Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (16 page)

While “get on cartilage time” put me on the appropriate time scale for healing, my last rule put me in the best position to succeed. True, it wasn’t as relevant for me because of my slight frame. Still, adhering to this simple rule can lead to a lot of knee pain relief.

Lose weight
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I never thought much about the relationship between body weight and knee pain until a trip to Mui Wo that turned into a book-buying orgy.

I’ve always loved secondhand bookstores. I like the thrill of the unexpected find, the possibility of snaring a bargain, and on a more visceral level, just the heavy, dusty scent of old books that fills the air. So one December day when Congyu and I took a Saturday ferry to Mui Wo, I was delighted to find a sundries shop with thousands of used books tucked away on the second floor. Congyu waited patiently while I selected a bunch of paperbacks. After paying for them, I found another secondhand bookstore down the street and bought a few more.

All the books went tumbling into my backpack. We then strolled around. Mui Wo has a lot of charm and feels like a blend of old Hong Kong village and hideaway resort. A white elephantine hotel overlooks the long beach. Away from the shoreline, paths wind toward the hills in delightful and unexpected ways, past small temples and homes that seem impossible to find again on future visits.

I should have realized that my book-filled backpack would cause trouble later. The next day I noticed a light burning in my knee joints while standing. Well, I thought to myself, it’s no wonder. My backpack must have weighed twenty-five or thirty pounds. To verify this, I reloaded it with the books and stepped on my bathroom scale. I was astounded to find that it was only eleven pounds. But it felt so heavy! I couldn’t imagine having bad knees and lugging around that much extra weight all the time.

An afternoon of carrying a full backpack taught me a real-life lesson about why doctors tell heavy patients with knee pain to lose weight. Unfortunately, the advice is all too often ignored. It’s simply hard for someone to imagine the effect of shedding ten pounds. If so, I heartily recommend the “backpack test.” Fill one with ten pounds, then wear it on a long walk. That should convince anyone. It convinced me.

For a knee pain sufferer, losing weight makes sense for so many reasons. First, you just feel healthier after shucking that excess fat. Then you have the mechanical benefit. Cartilage that thins or becomes damaged is a less effective shock absorber. Dropping pounds lightens the burden it must bear. There’s yet another advantage, if you believe motion is good for your joints. The lighter you are, the more you’ll be able to move without stressing them too much.

Any remaining doubters should look at the scientific evidence. Studies consistently show a strong link between weighing too much and developing knee problems. In one group of women, the risk of developing osteoarthritis in the joint soared by more than a third with every eleven pounds of weight gain.

That didn’t surprise me at all. Knee joints are sort of like the body’s rugged stevedores, dockworkers who muscle around heavy loads all day long. And for the human body, what’s a more direct input into the load equation than how much you weigh?

I was already rather thin when I developed knee pain, so there was no spare tire for me to work off. I did drop five pounds, from 175 to 170. Early in 2009, I went for broke and tried to reach 165; I last maintained that weight in high school. My battle to shed pounds proved revealing. As I seesawed higher and lower, I would notice small differences in how my knees felt, even between weighing 171 and 168.

You may not immediately sense those extra two or three pounds. But your knees know they’re there.

As far as I know, no one has ever done before what I did: conduct a twelve-month experiment, both tightly controlled and well-documented, into what affects and improves a pair of knees with damaged cartilage. That statement isn’t meant to sound boastful. You have to become rather boring and an obsessive note taker to accomplish such a thing. I turned into a guinea pig of my own making.

My life was dull and repetitive to an almost embarrassing degree. Many days I went for walks on similar paths at similar times. Each evening, I sat on a dark-brown couch and watched a full-length movie DVD for entertainment. Even my meals remained basically the same, week after week. I was Mr. Predictability.

Which was exactly perfect for this experiment
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My dull, structured existence allowed me to zero in on any significant day-to-day changes. They became factors to monitor to determine their effect on my knees. I purposefully tweaked certain variables, one at a time. One week I might try doing a new exercise, or walking on hills, or cutting my step count by one-third. Another week I might try a nutritional supplement.

