Yes! A Little Validation for the Ideas in "Saving My Knees"!

Next week I'll finish the series on stretching. The basis theme of the last installment is, "Why does stretching have such an ardent following, and why will humans probably do it until the end of time, even if God Himself were to appear and announce that it doesn't work?"

This week, I wanted to take a break from the stretching-fest to show that the "radical" ideas in my book Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain are being validated, slowly but surely.

For example, anyone who's read the book will remember one of my four golden rules for bad knees: Use It or Lose It.

Now, check out this April 12 Wall Street Journal article on bad knees entitled "Doctor's New Advice for Joint Pain: Get Moving." This is the lead:

Doctors increasingly are recommending physical activity to help osteoarthritis patients, overturning the more traditional medical advice for people to take it easy to protect their joints.

Amen.

Here's the banner quote:

"The most dangerous exercise you can do when you have arthritis is none," says Kate Lorig, director of the Patient Education Research Center at Stanford University.

You'd be surprised at the number of doctors though who believe in -- what I like to call -- the "your knees are like a car" analogy.

Which works like this: You buy a brand-new car and drive it out of the showroom. That car will run fine for a certain number of miles, then begin to break down. Now you can go easy on that car -- shelter it in a nice garage, replace the oil regularly, avoid running it at excessive speeds etc. -- and the engine may last 130,000 or 140,000 miles instead of 110,000.

But, with enough use, after enough time, the car will break down. It just wears out. Gosh! That does sound kind of like your knees, huh?

Except the analogy really doesn't make sense at all, when you think about it. And it doesn't for an obvious reason: you're a living, breathing organism. Your car isn't. Your car isn't a hotbed of cellular activity, able to replace worn tissues and adapt to external forces. If you drive over a potholed road on the way to work each day, your car doesn't develop sturdier shock absorbers to better withstand the impacts. It's just a chunk of metal and plastic parts.

You're not. Triathletes have been shown to have thicker-than-normal knee cartilage. That's an adaptation to their sport and training. How many cars, outside of a Disney movie, are capable of growing larger-than-normal engines to adapt to regularly racing down freeways at fast speeds?

Yet the "your knees are like a car" thinking is surprisingly common. I encountered it on a message board recently. A doctor (!!!!!) was advising a knee pain patient against cycling. Why? Because it entailed a lot of repetitions, which would wear down the bad cartilage faster. I haven't gone to med school, and I recognized how silly that reasoning was. Even so, it's a perfect expression of the "your knees are like a car" analogy.

So the Wall Street Journal recognizes moving is a good thing for bad knees. Bravo! Of course few 21st century physical therapists would dispute the value of exercise (even if some old school doctors still resist the notion).

Where I sharply part ways with most physical therapists, however, is that I believe in joint-first, not muscle-first, exercise (taking my inspiration from a very smart man, Doug Kelsey, who first enlightened me to the fact that bad cartilage can improve, slowly, under the right exercise regimen).

Now it appears I have more scientific evidence supporting a joint-first approach, this from the April 2011 issue of the Journal of Pain (yeah, I guess there's a journal for everything, huh?). The article's title: "Experimental Knee Pain Reduces Muscle Strength." (I can link only to this abstract -- sorry -- because the full study is behind a paywall.)

The conclusion (my bold):

This study showed that knee joint pain has a significant impact on muscle function. The findings provide evidence of a direct inhibition of muscle function by joint pain, implying that rehabilitative strengthening exercises may be antagonized by joint pain.

Here's a translation of the bold type: "Joint pain inhibits how well muscles function. Thus, the existence of pain in your knee joints may counteract the effects of doing exercises to strengthen the muscles."

In other words, to simplify further and distill the nub of the thing: Joint pain limits how effective muscle-strengthening exercises are going to be (what's more, the study found that the more pain, the greater the reduction in muscle strength):

Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P < .001) in both knee extension and flexion at all angular velocities. The reduction in muscle strength was positively correlated to the pain intensity.

The obvious objection to this finding, of course, goes like this: "Well, naturally, people with more knee pain have less muscle strength! That's because they stop using the leg with the bad knee so much, because the joint hurts, and therefore the muscles begin wasting away."

That objection is wholly irrelevant here, however. This study induced "experimental knee pain" -- which is to say, the subjects didn't have pre-existing knee pain. They were all perfectly normal. The "knee pain" patients had hypertonic saline (a form of salt water) injected into their infrapatellar fat pads to create knee pain. Then their muscle strength was measured and found to be reduced.

