Day 1: Patellafemoral pain syndrome

Hi everyone,

I’m a 33-year-old male, and I’ve had persistent knee pain for the past three years. It first started during a multi-day cycling trip—my first of the season—where I was untrained and riding about 100 km per day. The pain began on day two, and although I pushed through, by the final day my right knee was extremely painful, and I also felt discomfort in my left knee.

Looking back, this happened during a stressful period in my life. Two years earlier, my mother had passed away (my father died eight years before that), and I was about to move across the world with my partner to live in her home city after spending two years in the Netherlands. My family was sad about me leaving, and I was under a lot of emotional pressure—even if I didn’t fully realise it at the time.

After the trip, I saw a physio who gave me the standard VMO exercises. I could still walk fine then, so I switched from cycling to walking to work, since cycling would immediately trigger the pain again. Things improved a little, but I never got back to pain-free cycling. (In hindsight, I also had a very poorly fitted city bike, which probably didn’t help.)

A few months later, I went hiking in the mountains. I was definitely worried about my knees going in. On day three, my knee became swollen and painful, and I had to abandon the hike. I tried icing and rest, and after about two weeks, I could walk again—with knee braces, which helped a lot. With the braces, I could dance, hike, even cycle again.

I saw another physio who focused on hip mobility and trigger point work. Over time, the pain kept improving, and I gradually returned to most of my normal activities.

For about two years, things were manageable. I still used braces for long hikes or intense activities but was able to hike the full GR20 in France last summer without major issues.

Then, about six months ago, I decided to return to longer cycling trips. I did three 40 km rides in one week, which triggered a major flare-up. I saw an exercise physio who gave me squats and strength work, but my pain only worsened. After two months, I could barely walk more than five minutes without pain. I also developed back pain and RSI symptoms, which I thought were from being too inactive. Strangely, during my back flare-up, my knee pain improved—possibly because I was lying down and resting more.

Later, I went on a relaxing holiday with my sister, and both my back and knee improved. I was even able to go on two-hour hikes. But once I got home, the pain slowly returned, and I blamed it on too much sitting.

Recently, I read The Way Out and The Mindbody Prescription, and the TMS concept really resonates. The emotional link makes sense given everything going on in my life. Still, the fact that the pain always seemed activity-related gives me some doubt.

One thing that stands out: being careful and hypervigilant always made the pain worse. I followed Doug Kelsey’s approach for a while, but it seemed to backfire because I was constantly monitoring my knee. Two weeks ago, I went to a wedding and danced for five hours (I was drunk), and strangely, my knees felt better that night than they had in weeks.

So there's definitely some hope—and some clear signs pointing toward TMS. I’m still working on fully accepting the diagnosis, but I feel like I’m on the right path.

 

I wanted to reply here as well to affirm that I see my own experience in your post! I have tried many of the same things.

I am so happy to hear that just two weeks ago, you were able to dance the night away! The fact that your knees felt good moving like that sounds like really important evidence to hold onto - that your body has the capacity for healthy movement, even if it sometimes tries to tell you otherwise.

I don't know if this will be helpful, but since we are both working through knee pain, I thought I might share some of the things I've been considering and trying out as I explore the emotional roots of this experience. I've talked to a lot of wise healing-oriented people who have offered me some suggestions about what knee pain can represent. I've heard that the knees can represent movement forward in life and relationships, so knee pain might prompt one to consider "is there a next step in life that I am afraid to take?" or "is there something emotionally holding me back from moving forward." Knees can also represent surrender. It's all very woo woo, but I spoke to a very intuitive person who suggested to me that the inflammation we carry is very often not our own - but can represent trauma of others we've sort of taken on in maybe kind of a co-dependent way (e.g. emotional stuff I'm carrying that belongs to my parents or to an ex-partner). Don't know of all of these ideas are strictly TMS consistent, but I've been using some of them as prompts for deeper reflection and emotional exploration, which I figure will be helpful in any case.

 

@Jlucas
My current batch of symptoms all started with my knees acting up and with me taking longer walks than usual. At the time, I had about 8 major things wrong in my life. From there my symptoms had a party and spread all over my body. I tell you this to validate you. But really, you don’t need to find someone with your same exact physical symptoms to prove you have TMS. Knees are common. What I’d focus on is the evidence you already now have that point to TMS —the dancing (which distracted you and made you happy), which suspended your pain. You have a lot of reasons your body would want to distract you from your emotions right now. Loss of your parents. A move. These are good places to start digging for what’s going on with you. It’s hard at first, but fully embrace that you have a MIND-body issue, not a body issue. Your mind is where this starts and ends. You’ve read some good books. I’d read some MindBody Prescription every day for 30 min. That will help you get things straight. Also: it’s great you’re doing the Structured Educational Program. Welcome to the Journey. It’s hard work and you’ll learn more about yourself than you ever could imagine. You’ll change in amazing and good ways. And you’ll get better.

 

Thanks so much everyone for all the lovely replies! Reading some more into the different emotional meanings of knee pain, very interesting!

Forgot to add in the first message, that I am also Renovating a house at the moment, and having a wedding in 2 months. So def a lot of stressful things going on, which would all point more towards TMS. It seems so obvious most of the time, and then still sometimes the doubt creeps in of course.

Going to see my psychologist again in a couple of weeks, and trying to give my emotions more room by journaling and meditating.

@Diana-M What kind of Mindbody Prescription would you suggest?

 

What I meant was read some pages of The MindBody Prescription by John Sarno every day. Read the book over and over. It helps to get everything to sink in.

A wedding and house renovation sounds like pressure. That’s good you are journaling and seeing a psychologist. Sounds like you are on track.