Lots of active people - runners, walkers, cyclists, dancers and ballplayers of every sort - have trouble with their knees. Sometimes the problem is structural, sometimes it's poor technique, bad shoes or inadequate conditioning, and sometimes it's a messy collision that leaves you hobbling. Bummer.
Bad knees are bad news when it comes to staying active, so let's take a little time to consider your amazing knee joint: how it works, why it goes bad and, most important, what you can do to keep your knees strong and pain-free.
The architecture of the knee is complicated, but totally necessary. The hingelike joint allows for the motion of walking, also running, skiing, jumping, etc. The ligaments of the knee give it stability. They include anterior and posterior - front and back - cruciate ligaments that control the back-and-forth movement of the knee and collateral ligaments that control side-to-side movement.
Cartilage in the knee complicates things even more. Cartilage is nature's way of Teflon-coating the knee to prevent the raw end of the shinbone from rubbing against the raw end of the thigh bone. Indeed, there is a cartilaginous covering at the end of all bones that form a joint, elbow, shoulder, hip, to allow for a smooth gliding mechanism. Cartilage can be ripped, torn or damaged. There is a second form of cartilage in the knee, the meniscus, which aids in stabilizing and weight-bearing.
And finally, the knee movement involves two different muscles: The quadriceps - front thigh muscle - is the knee extensor, and the hamstring - rear thigh muscle - is the knee flexor.
Bottom line? There is so much that can go wrong.
Some things that can go wrong. The following is a depressing list of common knee injuries.
- Chondromalacia or patellar pain syndrome. This painful condition is usually brought on in adults by overuse or improper mechanics. It involves pain and grinding under the kneecap, typically caused by too much running, a worn running shoe, a poorly fitting bicycle or some other form of body abuse.
The problem can be short-lived if you correct it. Get a proper bike fit, a new pair of running shoes or an orthotic, a neoprene knee sleeve or begin a quadriceps-stretching program. To prevent it, don't overdo it on the machines and cross-train - mix up your sports - to avoid using the same muscles over and over again.
- Tendonitis. This very common problem could be the subject of an entire column, so suffice to say that tendinitis may cause pain below the kneecap - intrapatellar tendinitis - or on the outer side of the knee - iliotibial band syndrome.
In either case, pain with usage is the problem. The more activity, the greater the pain. You may also experience a crackling in the area of discomfort. What to do? Ice, rest, anti-inflammatory drugs and a neoprene sleeve will usually do the trick. To prevent it from coming back again, get involved in a stretching-and-strengthening program designed to protect your knee joint, and don't overdo it when you exercise.
- Patellar subluxation or lateral tracking of the patella. This is most commonly seen in active women. They complain of a buckling or giving away of the knee when they do sports that require them to cut or rotate. What happens is the patella, or kneecap, migrates off to one side.
Chondromalacia can make matters worse. If the kneecap moves all the way off the femur, it is considered dislocated. Women to whom this happens frequently need the help of a good orthopedist. A strengthening program can help, and so will icing the knee and wearing a neoprene knee sleeve.
- Anterior cruciate tears. These nasty injuries often follow a major trauma to the knee, a fall or a collision. Bad news! A torn anterior cruciate ligament is a big deal and requires immediate care and diagnosis. Whether surgery is required is up to you and your doctor, so stay involved, ask questions and never believe it when a physician calls it "minor surgery." Only a minor surgeon would say that.
Prevention of an ACL injury takes some luck, but good leg strength and flexibility can reduce your risk somewhat.
- Torn cartilage or meniscus. This is a common source of continuing and recurring pain in the knee. It is often accompanied by the "locking knee" phenomenon. If your knee is otherwise healthy, you're unlikely to tear your meniscus unless you're hit in the knee or have a traumatic injury or fall. If that happens, you'll needs a good sports-medicine doctor to determine the course of treatment.
The best treatment? Avoid the accident altogether. Since that's not always possible, practice the basics of knee injury prevention, which are:
- Stretch every day. Leg muscles that are stretched and flexible can withstand the stresses of everyday exercise and protect the knee much better than muscles that are tight and inflexible.
- Don't overdo it. Many knee injuries come from simple overuse, trying to do too much, too fast, on legs that are not strong or flexible enough to take the stress. Learn to listen to your body.
- Strength train. Be involved in a strength-training program two or three times a week that build muscles all over your body. Yes, strong legs are important, but so are strong arms, shoulders, back and torso.
Write Marilynn Preston in care of The Light, 565 Pearl St., Suite 300, La Jolla, 92037.