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Really Struggling with Knee Pain

So I’m 2 weeks into my renewed efforts to help my knee pain. I’m on day 7 of the structured program. Wanted to post my status so far, get some thoughts from others.

4 months ago I re-started my cycling, after a few years with minimal bike time. I used to cycle 3 or 4,ooo miles a year, so have the muscle memory for the sport. In May of this year I started with a modest 3X a week, over a couple months, 5X a week. After 3 months of excellent improvement and about 12o miles a week, my left knee began to hurt, the pain would move around a bit, but always in relation to the kneecap. I self diagnosed it as PFPS.

After just a week of mindbody healing, the pain basically went away. (For a few days) This week I ramped my cycling back up to 100 miles, with one ride at 35 miles. During that ride, my left knee began to ache, not hurt so much but ache. I followed that ride up this morning with a 20 mile ride, which my knee continued to ache. Not much, like a 2 or 3.

My point is, I feel like I’ve made good progress, but I do wonder if I am simply feeling the normal muscle tiredness from going from 0 miles per week to 100 per week in 4 months. Either way, I plan to keep doing what I’m doing, but being smart about it as well.

I would like to ride most every day, but I take days off to make sure I’m giving my body some rest. (Or maybe I’m allowing fear to control me?)

BTW, I am a textbook TMS patient, fortunately I discovered Dr. Sarno a long time ago.

Any input would be appreciated!
 
Owyhee1 said:
So I’m 2 weeks into my renewed efforts to help my knee pain. I’m on day 7 of the structured program. Wanted to post my status so far, get some thoughts from others.

4 months ago I re-started my cycling, after a few years with minimal bike time. I used to cycle 3 or 4,ooo miles a year, so have the muscle memory for the sport. In May of this year I started with a modest 3X a week, over a couple months, 5X a week. After 3 months of excellent improvement and about 12o miles a week, my left knee began to hurt, the pain would move around a bit, but always in relation to the kneecap. I self diagnosed it as PFPS.

After just a week of mindbody healing, the pain basically went away. (For a few days) This week I ramped my cycling back up to 100 miles, with one ride at 35 miles. During that ride, my left knee began to ache, not hurt so much but ache. I followed that ride up this morning with a 20 mile ride, which my knee continued to ache. Not much, like a 2 or 3.

My point is, I feel like I’ve made good progress, but I do wonder if I am simply feeling the normal muscle tiredness from going from 0 miles per week to 100 per week in 4 months. Either way, I plan to keep doing what I’m doing, but being smart about it as well.

I would like to ride most every day, but I take days off to make sure I’m giving my body some rest. (Or maybe I’m allowing fear to control me?)

BTW, I am a textbook TMS patient, fortunately I discovered Dr. Sarno a long time ago.

Any input would be appreciated!
Click to expand...


There’s nothing wrong with taking rest days. Perspective is important. Rest to allow the muscles to grow and recover, to honor and respect your body and the work it has put in? Awesome! But rest from the perspective of having some structural issue that can only heal by inactivity does not align with TMS work.

Part of this journey is learning to trust our bodies again, being able to distinguish normal pains like soreness related to exercise and pains related to TMS. As we stick to the journey it gets easier and easier to distinguish between the two.

I notice this trend on this forum and TMS personalities in general where they feel this compulsion to exercise obsessively (I am included in this category!). Not sure if that’s you. It’s not really conveyed in your post aside from you expressing the desire to cycle everyday. But I’d say be mindful about these thoughts. I think a lot of us chase things because our history of having low self worth. Not saying that’s you, but I think the way we mentally approach our hobbies and outlets is important. Ex. I am doing this because it’s fun and I derive joy? Or I am doing this because to not do it means I’m weak and pathetic?
 
