Ask DK

question_mark_dkWant to ask me a question?

I  love helping people find answers to questions about how to move better, feel better and get more out of life.

But….

I cannot answer specific, personal health or injury related questions.

If you have a quick question that I can answer easily in a few sentences, feel free to ask in the comments box below and I’ll try to get to it as soon as I can.

I often answer questions in my blog (but I change any personal identifying information).

PLEASE, DO NOT ASK ME FOR ADVICE FOR YOUR, OR A FAMILY MEMBER’S, HEALTH OR INJURY RELATED PROBLEMS.

If you do, I won’t respond. I don’t mean to be harsh. This isn’t the venue. You can email my colleague, Laurie Kertz for more personal assistance.

125 responses to “Ask DK”

  1. Bill says:

    Hi Doug,

    Any advice on how to heal from patella tendonitis. I look forward to following you on your new blog.

    I am a 51 year old runner who wants to be able to run.

    Thanks in advance,

    Bill

    • Doug Kelsey says:

      Hi Bill –

      Thanks for your question. Tackling something like patellar tendonitis is a broad subject and it wouldn’t be proper for me to give you specifics via this venue. I can give you some general guidelines that might help though.

      There are a number of disorders that can cause anterior knee pain so you to be sure you have tendonitis and not something else like tendonosis, bursitis, or patellofemoral syndrome or referred pain. But assuming you have a tendon injury, you have a couple of options.

      Tendons heal from applied physical stress – either a low load over a long duration or a higher load and fewer reps. If you have symptoms at rest or soon after starting an activity, then you’ll need to go the low load, high rep path.

      Biomechanics come into play too – adequate range of motion of the hip and ankle, enough strength in the hip to prevent too much rotation at the knee, etc but these these have to be evaluated by a health practitioner.

      There are some good taping techniques that seem to help with symptoms and sometimes improve mechanics – you can look into kinesiotaping and probably find a practitioner near you.

      I go into more detail about the knee and running in my book – The Runner’s Knee Bible at http://www.runnerskneebible.com

      I hope this helps and good luck on your quest.

  2. Curt Miller says:

    Hi Doug:
    I called your office today to ask for a physical therapy referral in the Dallas Ft Worth area. I’m in Bedford. The office said the closest was Oklahoma. I wondering if there is someone in my area with a similar mindset as you?

    I suffered a right ankle inversion dislocation from a ladder fall two and half years ago. I’ve developed PF and more recently for the last three months or so routine peroneal tendon pain. The young orthopedic doctor a recently saw has just put me back in my air boot for four weeks with an rx for physical therapy. He want’s to do do an MRI if not improved in 30 days. I have this feeling we are off on the wrong track. I am hopeful that I can rehab these issues with some effort on my part. I successfully self-rehabbed the same leg after a total knee replacement several years ago with good direction from my knee surgeon. I do know how to follow directions.

    So, is there someone that can get me started in the right direction locally or can I do this on my own with remote direction from Austin? Since it’s kind of a tough commute to Austin.

    Thanks for any help,
    (65 y.o. that still wants to be active. Not riding the bike anymore and only light duty on the indoor recumbent till I have a plan in place)

    • Doug Kelsey says:

      You should see Marty Stajduhar – he’s in Bedford I believe at : http://www.texashealth.org/MeettheStaffbh
      I’ve known Marty a long time. Smart guy, great skills and has an extensive background. Tell him I sent you.

      • Curt Miller says:

        Thanks for the quick reply! Marty no longer has an active number in Bedford and is not at Texas Health any longer….. Anyone else? Thanks in advance!

        • Doug Kelsey says:

          I would try Dale Smith, PT. I believe he’s in Dallas – Greenville Ave last I knew.

  3. Lacey says:

    Hey Curt,
    I drove to Sport Center from Altanta. It’s worth it. Really, it is. I would do it again without hesitation.

  4. Curt Miller says:

    Doug: Thanks again for the help! Dale has an office in Southlake and I look forward to meeting him shortly.
    (Didn’t know this was a public access. Could my contact info in the first message be removed before Google harvests it? Thanks)

    Lacey: I want a non-surgical solution and I’m very much willing to cruise down to Austin if this doesn’t work out locally. Thanks for the feedback. I’m looking forward to my own success story!

  5. Doug Kelsey says:

    Curt – I removed your contact info.

  6. Des says:

    Hi Doug
    I watched a BBC Horizon documentary recently (no, not the Fast diet) about the human body clock. One aspect of this they talked about was the best time of the day to exercise (as I recall this was mostly in reference to “cardio” exercise.) Something that interested and worried me was the claim that cardio in the morning not only had no benefit on blood pressure but was also dangerous. Your blood pressure is naturally higher in the morning and putting more pressure on the heart at this time is asking for a heart attack. I usually prefer to run in the mornings and now that I live in Houston, if I want to run outdoors, the morning is the only sensible option. I’d be interested in your opinion on this subject.

    Thanks,
    Des

  7. Regina Clarke says:

    Hi–

    I just did an Internet search to find out the best way to strengthen my quads because I had knee pain. The first article that jumped out astonished me–by Richard Bedard–refuting the very idea of doing that and describing the advice he got from you. My story parallels his so much in terms of what doctors have told me that I just assumed quad work was necessary–I had to do something! Always active, I nevertheless had four knee surgeries–two on each knee–once in my teens to add wood screws to hold the kneecap in place, and then in my forties to have the nails removed. The second op seems to have accelerated arthritis, which I had not known prior to it (not felt). For 12 years now it has been up and down. But I just assumed the cartilage would stay as it was–the MRIs showed marked deterioration when I had them filmed in Austin–where I lived a few years in 2003-2005. Just hearing the revelation that cartilage can repair itself–never having heard that ever before–is enlightening–for now that is how I will “talk” to my legs and knees–with awareness they have inner healing capacity–I am a believer in whole body and mind interconnection.

