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Get in the Groove for Better Knees

Posted Aug 16 2009 10:07pm

Today's article was inspired by a reader - Adam S - who happened to read an article in the New York Times about how running might actually help your knees. Thanks Adam for sharing the article with me. Here it is.

Your joints are like your life. You get in a comfortable groove, a pattern or routine where things are balanced and understandable and everything seems to be going along fine. In fact, the more you stick to the patterns, the more grooved in your life becomes and for many people that creates a certain comfort and happiness.

The cartilage in your knees, for example, adapts to the loads you regularly expose it to and becomes stronger. It gets used to the force, the pattern of loading, the grooving, and adjusts. And as long as you keep doing this without inserting an injury into the equation, all is ok.

But, when you expose your knee to unusually high loads or new motions with higher loads, you can injure the joint. Once the joint is damaged, your pattern or groove changes. Loads shift and the joint has difficulty adapting mostly because it's tolerance for load is less than what you're exposing it to and a degenerative cycle begins. It sets up a biochemical imbalance that gradually degrades the quality of tissue leading to swelling, pain, and declining function. I'm not the only one who thinks this way. There is scientific evidence that joints use motion to strengthen themselves and when something happens to cause a shift in how the joint is loaded, the cartilage has a harder time adapting.

Most of the medical profession though believes that there is nothing that can be done, conservatively, for a joint with degenerative changes.  The medical options are to quit doing things that make your knee hurt, use medications to control inflammation and pain and / or perform surgery - partial or total knee replacement. Usually, surgery is reserved for very advanced deterioration of the joint. Sometimes people will get sent to a physical therapist with instructions to strengthen their quadriceps muscles. Of course that often fails or is ineffective because the force needed to strengthen the muscle is beyond what the joint can withstand and it fails to create a new pattern or groove for the joint.

I've seen thousands of people with damaged cartilage over my career and a large percentage of them recover. While we can't say that the cartilage has regenerated, it is safe to assume that what has happened is that joint has achieved a new equilibrium; a new pattern that the joint likes. And, as long as you follow the rules, you can do a lot of stuff again. A client of mine with some advanced degenerative changes in his knee was headed for a knee replacement. Instead, he opted for a joint conditioning program. In May of 2008 had a Load Tolerance of about 30% in that leg (i.e. he could apply only 30% of his body weight on his leg safely and without symptoms). A year later, he was at body weight force. But, because of the significant changes in his joint (like exposed bone), he has to be careful about introducing anything new. Like walking way too much which he just did on a trek to Africa where he walked 5 hours a day for three days in a row and a lot of it downhill. His knee said no thank you. Completely understandable though when you consider he performed about 8900 tons of work over that three days and what his knee was used to was closer to a couple of tons.

I was told 15 years ago when I had a partial menisectomy in my left knee that I would never run again. Last week, I hopped on my kickbike (which uses a sort of running motion to propel it) over to a local school, ran 10 x 100 yard sprints, did agility drills on a football field, kickbiked my way home, and jogged with my dogs. I did that though by training up to it and I stick to a training routine to maintain my improvements. I can still overload my knee but I know what to do to get things back on track. That's the real benefit of going through something like a joint conditioning program. You learn how to train your self and become more in control of you.

The good news though for those of you who like to run is that if you can keep running and avoid an injury, you stand a very good chance of running for along time without damaging your knees. Of course, the sooner you start running and keep running the better. You can still start in later years but you have to introduce the loads and new pattern very slowly. Your knees have to learn the pattern and adapt and this takes some time.

And for those of you with knee injuries who are not yet ready to give up, you also stand a good chance of recovery if you can create a new pattern of movement and loading for your knees and gradually increase the loads. 

Gotta' run :-)

Make today count.


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