What’s the Relationship Between Knee Pain and Cartilage Damage?

Ah, what an interesting question. Early on, I tended to think that, where there was chronic knee pain, you’d find damaged cartilage in the joint.

Of course, not in all cases. But in very many.

However, after I learned more (and heard more personal stories from all of you), I modified that belief. People who have knee cartilage that appears perfectly fine get terrible knee pain sometimes. And people with potholed cartilage can have pain-free knees.

But – here’s the but – I definitely think there’s a high correlation between knee pain and bad cartilage. One does not necessarily imply the other. But there is a good likelihood that if you have persistent knee pain of difficult-to-determine origin, you have issues with the cartilage in the joint, or vice versa.

In fact a recent study, looking at 565 people who had a knee arthroscopy, supports this:

Published results showed a strong association between patient-reported knee symptoms and the burden and severity of underlying cartilage damage rather than with specific meniscal pathology ... researchers intraoperatively confirmed and classified the diagnosis of meniscal pathology and concomitant cartilage damage.

The researchers found that “the mean average symptom score increased with the severity of cartilage damage.” Also, there was a relationship between the number of compartments where damage was found and the intensity of symptoms reported.

When there was damage in three knee compartments, there was more frequent catching and locking of the joint, as well as grinding and clicking symptoms. Women and heavier people (a BMI of more than 25) were more likely to have more widespread cartilage damage.

The good news is that cartilage doesn’t have to be restored to a pristine state to get rid of bad knee pain, I believe. So, in the end, “damaged cartilage” shouldn’t mean you’re stuck with those bad knees forever!

I Love Success Stories! Here Are Some You Should Read.

It's easy to get discouraged when trying to heal your knees from chronic pain. One step forward, one step back ... when will it ever end?

It's comforting and uplifting to hear occasionally from people who have beaten stubborn cases of knee pain.

In my last post, I wrote about a triathlete who posts here as TriAgain, and his success story. I thought that today, for ease of reference, I'd do a short post that provides an overview to the success stories that have been published on this site.

* The most useful post of TriAgain's success story was probably this one, on lessons learned. It's worth a close read.

* Here's a success story I found on Yahoo's chondromalacia forum. This person had left knee cap pain that was getting worse, and exercise aggravated his knee.

* I was delighted to find out that my book had found its way into the hands of a couple apparently from South America. The husband, Luis, wrote about his wife, a professional runner, and how she beat knee pain. It was a success story in two parts: here and here.

* This one is from "Ron," and one of my first success stories. I was so excited that I went in and shared it with my wife and daughter, who was two at the time (and is now 11!).

* You're never too old to heal! "Pat" told me the story of how she did, and she was 66!

* One of my favorite commenters over the years was "Knee Pain." She seemed to be the epitome of a "can do, never say die" attitude. She got discouraged, I could tell, but vowed not to give up. So I was particularly pleased to be able to offer her success story.

* This was a "train through the pain" success story. I shared it, but with a caveat that the approach taken wasn't one I would endorse. But still: it's good to be open-minded about ways to heal.

* "Karen" shared a success story that involved my favorite sport: cycling. But she had a clever way of dealing with the sometimes too-heavy joint strain of pedaling.

I hope you enjoy these and are able to learn something from them!

Another Success Story to Celebrate!

I love success stories. They lift the spirits of people struggling to stick to what can be a years-long process to rehabilitate their bad knees.

I was pleasantly surprised last month to learn that TriAgain, an Australian triathlete who was one of the first people to post comments on this blog, has announced that he has completely healed.

"I'm declaring my knees 100% fixed now," he wrote in a comment. And how long did it take?

Only ... eight years and six months! How's that for dedication to a cause? It makes my own experience seem like a walk in the park.

Congratulations to TriAgain! There's more on his story here; I wrote about his battle back in September 2015. And his latest comments are here.

One thing I have come to realize is that we all don't heal in quite the same way, or hold quite the same beliefs. For instance, I'm quite skeptical of the value of stretching. Meanwhile, there are some who have healed from knee pain who swear stretching really helped.

But I think we agree on the important stuff. To me that's:

That bad, cranky knees can get better. If you choose to give up on your knees, that's your choice, but it's not as if they must inevitably stay the same or get worse.

