Is there hope? An amazing knee pain recovery story

I recently got the nicest possible kind of note from a reader, a serious alpinist with equally serious knee issues. She was excited to update me on her complex case (oversimplified as patellofemoral pain, but there was a lot going on). We worked together in 2021, trying to improve her odds of returning to major climbs.

And, wow, did she ever return. I’ve heard of some great rehab victories, but this one is in another league: after five surgeries, she went on to climb the Seven Summits, the highest mountains on each of the continents, and five of those in the last couple years. And she has just returned from the eighth highest mountain in the world, Manaslu (AKA Kutang) in Nepal. (Big as it is, I’d never even heard of Manaslu. Gorgeous mountain!)

Samdesherpa, CC BY-SA 4.0, via Wikimedia Commons

Manaslu, Nepal. Imagine climbing the eight of the biggest mountains on Earth after years of battling complex knee pain.

What a comeback story! Obviously they can’t all end well, let alone this well, but knees are more resilient than people give them credit for. Readers often ask me if there’s hope for their pain, if there’s a chance that they will ever be free of it someday. It’s probably the most frequently asked question of my career. There is never a guarantee, of course, but there’s almost always hope — as demonstrated by the many surprising success stories like this that I’ve heard over the years. But this story? Instantly the GOAT, and hard to beat.

She might make it even more impressive, though! She is now “going after” the eight-thousanders: the 14 mountains in the world that are more than eight kilometres tall.

Update: So what did she do? How was this victory achieved?

So why didn’t I explain how someone was able to recover from severe chronic knee pain well enough to climb eight mighty mountains?

Mainly because I don’t actually know. Life finds a way? 🤷🏻‍♂️

Just because it happened doesn’t mean we can explain it. There’s no simple, confident answer, and perhaps no answer at all. I’d have to discuss it with her thoroughly to maybe get a decent sense of it. That may yet happen, but even a full debrief is unlikely to lead to a nice tidy explanation for her success.

I do know this much: a key factor in her recovery was upgrades to her “load management” game. That’s based on principles explored at length here (free), and more focused on knees in my patellofemoral pain book (not free, but totally worth it). I believe that rehab is often rushed in modern physical medicine, and my hypothesis was a major focus of our discussions back in 2021. From that free article:

Both patients and professionals often pay lip service to the importance of rest, but in practice they seem to mostly ignore it, or even defy it. Patients may even be encouraged to do precisely the opposite of rest: to “work through” their pain, to push too hard too soon, to value ongoing performance and fitness over rehabilitation. The number of cases where resting is actually treated like a meaningful strategy are greatly outnumbered by the cases where it is given only the most token consideration — by about 10 to 1, I think (a squishy estimate, of course).

“I have to load manage,” she wrote from Manaslu basecamp, so clearly these ideas were influential. But I am also sure that there was more to it. She’s waiting for patellar replacements. Load management can’t be the whole story.

Nevertheless, the miracle happened, and my short-term priority was just to share this proof that extraordinary recovery stories do indeed exist.