** 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 email@example.com or via social media @strengthottawa. And feel free to like and share! Until next time, keep your joints happy and healthy!
This is another success story I’d like to share with my readers and anyone interested in what I do. This case really illustrates the gradual use of resistance to create tension and hold positions for spinal issues and how they can be improved.
Randi came to me through a referral from one of my local MAT practitioners. Often when these people are receiving treatment they require someone who has my skills to help increase their strength once their body is able to fire muscles properly again. Having this combination is a really great way to enhance your gains in strength and allow your body to develop at a much more rapid pace. By the way, I highly recommend MAT to anyone looking to improve their physical self, you can find more about it HERE.
When I first assessed Randi it was a challenge. In a nutshell, everything we tried caused pain in her back, localized mostly around the right SI joint area which was indicated as the main issue. This had been going on for almost eight years and caused her to give up a lot of things she enjoyed doing, like hiking, cycling and even caused her problems while walking her dog. She had trouble with simply standing in proper posture, which put pressure in areas that her back “didn’t like”. This became a frequent gauge of her pain levels during our first few sessions.
Doing what I do, I will at first admit that I miscalculated and didn’t realize how much Randi’s back would react to my initial movement pattern assignment. After our first session she was okay, but after the next couple her back was sore for four days to the point where she couldn’t do normal everyday activities. This is after doing much movements as simple hip flexion, mild bracing, some basic extension (ie hip hinging) and trying to integrate her hips with her shoulder girdle. I was surprised, but glad that Randi (after she recovered) allowed me to try again.
The lesson here for both you and myself, is that you can reduce any level of force to an appropriate one for any person. So what did I reduce to? Randi started out most of her subsequent sessions with postural holds (bracing in a standing position), walking in proper alignment, and then going through various drills and movements unloaded in order to teach her body to facilitate coordination without any load. Loads were added eventually, but using angles of her body and longer ranges of motion, not weights. This Is a very broad description, but it worked. Before long, Randi’s body was to the point where she could endure long car rides, do sustained long activities she enjoyed like cooking and was able to think about buying a bicycle for her main goal.
Randi’s main goal was to be able to bike 26 kilometers for her trip to the Canadian Rockies, something she had wanted to do for a long time. The first step was to get her back on a bike again. She lasted for only 45 seconds the first time we put her on one. Then, through gradual application and increasing of mileage not only did we get her back onto a real bicycle (after finding one her body could tolerate) but we got her to the point where she could bike for over an hour (with breaks) and while her back was tired, she was able to recover quickly and function normally afterwards. Progressions were done weekly and she was also given specific technique rules and ways she could approach what she was doing on the bike to take tension off of her back. With some movements, it is a matter of reteaching the body how to move.
One interesting weekend Randi pushed herself a bit too hard, not realizing that a 15km route (which was prescribed) was actually a 20km route with hills. Her back reacted accordingly, but the great thing was that she recovered fairly quickly. Recovery time is always a great marker for performance improvement. Normally what would have done her in for a week had her sore for a couple of days, which is fairly normal when you’re doing something you haven’t done in eight years.
I’m happy to say that Randi has made incredible progress. Not only did she successfully ride the trail in the Rockies, she is now dead lifting up to 50 pounds, performing movements like lunges and pulldowns and planks, and is able to recover from workouts quickly. Her MAT therapist has seen a significant change in the way her muscles hold onto position. This is all in a period of about six months.
Once of the best parts of my job is helping people like Randi and sharing in the results. Here’s a picture she sent me of her on the bike out in the Rockies accomplishing her goal:
Randi’s goals have moved away from reducing pain and into more typical goals like weight loss and strength gain, which is fantastic. Everyone has to start somewhere, and the great benefit that I tell my clients is that if you can teach your body to tolerate forces, then it will always improve. If you have any specific questions about my work with Randi (or anyone else) feel free to contact me through this site or at firstname.lastname@example.org. I’m always willing to help if I can.
It’s that time again – I saw the first inspirational commercial yesterday, with two former NFL athletes who are now severely obese starting on their weight loss journey followed by millions of people. Complete with massive weekly weight losses, lots of crying and screaming from trainers, product placement shots from Jenny-O brand ground turkey and Subway and lots of manufactured drama we can look forward to another person losing up to 50% of their body weight whether it be healthy or unhealthy.
You might remember at the end of last season where the winner looked severely depleted on the finale and there was a massive public outcry about her weight loss methods and how unhealthy they were both physically and mentally (and then it was revealed that most of the finale winners do the same thing, she just did it better). So here’s a few revealing notes about this show and some things to think about when approaching your own fitness regime, if this show inspires you to get off of the couch and actually get healthier.
