Sunday, February 25, 2024

'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.)

Monday, January 15, 2024

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.

Sunday, December 17, 2023

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!

Sunday, October 22, 2023

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! 

Sunday, September 10, 2023

On Crepitus, 'Normal'-Looking Cartilage, and 'Real Pain'

I've received a few good questions in the comment section, and am a bit dry on blog posting material, so I thought: why not use these? The first one (edited lightly): 

I noticed crepitus in one knee about two years ago, but brushed it off. I had no other symptoms until I pulled my calf during running, and after that developed a baker's cyst. I rehabbed the cyst, but I was asking the physical therapist about the crepitus, and he said the same thing: unless there is pain, just ignore it.

I returned to life as normal without pain, but when I started training for a half and working on my squats I noticed the same posterior knee pain, but now on both knees. I took it easy for a while since it seemed everything I was doing was causing pain. Once I got back to running, I noticed tightness in the front of the knees although still only crepitus on one side.

I went back to the PT, who did an ultrasound and found no issues. I asked if he could examine the cartilage with other methods and he said that with just the ultrasound it's showing the cartilage is thick and healthy, so there is no need for other exams. I am trying to get a second opinion, but now I am in the trap of, "What am I really feeling? Do I feel real knee pain or is it only mental/psychological?"

I have also started having back pain, which I never really had before. I keep pretty active with cycling almost every day to work, but I have dropped running. I am afraid everything I am doing is destroying my joints, but am also afraid doing nothing is destroying my joints. Did you have issues of navigating this in terms of knowing what is real pain versus normal sensations your body is interpreting as pain? How do you navigate that? Also, how does one get your book if they live in a country where the Amazon site there does not offer it?

First, on finding my book if you live in a country where they don't offer it: it is also available on Smashwords. If you can't get it through Smashwords, no big deal. What I say in the book is scattered all over this blog. It's not like I'm holding anything back with the promise, "This secret is in the book!"

Lots of things to react to in this story (and readers may wish to chime in with their own thoughts). A few things to think about:

* Once I got back to running, I noticed tightness in the front of the knees although still only crepitus on one side.

"Tightness" can be swelling. As Doug Kelsey once observed, it doesn't take much swelling at all for the joint to tighten up. And swelling means you're pushing the knee too hard. What happened? I know very little about your situation but I can almost imagine:

Baker's cyst diagnosis. Stop/reduce running, focus on rehab, then when the "all clear" signal is given, ramp up running, perhaps too quickly. Problems then ensue.

* I went back to the PT, who did an ultrasound and found no issues at all with the knees. I asked if he could examine the cartilage with other methods and he said that with just the ultrasound it's showing that the cartilage is thick and healthy ...

Um, color me a little skeptical here. I think ultrasound might show the cartilage is of normal thickness. But I'm not sure how it can see whether it's "healthy" exactly. Also, remember: people with normal-looking cartilage can have lots of knee pain. Or people with rough-looking cartilage can have no knee pain. I do think there is a correlation between the amount of knee pain and how much cartilage you have and how it appears on an imaging test, but that's not a perfect correlation at all.

Further, crepitus can be a sign of early cartilage damage and thin synovial fluid. I had a lot of crepitus, but a relatively clean MRI.

* I have also started having back pain, which I never really had before.

Yup, sounds familiar. It could be a compensation injury (i.e., you're using your back in ways you never did before, to compensate somehow for the knee injury). Or, it could be what I call the ol' "poltergeist loose in the house, that keeps popping up in random rooms." Chronic inflammation can cause strange joint problems all over the body -- at least that's what I believe.

* I am afraid everything I am doing is destroying my joints, but also afraid doing nothing is destroying my joints. Did you have issues of navigating this in terms of knowing what is real pain versus normal sensations your body is interpreting as pain?

Doing nothing is definitely bad, but you may also need to scale back your activity somewhat. This can be a hard balance to achieve. Does the biking bother you? If not, then maybe become a casual cyclist for a few years (ramping up intensity over time if you can). Forget about running. Shove it right out of your mind. Maybe someday you can return to it; maybe not. Make your peace with that.

