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If you’ve had a very sedentary life for a could years owing to injury, how can you navigate strengthening exercises while respecting the cartilage that would’ve lost strength – is it just ensuring there’s a very gradual return to fitness/strength? Thanks.
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Hi Mel – thanks for your question…it’s a good one. The short answer is yes but in my experience the difficulty is in the details. For example, many MD’s have advised clients to “just go easy, use common sense”. What exactly does that mean? What “go easy” for you is likely quite different from someone else. Your question has sparked an idea for a blog post so a longer answer will be forthcoming. In the meantime, a general rule of thumb I use is whatever you’re thinking of adding back into your routine, cut it by 50%. For example, if you’ve not been active for a few years, decide you want to get in better physical condition by adding a 30 minute walk, I would start with 15 min. At first, you might think, “well I can certainly do more than that” and you might be right but usually people over estimate their capacity. More to come..thanks again for your question.
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In your book “Better Hips, Better Life”, in Chapter 39 “The Routine”, section, “Track I and Track II – Joint Strengthening Exercises” , you tell the reader to see the chapter “Joint Strengthening Basics” to find the exercises for this area. This chapter does not exist. I see also that another person asked you this question in the comments here, and you told them to refer to the chapter – The Routine. The exercises are either not listed there, or it is unclear where to find them in that chapter. Can you please direct me to those exercises? Thank you.
Reply Hello JC – I think what you’re looking for is on pages 234-238 and I can see why you might be confused. I appreciate you pointing this out. We’ll work on making that clearer in the next update of the book. Thank you for purchasing my book. If you have other questions or issues, please let me know – you can email at info@dougkelsey.com
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In “The 90 Day Knee Arthritis Remedy” on page 140 there is a broken link to a knee compression sleeve so I can’t see what it is.
Can you share with me the name of the sleeve so I can search for it on the Internet?
Thank you for sharing your wisdom in this book.
Hi Mark – I’m not sure why the link failed to work for you. I checked it and it worked on my end but here’s the link itself -> https://www.amazon.com/PURE-SUPPORT-Compression-Knee-Sleeve/dp/B082Z8V5H4/
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Hi Gladys – we moved out of Austin in 2020 and I retired from clinical practice in 2021. If you would like to share your situation – dkelsey@dougkelsey.com – I might be able to refer you to someone.
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I’m finding it difficult to find a facility with a VIP. I have arthritis in my knees. Thanks Dale Shuey.
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Just found your article on the web, Why Does My Knee Hurt On An Elliptical Machine?. I have been using the Elliptical 3-5 a week for the past six months. Over the Summer My right knee has swelled up and is very tight. A little rest from the elliptical seemed to correct the issue. Back on the Elliptical and my right knee is swelled up and tight again! I found your article very enlightening and answered my questions ! Time for a good look at another solution.
Reply Hi Doug, I’ve got your 90 Day Knee Arthritis Remedy book already. I was just wondering when you mention cartilage healing being possible, would that be for all areas of cartilage including retropatella chondromalacia? Many thanks in advance.
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Hi Doug,
First I want to thank you for your newsletters. You always seem to say something I find relevant. I’m seeing a PT for back pain again. I say that because it seems as though I do something every few years or so that causes lower back pain, in particular. This time I think it’s related to a tibial lateral plateau fracture I suffered a year ago. I spent some time in bed, then a walker and wheelchair. I couldn’t put any weight on that leg for 6 weeks, as I recall.
Anyway, I worked hard to recover, and I still have some issues, but I’ve made a lot of progress. Everything was fine, and then I started wanting to strengthen my upper body, so I was doing things like squats (for my knees and hips), 5 lb and eventually 8 lb dumbbells for standing curls, then the same weight for bent over lifts (careful to use my core), bent over flies, and finally bent over and pushing my arms (with 5 lb weights) straight back to strengthen my triceps.
Things were going fine, and then I started having back pain. So, back to PT, and it’s helped, but it’s been 8 weeks and I’m still having issues, and only two more sessions to go.
I keep thinking that my knee injury has something to do with all of this. I just read your most recent newsletter on lower back pain, and I see that my PTs are going through the usual diagnosis and “remedies.” I have tight hips, for instance. I hurt more on my left side (my injury was on my right). I know you’ve written about injuries and how long recovery can take, and so even though it’s been just over a year (I’m 70), do you think I’m expecting too much too soon?
Thank you, Anne
PS I bought your book on core strengthening some years ago, and I have no idea what happened to it, so I just purchased it again. I really appreciate the effort you’ve put into helping us help ourselves.
Reply Hello Anne – I’m sorry to hear of your struggles. I understand how hard that can be. Without knowing more about your specific situation, it’s difficult to give you a specific or detailed answer but back pain can sometimes take a while. Most people find a way through it within 2 years (I know that probably sounds like an eternity). The exercises you list all load the spine, some more than others and perhaps that’s the original source of injury. Finding a therapist who can help you build up your strength while respecting your limits is probably where I would start. As your body gets stronger, some of the tightness/restrictions can resolve and you’ll likely start feeling better. Hang in there. – DK
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Hello! If you have written anything on knee pain related to rheumatoid arthritis (rather than OA), can you direct me to it? Thanks for all you do!
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I’ve been looking for a hard copy of two of your books (The 90-Day Knee Arthritis Remedy & Build a Rock Solid Core) but can’t find either at online used book stores. Have they always only been available as digital books so I would have to have a digital reader to access them?
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Assuming you have been diagnosed by a hip surgeon with moderate hip OA by X-rays, is it inevitable that it will progress in the coming years which would then require a total hip replacement? Anotherwards, does it always progress? Thank you Doug.
Reply Hi Brad – good question. The general consensus is that the disease progresses over time …but…how much progression and the degree of symptoms is partly a function of lifestyle. Type of exercise, diet, stress management, mindset all play a role in modulating the disease and symptoms.
Reply Hi Doug, again great book on the hips. I currently do 30 minutes daily of movement and hip exercises a lot similar to the ones in your book. Not all and some that you don’t list. I also walk daily with walking poles to take force off the hip joint and ride the exercise bike at a very easy gently level. This is all based on your teachings of nudging the joint but not too forceful. However, I continue to lift weights 3 days per week but only upper body. pushups, incline DB presses, seated DB presses, bent over DB one arm rows, TRX pulldowns, some tricep and bicep work. Nothing is overly heavy allowing me to reach 12-15 reps. My question is in your opinion in order for me to totally benefit from what you have outlined in your book, should I cease doing any upper body work with weights? At my age now(69) it is vital to maintain muscle mass and bone strength from strength training. Thank you.
Reply Hi Brad – thank you for your note, feedback and question. I agree with you that it’s important to build and maintain strength as one ages…you can do that even if your hip (or hips) tolerance for load is not quite where you would like it to be. You just have to be mindful of the positions you choose and also pay attention to how your hip reacts. For example, standing and doing barbell or dumbbell curls creates a reactive force in the legs at least equal to the weight being lifted. That might – or might not – over load your hip. You could change the position to sitting slightly reclined which reduces pressure on the hip and also reduces the reactive force. Hope this is helpful to you.
Reply Hi Doug, enjoyed your book on hip pain. I have been dealing with it now for over 12 years. Originally it was my hip that stiffened and then just went away but seemed to have transferred to the back. I spent the last 10 years thinking it was my back and even spent four of those years with Stuart McGill to help heal my spine. I have now figured out it was my right hip all along causing discomfort and making walking quite uncomfortable. I recently saw a hip surgeon for the third time in five years so he has seen the progression of my OA in my hip. He still termed it moderate but says it will only get worse as I am now 69 years old but very fit. I’m on the list for surgery with him and will probably get the call within one year. So now I have time to explore other options and that brings me to you. I don’t want to have hip replacement surgery but everyone I talk to says it’s the best thing they ever did. I’m going to attempt the exercises in your book daily and be patient and by the way I am quite disciplined. I just wonder if once the cartilage wears down to a certain point, have you reached a point where no amount of exercise and diet and supplements can reverse what is already there? Is it possible I have never really trained the hip joint itself and on the surrounding muscles and that is why I am still in pain?
Reply Hello Brad – most people with pronounced hip pain who also have OA and have hip replacement surgery are typically happy about it. Your question though about is it inevitable is hard to answer. We know that atypical anatomy – thinner, weaker cartilage for example – doesn’t always translate to symptoms. I’ve seen clients who have had Grade 3-4 lesions who seem to do quite well with non-surgical options and have had clients with Grade 1-2 joint who are in considerable pain. Why? Well, there are several factors that come into play. Diet, movement, attitude, how one handles pain emotionally for example. Cartilage needs a lot of controlled motion plus a gradual increase in force to change its strength or resistance to compression. The decision to opt for surgery is highly personal one. I hope this helps.
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Mr. Kelsey – I plan on getting a hold of Laurie to help me alleviate Grade 1 Chrondomalacia – (MRI confirmed, reaggravated case). I have pretty bad clicking and popping at times. I think I know the answer here but I thought I would ask: Can articular cartilage heal, improve, and symptoms resolve to normal functioning or pretty close? Thanks Josh
Reply Hi Josh – yes, many people are able to improve their symptoms and function with the right kind of training. Laurie is an excellent resource for finding what’s best for you. You can schedule a free consultation by going here
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Hi DK,
I have followed you for years. I wanted to say how much I have enjoyed your work and to offer condolences for your loss. Time…it seems to be the only thing that helps. Sincerely,
Eric F
What makes an exercise “mechanobiological” or not?Many readers have written in asking for a referral to a physiotherapist in their hometown who is familiar with the concepts taught in The 90 Day Arthritis Remedy and you usually don’t know of one, so I may have to work with one not knowledgeable of these concepts and design a program.
As well, I have bone spurs. One reader had written in asking what the role of bone spurs is in rebuilding cartilage. You had explained how they came to be formed and how they helped the joint stabilize. You went on to say that one doesn’t regrow cartilage; instead one grows a kind of “second-tier” cartilage that is more like scar tissue. I take it that the more “ mechanobiological “ the exercise is, the better it is at creating that scar tissue. I think that Scott may have been alluding to a concern that you mentioned when you talked about how cartilage breaks down. Little flakes of cartilage cause irritation, causing the cartilage to degrade. Can bone spurs do the same thing, causing the cartilage to get irritated when a person is exercising a joint to try to grow this scar-tissue cartilage?
Would it defeat the whole purpose of the program? Does a person need to get bone spurs removed before beginning a mechanobiological program? This stands in contradistinction to your statement that the program will work in the early stages of arthritis ( I think I’m stage 2, not too many bone spurs).
Sincerely,
Jonathan Todd
Reply Hi Jonathan – good question. Mechanobiology is the science of how the application of external force alters the internal biochemistry of injured tissues. It is the intersection of biology and physics. Mechanobiology focuses on how cell/tissue mechanics and physical forces influence cell behavior and the change in biological tissues. Bone, tendon, ligament, cartilage, muscle, fascia all respond to external stress or load. Too much load, more than what the tissue(s) can withstand results in injury. Too little load over too long of a time, the tissue gets weaker. So, in a a sense all exercise influences tissue but what works for, say, muscle, won’t work for cartilage. This means that how you dose the exercise, more like a prescription, influences tissue healing / strengthening.
Your question about bone spurs – yes, they most often form in response to gliding forces (which your joints don’t like) to help stabilize the joint. Some people need to have them removed while others don’t. I’ve worked with clients who had the same diagnosis, same functional condition of their knees yet one might respond very well to controlled loading while the other one not so much. Why? Well, there are a number of other variables one must consider which is more than what I can cover in a comment post. I taught for many years, many of my former students use the principles although I don’t know where they all are located. You can contact my colleague Laurie Kertz Kelly (kertzcoaching.com) for personal coaching / guidance.
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Doug, many years ago your blog saved my knees – I will always be in your debt. Later, you herniated a disc, and blogged on how you recovered. My brother is flat on his back with a bulging or herniated disc, and I wanted to forward what you wrote – but I can’t find it online anymore. Is it still available? Thanks, Paul
Reply Hi Paul – that’s great to hear and thank you for letting me know. Made my day. The blogs about my herniated disc, those were an asset of my practice so that when I sold the practice in 2013, those were transferred to the new owner. But, your comment caused me to think about ways I could write about that issue here on my current blog. I’ll see what I can do. Thank you.
