TriAgain, an Australian triathlete who has spent long years rehabbing his knees, left a link behind to a post that I found amusing.
Amusing, I guess, because it does sound a lot like what I’ve been preaching for the last 15 or so years (and what Doug Kelsey was preaching before me) about the ability of knee cartilage to strengthen and heal. It’s by a fitness coach called Julien Raby.
Right near the top, he says:
Cartilage is a living tissue with active cells that respond to movement — and certain types of movement can actively help it rebuild.
Yes, yes, exactly. He then goes on to helpfully explain:
Cartilage consists of living cells called chondrocytes, which produce collagen and matrix—two components responsible for the tissue’s ability to absorb shock and allow for smooth joint movement.
These chondrocytes respond to specific types of physical load by increasing anabolic (building) activity. In other words, move right, and the tissue gets stronger. Move wrong, and degradation accelerates.
That’s pretty much the formula, in a nutshell. Of course finding that sweet spot of exactly the right amount of movement, that builds up the tissue instead of tearing it down further, generally involves a lot of exasperating trial and error. Or at least it did for me.
But the underlying optimism is correct, I’m convinced (cartilage can heal). And so is the broad prescription (movement, of the right kind, and in the right dose).
I’m not sure I agree with all he has to say. He thinks leg presses are a suitable high-repetition activity for knee pain. I’d be rather doubtful, but maybe if the weight is very light and the motion is smooth and easy? Also, he mentions glucosamine as a “promising” nutritional supplement — I tend to doubt that, for reasons explained elsewhere (on this blog, in my book), but your mileage may vary.
Still, it’s great to see someone out there proclaiming cartilage can heal, so confidently and so openly. When I published “Saving My Knees,” fifteen years ago, I hoped and thought that the day would come that the thinking about knee pain would evolve. The old model, that knees simply wore out like a pair of old tires on a car, never made sense. It amazed me that so many people bought into that line of dismal thinking, and not because I’m a pie-eyed optimist (if anything, I’m a pie-eyed pessimist).
And here we are, a decade and a half later, and there are more voices emerging, saying, “Hey, cartilage can get better. Your knee pain today doesn’t have to be your knee pain forever.”
That’s a great message to have at your side if you’re trying to recover from knee pain.
Hello Richard
ReplyDeleteThank you for this post.
This makes some positive perspective for my joints.
Hi mr Richard.
ReplyDeleteI commented on your previous post thanking you for your book because i struggled with chondromalacia patella in both knees for over 1 year having a "joint first" mentality taught by many PT's. After i discovered your book I was amazed by how blind I was before. Your book opened my eyes. Instead of focusing on the actual joint, the doctors/PT's focus on the muscle first and thats doing damage to the cartilage if the CP is advanced enough. And my CP is pretty bad.
3 weeks ago after I found your book I started a biking program. 10 mins 2x/day very low resistance. I progressed well the first two weeks and I increased the volume by 5 mins the first week and 5 mins in the second so after two weeks I was doing 15 mins 2x/day. After I increased the volume the second time, my left knee started to feel weird while biking and afterwards. The feeling I can only describe it its like 10 very small needles pinching the kneecap and the surrounding area every 2 seconds but in a very weird way (not actual pain, its more like a radiating sensation 1/10 painful). I tried switching to 10 mins 3x/day but i still have the same feeling and it persists throughout the day. I noticed the feeling appears and increases after the minute 8 of biking so I'm thinking about doing 3x 7mins/day and go from there. I'm not sure if I should go even lower on the volume if this doesn't work or to drop biking completely and try a walking program and start from 6-7 mins of walking 3x/day. Or I can even try pool walking since I have a pool close by. I am determined to save my knees and I am eternally grateful to you for writing your amazing book.Maybe you'll have the time to answer to this comment. Thank you again for everything . Cheers
Edit: "I struggled with chondromalacia patella in both knees for over one year having a "MUSCLE FIRST" mentality taught by many PTs
DeleteI'm also curious about how you dealt with flareups. Lets say you were walking one mile two times per day and you had a flareup. How much would you cut from the walking volume and for how many days? Did you ever stop completely for one or two days if the flareup is bad enough?
ReplyDelete