As for knowing what is real pain versus what are normal sensations masquerading as pain ... my default would be to assume it's all real pain of some kind, and to treat it carefully. Personally, I aimed for the least amount of pain possible. Even if it was all in my head, it felt real enough, and when I ignored the pain, it seemed to come back with greater force, so my approach worked for me.

However, TriAgain (who fought and overcome knee pain and often visits here) might have a somewhat different perspective. He took medication for a while to get on top of inflammation that was limiting him severely, and doing so was key to his recovery, so he might have thoughts on the mental aspect.

Best of luck and hang in there!

Sunday, August 13, 2023

Saving My Knees: the Elevator Pitch

Recently I was thinking about the "elevator pitch" for my book (which is basically what I learned about healing bad knees). The elevator pitch, as most people know, is the 30-second speech encapsulating something that can be fairly complex. It's supposed to be an idea condensed to the amount of time one might spend riding an elevator in a high-rise.

What put me in mind of elevator speeches was a conversation I had a few weeks ago with someone about what I did to heal my knees. Generally, I try to avoid the subject. There's so much that could be said; I feel sort of talked out on the matter; many people don't respond well to the book's core message anyway.

But occasionally I find myself engaged again in a dialogue on the topic, and my thoughts skip through a whole bunch of things and I get kind of excited until in the end I figure I've either made a convert to my way of thinking or my interlocutor thinks I'm crazy.

So I started thinking, once again, about the essence of my message. I guess it would go something like this:

You can heal your bad knees. The pessimistic doctors are wrong: knees don't just "wear out." But be careful: many physical therapists urge strengthening muscles around the joint, and that can further damage your knees. Broadly, the best way to heal involves lots of easy movement and very, very slow progress that can be maddening, with disheartening setbacks. More narrowly, you'll have to experiment some to find out what works best for your particular knees.

I think that's the essence of what I have to say. My particular story is what the book is all about. But, once again, no one needs to buy the book. The message is here on the website ... look around for a while and see whether or not what I'm saying makes sense to you. Everything I learned is here. Plus, on the website you benefit from getting to read some cool success stories about how others conquered their knee pain!

Sunday, July 16, 2023

Don't Discount the Placebo Effect

This was a strange story. A 60-year-old man, who lives out in the country, is suffering from knee pain. He consults with a neighbor, who advises him to try ...


As most of you probably know, WD-40 is a lubricant. I own some myself. It's good for freeing rusted machinery parts, stuck bolts, that kind of thing.

What happens when you apply it to your knee, repeatedly? Well, this man showed up at his doctor's office, complaining of his knee pain. The doctor noticed that the skin around his knees was "rough, reddish." It turns out he had been using the spray for months at that point.

You might think this is just a titillating story about something that a reasonable person would have the common sense not to do. But there's more to it than that.

The doctor told the man, of course, to stop spraying WD-40 on his knees, immediately. But what's interesting is that the patient reports that, when he first tried the lubricant, he "felt some relief," so he continued using it.

Felt some relief? From a smelly, petroleum-based chemical that's meant for things like lawnmower parts, not human skin (and what lies underneath)?

To me, this strongly suggests some kind of placebo effect. What's more, I'm convinced that there are a lot of suggested solutions for knee pain that involve the placebo effect.

I've never been convinced of the efficacy of glucosamine or chondroitin. Yet people swear by them. The placebo effect? I think that there's a high chance that's involved here.

I'm not sure the placebo effect is necessarily bad. If someone said to me, "On days, when I wake up and rub the belly of my lucky Buddha statuette, I have less knee pain," my response would be, "Keep rubbing the belly of your lucky Buddha."

Why not? A certain amount of pain is what we perceive on a subjective level. If we can somehow "trick" our brains into thinking there is less pain there, that doesn't seem like such a bad thing. But of course, the placebo effect works better on some than others. Sadly, I don't think it would help me much because of the way I am.

For others though, if something helps with your knee pain, and it's not doing harm to your body (or to your pocketbook, or at least not excessively), why not keep doing it?

Just don't spray WD-40 on your knees. Please.