Meet Stellis. Shes an 82-year-old client of mine who managed to completely eliminate her knee pain in just 8 workouts, despite having some osteoarthritis in there.
In this case study article, well discuss:
- How the knee pain was affecting Stellis.
- What shes tried in the past to reduce her knee pain.
- Highlights from the exercise strategies that I used with her to decrease her knee pain.
- The results that she achieved.
- How her life is different now that her knee no longer hurts.
If youd like to hear Stellis explain all this herself, check out this video:
And if you have knee pain, and you want to get rid of it ASAP, you can see if you qualify to work with us by filling out the application form on our home page.
How the Knee Pain Was Affecting Stellis
Despite being retired, Stellis has a lot going on. Shes very actively involved with her church, and that takes up a lot of her hours. Besides that, she enjoys spending time with friends, her 3 kids and grandkids, and travelling (well before covid, that is). Plus, she goes for daily walks.
She has no time for knee pain. But the knee doesnt care.
So at first, the knee was basically affecting her all the time. Her right knee would hurt constantly, from waking to sleep (although funny enough, in her video, she said it hurt intermittently. Its amazing how once youre out of pain, you forget how much it used to hurt. When she first started with me, she said it was constant). For someone who likes to go for walks, thats a big problem, because every step hurts.
Every time she would get off her chair or couch, it hurt. And you can just imagine how limiting constant pain would be to your travel plans, especially when your travel plans involve a lot of walking.
What Shes Tried in the Past to Reduce Her Knee Pain
In the past, Stellis has tried a number of things:
- Traditional medications for arthritis. She says they didnt work.
- Common supplements for arthritis (glucosamine, chondroitin, etc.). They worked a bit, but not enough to completely remove her pain.
- Orthotics. Those didnt really work great to remove her pain either.
After trying a bunch of things that didnt work, she thought it was time for a more personalized approach. Back around 2014 or 2015, I gave a presentation at a weight loss group, and she signed up for my newsletter. She had been receiving my newsletter for about 6-7 years, and eventually, after reading enough about ourother client success stories, she thought that it was time to get some professional help.
Stelliss Initial Assessment
During Stelliss assessment, I tried to learn as much as possible about her health history, and any injuries. Shes never really had a knee injury per se, just the progressive wear-and-tear on your joints that you accumulate in 82 years.
Also, the first question I ask at every initial assessment is whats your goal? She had 2 goals:
- To lose about 15 lbs.
- To make her knees stop hurting.
People often say that if you lose weight, your joints hurt less. And while that may be true, weight loss is a lengthy process about 1-2 pounds per week. And thats IF we have good compliance to nutrition. But our clients are in pain right now. They want to get rid of the pain ASAP, rather than waiting for many weeks/months to reach their ideal weight, and then experience pain relieve. So we have to use strategies that work much faster than weight loss (while still helping them lose weight in the long-term).
Since pain is a subjective experience, you cant measure it with blood work, or X-Rays or MRIs. You can measure the degree of mechanical damage, but we know that damage does not equal pain in all people. So how do we assess a persons subjective experience of pain? Simple: we ask them about the severity (on a 0-10 scale), frequency (how many times per day/week they feel it), duration (for how long it lasts), quality (what it feels like burning, shooting, stabbing, pulling, etc.), and whether its constant or intermittent.
In Stelliss case, her knees hurt at an intensity of 8/10, and constantly (even though in her video, she says 5-6/10 and intermittent. Again, once youve been out of pain, you quickly forget how bad it was).
A semi-objective way to measure pain is to identify motions or activities that the client cant do due to their pain. In Stelliss case, she couldnt do one-legged deadlifts, walk, or get off the chair/couch without pain.
Exercise Strategies That I Used with Stellis to Get Rid of Her Knee Pain
As you know from a previous article, I hired a researcher to do deep research into how to use exercise to manage osteoarthritis. So I used the strategies that I learned from the clinical research to help Stellis eliminate her knee pain.
In no particular order:
Strategy #1: Traction
Traction comes from the word distraction, which means to simply pull apart 2 bones. If theres arthritis in the knee, it means that theres not enough space between the thigh bone and the shin bone. Traction is one of the few things that actually helps increase the space between 2 bones, according to this study.