This study features a key takeaway for those eager to heal their knees: If joint pain is working against the effect of exercises to build up your muscles, might you have things bass ackwards, as they like to say in fifth grade?

Maybe the right approach is strengthening the joints first (and getting on top of the joint pain), and THEN attempting to strengthen the muscles.

That's what I did, during a recovery that spanned the better part of two years. And that's what worked, after the traditional "muscles-first" physical therapy approach failed miserably for me.

On the Real Benefits of Stretching If You Have Knee Pain

I became a stretching skeptic partly because of my unusual history.

All my life, I've been tight-jointed (the kind of person who is usually advised to stretch). At the same time, as a youth, I loved sports: basketball, baseball, winter pickup games of touch football on frozen fields.

I never stretched beforehand. And I never got injured.

When I finally did have a serious injury, in my mid-forties -- cartilage damage in both knees -- at the advice of my physical therapist, I started stretching. Every day. I stretched and stretched and stretched (and did a number of exercises that he prescribed as well).

But I didn't get better. At some moment I began to wonder, "What does this stretching really do anyway? And what's the mechanism by which it fixes what's wrong with my joints?" It soon became clear that stretching didn't fix anything -- for me, and I suspect for many other knee pain sufferers as well.

Still, it can't be completely useless, right? Today we'll look at the question, "What's the best case to be made for the benefits of stretching?"

Here are some arguments that strike me as defensible reasons to stretch.

1. Stretching just makes me feel good.

If you happen to simply like the feeling after a good stretch -- of being loosened up, and relaxed, and ready to take on the world -- great! This seems like a valid reason to stretch.

2. I believe stretching is helping improve the condition of my knees.

Belief is a powerful force! In Saving My Knees I discuss the dietary supplement glucosamine. My doctors were vague and unhelpful on several fronts, but when it came time to prescribe something, on two occasions that something turned out to be glucosamine. Later I discovered the black joke: glucosamine has been shown not to work. Let me explain in brief:

* A number of scientific studies have emerged in the last decade indicating that it's not effective.

* Even if you don't believe these scientific trials that looked at pain relief and arthritis symptoms (after all, others claim a beneficial effect), at least two studies examined glucosamine on the level of molecular biology. They showed that the supplement, after being swallowed, is essentially ripped apart by the liver. The amount that ends up circulating in the blood is far lower than what's needed to have a salutary effect on your knee cartilage.

* If you're still skeptical, ponder this. People claim they need glucosamine to "feel better" and immediately notice when they skip taking a pill. Meanwhile, glucosamine is supposed to act on cartilage, a tissue that has no nerves and heals very slowly. So riddle me this: How is it that glucosamine takers get such immediate, snappy neural feedback in taking a pill that's supposed to improve the health of something that has no nerves and heals very slowly?

The glucosamine story is probably a placebo story. The stretching story may also be a placebo story, to some degree. But a placebo story doesn't have to be bad. Beating knee pain requires mental fortitude and a positive outlook. So if stretching lifts your spirits and you think it works, it can be somewhat irrelevant whether it actually does or not.

3. Stretching is necessary to preserve knee motion after surgery.

In Dr. Ronald Grelsamer's book What Your Doctor May Not Tell You About Knee Pain and Surgery, he says:

Following an injury or surgery, your knee will not want to straighten all the way. And it will not want to bend. Indeed, bending or straightening stretches the ligaments and tendons, which is painful. If you give in to the knee's reluctance to straighten and bend, two things may happen: Your knee pain may persist or worsen. Moreover, you might permanently lose knee motion.

Certainly, right after surgery there will be a period when you won't want to move much and will avoid bending or straightening your leg. However, you need to. Post-surgery, you're especially at risk of developing scar tissue (reducing range of motion and hindering function).

So, with the aid of a physical therapist at first, you need to bend your leg through as wide a range of motion as possible. This seems like an acceptable reason to stretch. But still, note that stretching isn't what's most important. You're not trying to achieve "range of stretching." It's range of MOTION -- and stretching the leg, to push it through the range, is what's required at that point.

Later, when the joint is capable of bearing weight and you're strong enough, regular motion and bending exercises can replace the stretching.

