Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (10 page)

Now for the kicker. Say the researchers could basically wave a magic wand and make all these complexities go away. Say they attached a super-sensitive device to everyone in the study. It measured each step taken, how much force the knee joint absorbed each time the foot struck the ground, and even whether the subject was sweating at the time. This astounding gadget makes the argument about an uncontrolled environment irrelevant.

Believe it or not, they may
still
be wasting their time trying to find out, “Does exercise help prevent knee osteoarthritis?” Because they may be asking the wrong question to begin with.

Here’s an illustration that will make clear why that’s so:

Suppose I tell you about a scientific investigation into whether exercise helps or hurts knee joints. I describe the methodology: Researchers rounded up one hundred people who were asked to run three miles, three times a week. MRI exams were done at the beginning and end of a two-year period.

Then I break the bad news. More than ninety-five percent of the subjects experienced a disastrous thinning of cartilage with many more defects present. Faced with that set of facts, you would probably conclude that running must be harmful for knees.

Now I spring a surprise on you: the subjects were all at least 150 pounds overweight. At this point you’d probably start laughing and revise your conclusion. In fact, you’d probably end up arguing that the study doesn’t really show anything at all about the link between exercise and knee health. It stands to reason that the morbidly obese shouldn’t suddenly take up running nine miles a week; that’s too much stress on their joints. Perhaps a program of light walking would suit them better.

In other words, exercise isn’t some pure good, where more is always better. We know that on a gut level: if running three miles a day makes you fit, running thirty miles a day doesn’t make you ten times as fit (in fact it would almost certainly start to wear down your body fast). So the right question when it comes to the link between exercise and the health of knee joints may be something more subtle like this: “Will the proper amount of appropriate exercise help prevent osteoarthritis?”

To further appreciate why framing the question this way matters, let’s invent two people for the Framingham Study and call them June and Jim. They both have achy knees and are at risk of developing osteoarthritis. June appears inactive from her survey: she doesn’t do any “exercise,” even walking. She moves as much on her bad knees as is comfortable. She sometimes goes outside to a nearby field to pick wildflowers, or takes a short stroll to visit a neighbor.

By contrast Jim is a dynamo. He was a track star in his younger days and doesn’t want to abandon an active lifestyle. He runs five miles four times a week. A hardened ex-soldier, he has a “damn the torpedoes” attitude. He wears supportive sleeves over his knees and ices them after workouts to reduce swelling. He accepts the pain with no more than a slight wince.

If Jim develops osteoarthritis but June doesn’t, they become statistics to bolster the argument “exercise contributes to knee osteoarthritis.” But someone might also conclude that Jim is simply pushing his bad knees too hard. Meanwhile June appears to be inactive, but perhaps the movement she gets is ideal for what her joints can support. She sometimes pushes herself a little, and that’s just enough for the cartilage to get the right signals to rebuild a little more. Maybe she even starts to feel better.

If researchers did want to set up a sophisticated study—one that looks at whether the proper amount of appropriate exercise helps knees—they might want to consult someone like Doug Kelsey. Patients at his Sports Center clinic in Austin routinely have their bad knees precisely tested. They do repeated squats to determine their “load tolerance.” That refers to the level of force that they can withstand, pain-free, without a breakdown in form. That’s important, Kelsey says, because a 200-pound man who has a load tolerance of 120 pounds overloads his knees by 80 pounds with each step up a flight of stairs.

Acquiring such data strikes me as critically important. The numbers establish a baseline on which to build. They guide a physical therapist in tailoring a workout program to a patient’s capabilities. Exercise should be seen as a qualified good, rather like medicine that’s beneficial in the right dose.

After coming to terms with the Framingham Study, I was ready to move forward on my own plan. My confidence was high that my bad knees could become better. That seemed like a nebulous goal though, the more I thought about it. I began grappling with the question of what exactly I expected to achieve. Objectively, what qualified as “getting better”?

After some thinking, I laid out three levels of improvement. The first would be simply feeling better. The bad cartilage would be unchanged, but I’d no longer have knee pain. The next level would be not only feeling better, but also having stronger cartilage. Still, the tissue would look the same as before (if anyone were to examine it), and my knees would remain just as crunchy.

Level three would be the Holy Grail of healing: to have the tissue actually repair itself and thicken. It would incorporate the benefits of the previous levels: no pain plus improved properties of the tissue itself. Even then the cartilage would not be restored to its original state, I was pretty sure, but that was okay. Most healthy individuals have some defects anyway.

Doing this assessment comforted me. Escaping my misery required only reaching level one. The bar to clear was low. Plenty of scientific evidence suggested that I could go further, perhaps all the way to level three. But to be happy, I didn’t need to.

That matter aside, I then had to confront who I was: a scared, unhappy guy who chafed to get back on his bike but whose knees hurt most of the time. This guy feared losing all his hard-won aerobic conditioning and leg strength. The problem was, he was deceiving himself. For months he kept saying, “Another week or two, and I’ll be cycling again, and all this will be behind me.”

That was unrealistic. I had to accept that.

In my mind, that wasn’t the same as accepting defeat. I drew a clear, bright line between the two. Congyu once said, “You should accept your knees are bad,” but her tone suggested that they would always be bad and that was my fate. I rejected that as a self-fulfilling prophecy of failure.

Instead, I accepted that my bad knees would not get better overnight. Adopting a longer-term perspective for healing changed my mindset in a good way. I stopped riding an emotional yo-yo. The entries in my personal journal no longer resembled the writings of a manic depressive: one week gloom and cursing, two weeks later optimism that “I think I’m pulling out of this at last,” then a week later more despair. That mirage of false hope that repeatedly appears and vanishes can be as cruel as anything.