    My question is in light of this last surgery when I had the nails removed. The doctor was a sports doctor in CA. He said it was a casual op. But it wasn’t. He added three inches to the scar on the right knee that was already long enough. And advised no physical therapy after the operations on both knees (done at the same time). I saw the wood screws–astonished they looked like screws for cabinetry! And he told me after the surgery ( with irritation) that he had a devil of a time getting the tendons or ligaments back in place. He said something about pulling them around. Now, years later, one thing I feel every time I get up from having my legs straight out or after sleep, and try to bend my knees, is first a kind of motion inside around the knee as if the ligament or tendon is sliding over into a new location. As if it settled almost on the knee cap and then moved aside. It wasn’t until recently I even remembered his saying he had done that. So could this fact affect healing, too? is there anything I can do about it while approaching the cartilage healing Mr. Bedard has presented from your advice?

    I guess even to know what it is the doctor did, based on his description, would help. And whether it might have accelerated the apparent atrophy that has slightly bowed the legs.

    Another way I could describe the sensation is that when I bend my knees even slightly to get up, it’s like there is a rope blocking the bone that eventually a few seconds later slips to the side.

    Thanks for any comment, indeed.

  8. Doug Kelsey says:

    Hi Regina –

    Without knowing exactly what was done surgically it’s hard to say what the cause is for your symptoms re: the sensation of something slipping. It may be that you have adhesions in the area which come into play when the knee is at certain angles. This could interfere with efforts to strengthen your joint since cartilage requires a very high volume of motion at low loads. The repetitive motion could irritate other tissue in your knee since the movement will not be smooth and unimpaired. I’ve sent people with complex knee issues to the Steadman Clinic in Vail, CO. They have a lot of experience with situations like yours.

    I hope this is helpful to you and things improve soon.

  9. Naomi says:

    What would be the “legal” pause between sets of any exercise? How many seconds?

    • Doug Kelsey says:

      Naomi –

      For the Elements, there is no “legal” or “illegal” pause. You rest as needed while aiming for shorter rest periods over time.

  10. Mary beth pace says:

    Please post the how to fix your toe video…saw it once now can’t find it. Thanks

  11. Lori says:

    Hi Doug- After many years of running five miles a day, I was diagnosed with chondrosis in my left knee and tendonitis in my right knee. I went through five months of physical therapy to strengthen my quads and hips and the therapy only made the pain worse. I had supartz injections in my left knee which had to be stopped after the second injection because I could no longer bend my knee without pain (I didn’t have that problem before the injection). I live in New Jersey and wanted to know if there are any therapists here who are familiar with your way of treating these problems (I can travel to New York City for one session as well). If not, do you have any reference materials that you provide to other therapists? Thank you.

    • Doug Kelsey says:

      Hi Lori –

      I don’t know of anyone in the NJ / NYC area unfortunately. I know therapists who have purchased my book – The Runners Knee Bible (http://runnerskneebible.com) have told me that it was helpful in explaining the principles and concepts around joint related problems. You could also contact Christine Springer – look under the ABOUT tab on this site. She may be able to help you.

      I hope this is helpful to you.

  12. Anne says:

    I noticed that in your knee bible book you include the bird dog as part of the evaluation. Isn’t kneeling totally contraindicated for damaged knees? Thanks, Anne

    • Doug Kelsey says:

      Hi Anne – thanks for your question.

      The Bird Dog is part of a Priming sequence (I don’t believe it’s part of the assessment). Kneeling is not a contraindication but is a precaution. If kneeling is painful, by adding sufficient padding, you can relieve the discomfort. If your knee pain as from, for example, bursitis, then kneeling might be too painful to do but the book primarily addresses runner’s knee syndrome and kneeling is often tolerated.

      I hope that is helpful to you.

  13. Patrick says:

    Doug–

    What are your thoughts on a rope machine? I’ve been using a Marpo Vmx at the gym, and at home just 20 feet of heavy rope (not too heavy), which I use to strengthen my upper body and burn some calories. Since my knees are slowly healing, what I like is the ability to stand up and sit down, even walk around while I manipulate the ropes. so far it seems to be a good way to combine exercise forms and also to be able to work out at home outside while the weather is still good. Thoughts?

    • Doug Kelsey says:

      Patrick –
      I’ve not used a Marpo Vmx so I can’t help you much there. The heavy rope drill can be a very demanding drill on the shoulders and trunk. It’s a function of the length and weight of the ropes. Since I don’t know the exact issue with your knees, it’s hard for me to say whether that exercise is one that could indirectly overload your knees. There is a reactive force from stabilizing the body – question is whether that force is too much or not.

  14. JONATHAN hALL says:

    I found your article on back pain in the morning (‘flexibility is my friend’) very interesting. I have similar problems for about 5 years now, my doctor has examined my back and I have had an X ray scan of the back, there seems to be nothing wrong with the basic bone structure of the back. I believe the problems are with the muscles supporting the back The problems come early in the morning after 6 hours sleep. It seems that my back cannot take lying in the same position for that length of time. The muscles supporting the back then start to ache, and I am missing out on some sleep. The pain is not severe, its just enough to wake me up and then stop me from falling back to sleep again. During the day my back is fine, I feel no pain. My doctor says there is nothing more he can do for me here, he cannot explaiun why I am feeling pain early in the morning. I feel conventional medicine has failed me. I would like to get a referral to a sleep unit here in the UK, but to do so I would need to be referred by my doctor. But would a sleep unit be able to help me here? Are the problems best dealt with by a Physiotherapist or Chiropractor? Any advice considered!

