Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (12 page)

We took a long trip to Qinghai Lake that involved several hours sitting on a train and then more sitting in a hired car. After that came the real test of stamina, the thirty-hour railway passage to Lhasa. We moved very little over that day; the train was too crowded. We also took a half-day jeep ride to Namtso Lake. Of course on other days we did often walk, whether in search of another cultural attraction or just a sidewalk vendor selling crisp red apples.

The Tibet experience wasn’t about an orgy of motion leading to the first signs of healing for my knees. I had drawn the wrong lesson. A more subtle truth appeared more likely, that my knees had responded well to the right amount of movement: not too much, not too little. In Tibet I fortuitously landed in that “sweet spot” by accident. But finding that sweet spot again wouldn’t be easy. My disastrous weightlifting adventures in the gym had further damaged my knee joints and set me way back.

Over the next month, I tried to find the right balance between movement and rest. Weekday mornings, I would first go to Bloomberg to help update the headline screens that displayed our top stories worldwide, confer with the China reporters, and do some editing for the Asia finance team. At 10:30 I would leave and faithfully do my walking and pool exercises. I would return to work at 3:30 and finish my day at six.

Despite my best efforts, that whole time I floundered about. No matter how hard I tried, my knees didn’t improve at all. It was exasperating.

Early on, I had vowed to be flexible during this experiment. Inflexibility cost me dearly once, when I persisted lifting weights with my legs even though my knees kept feeling worse. So with no progress to show after three weeks, I changed course. I scrapped my regular routine of light exercise to try something different.

Very, very different.

A casual observer might have assumed I had thrown up the white flag and surrendered: No swimming. No long walking. In fact, it didn’t look like I was doing much of anything, except lying on my back beside an indoor swimming pool and reading novels.

Actually, my new program was more complicated than that. When elevated, my knees burned less, so I would lie backwards on a chaise longue. My feet were propped up on the back rest. Every nine minutes, I got up and walked for a minute around the swimming pool, exactly 101 steps. Then I repeated the sequence. Again and again, for three or four hours at a time. Short bursts of motion interspersed with a knee-friendly resting position.

Over the next two weeks, my knees began to feel noticeably better.

When I visited my physical therapist and told him about this “exercise,” and how well it worked, his reaction was unforgettable. Tim looked as if someone had just slapped him hard. He didn’t know what to say. By Tim’s physical therapy playbook, I should have been doing quad-building exercises in repetitions of ten to thirty. Or at least something more strenuous than strolling once around a pool, then resting.

Meanwhile, the fact that something that stressed my knees so little worked so well alerted me to a dark reality: I was in pretty bad shape. My weak joints became irritated very easily. But a paradox puzzled me. I walked fairly normally. My knees moved normally. An MRI had indicated no more than “mild” chondromalacia. Why did I hurt so much if the problem wasn’t so bad?

That prompted me to investigate what causes the pain that accompanies cartilage disorders. My research led to the discovery of an odd disconnect. You may have severe chondromalacia and no knee pain. Or you may have mild chondromalacia and lots of pain. You can’t always correlate how much you hurt with how much cartilage you have left.

That seems counterintuitive at first—a man with a scratch on his arm should suffer less than someone who has a gaping flesh wound. But that easy analogy overlooks a key fact about hyaline articular cartilage: it has no nerve endings. So when the tissue weakens and fissures, it doesn’t relay any pain signals itself. Instead two nearby structures are mainly to blame for the discomfort.

The first culprit: the bone lying under the cartilage (for example, the femur or tibia). It happens to be nerve rich. Normally cartilage protects the bone from excess pressure, such as from long periods of bent-knee sitting. When healthy, the rubbery tissue transfers load agreeably. When not healthy, look out. The adjacent bone is exposed to more stress and responds by firing off pain sensations.

The second culprit: something called the “synovium.” It’s a membrane that lines the knee’s joint capsule and seals in the synovial fluid. For a knee pain sufferer, the synovium can become irritated through a multi-step process that may begin with something as simple as a brisk trot across the parking lot.