THE STRUCTURALISTS MAKE A CAMEO APPEARANCE

You may think I've overlooked a big reason to stretch: to redress issues of tightness or imbalance that cause unusual and harmful wear patterns in the joint. I think though that "tightness" and "imbalance" are often structuralist code words that don't get at the heart of the problem and don't offer a real, lasting solution (for more on structuralism, check out this earlier post).

I think the stretching-to-fix-tightness-or-imbalance doesn't make a whole bunch of sense. It's a way for doctors and PTs to avoid the real issue: you need to fix the joint (which most of them are still mystified about how to do). Most imbalances serious enough to cause your joints to degrade, it seems, couldn't be fixed by stretching alone. Surgery perhaps.

NEXT TIME: A meta look at the attraction of stretching: why, even if the heavens parted and God himself appeared and said stretching was useless, everybody would keep stretching. Why has this activity so thoroughly captured the imaginations of those in the physical therapy and medical community for so long?

Stretching, Part III: A Critical Look at the Biggest Pro-Stretching Claims

Last week we looked at what often needs fixing with bad knees -- defective or missing cartilage, inside the joint -- and how stretching (whatever you think of it) won't help mend this problem.

But of course stretching proponents don't make such a claim anyway. So what are their claims, and how do these fare when scientifically tested and scrutinized closely?

Fortunately, the most common beliefs about stretching and knee pain happen to appear in one place (how convenient!): Say Goodbye to Knee Pain by Marian Betancourt and Jo Hannafin. Dr. Hannafin appears to be a prominent orthopedic surgeon; Betancourt has written books on health and women's issues. The copyright is 2007, so the book certainly isn't outdated.

Let's walk through the purported benefits of stretching, one by one. Betancourt and Hannafin are represented by bold italics; I follow in (mostly) normal type.

1. Stretching is critical to increasing flexibility of your muscles ...

Yes, it's true that stretching helps increase flexibility. It's also true that if you have someone constantly stretch out your neck every day (for many hours at a time), you might be able to achieve this:


The point being: there are lots of things that are true, about stretching and about many phenomena in the world at large, but the larger question is, why is the end result desirable? In the case of stretching, who really needs greater flexibility, outside of a normal range? (Paul Ingraham makes this point and many others in his excellent, fact-based analysis of stretching, which I recommend.)

But what about professional or even serious athletes? They aim to compete at the highest levels. Don't they need to be more flexible?

Certain athletes, such as ballerinas and gymnasts, obviously benefit from stretching. Which is kind of logical, if you simply watch their routines/dances, which include bending the body into positions that are hard to attain, even for someone with superior flexibility.

Most sporting activities don't resemble ballet and gymnastics, though. For other athletes, such as cyclists, sprinters and weightlifters, stretching has been shown to impair performance.

Example: four minutes of static stretching had the effect of slowing down sprinters in a study reported in the February 2009 issue of Medicine & Science in Sports & Exercise ("Effects of Static Stretching on Repeated Spring and Change of Direction Performance").

2. Stretching reduces your risk of injury during exercise or everyday activities ...

This claim has been thrown seriously into question.

In Australia, a year-long study of 2,600 soldiers found the same rate of injuries among those who stretched their leg muscles before exercise and those who didn't. On one message board I came across (a stretching debate was going full tilt), a poster derided this study's findings, saying that soldiers wear combat boots and he doesn't.

Okay then, try this on for size: the Centers for Disease Control and Prevention conducted a mass review of 350 stretching studies over four decades. And it also concluded there's no evidence that stretching prevents injuries.

3. Initially, stretching is important because it warms up the muscles and readies the body for exercise ...

Paul has the best line by far on this claim, which is more than faintly ridiculous on its very face. He says, "That's like trying to cook a steak by pulling on it."

What's ironic is that stretching advocates apparently have figured out as much -- though they haven't connected the dots yet. Listen to this guide at About.com (you can find similar thinking in plenty of other places, but this is the first offender I chanced upon):

Always warm up before you stretch. It's a bad idea to stretch cold muscles.

But a stretching fanatic might rightly wonder: "Wait a second. Isn't that why I'm stretching? To warm them up? So I have to do some other activity to pre-warm them? What the heck's going on?"

The truth is, the most sensible way to really warm your muscles isn't to stretch. It's to do your intended activity at half-speed or half-force (i.e., jogging slowly to prepare for running a race).