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Rabscuttle said:
they feel this compulsion to exercise obsessively
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I'm like this. All or nothing. Moderation is difficult for me -- I actually have a really hard time figuring out when I need rest from exercise and when I don't! I have zero common sense about this. As in, it's not that I know I should rest and I refuse -- it's that I *really have no sense of what is normal and healthy in terms of rest and activity*.
I think this aligns with the TMS personality -- we're willing to punish ourselves by behaving as if we don't have normal human needs. Like for rest from intense exercise! To the degree that, for me at least, I don't actually really know what normal, healthy human behavior in this area is. I don't really know what normal human needs are in terms of a lot of different things! I get allll mixed up on this!
 
Thank you @Rabscuttle - your words capture the issues and my personal experience. You said, ‘Part of this journey is learning to trust our bodies again, being able to distinguish normal pains like soreness related to exercise and pains related to TMS. As we stick to the journey it gets easier and easier to distinguish between the two’

That’s the perspective I haven’t learned, but I want to.

And yes, I do have the compulsion to exercise excessively. I haven’t figure out exactly why, but I’m working on that.

Anyway, your post was exactly the kind of perspective I was looking for! Thank you!
 
Rabscuttle said:
I think a lot of us chase things because our history of having low self worth.
Click to expand...
This is so true for me! I’ve been working on trying to feel I’m worth something just for being me and just for being alive. Not having to prove I have value through an achievement. But it’s still a challenge.
dlane2530 said:
. I don't really know what normal human needs are in terms of a lot of different things! I
Click to expand...
Yes! Me too! You’re not alone on this.
 
Owyhee1 said:
I would like to ride most every day, but I take days off to make sure I’m giving my body some rest. (Or maybe I’m allowing fear to control me?)
Click to expand...

When in doubt, go back to Sarno. And what Sarno said on this (i.e. physical therapy, or physical things we choose to do), is that they are fine to do so long as it is not done to manage the chronic pain.

So, for example, your PT prescribes quad strengthening for your PFPS (in my case he did), which you begin doing, it does nothing for your pain, but you find that you enjoy the work and that it benefits you in other ways. So, you continue to do it - but NOT as a goal to eliminate pain. So in other words, as Sarno said, it's perfectly okay to do strength work or stretching etc, just as long as it's not intended to eradicate your pain.

So to apply to your example, it's okay to take those rest days, as long as the goal there is to provide recovery to your overall training - NOT to "give the knee a break." It's a mindset thing.
 
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Rabscuttle said:
I notice this trend on this forum and TMS personalities in general where they feel this compulsion to exercise obsessively (I am included in this category!).
Click to expand...

In my running issues thread here, a helpful commenter sent me to a great blog that I now follow. I'll repeat what I posted over there because it applies to what your saying:

~~~~~~~~~~~~~~~~~~~~~~~

In her blog "why we can't stop exercising despite pain/injuries" she makes some insightful comments around training (whether it's running, cycling, weight lifting, etc).

https://www.thepfathlete.com/blog/why-we-can-t-stop-exercising-despite-pain-and-injuries (Why We Can’t Stop Exercising Despite Pain and Injuries)

I think alot of these ring true.

  1. We want to train perfectly and follow an externally developed plan because we don’t trust ourselves to do enough or to do too much.
  2. We are insecure and base our self-worth and identity on athletic achievements and race results so we can be seen and praised.
  3. We do activities we don’t enjoy and that may be detrimental to our health (such as training through injuries) in search of connection, acceptance, and recognition.
  4. We push through physical pain because we are afraid of what it means about us if we must stop.
  5. We distract ourselves with perpetual movement because we are uncomfortable being still and want to avoid difficult emotions and feelings.
  6. We are addicted to setting and reaching challenging athletic goals and are unsettled without a “next event” on the calendar.
  7. We fear disappointment and become approval seekers, only feeling good when we do well and receive praise from others.
  8. We rigidly control our daily schedule because routine makes us feel safe.
  9. We disregard injuries out of fear of losing fitness, weight gain, disapproval, criticism, and being alone.
  10. We lack self-acceptance, have a distorted perception of our bodies, and feel guilty when we take a rest day.
  11. We confuse having a bad training day with being a bad and unworthy person, relentlessly judging ourselves for not working hard enough without compassion.
  12. We are stuck in the sympathetic nervous system (stress response) and need to “smash” ourselves through physical exertion to reduce anxiety, which makes us feel like we can relate well with others.
  13. We are soothed and feel “normal” within a community of like-minded people with a shared ambition.
  14. We often put the needs and wants of others before our own (people pleasing) and participate in athletics because it is an activity that is just for us and justifies taking time for ourselves.
  15. We use athletic endeavors to connect with feeling, thinking that if we are suffering, we are both worthy and connected to ourselves.
 
Mr Hip Guy said:
In my running issues thread here, a helpful commenter sent me to a great blog that I now follow. I'll repeat what I posted over there because it applies to what your saying:

