Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (15 page)

After my long struggle to fix a pair of achy knees with bad cartilage, I spent some time reflecting. What had I learned that might transcend my own experience and help someone else? If my knowledge were distilled into a few simple guidelines, what would they be?

I came up with four golden rules that helped me greatly in my recovery. Superficially, they’re all rather obvious and about as controversial as vanilla ice cream or Mother’s Day. But they turn out to be more complex than meets the eye. I bet you’ll find a few surprises in here.

Use it or lose it
.

Knee cartilage has a thankless job. Owners of knees do stupid things all the time. Over time, damage can occur to the cartilage, the shock absorber that helps the joints function properly. But once the cartilage is damaged, and a knee begins to hurt, the answer isn’t to stop moving. It seems paradoxical at first, but immobility only feeds the process of decay. Joints starve when they spend too much time at rest.

My personal experience convinced me that a program to mend bad knee cartilage needs to be based on motion. It’s not the high-force motion of exercises designed mainly to build up your quadriceps. That approach risks trashing your joints as you try to save them. Gentler, high-repetition activity does much better at nourishing the injured soft tissues.

As for what kind of motion, this probably depends on what your knees tolerate well and what you want to achieve. For some, walking may be best. For others, it may be cycling—or doing easy leg kicks in a swimming pool.

“Unloaded” exercises may help you return to your desired sport. I know that Doug Kelsey has invented a device that enables unloaded running. The user hangs from a harness that creates a sort of anti-gravity effect. The setup allows running over a treadmill at less than full body weight.

I created my own unloaded exercise, a “bungee squat.” I draped thick bungee cords over a two-by-four that ran overhead in a garage, then attached the hook ends to a rock-climbing harness I wore. With my bungee support in place, I repeatedly lowered myself from a standing to seated position for five to ten minutes at a time. I easily did four or five hundred repetitions with little stress on my knees. Plus it was kind of fun!

Of course, whatever exercise you settle on, it’s always going to be challenging to figure out how much sustained movement your bad knees can handle, and at what force. That leads to rule number two:

Listen to your knees
.

This seems like a real Homer Simpson “D’oh!” statement, obvious in a forehead-slapping kind of way. Actually nothing could be further from the truth. I suspect there’s an epidemic of people who don’t know how to listen well to the signals from their recurring knee pain. That’s because I used to be one of them.

I thought I knew how to listen to my knees. If an activity hurt, I didn’t do it. If it didn’t hurt initially, I would do it until my knees told me to stop. That was my superficial way of listening. Had I remained at that level, I never would have gotten better.

My problem: I wasn’t listening smart enough or hard enough. Once again, cartilage has no nerve supply. If a quarter-inch-high imp crept into your knee joint and slashed the surface of the articular cartilage a thousand times with a tiny razor blade, you wouldn’t notice a thing at first. The pain signals never come from the tissue itself, but rather from surrounding structures, such as a synovium that becomes inflamed after absorbing free-floating cartilage fragments.

The lack of nerves has huge and unfortunate implications. It confounds your ability to draw straight lines between cause and effect. What would happen if you banged your thumb with a hammer on Monday, felt no pain at that moment or the next day, but then sometime Wednesday morning you yelped “Ouch!” That would be strange. You would be inclined to reason, “It couldn’t have been that accident with the hammer on Monday, because I didn’t feel anything then.”

In fact, because of the delay in receiving the pain signals, you might unwittingly do further damage to your thumb. After a while, as it occasionally became sore for no clear reason, you might conclude that you just had a bad thumb and that nothing could be done to fix it.

That sounds scary. That also describes how bad cartilage often behaves. When you screw up and further damage the tissue, your knees may not let you know until the next morning, or even two days later. My knee journal was littered with examples of this “delayed symptom” phenomenon.

On one occasion, for instance, I decided to buy an electric fan as another long, brutal Hong Kong summer approached. The small models in the stores looked underpowered and overpriced, so I found a big pedestal fan through an online flea market. I walked over to the owner’s apartment to test it and found that the blades blew a nice, strong breeze. There was only one issue that made me hesitate: the fan was heavy. Carrying it home would strain my knees too much. They were very weak then.

The seller graciously agreed to drive me back in the family golf cart. So I only had to lug the fan down a few flights of stairs to the waiting vehicle, then after a short ride, carry it into my building to the elevator bank, then down the hall to my apartment. It didn’t seem far. My knees felt okay the whole time, but I knew the cartilage was soft and vulnerable.

This all took place on a Saturday. On Monday, my right knee got very sore and stayed that way for a few days.

At first I refused to believe that moving the fan was to blame. I pored over my knee journal and studied all the other possible variables between Saturday and Monday: the weather, my daily step counts, other activities. No other likely culprit emerged. I’m almost certain that the weight of that fan, coupled with the act of descending the stairs, caused my fragile knee to blow up. If that were an isolated incident, I might be skeptical. But the delayed onset of symptoms occurred too often to be denied.

So it became clear that listening to my knees involved much more than monitoring symptoms during an activity and immediately afterwards. I had to listen smarter, over a couple of days. Otherwise, I stood no chance of drawing the correct conclusions about what my knees could and couldn’t do. Had I not connected the dots between toting that heavy fan and suffering soreness two whole days later, I might have just sunk into despair and chalked up my pain to a random bad knee day. Instead I gleaned valuable information about the poor ability of my joints to support extra weight.

Listening harder is somewhat different. It became important because my knees often behaved like a mumbler, or like that low talker on an episode of the
Seinfeld
sitcom that no one can seem to understand. I would frequently have strange sensations that didn’t express clearly what was wrong—or even if anything was wrong. They might be little twinges, or tiny spots of soreness, or maybe a small touch of achiness. I consider them sub-pain signals. They don’t really hurt. If my knees were great, I would ignore them without thinking twice.