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Hi Dr. kelsey. Its been about two years since discovering your book. Its been a great help for me. However, my lateral plica still remains the same. The snagging/catching wont go away, plus localised dull ache/pain whenever i come back from a long walking session/squats. Im afraid all these time of continuous rubbing against the tip of the femur may have caused some spot erosion, and thickened the plica. I had a more extensive x ray done today, which shows a tilted patella, mild narrowing of lateral patella gap, mild quad enthesopathy. I dont buy the ortho’s explanation that the tilted patella is a birth defect, though i wonder all these years i have been walking, running like normal with pain and/or issue. Im still keeping up with the quad sets, some basic leg exercise( mostly isometric as i find that really activates my quads). Avoiding surgery as much as i can, it may be a last resort.
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hi. I bought the 90 day book on amazon kindle. I don’t think my kindle is sophisticated enough to get the video. I tried to send this request through the kindle, but doubt it got through. Can you send me the info on how to get the video of the exercises on the internet? Thanks
Reply Hi Donald – the links embedded in the book, whether reading on a Kindle device, tablet or phone, direct the reader to the online video which is stored in Amazon’s cloud-based server. You might try using the Kindle app on a phone or tablet or computer. The Kindle uses its’ own network as opposed to a local network and browser. Unfortunately, the only way to get to the videos in through the links. Best regards, DK
Reply Dear Mr. Kelsey:
Hi, do you have a program similar to the 90 Day Knee Arthritis Remedy for shoulder arthritis?
Sincerely,
Jonathan Todd
Hi there,
My name is Mark Ellings. I am a 29 year old former runner who is based in the UK. Since September 2020 I have been unable to do much activity due to chronic PFPS in both knees.
I’m currently reading Saving My Knees: How I Proved My Doctors Wrong and Beat
by Richard Bedard where Doug Kelsey is mentioned a lot. It’s inspiring and does give me hope that I can beat this.
In the book Richard mentions a blog post from Doug called ‘the cold truth about ice’ which I cannot find anywhere. do you know how I can read this?
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Hi Doug, I took your “Things They Didn’t Teach You in PT School” course back in “the day.” The Unloading Principle you taught me has been invaluable for me and countless patients. Recently, I had a discussion with a colleague regarding the evidence for the tissue response to unloaded exercise. As I recall, It takes 2000 reps per exercise session for articular cartilage(to increase it’s O2 tension) , 1000 reps for tendon and less for muscle. I believe you cited a study in a Rehab Acta Scandinavia journal if I’m not mistaken. Do you still have those references for the support of unloading. If so, I would be eternally grateful for your help. Do you still have the Zuni? I appreciate you devotion to excellence. It was very motivating to me and I know at times it had its costs to you. Again, thank you. -DW
Reply Hi Duane – thanks so much for getting in touch. The articular cartilage dosage was derived, in part, from studies done on continuous passive motion. I might have the reference list from that course…I’ll check. I invented a follow up to the ZUNI called the Newton. I know a lot of places still have their Zune’s though…built like a tank :-). Thanks again. – DK
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Doug! Is this real? Are you really answering questions in 2021? I’m a former SC client and I’m still doing the work and trying to beat back Father Time. I’m hiking the rim to rim trail of the Grand Canyon in October, and maybe all in 1 day, but hopefully I can get the group of dummies/crazies I’m hiking with to break it into 2 days. I’m trying to put together a viable training program. Do you do consultations?
Reply Hi Lacey –
Yes, I answer questions although if the questions are something specific about a person’s situation, then no, I don’t answer those. I’m not taking new clients right now but you can reach Laurie Kertz Kelly who works with me to inquire -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146. And it’s free.
Hi Doug, I have just come across your book so feeling a little more positive about my situation. Injured my knee 3 years ago and have been struggling with it ever since. Just had an MRI and have been told I have a ‘punched out lesion within the cartilage of the patella in a central position. There is thinning of the trochlear cartilage in association with this. No reactionary oedema but evidence of a dominant lateral trochlear facet which is slightly dysplastic’.
Trying to make sense of this and if in your experience, people have improved or healed from this? I haven’t purchased the book just yet! I’m 28 years old, fit and healthy. I seem to not get pain in a split squat position but always pain up and down the stairs. I’m very light at 51kg and 5ft 8 but fear my knee is getting worse with time.
Reply The MRI (or other imaging) results show you one part of the picture. We’ve worked with people who have had changes on the MRI, some quite pronounced, who go on to recover and restore their function. Each person’s situation is unique though so for me to tell you yes or no wouldn’t be proper. You can schedule a consultation with my colleague, Laurie Kertz Kelly, though and learn more. It’s free. Click here to schedule -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
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Do you have an opinion about WBVT – whole body vibration therapy…? Those machines, some a few hundred dollars, and some way up from that, which purport to increase bone mass, and do other good things as well? I’ve been reading your “knee book” and since you seem in favor of constant, easy motion of the knees, would this help? Not as a replacement for exercise, but perhaps as something to stand on while using one’s standing desk? I’d appreciate hearing what you think. Thanks!
Reply Hi Carrol – great question. WBVT can be a great addition to the program but, depending on the device, it will create above body weight load (in some case 15-20% more load than just standing). I wouldn’t place it in the category of “easy motion” though. From what I’ve read the desirable frequency is 30-40 HZ and should be a vertical oscillation and not horizontal. Hope that helps.
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Hi Dr Kelsey,
Just wondering if a hip labral tear has the capacity to heal on its own similarly to knee cartilage? Thanks, Brian
Hi Brian – a hip labral tear can sometimes heal or become asymptomatic. There are several factors that come into play one being the size and location of the tear. The approach I’ve used includes the basic principles of joint strengthening but with an added focus of stability. The more stable the joint is the better the chances for improvement …much like a meniscus tear in the knee. I hope this helps.
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Hi Doug, after going through all protocol in your book, and great session/consult with Laurie. I am in Week 6 of the Return to Running program. My pace is very easy, and much slower pre-injury – OA/cartilage damage. Everything going well. Wondering about my cadence, in trying to run softer and watching the video links from the book, all my runs end up in the 185-192 cadence. Should I be concerned that cadence is too high?
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Hello, first of all, thank you so much for your blog, it opened my eyes into a whole new world of hope for my knee pain and my tendons (i’m only 21 and have chondromalacia on both knees) I wanted to know if it’s possible for you to talk about the “safe range of motion” for people with chondromalacia, is it true? Does the range increase as the health of the knees improve? Is it safe to go beyond 45º on a squat? etc. Many thanks again!
Reply Hello Genis – that range of motion limitation for people with chondromalacia is common. The reason isn’t so much the angle but the force at that angle. So, if you weight, for example, 150lbs, you’ll have slightly more than that load of 150lbs if you squat down as in sitting down to a chair. However, if you have a way to reduce the load, like with a Variable Incline Plane, then the angle isn’t much of an issue because the force is greatly reduced to a percentage of body weight (for example 20% or 30 lbs).
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Hi, Dr. Kelsey. Thanks very much for taking the time to answer my question. I re-read the sections in your book (The 90 Day Knee Arthritis Remedy) about your Load Tolerance test, but there’s no mention in the book of a long-duration squat (and searching that term plus your name in Google produced no results), so I’m not sure what that is. It sounds like it’s either a slowly-done squat, or a squat where you hold for a period of time at the bottom of the squat, but I’m just guessing. Your suggestion to not try a long-duration squat on my setup is noted and makes sense, since it’s difficult to control the load by just holding onto the rope. The shipping from the US to SE Asia would be very high for a heavy item like a VIP, but maybe I can find a way to have one made here.
Reply Hi, Dr. Kelsey. I have a question regarding information in your book The 90 Day Knee Arthritis Remedy. I’m a 67 year old male with some knee pain. It’s just occasional and not severe when walking, but I’m unable to run any longer without significant knee pain. I did a lot of distance running in my past (about 12-15 miles a week in my 20’s and 30’s, 3 to 6 miles a week after that). I’ve been focusing on doing squats, using a rope anchored to the top of a door to make them easier. I think that’s what you called an Assisted Sit to Stand exercise, and it seems it would be very similar to doing squats on a Variable Inclined Plane (which I can’t buy, as I’m living in Southeast Asia). In your chapter The Routine, you recommend doing this exercise twice a week. However, the forest firefighter who you reference in your section on the VIP machine worked up to doing 30 minutes of squats every day.
So my question is this – Is it better to do the assisted squats every day, if my knees can tolerate it, or should I have rest days in between doing them?
Hi Eric – first, I can’t answer some of the specific issues you have. That would require a conversation (which you can have with my colleague Laurie Kertz Kelly by clicking here. Keep in mind that the example from my book is based on that person’s Load Tolerance which was well above her body weight. Long duration squats are done after testing Load Tolerance and using the results to determine the proper load. In your case, and I don’t know your Load Tolerance but suspect it is at some percentage of body weight, you would need a Variable Incline Plane. Some people have built their own, sometimes you can find one on EBay. I wouldn’t suggest doing long duration squats with your setup because you could overload your knee.
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Hi Doug, I bought the 90-day book and I love all the information. Thank you so much!
You mention that treatment is different for a subluxing patella. I have Ehlers-Danlos Syndrome, so my kneecaps are quite loose. After sitting out from exercise while rehabbing a meniscus tear a few years back, I lost a lot of strength in my legs and I now notice even more patellar movement – plus I’m getting crepitus, which I bet is from softening of cartilage underneath due to the patella moving. I’m only 27 so I’m really hoping to nip this in the bud. Do you have any recommended resources on how to stabilize the patella?
Many thanks 🙂
Reply Hi Kelli – thank you for your note. Because of the nature of Ehlers- Danlos, I suggest you look into coaching with my colleague Laurie Kertz Kelly. It’s not something I can solve within the limitations of this medium. You can set up a free, 20 minute Strategy Session with Laurie by going here -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146.
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Hi Doug. I read your blog with great interest after coming across it via Richard Bedard’s book. His experience and your strategy chimes with my (long and tedious) experience with nagging knee pain. I’m in the UK – near London. Are you able to recommend anyone over here who might be able to help me? Thanks so much.
Reply Hi Andy – thanks for your note and comments. I don’t know anyone there but you can schedule a free, 20 minute Strategy Session with my colleague Laurie Kertz Kelly. She has worked with me for a number of years and helps people all over the world via a remote, online medium. The link to schedule with her is here -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
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Hello. I am 40 years old and have problem with my right knee. My knee cartilage is damaged. After sports my knee swells. Which book do you recommend me to buy.
Thanks
Hello Anton – I’m sorry to hear of y9our knee trouble. I know how frustrating it can be. I suggest the 90 Day Knee Arthritis Remedy (you can get it on Amazon – https://www.amazon.com/Day-Knee-Arthritis-Remedy-Switching-ebook/dp/B07MD3C8V6). There’s a lot of content in the book about the knee, pain, how the knee heals, what exercises to use when, why, and how among other things.
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Hello. Is it possible for me to book an appointment with your clinic via Zoom from the UK?
Reply Hi Rosie – yes you can set up a free, 20 minute Strategy Session with Laurie Kertz Kelly by clicking here -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
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Do you have any information on how to buy a hovr leg swing, or something similar, as recommended in The 90 Day Knee Arthritis Remedy?
I prefer the portable model because I don’t have a wood desk or table to attach the under desk model, and also, the portable model would be much more convenient.
The hovr website, hovrpro dot com, doesn’t work. No matter what you click on to buy either model, you’re simply returned to the home page.
Another site, sitflow dot com, has what appear to be the identical items, but you can only buy the under desk model. The portable model is sold out with no information about if or when it will be available again. Amazon also only carries the Sitflow under desk model.
I realize this isn’t your responsibility, but I’m hoping you might know what is going on with hovr/sitflow, or be able to recommend a different item.
Reply Hi Rosemary – I don’t know why you would have trouble with their site. I accessed it on an iPad and it did appear as if something was off – the layout and the navigation. As for SitFlow, the device looks very similar to the Hovr but I’ve not used it or know anyone who has. You might try submitting a request on the HovrPro.com site under Contact Us. I’m sorry I couldn’t be of more help. If you find something out, please let me know if you could. Best regards – DK
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Hi David – thanks for your note. The emails are taken from the website automatically by an email distribution vendor. The font size is 16point. However, email clients (Outlook, Gmail, Mail, etc) read the code or interpret the code differently. Some people have sent me a note saying the font is way too big while for others it’s too small. You can always read it the blog post on the website. I send it out in full format in an effort to save people time but for some, like you, it doesn’t work quite right and there’s nothing I can do about that so my apologies.