~~~~~~~~~~~~~~~~~~~~~~~

In her blog "why we can't stop exercising despite pain/injuries" she makes some insightful comments around training (whether it's running, cycling, weight lifting, etc).

https://www.thepfathlete.com/blog/why-we-can-t-stop-exercising-despite-pain-and-injuries (Why We Can’t Stop Exercising Despite Pain and Injuries)

I think alot of these ring true.

  1. We want to train perfectly and follow an externally developed plan because we don’t trust ourselves to do enough or to do too much.
  2. We are insecure and base our self-worth and identity on athletic achievements and race results so we can be seen and praised.
  3. We do activities we don’t enjoy and that may be detrimental to our health (such as training through injuries) in search of connection, acceptance, and recognition.
  4. We push through physical pain because we are afraid of what it means about us if we must stop.
  5. We distract ourselves with perpetual movement because we are uncomfortable being still and want to avoid difficult emotions and feelings.
  6. We are addicted to setting and reaching challenging athletic goals and are unsettled without a “next event” on the calendar.
  7. We fear disappointment and become approval seekers, only feeling good when we do well and receive praise from others.
  8. We rigidly control our daily schedule because routine makes us feel safe.
  9. We disregard injuries out of fear of losing fitness, weight gain, disapproval, criticism, and being alone.
  10. We lack self-acceptance, have a distorted perception of our bodies, and feel guilty when we take a rest day.
  11. We confuse having a bad training day with being a bad and unworthy person, relentlessly judging ourselves for not working hard enough without compassion.
  12. We are stuck in the sympathetic nervous system (stress response) and need to “smash” ourselves through physical exertion to reduce anxiety, which makes us feel like we can relate well with others.
  13. We are soothed and feel “normal” within a community of like-minded people with a shared ambition.
  14. We often put the needs and wants of others before our own (people pleasing) and participate in athletics because it is an activity that is just for us and justifies taking time for ourselves.
  15. We use athletic endeavors to connect with feeling, thinking that if we are suffering, we are both worthy and connected to ourselves.
Click to expand...
Mr Hip Guy said:
In my running issues thread here, a helpful commenter sent me to a great blog that I now follow. I'll repeat what I posted over there because it applies to what your saying:

~~~~~~~~~~~~~~~~~~~~~~~

In her blog "why we can't stop exercising despite pain/injuries" she makes some insightful comments around training (whether it's running, cycling, weight lifting, etc).

https://www.thepfathlete.com/blog/why-we-can-t-stop-exercising-despite-pain-and-injuries (Why We Can’t Stop Exercising Despite Pain and Injuries)

I think alot of these ring true.

  1. We want to train perfectly and follow an externally developed plan because we don’t trust ourselves to do enough or to do too much.
  2. We are insecure and base our self-worth and identity on athletic achievements and race results so we can be seen and praised.
  3. We do activities we don’t enjoy and that may be detrimental to our health (such as training through injuries) in search of connection, acceptance, and recognition.
  4. We push through physical pain because we are afraid of what it means about us if we must stop.
  5. We distract ourselves with perpetual movement because we are uncomfortable being still and want to avoid difficult emotions and feelings.
  6. We are addicted to setting and reaching challenging athletic goals and are unsettled without a “next event” on the calendar.
  7. We fear disappointment and become approval seekers, only feeling good when we do well and receive praise from others.
  8. We rigidly control our daily schedule because routine makes us feel safe.
  9. We disregard injuries out of fear of losing fitness, weight gain, disapproval, criticism, and being alone.
  10. We lack self-acceptance, have a distorted perception of our bodies, and feel guilty when we take a rest day.
  11. We confuse having a bad training day with being a bad and unworthy person, relentlessly judging ourselves for not working hard enough without compassion.