    • Doug Kelsey says:

      Jonathon – from your description, it sounds like a Physiotherapist or Chiropractor would be the best choice. They might be able to assess sleep positions, sleep surfaces, your biomechanics. Another thing to consider that seems to affect some people is gluten. Some people are sensitive to gluten in their diet which causes a low grade inflammation. You could remove gluten from your diet for 6-8 weeks to see if there was any difference in your sleep quality / quantity.

  15. Jola says:

    I got 286 copies of Will Eating More Fat Make Me Fat? in my inbox this morning.
    Sorry, I know this is not the right forum for this question, but I didn’t know how else to reach you.
    j

  16. Naomi says:

    Is there something you can say about exercising in the Austin heat? I find it puts a real dent in what I can do and not feel really drained later in the day. Is withstanding the heat part of conditioning? I do start early and drink much water along with electro-mix.

  17. Doug Kelsey says:

    Naomi – yes, I can say something about exercising in the Austin heat. It’s awful.

    Having said that, make sure you’re well hydrated before you start, drink plenty of fluids both during and after. I train in my garage mostly or outside and typically drink at least 1 liter of water within a session – for example. Feeling drained later is often dehydration but could also be not eating enough of the right things so look at that as well. And yes, there’s an adaptation to training environments (heat, cold, wind, elevation, etc) but unless you must exercise in the heat, I would opt for more tolerable conditions.

  18. Lynn Bjorklund says:

    Have you heard of the slack line as a fun way to try to improve balance? Do you think it might be a good tool?
    These folks in this video have really mastered the art of balance: http://www.youtube.com/watch?v=3MdDobR65Oo
    I suspect they would have no trouble standing on one foot for a minute or even do the Tree Pose to Superman!
    Lynn

  19. Barb says:

    Have you heard of any physical therapists with your philosphy on healing knee cartilage in central IL? I’ve been told I need knee replacements for both knees as I am “bone on bone” in both. Trying to rebuild cartilage before going that route (57 yrs young) but need some help. The surgeons, PT’s and trainers I have been to tell me it is impossible. Thank you so much for your informative posts.

  20. Doug Kelsey says:

    Hi Barb –

    When you have enough exposed bone, you won’t have enough cartilage to create a healing response. In some cases of a very small, focal area a microfracture technique can help but it sounds like you may have a larger area of exposed bone.

    And, no, sorry, I don’t know of any therapists in Illinois.

  21. Kim says:

    Hello.
    I have a diastasis recti (from two pregnancies) and the beginnings of a ventral hernia. Am considering a hernia repair with the mesh as well as an abdominoplasty. I was wondering whether you could tell me anything about the surgery, or if you knew of any reliable references that I might read?
    Many thanks in advance, and thank you for a great blog and ebooks!

  22. Doug Kelsey says:

    Kim – I think the best source for info about your surgery is the surgeon. While there is general info on the Internet, it doesn’t replace the back and forth question and answer that can come from a focused meeting with your surgeon. Most offices will have a process in place to facilitate answering common questions. This site has a number of FAQs that you might find helpful:
    http://drdumanian.com/pages/abdomen-hernia.html#rectus_diastasis

    Hope this is helpful to you.

  23. Bjoern says:

    Hey Doug! I love the way you describe about cartilage since no one else seems to say anything about it.

    I have been diagonsed with a cartilage injury on my right knee medial femur chondyle size 2*1 cm (Grade II 50% OF CARTILAGE LEFT). No other knee problem. The injury is with approx 20 degree of flexion in the knee joint.
    Running and jumping is completly impossbile at the moment.

    I am trying to determine my load tolerance from your book but my knee is different. Since the injury is in 20 degrees I have pain when I am trying to sit down or if I use my knee over the 20% 0f flexion. Squatting etc.
    I also get pain from walking up and down stairs.

    I can easily do Static Hold in 90 degrees towards a wall for a couple of minutes
    I can do back slides on my injured knee pain free (Maybe the injured area doesn´t disturb any other tissue in that excersise)
    I can also sit in Third World Squat without pain.

    I can change the load on my injured knee for example when squatting put the knees in slight valgus position or put the feets next to eachother (more lateral load since injury is madial)

    Have you got any recommendations for how I should continue? Have you worked with similar patients?
    I live in Sweden.

    Looking forward to your reply. Thank you in advance!

    Björn

    • Doug Kelsey says:

      Bjorn – this is very difficult to do via a comment box but from what you describe, it seems as if you do have a load tolerance issue. If you hurt getting up and down from a chair, for example, then what I would do is test your leg using a variable incline plane as I described in the book (and I assume you mean The Runners Knee Bible). This will give you a threshold for load tolerance within the offending arc of motion. Once you know this, you can then find the optimal load level for reconditioning the joint. And yes, I’ve seen many people with similar problems. For more personalized help, email me and I’ll send you contact info for my partner, Christine Springer.

  24. Naomi says:

    Doug: In this formula 208 – (AGE*.70), does the “AGE*” mean “your active age” from the test? If my active age is 39.11 then do I subtract 39.11.70 from 208? I can’t be the only one this dumb. 🙂 N

  25. Kyle says:

    Hey Doug. Before my question I just want to thank you because you give me hope in a world that is way to quick to write off problems as “just something you’ll have to deal with for the rest of your life”.

