Be nice to your knees: if you want to keep running, jumping and lifting, do your knees a favor and follow this preventive program

Muscle & Fitness/Hers, May-June, 2003 by Erinn Morgan

Our knees deserve a lot of respect. They've carried us through childhood into youth and adulthood. Our gams endure countless hours of bending, squatting, cycling and walking, all courtesy of the knees. Like many other things, we often don't appreciate the work of this incredible joint until it's no longer working properly.

Each year more than six million Americans seek medical help for knee pain--about 2.5% of the population, according to the book Knee Pain: The Self-Help Guide by John Garrett, MD, and Bob Reznick, MBA (New Harbinger Publications, 2000). Because of the wear and tear our knees undergo each day--as well as the extra demands placed on them by fitness and sports activities--the knee is the most injured joint, representing 26% of orthopedic business.

Women make up approximately half of the population of knee-pain sufferers, but we're far more susceptible to specific types of injury, such as tears of the anterior cruciate ligament (ACL), which helps hold the knee joint in place. "Studies have shown that women are twice as likely as men to tear their ACL," says Tarek Souryal, MD, an orthopedic surgeon specializing in ACL repair with Texas Sports Medicine in Dallas. As a result, this acute knee injury in women has received much attention and research.

"We see ACL injuries from slipping on the ice, skiing, wakeboarding, mountain climbing, baseball, volleyball and basketball--mainly cutting, jumping, and twisting sports," says William Krissoff, MD, an orthopedic surgeon located in the Lake Tahoe area in California, where knee injuries are as common as outdoor sports. "We don't see it as much from straight-forward sports such as running and biking."

Krissoff says there are many schools of thought about why women are more prone to ACL tears than men. Possible reasons include the fact that women have wider pelvises than men and thus land more knock-kneed after jumping, increased susceptibility during hormonal cycles, and the smaller size of the notch that a woman's ACL fits through, as compared to a man's.

To ward off time-consuming ACL and other knee injuries, many women's sports teams--from basketball to soccer--have instituted workout regimens focused on strengthening this joint. One study conducted by Timothy E. Hewett, MD, of Cincinnati Sports Medicine shows that this type of training can reduce the incidence of injury.

The study involved videotaping and analyzing 49 female high-school varsity athletes. The women were directed to jump off a one-foot-high box during videotaping, which was later analyzed for landing patterns. The women then underwent a six-week training program that included single-leg balances, jumps, and stretching for 90 minutes per day, three days a week. The study results indicated that trained, conditioned knees can prevent as much as 80% of ACL and other knee injuries in female athletes.

the culprits

The mechanics of the knee are very complex, so much so that there are 25 to 35 different types of knee injuries. According to Garrett, the four most common knee problems are: 1) pain from the kneecap; 2) torn meniscus (cartilage that cushions the knee, often worn out over time); 3) ligament problems; and 4) tendon problems. Injuries involving these areas are either chronic or acute.

Chronic knee injuries include things like strains, sprains and tendinitis. "In my office, the chronic injuries are more common," says Souryal. "But these can be easily avoided. Use common sense in how often or hard you work out." Symptoms of chronic injuries include inflammation of the knee, aching pain, grinding or a clicking noise during movement of the joint.

Symptoms of acute injury are much more noticeable. A sudden trauma to the knee will result in swelling of the joint, intense pain, nausea and, in the case of an ACL tear, a popping or cracking sound.

If you experience the symptoms of knee pain--acute or chronic--make a trip to your doctor or orthopedic surgeon for an exam. Catching the signs of injury early on will greatly benefit you; rehabilitating a knee pushed to the edge may save you from surgery or long-term problems.

STRENGTHENING EXERCISES AND STRETCHES TO PREVENT INJURY

A practical program of targeted exercises and stretches can help you combat the risk of a knee injury. Many of the exercises outlined below have the added benefit of strengthening and defining the quad and calf muscles.

"The stronger the knee is at absorbing a twist or impact, the better the chance of avoiding an injury," says John Garrett, MD, founder of the Atlanta orthopedic group Resurgens.

One key to success with this program is to focus on exercises outside the "pain zone," according to Garrett. Don't force the knee to perform motions in a zone that generates acute pain. Instead, start the activities in a pain-free, comfortable range and work to expand that range.

The mechanics of the knee are very complex, so much so that there are 25 to 35 different types of knee injuries.

warm-up

As a general rule, always do 5-10 minutes of light cardio before you begin exercising.