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All our friends and acquaintances, as well as seniors in our families, have arthritis and I really intend to tell them about your work, which was cited in the Nov 19, 2019 Health Section of “The Washington Post” and I kept all this time in my “To Read” file. Thank you so much for your spontaneous generosity and kindness, Dr. Kelsey – so refreshing particularly in these difficult times. Much obliged, Mignon
Reply Dr. Kelsey, you have just issued me a refund for $19.95 for the printed version of “The 90-Day Knee Arthritis Remedy” in swift response to my inability to print it, but my son was able to help me with it and I now have it, so please withdraw the refund so that I can properly pay for it. Sorry to give you the extra work; I did not know my son could solve the problem. Let us do what is easiest for you – I can pay for it again if it is difficult for you to cancel the refund. Thanks very much, Mignon.
Reply Wow, Dr Kelsey, thanks so much for that lightning-swift reply and your responsiveness! Perhaps in future there can be an easier and surer access to the printed version for us old people. Kudos to all the good work you are doing; I shall be a follower. All the best, Mignon
Reply Hi, I just paid $19.95 for the printed version of “The 90-day Knee Arthritis Remedy,” Order # 120756583, downloaded it and proceeded to print. Since it is over 200 pages, I thought I’d first try to print pp. 120 to 197 as a trial run (I am not computer savvy). It wouldn’t print and I’m afraid to push any more buttons as the printer might print it twice, as this has happened in the past and I don’t know how to stop the printer. Do I need to wait a couple of days before being able to print it? I’m thinking perhaps the payment has to clear first. Can you kindly give me a refund and I will ask my son in NYC to purchase the printed version himself so he can print it for me? Thanks so much for your help. Sincerely, Mignon
Reply Hello Mignon – Yes, we will issue a refund for you. The book works best on either a computer, smart phone or tablet as it has a number of links to videos and other content. I know some people have printed it but I can’t guarantee it will work since computers and printers – we don’t offer that kind of technical support. Your refund should show up within 24-48 hours. Thank you.
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Hi Doug,
Recent read your book and am progressing on recovery track 1 to rebuild the tissue in my left knee. My biggest obstacle is my desk job. I use a standing desk and take walk breaks as much as possible but during the longer work weeks I still get knee stiffness which sets the entire process back. Wondering if you have any recommendations for treadmills or elliptical companions to a standing desk, or have treated clients with same problem?
Thanks!
Griffin
Hi Griffin – Yes, that’s a common issue, one I’ve seen thousands of times. I can only answer in general terms. My programming is derived from the unique blend of a person’s load tolerance / physical capabilities, work and personal situation and mindset. Your idea is correct to use what I call “pattern interruption” – change from one position to another and introduce motion. But, in your case, the angle and load on your knee is roughly the same between standing and walking (walking carries a little more load). I usually suggest a seating arrangement that can move from a typical seated position to 3/4 standing to standing alternating through these positions every 30-45 minutes. Then, move your knee more in a lower load position – I describe foot sliders in the book, that usually works well. Make sure you’re also getting in enough “quad sets” as described in the book. Many people feel much better when they increase the repetition count closer to 100 per day. If you feel you need more customized help, you can set up a free 20 minute “Strategy Session” to see if working with my colleague Laurie Kertz Kelly would make sense for you. You can do this by going here -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
Hope this helps.
DK
Can a variable incline press double as a weight bench? I’d love to get one but don’t have space for both. Thx!
Reply Hi Debby – yes, I’ve used a VIP as a weight bench. One of the reasons I like it as a “bench” is that I can load my legs – as in an isometric squat – while performing and upper body exercise. Something to keep in mind – for the bench to be flat, you have to set the bottom of it up on a sturdy surface with the upper part at a level of 3 or 4 rungs up from the bottom (depending on the brand and model, that level can be different from machine to machine) or to what ever level is needed for the surface to be parallel with the floor.
Hope that helps.
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I have the “90 day” books on hip and knee, and can’t seem to tell where walking, primarily for cardiovascular benefits, fits into your program. OK from the start, or wait for some milestone? Talking about 2 miles a day at about 17 min pace, 5 days a week to get the recommended 150 mins. Knee pain just about gone, hip still bothersome. Also, any thoughts on use of a rowing erg like the Concept Two?
Reply Hi Bill – The answer might require a conversation and if you have more questions or would like personalized help, you can schedule a free, 20 minute Strategy Session with my associate Laurie Kertz Kelly -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146. In a nutshell, nearly all decisions about programming are derived from something I discuss in my books – Load Tolerance. If you can walk for 30 minutes, for example, and have no symptoms during or up to 48 hours later, then that level of load should be okay. But, usually, people don’t have such clear cut responses. Sometimes symptoms show up at maybe 15-20 minutes or the following day or even 48 hours later, the joint (hip, knee, ankle, spine) feels stiff or aches. In this case, the joint(s) is not ready for that level of load. I strongly encourage people to get a Variable Incline Plane (VIP) to help condition the joints for more load. You can learn more about a VIP by going here -> https://www.dougkelsey.com/variable-incline-plane/. The rowing ergometer, that will depend on load tolerance and technique. There’s no way to measure hoW much load your hip is exposed to, so it makes it impossible to progress precisely (and one of the keys to improving joint strength is being able to measure loads and gradually increase them as you might do with muscle strengthening).
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Hi Doug I recently purchased your book on Amazon! I am not sure if you have any suggestions or experience on exercises or treatments regarding diagnoses of focal chondrosis, narrowing of the patellofemoral joint, subluxed patellas or joint effusion? All of these terms are alien to me!
Reply Hello James – the program I describe in my book covers those conditions since they all relate to a soft or weak joint surface (articular cartilage). If you need more personalized help, you can schedule with my associate – Laurie Kertz Kelly. She offers a free, 20 minute Strategy Session. Go here to schedule -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
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Hi Doug, I found your site while looking for legitimate info and just subscribed. Any thoughts or suggestions for maximum exercise & w/health benefits in minimal time (stamina/fatigue issues due to autoimmune), that can be done in my home? I have a weighted vest for women, http://ironwearfitness.com/wozifrvewadh.html, an Elliptical Trainer Machine, https://www.soletreadmills.com/ellipticals/e95-sole-elliptical and 10 pound dumbbell weights. Any feedback would be greatly appreciated!! Thank you for your time!! Debbi
Reply Hi Debbie – thanks for signing up and for your note. Good question. There’s no shortage of exercises. programs, etc on YouTube and elsewhere but you have to be careful since there are often exercises that are too risky. You can find several of my routines on my site -> https://www.dougkelsey.com/routines/. They use simple tools, have low risk movements, can be done in a short amount of time and are very effective. And they’re free.
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Hi Scott- thanks for your question. Bone spurs generally form in response to a loss of joint stability. The loss of stability creates tiny “collisions” on the bone and in response, spurs form as a way to self-stabilize. Usually, the loss of stability stems from a decrease in the thickness of either articular cartilage (lines the end of the bones), the meniscus cartilage, or in the spine a loss of intervertebral disc height. Articular cartilage doesn’t regrow but instead forms a different type of cartilage, in a sense, like scar forms with a large cut in the skin (there are some experimental studies that have shown articular cartilage formation but so far I’ve not seen that in humans). Some people with bone spurs experience symptoms while others, not so much. Improving function and decreasing pain relates to something called “Load Tolerance”. You can learn more about that here.
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Hi Doug,
I have just bought your Runner’s Knee Bible after struggling for past 8 weeks with what a local PT diagnosed as fat pad inflammation. In general does ‘runners knee’ book advice apply to fat pad issues?
Thanks
Hi Anne – The book’s main topic is Runner’s Knee, sometimes also called Chondromalacia Patella or PatelloFemoral Pain Syndrome. What you’re describing – Fat Pad Impingement – sometimes accompanies Runner’s Knee. But I would make sure first that you really have that particular disorder. The fat pad sometimes gets “pinched” by the patella which can stem from certain weaknesses and biomechanical changes in the knee from other disorders. So, in that case, you can treat the inflammation from the impingement and then track down the underlying cause which is where the book comes in. I hope that helps – DK
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Hi Doug,
I was wondering what your thoughts are on using a rebounder for cardiovascular exercise when you have chondromalacia in both knees.
Hi Julie – a rebounder can be an effective tool for cardiovascular work but it depends on two things. One – the load tolerance of your knees, This is the amount of force your knees can produce or withstand without pain. If you can perform several sit to stand motions from a chair without knee pain, then the rebounder exercise will probably be okay (I would still start out slowly and build up your time on the device). And two – the stiffness of the rebounder surface. Less expensive rebounders tend to be “stiffer” which means there will be more force going through your body (and knees) compared to more expensive devices. The rebounder I have and use is made by Bellicon. Another feature of rebounders is the exercise can help build / improve balance reactions.
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My 85 year old mother does not want knee surgery. Wants to work with PT, was hoping your book was available in hardcover which would make it easier for her to read. Also she lives in Carlsbad Ca. Could you recommend good PT
Reply Hi Debra – my book The 90 Day Knee Arthritis Remedy is a multi-media book and as such comes in only a PDF version or the Amazon Kindle version (which can be read on a tablet or computer with Amazon’s free Kindle app). Some people have printed the PDF but I don’t recommend it since you’ll lose the embedded links to various content such as demonstration videos.
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Hi Doug,
Should I do the running preparation (single leg squat drive, side hops, sprint hops) only on days based on the running program that is in the last few chapters of the book? Or can i also do the running preparation on days that I am not running. Thanks
Hello Rabin – if I understand your question, the running prep exercises are intended to be done to help you prepare to run. You wouldn’t be doing running prep exercises and running. You should be able to do all of the drills in Track II with ease, then the running prep drills, then the return to running program.
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Hi Doug, what type of tear did you have in your meniscus when you did PRP injection?
i tried 3 PRP injections for my radial medial meniscus tear 3 months ago. My concern is that PRP may not help radial tear. If yours was radial tear, it give me some hope. Thanks
Reply Hello Rabin – the tear I had was a large posterior-medial tear from an injury. PRP injections can help but often times what is overlooked is the post-operative procedure. For example, I typically suggest the use of crutches for at least 10 days (and in my case it was three weeks) and a controlled-loading rehab program. Also, the technical aspects of the injection make a difference: guided versus unguided, number of injections used, and the manner in which the PRP is produced. I hope that helps.
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Greetings from India,
I am 46 years old and couple of months back came to know that I have Chondromalacia Patella (between Grade 2 and 3). I can walk without pain but full squatting, climbing stairs and sitting for 30 minutes + in one stretch starts irritating my knee. There was no recent injury except ~ 30 years back I had injured my knee (do not recall as there was not report of that time with me) possibly knee cap dislocation from which I recovered.
At present I am am doing the following as per doctor and PT advise
1) Collagen – 10 g daily (asked to take for 6 months)
2) 35-40 Minutes walk in one stretch
3) Lying on bed – Isometric, Lying on bed and leg raise excercise for Quads
4) Sitting on Bed and Leg raise – No weight, then with 2 Kg ankle weight and then with 4 kg ankle weight.
My height 177 cms, Weight is 71 Kg
Please advise if I am on right track to heal my cartilage or suggest oherwise
Best Regards
Hello Sujeet – thank you for your note. It’s not possible for me to tell you what you need to do without knowing more about your situation and I am not currently accepting new clients. In general, what you’re doing is certainly part of an overall plan. I have several articles on this website about joints, how to use exercise to improve joint health and strength. I have a book – The 90 Day Knee Arthritis Remedy – that covers the topic in detail. And you can schedule a free 20-minute Strategy Session with my colleague Laurie Kertz Kelly by going here.
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Hi Doug, my MRI report shows Level IV cartilage wear in both my knees! I note that you have said your book is not appropriate for this level. Can I still use some of the exercises and concepts you suggest or not. Thanks Jann
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Hello Doug, Do you have an option for ordering a book? For those that prefer book reading in bed rather than on the phone it will be another $25 to print the PDF version. If you get a chance, will you please let us know what print options you might have for the knee book? Thanks so much. M
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Hi Doug
I’ve tried to find a VIP in Australia, but no luck. Do you know of any suppliers here, or any other name that they might go by that I could search?
I was diagnosed today on my right ankle joint with begining of Arthritis. Which of your book do you recommend in order to exercise to strengthen my joint?
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I bought 90 Day Knee Arthritis Remedy from Amazon. I’ve tried several times to download email with videos without success.
Reply Hi Lisa – Could you explain a bit more about what you mean by “tried several times to download email with videos”? I’m not sure what the problem is exactly. Thank you…and you can send your explanation to info@dougkelsey.com
Reply Thanks Doug for the reply.