This will increase blood flow to muscle tissue, boost the temperature of the tissue, and increase the range of motion in an activity-specific way. Stretching won't.

4. It is also important to stretch after you exercise or are active, to ease the tension in your muscles ...

I'm not quite sure what this claim is, but let's say the authors are advancing the "stretching prevents the onset of muscle soreness" theory. That's a common belief.

However, an analysis of ten randomized trials that appeared in the Cochrane Database of Systematic Reviews disputed this conclusion. Stretching before exercise or after had little or no effect on how sore someone's muscles felt.

Paul Ingraham quotes a clever line here: "Only soreness can prevent soreness." In other words, soreness is part of the price you pay for training, and increasing loads, and taxing muscles to get stronger.

So there you have it: four big stretching claims to approach with a good dollop of skepticism.

NEXT TIME: So what is stretching really good for? There must be something, right?

Can Stretching Really Help Fix What Ails Your Knee?

A brief update on last week's post: I had a few twinges and tinglings in my knees after my spirited workout (I got up to 349 watts while doing intervals on the stationary bike). That was probably to be expected, after three months of indoor cycling at a leisurely Sunday-at-the-park pace. Maybe it wasn't so bright to ramp up to time-trial intensity so fast. :) So I'm going to take a few more weeks to "break in" my knees for the 2011 cycling season. Who wants to ride in the cold anyway?

Now for the discussion on stretching, resumed:

WHAT'S WRONG WITH YOUR KNEES AND HOW DOES STRETCHING FIX IT?

Okay, I'm going to start with what was wrong with my knees, because my problem was fairly common -- and I have to start somewhere.

I had cartilage damage in my knee joints. That can cause pain mainly in two ways (as I explain in Saving My Knees): (1) tiny pieces of the soft and damaged cartilage flake off -- which you don't feel because the tissue has no nerves. They float in the synovial fluid and then migrate out to the synovium (the lining of the joint capsule) -- which you do feel, because the synovium is nerve rich. (2) cartilage that is thin or damaged fails to adequately cushion the underlying bone from pressure (such as from bent-knee sitting or walking). Bone endings also have plenty of nerves, unfortunately.

So my primary challenge (and the challenge of millions of others with pain from chondromalacia and osteoarthritis) is as simple and complicated as this:

How can bad cartilage be fixed?

This is where some doctors head for the exits, claiming it simply can't be done. That's just not true though. Even if you can't restore cartilage perfectly to its original state, you certainly can strengthen it and, if you do all the right things and are patient, even regrow it, I'm convinced. (NOTE: natural regeneration of cartilage has been shown through at least three scientific studies; I discuss the subject more here and here).

So then, how can the cartilage be fixed? Through a program of stretching?

This makes no sense at all. Just think about it. How would that even work? Would you stretch the cartilage? Of course not -- you'd stretch tissues around it, primarily muscles. But if you stretch your quadriceps, or your hamstring, how does that help repair or strengthen your damaged cartilage?

It doesn't. To change the health of the cartilage, I strongly believe you need to adopt a program of appropriate motion, that gradually intensifies over time. That's what succeeded for me.

MY IMAGINARY CRITIC LASHES OUT: "TALK ABOUT A 'STRAW MAN' ARGUMENT! WHO SAYS STRETCHING HELPS CARTILAGE! IT HELPS OTHER THINGS!"

Later we'll look at that: specifically, what's the rationale behind stretching for sufferers of chronic knee pain? For now though, it's important to start with the simple essence of the matter. Which is: If your problem is damaged cartilage, you need to improve the condition of that tissue. And stretching doesn't do that. How could it?

A more sophisticated rebuttal (from Mr. Imaginary Critic) might be that stretching helps you do the things that will fix the cartilage (such as engaging in lots of not-too-strenuous motion). Or that stretching redresses imbalances that are causing the damage in the first place (notice that, in this second scenario, stretching still doesn't claim to repair the tissue -- only prevent it from being chewed up more).

I'm skeptical about both assertions in the preceding paragraph, but that's for an upcoming post.

MY IMAGINARY CRITIC AGAIN: "YOU WANT SIMPLE, WHAT ABOUT THIS? I HAVE A BAD KNEE. MY BAD KNEE MAKES THE JOINT AND NEARBY MUSCLES FEEL TIGHT. STRETCHING HELPS ME LOOSEN UP AND FEEL BETTER."

