Common training troubles – Knees

After my last columns on the problem areas of the lower back and shoulder, I couldn’t decide what should be number three on my list of common training troubles. One of my clients helped me to decide that knees should get the nod.

A year ago Wayne Deans’ right knee was swollen, painful and debilitating. After an MRI his doctor told him he had no cartilage left on the joint surfaces, and he needed joint replacement surgery. I’m going to share how he’s been able to avoid surgery so far, and at 66 years old, is currently very active and 100% pain-free.

The knee is a relatively simple hinge joint, but it does have its share of problems. Because of the amount of stress we impose on our knees through weight-bearing activities like running, cycling, golf and skiing, the internal structures of the joint can become damaged and worn. This leads to painful, progressive conditions like arthritis. In Wayne’s case, years of high-level competition in hockey, squash and triathlons had taken their toll.

In addition to wear and tear, acute knee injuries are common. Torn cartilage or ruptured ligaments can happen to anyone, at almost any time, and will often need surgical repair. I’ve had a major knee reconstructive surgery myself, as a result of a soccer injury. It was performed 25 years ago by Dr. Brian Day, and because I saw the top surgeon and was diligent about my rehabilitation, the knee has been 100% functional since.

In the case of Wayne, myself, and dozens of other clients, the most important aspect of managing knee injuries is to minimize the stress to the joints through proper body position and movement strategies, while optimizing strength and flexibility in the legs.

Always remember to perform a progressive warm-up before training or sports, and get medical approval before beginning a new fitness program.

Knowledge – It’s pretty hard to address a complicated, painful joint condition without knowing exactly what is causing the problem. A good practitioner can often accurately diagnose a knee condition through a detailed history and careful assessments, however appropriate imaging like X-ray or MRI is sometimes necessary. Once you’ve determined the cause, an effective management strategy can be put in place.

When I first injured my own knee, the sports medical practitioners in my hometown put me through almost 6 months of passive treatment, like ultrasound, etc. Every time I would try to play sports I would re-injure the knee and it would swell up like a balloon. Finally I came to Vancouver to see Dr. Day and in 2 minutes he told me that my ligament was ruptured and I would need surgical repair. All the therapy in the world wouldn’t have made a difference. The right diagnosis was essential.

 

Treatment – Just like the other areas that I’ve discussed, if you do have a knee problem, whether acute or chronic, try to get an assessment and treatment by a qualified practitioner that you trust. Once you’ve learned the cause of your issue, I’m going to bet that a good portion of your treatment plan will include strengthening the muscles that support the knee joint, and stretching the muscles that surround it.

Even in a condition like Wayne’s, where the joint is seriously worn and the bone-on-bone contact is causing pain and inflammation, a simplified approach of improved strength and flexibility can yield great results. Where he used to have a 6-8” deficiency in the flexion of his right knee, Wayne has worked hard to achieve full range of motion, getting his heel to his buttocks. We’ve also re-programmed how he stands and moves to properly utilize his muscles and joints. Through a combination of better body position, core function and movement quality, Wayne now uses the correct muscles, which keep his knees healthy rather than harming them.

Prevention – What can you do if you’ve never had a serious knee issue, and want to avoid them? As far as I’m concerned maintaining strong, flexible legs should give you the best chance of living your life with healthy knees. Of equal importance is making sure you move your body in a way that doesn’t cause wear and tear. I’ll use Wayne as an example again. As part of my assessment I determined that every time Wayne transferred his weight onto his right leg, his glute and hip musculature was less active than it should be. This allowed his pelvis to slide too far outward, rather than staying in line with his body, and put too much weight forward onto the ball of his foot. This shift of the pelvis off-loaded his strong, stable hip joint and transferred excessive load and rotational stress to the knee joint. Every step was aggravating his knee. Changing this pattern has been a big part of his success.

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