Inside the joint, the force from that act of running shears off fragments of soft cartilage. Along with related debris, they float about in the synovial fluid. (Doug Kelsey colorfully likens the fluid at this point to a snow globe.) Eventually they reach the synovium (which, like bone, has plenty of nerves unfortunately). It absorbs the cartilage remnants and the assorted cellular detritus and becomes inflamed and possibly swollen, communicating a dull aching to your brain.

The role of the synovium in knee pain especially intrigued me. I wondered if it could help explain why my “mild” chondromalacia caused so many difficulties. Could there be profound changes to the structure of my cartilage, undetected by MRI, along with widespread superficial damage? And could that superficial damage be more painful than a few deep lesions? A large area of roughened tissue could create a field of loose fibers, susceptible to being sheared off.

I wondered if cycling hard uphill predisposed me to this kind of trauma. The circular smoothness of pedaling implied a certain kind of pressure—fairly steady, intense, and evenly distributed. The breakdown of the tissue may have taken place over a broad area because the cycling motion doesn’t produce the same focused, striking force as jumping or running. Also the location of maximum damage would most likely reflect the contact points when my knee was pushing hardest on the pedals. That would be an almost ninety-degree angle: the same as for sitting in an office chair.  

My thoughts were only armchair musings, I admit. I was groping about for some way to explain the misery of my condition and figure out what to do next, as my experiment neared the halfway mark. The simple pool walkarounds certainly helped my joints, but they weren’t vigorous enough. I had to make faster progress.  

My mother mailed me a book from the United States on healing knees that suggested a solution: aquatic exercises. I had splashed around in the pool some, swimming and kicking softly, but hadn’t yet tried formal exercises. The authors raved about the miraculous effects of immersing yourself in water. They laid out a ten-minute pool program designed to put knee pain sufferers like me on the comeback trail. It consisted of short, minute-long exercises. None appeared very stressful.

I typed them into my computer and printed out the sheet of paper. I bought a waterproof sports watch for sixty-five dollars to time each exercise interval. Then, on a December day, I slid into the pool, looking forward to the promised benefits of water therapy. Following instructions, I walked over the bottom of the pool, then did some kicking, curls, and squats.

I had no pain at the time, and my knees felt fine immediately afterwards. Then a familiar ache began to set in. Back at work, my knees felt increasingly uncomfortable. By evening it was clear to me what had happened: I had backslid because of ten minutes of mild pool exercises. It was an astonishing failure that depressed me for days.

Part of me flatly refused to believe it. On January 4, I mustered up enough courage to try again. This time, I decided to walk across the bottom of the pool for six minutes, and do nothing more. If that went okay, I could build on that base. Once again, I felt fine in the water. Later though, my knees got a bit stiff. The next morning, I woke to the dreaded burning sensation in my joints.

That day’s knee journal entry practically screams out my frustration: “I feel like I’m going to hurl myself off a bridge.” I couldn’t even walk over the bottom of a swimming pool for six minutes without suffering problems!

It seemed ridiculous. My knees couldn’t be that terrible. It was impossible. So I decided to try an experiment that drew on one of my dubious “advantages,” that of bilateral joint pain.

I returned to the weight room, to the machine for seated leg lifts. My left knee would be the guinea pig, my right the “control.” I inserted the pin under the five-kilogram plate (eleven pounds). That wouldn’t put much strain on the joint. Using my left leg, I lifted the weight a little, held it briefly, then lowered it. I did that only five times.

The next day, the difference was clear. My left knee felt “full,” a symptom of mild swelling, and noticeably worse than my right.

Two weeks later, I tried a similar test. The exercise: straight leg raises. While lying down, I lifted my left leg only, held it for ten seconds, then lowered it. I did only ten repetitions. The next day, my left knee felt warm and tingly compared with the right.

