I have been having a lot of patients with knee problems lately. A few of them have had actual knee replacements. These knee replacements are pretty ugly surgeries in terms of recovery. Hip replacement surgeries seem to be a piece of cake by comparison. The knee replacements only seem to work in about half the people, meaning being able to walk normally after surgery. The big problem seems to involve the amount of scar tissue that forms after this surgery that keeps the knee from being able to fully straighten out. I have several patients now that walk awkwardly because one knee is always partially bent. This obviously causes back problems as the bent knee side makes the leg shorter on that side. Physical therapy after surgery is really focused on getting the knee to straighten out after surgery, but this is apparently both really difficult and quite painful. A couple of patients have had to have a different procedure in which they are put to sleep and the doctor forces the knees straight by ripping the scar tissue apart, but this only creates new scar tissue and more of the same problem. The big lesson here is, keep your knees healthy and happy!
We don’t tend to think much about our knees unless something goes wrong. It is a simple hinge joint. It basically only bends one direction and only about 135 degrees at that. Hips and ankles are way more complex. The shoulder is crazy complex. Nevertheless, we seem to get lots of issues with our knees. This is probably because they are not close to a point of fixed stability like the ankle is fixed to the ground and the hips are fixed in place by the pelvis. This makes them vulnerable, particularly since they also have to hold us up stably. Elbows are also vulnerable in the same way, but the arms do not have to hold us up in place, so if something throws them aside, they can just go with it to relieve the stress.
There are lots of powerful muscles and ligaments that can get injured in the knees, as well as the joint cushions called menisci and the cartilage covering the ends of the bones. It is when this cartilage breaks down enough that they do knee replacement surgery. So what can we do to protect all these structures? The answer to that question is not surprising – balance, muscle strength and coordination, full range of motion movement, and avoiding excess stress on the joints. But just how easy it is to let one or all of these fail is a major problem. We form simple little bad habits that don’t seem to matter in the moment but develop into problems over time. For instance, we will fall into letting our knees lock back into position when we stand for any length of time. We let the ligaments do the job of the muscles because it is easier – it takes less effort. But this position compresses the joint cartilage in the front of the knee which will create degeneration of the cartilage over many years. Bad postural habits are like smoking – they don’t cause lung cancer tomorrow or next week, but over many years the damage accumulates. Finally over enough time, surgery results.
Let’s look at some of these bad habits and what we can do about them. The one we just mentioned is being conscious of keeping a slight bend to the knees while standing. This is a common problem while standing working at a counter or standing desk. The same thing happens when you are sitting and putting your feet up on an ottoman. The backs of the knees are not supported and the ligaments behind the knee get stretched out. Similarly keeping the knees bent for long periods of time such as in the lotus position while meditating or on your knees while working at ground level should be avoided. I found quite a number of yoga websites that write about modifying various postures to protect your knees. So, no sitting on your feet.
Last week’s newsletter focused on balance, and this is critical for good knee health. When your balance is poor, it means the muscles around your knee are not coordinating their contractions properly. Without proper coordination, the knee joint will slip and slide in different directions causing wear and tear in the joint. A frequent problem I find with patients is the little muscle that is supposed to lift up the kneecap as the knee is bent is often not working. This causes the kneecap to not lift up at the right time and that drags it across the joint causing pain under the kneecap. Ankle muscles and hip muscles also must coordinate to keep the knee from twisting and getting inflamed. Use the multiple-step protocol I outlined last time to rebuild your balance. My brother mentioned an interesting activity to help this also – walking backward.
Next, let’s look at strength. There are lots of exercises for building strength in the leg muscles. As a starting place, you can sit up in your bed, put a rolled towel under your knee, and simply push your knee down into the towel as hard as you can for about 5 to 10 seconds. Repeat this three times. Next, lay back and bend one knee about halfway up. Now push your heel down and toward your hips for 5 to 10 seconds. Alternatively, you can do this with the legs straight, which in this case will result in your hips lifting off the bed. This can also be done sitting in a chair with the leg outstretched and then digging the heel into the floor. Again do this three times. Wall squats are another good knee exercise. Back up against a wall and slide your butt down until you are in a sitting position or however far down your leg strength permits. Hold this for 10 to 30 seconds 3 times. Lower leg lifts are easily done either in bed with the rolled towel under your knee or seated in a chair, simply straighten out your leg at the knee. From a standing position, flexing your knee as far back as you can, lifting your heel towards your butt is another good exercise. Check youtube for knee exercises, there are lots of things you can do at any level of ability. Here is one.