Expanding my timeframe for healing was smart for another reason. Bad knees aren’t very forgiving of mistakes; they swell and ache in protest. I needed to build in time for them to recover from the many small mistakes I would make.

A fitting metaphor for this challenge occurred to me one day, after a brunch with Congyu. We went to an all-day breakfast nook off Discovery Bay’s central plaza. Outside, children raced over the sun-splashed cobbled stones under the watchful eyes of their nearby mothers. We both ordered hearty breakfasts.

While waiting for the food, I spied a
Chutes and Ladders
game in a box of toys the restaurant kept on hand to divert squirming youngsters. I had never before played this old classic. So Congyu and I, both of us well over thirty years old, decided to give it a whirl. The game turned out to be quite simple. You roll a die and advance the indicated number of spaces. You weave back and forth across the board, climbing higher. The first player to the top wins.

On the way you encounter many chutes and ladders scattered across the board. Whenever your playing piece lands at the foot of a ladder, you “climb it” vertically to a higher-numbered square. Anytime you land on the upper end of a chute though, you slide down to a lower-numbered square. So the thrill of the game consists of constantly being bumped up and down the board by the many chutes and ladders.

We must have played for the better part of half an hour. Sometime afterwards, I realized that this basic board game held significance for my struggle to save my knees. You could say, in real life, I was playing a game called simply
Chutes
.

It was
Chutes and Ladders
without the ladders. It worked like this: I did all the right things for a week or two, progressing up that long path to getting better. Then I made a mistake, doing something that overstressed my knees. At the time it could seem as innocuous as a short hike up a steep hill. My knees wouldn’t bother me at that moment, leading me to think, “Great, I must be okay now.” Then the next morning they would feel sore. I had just tumbled down a chute.

Chutes
, I realized, is a cruel game. Chutes throw you down fast, but there are no ladders to lift you up as quickly. Instead, you must climb back up that path slowly, step by painstaking step. If you continue to make mistakes, you keep falling down chutes. For knee pain sufferers, they can be everywhere. A chute can be as simple as a weekend shopping expedition where, without realizing it, you walk a few thousand steps too far. After a while, you don’t even recognize that you’re trapped in this game. You give up.

To win at
Chutes
, I needed to be determined, as well as clever enough to exploit whatever advantages I possessed. My leg strength, for example, seemed like an asset. My thighs were still thick and muscular from my years of intense cycling workouts. However, that also could count as a disadvantage. My tremendous leg strength may have masked the extent of my joint problems for a while and may have caused me to do even more damage. Now that I couldn’t exercise, I risked losing power in my thighs fast, exposing how bad my knees really were.

Fortunately, I possessed a disadvantage that, on closer examination, could be spun into an advantage of sorts. I had pain in both knees. That fact doesn’t appear to contain any upside, only twice the misery. Yet I recognized that, thanks to the lovely property of bilateral symmetry, it could be useful to have two equally bad knees. Bilateral symmetry of course describes how the left and right sides of our bodies essentially mirror each other. Because of that, I could test a certain exercise on one knee at a time, using the other as a “control.” If the first knee responded well, then I’d try it on both.

All this thinking in the abstract about my knees was fine, but I also had to choose some kind of suitable exercise. It would have to agree with a joint-first approach to improving my knees. If my bad cartilage could adapt best under the load of thousands of light repetitions, I needed a low-stress activity. My knees didn’t tolerate even gentle cycling; that was out. I walked fairly well though. An easy stroll of a mile and a half would give me about three thousand steps.

And so walking became my exercise of choice. I went out and bought my first-ever pedometer, a basic ten-dollar model. Until then I had no clue about how a pedometer worked. It just seemed like a convenient device that attached to a belt and somehow managed to calculate how far someone walked.

Mine had an electric-blue casing and was a little larger than the head of a wristwatch. I unwrapped and studied it. My bottom-of-the-line version was simple. It had only a small display screen and a pair of identical buttons that reset the step counter to zero.

A little research revealed what lay inside the unit. A motion sensor that can be as simple as a swing arm records each step. The sensors turn out to be fairly accurate because the act of walking is actually rather jarring. During a normal step (by tiptoeing you can fool the pedometer), your foot smoothly descends then abruptly strikes the ground. The delicate sensor registers the jolt.

At first I was disappointed by how it worked. My pedometer counted steps, not distance. But then, after some thought, I realized that the device suited my needs perfectly. The amount of force on my knee joints mattered much more than how far I went. My pedometer indirectly tracked the variable of force by ticking one digit higher each time my foot struck the ground.

Using my pedometer, I began keeping records of my daily walks. I jotted down how many steps and what kind, noting whether the terrain was flat, hilly or something in between. I observed whether the steps came in bunches, such as during a trip by ferry to Tsim Sha Tsui to buy a portable CD player, or all at once, such as on a long walk.

The details went into my knee journal. I created the journal to have a place to put down daily observations about how my knees felt and how I used them. I hoped the journal would wind up charting my progress over months. More importantly, I believed it could help me see patterns and isolate cause and effect along the way. For me, a bad knee day wasn’t a waste unless I failed to learn something about why it occurred.

That philosophy seemed to put me at odds with Dr. Chiu, who once said in an offhand way, “You’ll have good days and you’ll have bad days.” That statement makes knee pain sound like colors on a roulette wheel. Sometimes the ball of chance rolls to a stop on black (no pain), sometimes red (pain). That seemed too arbitrary to me. I wanted to explore what contributes to making days good or bad.

Take the weather. People with bad knees complain about being human barometers, able to feel the approach of storm fronts by the discomfort in their joints. On several occasions, my knees worsened when typhoons swirled closer and the air pressure plunged. So I kept notes on air pressure in my journal. Gradually a pattern emerged. When my knees were in poor shape they could predict bad weather, but once they improved enough, they (happily) lost that ability.