It wasn’t an exciting life by any means, but the insights I gained were tremendous. By the end of the year, my head was swimming with thoughts and observations. Some of what I learned fit into my four golden rules. Much of it resisted easy classification. If a common theme described the leftover bits and pieces, I would say it’s “orienting both mind and body toward healing.”

First, orienting my body required figuring out, on a physical level, what my knees needed to get better.

To determine this, I constantly drew lines between how my knees felt and what probably caused that feeling, good or bad. What I discovered was fascinating. The hands-down winner for what influenced how happy my joints were: movement.

Sometimes the link wasn’t obvious. Early in the summer of 2008, I spent a lot of time scrubbing outbreaks of fungus off my apartment ceiling and cleaning in general. Meanwhile, my knees worsened. I became frustrated and went for shorter daily walks, thinking that might help. It didn’t.

That left me looking for something else to blame for my deteriorating condition. Then one day I decided to wear my pedometer while cleaning. That led to a revelation. In one day, I racked up a whopping 8,258 steps without leaving my apartment—the same as for more than four miles of walking.

Other times, the influence of motion on my troubled knees was quite clear and indisputable. The joints reacted to how much they moved (three thousand steps? five thousand?), in what fashion (walking? cycling?), and with what load (nothing? backpack? heavy fan?).

During my recovery, I also made sure my body had the nutrients it needed. I ate regular meals of brown rice and garlic (the spice is touted as a natural anti-inflammatory, among its many good properties). I topped off my day with a protein powder drink, to make sure my body had an ample supply of the raw materials needed to mend injured tissue. And I drank plenty of water, the liquid that accounts for up to four-fifths of cartilage, in order to stay well-hydrated.

I also took a number of supplements that target injured joints. My experience with these smartly packaged products was like a series of blind dates that all end badly. At first I would get excited by the label: one promised to end inflammation, depicted by a red flaring spot of pain on a man’s knee. The product contained rosemary, turmeric, and ginger. Another boasted of assisting the body in tissue repair using proteolytic enzymes. Not one had any perceivable effect.

Orienting my mind toward healing required a different emphasis. To begin with, I had to lose my gloomy perspective and come to grips with my fears. Negativity had taken over my life. Whenever I looked in the mirror, the face that gazed back was anxious and unhappy.

When you live sad and discouraged in a world of hurt, your outlook begins to change and turn against you. Doubt robbed me of the ability to enjoy small victories. Instead of celebrating a good day for my knees, I would think, “What if this is an illusion, or an aberration?”

Countering this negative mental energy required a certain inner fortitude. It also helped tremendously having an exercise program that allowed me to make continuous progress, even if in tiny increments. When unsure about how much exercise to do, I tried to err on the conservative side.

That helped me avoid setbacks, which are bad for many reasons. They’re demoralizing, for one. They chip away at your resolve and darken your mood. They may cause you to abandon your exercise program for a while, as you succumb to feelings of hopelessness.

Setbacks are also wasteful and confusing. They erase gains and send you rolling down another “chute.” Once you get up and brush yourself off, you then have to try to figure out how far you have fallen. If the activity that brought on pain symptoms was too hard, and perhaps damaged your knee further, what now? Do you return to the exercise regimen of a week before, a month before, two months before?

Avoiding setbacks isn’t easy. Sometimes I seemed lost in a game of Pin the Tail on the Donkey, trying to hit a target while blindfolded. I lurched around quite a bit, trying to find that sweet spot between doing too little exercise and doing too much. During one winter, I walked too far too fast; luckily my knees sent out warning signals to slow down. By contrast, that previous August and September I probably did too little, scared that my joints would quickly worsen as they did earlier in the summer.

This tendency to settle into one of two extremes—being too active or not active enough—constitutes its own kind of mind trap. I even came up with a shorthand for the people who get stuck in these two behaviors: the “Warrior” and the “Humpty Dumpty.”

During the early months of my struggle, I was definitely a Warrior. I didn’t want to accept the reality of my hurting knees. I persisted with my same level of activity. Gradually I made a few concessions, such as cycling more slowly uphill and tinkering with my pedal stroke, but I still rode hard.

After working out and showering, I would go straight to the freezer. The bags of ice had melted to the inverse shape of my knees. Twenty minutes of extreme cold numbed the joints, which felt good—at least until they warmed up again.

