Managing a High-Mileage Knee

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As far back as I can my remember, my right knee has been funky. Thankfully "funky" hasn't involved much pain, though my right knee has long been unstable. And this instability was accompanied by intermittent clicking, locking and grinding.

Sensations of grinding within a joint, perhaps not surprisingly, generally indicate that something is ground. And that something is generally cartilage; in my case, both hyaline cartilage (articular) and fibrocartilage (meniscus) were ground away by the bedstones of my femoral chondyles and runner stones of the tibial plateaus.


As can be seen in the accompanying image, years of this "milling" ground away the cartilage. The formerly plump space between thigh bone and shin bone no longer exists, indicating the state of "bone on bone." Upon viewing the X-ray and MRI images, the orthopedist shot a sympathetic look my direction and asked me how I was managing the pain. His hand seemed to almost tremble in anticipation of writing a prescription for pain meds, when I replied "I have virtually no pain."

It's true, my right knee only hurts if I don't practice Pilates 3+ days per week. Without Pilates, my knee actually hurts quite a lot and with a regular Pilates practice, it doesn't hurt at all. I've experimented with adjusting the dosage of Pilates, and the result is consistently the same. Of course, managing this high mileage knee will probably require more than just practicing Pilates. I've put a lot of thought into managing this knee, as the medical profession only has one treatment option for this degree of wear - full replacement.

Knee replacement has come a long ways, and I'm relieved to know that option exists. However, I hope to extract many more years out of the original equipment (OE). My management strategy consists of three limbs:
  1. Maintain a robust Pilates practice
  2. Keep body-weight as low as possible while maintaining healthy muscle mass
  3. Reduce systemic inflammation
In future essays I'll discuss in greater detail the hows and whys of this 3-point plan for managing a high-mileage knee. Whether you have a high-mileage hip or knee, I think these points are somewhat generalizable for many people. Perhaps you have something similar you're working with?


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