    Anyway, can degenerative discs repair via motion and repetition? If so, what exercises do you recommend for degenerative discs?

    • Doug Kelsey says:

      Thank you Kyle – I appreciate the kind words.

      About degenerative discs, in a nut shell the repair process is similar to a joint surface injury but because of the nature of the tissue involved, the program is different and too complex to answer here. One of the things you have to “reboot” is the stabilzer musculature. I wrote an article about that here:

      http://dougkelsey.com/tougher-abs/

  26. Bruce says:

    Doug,
    I saw an article you wrote in 2005 on dealing with Plantar Faciitis and you suggested using crutches for 2-3 weeks to let the ligament heal. My wife has been battling this for 3 months , but hasn’t tried crutches. Is that still the best advice

    Thanks

    • Doug Kelsey says:

      Bruce – for some people, crutches are needed. But it’s part of an overall strategy based on your weight bearing tolerance. I’m working on a series of articles now on the topic of plantarfasciitis that might help explain it. Too much info for a comment box.

  27. anNe Flanagan says:

    Hi Doug-

    Can you address bursitis, specifically of the greater trochanter? I understand that this can be a long term problem, and I am trying to do the right things which I have been told are stretching and strengthening the muscles around the hip. What are your feelings about cortisone injections in this situation? Do you see this condition much in cyclists?

    Thanks

    Anne

  28. Pam Weikel says:

    Hi Doug,
    It’s been a long time since I crossed your path. Years ago I spent traveling back and forth from Houston to Austin for my shoulder – which of course, back in the day, you rehabilitated. Looking forward to joining the ActiveAge Blueprint. I believe THIS is what I’ve been looking for…can’t wait to post results down the road! Pam. p.s. Just ran across your blog the other day – it’s awesome!

    • Doug Kelsey says:

      Hi Pam!

      Great to hear from you and thanks for checking out my blog. Hope you find things that are helpful to you!

  29. Mary Hobbs says:

    My 16 yr old daughter plays club soccer. Recently several of her teammates have blown out their ACL – it wasn’t even under game play – they just tripped or slid on wet grass and Bam! Is your Running Program appropriate for helping prevent this injury? Soccer players have to make so many changes in direction.

    Thanks,

    Mary Hobbs

    • Doug Kelsey says:

      Hello Mary –

      There is a relationship between low hip strength and ACL injuries in young women. Your daughter would need a more customized program, assuming she has such weakness, than what is in my book “The Runner’s Knee Bible” or an off the shelf return to running program. Most sports/orthopedic physical therapists know about this issue and could help.

  30. Karen Harwood says:

    Hi Doug,

    I was wondering if you know anyone in Oklahoma (Tulsa area specifically) with the same approach and mind set that you have. I am dealing with a hip problem that has become a back problem. The symptoms seem to be going back and forth.

    I am a physical therapist myself but I am wanting someone to bounce ideas back and forth and get some guidance. It’s harder to do this alone. My “specialty is neuro based, hospital based and rehab work. Orthopedics is not my strength but I know the body and can understand the principles. I have read your blog for years and love your wisdom and approach.

    I am thinking of joining active age blueprint soon…but I don’t want to perpetuate an injury. I think part of my problem is being a little bit too much inside my head and being scared to move. I need someone to push me a little bit.

    Thanks for any guidance you can give,
    Karen

  31. JANE says:

    I FEEL MY LOWER BACK (EXTREMELY STIFF AND PAINFUL IN MORNING – TAKES AN HOUR TO GET DISCS LOOSENED UP WITH HEAT, COLD, BATH, SWISS BALL, STRETCHING, ETC. – OR I CANNOT BEND FORWARD AT ALL) IS CAUSED BY SPINE LOSING FLUID IN DISCS. i’VE LOST HEIGHT. A FORMER RUNNER AND CURRENT TENNIS PLAYER, HIKER AND I WALK DAILY. ANY SUPPLEMENTS i CAN TAKE TO HELP BOOST THE LOST FLUID? (I DRINK ONLY GOOD SPRING WATER) AFFECTS MY NECK TOO. PROBABLY AGE CAUSING MY SPINE TO BE IMPACTED. HIPS ARE GETTING SORE TOO, ARTHRITIS? I’M OVER 60. HELP.

  32. Alpa Kulkarni says:

    Hi Doug,
    I have been told that my RA is causing such a huge amount of inflammation that Cortisone and Supartz injections are not helping my knee pain. What are your views on how Rheumatoid Arthritis and Osteo Arthritis work together to cause knee pain? More importantly, the exercises that you prescribe, will they work even with RA? Or is there other specific treatment for RA affected knees?

    Thank you,

    Alpa

    • Doug Kelsey says:

      Hello Alpa –

      While Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are different diseases, people with either tend to improve with joint friendly exercises. The key is getting the load levels correct. In the case of RA, I’ve found that the exercise routines must be customized to the person and adjusted frequently. The disease tends to wax and wane and as a result, the tolerance for load goes up and down. Consulting with an orthopedic certified physical therapist may be helpful to you.

  33. Madshus says:

    Hi Doug
    Do you have any views or experience with knee conditioning exercises following stem cell therapy? What is a good approach to take?
    Cheers
    Madshus

    • Doug Kelsey says:

      Hello Madshus –

      Thank you for your question. Generally, you could follow a post-platelet rich plasma injection protocol or one that is designed for cartilage repair. The cells following the procedure are fragile so you have to be careful how much force you use and how rapidly you progress the program.

