When a Bad Knee Just Gets Worse

I came across this tale recently. It begins with our protagonist limping a little.

A few Tuesdays ago, I noticed Joel limping a bit, dragging his right leg. I asked him what was the matter. “Knee’s a little sore. Don’t know what I did,” was his response.

“Maybe you should rest it,” I suggested. “Do you need some ice?” 

“No, I don’t need ice. Good grief. Geesh. You think I’m a weakling?” he grumped.

Now what happens?

This is an interesting juncture for someone who has just developed knee pain seemingly out of the blue. The sudden, unexplained onset of knee pain can be frightening. It’s one thing if you bang your knee hard against something and then it becomes sore. A simple line can be drawn between cause and effect.

But if you can’t even recall what you did? Yikes. That’s not a good sign.

Well, Joel decides his leg needs more exercise. He chooses to walk downtown to run errands instead of drive. The next morning? Yup, you guessed it:

The knee is swollen. The limping is worse.

So he drags himself around the house for a while. He rests on the couch, an ice pack over the hurting joint. He starts wearing shorts, because his jeans won’t slide up over his swollen knee. His wife (narrating all this) gets exasperated with him.

Finally he breaks down and sees a doctor. An MRI is done. The report comes back with a lot of impressive-sounding jargon like:

“Large joint effusion,” “periarticular fluid signal and edema, greatest in the popliteal fossa and lateral soft tissues,” “subcutaneous edema in the prepatellar region, complex cystic structure along the later [sic?] popliteal fossa, adjacent to the lateral head of gastrocnemius.”

Of course the effusion and edema just mean that Joel has swelling. His doctor tells him the test confirms that his knees are getting old and orders medication for swelling and pain. And that is pretty much where the story ends.

But after reading this, I found myself thinking: Where did things go wrong for Joel, and why?

Things really went wrong when he decided he needed more exercise. So think about this in terms that have become familiar to visitors to this website: Joel’s envelope of function had narrowed. His knee joint hurt. It was less capable of handling stress.

So what does he do? He goes out and stresses it more than he would during a normal day when it wasn’t hurting!

Where the heck is the logic in that? What could have possessed the poor guy?

Here we can only speculate, but:

What’s the message you hear constantly from physical therapists trying to rehab bad joints? You need to strengthen your legs to protect the joint! Build up your leg muscles!

One can just imagine poor Joel Googling around for answers for his condition, landing on this message repeatedly – strong muscles protect weak joints! – and deciding, by God, he was going to strengthen those leg muscles and banish that knee pain!

Building up leg strength is a great idea ... before you have bad knees. Once you do, you need to move much, much more carefully. This is something that Joel has now presumably learned. That, and an MRI often isn’t really very useful. :)

Open Comment Forum: What Discovery Has You the Most Excited?

Okay, I'm going to hand the controls over to all of you.

As I've said a number of times, as I move farther away from my knee pain days, and as I exhaust new subjects to write about, and also -- frankly -- as I find myself increasingly strapped for time, I am writing shorter and also letting all of you talk among yourselves more often.

At this point, turning over the comment section to readers and letting you discuss issues that you're having, with people chiming in to suggest ideas, is probably most valuable.

So here's a question to get everyone started (or feel free to ignore this suggestion, and just talk about whatever you want to!): What's the discovery you've come across, say in the last five or six months, that has you the most excited when it comes to healing your knees?

It could be a scientific discovery. Or if you want to broaden the topic a bit, it could be an article you came across or a personal story you read about a knee pain sufferer who tried something that worked that you think may work for you too.

Anyway, open comment forum, so everyone's welcome to share their thoughts on anything!

Cheers, and I hope everyone is doing well in the new year.

The Villain in the Story: Inflammation

I’ve written about chronic inflammation a number of times. It’s sort of like writing about the hazards of being overweight, a subject that I think deserves multiple posts, even if they do become a bit repetitive.

My thoughts returned to inflammation recently because of an article in the New York Times that I happened to see in a newspaper I scavenged one day on my commuter train into the city.

Near the top is this paragraph, written with plenty of dramatic flair:

Specialists in the biology of aging have identified a rarely recognized yet universal condition that is a major contributor to a wide range of common health-robbing ailments, from heart disease, diabetes and cancer to arthritis, depression and Alzheimer’s disease. That condition is chronic inflammation, a kind of low-grade irritant that can undermine the well-being of virtually every bodily system.

Chronic inflammation is a dangerous beast. It’s hard to understate this. I had it. It started in my knees and, I’m convinced, spread in small, practically undetectable ways throughout my body. I say this because at one point (as readers of my book know), I went in for a blood test, thinking I might have rheumatoid arthritis, after experiencing weird problems with multiple joints.

My blood test was excellent: no signs of systemic inflammation. However, I am still convinced that there was something going on throughout my body that was related to my troubles with my bad knees. A knee doesn’t exist in perfect isolation. It’s not walled off from the rest of the body.

At one point I had bursitis in an elbow. And I had throbbing, constant back pain.