That was an unbelievably frustrating time. Still, it forced me to accept unpleasant truths and move on. For instance, one key to improving your knees is simply finding out what they like to do. Mine didn’t like working out in water, even gently. That was okay, I consoled myself. I didn’t live in the water. At some point, my knees would have to adjust to the stresses they would endure on dry land.

As the end of January loomed, I made a final spirited push to get stronger, mainly through my walking regimen. My three months of working half time were almost over. Dr. Song resisted supporting an extension. The gains I made had taken longer than expected and seemed fragile, I confessed to my boss.

Bloomberg had been very supportive of me during this time. It bothered me that the company insisted on paying me full wages for working half as many hours. To clear my conscience, I returned almost $4,000 to Bloomberg (that was then donated to a good cause, I learned). By rights, even after adjusting for taxes, I should have given back more. My boss convinced me to keep the rest in case unexpected expenses arose related to my knee problems.

On January 28, 2008, I returned to work full-time with fingers crossed, hoping for the best. To counter the long spells of sitting, I walked around the perimeter of the floor every half hour. The 170 steps took me past the copier nook, the TV studio, the glass-walled conference rooms, the long rows of data workers. I also used my lunch break to swim at the health club pool.

The first few weeks my condition was stable. I felt a good deal better than in the fall of 2007, but at the same time, my knees occasionally became inflamed while sitting. That worried me. How much better was I, really? It felt like I was living in a house that, while structurally sound to the casual observer, might be perched on quicksand.

Then, in mid-February, the downward slide began. My knees started to worsen. My initial reaction was disbelief, then my moods swung between gloom and a directionless rage. Finally I made myself face the facts. I hadn’t come that far over the three months of half-time work. Starting out, my expectations were high, of getting strong enough to ride my bicycle again for hours at a time. But my knees were just too bad.

A fellow finance editor heard of my renewed woes and recommended a product called Tiger Balm. He used it once successfully for a knee injury. I found it easily at a local pharmacy. Tiger Balm looked like an Asian version of Ben Gay. The orange-brown, camphor-rich ointment came in a small, six-sided bottle bearing a crude image of a leaping tiger. A slip of paper inside the box claimed the product derived from “a secret herbal formulation that dates back to the times of the Chinese emperors.” Tiger Balm supposedly treated everything from headaches and stuffy noses to muscle aches and flatulence.

Despite my natural skepticism, whenever I tried something new, I always wanted to believe it could work. I rubbed the Tiger Balm thoroughly on my knees before retiring at night. The flow of blood in the region definitely seemed to increase for a while, judging by how hot my knees got. The skin would feel prickly; my legs would sweat. After a couple of weeks though, I had to accept that Tiger Balm may be effective for muscles but not for cartilage, lying deep inside the joint.

I continued to struggle to get through the long workdays. I wore my soft-soled New Balance running shoes around the office, though they didn’t help much. The human resources department ordered a special ergonomic device, a footrest with a tilting top. That let me elevate my knees somewhat and move my legs a little while sitting. When that failed to offer enough relief, I propped my feet (and knees) on top of my desk.

A simple bit of math began to obsess and discourage me. My knees hated sitting. At work alone, I occupied a chair for ten hours. That constituted more than half of my waking day. Getting better under those conditions seemed impossible. It was like having a large abrasion on my forearm that, instead of letting heal, I scratched anew every day. I was doomed if I didn’t get out from behind that desk for a while.

I tried to work with Bloomberg to design a plan to take a period of unpaid medical leave. But HR departments, as I knew all too well by then, have policies that constrict their flexibility. Complicating matters, the Hong Kong office was only one arm of the global company based in New York. A thicket of bureaucracy lay before me.

At least my boss was on my side. During that trying period, I gained a deep respect for him. He was fairly young to be leading the finance team. That may have explained the frown stamped onto his features; he must have always felt the pressure from Bloomberg to succeed. At times he could seem a bit cold and brusquely efficient, but he tried his hardest to do the right thing by me. He supported the idea of medical leave.