Arthritis and walking long distance paths, is age going to stop me?

Having limped back from Scotland with a poorly left knee I initially thought I had strained a ligament by overuse or whatever and that it would just need a few weeks to recover before I could continue my walk to John o'Groats. To speed up recovery I booked an appointment with a physiotherapist. He wiggled my leg back and fore, up and down, bent and pulled it, pushed against it and declared that my ligaments were fine but I had some weak thigh muscles and probably "age related" degradation in my knee joint. After walking 820 miles I was surprised to be told I had weak leg muscles. As I had planned many more walks in my lifetime I took "age related" problems as a bad sign. The physiotherapist suggested taking up cycling and described how I should kneel when weeding the garden. Cycling among the fast moving, modern traffic, was not something I enjoyed, feeling my life was at risk due to some driver not noticing me. Gardening is my wife's preserve, she receives many compliments on the colourful display from passers-by, I was happy to leave her in charge. I suspect the physio had an image of me as an old man pottering in an allotment, an image I took exception to.

I carried out the exercises he described, such as squatting while leaning against a wall (which ruined my tee shirts) and squeezing a ball between my knees and gradually increased the amount I walked each day to 10,000 steps according to my activity watch, and then to over 20,000. There was improvement in the range of movement I could achieve, e.g. by squatting down, and I began to feel I could run a few steps if I tried (which I didn't just in case it was premature), although mild pain persisted at changing locations around my knee. Unfortunately when I tried some 20 mile walks (40,000 steps or 32 kilometres) there was significant pain. The crackling sound on bending my knee (adding to the clicking that had existed for a number of years) was also not encouraging. Resuming my walk to John o'Groats did not yet seem an option to me.

When previously I had consulted one of the GPs in my local doctor's practice on this type of issue (what my sister referred to as a self-inflicted injury), the advice was to stop what you are doing that causes the pain (in this case long distance walking) and look up some exercises on the internet. In addition they might also have trotted out the "RICE" formula: Rest, Ice, Compression and Elevation; good advice when your knee is inflamed as an initial response, but I could see no signs of swelling. No apparent signs of swelling anyway, but my left knee did look bigger, less defined and more knobbly than my right, but felt all hard rather than puffy when I tensed it. Seeing a GP is also extremely difficult in the (hopefully) latter stages of the Covid 19 pandemic, a telephone conversation would be the best that I could hope for at a time suited to the doctor, that was if I could get passed the outer defences of the receptionists.

Feeling my life would be dull if I could never tackle the paths and byways again, I paid to see a specialist sports doctor. His ultrasound revealed regions of fluid build up around my knee, black cavities on the screen compared with the white patterns of muscle and bone. One of these fluid filled cavities at the back of the knee he called a "Baker's Cyst" and I could see why it would restrict bending of my knee. He also pointed out additional bone growth, the beginnings of arthritis. This was confirmed by an X-ray, in addition to "spurs" of bony arthritic growth it showed a reduced gap between the bones on the inside of my knee (called the "medial" side), the result of an arthroscopy (a knee operation) performed on me some nine years earlier. I had the arthroscopy as a bit of the "meniscus" (soft cartilage in the middle of the knee joint) was catching somewhere, which resulted in a sudden, excruciating pain forcing me to sit down, which faded away over the following hour. Although the arthroscopy completely cured that problem, such operations are apparently no longer recommended after the age of 45 or so, as they result in later knee problems. The consultant also pointed out bony features that were the result of a growth spurt in my teens.

After walking the 820 miles from Chepstow, irritation from the arthritis and the effects of the arthroscopy probably resulted in the pain and fluid accumulation around my knee and restricted my ability to bend my knee. The doctor drained what seemed a lot of fluid (well 12 millilitres of surprisingly clear fluid) from the back and side of my knee and gave me a steroid injection. He then advised me to spend the next week resting in front of the television watching the test match (he was obviously a greater cricket fan than I will ever be) and gradually build up exercise over the following weeks.

Whether it was the steroid injection or the draining of fluid, my knee had a greater range of movements. However, the pain, sometimes a sharp and short, sometimes a dull ache, continued, despite walking what were for me, relatively short distances. While the pain was not great and easily manageable, I worried it would become significant on my long distance walks and I would loose the mobility needed to clamber over rocks. I could already see fluid slowly starting to build up (although a period with a compression sleeve over my knee helped to reduce it). Normally a positive person, my knee afflictions were getting me down. Would I ever tackle any of the long distance walks on my lengthy "to do" list? I was reading a book written by someone who hiked the Pacific Crest Trail. He commented that he planned to walk such trails until his knees gave out. Had I, in my early sixties, already reached that point, terminating the activity I enjoyed? Earlier in the year I had been running twice a week. I completed the 268 mile Pennine Way in just over 14 days with ease, how could my walking career be at an end just three weeks later? Was this a sign of my irreversible decline into old age and death, ending with me sitting all day in front of a television in cosy slippers and a woolly cardigan? Not prepared to give up, some ten weeks after I returned home from Kinlochewe I booked tickets to fly to Scotland and restart my walk to John o'Groats.

Contrary to what one might expect, exercise is encouraged if you have arthritis, there is evidence that it reduces the pain and no evidence that it speeds up the joint's deterioration as far as I understand, however, the right amount of exercise is somewhat vague. My sports doctor suggested I listen to my body, take breaks between hikes, pace myself. So for the next section my itinerary is based on walking on average 16 kilometres a day rather than my more typical 23 kilometres. I have just covered such distances near my home for three days in succession, so I have deemed myself ready....

Knees on a good day.

Knees before restarting my walk, compare the definition of the ligament on the outside of the right knee with the one on the left, or as in the previous picture.