Open Comment Forum: Anyone Want to Share a Problem?

It's been a super busy weekend for me, so I'm just getting around to this blog post now.

I thought I'd keep this short today and ask if anyone out there is struggling with a particular problem when it comes to their knee pain.

Want to share? Someone here (either me or one of the regular blog visitors) might have some ideas about what you could try next.

Or, if you'd prefer to discuss something else, that's fine too. The comment section is wide open.

Meanwhile, I hope you're all staying safe. In America, the vaccines are becoming more widely available. I haven't been able to get one myself, but my mother has, and my father is getting close.

We just have to hang in for a few more months, then hopefully life starts to return to normal.

Best wishes to all, and keep moving those knees! 

When You're in Pain, It's Good to Try to Figure Out What's Wrong

Seems obvious, right?

I mean, who would dispute that?

I was thinking about this recently though because of my mother. She told me she has plantar fasciitis.

Now I don't know much about plantar fasciitis. But I do half-remember a post that Doug Kelsey, whom I respect very much, wrote about the problem.

I tried finding his post -- unsuccessfully, sadly. I wanted to send it to my mother. Because right now she's in that early stage of: I have this condition. It hurts. What do I do?

I caution that I'm imperfectly remembering what Doug wrote, but I recall the part that resonated with me went something like this:

People often do the wrong thing to recover from plantar fasciitis. They do the wrong thing because they don't understand what it is. It's actually a slight tear in the ligament near the ball of the foot. Some people recommend stretching, but this doesn't make sense. Why are you stretching a torn ligament? You need to let it heal, then slowly strengthen it.

Anyway, I wish I could find that post, because that really struck me as very logical, even though plenty of people don't do it. In fact, my sister-in-law had plantar fasciitis. She's a personal trainer, and she loves to stretch. So what did she do? It felt tight, so she stretched. I guess eventually it healed, but probably not thanks to the stretching.

What does all this have to do with bad knees?

Chronic knee pain can be a maddening puzzle. Early on though, I think it's good to try to figure out what exactly is going on in the joint. The most sensible treatment for your knee pain will differ, depending on what's wrong.

In the end, if there is no clear cause -- if you basically get a shrug from your doctor(s) -- then I would think about adopting the high-repetition, low-load method of trying to heal slowly, but steadily. That's what worked for me. And that's at the heart of other success stories you'll find on this blog.

 

What’s the Relationship Between Knee Pain and Cartilage Damage?

Ah, what an interesting question. Early on, I tended to think that, where there was chronic knee pain, you’d find damaged cartilage in the joint.

Of course, not in all cases. But in very many.

However, after I learned more (and heard more personal stories from all of you), I modified that belief. People who have knee cartilage that appears perfectly fine get terrible knee pain sometimes. And people with potholed cartilage can have pain-free knees.

But – here’s the but – I definitely think there’s a high correlation between knee pain and bad cartilage. One does not necessarily imply the other. But there is a good likelihood that if you have persistent knee pain of difficult-to-determine origin, you have issues with the cartilage in the joint, or vice versa.

In fact a recent study, looking at 565 people who had a knee arthroscopy, supports this:

Published results showed a strong association between patient-reported knee symptoms and the burden and severity of underlying cartilage damage rather than with specific meniscal pathology ... researchers intraoperatively confirmed and classified the diagnosis of meniscal pathology and concomitant cartilage damage.

The researchers found that “the mean average symptom score increased with the severity of cartilage damage.” Also, there was a relationship between the number of compartments where damage was found and the intensity of symptoms reported.

When there was damage in three knee compartments, there was more frequent catching and locking of the joint, as well as grinding and clicking symptoms. Women and heavier people (a BMI of more than 25) were more likely to have more widespread cartilage damage.

The good news is that cartilage doesn’t have to be restored to a pristine state to get rid of bad knee pain, I believe. So, in the end, “damaged cartilage” shouldn’t mean you’re stuck with those bad knees forever!

I Love Success Stories! Here Are Some You Should Read.

It's easy to get discouraged when trying to heal your knees from chronic pain. One step forward, one step back ... when will it ever end?

It's comforting and uplifting to hear occasionally from people who have beaten stubborn cases of knee pain.

In my last post, I wrote about a triathlete who posts here as TriAgain, and his success story. I thought that today, for ease of reference, I'd do a short post that provides an overview to the success stories that have been published on this site.

* The most useful post of TriAgain's success story was probably this one, on lessons learned. It's worth a close read.

* Here's a success story I found on Yahoo's chondromalacia forum. This person had left knee cap pain that was getting worse, and exercise aggravated his knee.

* I was delighted to find out that my book had found its way into the hands of a couple apparently from South America. The husband, Luis, wrote about his wife, a professional runner, and how she beat knee pain. It was a success story in two parts: here and here.

* This one is from "Ron," and one of my first success stories. I was so excited that I went in and shared it with my wife and daughter, who was two at the time (and is now 11!).

* You're never too old to heal! "Pat" told me the story of how she did, and she was 66!