      • Madshus says:

        Thanks Doug. Where could I get the protocol or one designed for cartilege repair. I’m in Australia, by the way, and am facing a stem cell procedure soon.
        Cheers

  34. tAMMIE says:

    Hello Doug,

    Can you advise on how to treat a shoulder impingement? I would love to get back to pushups and weight training but due to having this shoulder impingement now going on 6 months with PT(concentrating on posture only seems) my body has gone to mush. I was told that the impingement can cause back and neck pain both of which I do have as well now. I just want to get this shoulder back to norm so all this pain will be gone and I can start working out normally again with no pain.

    Any advise on how to heal this darn thing would be greatly appreciated.

    Kindly, Tammie

    • Doug Kelsey says:

      Hello Tammie –

      Shoulder Impingement can be caused by a number of things – rotator cuff tear / tendonosis, instability, scapular dyskinesis, lower trapezius weakness or myofascial tear among others. Once you know the possible cause(s), then the solution is easier to determine. Physical therapists who are board certified orthopedic specialists should have a good idea of how to help you. You can visit the American Physical Therapy Association website to locate a therapist in your area.

  35. Amy says:

    Hi Doug,
    I am suffering with chondromalacia and have seen a number of doctors and therapists over the last year.
    Without fail, each one is suggesting that I work on my VMO. Your recent blog post on this subject really got my attention.

    I am in Ontario, Canada. Do you know of any therapists/specialists in my province, that subscribe more closely to your thinking that the VMO cannot be isolated?

    Thank you,
    Amy

    • Doug Kelsey says:

      Hi Amy –

      Sorry to hear about your knee. Unfortunately, I don’t know of anyone but I bet there are therapists or trainers who work from a movement model. Another thing to keep in mind is that cartilage needs a lot more reps, for example, than muscle. So, the person you see should have an understanding of cartilage physiology as well.

  36. Robert Catenaro says:

    Do you have a link to your video on “tailgaters” program for the knee, which shows how to do “low load, high volume repetition” exercises for knee pain?

  37. Elsa says:

    Hi Doug,

    Thanks so much for all of your valuable information. I’ve got collapsing arches and have been told that wearing orthotics is the only solution, that exercise alone will not resolve the problem. I’m not sure whether you have posted any information about this anywhere. I’ve read a lot of negative information about orthotics, that wearing them will weaken the intrinsic muscles and will make the problem worse. I’m not sure who’s right – the proponents of the barefoot/minimalist school or the podiatrists. I would be curious to know what you think about this..
    thank you!

    • Doug Kelsey says:

      Else – thank you for your question. The answer is somewhat complicated but in a nutshell, the formation of the arch of the foot has several factors. Yes, the intrinsic muscles of the foot play a role but so does the position of the rear foot, position and movement of the hip, and the strength of the soft tissue in the foot. If you have foot pain and the you’ve been told it’s from “fallen arches” or “flat feet”, keep in mind that about 20% of adults have “fallen arches” and have no symptoms. I’ve used orthotics with my clients before to alter the force distribution through the foot while they retrain the strength of their soft tissue and work on improving their biomechanics. I don’t think you have to wear an orthotic forever necessarily.

  38. Saroj says:

    Hi Doug,
    I found your information from “saving my knee” blog and book when searching through internet from last seven month to find answers to my knee problem. I am very impressed by reading your articles about knee pain, and a regular reader of your post from last one month. Your article has given me something very important which I had lost, “hope to heal”. Thank you for all the work you do to help people like me.
    I broke my meniscus working out on elliptical machine seven months ago. I thought gym exercises are good and starting going to gym; third week while trying to keep elliptical machine running with one straight leg – in order to pause after 1-2 minute of exercise on machine – , I felt strong pull in my left knee. The injury I thought was a minor sprain turned out to be one of the biggest health problems of my life. I had swallow and stiff knee for two months after the injury. No mobility at all, was bedridden for two three months. Saw few doctors in stanford and they said that there is no option other than bearing this pain and spend life like this because you broke meniscus which does not heal. Also, this condition will get worst as you age. When I asked how can I make it better or prevent it from getting worst, their answer was “nothing , it will get worst.
    My life has stopped after my knee injury. I am 47 yr. old female. Feeling all time low and desperate to get some help. Your articles about cartilage healing have given me hope. But, I am looking for your guidance and help to make my knee better and get my life back, and ready to do anything to achieve it. I had not done anything else to abuse my knee other than this mistake in Gym not knowing it . Doctors gave me quards exercise and doing one knee standing 1-10 count exercise for 2 minute had thrown me back last week back to square one. I am bed ridden again. Too much burning in knee. Not able to even walk slowly.
    My reports says: complex tear of the posterior horn of the medial meniscus. Tear of the free edge of the body of the lateral meniscus.
    5 mm anteriorly projecting osteophyte arises off the proximal margin of the intercondylar notch, abutting the adjacent patella articular cartilage. Full thickness cartilage loss along the lateral patellar facet. Cartilage thinning and irregularity overlying the median ridge and medial patellar facet and lateral femoral condyle.
    Can you please guide me with your feedback as what I need to do to heal my knee and get my life back. As I said, I am ready to do anything to get my life back. I wanted to ask this in some of your article by commenting it but could not find a way to comment there.

    Many Thanks for your help

    • Doug Kelsey says:

      Saroj –

      I cannot give personal, specific advice on the blog. It would not be appropriate nor would it likely work for you since a problem always has multiple factors to consider which cannot be determined via email, comment box, etc.