Would there be a free update for those who already purchased the kindle ebook version when the book is updated? if yes, would there be an email update to existing buyers?
I would like to read your findings on anthrogenic muscle inhibition and other knee-related topics.
Thanks.
Reply Hi Dr. Doug,
May I enquire about your opinion and reason as to why anthrogenic muscle inhibition is not mentioned in the book, the runner’s knee bible?
thanks
Reply Hi Rabin – thank you for your question. The short answer is that at after I wrote the book, I had feedback that some parts of the book were a bit a too technical for someone without a medical / professional background. However, the book is due for an update this year so I will look at adding this back in. Appreciate your interest in the book.
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Hi Mr. Kelsey (Doug),
I am very interested in reading your book – 90 days knee arthritis remedy. I am an active 62 year old female with OA in knees and hips. I follow the theory and practice of moving the joints/muscles for creation of fluid in joints for pain relief and strength. I really prefer hard copy books but cannot find yours anywhere except in Kindle format. Any books to buy? Thank you. Judy Cluthe, Ottawa, Ontario, Canada.
Thanks for your reply. I just noticed that I can purchase your book on knees in pdf. form. Would I then be able to print this? Most of my reading is in the evening, or at bedtime and I don’t use computer, phone or tablet at that time of day as it interferes with my sleep pattern.
Reply Since it’s a PDF, you can print it but I can’t vouch for the quality. The software used to produce the file may not have created a high enough resolution. It’s also over 200 pages long and there are links in the book to videos which to view you would have to manually The web address of the video into a web browser. I want to be sure you understand the potential limitations of the file and are not frustrated by them.
Reply Can I purchase your book in hard copy form? don’t have an e-reader. I much prefer a book as well.
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Do you have an exercise program for hip osteoarthritis. Or can I adapt the 90 day knee program.
Reply Hi Louise – yes, I have a book “Better Hips, Better Life” that covers osteoarthritis of the hip:
https://www.dougkelsey.com/better-hips-better-life/
For some reason, from Canada, we can’t buy your kindle books on Amazon. I’m particularly interested in the knee and spine ones. I can get the knee book as a PDF. Is there a way to get the spine book outside amazon?
Reply Hi Douglas – I don’t know why Amazon does that and I understand it’s frustrating. It is for me too. The book is designated for world wide distribution. I know some people have found a work around for that problem. I don’t have a PDF of the Build a Rock Solid Core book which is what I think you mean by “spine” book. I am currently writing a comprehensive book on the spine along the lines of my knee books. I’ll put converting the current book to a PDF on my list of things to do.
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Doug, would the routines in your hip and knee books be useful as preventive measures in someone who is currently asymptomatic? Thanks!
Reply Hi Frank – good question. The best things to do are to increase and maintain strength of the joint, supporting connective tissue and muscle and move a lot. In the book I talk about the three training environments – sub-gravity, gravity and super-gravity. The routines in the book help people move from sub-gravity – the ability to withstand loads less than body weight – to super-gravity – the ability to withstand loads above body weight. So, if you’re not symptomatic, we could assume you at least tolerate gravity level loads. You could use the procedures in the book to identify your training environment and then work on improving it to super-gravity and keeping it there.
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Hi! Would the 90 Day Knee Arthritis Remedy book be beneficial for someone with some Patella Tracking issues who has been told there is some degeneration of the cartilage under the patella? This issue makes for “noisy’ knees when squatting but no pain. Thanks!
Reply Hello Wade – First, answering your question without knowing more about you, your knee, your situation, is difficult. “Noisy” kneecaps are fairly common (as is patella tracking problem) and as odd as it might seem, are not always something to be concerned about. Having said that, the content in the book might be helpful in reducing the crepitus (the technical term for the “noise”). But, if this is your only symptom and you do not have pain, stiffness, swelling, aching, you might also take a wait and watch approach.
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Is your book on Knees available in Spanish? We have a guest coming in May next year who has knee problems and speaks only Spanish. I’d like to help him.
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I’m trying to sort through and obtain the recommended supplements, but I’m stymied by the ACES recommendation. TwinLabs Dualtabs don’t contain the supplements in the level you suggest any more. They also don’t appear to be available on Amazon. What is available is the Daily One, and their content is no where near what you suggest. Do you have any other recommendations for multi-vitamins? Thank you. (BTW, the SamE and Glucosamine/Chondroiton really seem to make a difference).
Reply Hi Danielle – this item appears to have the correct levels and is on Amazon – https://www.amazon.com/Carlson-ACES-Selenium-Vitamins-Soft/dp/B003BVIDRM
Reply hi, i just finished reading the runners knee bible. is the 90 day arthritis book and this book have similiar content? I have an ostensible radial meniscus tear from exercising 1.5 years ago and affected my dancing. Please advise whether the 90 day arthritis book is beneficial for my situation. thanks
Reply Hello Rabin – the two books have content that overlap since the conditions are quite similar. The principles in the Runners Knee Bible are what we use to help people with meniscus tears. Most people, because of the variability in size of tear and stability of it, need a customized routine. You can speak with my colleague Laurie Kertz Kelly in a 20 minute free Strategy Session to learn more. Link is here -> https://thekelseygroup.as.me/schedule.php?appointmentType=6829146
Reply hi Doug,
in your ebook on 10 exercises to avoid, the barbell squat is mentioned. i like to do front squats with a barbell on my shoulder deltoids. the strength training community consider barbell squats as one of the kings of exercises because of the compound movement which engages multiple large muscle groups.
If the barbell squat should be avoided, then what is a suitable substitute to train the lower body?
Thanks,
Rabin
Doug,
I have two questions regarding treating knee pain in the presence of both articular cartilage damage and degenerative tears of the medial meniscus—a situation that is quite common in older individuals. While surgery to remove or repair the meniscus is usually advised for meniscal injuries in younger patients, a lot of orthopedists are now hesitant to perform the same surgery in older patients with degenerative tears since recent large studies haven’t shown a clear benefit over non-surgical treatments in this age group.
My first question is whether or not, in your long experience with rehabilitating patients with knee pain, have you seen benefit from meniscal surgery in older patients with degenerative tears? My intuition would be that removing damaged meniscal tissue would lessen inflammation in the joint space and perhaps less ongoing damage to the underlying cartilage…
My second question is a more practical one. In your 90 Day Knee Arthritis Remedy, you mentioned that individuals with a meniscal tear might not benefit the most from the program or require a different solution. Does that still hold true if one has both osteoarthritis and a tear?
Any insights would be appreciated. Thanks.
Paul
Reply Hi Paul – a small, stable, degenerative meniscus tear can respond well to the principles outlined in my book and this is a condition that tends to go hand in hand with osteoarthritis. Larger tears or tears that are unstable (catching, locking of the knee) often require more customization of the routine. I often suggest Platelet Rich Plasma injections to boost the healing of the tear as opposed to surgery which, as you mentioned, tends to not work well over time.
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Hi, I have chondromalacia patella. I was looking at your article on vertical incline planes. I’m just wondering if you’re able to squat without pain onto a chair 15 times, do you still need the vertical incline plane?
Reply Hello Maria – a VIP is one of the best tools to address both muscle and joint strengthening. For joint strengthening, you need low loads, below body weight force, which is where a VIP comes in very handy. For someone with knee pain, a VIP is very helpful and in many cases critical to have but without knowing your situation, I don’t know if you would need it or not.
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I am having trouble following the routine in your book, specifically the joint strengthening section. There is no chapter called “joint strengthening basics” and I don’t see a list of these basic exercises. Thanks
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Hi. I bought your book, The Runner’s Knee Bible, but I notice the link to the hip burner exercise video is broken. Do you have a new link to this video, and if so, would you mind sharing it? Thank you.
Reply Hi Linda – thank you for purchasing my book and I’m sorry you’re having trouble with that video. Which version of the book do you have? The PDF version or the Amazon/Kindle version? Also, could you email me the web address of the video that seems to be broken? we will get you the video you need once I know which version of the book you have. Thank you – email is-> info@dougkelsey.com
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I would like to purchase your book The 90-day Knee Arthritis Remedy. But I do not have an Amazon account, do not have a Kindle, nor do I wish to have either. Do you have another way to purchase this book? Is it available in print format?
Reply Hi Laurie – there is a PDF version available here -> https://www.dougkelsey.com/doug-kelsey-books/. You’ll see a PDF VERSION button. Click the button to purchase it. Thank you.
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I just paid $19.95 for PDF version of the 90 Day. I then received a junk email from client@e-junkie.com saying I can download. I’m not comfortable at all doing this. Why is it coming from something called junkie and not you or your site?
Reply Hi John – thanks for your note. When I was ready to sell my first book almost 12 years ago, the business and website suggested to me by a consultant I had hired to help me was https://e-junkie.com. They handle all of the sales side of the transaction from providing safe, secure credit card processing with PayPal to delivering the product and maintaining all pertinent transaction records. Our company is too small to tackle all of these elements of an online sale. Why they chose to name the company the way they did, I don’t know but I understand why you might be suspect of it. You need not be. They have an excellent rating from me. You can download the file and feel confident about it. Thanks for bringing it up and asking about it.
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Dear Mr. Kelsey, I just bought your “90 days…” book and also Saving My Knees. I am 82 and recently got pain in my right knee when going up and down stairs. My question: does bicycling do the same for your knees as doing quad reps? Or should I do both? P.S. I am also recovering from spinal stenosuis and it seems to me that motion is also a royal road to recovery. Like getting into a pool and moving your legs forward and back, up and down, for at least 30 minutes every day. What do you think?
Reply Hello Bo – thank you for purchasing my book and for your questions. Cycling and quad sets help improve the quality of the fluid in the knee joint but cycling carries with it more load or force to the knee. I can’t answer questions about what you should or shouldn’t do since I’ve not taken a history, I don’t know all of the details. In general, walking or exercising in water can be helpful for lower back pain but without knowing more about your situation, I can’t give you specific advice. If you feel like you need professional guidance, my colleague, Laurie Kertz Kelly, provides a free 20-minute Strategy Session You can learn more about that here – https://www.kertzcoaching.com/services
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Hey Dr Kelsey, I’ve been struggling with chondromalacia patella- at least, that’s what a couple doctors have called it- since I was in my teens. My main issue these days is trying to get a doctor to LISTEN to me about my pain and symptoms! I’m only 29, and my knee cartilage is technically intact…it’s just very, very porous and spongey (this was confirmed via bilateral arthroscopy). But, because my X-rays look relatively normal, most doctors insist that my severe knee pain is “all in my head”. This has led to about 5 different diagnoses, and NO solutions!
Do you have any advice for patient’s advocacy, finding a reliable doctor, etc?
Hi Kari – I know how frustrating it can be to not be heard. Sometimes doctors get frustrated too because they feel out of options and that can be expressed as indifference or an unwillingness to listen. My colleague – Laurie Kertz Kelly – offers a free 20-minute strategy session. This might help you sort out the issues and formulate a plan. This link will take you through the appointment process – https://TheKelseyGroup.as.me/?appointmentType=6829146
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I’m not sure what book I should get to give me guidance on very low level exercises for my knees. Reason I say this is I don’t have any signs of cartilage wear (three clear MRI scans, though a white hot area on a bone scan at the tibial tuberosity) however I’ve been suffering from chronic knee pain for almost three years and intensely for one year now following initial overloading extensor mechanism event and subsequent over exertion over years.
Would your 90 day arthritis book still be suitable and useful for me or is there something else I can get guidance from for joint friendly exercises?
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How can I buy your book in hardcopy? I do not own a kindle and do not like reading on a screen.
Thanks, Patrick
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Hi Kathy – first step is figuring out what is causing the symptoms. Sciatica is a term that is sometimes used for any type of referred pain in the leg. Technically, it means pain that follows the path of the nerve. If the pain is from an irritated nerve, relieving pressure on the nerve through the day is sometimes helpful. I’ve found this exercise to work for many people – you can find it in this post – https://www.dougkelsey.com/backpain-in-the-morning/
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I want to but a print version of your 90 day remedy book. I saw a link for that, gave all my info and it went to an page with all arabic. I got no confirm number so I hope that was not an internet trap and some sleazeball just got all my info!!. I do not want the kindle version. please tell me how to purchase a print version
Reply Hi Elizabeth – I don’t know what happened with your purchase attempt. I just checked the link. When you click BUY PDF VERSION, the next page you see will be the “shopping cart” with your item in it. On the right hand side, is the pay option and when you click that, it takes you to PayPal. If you have a PayPal account, you then sign in and follow the instructions. If you don’t have an an account, you can pay with a debit or credit card. The page to purchase the PDF version is https://www.dougkelsey.com/how-to-build-stronger-knees/
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just need a paperback version for the 90 day knee arthritis remedy for my aunt in india, how do i get it?