With bad knees, I didn’t have that luxury. Failing to heed a subtle warning can have painful repercussions. So when someone is a mumbler or a low talker, but what they’re saying is critically important, what do you do? Listen harder. If you listen hard enough, you can start to decode the language. You can figure out whether to be concerned about that twinge at the outset of your walk. You can judge whether it’s a normal part of warming up or a sign of trouble ahead.

Listening to my knees properly meant reacting to what they were saying and being willing to break with my exercise program, and very quickly at that. Had I understood what my knees were telling me, I never would have continued so long with the weightlifting that my physical therapist advised. My knees were screaming that it wasn’t working. And they were protesting in their peculiar, complex way: they felt fine during the workout, but the next morning the burning in my joints told me they weren’t happy.

The “listen to your knees” rule matters so much that I cringed on seeing an activity scale for bad knees in a book. Here’s how the scale works: You have a certain amount of points you can “spend,” if you will, on physical activity each week. The younger, healthier, and thinner you are, the more points you get. So for instance, a forty-six-year-old with current knee problems who is twenty pounds overweight may have enough points to walk up and down hills for five hours a week.

This strikes me as a really bad idea, tailoring your activities to a crude point system. It’s like trying to fine-slice prosciutto with a dull ax. Perhaps that overweight forty-six-year-old with painful knees shouldn’t be walking five minutes a week on hills. Maybe he can’t tolerate a stationary bike either (when I figured out my allotment of weekly points, the total indicated that I should be able to cycle over hills for more than ten hours a week; in reality I couldn’t tolerate ten minutes).

Listening to your knees also involves trying to distinguish between sounds that are meaningful and those that aren’t. Normal knees make a lot of noise: airy pops and clicks and even scary-sounding cracks. Experts say knee noises unaccompanied by pain can be safely ignored.

I don’t think that’s quite true because damaged cartilage makes a telltale sound. When you bend your knees, it may remind you of a soft wet ripping, or the grinding of bits of gravel, or the crackling of potato chips breaking. That noise deserves attention, even when no pain is associated. You need to make changes, and fast, to whatever stressful knee activities you engage in. Trouble may be lurking on the horizon. I wish I had known this.

Finally, to really listen to your knees, you need to be able to hear them. That’s a big reason I eventually threw out my painkillers and anti-inflammatories. While I’d be the last person to snatch pills out of the hands of a chronic pain sufferer, just think of what these medications do. They mask the very symptoms that are crying out, “don’t do this” and “stop doing that.”

I discovered as much after taking an arthritis drug once. It allowed me to sit normally at work with only background sensations of pain. The next morning though, I paid the price. While sitting, my discomfort was twice as severe. Obviously one response is to simply pop another pill to make the next round of pain go away.

Then an epiphany hit me: isn’t the pain itself an important message? You can stifle that message. You can drown out what your knees are saying with the pleasant white noise of a little red or yellow or pink pill. But does that really help you get better?

Once I learned how to listen to my knees, I was ready to apply my third rule:

Get on cartilage time
.

I once saw a cartoon where a frightened mayfly blurts out something like, “My life flashed before my eyes: all twenty-four hours.” The joke makes us laugh because we realize everything has a different scale of time. For an igneous rock, a decade is the human equivalent of an eyeblink. Meanwhile a mayfly born at the crack of dawn is passing through middle-age by sunset.

Parts of our body heal on different time scales too. Muscles are bathed in blood; they recover more rapidly from injuries. Cartilage has no blood supply and its cells are isolated within the larger matrix; it improves very slowly. I used to quip that healing my knees was like watching paint dry—except paint dries much faster.

Getting on cartilage time requires adjusting expectations. Healing bad knees may take six months, a year, several years. It’s one thing to say, “Okay, I’m willing to get on cartilage time and devote a few years to fixing my knees” and another to fully understand what that implies. For me it meant telling myself to stop being impatient and to stop fixating on short-term results.

Early on, I always compared one day to the previous, looking for signs of healing. An especially good weekend made me feel giddy, thinking my pain would soon be gone. Then a bad day would follow and send me into black despair. The up-and-down cycles left me depressed and sapped my energy. It felt like I was flailing about. At one point, realizing how deadly my short-term thinking was, I stopped recording my knee scores for a while. They seemed to put constant daily pressure on me to improve.

Once you get on cartilage time, you can focus more on the trend line of healing, not the noisy data points that jump around a lot. After all, no matter where you find yourself on that trend line, there will be good days and bad, relatively speaking. But are the bad days better than they were a few months before and less frequent? To settle such questions, I would track long-term trends by noting in my knee journal the “good” and “bad” from each week.

This feature occasionally turned out to be useful for moral support. Nine months after leaving Bloomberg, for example, I got discouraged after a couple of bad days. I browsed through old knee journal entries and they lifted my spirits, showing how far I had come. At the two-week mark, I was in such poor shape that I had to sit with my legs draped over a box and considered good my ability to stand in one spot and brush my teeth at night without too much burning in my knees. At nine months, neither of these problems had been an issue for a while.

When you give yourself more time to heal, something beautiful happens. Time becomes your friend, instead of the enemy that’s constantly draining out of the hourglass. You make peace with taking baby steps toward your goal. You allow yourself to proceed more slowly and carefully, without self-recrimination. That may sound easy, but for hard-driving, competitive people, it’s not. I knew that firsthand. 

Before my knee injury, I trained intensely and constantly tested the limits of my endurance. When Dr. Chiu told me during our first appointment that I should reduce my cycling, perhaps to ten minutes a session at first, I almost burst out laughing. My body was conditioned to go two to three hours, hard. In ten minutes, I would barely break a sweat. But then, a few months later, my knees were unable to handle even five minutes of gentle biking.