* One of my favorite commenters over the years was "Knee Pain." She seemed to be the epitome of a "can do, never say die" attitude. She got discouraged, I could tell, but vowed not to give up. So I was particularly pleased to be able to offer her success story.

* This was a "train through the pain" success story. I shared it, but with a caveat that the approach taken wasn't one I would endorse. But still: it's good to be open-minded about ways to heal.

* "Karen" shared a success story that involved my favorite sport: cycling. But she had a clever way of dealing with the sometimes too-heavy joint strain of pedaling.

I hope you enjoy these and are able to learn something from them!

Another Success Story to Celebrate!

I love success stories. They lift the spirits of people struggling to stick to what can be a years-long process to rehabilitate their bad knees.

I was pleasantly surprised last month to learn that TriAgain, an Australian triathlete who was one of the first people to post comments on this blog, has announced that he has completely healed.

"I'm declaring my knees 100% fixed now," he wrote in a comment. And how long did it take?

Only ... eight years and six months! How's that for dedication to a cause? It makes my own experience seem like a walk in the park.

Congratulations to TriAgain! There's more on his story here; I wrote about his battle back in September 2015. And his latest comments are here.

One thing I have come to realize is that we all don't heal in quite the same way, or hold quite the same beliefs. For instance, I'm quite skeptical of the value of stretching. Meanwhile, there are some who have healed from knee pain who swear stretching really helped.

But I think we agree on the important stuff. To me that's:

That bad, cranky knees can get better. If you choose to give up on your knees, that's your choice, but it's not as if they must inevitably stay the same or get worse.

That the road to recovery is often not easy, and there aren't any gimmicks or magic pills. I suspect that a number of people bought my book looking for some "secret" on page 159 or some such. I truly learned a lot from having knee pain and healing, but there's no magic juice or exercise that does the trick for all.

That healing requires a certain fortitude, optimism (but very much grounded in the possible), tenacity, determination, and stubbornness not to give up the fight, even when you seem to be losing (and there will be plenty of those times).

That, in a world where facts sometimes don't seem to matter, facts and science really do matter if you are serious about healing, because a knee pain sufferer is running an experiment of sorts, trying to unlock the combination that leads to steady, slow improvement (per Scott Dye).   

That patience is a key virtue, because it can take months (or even eight years) to get better.

A Good New Year's Resolution: A Vow to Be Patient

I was out doing my twice-a-day walk recently and a thought struck me, as I kicked a rock out of the way.

If you found a rock, and put it outside, and took a close-up photo of the rock once a month for ten years, you would have 120 photos, and would probably arrive at an interesting conclusion:

Rocks don't change over time. The rock in the first photo would look identical to the rock in the last.

But we know that rocks do indeed change over time. It's just that it takes a long time, usually, for visible changes in a rock to appear. Most don't look any different after 10 years, or even 100 years.

Similarly, healing from chronic knee pain can be maddening, because it's so slow. On any given day, it can seem that there's been no progress.

In fact, in a way, it's worse than watching a rock, waiting for some change to occur. With a bad knee, you will have good days and bad days and in-between days, and you'll feel like you're going forward and then sliding back a few days later. In the end, you may feel so confused you want to give up.

That's why, as we approach the new year, I think the best thing many knee pain sufferers can do is adopt an attitude of patience. Healing is usually not quick. Go into your knee rehabilitation program with that mindset, and you can only be surprised pleasantly if healing is faster than expected.

But if you go into your program thinking, "I can fix this in a few weeks," you risk being so frustrated that you lose hope.

So, I'm wishing everyone out there with knee pain some patience in 2021. Good things can happen. Just look at the many success stories on this blog (there was just one posted in the comment section last week).

But patience is often necessary. And that patience will be tested severely, so be prepared for that too.

Open Comment Forum: How are YOU doing?

I figured I'd do an open comment forum today, hopefully to stir up some discussion.

As usual, feel free to bring up whatever you want in the comment section below: new studies, vexing knee problems, lingering frustrations, what's working, what's not working.

If you don't feel the need to say anything in particular, then if you've been a knee pain sufferer for a while (and a visitor here), it would be nice to hear an update of how you've been doing. Often, I've been happily surprised to hear from people who started leaving comments seven or eight years ago, then disappeared for a while, and later resurfaced to share their stories.

Mine is, unfortunately, a rather boring story at this point. I feel like a bit of an impostor sometimes. See, I have this blog about chronic knee pain, but I don't have chronic knee pain anymore. Now, knock on wood, I'd like to keep it that way and don't want to tempt fate. I'm aware that circumstances can change swiftly.

But it's a relief not to have to plan my life around a pair of complaining knees. Yesterday I rode hard on Zwift (virtual reality cycling!), banging out close to 3 watts per kilogram for two and a half hours. Today I meant to go easy on Zwift, then got suckered into trying to catch a large group of riders climbing a long, steep mountain road, and so I had another intense session.

And my knees are fine. No ice. No stabbing pains. Nothing. I know I'm lucky that my knee pain story has become boring.

But what about you? Anything to share? Please leave a comment below!