The logic certainly seems straightforward. Stretching is about getting loose. Having bad knees is usually about feeling tight -- whether it's a "knot" in the joint, or tight muscles around it, or just an inability to move a knee through a normal range of motion. So isn't getting loose just common sense, in order to feel better?

That depends. What's the source of the tightness? And does stretching help take care of that?

It doesn't appear so.

Listen to Doug Kelsey, chief therapist of Sports Center, a guy who's much smarter than me:

If the muscle is tight from irritation of the joint (which is almost always the case), stretching proves to be exceptionally frustrating. You're flexible right after the stretching but within hours or days, you're just as tight as before the stretch.

That tightness or fullness can be caused by swelling in the joint. Kelsey says that "as little as 20 milliliters of extra fluid in the knee [the equivalent of half a shot glass, he says] will intimidate the quadriceps muscle into near total inactivity." That swelling may not even be that visible.

So how effective is stretching in reducing swelling? Not very. Stretching may be effective in inducing swelling -- causing more swelling, when you overstretch -- but it doesn't relieve it. (As Kelsey notes, stretching may make you feel temporarily more flexible, but soon you tighten up again, especially if there's swelling in the joint. That was my experience exactly.)

How can you beat the swelling, and begin to eliminate the tightness, in a real, significant way? Kelsey suggests (1) elevating the leg and (2) light exercise, such as slowly spinning on a bicycle or walking in a pool. My opinion: that is what you need to focus on, not stretching.

(By the way, after quoting Doug Kelsey at some length, I should be gracious and point out that he has produced The Runner's Knee Bible, which contains many photos and videos and I'm sure is terrific.)

NEXT TIME: What are the arguments for how stretching benefits someone with bad knees?

My Personal Recovery: The Epilogue to "Saving My Knees"

I will return soon to the subject of stretching. Meanwhile, if you want a glimpse at the stretching controversy, just check out the "talk" page behind the Wikipedia page on stretching. True, many of the comments are semi-informed at best, but the back and forth suggests a citadel of belief may be crumbling ... :)

Today I want to do something I've meant to do all winter: provide an update on my knees and where they're at, post recovery.

Saving My Knees takes a reader to the end of April 2009, when I returned to the U.S. from Hong Kong. My knees were much improved. I made slow, steady gains through a joint-focused (NOT a quad-focused) regimen of appropriate motion. I was convinced better days lay ahead.

So what happened?

First, my knees did continue to get better (I returned to vigorous cycling by the late summer of 2009). I still noticed some discomfort while sitting during the summer of 2009. But by that fall I felt my knees were strong enough to return to full-time desk work. It took me a while to find a job (I ended up with my old employer, Bloomberg News, except in New York City).

I resumed my journalism career as a corporate finance editor late in December of 2009. Do the math, and that's 20 months since my attempt to heal my knees began at the end of April 2008. 20 months, and I'm not going to kid you -- there was still a touch of residual discomfort, while descending stairs or sitting at a desk for long hours. Not much, just a little.

I stuck to my motion-based program (a lot of cycling and walking), and sometime during the early or middle part of 2010 -- I can't even tell you exactly when -- the last reminders of my chronic knee pain went away.

Of course I was overjoyed. I cycled hard last summer, throwing caution to the winds. I'm sure that I ramped up too fast. I was riding to that happy point of total exhaustion. By November, I felt a little soreness in my left knee while on the bike. So you may be thinking, "Oh no! There it goes again!"

Nope. Whatever was going on with my knee -- I suspect a little tendinitis around the patella, but I'm not entirely sure -- this time didn't scare me. I felt as if I had the knee care manual in my back pocket. I was fortified with experience and knowledge. I also had the comfort of knowing I had a sore strong knee. That makes a lot of difference.

Still, a little slow-down intervention was needed. That came in the form of winter, when it's too cold to cycle outside here anyway. I vowed to dial back my intensity, keep cycling a lot, and wait for the soreness to subside. I developed a winter training plan. For instance, for all of January, I spun on the exercise bike at a very low resistance.

Over two months, the soreness disappeared. My knees feel perfectly normal now. During February, I started to pick up the intensity, preparing for a new cycling season. This month, I accelerated my training even more, because I want to start doing 50-60 mile punishing bike rides in April.

