** This is an excerpt from my upcoming course for trainers on knee rehabilitation. If you are a trainer reading this and would like to know more, please feel free to contact me. If you are a client with knee issues and have questions also feel free to contact me.**
The knee is one of the most complex joints in the body in terms of demand. It is asked all day long to help propel us in various directions, sit down and stand up, climb stairs or even bend down to pick things up. It is a small wonder that over time the mechanisms within this joint tend to wear down over time.
Osteoarthritis is defined as degeneration (over time) of joint cartilage, which is the protective coating that surrounds our joints and keeps the joint surfaces gliding over each other. In the knee there are two of these – articular cartilage at the end of the long bone (ie the femur) and the meniscus which is a padding between the bones of the knee. For the knee, osteoarthritis is the degeneration of articular cartilage, which leads to degeneration of the meniscus (kind of a chicken and the egg issue). Once these two components wear down over time or are subjected to too much stress it creates inflammation, pain and eventually the joint in question usually needs to be replaced.
In my practice, there are what we call “warning signs” that knee degeneration is taking place. This actually begins long before things like pain. The issue with most regular exercisers and especially type A personalities is that unless there is pain associated with the movement, it gets ignored and simply leads to further damage.
Osteoarthritis has 5 stages. The first of which is a healthy knee joint, or stage 0. Stages 1 and 2 are generally very mild with only bone spur growth. These result from impact between the bones. By the end of stage 2 a person may start to experience stiffness and tenderness or pain after a long run or walk.
What I’m going to point out is that the usual symptoms that one would start to notice come at the END of STAGE 2. By this time synovial fluid has degenerated, there may be mild narrowing within the joint space and there are bone spurs.
Something to listen for when your knee joint is moving is something called crepitus – which is a popping, cracking or grating sound in the knee during movement. This is really your first warning sign that joint degeneration is taking place. So you’re wondering what that noise is or if you should be worried if your knees are “talking to you”? Yes, you probably should and can think about addressing it at that stage, not waiting until stiffness or pain kicks in. This noise typically means you are already in stage 2 of osteoarthritis.
Again, by this point you should definitely be addressing the issues in your knees.
Stage 3 and 4 of osteoarthritis are the point where pain and stiffness are fairly constant, and medical intervention in terms of cortisone shots and surgery become options. Hopefully you’re not at this stage yet and can avoid it as long as possible.
Now – another thing I’m very blunt about is that degeneration of this joint is inevitable over time. Especially for active people it is a reality – and the more active, the more likely the degeneration is going to be progressed. But how can we slow down the process and not progress through these stages as quickly? There are two main ways and the good news is that both of them are fairly easy to accomplish:
Maintain a Healthy Weight
Obviously less load on the knees over time means less degeneration. From a loading perspective, for every 10 pounds of weight loss the knee is subjected to 48,000 pounds LESS compressive load – for every mile walked. Considering most people should walk 4-6 miles per day, that’s 88 MILLION (or over 40,000 tons) pounds less load per year.
If you’re not at a good weight for your body then focus on whatever weight loss you can accomplish and every little bit will help reduce the degeneration in your knees.
Strengthen Your Muscles
The more your muscles can take pressure off of the joint during movement, the less load they are taking – especially during exercise – but even with regular walking. The knee has many muscles that cross it and give support to it. Strengthening them all and maintaining a good strength ratio between muscles like the hamstring and quadriceps is also important. Progressive loading of forces is also important so that you’re not doing too much too soon and making things worse rather than better.
In terms of what exercises are best, studies have shown that the most stressful knee forces come from lunging, whereas a dynamic squat is the least stressful. And yes, your knees can come in front of your toes IF THEY SHOULD. Restricting forward movement of the knees does reduce shear through them – but then transfers it into the hips and lower back, which can cause other problems. Loading appropriately is essential.
Work On Balance and Stability
This is not a major way to avoid issues, but having a stable joint means that one side or direction is not constantly wearing down more so than another. Another major source of knee trauma and major loads that cause problems is things like falls and sudden shear movements through the joint. Developing the ability to avoid these things, especially as you age is vital for good knee health.
You need your knees. You need them as long as possible and once the degeneration is there, it can’t be reversed. Current studies do show that there are cells in the knee that could potentially regenerate cartilage but there has been nothing found to stimulate this. So if you already have noise inside your joint, please take some steps to counter the onset of this. For prevention of pain down the road of life, it is important to give your knees a healthy amount of strength and make sure your weight is in line.
If you need any more information or want to know my best ways that have worked with my clients, please feel free to contact me here, via email at firstname.lastname@example.org or via social media @strengthottawa. And feel free to like and share! Until next time, keep your joints happy and healthy!