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Love Your Knees

  • How to Stay Fit and Free of Pain

  • We carry the weight of the world on our shoulders, and yet all it takes is one bad knee to take us down.

    Those knees just won’t forget the past -- the marathon back in ’84, the DIY landscaping that had you kneeling for days, the yearly hike in the Sierras. Like it or not, our long-suffering joints tend to take issue with all those years of abuse. It’s no wonder then that knee pain is by far the most common musculoskeletal problem for baby boomer women.

    “What seems to be the first thing that goes are the knees,” says orthopedist Charles Stuart, M.D. “It’s not that the knees wear out specifically from something like running; it’s that they take such a beating in every day life.”

    But it’s not as bad as it sounds. Knee wear and tear is a gradual process that can be managed successfully for many people, adds Stuart.

  • A Little History

  • The knee is a hinge joint joining the femur, tibia and kneecap and held together by four major ligaments – the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL) and the lateral collateral ligament (LCL). Connective tissue called menisci protect the joint by acting as pads between the bones.

    Somewhere between the late 30s and age 50, a large percentage of active people (particularly those who’ve participated in high impact sports) will begin to notice knee pain. One might feel a slight twinge or buckling while climbing stairs or notice a little swelling, all early indicators of arthritis. In women, the primary culprit is often patellofemoral syndrome, a misalignment of the kneecap (the patella) with the femur

    According to Dr. Stuart, women have a much higher prevalence of kneecap alignment issues, likely due to the angle between the hips, the femur and the patella. “These issues can start as early as the teen years and lead to arthritis,” says Dr. Stuart. “When women get to be in their 40s, we see a lot of them with chronic patella problems that make it difficult to climb stairs and squat.”

    In addition to kneecap issues, increasing numbers of young women have torn their anterior cruciate ligaments (or ACL) after months of intensive training in sports like soccer and basketball, placing them at risk for arthritis by mid-life. Recent studies are beginning to piece together why women are more vulnerable to ACL tears than men. Findings point toward the specific muscle groups women use for movements like jumping. According to one study, females tend to activate outer thigh muscles more often than men, causing a knock-kneed position on landing.

  • Turning Things Around

  • When the knees begin to hurt or swell on a regular basis, low-impact exercise is a must. According to Dr. Stuart, many boomers have a difficult time accepting that the change is needed in order to stay active.

    “You’re not going to run the next San Francisco half marathon but you may be able to ride the next century bike ride,” says Stuart, who encourages people to see the big picture. In other words, why hold on to a high impact activity and disable yourself when you can change your exercise routine and stay active for years to come?

    Early signs of knee arthritis include stiffness, swelling and pain. Without intervention and lifestyle changes, early arthritis can progress to disability, making daily activities like climbing stairs nearly impossible and rendering over-the-counter painkillers ineffective.

    Too many people wait until knee pain has gotten out of control, says Stuart. “Many patients think surgery is the only option, but the truth is that the majority of aging overuse problems don’t require surgery and can often be addressed through activity modification, foot inserts and weight loss.”

    Recent news in the American Academy of Orthopedics Journal reported weight loss to have the single biggest impact on reducing knee pain. The knee bears three times a person’s body weight going up stairs and nearly five times the weight going down stairs. Given this, even a 10 pound weight loss can make a huge difference in overall knee health.

    Only once all non-operative approaches have been exhausted does surgery enter the equation. If you continue to have pain even after a good period of weight loss, exercise modifications and footwear changes, surgery may be an option, says Stuart. People facing knee surgery today have a much wider range of surgical options than those in the past. Today, doctors often opt for more conservative procedures that replace only the damaged part of the knee, such as the Oxford approach. Using techniques like Microfracture and the OATS procedure, some doctors are also beginning to work with methods that prompt the body to grow additional protective cartilage.

    And while partial and full knee replacements won’t have a person running 10Ks again, they can allow for a life of moderate, pain-free activity. “Once you have a knee replacement, the days of impact loading with sports like running and basketball are done,” says Stuart. “However, you can walk, hike, bicycle, swim and even downhill ski on a nice day.”

    Top Five Ways to Protect Your Knees

    • Stretch and strengthen the hamstrings, hip flexors and quadriceps, particularly the VMO (Vastus Medialis Oblique) muscles at least three times a week.
    • Make a point to lose extra weight. Do not try high impact activities until you have lost those extra pounds.
    • Ask your doctor if you might be a candidate for orthotic inserts to counter pronation problems.
    • Cross-train. For example, if you’re a daily runner, consider cutting back to three runs a week and choosing a low impact activity like cycling or an elliptical trainer on the other days.
    • As you age, avoid sports that require frequent pivots, starts and stops (e.g., soccer and basketball).

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