  12. We are stuck in the sympathetic nervous system (stress response) and need to “smash” ourselves through physical exertion to reduce anxiety, which makes us feel like we can relate well with others.
  13. We are soothed and feel “normal” within a community of like-minded people with a shared ambition.
  14. We often put the needs and wants of others before our own (people pleasing) and participate in athletics because it is an activity that is just for us and justifies taking time for ourselves.
  15. We use athletic endeavors to connect with feeling, thinking that if we are suffering, we are both worthy and connected to ourselves.
Click to expand...
Yep lol I’m all over this list
 
I've been trying to resolve some TMS-derived symptoms over the last few months. A few weeks ago, my TMS brain tried to trick me with Plantar Fasciitis, a symptom that, unfortunately for my TMS brain, I have a lot of experience with. I have gotten that to resolve for the most part in the last few days, only for my knee to start barking at me at odd times.

Really TMS brain? Do you actually think that's going to work?

Granted, telling someone else about all of this would make me sound like I'm ready for the looney-bin, but knowing what I know, it sure seems like TMS brain is not. Very. Smart.
 
My knee is much better, I’m on day 15 of the Structured Program. It has helped me identify new aspects of issues I’ve worked out in the past, but now I’m realizing nuances that I had missed. I’ve pretty much resumed my normal cycling routine, pushing the limits gradually, with good success. My knee still lets me know it’s there, but I’ve been listening to my whole body better, which has helped me to know how much to push.
 
I post this for the benefit of anyone who stumbles across this thread, dealing with persistent knee pain, PFPS or the like. First off, I am a classic TMSer, about every personality trait, upbringing, past and current life situations, etc.

I have been a student of Dr. Sarno for well over a decade, and was able to get my significant back pain under control a long time ago.

Now in my 60’s, I got back into cycling, after a 10 year hiatus. I used to be quite avid, cycling 100 miles a week all through the years. This spring I started with 60 a week, then 100, by mid summer a little more. Thats when the mild/persistent knee pain kicked in.

Was it overuse? Was it TMS? I didn’t know. A few weeks later, I found the Structured Educational Program, which I began in earnest.

I backed off the cycling to about 80 a week, with less intensity, but never stopped.

It took about 8 weeks to be pain free. Yesterday I rode a 75 mile ride just to be sure before I posted this, finishing the week with about 120 miles.

No pain at all. (Also no hand numbness, which I’ve had since spring)

Was it overuse? Was it TMS?

Day 20 of the structured program, Dr. Stracks answers that question. I was better before I arrived at day 20, but his comments are of great help.

I believe my pain was primarily TMS, but can’t rule out some possible overuse from not listening to my bodyI was training intensely when the pain began. (For my age) I also began a daily leg/knee strengthening exercise program at the direction of a sports therapist, who explained the dynamics of leg muscles specific to cycling. (I realize that a sports therapist who knows nothing of TMS might be misguided, but I didn’t believe it would hurt me)

I believe what cured me was my earnest efforts to search my inner self, as well as do a better job listening to my body. When it’s tired, give it a break. As well as practical exercises that don’t send the wrong message to my brain. After all, exercise is a good thing.

If you have moderate knee pain, I suggest the Structured Educational Program on wiki, as well as listening to your body, and continuing to enjoy your chosen activity in reasonableness, it worked for me. Hope this helps someone down the line.
 
I'm tentatively going for my half marathon on the 19th, since we're talking doing the thing. I managed my longest pre-race run, 12 miles, on Sunday. Not going to say I'm good by any means, my symptoms are full flare, but I'm just doing things anyway.
 
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