Beating Knee Pain: In Praise of Water

I guess that headline could be taken two ways. Drinking water is always good for a water-based organism. But the water I'm referring to here is the kind that you move through: in a swimming pool, lake or ocean.

I'm thinking about water therapy because my wife (who has a bad knee and has put on some weight) just joined a gym. I get my workout on a bike trainer in the basement; she will now go to the pool.

This was her first day. As she was preparing to leave, I shared my usual warning, "Be careful not to overdo it," while feeling quite certain that she would. She got back and said she felt some discomfort in her knee. I'm pretty sure she did overdo it, but I've got my fingers crossed that she didn't go way overboard.

Tomorrow will tell.

Still, I think returning to the water (she likes to swim) will be a good thing for her, and her knee. I tried to get her to ride a spare exercise bike in the basement. She never took much pleasure from that, and I think it was a bit irritating for her knee joint, even though I told her to keep the tension low.

She's definitely more excited about swimming.

I think water activities are great for bad knees, though you still have to be careful. Originally, I thought water would play a much bigger role in my recovery than it did. Probably it didn't because (1) I'm not really a water guy; I never learned how to swim and tend to stand around shivering in the pool (2) The water activities that I could do without aggravating my knees weren't that interesting to me.

In the end, I went the walking route, and as I say in the book, many weeks later I climbed out of the knee pain hole.

But anyone with access to a pool who has knee pain, and who enjoys water, should definitely try a program of water exercises. Linda Huey has some in the book she co-authored, Heal Your Knees, which is available on Amazon.

The buoyancy of water is like having a magic immersion machine that unloads your joints in space. If you're in the water up to your chest, no matter which way you turn, bend, step, jump, you're getting the benefits.

If you prefer to swim, consider wearing floats on your ankles (those same floats that are designed to be worn on the arms), until you're sure that the kicking motion doesn't worsen your knee pain. I used them myself with some success.

Make a splash! Good luck!

Happy Holidays, My Facebook Policy, and Good Cheer to Share!

We're almost at the end of another year!

First, a quick note about Facebook: If you want to message me there, or friend me there, I wouldn't advise it. I'm trying to get off Facebook as much as possible and rarely use it.

An incident last weekend is one reason why. I clicked a link from a long-ago friend, and it turned out to be a virus. My life is already busy enough without having to fend off Facebook viruses.

Most friend requests, I ignore. Virtually all messages, I ignore. If you want to talk to me ... well, there's this blog, and that's probably the best way.

Happy holidays! We're almost at Christmas, and let me ask you: what are YOU grateful for as this year comes to an end? Me, I'm so happy to have knee pain way behind me in the rearview mirror. It's just a fast-receding speck, and I'm delighted about that.

I'm not so cocky as to think I'll never have knee pain again ... maybe someday ... but this time, I feel like I'm prepared, if I do face that demon again.

So once again: what are you grateful for, in your knee pain battle? No need to say "this blog." I appreciate such sentiments, but I'm really not that needy. 😃

And finally, the good cheer: I was looking through the comments, deleting the junk commercial messages, and I came upon a comment from someone I would never recognize in person, as I've never met her, but that I have a soft spot for nevertheless.

She was here in the early days of this blog, and I admire her courage and perseverance and spirit. I really feel like a slacker compared to her, considering what she has been through. She goes by the moniker "Knee Pain," and she made this comment a week or so ago:

My back story is that I had a very, very long struggle with debilitating knee pain. Previously it was so bad I could sometimes barely walk -- even to the point of using a wheelchair on multiple occasions. But, now my knee is doing so well that I can hike for miles! I can road bike up hills! I can do open water swimming for over a mile. I can do swing dancing and rotary waltzing. In 2020 I started a new hobby of backpacking which you can imagine is very hard on knees, but, I can do it. It's amazing.

Love it! Knee Pain, keep sharing your message of hope and triumph! Everyone else: never give up!

Best,

Richard

On Knee Pain and Arbiters of Truth

I want to talk about something a little different today. At first it won’t seem at all related to my experience with knee pain, but I promise to connect the dots.

I want to talk about truth, and about arbiters of truth, and about powers given to those arbiters.

We’re still in the middle of a pandemic that has badly frightened and confused many of us. We are scared of getting the coronavirus and are desperately searching for guidance on what to do.

I’ve been vaccinated: both shots, and the second one walloped me. But I’m a data and science guy. I’ve read enough about Covid, and long Covid, that I don’t want to take my chances with either one.

Yes, the vaccines in rare cases can cause bad side effects, but if you’re playing the odds, Covid has a much higher chance of leading to serious damage.

Nationwide, there’s been a push to get more people vaccinated. Amid that has been an alarming rise of disinformation about the vaccines. On social media sites now, like Twitter, staffers have begun to label tweets that are considered false or misleading.

Apparently too, according to this ABC news story, people won’t be able to comment on, like, or retweet certain messages, such as “vaccines cause autism.”

