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?
ReplyDeleteI've been reading this forum and I've seen many people sharing their story so I decided to share mine here as well.
ReplyDeleteI'll summarize my story before my knee injury first:
- I'm a 33 year old male living in eastern Europe
- I started trail running in 2021 and ABSOLUTELY LOVED IT
- I trail ran casually (20-30 miles/week) from 2021 to 2024
- In 2024 I first injured my plantar fasciitis of my right leg (got it fixed eventually by wearing zero drop shoes and single leg calf raises)
- In September of 2024 I attended a "backyard ultra" event during which I ran 41 miles (a huge jump from me since I never ran more than 17 miles at once)
- After that event my knee started hurting so I hired a running coach thinking a more structured approach to running will help me not get injured.
- The coach increased my mileage from 30 to around 55-60 miles/week and with lots of elevation.
- I progressed very well and i realized how much I loved trail running even more but by January of 2025 , my right knee got worse
In January I started to feel pressure and pain in my right knee when sitting on chairs with my legs bent and more pain when running. The only way I was able to release the pain/pressure was to straighten my leg during which it popped.
In February 2025 I did something very stupid which began the domino effect on my knees. I kept running the usual 55-60 miles/week but I wanted to do something about this knee pain so I researched and found The Kneesovertoes guy on Youtube and instead of starting from the easiest version of his exercises , I went straight to the hardest ones . I started doing weighted single leg step-downs and weighted single leg split squats 3 times/week. I did them until failure and grinded every rep.
For the first week I felt better but during the long run of the 2nd week I started feeling pain on my right knee when running uphill. Instead of stopping , I kept running until my knee flared up so badly I couldn't even walk normally. I got an MRI and sure enough I had a grade 2-3 chondromalacia patella.
I took 2 weeks of rest and after that my running coach told me he will help me rehab(he didn't know about chondromalacia patella , he just assumed is like a lot of knee injuries where you just need to strengthen your muscles). So I started rehabbing with him 2 times/week.
After 6 weeks my right knee felt 95% healed and he told me to start running again and it will get better in time. I did just that and I had one month of running pain free. I got to my usual 50 miles /week with lots of elevation and the pain started again , now in both knees. Of course I ignored it thinking it will go away but by June of 2025 , both my knees gave out during a run and I had to stop. Got an MRI on both knees and sure enough, both my knees had grade 2-3 chondromalacia patella now.
From June to September I kept rehabbing with my coach but this time I felt no improvement, actually I felt things are getting worse and worse. I stopped rehabbing with him and I searched for a PT in the US (thinking I will get better care from a US trained specialist than from eastern Europe). I found one and she seemed really nice and she assured me I will start running by the end of the year. I agreed on working with her even though it was 7 times more expensive than a PT from my country.
Long story short, she had no idea how to properly manage chondromalacia patella and she had me run way too early and my knees flared up badly.
In February 2026 , I was desperate. From September 2025 to February 2026, I wasn't enjoying life anymore. I went from running 60 miles/week to 0 and not only that, I couldn't see any light by the end of the tunnel and it seemed like my problem is getting worse and worse. I was thinking about my knees every second of the day and couldn't figure out why am I getting worse since I was doing "everything right". Everything that the science says I should do , I was doing. I was strengthening my muscles gradually, I was taking a lot of supplements and ate lots of protein.
One night the pain got so bad, I was so desperate , I posted on reddit a rant saying how chondromalacia patella ruined my life. One comment said "read Saving my knees by Richard Bedard". I bought the book and read it in one go. I was amazed by how blind I was all this time. When I finished the book and read what Richard said about his knees now, I had burst into tears for 5 minutes. Finally I've read about someone that had the same experience I had and everything he said about his healing made perfect sense.
DeleteIts been 1 month since I've read his book but its been hard for me to find my "envelope of function". I started biking on my stationary bike on a very low resistance for 10 mins 2x/day and increased it by 5 mins every week. By week 3 I was doing 15 mins 2x/day but my left knee felt weird like I described in the comments above. I dropped biking , thinking walking will be better but after 3 days of 10 mins 2x/day easy walking + daily life steps which were about 8000-9500 steps in total, my left knee flared up pretty badly. This is where I'm at now. My knees are worse than they've ever been but at least I now know what I have to do and I just need to find my "envelope of function" and progress from there.
Thank you Richard again for writing your amazing book!
After I read "Saving my knees" I was so hopeful and I've already seen myself running again slowly by the end of the year but this month so far has been very humbling. This injury is no joke. At this point I just hope I'll be able to run again at some point without having time expectations.
DeleteMaybe reach out to Laurie Kerz-kelly via website better knees.com so worked for years with Doug Kelsey. It sounds like you are trying to do way too much way too soon. She can help you get the right program in place you may also want to get a total gym/vertical incline plane to help you get the right dose/load constitently. I'd also heed Richards advice re cartilage time remember it took him 12 months
DeleteHello Richard do you have any more stories of success -other than your own - with people who had say grade 2/3 symptomatic CMP and healed their knees? I find it really helpful for belief as I'm struggling with it. Cheers
ReplyDelete