That the road to recovery is often not easy, and there aren't any gimmicks or magic pills. I suspect that a number of people bought my book looking for some "secret" on page 159 or some such. I truly learned a lot from having knee pain and healing, but there's no magic juice or exercise that does the trick for all.

That healing requires a certain fortitude, optimism (but very much grounded in the possible), tenacity, determination, and stubbornness not to give up the fight, even when you seem to be losing (and there will be plenty of those times).

That, in a world where facts sometimes don't seem to matter, facts and science really do matter if you are serious about healing, because a knee pain sufferer is running an experiment of sorts, trying to unlock the combination that leads to steady, slow improvement (per Scott Dye).   

That patience is a key virtue, because it can take months (or even eight years) to get better.

A Good New Year's Resolution: A Vow to Be Patient

I was out doing my twice-a-day walk recently and a thought struck me, as I kicked a rock out of the way.

If you found a rock, and put it outside, and took a close-up photo of the rock once a month for ten years, you would have 120 photos, and would probably arrive at an interesting conclusion:

Rocks don't change over time. The rock in the first photo would look identical to the rock in the last.

But we know that rocks do indeed change over time. It's just that it takes a long time, usually, for visible changes in a rock to appear. Most don't look any different after 10 years, or even 100 years.

Similarly, healing from chronic knee pain can be maddening, because it's so slow. On any given day, it can seem that there's been no progress.

In fact, in a way, it's worse than watching a rock, waiting for some change to occur. With a bad knee, you will have good days and bad days and in-between days, and you'll feel like you're going forward and then sliding back a few days later. In the end, you may feel so confused you want to give up.

That's why, as we approach the new year, I think the best thing many knee pain sufferers can do is adopt an attitude of patience. Healing is usually not quick. Go into your knee rehabilitation program with that mindset, and you can only be surprised pleasantly if healing is faster than expected.

But if you go into your program thinking, "I can fix this in a few weeks," you risk being so frustrated that you lose hope.

So, I'm wishing everyone out there with knee pain some patience in 2021. Good things can happen. Just look at the many success stories on this blog (there was just one posted in the comment section last week).

But patience is often necessary. And that patience will be tested severely, so be prepared for that too.

Open Comment Forum: How are YOU doing?

I figured I'd do an open comment forum today, hopefully to stir up some discussion.

As usual, feel free to bring up whatever you want in the comment section below: new studies, vexing knee problems, lingering frustrations, what's working, what's not working.

If you don't feel the need to say anything in particular, then if you've been a knee pain sufferer for a while (and a visitor here), it would be nice to hear an update of how you've been doing. Often, I've been happily surprised to hear from people who started leaving comments seven or eight years ago, then disappeared for a while, and later resurfaced to share their stories.

Mine is, unfortunately, a rather boring story at this point. I feel like a bit of an impostor sometimes. See, I have this blog about chronic knee pain, but I don't have chronic knee pain anymore. Now, knock on wood, I'd like to keep it that way and don't want to tempt fate. I'm aware that circumstances can change swiftly.

But it's a relief not to have to plan my life around a pair of complaining knees. Yesterday I rode hard on Zwift (virtual reality cycling!), banging out close to 3 watts per kilogram for two and a half hours. Today I meant to go easy on Zwift, then got suckered into trying to catch a large group of riders climbing a long, steep mountain road, and so I had another intense session.

And my knees are fine. No ice. No stabbing pains. Nothing. I know I'm lucky that my knee pain story has become boring.

But what about you? Anything to share? Please leave a comment below!

'I'm Only 18. I Have Knee Pain. What Now?'

Recently, an 18-year old suffering from knee pain left some questions in the comment section.

A brief synopsis of this case:

I have been experiencing patellofemoral pain (as well as achy quads and calves, and some sharp medial pain that comes and goes a bit too much for me to fully attribute to a meniscus tear) for 7 weeks now. ... I am only 18 years old, was previously fairly active on a day-to-day basis, and a runner and casual player of many sports. I can work out why my pain (probably) started - a sudden fitness obsession after months of a mainly sedentary lifestyle brought on by the pandemic and moving from a relatively flat area to a rather hilly one.