As a guy who likes data and science, I suppose I should be delighted. But honestly, this entire project makes me deeply uncomfortable.

Yes, we have a bad problem in the United States right now. The inability of many Americans to evaluate arguments, in a logical, methodical way, is stunning. We’ve increasingly abandoned reason for tribal affiliations. We’ve become a nation of Team Democrat vs. Team Republican.

And your team apparently determines how you perceive truth, as insane as that sounds.

Still, this idea of “truth arbiters” cleaning up content bothers me. “Truth” is not a static, fixed thing. It changes. And “official truth” is even more suspect. Do you recall the early days of the pandemic when the country’s top health officials told us not to wear masks, that they weren’t effective?

Imagine if the Twitter truth sanitizers had gone through tweets, labeling any pro-mask tweets as “misleading.”

As for the Covid vaccines being safe: I honestly think they are. Am I 100% sure? Of course not. Could we find out, in some longitudinal study conducted in 30 years, that people who got these vaccines had a 60% higher risk of kidney disease, or some other thing?

It seems unlikely, but possible. We’re in the early days with these rapidly developed vaccines. I don’t regret for a moment getting one, but I also don’t know what the future holds.

Imagine that there was some terrible, as yet unknown side effect of getting these shots. And that a small number of people began to tweet about it. The self-appointed truth minders at Twitter would put a damper on that dialogue, fast.

Again, I want to be clear: I’m pro-vaccine. But I also look at things with a kind of radical open-mindedness. Anything I know, I realize, might be false. It doesn’t mean that I quickly ditch any well-founded beliefs that I hold in the face of a few bits of contravening evidence.

But part of me, deep inside, says: Anything is possible. That’s why I don’t like people who screen what’s true/not true for me.

Sure, you might be thinking, good for you. But not everyone asks the right questions, analyzes critically, weighs the evidence and probes for weaknesses in it.

And that’s a deep, deep problem in America today. But I think the answer lies in lifting people out of ignorance, even though that’s a harder thing to do. If you simply stamp that ignorance “false” or “misleading,” you drive them underground, into their little warrens of like-minded conspiracy theorists.

What does this have to do with bad knees?

My book, that I felt so strongly about writing, represents a minority viewpoint. I’m sure if it were passed around to many physical therapists and doctors, they would be inclined to label it “false” or at least “misleading.”

And because of that label, many people who might benefit from Saving My Knees would have been discouraged from reading it.

So just keep in mind: today’s “truth” may not be tomorrow’s. That’s one thing that my chronic knee pain experience taught me.

Okay, I’ve gone on far too long! If you have questions about your knees, leave them below. Or, if you have a good knee story, leave that too and I’ll devote a post to it.

Cheers!

Be Careful Not to Become a 'Knee Obsessive'

There were a lot of comments after the last post I made. That's great! I'm sure a lot of you are benefiting more from talking with each other than listening to me, as my bad knee experience fades from memory.

One comment struck me as especially interesting, because "Lindsay" listed some things that have helped her. What got me thinking was what she put near the top of the list:

2. Having time in a day where I do not research cartilage/chondromalacia/patient forums etc.

3. Exploring new interests: photography/more reading/films/kayaking

4. Not telling friends too much about my condition ...

I could definitely relate to this. When I had bad knees, I was scouring the internet constantly, looking for advice, for research, for anything I could learn from. If someone wrote a 20-page paper on "the effects of pickle juice on chondromalacia," I probably would have read every single word.

As you all know, I followed my knee progress, during my recovery, with an uncommon obsession. When people asked me casually at work, "How are your knees?", I would answer them as if they really wanted to know, when usually they were just making the equivalent of small talk.

After a while, I figured out I had become a "Knee Bore" and started to limit my responses so as not to drive away my colleagues. Who wants to chat with a guy who's always yapping on about his knees, and his latest ideas for how to heal them?

I also realized, after I wrote my book, that I may have done some harm along with some good. A knee journal was a great idea for me, and I do believe in carefully listening to one's knees, but ...

At some point, you do have to take a deep breath. And exhale. And relax. And try not to think about your knees every hour of the day. My book tends to encourage the idea that you have to be scribbling notes about your knees and running experiments on them all the time.

So, to address that, I want to point out that I found meditation useful. I'm not a natural meditator, so it didn't really come naturally to me, but I could feel the benefits.

Obsessing over your knees can be bad, if for no other reason, because healing takes so long. If you're just sitting around all the time, wondering about your knees, thinking about your knees, you're doing the equivalent of standing in a room watching paint dry.

Anyway, I thought it was worthwhile to give a thumbs up to this idea of exploring new interests. Try to take your mind off your knees for a while. Be knee conscious, but try not to be too knee obsessive.

I think it's a good distinction. 😊 (Boy, the blogger emojis are really bad, huh?)

Mastering the "Goldilocks" Problem With Bad Knees

I found this recent comment interesting, as one of the most frustrating aspects of healing bad knees is getting the "Goldilocks principle" right: You don't want to move too much. But you don't want to move too little either.