Even after swearing off cycling to give myself a chance to heal, sometimes I would revert to this Warrior behavior against my better judgment. I would throw up my hands and say to myself, “Why not work out? I have to do something. My knees can’t get any worse, right?” Of course they could and sometimes did.

You can find Warrior types without looking hard. Sometimes they’re wearing big, bulky knee braces that they put on quickly, from having had so much experience. They may look normal on the volleyball court or on the running track, but their lives are propped up with pills and ice. After exercising, they hurt. But they have courage and a commitment to an active lifestyle. They will be lowered into their graves wearing a defiant snarl.

The Warrior types believe in motion (good), but to an excessive, harmful degree. They remind me of a curious finding from an animal experiment where dogs had one leg encased in a cast for six weeks, then after that, ran heavily on a treadmill. They were killed, and then the immobilized joint was studied. The good news: the dogs’ cartilage responded to the demanding treadmill activity by cranking out more proteoglycans, making the tissue more elastic. The bad news: the cartilage was thinner.

By contrast to the Warrior, the Humpty Dumpty appears to be the very picture of caution and good sense. These types are acutely aware of the limits their bad knees place on them. They find it prudent to avoid anything that stresses their knees. Their problem: if they’re not careful they finally reach the point where they don’t do much of anything at all.

I went through a brief Humpty Dumpty phase. I took a lazy week-long vacation to rest my knees, hoping they would improve. No walking, no biking, just a lot of lying about. They did start to feel better. Then I returned to work and found myself in the same place as before, or perhaps worse. Knee cartilage softens when not used enough. Soft cartilage is more susceptible to tearing or fraying and doesn’t function as well.

It’s easy to imagine how a Humpty Dumpty is created. I had to look no further than my wife.

When she first had problems with her left knee, in her early twenties, I don’t think she was a Humpty Dumpty. She waited for it to get better and tried to live her life as before. But then, from time to time, something would send her spilling down one of those familiar knee-pain chutes.

A few years ago, for instance, she felt okay and ran a short distance to catch a bus. The next day a painful swelling stiffened the joint. Her response to that incident: she had acted rashly, she got burned, and she wouldn’t do that again.

Instead of trying to strengthen a bad knee enough to withstand a short dash, Humpty Dumpties retreat into a defensive crouch. They become fearful of re-injuring their knee. So they may baby it a little. They may also try not to use it as much. They become prone to falling into the debilitating spiral where less activity weakens the knee, causing it to hurt more, leading to less activity, and so on.

Humpty Dumpties buy into the bleak pessimism that bad knees never get better. Knees to them are like cars. They just wear out, as your car eventually does after being driven out of the showroom. Treating the joint better delays the breakdown, just as changing a car’s oil periodically and performing regular maintenance will prolong its life. Still, deterioration is seen as an inevitable, one-way process.

When I oriented my mind toward healing, I rejected this kind of thinking. I believed that my knees could get better and stronger, not out of some misplaced romantic notion, but because that made the most sense. Cartilage is living, biological tissue. In anyone’s knees, old cartilage is constantly stripped out and new is laid down. This process gets out of whack when the joint goes bad. But who says the imbalance can’t be corrected? I found that you can restore ailing knees to good health, though very, very slowly.

I’m hopeful that the next generation of physical therapists will realize this too. I’m hopeful that they will abandon their muscle-centric approach and focus first on fixing bad knee joints.

That will require a much more precise and smarter approach. For one, it will mean no longer sending patients out the door with recommendations to do ten of exercise A, twenty of exercise B, and to stop of course if you feel pain. That’s frightfully imprecise. Legions of knee pain sufferers deserve better.

If my vision comes to pass, smarter physical therapy will be the wave of the future. Programs will be “bespoke,” or highly tailored to the individual, like a custom-made suit that drapes smoothly over one’s frame. Therapists will become more scientific-minded, to better measure progress over the long arc of healing. They will collect exact measurements to establish baseline capabilities for bad joints, with the aim of improving those over time. They will update their measurements frequently, take more-detailed notes, ask more questions about the full range of a patient’s weight-bearing activities. 

If all this comes true, physical therapy will solve many more cases of hard-to-treat knee pain and help patients avoid one unpleasant option: surgery.