      However, I can give you some general tips. First, I would investigate Platelet Rich Plasma (PRP) injections for your knee. The PRP injection uses growth factors that naturally occur in your blood to help stimulate tissue healing. Here’s an article I wrote about it from my personal experience:

      http://dougkelsey.com/meniscus-tear/

      Once you have a more optimal healing environment established via the PRP, then you may benefit from the principles and techniques I discuss in my book, “The Runner’s Knee Bible” (http:/runnerskneebible.com) or secure the coaching services of someone who understands how to facilitate joint healing via special exercise techniques.

      Best of luck to you. I hope things improve for you soon.

      • Saroj says:

        Hi Doug,

        Thank you so much for your prompt reply and advice. I will buy your book “Runner’s Knee Bible” to gain more insight and apply those techinques for more recovery.
        However, I do have one follow up question for you. I was able to resume my normal life slowly – slow walk, normal household work, going out for shopping etc. – after two-three month of rest after my original injury in April, 2013. However, I want to squre one two weeks ago just doing just 2 min. single leg standing quard exercise which tells that my cartilage are not healed yet or cannot take any load.

        Can I give my body some more time – following Your book and “saving my knee” suggestions – to heal meniscus naturally and then decide for PRP injection after that? What do you suggestion?
        Is meniscus and cartilage tear is same thing?
        What is your contact email to discuss few specifics and get your suggestion? I am not sure about your consultation fee etc. though.

        If you need my email to let me know all that in an email, please do let me know.

        Many thanks in advance for your help
        Saroj

        • Doug Kelsey says:

          I cannot give personal, specific advice on the blog or via email. It would not be appropriate nor would it likely work for you since a problem always has multiple factors to consider which cannot be determined via email, comment box, etc. For consultations, please contact my colleague, Christine Springer.

          Best of luck to you.
          DK

  39. Iris says:

    I am (was) a runner and don’t have Runner’s Knee, but do have osteoarthritis in one knee (maybe as a late result of a skiing injury in my teens). I would love to one day run again. The orthopedist tells me it is “mild to moderate” and told me to find another exercise. My main goal is to avoid further degeneration and knee replacement. I’m thinking the exercise that I have been doing isn’t helping (i.e., muscle strengthening). Your philosophy and work give me hope that I might run again! I was wondering if your Runner’s Knee Bible would be appropriate for me. Thanks.

    • Doug Kelsey says:

      Iris – thank you for your question. The Runner’s Knee Bible was written to help people with PatelloFemoral Pain Syndrome (also called Runner’s Knee Syndrome) which is a cartilage problem similar to osteoarthritis. The book would be a good reference tool for you almost like a text book. The programming in it though is geared to more of the specifics of PatelloFemoral Pain Syndrome although many of the concepts and training techniques are used in programming for osteoarthritis.

      • Iris says:

        Thanks, Doug. I bought the book and it’s great. I know you can’t advise me in my situation but, theoretically, it seems as if a person might apply the principals of joint healing to osteoarthritis with some success over a longer period of time. A person with a weak joint could try strengthening the joint using the principals you outline in the book. If other factors, such as poor mechanics and imbalances, etc. are corrected, do you think it’s at least possible to improve the cartilage (articulate and meniscal) to a point where the degeneration is stopped?

        • Doug Kelsey says:

          Iris – the progression of OA can be slowed and there’s some evidence suggesting that with the proper blend of exercise and nutrition, it may even be halted. The exercise though has to be within the joint’s “load tolerance” which I cover in the book. While biomechanics plays a role, the more important thing is your “biologic reserve” – the amount of force your joint can produce and / or absorb and still have some capacity left over. The bone underneath the cartilage reacts to the load and if the load is too great, the bone will harden and cut off vital nutrient supply to the cartilage. This is one of the reasons why “load tolerance” is so important.

  40. lee says:

    Hi,

    I was wondering if a rocking chair, or a rocking office chair could be useful for CPM?
    Thanks.

    Lee

    • Doug Kelsey says:

      Hello Lee –

      Are you asking about the rocking chair as a CPM for the knee? If so, it’s not the best solution because the knee joint doesn’t move much and it’s bent most of the time during the movement of the chair. It’s better than not moving the knee although it can also make it worse if the joint surface happens to be soft or weak at the specific angle created by being in the chair.

  41. James Jeffcoat says:

    Doug – Purchased your Runner’s Knee Bible, and have been employing the exercises, and have also found the blog very informative. Can you please tell me your thoughts on Hoffa’s Syndrome, specifically whether or not chronic fat pad impingement is treatable without surgery? Thanks.

    • Doug Kelsey says:

      James –

      I’ve approached Hoffa Syndrome in generally two ways:
      a) taping technique of the inferior patella along with load controlled, closed chain strengthening of the hip rotators and lower extremity
      b) the above plus a corticosteriod injection of the fat pad.

      Of the two, (b) was successful more often than (a).

      Hope that helps you.

  42. Saroj says:

    Hi Doug,

    I bought your book “Knee Bible” and read that. Great book!
    However, my situation is very messy and bad and I don’t know where to start. I am hoping if you can please advise me. I really need your suggestion and advise.
    I saw another orthopedic and he diagonst 2 problems in my knee – 1) Meniscus tear in posterior horn of medial and lateral meniscus (injuery happened 9 months ago, I was functional up until this rececnt flare up 6 weeks ago.. 100% bedridden.)
    2) This second dr. said I also have chondromalacia. where as first dr. told this as patellofemoral pain.

