Fighting Through That Hopeless Feeling

I got this comment from my latest blog post, and I imagine a lot of people here can relate:

I’ve been suffering from knee pain for 8 weeks now. I fell into the trap of “resting” and immobilizing because I was scared of pain, and because I couldn’t get free of the pain. Along the way I found your blog, and decided to try your methods. I finally got free from the pain 2 weeks ago. I walked 1,500 steps in the course of a day. Doing 50 to 100 steps every hour. And I woke up the next day with a return of pain. I’m so crushed and in disbelief. How did I go from walking 6 miles a day to unable to walk barely half a mile without pain? I feel so hopeless. I’m only 25.

Setbacks. They are ugly and so, so depressing. This fact has come into greater focus for me now, as I try to recover from whatever is ailing my left foot (maybe plantar fasciitis?). Twice, I thought I had this foot problem licked. And twice, I have had setbacks. Ugh.

So what should be said to someone who is only 25 and is unable to walk barely half a mile without pain? And who feels like everything is hopeless?

Well, first, I guess I'd say: look on the bright side. You're 25. That may be seen as a curse (what 25-year-old is cursed with chronic knee pain?). But it can also be viewed as a blessing. Younger bodies generally heal better. I would not write off being able to heal at any age, but it gets harder as a 65-year-old.

Then: have you seen a doctor or therapist? It might be time, if not. Sure, a doctor might leave you frustrated and confused. But it's possible that this doctor -- or an imaging test that's done -- may discover something going on in your knee that, in the end, will put you on a smoother glide path to healing. It always helps to have a professional examine your bad knees and question you about them and offer an opinion about what's going on.

And then, on your setback: I know how this feels. I remember trying to heal my knees, and the times when I pushed them a little too hard and suffered a setback. It was always crushing. That's a reason why, to this day, I say that healing my knees was by far the hardest thing I did in my life (and, as a result, the thing that I'm most proud of).

If walking bothers you now, you might think of trying gentle cycling (a stationary bike is generally better, as it's easier to control the force applied) or gentle movement in the water (is there a pool nearby?). And, if it makes you feel better, make yourself a big "I've Fought Through a Setback" badge and wear it proudly. You'll have more. That's typical of healing through knee pain.

Lots of luck, and don't give up!

Why to Be Optimistic About Recovering from Knee Pain

Right now I can't ride my bike. I'm frustrated.

But all this has absolutely 0% to do with my knees. Rather, the weak link in the biomechanical chain for the past month has been a sore left foot. Why is it hurting? I don't know. Part of me thinks that it's the dreaded PF: plantar fasciitis.

Of course because exercising becomes addictive, I was slow to walk away from the bike and my active lifestyle (sound familiar? welcome to how Type A people deal with sports injuries). I don't have easy access to a pool (and am a poor swimmer), so I'm casting about for some other cardio activities. I am toying with the idea of buying a rowing machine.

Anyway ...

That's just a quick update of me, and where I'm at currently: great knees, lousy left foot. During this self-imposed period of being on the sidelines, I've had more time to reflect. I don't contribute much to this blog anymore, but then I see a little spurt of book sales (kind of amazing that the book still sells, even in modest numbers), and I think of the "knee journey."

I know occasionally I post about it, the Big Picture Overview, for people who may have just stumbled onto this blog. I know how they feel, and how they're struggling with trying to digest so much advice, some of it conflicting. I know that in a fresh way too (with my left foot, I'm seeing "walking barefoot is good" and at the same time "don't walk barefoot," e.g.).

Today I just want to talk about one uplifting, inspiring part of my journey: realizing that the old doc's line that "bad knees can't heal; they'll just get worse and wear out over time" was a load of crap.

The thing is, the more I thought about it, the less sense it made. Our bodies are designed to heal. Even brains adapt after horrible traumatic brain injuries. How can a knee joint -- a joint that has evolved to take a lot of pounding force, day after day -- not have any capacity to improve?

But what happens is bad knees have a much smaller "envelope of function." They can't tolerate as much stress. So when you subject them to the normal forces that normal knees can withstand, yes, they do get worse. And yes, if you continue to do that, you won't get better.

The first problem is, most of us are great at digging holes, and not the good kind. We feel twinges of pain and we think, "Oh, I'll exercise through it" or "It'll go away soon." We don't try to modify whatever behavior is contributing to that pain for a while, and sometimes a long while. We dig a giant hole for ourselves, where we unhappily find ourselves at some later time, desperate for the solution to our nagging knee pain.

It can require radical changes to get your knees back within that "envelope of function" that will allow healing to begin, very slowly. Most people, I'm now convinced, lack the patience and determination and sheer willpower to heal their bad knees.

But even before you set out on the journey, you have to start with that little seed of optimism: that it's possible. I did it. Someone who posts here under the name "Knee Pain," she did it. And "TriAgain," who also posts here, he did it. I have more respect for these people than for myself, and my journey, because theirs took longer and seemed to me to be more difficult.

But it all starts with a simple premise: bad knees can get better. You have to believe that. I did, not because I'm some kind of starry-eyed optimist, but because the rational part of my brain told me that this was the only viewpoint that really made sense.

How the Idea of 'Sunk Cost' Relates to Recovering From Knee Pain

I was thinking of the idea of "sunk cost" a few days ago while trying to fix the vent for my dryer.

The vent is a four-inch wide tube, made of thin metal, through which the dryer's hot air whooshes outside. Ours is old (like everything in this old house) and I had to replace the cracked cover. Among other things, the cover keeps small animals (and insects) from entering your house through the vent.