Reply Thank you for your question. The book is available from Amazon (e-book) or in a PDF version from this page (https://www.dougkelsey.com/how-to-build-stronger-knees/). It is not available in paperback or hardcover currently.
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Many thanks for Doug Kelsey’s wonderful insights on cartilage as capable of self regeneration and self repair.. He has been right long before the mainstream recognizing this reality …
https://www.the-scientist.com/news-opinion/adult-humans-can-regenerate-cartilage–study-66558
https://www.the-scientist.com/news-opinion/adult-humans-can-regenerate-cartilage–study-66558
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Is your book titled The 90 Day Knee Arthritis Remedy available to read in the UK? I am having difficulty getting an ebook version here.
Reply Hi Jackie – as far as I know, Amazon decides where books are available. The book is designated for worldwide distribution but some people have emailed me with a complaint like yours. This article might help – https://www.howtogeek.com/328197/how-to-change-your-country-on-your-amazon-so-you-can-buy-different-kindle-books/
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Dr. Kelsey,
First off, I want to thank you again for the excellent advice on how to treat plantar fasciitis. Back in 2007 or so, I came across your article and it made so much sense. Myself and others have followed your advice in using the Strassburg Sock and let the fascia heal. The traditional advice certainly had it all wrong. We are forever in debt to you.
My question today – I have a friend with plantar fibromas and we are looking for that “outside the box ” information, if any, on how we we might deal with this in the most effective way. We are about to start some detoxification of the feet through soaking in magnesium bicarbonate and such to help alkalize the foot area. We have read of the metabolic acids causing issues in the plantar. It’s a start 😉
Best regards,
Patti Chastain
Hi Patti – thanks for your note and I’m glad to hear you got some benefit from the article. On fibromas, something to try is transdermal verapamil. This is a prescription which comes as a gel or as a compounded cream. In a nutshell, it helps improve the pliability of the tissue. Sometimes, the verapamil is blended with an anti-inflammatory but that depends on whether the pain is from inflammation or if it’s non-inflammatory pain. There are also some kinesiotape taping techniques that sometimes help support the connective tissue. For exercise, I prefer a Variable Incline Plane so you can control the amount of force into the foot, identify the level of non-painful force and control the increase in load. And all of the things you do for plantarfasciitis come into play too.
I hope that helps.
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Doug,
Thanks for you reply again!
Didn’t realize there was an expanded version in ebook, thought I was getting everything with the Amazon book.
Since I am self diagnosed with stage III OA of the knee can you tell what advantage there will be in getting the full version?
Thanks – wyatt & Merry Christmas!
Reply Hi Wyatt – the full version has about 23 more chapters of content and includes self-assessment, detailed programming, necessary forms and demonstration videos. You can find the webpage for the book by : clicking here Hope you enjoy the holidays.
Reply Hello Doug,
Couldn’t reply to you so I will make a new comment.
Answered my own question, found your book on Amazon ’90 Day Cure’ for my stage III knee OA. I am doing the furniture sliders now and backing off squats in the gym and long walks to see if I can encourage the healing you point to which I know can happen – although I am
suddenly feeling really old (8
I’m 66 and in relatively good shape but realize in the last couple weeks symptoms I have ignored for a couple years because I am fairly physically active and was able to ignore the issue not realizing what was happening.
I just found your hard back on line this this morning as well.
Thanks for the information!
Reply Hello Wyatt – thanks for your note. The book on Amazon is the introductory edition of the 90 Day Knee Arthritis Remedy. It covers the foundational principles of the program. The full version is on my website. Both editions are ebooks – just FYI. Best of luck to you.
Reply Hello Doug,
The link to your book is broken on this page. Is it still available? Thanks!
Reply Hello Wyatt – Sorry you ran into a broken link. What page or book were you trying to find?
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Hi Doug, I enjoy reading your comments. I, like you appreciate the accumulated knowledge of conventional medicine but disagree with almost all of their conclusions and advice. One thing is missing from your approach that I have discovered, and that is #3 the power of food. The power of food to impeed healing is not mentioned. I would be glad to send you my book, Chronic Pain Gone 90 Days
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When there is fluid in the knee, what is the best way to get it to drain? From your book and this article, it seems that likely methods include quad sets, light cycling and sliders on the floor? Is that correct? Does icing after the light exercise help or hurt with the drainage?
Reply Hello Albert – elevation (knee above the level of the heart), compression, activity modification, light movement, quad sets are the main things to do. Ice, if the injury is acute, can help but after about 3-4 days, ice is more helpful for pain control than fluid control.
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Hi Doug. From your book, I know you recommend isometric quad sets, up to 100 a day, as a way of strengthening the knee joint, by thickening the synovial fluid. Do you know if there are any similar benefits from high-rep isometric exercises of the hip adductors and/or abductors (for those whose knees can’t yet handle quad sets)? Many thanks.
Reply Hi Kevin – hip isometrics likely helps the hip joint but unless the quad fires, I doubt it would have an effect on the knee. Usually when you contract the gluteal muscles though, the quadriceps fires as well.
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Can you recommend a body weight exercise program? I am 67 year old male, good health, am not taking any medication for any illnesses. Many of the body weight programs include exercises you discourage. I have used your rock solid core program with great success and I trust your recommendations.
Thanks,
John Newton, 630-881-2690 I live in Fort Worth area
Hello John – I don’t know of a program that doesn’t include at least one exercise / movement that carries too much risk. There might be such a program though and I’m just unaware of it. I’ve posted some of my routines here – maybe that will help. Glad to hear the Rock Solid Core program worked well for you – thanks for sharing that.
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I was hoping you could talk a little about which forms of exercise for cardio are least stressful on knee joints. Rowing involves flexing at the knees repetitively, but it seems like most of the force is in the posterior chain, similar to a deadlift or kettlebell swing. Is it something you would suggest be approached with caution to the type of person using your Runner’s Knee Bible to improve their knee joint strength? Is there any form of cardio that you would strongly encourage?
Reply Hi Erica – good question. It depends on your Load Tolerance or how much of your body weight you can place on the affected leg and how easily symptoms are produced. If you’re over 50%, then an elliptical or other machine similar to it will usually work. If it’s less than 50%, a stationary bike can sometimes work. Upper body bike / ergometer should work. Rowing would not be my choice. Too much force at a deep angle of the knee.
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Hey Doug
I bought The Runner’s Knee Bible and I am in the process of doing the strength tests. However, I am struggling because I have already pain “at baseline”, often the whole day, and I can do the strength tests anyway because my pain doesn’t increase during the tests, but afterwards, with a delay of a few hours or more.
What should I do then? Does it mean I am not ready yet for doing any PT and need rest or drugs?
Hello Daniel – I suggest you contact my partner Laurie Kertz Kelly. To answer your question thoroughly requires a discussion and perhaps a consultation which this forum isn’t set up for.
You can reach Laurie at laurie@kertzcoaching.com
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Hello Doug
I have been suffering from runner’s knee for several months. Lately my knee becomes stiff as soon as I stand or walk for more than 5 minutes. What are the possible causes of stiffness in the knee in absence of evident swelling (maybe there is but I cannot see it??) ? I have always thought that stiffness is relieved by movement, but it doesn’t seem like so…
Reply Hello Kelly – stiffness is generally due to swelling and it doesn’t take much, in the knee, for it to have an effect. About 1.5 ounces of fluid can reduce muscle activity in the quadriceps. This small amount of fluid would not be detectable by the eye or even measuring the circumference of the knee. Stiffness is often relieved by movement but it’s also the load associated with the movement. So, for example, perhaps your knee would feel less stiff if you slowly pedaled a stationary bike rather than walked.
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I have pain in my ankles (arthritis) I have been walking but would like your take on the use of a foot bike to add to my exercise. Is it any more beneficial than riding a bike?
Reply If by bike you mean a road bike, then a stationary bike is better. Foot bike is less expensive and for some people easier to use but the effect is not much different than a stationary bike.
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i saw something on Amazon that you had a good stretch or pt program for those suffering from arthritis. I have moderate hip arthritis, do you have something that address this? Thank you
Reply Hello Charles – I don’t have a book or written program available to the public for hip arthritis. Here’s an article about one of the exercises I often use for hip OA – http://box5179.temp.domains/~dougkels//hip-swinger/ . Hope that’s helpful.
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Thanks for replying Doug. Are you familiar with the Envelope of Function concept by Dr. Scott Dye? It’s similar to the load acceptance graph that you present in the Runner’s Knee Bible. Am I right? Does it fit with your mechanobiology framework?
However, if someone’s knees are more or less in pain the whole day, even at rest and not just during certain exercises, would you advocate for an extreme and total rest, like going on crutches or bedridden for a long time (weeks, months??) until the pain and inflammation subside spontaneously? Or what would you suggest to do?
Reply Yes I am familiar with the concept which is similar to the Functional Zone and Adaptation Zone I explain in my books. As for your situation, I can’t help you unfortunately. There are a number of variables to consider and this forum isn’t set up for that type of interaction.
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Thanks Doug. Do these symptoms wax and wane for a long time after the PRP (several months, one year or more)? Could it be a sign that the PRP is working?
Have you had patients who did PRP for CP (rather than meniscus tears or OA) and had benefits from it? I wondering if the indication was correct…
Reply Hard to say. There are differences in the PRP technology from one MD to the next, differences in what people do post-injection, and differences in each persons pre-injection physical state. Those variables probably have more impact on the outcome than whether the injection is for meniscus, ligament, cartilage. etc.
Reply Doug,
you have mentioned in one of your post PRP and the so-called “prolocoaster” effect. Could you tell a bit more about that?
I had PRP (just a single shot) in both my knees for chondromalacia patellae 4 months ago. So far I have not felt any benefit from it and, actually, in the past month the pain has been worse than ever, even though I have not in any way overloaded the knees, in fact I even reduced the amount of activities recently.
The “prolocoaster” is a term we coined to describe the symptomatic process following PRP although the technology has advanced and it seems this is less often the case. The cells progress through certain stages of healing and because of that might be more fragile, more easily overloaded which then creates symptoms.
Reply Hi Doug
I am having a stubborn case of PFS with little or no improvement over the past year. This term seems to be used as an umbrella term for various conditions and it doesn’t seem that orthopedic surgeons agree on which tissues in the knee are responsible for the pain. Some equates PFS to chondromalacia patellae, some other say that it’s a chronic inflammation of the synovium (synovitis). What’s your opinion on these? What do you think of the “loss of homeostasis” theory?
On another note, I have read the Runner’s Knee Bible, but I could use the help and guidance of a PT. Are you able to recommend PTs with expertise on PFS in the Northwest USA (WA, ID, OR, MT)? Or, even if it’s not ideal, knowledgeable PTs who do remote consultations?
Reply Hello Marco – inflammation could be considered an outcome of the loss of homeostasis in the joint – a biochemical homeostasis. Synovitis is often associated with chondromalacia patella but people with chondromalacia patella don’t always have synovitis. For practitioners, you can email my partner Laurie Kertz Kelly at laurie@kertzcoaching.com. I know Carol Link, (healthlinkpt@gmail.com) former student of mine, in Montana – 134 South Main St Butte MT 59701 ph: 406.310.0296
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Doug,
I read your story about your personal experience of dealing with an acute disc herniation a few years back and wanted to share with a colleague. If you still have that post and could share I would really appreciate it. Thanks for all you do!
Best,
Dana
Hi Dana – thanks for your note. I wonder if you’re referring to a series of posts I did on my injury (it was more than 20 posts). If you could give me a bit more info or direction, I probably can find the post (or posts) you want. Thanks –
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Hi Doug. Guess it’s my day to bug you with emails. Anyway, something didn’t make sense to me about your experience with PRP for your meniscus tear (kind of like your nagging cartilage metabolism questions to your PT professor!) If the meniscus is largely absent a blood supply (except along the peripheral red-zone), do you have an idea about the mechanism of action for PRP? It may well have been that your tear was along the periphery. Also, FYI, Dr. Justin Saliman offers an interesting explanation about synovial fluid “filling gaps and preventing healing” in such injuries (probably not an exact quote, but close). My guess is that he is suggesting by “filling gaps,” the synovial fluid is actually remaining in the gaps caused by tears, thereby precluding waste from being excreted and nourishment from entering. I’d liken it to a COPD patient who is unable to fully expel the stale air in their lungs and, therefore, unable to draw a complete and fully nourishing breath. I’d be interested in your thoughts about my theory. Thanks again.