The Winner is pretty easy to pick right away
Here’s the thing – when your body was fit and healthy in the past it really, really wants to get back that way again. Some of the contestants have been unhealthy and overweight their entire lives, and these are the ones that have a hard time once they hit a certain point. The contestants that were formerly athletic and thin (and have a ton of weight to lose) make the final 4 almost every time (unless they get booted due to politics), and almost all of the winners have been fit in the past, either when they were younger or just a few years before. So when I’m watching and I hear that “I was a high level athlete in high school/college” or there is someone who turned 20 and then gained 200 pounds that’s the person you’re going to see going really far unless they sabotage themselves or fall victim to the game politics.
I won’t comment on the trainers except to point out that the workouts they put the contestants through aren’t anything revolutionary or different than what a decent trainer would do – except at a much higher intensity (which isn’t always a good thing) and with lots of screaming and drama for the benefit of TV. And just because they do it – doesn’t mean you should.
Lesson: Your body likes to be healthy – and will try hard to get back there even after you have done awful things to it. It might take a bit longer to do so, but odds are you can get back there as long as you stick with it.
What these people do daily is NOT healthy
Contestants on the show are contractually obligated to burn x amount of calories every day and eat x amount of calories, all of which is controlled. The workouts you see with the trainers are for about 1 hour of the day and are somewhat staged, but they do work out – for hours. People hurt themselves constantly and sometimes you see it and sometimes you don’t, but if you watch you will notice how sometimes things like knee braces and support tape start appearing. When they go home, inevitably their weight loss slows down – because they aren’t working out hours a day and they actually have a real life time management situation with family, children and jobs. If many of you could dedicate 15-20 hours a week to exercise and eating right, you would lose weight too, possibly just as rapidly. Don’t assume that just because they did it, you can too – real, healthy weight loss is much more gradual.
Most of the gains you make while attempting to lose weight are done outside of the gym by eating properly, lowering stress and sleeping well for recovery so that you can exercise again as soon as possible. This is how real gains are made over time.
Lesson: Your body also likes to make change gradually, and will fight back against doing anything forced. Give yourself time and constant effort and the weight will come off.
Buyer beware with the products that they push
Please remember that the products that they promote are based on marketing dollars – not the best products. For example, on the most recent episode they were promoting canned soup. Low calorie, certainly – but canned soups are often high in sodium. There are also highly processed ingredients in them, even if they claim to have chicken or vegetables as an ingredient. Subway, which has been a huge sponsor of the show has been shown to not have much more nutritional value than many other fast food places. Things like Lara Bars and other quick snacks are fine once in a while, but should not ideally be eaten over something natural and whole. Ground turkey and chicken are good protein options, but possibly having a whole product from your local farm would be a much better idea (and cheaper). Instead of vegetables cooked in a plastic box, get them fresh from the produce aisle. The trouble is that the general public doesn’t know and will blindly purchase something because they paid the show to be a sponsor – don’t be that person.
Lesson: Just avoid anything processed as much as possible. Eat real food whenever you can. Period.
Don’t get discouraged if your personal journey takes a long time
The main focus for anyone changing their lifestyle should be HEALTH FIRST. In case I didn’t say that emphatically enough. Scale weight coming off is a nice by product of maintaining an exercise program and eating whole foods within your caloric requirements, but it should not be the top priority. In fact, stay away from the scale at the start if you can. Compare how your clothes fit, think about things like energy levels and sleep quality and improve steadily day by day – then step on the scale. Sometimes you get a pleasant surprise when you have had all of these amazing benefits plus you’re down 20 pounds. On the show they do some brief doctors’ visits with lots of tears and crying, especially when people do things like lower their blood lipid values or successfully reverse diabetes onset. The thing is – you can do that too. It’s really not that remarkable if you just start treating your body with respect.
Lesson: Getting started is the hardest part, but pretty much any condition can be slowed, stopped and even reversed if you do things the right way. You don’t have to feel the way you do right now if you’re unhappy – it’s a choice.
Television shows are meant for entertainment, and this show is a prime example. As I have said in the past, if this show inspires regular people to get off the couch and start exercise, eating maybe a bit healthier and changing their lives then fantastic. Obesity is a horrible epidemic that will continue to get worse if we don’t start getting smarter about it. This article simply means to point out some perspective on the fact that what you see (especially in the fitness industry) often isn’t real.
Until next time, losers. And I mean that in the nicest way.