Another key to knee function is good strength in your hip muscles. Your hip is much more flexible than your knee, and it is what positions your knee correctly as you move. Weak hip muscles are a common source of knee pain. Laying on your tummy in bed and raising each leg up will work the gluteus maximus muscles of the hip, or if you are more adventurous try a bird dog position. Lying on your side and raising one leg activates the gluteus medius and gluteus minimus muscle.
Stretching is the next super important knee activity. When muscles around the knee are too tight, the joint gets compressed and movement compromised. The most classic is the hamstring stretch. The easiest is just sitting in bed, flop your upper body forward as far as you are able. When you are really good, you can touch your head to your knees. You can crank this up a notch by doing something called PNF work. Laying on your back raise one leg up and use a towel to hold it up in place. Now push down against the towel with your leg muscles for 10 seconds (your hands hold the towel so there is no movement). Now gently pull the towel toward you to get an even greater stretch than you had before. Watch it here.
I think of them as torture devices, but some people love foam rollers on the leg muscles. A much better choice in my opinion is doing “Gua sha” or the butter knife technique on the legs. Here is a link to a nice demonstration of this technique by a fellow chiropractor.
This is not only good for keeping the knees healthy, but it is super useful in rehabbing a knee that has pain now. Although the general response to joint pain is to limit motion, this is the wrong choice. Joints need movement. Joints have a very poor blood supply and rely on movement to move fluid in and out of the joint to bring in the nutrition they need to repair. The trick is to keep the joint moving when injured but to remove the weight stress. So passive movement is good, or movement in a pool, or other supported movements. Don’t keep pounding on an injured joint.
A word about nutrition. Obviously getting rid of excess weight will help out your knees tremendously. That excess weight grinds down those knee cartilages. Nutrition for the joints is to consume joint tissue. That means eating collagen or bone broth. Joints heal slowly so give them time. Some people think that once the cartilage is worn down it is game over, but I have seen x-rays showing the rebuilding of cartilage in knee joints when all the right things are done to rehabilitate the joint.
I have been having a lot of patients with knee problems lately. A few of them have had actual knee replacements. These knee replacements are pretty ugly surgeries in terms of recovery. Hip replacement surgeries seem to be a piece of cake by comparison. The knee replacements only seem to work in about half the people, meaning being able to walk normally after surgery. The big problem seems to involve the amount of scar tissue that forms after this surgery that keeps the knee from being able to fully straighten out. I have several patients now that walk awkwardly because one knee is always partially bent. This obviously causes back problems as the bent knee side makes the leg shorter on that side. Physical therapy after surgery is really focused on getting the knee to straighten out after surgery, but this is apparently both really difficult and quite painful. A couple of patients have had to have a different procedure in which they are put to sleep and the doctor forces the knees straight by ripping the scar tissue apart, but this only creates new scar tissue and more of the same problem. The big lesson here is, keep your knees healthy and happy!
We don’t tend to think much about our knees unless something goes wrong. It is a simple hinge joint. It basically only bends one direction and only about 135 degrees at that. Hips and ankles are way more complex. The shoulder is crazy complex. Nevertheless, we seem to get lots of issues with our knees. This is probably because they are not close to a point of fixed stability like the ankle is fixed to the ground and the hips are fixed in place by the pelvis. This makes them vulnerable, particularly since they also have to hold us up stably. Elbows are also vulnerable in the same way, but the arms do not have to hold us up in place, so if something throws them aside, they can just go with it to relieve the stress.
