Tuesday, August 24th, 2010
Last week I discussed the knee joint, causes of injury, and why statistics show females are more likely than males to suffer non-contact knee injuries. This week is dedicated to injury prevention. Regardless of whether you are male or female, you can benefit from some preventative work. Before I delve right into a nice mobility/stability circuit you can add to your training, let’s touch upon the fact that we need to focus on more than just the knees.
Everything is connected; your lack of mobility in your ankle is going to affect your knee just like lack of mobility in your hip is going to affect your knee. However, the lack of mobility in your hip can also have numerous causes spanning from the way you sit at your computer to the body slam you received in last night’s hockey game.
No matter how you slice it, the body should be looked at as whole. Were you to visit a professional in the field, he/she would watch you move and immediately determine your body’s patterns, imbalances, and needs; be it myofascial release, strength, mobility or flexibility. While these are diagnosis you cannot make on your own, there are mobility and stability drills you can add into your daily regime to keep you healthy. Bear in mind these are not a fix-it for an injury nor are they meant to completely overhaul the patterns in your body. They are meant to aid in injury prevention and keep your joints in working order.
There are four areas I want to touch on: (1) mobility/stability work, (2) myofacial release, (3) changing the way you decelerate and (4) strengthening the hamstrings/glutes.
Mobility and Stability
Check out an older post of mine where I discussed my favorite mobility and flexibility drills. In addition to those, there are a few more I love to do when I’m preparing for any lower body work.
Ankle Circles for Mobility
You know this one as you’ve probably done it in gym class as a kid; simply make circles with your ankle. While these may seem unimportant, by simply rolling your ankle in circles clockwise and then counter clockwise, it will not only keep your ankles mobile, but show you any knots or kinks that might be lurking.
Hip Circles for Mobility
While these may also seem simple, they happen to be my favorites. Start on all fours (knees and hands). Make sure your knees are directly under your hips, hands directly under shoulders, and spine is neutral. I recommend doing this next to a mirror the first few times (if available). The movement is simple, lift your knee off the ground and begin to circle it in one direction. You will be tempted to allow your back to move with the hip or to shift your weight over to the grounded knee. Instead, try to maintain a neutral spine and keep weight evenly distributed. The hip joint should be the one moving. You will notice pretty fast if the joint does not want to move and the back takes over. Complete 10 circles each direction then switch sides.
Single Leg Hops for Stability
Start by standing on one leg and jump in place. Focus on exploding off the ground and then landing and ABSORBING. If you do not absorb, Jodi will come for you! What does absorbing mean? It means you are not landing straight legged. As you land, the knee and hips will bend as if you were doing a squat. No, you will not have to absorb as much as you would doing a depth jump, but make sure you are absorbing. Once you land, stick the landing and hold for 3 seconds, this ensures you are actually stable and balanced.
Once you are comfortable with plain single leg jumps, add in some movement. Find a line on a basketball court, a crack in the sidewalk, a line on a track or field and stand on one side; simply single leg hop over the line, land and reset to hop back. Make sure you absorb as you land and reset. It will be tempting to touch down and immediately jump again. This is actually the easy way out as you are not stabilizing yourself when you land. Stabilization is the whole point of this exercise.
Finally, you can find a step in a gym, outside or stadium stairs and hop up onto the step. Again, make sure you do both sides and front hops. Remember to land, absorb and stabilize before the next jump.
Myfoacial Release
Knee pain/injury can also come from tight muscles pulling on the joint. The calf is one of the main culprits. One of my favorite calf releases requires nothing more than a tennis ball. Kneel on the floor, lengthen on leg and place the tennis ball in the crook of the knee, and then resume the kneeling position. You will immediately feel the tennis ball working on calf tightness. Settle in to the semi-discomfort and allow it to release. Gently shift your weight over to the right, hold, and then shift it back through center over to the left. Repeat on the other side.
Tight quads are another culprit of knee pain. I like foam rollers to open them up.
Changing the Way You Decelerate
Basketball, soccer and football players have to be exceptionally accurate in their cutting techniques and direction changes; the key to which is controlling deceleration. Often times we use 1 step to decelerate yielding an exceptional amount of force on the knee. The alternative to this is a 3-4 step deceleration technique. Work on this when you practice. In the beginning you might worry it will slow you down. Btu if you take the time to practice and master the technique, it won’t.
Hamstring Strength
Last week I alluded to the fact that females tend to have weaker hams than quads. Well, there is only one way to fix this, get up on that hamstring work!!!!! Take a long hard look at your lower body training and you will likely find you are doing much more squatting than anything else. For a refresher on my favorite exercise, check out my post on the deadlift.
So there you have it, some great ways to work on knee health; mobility and stability, myofacial release, deceleration foot work and hamstring strength!
Monday, July 26th, 2010
I’ll cut right to the chase: I’ve torn my meniscus. The meniscus is the cartilage that acts as a shock-absorber in your knee, also preventing bones from rubbing on one another. It’s a pretty common whoopsie, and it’s likely that mine has been there for a while, I just made it extra mad by Warrior Dash-ing, taking on an “extreme” (per its name) lifting program, and starting up with running again. What’s just as common is the knee-jerk response (pun totally intended!) to have arthroscopic surgery, especially here in the United States. So common, that while it’s still a surgical procedure to repair or remove all or part of the meniscus, it’s still often lightly referred to as a “treatment” in the biz. Um… If you have to knock me out cold with anesthesia for something, it’s beyond a “treatment”. I just had a facial two weeks ago, I know the difference.