Then, the person asked:

After reading your book and Paul Ingraham's, I have some questions. Firstly, I know that both of you encourage rest and many doses of light exercise to slowly build up joint strength. This seems reasonable. But what did you do (or what do you recommend) when you were *not* able to rest and *had* to push that envelope of function? Does this mean constant setbacks, or is it possible to push it a bit and then rest/light exercise for a longer period of time?

This reminds me of something that of course should be quite obvious: We live imperfect lives in an imperfect world when it comes to developing programs to heal. We have to sit too long at desks at work. We have to climb hills sometimes to get to the commuter train station. We have small children who insist on being carried around.

What's the answer to all these knee-unfriendly obstacles that are part of everyday living?

I wish I knew. Luckily, when I lived in Hong Kong, I was largely able to control my healing program. But I quit my job and had no family at the time! This enabled me to conduct a scientific-like experiment, and not many have that luxury.

My best thoughts on this are that people should control what they can, closely monitor what they can't, and try to learn from mistakes. So for instance, if I know that I have to walk up a couple of hills just to get to my train station (which I can't control), then maybe I don't take a long walk at lunch and instead do something less intense (which I can control).

Also, if I'm doing something that turns out to really bother my knee (in other words, I made a mistake), I should try to learn from that. But what if it's something I can't control, like walking up those hills? Well, humans are quite ingenious and can often solve difficult-seeming problems.

So maybe I try walking up the hills much more slowly. Or I hitch a ride with someone. Or?  

And then this question:

Secondly, do I have a chance of this not lasting as long as your pain and the pain of some others in this blog, as I am starting my attempt at recovery (hopefully) early and because of my age?

I think your age is definitely a positive factor, being only 18. And if you've only had your knee pain for seven weeks, and you're already serious about fixing it, you should be in very good shape indeed.

Try to be positive! Which leads us to:

Thirdly and finally, what advice do you have about the emotional side of pain? I was very depressed and anxious for over a week after one of the remissions and I am now grimly aware that this recovery may be a long, non-linear process and I may never get back to running or competitive sport again.

Well, heck, that sounds grim! I already sense a lot of negativity here. So I would tell myself:

I'm only 18. I haven't had knee pain that long. I have a great chance of beating this, and I will.

What I might do, if I were you, as you seem to like to be very active: Figure out a new knee-friendly sport to throw yourself into (well, ease yourself into may be a better phrasing). I think cycling, if you can tolerate it, can do wonders for bad knees. Some people like swimming, or exercising in the pool.

Again, try to be positive! I've read a lot of very tough, hard-luck cases in the years doing this blog. And yours, be thankful, isn't one of them. You seem like a great candidate for figuring this out and being able to do a lot of the activities that you did before this pain crept into your life.

Good luck!

If anyone else has any thoughts, please chime in below, thanks. 

When Knee Pain Comes With Golfer's Elbow

 I got this comment recently:

Hey Richard, funnily enough I have now developed that elbow pain you were talking about in your book. Has yours healed now? Any tips?

That "elbow pain," for me anyway, was "medial epicondylitis," also known as golfer's elbow.

Some context: I had had the knee pain for a while. The golfer's elbow just came out of the blue. There were no identifiable triggers for it. None at all.

Of course, as many of you know, this led to a lot of musing on my part about the ghost of inflammation loose in the haunted mansion of the body (if you want to ladle on those Halloween metaphors).

In other words, once inflammation takes up shop somewhere, in a matter of time you can develop other weird, seemingly unrelated problems in distant areas of your body. And I think the problems may be connected.

I have not seen a lot of science on this, so I could easily be wrong here. But I find it very odd that, as my knee pain deepened and persisted, various other ailments began to plague me, from the golfer's elbow to back pain (though that had a proximate cause, because I was sitting in an unnatural position).

Anyway, to the question: what to do?

I had terrific success with eccentric bicep curls (look them up on YouTube; you'll find lots of videos).

We're all accustomed to regular bicep curls, where the effort is expended in curling the weight up. For the eccentric version, the emphasis is on slowly releasing the raised weight back down to the starting position.

Over time, I really think this rebuilt the chaotic tendon fibers. My tendons went from being painful and dry and crackly feeling (they were almost like parched sticks, it seemed) to normal. I have no problems today and there's no reduced tendon strength as far as I can tell.

Be patient though. It does take time.

That's my experience, at least. Anyone else with any other ideas?