Now, being blissfully free of knee pain for a decade now, I see the inflammatory aspect of the condition as even more alarming than I did back then. To escape knee pain, I think it’s partly a race against time, if you have constant burning, or inflammation. You need to get beyond that, and as soon as you can.

Inflammation of course is a natural reaction by the body to injury, or even to vigorous exercise. What becomes a problem is when the inflammatory response doesn’t die down, when whatever is prompting the reaction continues to fire up the immune system. It becomes a problem as we age, the Times notes, because “immune responses become less regulated.”

So what’s the solution? The Times mentions five recommendations:

* Fix your diet. A diet focused on fruits and vegetables is less inflammatory than one full of foods that are heavily processed, deep-fried, or sugar-sweetened.

* Lose weight.

* Make sure you get enough sleep.

* Minimize mental stress in your life.

* Be careful about overuse of antibiotics, antacids and nonsteroidal anti-inflammatories. They can kill off good bacteria in your stomach and lead to a “leaky gut” that lets bacteria loose in your body that encourage inflammation.

* Exercise regularly.

How do you rank on these five recommendations? Personally, I know I could be better. My diet isn’t great, but I am very fastidious now about maintaining a lean weight. On sleep, I slip behind (like most people) during the workweek. Sometimes I feel stress building up.

Where I can excel now, thank goodness, is in exercising. I work out hard on the weekends.

What about you? What steps are you taking to control out-of-control inflammation?

The Best Knee Pain Book You Can Buy (No, Not Mine)

While poking around Amazon recently, I noticed that Doug Kelsey’s books are now listed there, and for less than $10.

Wow, I thought (for the record, as long-time visitors know, I’m certainly not Doug’s publicist, but I found a stirring message early on in his blog writings that convinced me my knees could heal and that sustained me through many bleak nights).

Kelsey was originally selling the “90 Day Knee Arthritis Remedy” for $28.95, as I wrote here in May 2014.

At that almost-30-bucks price, I thought it was already a bargain. I mean, you’ll typically pay $40 for a copay to see a specialist who will review your knee history for all of 5-10 minutes, then probably tell you to visit a physical therapist or write you a prescription.

But at $9.95, it’s a must buy if you’ve got knee pain. Kelsey’s book has lots of exercises. Plus, he understands the challenge of chronic knee pain and knows that the situation is far from hopeless. You can get better! And yes, without surgery.

At this point I probably am sounding too much like his publicist. But let me tell you why:

I wrote a book about my story that chronicles a long journey into and out of the depths of chronic knee pain. I certainly think it has a lot of value. But still, I’m not a doctor or a physical therapist. I’m a journalist: bright and curious, I hope, but not a trained medical professional.

Kelsey is though. And he’s a damn smart one.

Early-stage knee pain sufferers are beset by confusion and a welter of conflicting messages. Glucosamine works! No, it doesn’t! You should stretch! Stretching doesn’t matter! Take this supplement! Supplements don’t work!

Your head can start spinning. What you really need most, I’m convinced, are some ways to move and nourish that sick knee joint without causing pain. Kelsey’s book will give you the exercises you need and explain a whole lot more too about your condition.

My two cents anyway. Now, for 993 more cents, you can own his book in your Kindle library. ;)

Happy Holidays to All!

This is my end-of-the-year shout out to everyone who visits regularly, semi-regularly, or even who's dropping in for the first time.

Thanks for coming by, and best wishes for your knees in 2020. If you've been on a program, whether designed by you or someone else, year-end is a good time to reflect on how well it's working. Beating knee pain can involve a frustrating amount of experimentation. Sometimes you have to look at what you're doing, in a very clear-eyed way, and say, "Hey, I'm not getting better."

That's different of course -- very different -- from "Hey, I'm getting better, but it's taking soooo long." That unfortunately is par for the course.

My knees this year have been very, very good. I think I sprained a ligament on the inside of my left knee, and because I stubbornly refuse to curtail my cycling much, it has become a bit of a nuisance injury. Still, I plan to shut things down for about a month this winter, and hopefully that will take care of it for good.

What about all of you? Anyone out there want to share the progress you've made this year? What are you resolving to do more of/less of in the new year? Leave your comments below.

Cheers, and best to all!

A Thinking Man’s Guide to Writing a Book About Knee Pain

After a Washington Post reporter wrote an article quoting me about my recovery from knee pain, I saw a predictable bump in sales of Saving My Knees.

A lot of people were motivated to buy the book, it turns out. A small number returned it, realizing it wasn’t quite what they wanted. (In the front, I now explicitly warn people that it’s NOT a book full of exercises, but rather my personal story.)

By the way, I love Amazon’s no-hassle policy on returns. I think it keeps merchants honest and careful about quality control. I’ve used it many times myself. I don’t have a problem if someone buys Saving My Knees, then decides, “Eh, it’s not really what I was looking for” and returns it.

