massive DVD holder. I made it out of a cabinet (top part) and the base for a swivel chair (bottom part). It's part of my new movement to "creatively recycle old things instead of buying new things." It can hold about 440 DVDs. It swivels around, with DVDs facing outward on both sides.

The project was more or less successful. As you might expect, my DVD holder is a little unsteady, because the cabinet top is much broader than the swivel chair base. But the base is well-attached, thanks to these:

And these things are what got me thinking about bad knees, and the mistakes we make when trying to fix them.

What are these things? They're actually rather clever in design. They are anchored to the wood of the chair seat. You can screw a metal bolt through them, connecting the seat to the metal swivel base.

Now, it goes without saying, if you're going to attach a chair seat to a base, you better make sure to do it well. It has to be able to withstand the weight of light people, heavy people, people who are leaning back in their chairs, etc.

That's what this hardware, let's call it a bolt sleeve, accomplishes. It fits into a wooden hole drilled into the seat of the chair. However, it doesn't just slide into a predrilled hole. Those pointy fangs must be hammered into the wood (thus ensuring the bolt sleeve doesn't rotate and also giving the attachment more stability).

When I disassembled the swivel chair, in the early stages of this project, I immediately spied these sleeves and said, "Got to reuse those!" I could see how they would be essential to making my DVD holder as sturdy as possible. If they're good enough to support a 300-lb.'er on a chair seat, they would work perfectly for my purposes, I surmised.

Only one problem: at the time, I wasn't aware of the pointy fangs that had been hammered into the wood. From what I could see of the bolt sleeves, all I had to do was somehow dislodge them and pop them free. So what tool did I choose for this? The great chewer-upper of wood (and even metal): the reciprocating saw.

I put the chair seat into a vise and sawed into it, toward the first bolt sleeve. I figured I'd cut into it from a few different directions, enough to free up up the sleeves. But, in doing so, I sometimes managed to damage them. It was harder to extract the sleeves than expected.

Then I started looking at the pointy fangs that had been hammered into the wood of the chair seat and I realized: "I'm using the wrong tool. I'm trying to cut these free. I should be using the claw of a hammer to pull them out, because what's mainly holding them in place are the prongs."

So I did, and the job went much faster, and I didn't create as much damage along the way.

Okay, that's a long walk, admittedly. So what does that have to do with healing bad knees?

One thing I noticed on my knee journey, when I was suffering a decade and a half ago: bad knees can be improved in a number of ways, and that can confuse people. I dealt with that topic in this blog post 10 years ago.

The problem is, various "tools" can do the job to some degree, and there are studies that show this, compounding all the confusion. For instance, one study might say hip strengthening is needed, based on an experiment with some subjects, and another might advocate quad strengthening. Both types of exercises can be shown to be better than doing nothing.

What we might find, at the end of the day, is quad strengthening > hip strengthening > doing nothing.

So some people might wander off to strengthen their quads, while others focus on their hips.

But what if there's an even better "tool" for the job, a "tool" that directly addresses what's wrong (the knees) instead of stuff that's in the immediate area (quads, hips).

That's what I realized I should focus on: simple, light exercises that tried to improve the health of my knee joints. I fashioned a program with this emphasis, which became necessary after the program that my therapist proposed, strengthening my quads, turned out to be a dismal failure.

It took numerous months, but I managed to heal my knees. Today I attribute my success to using the right "tool," if you will.

Are you using the right "tool" as you try to heal your knees?

One More Time: Running Isn’t a Death Sentence for Your Knees

I think I’ve been in the forefront of voices trying to spread the message that no, running isn’t inherently bad for your knees, and in fact can even help strengthen them.

Just search this blog. Here I am back in 2010:

Keep Running Past the Age of 40 and Your Knees Will Fall Apart! True or False?

The answer, incidentally, was a resounding “false.”

In October of last year, an article in the Washington Post highlighted more good news for runners. Studies are increasingly showing that not just running, but its extreme form, distance running, is actually beneficial for your knees:

… distance running does not wreck most runners’ knees and, instead, fortifies them, leaving joints sturdier and less damaged than if someone had never taken up the sport.

A recent 2019 study is cited, where the researchers rounded up 82 middle-aged first-time racers who had signed up for the 2017 London Marathon. Few had done much if any running. None had knee pain.

By conventional wisdom, this group should have been prime for lots of damaged knees. They were middle-aged, didn’t have a history of running, and were training for a 26.2 mile grueling endurance race!

But what the researchers observed: most of the pre-training knee scans showed signs that the runners did have signs of joint injuries setting up, such as cartilage tears and bone-marrow lesions. But two weeks after their first marathon, most of the lesions had shrunk, and so had much of the areas of bad cartilage.

Still, there were signs of fresh (though slight) damage in the bones and cartilage around their kneecaps. That was understandably concerning. So new scans were taken later, six months after the race and:

Many of the lesions and tears that had begun shrinking during training were smaller and the fresh damage seen around some kneecaps had largely dissipated, with few remaining signs of lesions and tears.