I bought a replacement cover at Home Depot for five or six bucks. But when I got home, I immediately noticed problems: It wouldn't fit over the existing, slightly crumpled end of the vent. Also, the screw holes to hold the cover in place weren't aligned with the existing holes.

I started thinking about how I'd have to drill new holes through the siding and into the house. I'd have to get a smaller vent pipe, that would fit my new cover. I went to a hardware store in that frame of mind ... and then ...

Voila! There was a vent tube for sale with an already attached cover. At first I passed it by -- after all, I already had a cover. But then I realized: No, wait a minute. This might be exactly what I need. So I bought it, took it home, and it fit just about perfectly, no new holes needing to be drilled.

The vent cover I had just bought? I realized it was a "sunk cost" (I couldn't really return it by then, because it had been scratched up after my attempts to jam it onto the existing vent). I had to write it off and move on.

Swallowing a sunk cost can be very, very hard to do. It's in human nature not to want to give up on something that we're invested in. I know five or six bucks isn't much at all, but my thinking had completely swung around to, "How do I make this work because I've already bought it?"

Similarly, with knee pain, if you're experimenting with ways to heal, you will sometimes have to accept the harsh reality of a sunk cost. As readers of my book know, I followed a very structured plan to get better.

But sometimes that plan just wasn't working, for whatever reason.

In the book, I described going to Tibet, doing some very slow walking with my wife (fiancee at the time), and feeling like my knees had been reborn. I was getting better! So when I returned to Hong Kong, I vowed to strengthen my leg muscles, as my physical therapist had been urging, to make sure my knee pain didn't come back.

But instead of the gym exercises pushing me beyond knee pain, they pushed me back into knee pain. My old problems returned. I stubbornly persisted with the exercises until it became impossible to ignore: they were hurting me. I couldn't continue that way.

In essence, I was staring at a sunk cost of sorts. I had invested heavily in this "strengthen your quads" approach. I was religiously going to the gym, lifting leg weights, trying to get stronger. Meanwhile, my knees were getting worse. To continue doing the same thing would be insanity.

I did walk away from that approach, but it was hard. It felt like I was giving up in a way. I had sunk my time and faith into something that didn't work. It's difficult to accept that, first of all, then summon the strength to move on.

Still, there will be moments in the journey to recover from knee pain where I think we do have to write off an approach, a belief, or whatever -- as a "sunk cost." We invested in it, sometimes to an extreme degree. But if it's not paying dividends, then the smart thing to do: go ahead and write it off and accept the loss (of money, time, or whatever).

Then find a new way forward.

'Your Knees Will Never Get Better'

No, no. A thousand times no. If your doctor is saying this, you need to find another doctor. This is the one thing I am convinced of, after a months-long personal struggle with knee pain that I won.

I thought that today -- a day when I honestly wasn't sure whether to write a blog entry, or just disappear into the basement and do an hour or two of easy cycling -- I would make a short post on this subject.

It is really the "raison d'etre" of this blog, and of my book. I wanted to counter the pessimism because I heard the same "your knees will never get better." And they most emphatically did.

I know that some doctors say "your knees will never get better" because they don't want to sugarcoat the reality of knee pain, because they truly believe they are speaking the truth. Maybe that's the saddest part, that they just aren't aware of how aching knees can heal.

It's not easy, but it can be done.

Here are some posts I've written on the subject:

How I Saved My Knees (in Dialogue Format)

What I Did to Save My Knees

Plus, as a bonus, for anyone who has an aching back ... 

How I Saved My Back

All free posts! (The blog is always free!)

And: anyone with a success story they want to share? (I always love to get those stories out there.)

A Success Story: Gradual Strengthening and a 'Reconditioned Brain'!

It's a new year, so what better way to start than with a success story? This one I got in the comment section. I edited it lightly:

I'm a long time reader. I first had knee pain in 2018 and lived with it through lockdown. It was agony. For much of it, I was ready to just chop my leg off.

Through walking, and cycling, and following your advice I healed about 70% in 2022. However, my wife and I learnt that we would have a second child in 2023 and I was desperate to fix it even more.

I visited my 5th physio. The others hadn't helped at all, but this physio had been highly recommended and seemed, well, enlightened.

So we began a very, very gradual strengthening program, always playing it safe and being careful. The physio was convinced I'd been badly advised by a doctor (who said I had very cracked cartilage and was basically a lost cause). This time, my physio reassured me that they were wrong, and that nearly everyone my age (45) has wear and tear, but that lots don't feel pain.

The physio based her treatment around the concept that the pain I felt was a memory - something stuck in my nervous system.

By slowly strengthening, I both made my leg stronger, but also reconditioned my brain, telling myself that the knee was good now and the pain had gone.

After 6 months of this, I was able to return to light jogging in summer 2023. Jogging now is helping - my knee feels strong, pain free and functions so much better.

My physio now feels that it wasn't cracked cartilage that caused my agony, but patella tendonitis .. My tendon certainly feels stronger now, and doesn't complain when I kneel on hard floors.

I would never have believed I could get back to running and cycling. One physio told me that I'd been stuck with it for four years so it was 'chronic'. I hope my story gives hope to others, as yours did for me.

Great to hear! I don't know as I really have much to add. Very, very gradual strengthening? Great idea. Pain as a memory, stuck in someone's nervous system? Hmm ...

That part reminds me of a post I wrote last year, Rethinking Osteoarthritis Pain (a Recent Presentation Now on Video). The speaker in the video talked about how bad knees are about more than the knee, and more specifically, as I wrote then:

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.

Interesting, and if that does happen, it wouldn't surprise me at all. I think the longer that someone lives with chronic inflammation, the more mischief it stirs up in the body.

And not in a good way.

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!