Some people do find the book annoying, because it’s a story, as opposed to a pared-down, just-the-basics manual on fixing bad knees. This is something I didn’t initially realize would be an issue. Rather naively, I thought, “People will want to read the whole story, because the outcome is incredible, and this is a book I myself would’ve paid $100 for.”

I suppose every author is self-delusional to some degree. Otherwise, why go to all the effort of writing, rewriting, rewriting again, and rewriting some more, when for all you know your book may sell all of 20 copies? It’s a rather masochistic exercise that does little but feed the ravenous ego, I suppose.

So anyway, I remember at first being surprised by comments in reviews about people skimming through it to get to the "good parts," or complaining it was full of “filler.” But I understand now. If you have bad knees, you just want to know, “What should I do? Tell me. My knees are hurting, dammit.”

You probably don’t care about some of the little details I dropped in there about my own life, or my athletic life before I had bad knees. In my mind, I was telling a story that had a dramatic arc, and a character (me), and I wanted to flesh these things out. But in actuality, I totally understand the mindset of that impatient reader: “How did you do it? Hurry up!”

I’ve sometimes wondered if maybe a better title would have been something like, A Thinking Man’s Guide to Beating Knee Pain.

But I do think there are some advantages to telling a fuller story, and this is partly what I wanted to convey today:

(1) Those little setbacks I had – whether from carrying a fan up a few flights of stairs, or a full backpack for a fairly short distance – may seem unrelated, but they’re very ordinary, everyday events, and every knee pain sufferer will have to recognize that these things will happen, and be prepared to deal with them.

(2) I know I’ve said this before, but negativity takes a big toll on you. And there was a period in Hong Kong, nursing my bad knees, when I was just a ball of intense negativity. So all those little things I mentioned that got me depressed, yes, I did blow them out of proportion, but this is what it’s like being in such a negative state. You do tend to hold a lot of one-person pity parties. And to get on the healing track, you need to move beyond that.

(3) I wanted to show the frustration leading up to the discovery of what eventually healed my knees. I wanted to because so many people go through this prolonged state of trying so many things, with one thing after another failing. This is part of the experience, committing mistakes and chasing dead ends, but still trying again and again.

(4) I wanted to explain what I learned about how knees work, because this helps explain why the solution I came upon makes sense. Again, I’m a logical, rational guy. I don’t want for someone to just tell me something works. I want to know why it works.

(5) And then – I like learning stuff! And I wanted to share the many things I learned. I suppose that’s the inner journalist in me talking.

What if I wrote the book really short? I suppose the ultimate condensation would be something like:

I hurt my knees.

I walked a lot.

I got better.

But that only scratches the surface of the story that was important to tell. So I told that story. But no, I don’t disagree with any reader who thinks the book does include a bunch of non-knee detail (especially at the beginning, where I’m setting a scene). Feel free to fast-forward!

Cheers, and I hope everyone's enjoying the approach of Christmas. Less than two weeks away!

Yes, You Can Avoid Knee Surgery. Read About it in the Washington Post!

The Washington Post ran a wonderful article a couple of weeks ago about alternatives to knee surgery.

I was flattered that the reporter, Sally Squires, saw fit to include a condensed version of my story. We talked a couple of times. As a journalist myself, I know that good reporters conduct a lot of interviews, and not everyone they speak with makes the final cut.

When interviewing me, Squires was quite careful and thorough. As she explained in the article, she has been suffering from her own travails with knee pain, so I imagine that the research she did had a special resonance.

She gives a great overview of the dimensions of the problem our country has with sore knees: one in four adults have chronic knee pain, and the number of sufferers has jumped 65% in four decades. About 680,000 total knee replacements were performed in 2014.

Can you imagine that? That’s about one in 500 Americans  – in just a single year. What’s more, when adjusted for population, that rate doubled from 1991 to 2010. As her article notes, the number of knee replacements is outpacing operations for coronary artery bypass surgery.

This country has a crisis of bad knees, it seems.

Squires also quotes someone about the delayed onset of symptoms with knee pain. This is critically important, and I don’t remember reading much if anything about this when I undertook my own journey to save my knees.

It means that the activity you do now may seem pain free, but your knees might protest hours later. And if you don’t connect the dots between pain now and something dumb you did yesterday, your knees may never get better because you’ll never try to modify your behavior! I talk about this at some length in my book; it was a key revelation for me.

Finally, one small thing: she did mention that I still notice some burning in my knees when sitting. Honestly, I did suffer occasional spells of burning in my knees (when sitting) during the “post-recovery” period after I healed enough to go back to work.

But the problem with burning under my kneecaps lessened over time. I haven’t had any issues for (I think) two years now. I have to put “I think” in parentheses simply because it’s been a while, and I no longer track every little sensation from my knee joints.

But she’s correct that I did have this problem, and it took a while to shake. And it’s not like my knees never complain. I really beat them up sometimes (like in a very intense Thanksgiving bicycle ride this week). I still like to play hard.

And I’m glad that I can again!

If you haven’t read the excellent article that Squires wrote, please check it out here.