I find your book useful as you say that during your initial months, you were not sure if you were improving or not and it was by month 7 that you knew your plan was working.

So you need to move your knees. To me, that's like a First Principle, not open for debate. Knees that don't move at all will only get worse.

But then how much do you move them if they hurt all the time/most of the time/some of the time? And how can you tell you're on the right track with your program?

This is very, very hard to do. It's where many people fail, I'm sure. There is no "Just do this" blueprint. Just imagine how easy healing would be if the prescription was something like, "Take 800 steps a day for the first four weeks, then increase that by 200 steps a day for the next four weeks, etc."

The problem is, that may be just right for your knees. Or too much. Or too little. Or your best approach to healing may not be through walking at all.

There can be a lot of experimentation during those first few months that feels more like flailing around. It's important not to push your knees too hard. But you do have to push them at least a little.

So what does that mean?

What helped me the most was when I decided to err on the conservative side, in a big way. I started slow, very slow, then chose to build from there. That's not always an easy path to follow, especially for a Type A personality, when you feel you should be doing more.

But the unfortunate reality is that, yes, there can be entire months where you can't tell if you're getting better, backsliding, or simply moving in place. It's frustrating. But you can take some solace in knowing that many others go through the same thing. You're not alone!

Will Quad Sets Help Your Knees?

This came up recently in the comment section.

I remember doing quad sets during my recovery, and my knees didn't like them much. So I stopped doing them and got better anyway. Because of my personal experience, I never really looked that closely at quad sets.

Doug Kelsey does so here, though, in "The Ultimate Guide to the Most Misunderstood Exercise for Knee Pain." He makes some interesting observations:

(1) That quad sets are sometimes prescribed for a mistracking patella. And he dashes some cold water on doing quad sets for this reason.

(2) That quad sets are sometimes recommended to strengthen the thigh muscles. But, alas, they're not really great at this, because they generally don't stress the muscle enough.

(3) That quad sets are definitely useful for something else: thickening the synovial fluid that helps cushion impacts in the knee joint and just makes movement easier in general.

For this use, he advises 100 repetitions a day, in sets of 10. Patience is helpful too: beneficial effects probably won't appear for two months.

What is the science behind this? I'm always curious about that. It appears that the seminal study, which Kelsey himself cites, goes back to 2003. The sample size was a bit small (20 subjects, with a total of 28 bad knees), which isn't optimal, but what they found was without a doubt impressive.

The subjects did an isometric exercise that involved keeping their leg straight and raising it. Patients were told to do the exercise 90 times a day. Joint fluid was taken from their knees at the beginning of the trial and after 12 weeks.

What researchers discovered:

Joint fluid viscosity increased from 45.8±7.6 to 59.8±8.6 mPas (P<0.05). In contrast, there were no significant changes between at baseline and after 12 weeks in the patients without any treatment.

A roughly 33% improvement is really good. Note that these aren't exactly quad sets that the patients did, but I have to assume the benefits are similar.

Anyone out there who has a story to share about quad sets, good or bad?

'I'm Not Dead Yet,' as Monty Python Once Said

Reading all the comments come in after I announced an easing away from the blog was almost like having a ringside seat at my own funeral. Part of me wanted to shout, "Hold on, hold on! I'm still here!"

Yes, my posting from now on will be more sporadic. The blog might go dark for months at a time, or maybe for good at some point. But we're not at that point yet.

If you want to keep the blog alive in some form, go ahead and post questions you have, and I'll answer them (and invite others to help me do so).

Finally, I did want to post this comment from Knee Pain. I realize to many of you reading this, "Knee Pain" is just another online moniker. But she's been with me almost as long as this blog's been around.

She is one of the original hard-luck cases. Look up her success story and you'll be amazed. Her comeback is much more inspiring than mine.

She left a very kind comment, and a great update on how she's doing.   

Hurrah for 10 year anniversary!! I'm very grateful that I found your book.

I remember I practically read it in one sitting. It was very encouraging and great to find someone who could RELATE to this tricky problem of finding just the right amount of movement BUT not too much that would cause a flare up

I remember stories that you shared that I could relate to like the one where you carried something kinda heavy around Hong Kong (maybe it was a fan?) and that caused a flare up. I carried a computer monitor down several flights of stairs and that caused a flare up and I also remember pulling a suitcase on a leash and somehow even that caused a flare up (I think because the act of pulling something heavy with just arm changed my weight distribution on my legs?) Argh.

I was just reflecting recently that my bad knee now seems totally reliable. I'm doing lots of walking and hiking and biking and even backpacking and.... I've stopped worrying that it is going to have a flare up. It doesn't even send me little grumpy warning signals anymore.

That said, I feel it's important to stay vigilant and keep moving and exercising and not get complacent. I don't want a relapse.

Excellent! That's the kind of comment that brightens my Sunday!

Have a good knee day, everyone.