Reply Hi John – thanks for your question…a good one. In my case the tear was peripheral but PRP contains a lot of growth factors which via the synovial fluid may stimulate healing (mesenchymal stem cells have been found in the fluid post-injury: https://www.ncbi.nlm.nih.gov/pubmed/24338094) in regions that are more avascular.
Reply Doug, re your post, “What’s The Story with Knee Cartilage Injuries,” was the left photo a full-thickness chondro lesion? Also, any thoughts on ACI, MACI, or microfracture to generate new fibrocartlage. Enjoyed 90-Day book and appreciate all that you do!
Reply Hi John – the photo is of a mid-thickness lesion. From experience, the ACI / MACI seem to work out better than micro fracture. But perhaps the most important part is what you do and don’t do after the surgery (any of them). Glad you enjoyed the book – thanks for letting me know.
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Hi Doug,
I read very good articles you published some time ago concerning tendon problems. You were using interesting scale to grade the problem where in the last stages the pain is constant, which is suggestive of a permanent damage to the tendon. My question is have you seen people reversing the such a chronic condition?
The thing that may be interesting for many people to know is how would you approach tendon problems where it is not only a matter of load tolerance because due to an injury or some other reason, but the muscles have lost balance, do not fire in harmony and have frozen in high resting tone, which does not allow for the tendon to rebuild itself due to the constant tension? So how do you loosen up muscles and balance them to work in symphony once again?
Thank you for all your articles!
Warmly,
Sveto
Hello Sveto – thank you for your question. Load Tolerance is the amount of force you can produce / absorb and control. If a muscle is weak, you will have a lower Load Tolerance. If a muscle has high tone, it may interfere with Load Tolerance. There are a number of possibilities that could cause increased tone – too many to get into in a comment section. Sometimes the tone is in response to a joint injury, swelling, irritation. Sometimes it can be from postural changes that “teach” the muscle a certain length / tension relationship. What you do to change the length/tension issue depends on why you have it.
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hi doug, I am wondering if you could advise me on what brand of pulley system you would purchase to do MET target tissue training in a small start up clinic. I am one of your past students. thanks for your time.
Reply Hi Susan – I use STEENS. Here’s the US Distributor website: http://www.metequipmentusa.com/index.html
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Hello! I currently have Medial compartmental OA in both knees. I have a Total Trainer which I have been using. My question is where and how should I place my feet? Should my toes be pointed straight, inward or outward? Should my feet be placed together or at the outer edges of the plate? Thank you for any advice you could give me.
Reply Hello Barbara – generally, foot placement is at the top of the attached foot platform, feet about shoulder width apart, toes pointing straight ahead.
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I book your book on arthritis. You say that “If you know you have patellar tendonitis, meniscus tear, ligament injury, a subluxing patella, or a condition other than OA or CP, the solutions for these conditions are different than what I present in this book.” Could you direct me to information on solutions to meniscus tears?
Reply Hello Stephen – thank you for your note. I wrote an article about how I healed my own meniscus tear – that might be helpful. The challenge with meniscus tears is the size of the tear, where the tear is in the meniscus and the stability of the tear. Small, stable tears tend to respond fairly well to the approach outlined in my books but in general I suggest working with a practitioner who can guide you. Usually meniscus tears need assistance from either injections or surgery and physical rehab to heal.
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Hi Doug and team,
I just wanted to say I bought the 90 Day Osteoarthritis Remedy about 90 days ago, after my good knee suddenly got much worse than my bad knee. I could hardly walk, and I’m still working at teaching mathematics in China . I knew I really needed to change, and I knew this was the way. I found your book reading Saving My Knees by Beddard. That book gave me hope but not method. Using your book, first of all I restored my good knee to better than it was, maybe better than it’s been for years. More than that, I strengthened my core and my balance, and I have a set of exercises which I intend to continue doing. I particularly like your idea of rest, so I do the exercises every third day. I also viewed the videos to make sure I was doing the exercises right. I’m 70 years old. Your book was a life-changing experience, and it worked exactly as you said it would. So I want to acknowledge you as the expert you are and thank you.
Russael Johanys
Reply Hello Russael – Thank you for your note and I’m thrilled to hear of your success. Well done! Thank you for taking time to let us know…made my day. If you can stick with a regular routine, your knees will thank you for years to come and it sounds like you’re on your way. Again, thanks much.
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To improve Knee chondromalacia patellar, which equipment you recommend, HOVR or mini bike?
I wants to improve stability, will squats further soften cartilage?
Thank you.
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Hi DK,
I’m a 33 year old fitness junkie who destroyed my knee back in 2009 from a car accident. I had my PCL, ACL, LCL repaired with cadaver ligaments. In 2016(from overdoing it at gym-probably plyometrics did it) I tore my meniscus. I had a partial menisectomy and it was great up until about a month ago. I, of course, was feeling great and kept increasing my loads with squats and lunges and like that, after one leg day my leg has been hurting every since. Mostly the medial side with constant throbbing, crepitus(which my knee usually has), burning. Im thinking its my meniscus again. My question is what is your opinion on BFR therapy? I did it after my first meniscus surgery and it maintained my muscle beautifully while I healed. I did it on straight leg raises, quad sets and light weight leg press. I go back to my doctor next week. Im so frustrated with myself over this!
Thank you
Hi Chastity – thanks for your question and I’m sorry to hear of your recent struggles. As for BFR (blood flow restriction), that has some promise for people who need muscle conditioning but whose joints can’t take the loads required. However, the lower rate metabolic tissues of the joint need low load, high volume work in addition to the muscle training, my two cents. Good luck with your recovery.
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Hi Doug,
I have a long history of chondromalacia in both knees from cycling and running. I’ve done PT for years starting back in the late 90s. I learned to manage the pain and continue to be active, until last year when constant pain and swelling made me stop being active. I’m in my late 40s and have quickly lost muscle mass over the past year. I need to really re-learn patience and focus so I can attempt to get back on the bike. I have both the runner’s knee bible and the 90 day knee arthritis books. My question is what is the difference between a sports PT and orthopaedic PT? Which would be best for me? Or is there something specific I should look for in a PT? I’ve been given the same exercises over the years that I lost faith in the system.
And I will be sure to start working on the quad sets again.
Thanks.
Hi Chad – thanks for your note. The Sports and Orthopedic PT is a designation of their respective specialties. There is some overlap in knowledge and skills though. If you’ve not had a professional assessment of the fit of your bike, I would get that done. Sometimes a small adjustment can have a large impact on the forces in the knee. As for as PT, you need someone who understands mechanobiology (how exercise alters tissue healing) and functional movement. If you would like to talk to my colleague Laurie Kertz Kelly about your situation, you can reach her at laurie@kertzcoaching.com
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What is your opinion of this fasting fad, waiting until 11am to eat or eating for 3 days then taking a day off food, etc.? Doesn’t that just slow down your metabolism and teach your body to save fat:?
Reply Hi Cheryl –
Thanks for your question. I understand your viewpoint and until recently, there wasn’t much proof behind the idea of intermittent fasting, A recent study, small in size, suggests that restricted feeling can help reduce blood pressure and excess bodyweight. You can find the study here: fasting study
Reply To do 100 repetitions of quad sets would take over 15 minutes per leg. Any reason you can’t save time and do both legs simultaneously, especially when sitting in an office chair?
Reply Hello Albert – yes, you could perform the exercise with both legs at once. The goal is 100 repetitions per day. Most people divide that up into smaller sets several times per day.
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Hello Doug:
Do you know any PTs who work remotely with people – who could at least coach someone in using methods like you use ?
I found Laurie Kertz for example. Is there anyone else ?
Also any particular book or other generic recommendations for fat pad irritation ? Lots of books on PFS, not much on this subject.
Thanks,
Michael
Hi Michael – you found the person I suggest. As far as fat pad irritation, that’s generally not a large enough topic for a book. Sometimes it occurs in isolation and a steroid injection works well. But many times it’s the outcome of a number of other factors and you would need a professional to help you figure it out.
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Have you ever worked with or any recommendations regarding comminuted patella fracture which required pins, screws & wires?
Reply Thanks for your question. Yes, I have had a number of clients with that type of injury and surgery. I would get in touch with a physical therapist who is certified in orthopedic physical therapy or familiar with the surgery. You can start with this website to locate someone near you: http://aptaapps.apta.org/findapt/default.aspx?Unique=&UniqueKey=
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No, sorry, I don’t know of anyone there but you can find an certified orthopedic specialist by going here: http://aptaapps.apta.org/DirectoryofCertifiedSpecialists/default.aspx
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I do not have knee pain, but crepitus – I hope to avoid getting pain by addressing this now. I would like to run more, but do not want to stress my knees too much either. Nutritionally I have already informed myself, so I am mostly interested into a good exercise guide. The Runner’s knee bible seems to be interesting, or would you rather recommend the 90 day knee arthritis remedy? The two books do appear to have some overlapping content.
Reply Hi Andrea – thank you for your question. Crepitus can appear for a couple of reasons but the most common one is that the protective fluid in the knee – synovial fluid – is a bit too thin. I’ve found the certain exercises seem to improve the crepitus and quality of the fluid or thickness. The 90 Day Knee Arthritis book would be a good source of info (and yes there is some overlap between that book and the Runner’s Knee Bible).
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Dear Doug – I was recently diagnosed with bilateral PFPS and into week 5 of acute phase. I am trying to follow your low load/high intensity advise for recovering from this awful condition. I get up and walk between 100-200 steps every 30min or so. No pain when walking BUT delayed mild pain and swelling/feeling of fullness on the top patella band (towards femur) from around 2pm daily. The simple exercises PT gave me (mainly straight leg VMO’s) aggravate the knees also. I am desperately trying to break this cycle of inflammation but still cannot work out what is causing the aggravation – any suggestions?
Thank you for all the info you are sharing, you posts give me hope.
Reply Hi Lili – sorry for the delay. I missed your question somehow. Usually, delayed pain and swelling is a sign of too much activity and / or load. Instead of walking, I might try sliding your foot back and forth on the floor on a paper plate. Just a minute or 2 once or twice a day and then assess how your knee responds. I can’t get into a lot of detail here – not the place and not proper without a history, interview, etc. If you need more help, contact my colleague Laurie Kertz – laurie@kertzcoaching.com. She might be able to assist you.
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Hello, Thank you so much for your article. I’m a believer that your body is designed to heal itself if you give it the right tools to do so. Like you, I have a hard time believing that cartilage will not repair itself. I have taught spin classes for years and I also teach a low impact boot camp, and have been physically active the majority of my 54 years young. I’ve been limping and in pain for 4mo now and just received my MRI results….Ugh! A torn hip Labrum. Anybody out there that have used your protocols for healing a labrum? Im determined to prove people wrong here…it is possible to heal this tear! No surgery for me!!!
Reply Hi Maria – a torn labrum is a different kind of cartilage injury than the joint surface and therefore needs a different approach than what I use to help strengthen articular cartilage. The labrum is a stabilizer of the joint and a different kind of cartilage as well. Some people recover without surgery, some have had PRP (platelet rich plasma) injections and rehab and do well. Some need surgery. It depends on how large the tear is and where it’s located. I hope this is helpful to you.
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Hi Doug.
First of all thank you so much for the work you do. I have recently purchased the runners knee bible and a total trainer and I have just started your knee recovery programme. My question is: do the foot slider/tail gaiter/ t-trainer? Squats thicken ALL of the cartilage or just the part in the range of motion practiced? I ask this because although my diagnosed patellofemoral pain syndrome has all but gone when going up/down stairs, I do get a crackling noise and pain ( delayed ache) when extending out my leg from a heel-to-butt position even when lying on my back. Note: I can only actually get my heel within about 6 inches of my butt because the pressure in my knee feels worryingly highly and begins to hurt.
Sorry I couldn’t keep the message shorter.
Thanks again.
Paul (England)
Hello Paul – the goal of joint strengthening exercises is to stiffen the joint surface or make the joint surface more durable and improve the viscosity of the fluid in the joint. The cartilage may or may not change thickness. What matters most is what you can do on your leg. There are several reasons why you might experience what you describe. One of those is that the joint fluid that is too thin but without an assessment I can’t say with any certainty. Generally, motion improves as the joint health improves.