    I have extreme burning behind my knee and under my knee cap. taking “aleve” from last one month.. not much improvement. My knee cannot even tolrate less than 1 min walk or 2 min of furniture sliding with foot drill from the book.

    I learned from you about PRP injection before going for a surgery for meniscus. But, due to this severe burning and flare up, I am not able to decide for PRP or surgery thinking it will increase my burning and flare up more.. Aleady it is ranging 5-9/10 , 10 being highest.

    Can you please advise, suggest where should I start? Should I wait until this flare up is bit settled before going for PRP?
    Is it advisble to take PRP with such a bad flare up?
    Where is this severe burning coming from? What I need to do to calm this down? Resting from last 6 week and aleve has not helped much.
    Is chondromalacia. and patellofemoral pain terms are same?

    I am ready to do or pay anything to get out of this death spiral. I have heard a lot about you and specially from Richard’s book.

    Thank you so much for your help in advance.
    Regards,
    Saroj

  43. Wyatt Stafford says:

    Hello,

    The only pain I have regularly is in the pes anserine bursa. Does your expensive ( sorry, but price is an issue for me) ebook address this kind of problem?

    Thanks,

    • Doug Kelsey says:

      Wyatt –
      Thank you for your inquiry. The Runner’s Knee Bible covers Runner’s Knee Syndrome. Pes Anserine bursitis is a different problem and not covered in the book.

  44. adam says:

    I HAD AN ACL SURGERY . WITH GRADE 3 CARTILAGE DAMAGE. I HAVE SHARP PAIN left bottom of my rt knee when i keep my leg straight for long time. Is this due to cartilage damage. Can my cartilage heal . And I also had meniscus tear grade 3. What is the difference between cartilage and meniscus can both of these heal over time. Please do tell me .I wanted to buy your book . Can I get paperback edition of your book .
    Thankyou

    • Doug Kelsey says:

      Adam – Currently, the Runner’s Knee Bible is in PDF only. Answering your questions is not possible in this venue. Generally, cartilage has healing potential but it depends on the severity of damage, location of damage, procedures used to facilitate healing; not a simple answer.

      • adam says:

        Thanku soo much for the reply. So detail of cartilage is given in your book and exercises. Sorry for too many question I have to be sure before buying ur book that it will cover my problem. I am not much of a runner but I want my knee to become good as before or at least close to it. Thank you soo much for your presious time.

  45. Madshus says:

    Hi Doug
    The membership to your active ageing blue print seems restricted to US residents. Is this correct? I live in Australia and am interested in the program.
    Cheers
    Madshus

    • Doug Kelsey says:

      Hello Madshus –

      Yes, at the present time, the AABP is only available to US residents. We’re investigating ways to expand access to the program.
      Thanks very much for your interest.

  46. Janet says:

    Are there general recommendations that can be made to strengthen cartilage? More specifically the labrum? Having surgery for multiple anterior dislocations, but wanting to know if there are supplements or nutritional choices that can strengthen a weak labrum.

    • Doug Kelsey says:

      Hello Janet – generally, I suggest Glucosamine / Chondroitine Sulfate and MSM supplements to support healthy cartilage. Also, make sure you’re well hydrated (drink your body weight in ounces per day of water) and eliminate refined sugar from your diet. Hope things go well for you.

  47. Waldemar says:

    Hi,

    I was wondering if you had any opinions on hyaluronan injections (e.g. Synvisc) for the knee. Might such injections aid or interfere with cartilage repair? Have you seen any results in your patients, one way or the other? Thanks!

    • Doug Kelsey says:

      Yes, I’ve seen patients who have had Synvisc injections. Some do well while others do not. These are good questions for an orthopedist who has some experience with the injections. Also, there’s some more recent research using hyaluronic acid with peripheral blood stem cells or bone morrow concentrate with fibrin mixture that shows promise.

  48. Madshus says:

    Hi Doug
    Just read your article on the si joint. What types of stabilisation exercises do you have in mind? What types of stretches or exercise should you not do?
    Cheers

    • Doug Kelsey says:

      It’s a big topic to handle in a comment but generally, avoid hamstring stretches which seem to be what many people do (because their hamstrings tend to feel tight) and avoid twists of the trunk on the legs or legs on the trunk. As far as exercises, many of the ones in my book work well (Build a Rock Solid Core), you could also search my site for other examples, or do an Internet search for “stabilization” exercises – you’ll find a lot of examples, some better than others.

  49. Sue Hurley says:

    Hi there,

    Just a quick question. Any suggestions for how to deal with stairs? I have a medial meniscus tear and stage 111 chondromalacia and I see the specialist in June. But my house has 7 steps that I have to go up and down, every time I leave the house. I have a dog and I do those stairs about 15 times a day – any thoughts? 🙂

    Thank you

    • Doug Kelsey says:

      Sue – you might try going up and down the stairs one foot at a time instead of foot over foot. Go up the stairs with the uninjured leg then the injured leg. Come down leading with the injured then the uninjured. It’s slower of course than foot over foot but it also gives you more control and reduces the loading on the injured leg.

      • Sue Hurley says:

        Thanks, Doug. I so appreciate your answer. I’m really taking it easy – I’m walking every day – but being careful, hoping to avoid any kind of surgery and hoping my meniscus heals on its own. I was shocked about the stage 3 chondromalacia, because until I tore my meniscus (competing with my dog in dog agility) I have never had one lick of trouble or pain in this knee, so it stunned me to read my MRI results and see that, and then to discover that it was stage 3 – sheesh.