But the more important, more broadly relevant message in this article (after all, not all of you are runners or want to be) comes from Jean-Francois Esculier, a clinical professor of physical therapy at the University of British Columbia in Kelowna. This is one of the BIG messages in my book (emphasis below is mine):

“For a long time, we thought that cartilage could not adapt” to running or other activities, he said, because it lacks blood supply and nerves. “But in fact, cartilage does adapt,” he said, “by becoming stronger and more tolerant to compression.”

Yes, yes, yes. Knee cartilage is not an inert material, like the rubber on your car tires, fated to eventually wear out. But the difficulty we face in recovering, with bad knees, is dialing back our level of activity enough so that we don’t continue to do further damage to our weak knees.

I’m happy that these messages are gaining wider acceptance. But the battle is not yet won, for as the article noted:

An online survey conducted by Esculier and his colleagues, its results published this year in the Orthopaedic Journal of Sports Medicine, found more than half of the 2,514 respondents believed distance running damages knees.

So don’t be surprised if your doctor isn’t on the side of the enlightened yet. But opinion in the orthopedic doctor/therapist community is finally swinging around. And that’s a very, very good thing for people with knee pain.

A Success Story to Start the New Year!

Why not start 2023 with a story of someone overcoming knee pain? Hoisted from comments and lightly edited (with emphasis mine): 

Your book "Saving My Knees" was an inspiration. It gave me hope that I could overcome the limitations of osteoarthritis (Stage 3 according to an orthopedist who interpreted my MRI results). Three years ago, I couldn't walk the length of my house without pain so bad that it even interrupted my sleep at night.

After reading your book, I decided to chuck the orthopedist and the NSAID he recommended, and embark on a program of my own design after reading everything I could about osteoarthritis.

I soon learned that inflammation played a major role in both the pain that people with osteoarthritis endured and the progression of the disease. In addition to daily walks and yoga, I adopted an anti-inflammatory diet consisting mostly of plant-based whole foods. Currently, I eat seven to ten fruit and vegetable servings per day as well as legumes, whole-grains, and soy. I also lost 20 lbs. of excess weight, which I'm sure has contributed much to my improvement.

This morning I walked [four miles in an hour] with no pain. Most days I walk 6,000 to 9,000 steps daily during my walks and about another 1,200 to 1,500 steps as I do my daily chores at home. Not bad for a man in his seventies!

I love reading stories like this.

First of all, note that this person's knee pain was hardly mild: "stage 3 according to an orthopedist" (I suspect that refers to the extent of deterioration in his cartilage, where stage 4 is bone on bone) and "I couldn't walk the length of my house without pain so bad that it even interrupted my sleep at night."

Can you imagine that? Just walking from one end of your house to the other, and then having intense knee pain at night as a result? I'm sure some of you can, but this is definitely at the more extreme end of the knee pain spectrum.

After that, he did a few smart things, maybe the smartest being this: "I also lost 20 lbs. of excess weight ..."

I'm not sure how much an anti-inflammatory diet contributes to alleviating knee pain -- it didn't seem to make a huge difference for me, but my dietary changes weren't really radical -- but I've read so many medical studies about how being overweight contributes to knee pain that I'm quite confident that shedding pounds will make some kind of difference, if you're patient.

I also sense a kindred spirit in these words: "I decided to chuck the orthopedist and the NSAID he recommended and embark on a program of my own design" ... which is exactly what I did. Again, I'm not trying to denigrate doctors, and some are very, very good, and they are important to help diagnose what might be plaguing you. But ultimately, a lot of healing chronic knee pain will depend on you and your individual efforts and plan to heal.

But of course he healed, you may have thought after reading the first few paragraphs -- he was probably in his twenties or thirties, at an age when healing is still possible ... nope! He was in his seventies!

In some ways, it may be easier to heal in your seventies instead of your twenties or thirties. Why?

When you are young, that illusion of immortality, of being unbreakable (at least in a permanent way), is still very much with you. And that can be a dangerous illusion. It will cause you to pronounce yourself prematurely healed; you will tend to think that all healing must be on a two- to four-week (or at most a four- to six-week) timeline.

When you are older (in your forties, fifties, sixties, or beyond), you have two advantages: (1) the knowledge that good health shouldn't be taken for granted, that it can be a fragile and easily lost thing if one is reckless or ignores the body's warning signals (2) patience.

Yes, healing takes longer in someone older, but that older person is more likely to possess the wisdom and patience to be able to handle that fact.

There you are: a success story to start 2023.

How are you all doing out there? This year, my posting will probably become less frequent, as book sales have kind of tapered off, and that has led to a corresponding dip in traffic to this blog. But I'll still be here, at least occasionally.

Best wishes, and to all, good knee health in 2023!