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Hi! Thanks for all information you have given us.
I would like to know if you recommend any doctors and/or physical therapists in Brazil.
Also, I’d like to know your opinion about insoles. I used one (for flat fleet) and it worsened my knee pain a lot in one knee. My physical therapist said it’s because I used for a long period of time in the beggining and it’s normal to have pain until my body adapts.
I’m sorry – I don’t know of any therapists or doctors in Brazil. Inserts can be helpful and there is often a period of adaptation so I usually suggest wearing them a few hours and gradually increasing the time.
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Thanks again, Doug. Would one of your books help me with my osteochondral lesion of the medial talar dome?
Reply Hi Bill – I don’t think so. The principles apply to all weight bearing joints but the tactics are different for the foot than, say the knee (which my books cover) or the hip / spine.
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My wife, late 50s, has started doing super-slow weight training and is now experiencing knee pain. I’ve just bought your book – the 90-day remedy. Should she stop the super-slow training, or can you provide some guidance how it should be done?
Thanks / Derm – Balls! I have not said that already!
Hello Derm – you’ll find the answers in my book but if the first step is to remove the offending activity so if exercise is causing pain, I would not do the exercise generally speaking. Super Slow is harder on joints because the load is sustained over a longer time period and the concept is to go to extreme fatigue. I generally advise people to “leave a little in the tank” when it comes to fatigue. This article explains how I approach fatigue: http://box5179.temp.domains/~dougkels//strength-training-for-champions/
Thanks for your questions.
Reply My wife, late 50s, has started doing super-slow weight training and is now experiencing knee pain. I’ve just bought your book – the 90-day remedy. Should she stop the super-slow training, or can you provide some guidance how it should be done?
Thanks / Derm
Thanks Doug! Thinking about getting PRP in my osteochondral lesion of the medial talar dome and a smaller lesion on the tibial plafond, but it seems there’s no standard way to formulate the PRP yet? Can you suggest a good way? What do you think of multiple PRP shots over a period of time? Thanks again!
Reply Hi Bill – yes, there is variability by the practitioner with PRP including the injection itself. I think guided injection (using ultrasound for example) makes more sense than unguided. Your question about multiple injections is a good one and something that would take too long to answer in this venue but I’ll put together an article about it soon. Thanks.
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Hi Doug, I see a lot these days about stem-cell regeneration injections. Do they work for bone-on-bone, where all the cartilage has been taken out? Thanks.
Reply Hi Ben –
Thanks for your question. Stem Cell Therapy won’t resurface the knee in exposed bone situations but it has helped people feel better and be more active. The explanation for that reaction to Stem Cell Therapy has to do with how stem cells help regulate the biochemical environment of the knee.
Hi Eric – yes I am aware of the study. The media often portrays studies that show a link or association as causative when it’s not. For a different perspective on the study, try this article: https://www.drweil.com/health-wellness/health-centers/men/does-fish-oil-cause-prostate-cancer/
Thanks for your input.
Reply Hi Doug,
I just purchased your ebook on knee pain. Looking forward to trying to help with a significant knee injury. You recommend fish oil. Have you seen the latest studies linking fish oil with aggressive prostate cancer? For many years I used to take fish oil. Then moved to krill oil. Have now eliminated both and take flax seed oil. Thought you might want to update your recommendations. Sincerely, Eric
Hi Doug,
I’m interested in buying the 90 day solution for knee pain you offer. My quick question is would it work for bruised articular cartilage damage? My gut tells me it would but wanted to check first. If not is there another approach you offer that I can follow? Specifically I have had an impact injury to my cartilage that prevents me from running. I miss my running, jumping, and all my high impact cardio exercises. It’s been nearly a year since the injury. Standard PT didn’t help much.
Hello Emily
Impact injuries to the cartilage result in a weakened joint surface. The book discusses how to build joint strength and explains the science behind it. The exercises are different than those used to improve muscle strength (which are important to include). Impact injuries take a long time to heal even with optimal programming – it’s the nature of the injured tissue. I hope this helps.
Reply We have an office in the Marathon Bldg in Austin, Tx (4111 MARATHON BLVD, AUSTIN, TX 78756). I’m not taking new clients presently. You can contact Laurie Kertz to inquire about her coaching services (she and I work together). Her email: laurie@kertzcoaching.com
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I keep seeing this device, a so called “neck hammon” on my FaceBook feed.
Doug, I’m curious what would your thoughts be in regards to it’s possible usefulness (or the opposite) for someone with the issues of daily computer desk job.
Thanks,
Skip
Hi Skip –
I haven’t used the device but am familiar with the concept. I suspect it feels good. You can achieve a similar effect by using a partially inflated beach ball (see the image below)….gently, slowly turn your head right (should take about 3 seconds) to the middle (3 seconds) to the left (3 seconds). If you do this a few times a day for 3 minutes each time, you might be surprised how much better your body feels.
Hi Doug,
Reading through the 90 day .. book. I like the bit about pain management and the ritual you went through. I may want to speak to your staff. How do I go about doing this? The book so far had educated me no ends. It’s only once I started having these nigles that I reallized how much we take our body parts for granted.
Thanks
Nalin.
Thanks for your note Nalin. The person to contact is Laurie Kertz. Her email is laurie@kertzcoaching.com
Reply Hi Doug,
Thanks. I came to your web site by way of Richard’s book. I will keep everyone posted how I progress and will download the recommended book.
Not sure what ‘s wrong with this knee but I look forward with a positive mind.
Thanks for sharing your knowledge. Buddha ( am a buddhist), said the sharing your knowledge is the best gift that one can give. Not money, not food, not clothes, not shelter. Knowledge empowers. Blessed are those who freely give their knowledge. That you do.
Thanks.
Nalin
Thank you. There’s a section in the book on “Guidance Glitches” that I think is some of the most important material in the book. I hope the content of the book is helpful to you.
DK
Reply You have three books. I want to make sure I am buying the right book to answer question about my knee. I am 60 years old and until now had no problems with my knees.At no point do I feel continuous pain. There is some instability ( mainly when walking – I don’t try to run) after we moved house a month ago. So which book should I go for?
Reply Hello Nalin – thank you for your question. Based on your information, The 90 Day Knee Arthritis Remedy will have the content I think you’re looking for.
Best Regards,
DK
I was pleased to find an article on the web by you about cartilage – meniscus. I have had a problem for one year. It is nearly corrected! Your article has given me one more “secret” toward becoming 100% on that knee without surgery. Want to know more?
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Hi Doug, do you have any recommendations for doctors and/or physical therapists in the New York City area who follow your way of thinking about cartilage regrowth? I am frustrated by the focus on my quad muscles and general pessimism. Please let me know of anyone who comes to mind! I would be so grateful.
Reply Hi – thanks for your note. I don’t know of anyone in the NYC area. But one thing you can do is ask about the practitioner’s approach to joint surface injuries. When some practitoners (and some of the public too) hear “heal” a cartilage injury, they think “regeneration”. Even the term “regrowth” will be associated with regeneration. Cartilage has the ability to heal and become stronger – plenty of science behind that concept however, articular cartilage does not regenerate. The healing is closer to a scar. With a minor scratch, the skin will regenerate itself. You can’t see any evidence of the injury. But with a larger injury, you will have a scar. I would inquire about how a practitioner uses exercise to help a joint surface injury. If the answer is only muscle training, then you at least know the approach. And by the way, muscle strengthening is an important part of the process….just not the only part.
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Hi Doug,
After a couple of years of off and on ankle pain, I got an xray that showed an osteochondral lesion of the medial talar dome. The pain wasn’t that bad, so I didn’t do anything about it. I got xrays every couple of years and it looked unchanged. I finally got an MRI 5 months ago. It showed a 9x24mm osteochondral lesion of the medial talar dome and a tibial plafond lesion measuring 6x11mm. There are some cysts as well. I agree with you that cartilage can heal, even though the doctors and PT’s I’ve talked to disagree. I was planning on getting off of it for 6 to 8 weeks to see if that might help it heal up, since I’ve never gotten off of it. 20 years ago, I had a medial meniscus tear and 2 surgeons wanted to do surgery, but I took glucosamine and chondroitin and swam and stationary biked for 6 months and went to a 3rd surgeon. She poked and prodded and said there was no way my meniscus was still torn, so I figured the same regimen might work for my ankle. I was forced into getting off of it 3 weeks ago when I went stand up paddle surfing for 4 hours and couldn’t hardly walk afterward. I’d only been off of the ankle for about 8 days when I got another MRI done to make sure I didn’t tear anything or have a fracture. I didn’t, so I decided to go ahead and stay off of it for a couple of months to see if the cartilage might heal. The 2nd MRI shows significant improvement in bone marrow edema, and some of the cysts looked better, but the lesions were still there. I’ve been swimming every day for 5 months to keep everything moving while I was still walking on it. Now that I’m off it, I’m still swimm every day, but am looking into cold laser and infra red light as a way to help it heal. Your PRP idea sounds encouraging as well. I’ve been taking glucosamine and chondroitin and a bunch of other supplements for 5 months as well. Yesterday I came across your article that cartilage can heal and am wondering if I shouldn’t stay off of it for that long without weight bearing. I don’t have arthritis and I’m 60 years old and don’t want it to get worse if I live to be 90 or 100. The gutter spaces are still pretty good as well. My idea was, if I have a lesion, why would I continually mash on it every day without first giving it a period of rest so it can try to heal? What do you think?
Bill – Most providers use the word “heal” and “regenerate” interchangeably. This is why many people believe joint surface injuries can’t “heal” …what they likely mean is regenerate. Joint surface injuries respond best to both controlled load and motion. Non-weight bearing for too long makes the joint surface weaker. So the challenge is finding a good balance of weightbearing, non-weightbearing, or even partial weightbearing with some activity that involves lots of repetitions. Stationary cycling sometimes helps..if you focus on moving the foot through the arc of motion.
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Hi Dk! I travel for extended periods of time with my husband for his job. (I’m a writer, so my work goes with me!) I’m working on building strength using a kettle bell, but the kettle bell can’t go on a plane with me. How do I keep myself in shape? I don’t want to purchase one of the books if it doesn’t give me ways to do this without equipment. Can you tell me if one of them addresses this and if so, which one? Thanks! I love your blog!
Reply Hi Jane –
My books won’t be of help to you. They are not general fitness books. But your question is a good one. Most hotels now have fitness rooms and almost all have dumb bells. You could get this attachment –> https://goo.gl/bRkF4h which turns a dumb bell into something a lot like a kettlebell. If not that, then I would get a Grey Cook band (you can find them on PerformBetter.com). I have used them for years and because of the design, you can use them for hundreds of exercises. Hope this helps.
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Hi,
I find this content very interesting and encouraging. My question is whether the same principles could be applied to a labral tear in the shoulder?
Reply hi Jeff – thanks for your question. Labral tears, hip or shoulder, are more difficult to heal. It depends on the size and stability of the tear. Smaller, more stable tears have a much better chance of healing. This is also true for meniscus tears in the knee. The principles to promote healing are similar to joint surface injuries but have a greater emphasis on creating stability.
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Hi Doug, I used to receive your Blog “The View” a number of years ago. Thankfully I saved a notebook of them so I could look you up again.. Today one of my therapists asked me why I stopped our staff from using the “superman” exercise for our low back clients and fitness clients. I said I had read a piece from you explaining that it was too much force on the lumbar spine to do so. So her question was how do we work on strengthening the back extensors if we don’t use this exercise. Can you please redirect me to the best answer to her question. I did not find the article you wrote on that subject, so I’m hoping you can help myself and our staff with this issue. Kathy Hammer PT
Reply Hi Katthy –
Thanks for following my writing…really appreciate it. Good question and one I will incorporate into a future article. For lumbar (and thoracic) extensors, the “Bird Dog” exercise will both challenge the extensor group while producing much lower spinal loads than “superman”. The research was done by Stuart McGill, PhD. Here’s a short video of the exercise – https://s3.amazonaws.com/fusionaustin/bird_dog.mp4 I hope that’s helpful.
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I’m wondering what you think of the Indo Board. It’s basically an oblong, oval board that sits on a flat “balloon” that can be blown up to different levels for balancing.
Reply Hi Anne –
I’ve not used the Indo Board but have used products similar to it. It’s a way to challenge your balance and in certain situations works fairly well. I tend to do simple things though first – like stand on one leg while brushing your teeth. Sounds easy but it usually is fairly tough to do. The small movement of the arm during the brushing forces you to counter it with your balance…and you’re working on two things at once 😉 Thanks for your question.