  50. Adrienne says:

    Doug,
    What’s your opinion on Rippetoe’s Starting Strength book and program? Is it a good program for strength training novices? Are there any specific exercises you would add or cut from the program? (For instance, I heard a suggestion that the program doesnt do enough to promote rotator cuff stability and to add rows to compensate.) I am starting out after (well-recovered) back and hip injuries, and am interested in developing impeccable form and gaining strength to protect from future injury.

    • Doug Kelsey says:

      Hi Adrienne –

      Thanks for your question. The “Starting Strength” program is designed for someone who is interested in barbell lifting which has its pros and cons. My philosophy is rooted in improving and maintaining movement and certainly strength is an important part of that. But, so is balance, mobility, stamina, power, coordination, speed. Here’s an article I wrote that might help explain what a good program needs to have in it – http://dougkelsey.com/good-training-program/

  51. Kimi says:

    Hi Doug,
    Does The Runner’s Knee Bible talk about which (knee) exercise to do on the Total Gym? I’m thinking of getting one (I have chondromalacia), but only if I know what to do with it!
    Thanks
    Kimi

    • Doug Kelsey says:

      Kimi – yes, the Runner’s Knee Bible covers how to use a Total Gym or Total Trainer in some detail. The book is currently being revised though. However, my book “The 90 Day Knee Arthritis Remedy” also covers how to use these devices for knee pain related to cartilage problems (which is what Chondromalacia is). You can learn more about it here: http://dougkelsey.com/knee-arthritis-remedy/

  52. David smith says:

    Hi Doug,

    I have a 2cm x 2cm ulceration of the articular cartilage in my left knee, it is almost to the bone. There is also some deterioration of the cartilage under the patella. I am a 34 year old Physical Education teacher assuming that the damage is a result of high impact activity.

    After reading your articles and Richard Bedard’s blog I am fully committed to helping my knees improve over the next 2 years. Do you think I should buy The 90 Day Knee Arthritis Remedy or wait until The Runner’s Knee Bible is re-released?

    Thanks in advance.

    David

    • Doug Kelsey says:

      Hello David –

      Thanks for your question. The 90 Day Knee Arthritis Remedy has the content your looking for. Although there is similarity between what you describe and Runner’s Knee Syndrome, the Runner’s Knee Bible has more of a focus on the issues that runners face and has more content organized around returning to running. Deep cartilage injuries can take a long time to recover and sometimes need additional interventions (injections, surgical debridement, grafting). It’s hard to know without first trying to improve the health and strength of your joint.

      • David smith says:

        Thanks for your quick response. I have had surgical debridement just over a week ago and would now like to give my the knee the best chance of being able to heal as much as it can naturally. Thanks again.

  53. jEFF rOSS says:

    Hello Doug,

    I have been doing much research on knee cartilage and different problems and conditions associated with arthritis
    and one that I haven’t had much knowledge of is Loose bodies or floating small pieces of cartilage in the knee.
    I was wondering what is your take on eliminating these fragments of cartilage WITHOUT knee arthroscopy.
    Is there any hope of possible dissolving these or reabsorbing them?

    • Doug Kelsey says:

      Thanks for your question. There are two main types of loose bodies – stable and unstable. A stable loose body will usually not cause too much trouble. It’s when it becomes unstable and floats within the joint that you run into problems. If the loose body is small enough, it can be reabsorbed but in many cases they have to be removed surgically.

  54. Steve says:

    Hi Doug, I bought your book on core training and it is fantastic! Would you have a book to recommend on upper body strength? I find all the machines at the gym a bit overwhelming and a good structured and safe program would be most welcome. Would have bought it if you had a book on the subject!

    • Doug Kelsey says:

      Hello Stephen – thank you for your feedback. I appreciate that. As for upper body conditioning, I don’t offer programming that is oriented by body area (upper, lower, chest, back, etc). My programming is oriented around natural, functional movements and is offered through my online course – the ActiveAge Blueprint. You can learn more about the course at http://dougkelsey.com/the-activeageblueprint

  55. Sue Hurley says:

    Hey Doug,

    Do you know much about monovisc? I saw the surgeon yesterday and he suggested an injection of monovisc for an arthritic knee. Would you advise that? I see that it’s only been approved the end of Feb, and I’m not too keen on injecting anything into my body. Do you know much about it?

    Thanks,
    Sue

    • Doug Kelsey says:

      Hi Sue –

      Monovisc is a synovial fluid supplement – it’s purpose is to improve the quality of the fluid and thereby reduce pain, stiffness and other symptoms associated with arthritis. It’s similar to Synvisc. I’ve had clients respond well and some not at all so those questions would be good to ask the provider who knows your situation and will be doing the injections.

      • Sue Hurley says:

        Thanks, Doug. The orthopedic surgeon I saw, thought it might help, but I’m just nervous getting something injected in me. Kind of gives me the willies – so I think I’ll wait before trying it. I did read that it helps some but not others. It’s also very expensive but my medical plan covers 80% of the cost. I might try it at some point. Thanks.

  56. ANGELA says:

    What is your opinion or experience with using trampoline rebounders to rehabilitate injured and arthritic knees? Do you think rebounding is as good for circulation and the lymphatic system as the rebounder companies seem to all advertise?

    • Doug Kelsey says:

      Hello Angela –

      Trampoline rebounders can be helpful for people with sensitive or weak joints because of the reduced impact force while allowing for some degree of exercise intensity. Movement of almost any type helps the circulatory and lymph system so making claims that rebounding is better in some way is a stretch other than if the person was unable to exercise or move at all.