So I had Stellis lie down, grabbed her shin bone, and pulled it down (away from her thigh bone) with about 10-15 pounds of pressure for 30 seconds. I repeated that for 3 sets.
Strategy #2: Proprioceptive Exercise
Proprioceptive exercises are basically drills to improve movement clarity. Basically, your brain has a certain map of your body. If that map is clear, you move well smoothly. If the map is not clear, you dont move smoothly. Certain muscles are contracting when they should be relaxing, and other muscles are relaxing when they should be contracting.
Proprioceptive exercises clean up the map of the body in the brain.
Its hard to explain what these exercises look like in words, but youre moving the joints in various different directions: up/down, left/right, circles, and figure 8s.
We did proprioceptive exercises for her ankles, knees and hips.
But wait, you might be wondering if the issue was Stelliss knee, why do exercises for the ankles and hips? Because, as Im often fond of saying the site of pain may not be the source of pain. Very often, the knee is a victim of bad mechanics at the joints above and below. Thats the ankles and hips. And given Stelliss initial difficulty at performing proprioceptive exercises at the ankles and hips, that theory was proven to be true.
Strategy #3: Strength Training
For a lot of people (including personal trainers), when someones knee hurts, their first instinct would be to do strength training exercises for the quadriceps (the muscles on the front of the thigh). But thats not necessarily the right thing to do. After all, the knee has a front, and the knee has a back. The muscles controlling the back of the knee are the hamstrings.
But what if the hamstrings are too weak relative to the quads? Then doing additional quad exercises would either maintain that imbalance, or exaggerate that imbalance, making the knees worse, not better. We know from my article on how to predict injuries before they happen that one of the strongest predictors is quads that are too strong relative to the hamstrings.
So what did we do with Stellis? First, we assessed the strength ratio between her quads and her hamstrings. After all, if were not assessing, we are guessing. We cant just assume that theres imbalance. We want to know for sure that theres an imbalance. Sure enough, we learned that her hamstrings were weak. Really weak. So we got to work on strengthening those hammies. Did we still work her quads? Yes. But we did a 3-1 ratio of quads to hamstrings. That is for every exercise we did for the quads, we did 3 exercises for the hamstrings.
The Results That Stellis Achieved
Sure enough, you push the right buttons, you get the right results, and it seems like we pushed the right buttons for Stelliss knee pain to completely go away in only 8 workouts.
In this short period of time:
- The intensity of her knee pain went from an 8/10 to a 0/10.
- The frequency of pain went from 1 but all the time, down to 5-6 times per day, but intermittent, and eventually, down to not at all.
This is despite her strength and endurance not improving significantly. They improved a little bit, dont get me wrong, but you dont get huge improvements in strength and endurance in only 8 sessions. However, the main point that were illustrating is that pain can go away a lot faster than:
- Strength can be improved significantly.
- Endurance can be improved significantly.
- Weight can be lost.
Sure, were still going to continue working together for a while longer, and maybe in 6+ months, Ill write a part 2 to this article about how much Stelliss strength and endurance improved, and her weight decreased, but the real point Im trying to illustrate is that the speed of pain reduction does not have to trail at the speed of fitness improvement or weight loss. In this case, small improvements in strength and endurance resulted in large improvements in knee pain.
How Her Life is Different Now
Now that Stellis is no longer in constant pain, her daily walks are pain-free. Her knees no longer hurt when she goes from lying to sitting and sitting to standing.
She can do a few movements that she couldnt do before in a long time, like:
- One-legged deadlifts.
- Squats.
Squats are particularly handy to be able to do pain-free if you spend a lot of time playing with short people (her grandkids ).
Although she cant travel right now, because of covid, once thats allowed again, she has a bucket list of trips that she wants to go on and now, her knees wont be the obstacle that they would have been just a few weeks earlier.
All in all, Stellis is a shining example and inspiration to an attitude that I highlighted in my article on healthy attitudes about aging: if you think of your pain as being due to age, you wont do much about it, because you cant control your age. But if you think of your pain as being due to controllable factors, youll do something about them. And she did
If youd like to get help getting rid of your own knee pain as fast as possible (or have a friend or family member that you think can use some help), you can see if you qualify to work with us by filling out the application form on our home page.