I’m sure most reading this already have an inkling that I’m not a fan of surgery. This is mostly true. I’m all about it for life-saving procedures. For less critical situations, I want more facts first. Being a chiropractor married to a physical therapist makes me both the best and worst patient ever for an orthopedist. The whole reason we stopped in to one the other week was because we were sure from our own analysis that something was wrong IN my joint, such as some torn cartilage, but we weren’t sure what exactly. After a 70 minute wait, some quick xrays, and about 10 minutes of the doctor’s assistant ruling out things we already had on our own, the doctor came in and spent a grand total of 90 seconds with me (tops) to say “torn meniscus, MRI to confirm, surgery will fix it no problem”. Well, 60 of those seconds were for that, the other 30 were spent on some snarky remarks about chiropractors and PTs, but that’s another rant…
I did schedule the MRI for a week later, but, after reasoning that it was not worth having one just for curiosity’s sake, I canceled. You see, I’d already decided I would not have surgery. Not just yet, anyhow. I’ve read enough stuff (see referenced articles at bottom for some examples) to know that, while having torn cartilage predisposes me to osteoarthritis, surgical repair of it does not improve that. Likewise, short-term (1 year) post-op recovery is particularly unsuccessful in females, through an as yet unknown mechanism. As a doctor, I’ve been around a lot of sloppy knees, many of which have had repairs to either the ACL (anterior cruciate ligament) and/or the meniscus. Throw into the mix my husband’s personal (he’s had 2 meniscectomies, 1 repair and he’s not a fan) and professional experience, and a recent random $.02 from a medical doctor that was decidedly anti (would you believe my GYN was discussing his torn meniscus with me during my pelvic exam? LOL), my own intellect-plus-intuition was confirmed and I decided I didn’t need a mugshot of my own meniscus. Probably best that I don’t know exactly what’s up, thus setting mental limitations on what I can achieve on my own. On that note, the orthopedist did mention that he believes I’ve been pretty much fine for so long because of all of the muscle in my legs. Score! It definitely added to my resolve to see what else I could achieve to on my own to support my knee for the time being.
So, what’s on deck? Well, my in-house PT has me on some specific exercises and modified ADLs (activities of daily living—example: I have to walk down the stairs one step at a time, injured leg leading. It takes forever!), and he performs this cool low grade joint mobilization on my knee that makes it feel so much better for a good bit. I’m on ice after activity and a therapeutic dose of ibuprofen for the short-term as we tackle the swelling and inflammation. Large amounts of glucosamine are in play as I build up my reserves of joint tissue making compounds, and sleep is an even higher priority these days. Acupuncture and massage will continue to play a role. The former because I know it’s capable of healing me on many, many levels as a whole person, not just as a knee with a person attached to it. The latter to keep trigger point development in surrounding tissues at bay while my knee is so sloppy. I’m so inspired and intrigued by meditation and guided imagery for healing, I’m investigating some programs for that now. I wear a knee brace. The compression feels good and I’m less gimpy after a lengthy stint of sitting. But, really, it’s mostly there to remind me not to be a jackass, especially while exercising. I don’t run, lift (with my legs), or jump, and I avoid bending my knees past 90 degrees. For example, while yoga is on the menu, my instructor knows to make sure I don’t fold up my knee during child’s pose, so I modify with a ton of blankets or stay on all-4s with something under my knees. I’ll admit it, I got depressed quickly. This is a BIG change for me, activity-wise. So I made a list of what I CAN do to make myself feel better. Here tiz: yoga, swimming, deep water aqua aerobics, NordicTrack, pilates, upper body lifting, biking, elliptical. (The cardio machines are not much of a consolation, but I have caught up on some reading.) Anyhow, I’ve learned to really like some of that stuff and my weight has held pretty steady, so I’m happy for now. Beyond that, everyone I work with is in the know, so I’m less tempted to demonstrate things that might make me regret having done so later in the day when my knee is barking.
Not only is my PT really smart, he's exceptionally handsome! 
What’s my point in telling you all of this? I’m not that unusual, for starters. This sort of thing happens all of the time, to people with fewer resources of information regarding alternatives. People like me are the ideal study subjects, in fact, because we are not professional athletes who are worth so much on the field, it’s considered a bad career move to not get duct-taped, spit-polished, and shined up until the next injury. Likewise, we are not children who might develop improperly if not repaired quickly. We are also active. Sedentary folks, especially those with other factors working against them, such as extreme obesity, are less likely to be studied too. So the information I have gathered showing that surgery does not provide an increase in favorable outcomes (ex. Pain reduction, decreased arthritis incidence, better functioning) is completely relevant to me. Finally, surgery will always be there. Once we re-evaluate my progress in 6 weeks, we’ll alter the plan, if needed. That plan may include surgery. Or the surgical option may play out years from now. Who knows? But I’m smart enough to know that if the knee being so dysfunctional starts to affect surrounding joints badly (ex. hip, lumbar spine), and surgery could correct that situation, then “duh”. Right now, the “duh” would be not trying to rehabilitate sans surgery.
The over-riding theme for the post is: Do your homework. We’re in a “patch ‘em up” society, especially in America. Get second and third opinions until you feel good about whatever decision you make. Know what you’re willing to do. Seek the advice of a variety of practitioners. Regarding ACL and meniscus repairs in those with formerly healthy knees, did you know that outcomes were equal between patients who had surgery + rehab as compared to patients who had rehab only? And that no study on those same knee surgeries in particular has been able to demonstrate a more favorable outcome for those receiving surgery? Kinda makes me think my husband should be making as much as an orthopedist! Especially when you consider the time involved with one versus the other. Nevertheless, check things out. It’s YOUR body. YOU’RE the boss of it. Always make informed decisions regarding the care and maintenance of it. And be flexible enough that, when new information and technology is available to you, YOU can change your mind. A win-win.
http://www.sciencedaily.com/releases/2010/06/100629081630.htm
http://www.sciencedaily.com/releases/2010/07/100722075224.htm