So where am I, this minute, in my post-recovery? To give you an idea, here is my knee-related workout program for the past week:

Tuesday: 45 minutes cycling. First, level 7 on the stationary bike (about 106 watts I think) for 10 minutes, then level 8 (about 20 watts higher) for 35 minutes.

Thursday: same as Tuesday.

Saturday: Time to get serious! 30 minutes cycling at level 7, then 30 minutes of intervals growing progressively harder, peaking at level 19 (that's 349 watts, for about 75 seconds, at more than 90 revolutions per minute).

Sunday: 60 minutes at level 7.

The first weekend in April, my goal is to be back with my cycling group, powering down the flats and charging up the hills of western Long Island. If I were living scared, I suppose I wouldn't do this. I'd stick with slow recreational rides. But the thing is, I'm pretty sure I know my knees well at this point. And I think they're strong enough to cycle hard.

Worst-case scenario, I'm wrong and I end up taking it easy for a year or two. I've developed a plan on "cartilage time" before. You have to make your peace with slow progress, but there's nothing wrong with that if the gains are real.

To Stretch or Not to Stretch, Part I

So I'm in the gym where I work out and see a sign to this effect:

"Please Ask A Personal Trainer About Assisted Stretching."

And I'm thinking, sort of wryly, "Yeah, there's a full-employment act for personal trainers -- not only do you need to hire them to show you the stretch, you need to keep them on, in perpetuity, to help you with the stretch."

Okay, that sounds a bit snarky. It's not that I dislike personal trainers. My sister-in-law is one, and she's one of the nicest people I know. But during my recovery from chronic knee pain, I had the opportunity to investigate the benefits of stretching. And what I discovered left me distinctly underwhelmed.

PREPARE FOR A GLORIOUS JOURNEY ...

I'm going to spend a few weeks blogging about exactly why I turned into a stretching skeptic.

This is a moment I've sort of dreaded, just because stretching is such a big topic and there are so many stretching advocates out there (and they can all touch their toes, and they're so damn proud of it :)). I'll probably end up annoying the hell out of someone. Stretching has become a quasi-religion in the world of physical fitness. Stretch before exercise! Stretch after! If you have knee pain: stretch, stretch, stretch!

But what are the arguments for all this stretching? What is the actual evidence about its benefits? Does stretching really make sense if you have knee pain? In other words, what are you trying to fix, and how does stretching help you fix it? Who was the first human anyway who said, "Hmm, I'm going to run across that field, so maybe I better stretch my quads first?" And if stretching turns out not to be that useful (as I believe), why has it become so solidly entrenched in our physical fitness culture?

I plan to cover most of those questions (I'm not sure about the "first human" one :)) in a series of posts. Hopefully, anyone who perseveres with me to the end will be inclined to accept that, at the least, the benefits of stretching have been (as I say in Saving My Knees) greatly oversold.

STRETCHING CAN HURT YOU

Even if you think I'm nuts, and you're loathe to give up your four or five favorite stretches, be careful. While cruising the KneeGuru bulletin boards one day, I came across an object lesson for stretching fanatics.

"Phrank" (his nom de message boards) started a thread "Can Certain Stretches Damage the Knee?" His story, in brief (I've edited his post down for length and readability):

First let me explain my history with my right knee. In 1992 it was dislocated, sept 2008 i had a lateral release and debridement ... it was also supposed to fix my knee instability ... In Jan 2010, I needed another surgery to correct my knee instability ... I would also like to include that I also suffer from I.T. Band syndrome ... In May of 2010 I began to jog, i was doing great, i slowly got up to jogging 3 miles non stop ... no pain, just i.t. band stiffness/soreness alone with muscle soreness. About two weeks ago I was doing a new stretch that a co-worker told me about that would help stretch my tendons and IT Band ... the last time I did it ... it felt fine when I was stretching it, I felt releif, nothing popped, nothing gave way ... so i sat back done to continue my work, got back up 10 mins later to get something, As i stood up I felt so much knee pain. It was really intense ... Now two weeks later my knee makes popping sounds when i get in and out of bed or sitting down and getting up from a chair.

Was the stretching necessarily to blame? Obviously, it's impossible to be sure, especially since we have only Phrank's account to parse. But he did include a diagram of the stretch he was performing. When I saw it, I just shook my head. Check this out:



In a reply I made to his post, I suggested that another name for this might be the "Just Asking for Trouble Stretch." Because look hard at this image, and think about what Mr. Knee Pain Sufferer is doing. He's putting torque-like pressure on an unstable knee joint in an unnatural position.