Hi Doug,
I have your books on knee healing and in one of them you mention a product called Hovr. It keeps the legs moving whilst sitting. I bought one for home and quite like it as I can small cycling type movements on it all day long without stressing my knee. I wonder if you had any further thoughts on this product or tried it yourself? My second question is that I seem to have meniscus degeneration but not a tear and have looked in prp injections but am confused as to whether the injection should go into the actual meniscus or just into the synovial joint fluid and then hopefully find it’s way to the meniscus. What’s your opinion?
Best Regards, Lee
Hi Lee –
I came across the HOVR in an article on the concept of NEAT – non-exercise activity thermogenesis. NEAT is one the the factors in altering metabolism. So as you sit at your desk, for example, and move your legs, your metabolism goes up. It’s surprising how well this works. When I saw the product, I thought it fit nicely into the concept of light, intermittent movement and would work well within the programming I developed for knee pain. As for PRP and meniscus, I had that done on my right knee. A good sized tear of the medial meniscus (degenerative tear). The injection was into the meniscus but also supporting tissues around the knee – some ligaments, fascia, tendons. It worked well.
Hey Doug, great to see you blogging again.
Quick question, So I know of the knee sliders and tailgaters for knee joint “health”. There’s the rock and roll with the exercise ball for lower back disc. For all of us daily computer workers, is there also an equivalent motion for neck discs.
Thanks,
Skip
Hi Skip –
Good question and I’ll put an article together on it but for now, yes, there is an option for the C-spine. You’ll need a 12” beach ball and a chair.
– Lie down on the floor with your lower legs on the chair (the hips and knees will be about 90 degrees each).
– Place the beach ball, having inflated it with a small amount of air, under your head and neck. The amount of air is determined by what feels good to you when you rest your head on it.
– Now, tuck your chin a small amount and roll your head right and left. The pace should be slow..about 4 seconds to the right, 4 seconds to the starting position and 4 seconds left.
– Do this for 5 minutes 3-5 times a day.
Thanks for asking Skip!
Reply The link to your Active Age Blueprint isn’t working for me, and I’d like to learn more about it. Thanks.
Reply Hi Anne – we discontinued the ActiveAge Blueprint – the reason the link might not be working. Thank you for your interest though.
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Are you mad? Just tead your article pain is in your head, blah, blah!
Have you EVER had severe, cgronic intractable pain from a paradoxycal effect to spinal shots of corticosteroids? Along entire right side of your body 24/7.? Kept me bedridden for 8 MONTHS! Also created edema around my spine, creating a “dead” lef feeling so when I stood o. Leg, i fell so hatd mt left doir hit door jam and I beoke mt hip.
But back to your article: per you to imagine what it looks like:
A red hot, blazing fire traveling from my lower waist to my foot with sharp pins sticking me 24/7!
I “imagibrd” suicide because of the pain. And I have Always had a high level for pain. Took my first “pilll”, an aspirin when I was 35 !
You do a disservice to those of us who don’t gave cancer, but Zi can promise you, hurt as bad. I talked with cancer patients!
Got disgusted with Norco, am getting my morphine implant removed. After 65 years, I now use pot. It’s immediate, won’t knock me out, and has a very slow, if any, tolerance fir me! I was taking 12-15 10 mg. Norcos many days…not all. And no way they last 6 hrs…barely 4. But DEA and AMA had fo ruin that by making legitimate usrrs drug seekers!
Until you have walked in my shoes…don’t try to tell anyone they can think pain away…just because they can!t find proper words to describe it!
Sometimes there are no words…all one can do is cry and just want it fixed!
Hi Karen –
Thank you for sharing your experiences with me. I can’t imagine how difficult that must be for you.
Unfortunately, modern medicine has created the idea that there is “real” pain and “pain in your head” – implying that some pain is not real. That was not my intent with the article. Rather, that ALL pain is real and it all is processed in your brain.
To answer your question, yes I have experienced severe, unrelenting pain with significant disability. In 2008, I was in a skiing accident in which I sustained a severe injury to my lower back. As a result, I could not sit, stand, walk more than 10-20 feet, put on my pants or shoes for many months. I slept in an inversion table 2 hours at a time because I hurt too much to lie down. It took me five years to overcome.
I would never assume to know your experience just as you can’t know mine. I apologize if you found my article offensive. I had hoped it would be enlightening for people.
Best regards,
DK
I want to thank you for your article on ‘how cartilage heals’ and your e-books on the knee – when i badly tore my meniscus you were one of the lone voices i found, online or in person,who said it could heal.. Using your advice from your e-book and also posture retraining via the Gokhale Method and Egoscue method, i did heal my meniscus tear and am now back to active living. The key was, as you said, going slowly as cartilage heals slowly. I really appreciate your work and putting out the information online.
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hi there! I recently had an arthroscopy for removal of loose bodies in my left knee ! I’m diagnosed with OA to my both knee ! I stopped playing tennis and stopped road biking after diagnosis! my knees always bothered my after a tennis match ,but, not too much though, or when I got to flex my knee allthe way down to the floor, not too much pain though for the rest of the time! my OA is stage 3 !, and is an old one (I’m 47 oldyear) my surgeon said. I ignored the few signs over the years cause I didn’t have serious pain!,So my question is:
WHY MY OSTEOARTHRITIS Doesn’t really hurt like most of the people?
Hi Dragos – good question. OA is painful when the joint tissues or other surrounding tissues are inflamed or overloaded. It’s possible to have changes in the joint (which is called osteoarthrosis) but hurt / have symptoms sporadically.
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Hello Doctor. Is there a way to know whether your knee pain is due to cartilage damage? I was diagnosed with Patell Femoral Disorder. I did PT for 4 months and have continued the recommended exercises/stretches for 5 months more. It helped a bit but my left knee continues to have sharp pain and aching. When the PT taped it, it was fine. I know my knee cap is out of alignment but I don’t see how the PT exercises help to fix that. I have been trying to follow the guidelines to get my kneecap to “track” properly but nothing seems to help. Thank you for any reply.
Reply Hi Kathy –
Without knowing more about you and conducting an examination, it’s difficult to say but most people I’ve seen, certainly over the age of 40, with Patella Femoral Disorder (sometimes also called Chondromalacia) have softening of the cartilage that covers the end of the bones. The pain in this case isn’t from the cartilage as it doesn’t have any nerve supply but from other structures (the underlying bone, the lining of the joint, tendons or ligaments). Your situation though is not uncommon and often responds to low intensity, low load but high volume exercise. You can find more info about this on my website. I hope this is helpful to you.
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Found a way to use the treadmill to tax all facets of the legs to recover from chondromalacia.
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Several years ago, Christine helped me overcome a torn rotator cuff by using your Fusion program. It worked and I continued the Fusion program. In June, at age 79,I had open heart surgery. Because I was in good shape pre-operation, I am recovering very well and continue using Fusion exercises. I expect to be near 100% in a few months. Thank you!
Reply Great to hear Frank! Thanks for letting me know…glad things are trending in a positive direction for you.
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Doug, I would think, posting your routines with explanations would be greatly appreciated by most of your followers, and while can’t speak for them, I for one if not many, would be willing to purchase them. Steve
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Welcome back, Doug! I’ve really missed your articles and am looking forward to what is to come.
Reply Thanks Eric for your note and kind words. Hope you like wherever my writing takes me 🙂
Reply I just purchased your Core Conditioning program and discovered I do 4 of the 7 “don’t do” exercises as part of my warm up. I first learned the drill in the military over 50 years ago and have continuously restarted it whenever sporadic motivation kicks in (every six months or so). During a recent restart a few weeks ago I experienced painful lower back pains for the first time, and think I must run out of reserves and gone over the “edge. After seeing a doctor and ruling out the more serious ones ailments, I think it was one of the four don’ts, which as simple as they are, probably triggered it. The pain has decreased and getting ready to restart when learned program and plan it to try out. Haven’t done the test yet but suspect mid Yellow. I was going to order the “ActiveAgeBlue Print as well, and disappointed to find it was no longer available . Do you know of a good comprehensive 30 minute program. (I have done many programs and find it difficult to do a good program within 30 minutes, and time and attaining thresholds have been one of the biggest reasons for setbacks.
Thanks, Steve
Reply Hi Steve –
Thanks for purchasing my book – hope it’s helpful to you. I’ve been thinking about how to answer your question re: programs. It’s a complex issue…although one might think working out isn’t all that complicated. But it is. I don’t know of any programs that don’t include exercises that are risky. Seems like there’s at least one. I can post some of the routines I use with explanations of why I do what I do if you think that might be helpful. Just let me know.
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Hi Doug, I would love to see your comments on exercise related to neck arthritis with aging..
Reply Hi Mary –
That’s a big topic and thanks for bringing it up. I can handle it better through a few articles so I will put that in the queue. Thanks again for your input.
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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?
Reply 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.
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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
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.
Reply 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.
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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!
Reply 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://box5179.temp.domains/~dougkels//the-activeageblueprint
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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?
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.
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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
Reply 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.
Reply 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.
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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
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://box5179.temp.domains/~dougkels//knee-arthritis-remedy/
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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.
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://box5179.temp.domains/~dougkels//good-training-program/
Reply 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
Reply 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.
Reply 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.
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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
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.
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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!
Reply 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.
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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.
Reply 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.
Reply 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
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.
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
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.
Reply 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.
Reply Adam – I don’t think my book will work for you. I do not cover meniscal tears in the book. You might consider contacting my colleague, Christine Springer, to discuss other options you may have.
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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,
Reply 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.
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
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.
Reply 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.
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Hi,
I was wondering if a rocking chair, or a rocking office chair could be useful for CPM?
Thanks.
Lee
Reply 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.
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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.
Reply 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.
Reply 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?
Reply 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.
Reply 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
Reply 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://box5179.temp.domains/~dougkels//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.
Reply 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
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
Just to be clear, I am not taking any new clients at this time but Christine may be able to help you.
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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!
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.
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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?
Reply Hello Robert – the concept of the low load, high volume repetition exercise is explained in detail in my book “The Runners Knee Bible” – you can learn more about it at http://www.runnerskneebible.com
Thanks for your question.
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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
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.
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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
Reply 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.
Reply 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
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.
Reply 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
I would start with the physician that is doing the procedure and then also check with a physical therapist who specializes in orthopedics.
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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
Reply 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.
Reply Thank you Doug. I will do that. Would you happen to know any such person in Lansing, MI?
Reply No, I’m sorry I don’t. But you can search on the American Physical Therapy Association website to find an orthopedic specialist.
http://www.apta.org/apta/findapt/index.aspx?navID=10737422525
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 CA– USED 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.
Reply Jane –
I understand the problem very well. This article might be helpful to you if you haven’t seen it:
http://box5179.temp.domains/~dougkels//backpain-in-the-morning/
Also, you may benefit from coaching since this issue is often multifaceted. I highly recommend Christine Springer. You can learn more about Christine here
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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
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
Reply 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.
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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!
Hi Pam!
Great to hear from you and thanks for checking out my blog. Hope you find things that are helpful to you!
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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
Reply Hi Anne – thanks for your questions. I’ll put them on my list for a future post.
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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
Reply 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.
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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?
Reply 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://box5179.temp.domains/~dougkels//tougher-abs/
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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
Reply 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.
Reply 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.
Reply 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!
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.
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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.
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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
Yes I am aware of a slack line and it’s a more advanced form of balance training.
Reply 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.
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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.
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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
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!
Reply 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.
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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?
Reply 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.
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
Reply 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.
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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.
Reply 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.
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Please post the how to fix your toe video…saw it once now can’t find it. Thanks
Reply Hi – here’s the link to the article containing the video.
http://box5179.temp.domains/~dougkels//big-toe-pain/
Thank you!
Reply Naomi –
For the Elements, there is no “legal” or “illegal” pause. You rest as needed while aiming for shorter rest periods over time.
Reply 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.
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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.
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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
Des –
There was a study done a few years ago that suggested early morning exercise was potentially detrimental to people who had hypertension or cardiovascular risk factors. If you’re otherwise healthy, there’s this more recent study that shows early morning exercise is beneficial: http://www.news.appstate.edu/2011/06/13/early-morning-exercise/
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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!
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Hey Curt,
I drove to Sport Center from Altanta. It’s worth it. Really, it is. I would do it again without hesitation.
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)
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.
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
Reply 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.
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