There are lots of powerful muscles and ligaments that can get injured in the knees, as well as the joint cushions called menisci and the cartilage covering the ends of the bones. It is when this cartilage breaks down enough that they do knee replacement surgery. So what can we do to protect all these structures? The answer to that question is not surprising – balance, muscle strength and coordination, full range of motion movement, and avoiding excess stress on the joints. But just how easy it is to let one or all of these fail is a major problem. We form simple little bad habits that don’t seem to matter in the moment but develop into problems over time. For instance, we will fall into letting our knees lock back into position when we stand for any length of time. We let the ligaments do the job of the muscles because it is easier – it takes less effort. But this position compresses the joint cartilage in the front of the knee which will create degeneration of the cartilage over many years. Bad postural habits are like smoking – they don’t cause lung cancer tomorrow or next week, but over many years the damage accumulates. Finally over enough time, surgery results.
Let’s look at some of these bad habits and what we can do about them. The one we just mentioned is being conscious of keeping a slight bend to the knees while standing. This is a common problem while standing working at a counter or standing desk. The same thing happens when you are sitting and putting your feet up on an ottoman. The backs of the knees are not supported and the ligaments behind the knee get stretched out. Similarly keeping the knees bent for long periods of time such as in the lotus position while meditating or on your knees while working at ground level should be avoided. I found quite a number of yoga websites that write about modifying various postures to protect your knees. So, no sitting on your feet.
Last week’s newsletter focused on balance, and this is critical for good knee health. When your balance is poor, it means the muscles around your knee are not coordinating their contractions properly. Without proper coordination, the knee joint will slip and slide in different directions causing wear and tear in the joint. A frequent problem I find with patients is the little muscle that is supposed to lift up the kneecap as the knee is bent is often not working. This causes the kneecap to not lift up at the right time and that drags it across the joint causing pain under the kneecap. Ankle muscles and hip muscles also must coordinate to keep the knee from twisting and getting inflamed. Use the multiple-step protocol I outlined last time to rebuild your balance. My brother mentioned an interesting activity to help this also – walking backward.
Next, let’s look at strength. There are lots of exercises for building strength in the leg muscles. As a starting place, you can sit up in your bed, put a rolled towel under your knee, and simply push your knee down into the towel as hard as you can for about 5 to 10 seconds. Repeat this three times. Next, lay back and bend one knee about halfway up. Now push your heel down and toward your hips for 5 to 10 seconds. Alternatively, you can do this with the legs straight, which in this case will result in your hips lifting off the bed. This can also be done sitting in a chair with the leg outstretched and then digging the heel into the floor. Again do this three times. Wall squats are another good knee exercise. Back up against a wall and slide your butt down until you are in a sitting position or however far down your leg strength permits. Hold this for 10 to 30 seconds 3 times. Lower leg lifts are easily done either in bed with the rolled towel under your knee or seated in a chair, simply straighten out your leg at the knee. From a standing position, flexing your knee as far back as you can, lifting your heel towards your butt is another good exercise. Check youtube for knee exercises, there are lots of things you can do at any level of ability. Here is one.
Another key to knee function is good strength in your hip muscles. Your hip is much more flexible than your knee, and it is what positions your knee correctly as you move. Weak hip muscles are a common source of knee pain. Laying on your tummy in bed and raising each leg up will work the gluteus maximus muscles of the hip, or if you are more adventurous try a bird dog position. Lying on your side and raising one leg activates the gluteus medius and gluteus minimus muscle.
Stretching is the next super important knee activity. When muscles around the knee are too tight, the joint gets compressed and movement compromised. The most classic is the hamstring stretch. The easiest is just sitting in bed, flop your upper body forward as far as you are able. When you are really good, you can touch your head to your knees. You can crank this up a notch by doing something called PNF work. Laying on your back raise one leg up and use a towel to hold it up in place. Now push down against the towel with your leg muscles for 10 seconds (your hands hold the towel so there is no movement). Now gently pull the towel toward you to get an even greater stretch than you had before. Watch it here.
A word about nutrition. Obviously getting rid of excess weight will help out your knees tremendously. That excess weight grinds down those knee cartilages. Nutrition for the joints is to consume joint tissue. That means eating collagen or bone broth. Joints heal slowly so give them time. Some people think that once the cartilage is worn down it is game over, but I have seen x-rays showing the rebuilding of cartilage in knee joints when all the right things are done to rehabilitate the joint.