Let's break down that bold type:

1. putting torque-like pressure: For this stretch to work, you need to push down on that knee, and since the leg being stretched is bent and folded over the other leg, the knee is subject to a bit of twisting pressure. Ugh. My knees have healed, and I just started to try this stretch, and quickly abandoned it out of fear.

2. unstable knee joint: Now imagine your knees are unstable. That makes this a double bad idea.

3. unnatural position: Now for the kicker: You're not even helping your knees adapt to some motion you'll be undergoing later. Look at this weird position! What physical activity does this replicate? When do you, in some sporting or life activity, swing your bent leg up over your other leg, and push down on it? What about, like, never? There's value to putting some pressure on your knee joint, say by climbing up stairs, if you want to train your joint to better climb stairs. But here you're putting pressure on your knees for no other reason than you think you need to stretch some muscles/tissues and can't find a better way to do so.

Stretching can be dangerous! Even seemingly benign stretches can lead to small tears in the muscles or tendons being stretched, especially for people who are weak (from short-term or chronic injury or whatever)/out of shape/healing from injuries. So even if, after reading all I have to say today and in upcoming posts, you continue to stretch, please be careful.

NEXT TIME

What's wrong with your knees? And how does stretching help fix that?

Update on "Saving My Knees," the Book

I realize there are a certain number of you out there finding this blog for the first time, feeling that you've dropped in during the middle of a conversation.

Nothing wrong with that. That's what a good blog should aspire to being: a lively conversation.

However, I imagine you first-time readers may be wondering: What is this book, Saving My Knees? Is it worth my time to buy, especially if I don't have a Kindle already?

Saving My Knees is my story of beating chronic knee pain and how I discovered much of what I was told to do, as a patient, was demonstrably, provably WRONG or MISGUIDED. The book is an argument (for a certain approach to overcoming knee pain). The book is a refutation (I hope) of the standard treatment regimen for chondromalacia/patellofemoral pain syndrome.

It has been on sale through Amazon.com for more than a month and has done better than I expected. What's more, a handful of copies have gone to buyers abroad, which really makes me happy, as it shows that the dissemination of my message isn't being constrained by geographical borders.

So who am I anyway? Not a doctor. Not a physical therapist. But I am a longtime journalist, a fairly bright guy, an analytical thinker with the ability to synthesize knowledge, and someone who is open-minded enough to know that the experts aren't always right ...

If you are a smart, discriminating person, willing to question authority when appropriate (I slavishly followed the advice of my physical therapists and doctors until I realized their advice didn't make sense), and you have knee pain, you should read this book. I don't mean to sound arrogant with the preceding characterization -- it's just that I've spent a lot of time lately on knee pain message boards. And I know there is a certain kind of person my book won't reach. Even though physical therapy has failed, that person has either jumped on the surgery merry-go-round (and once you're on that carousel, you often stay on it, I'm afraid) or can't quite wrap their head around the idea that current medical practices could be wrong.

These are the same kind of people who, 200 years ago, were being bled into bleeding bowls to cure problems such as acne and who weren't questioning why their acne wasn't getting better. (A colorful analogy I like to trot out from time to time -- medical science at any given moment in time will be imperfect; that's simply reality!)

I wrote Saving My Knees because there are NO OTHER books anywhere written in the first-person that chronicle how someone triumphed over knee pain after being told his knees would never get better. I wrote it because I followed a rigorous, fact-based approach to healing that I knew would be relevant for other knee pain sufferers. I wrote it because, selfishly, I wanted to plant a flag, on January 2011 (the publication date), showing that I was in the early vanguard of people who figured this out years before everyone else does.

Yes, I'm pretty confident that a lot of the thinking about knee pain treatment is going to evolve significantly over the next two or three decades.

So, if you're on the fence about buying Saving My Knees, you can:

Go here to read my (rather long) KneeGuru thread announcing the release of the book (and what it's about).

Go here to read my (really, really long) KneeGuru thread about my success story beating knee pain.

Go here to find out how to read an electronic book, if you don't have a Kindle (hint: it's easy).

And if you want to just hang out at this blog for a while, making up your mind, that's fine too ;).