Over the last few months, a common question has been appearing in my email box:
What if Exercise is Not Enough for Your Knee Injury?
I have been sitting on my hands, thinking of a reply and it finally hit me:
You Break the Knee Injury Rules
All of this came in a subtle way:
- clients asking what else they can do for their knee injury
- customers that ordered Knee Injury Solution
- registrants from past Exercise Rehabilitation of the Knee courses
- a family member asking for some help
I have purchased your knee injury solution product and many more.
They are great.
I have several clients though (I’m a Personal Trainer) that have knee injuries that are not going to go away.
For instance, the lady who has no meniscus left and damaged cartlidge and tendons throughout her knee but is told she’s too young for a knee replacement.
She wants to continue training, and she does, but she has no or very little stability in both knees and cannot perform any degree of squat or lunge without pain.
We therefore avoid these exercises, but there’s only so many hip bridges and rom deadlifts we can do.
We also do a bit of band work, but must be very careful about which plane we move in. She must sit for most things, even upper body work as some days just a bit of upper body movement is too much for her unstable knees.
Any ideas how I can further approach this?
On good days we can do boxing, battling ropes etc for cardio, cycling is no good-too much pain and definitely no running or even walking is out some days.
I have 3 clients in this same situation all due to being obese for years-all have reduced to healthy weight now and have endured knee operations that haven’t helped.
This is the Knee Injury Solution program that JB was talking about:
Let me go through a few things that she can do.
I can easily just ramble off stuff that I know would help but I wanted to dig in the research and see what it had to say on what she and you can do about knee injuries.
#1 – Losing Some Weight can Eliminate the Need for a Knee Replacement
Let’s start here.
This is a huge statement.
We oftentimes do not want to start here with our clients but it is probably the biggest factor and if this is not dealt with, everything else won’t matter much.
A lot of the research refers to osteoarthritis (OA) of the knee and hip and what can be done to help each with management and recovery of knee injuries.
Let’s look at some research that came out last month from Anandacoomarasamy (WoW, that is a last name.).
It is well documented in the research that weight loss can reduce symptoms in the knee due to OA.
This should be enough to motivate people to lose some weight.
In the pager, researchers wanted to see the effect weight loss had on knee cartilage structure. They had 111 obese adults in the study, at a mean age of 51.7 and 32% had clinical knee OA. They found that a 7% weight loss had a positive effect on the medial femoral compartment, not the lateral compartment.
In the paper, they made this powerful statement :
“Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage.”
They ended with the statement that weight loss could be enough to “reduce need for total joint replacements.” A very very very powerful statement.
To sum it up, your client might have to search out the best way for them to lose some weight. This might mean changing their exercise routine, having you clean out their kitchen, making a lifestyle change or medical weight loss.
This probably should be the first and most important step for one’s knee injury.
Where to get more information – Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, Sambrook PN, March L. (2012). Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012 Jan;71(1):26-32.
#2 – Stop Doing Upright Lunges
I have a feeling this statement is going to make the fitness technique police go crazy and a good chance a number of fitness educators will complain to the association that I am telling people to break the rules when it comes to the lunge.
The biomechanics of it is simple and the research backs it up.
Move from an upright lunge position to a trunk forward lunge position.
This will decrease the stress on the knee and activate gluteus maximus which will make the exercise easier to do but help work gluteus maximus which most people with knee injuries need to work on.
Not sure what else to say other than try it.
Do a lunge that has been approved by the fitness gods.
Then do a lunge with your trunk forward.
- How does it feel on your knee?
- How do the muscles in your knee feel?
- How does your seat feel when you do it?
Okay, moving on.
Where to get more information – Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM. (2008). Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J Orthop Sports Phys Ther. 2008 Jul;38(7):403-9. Epub 2008 Apr 15.
#3 – Take Some Good Pills
I am not a big pill popping fan.
After being sick this week and feeling how quickly I started feeling better after taking the right pills, my view has started to change.
The evidence is good when it comes to glucosamine sulfate and chondroitin sulfate in order to interfere with the progression of OA in the knee and the hip.
Dose, frequency, brand, form, etc are things to consider. I might dig in the research another time to see what it says about this.
If you’ve got a knee injury, look into GS and CS.
Before, I move on, pain may not be a good thing to look at when it relates to this stuff working.
Let me explain:
“This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.”
Glucosamine sulfate and chondroitin sulfate have small to moderate effect on symptoms (pain being one of them) but may interfere with the progression of osteoarthrits (OA).
Where to get more information – Bruyere O, Reginster JY. (2007). Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007;24(7):573-80.
#4 – What You Are Eating is Making Your Knee Injury Worse
If we look at weight loss being important for a knee injury and most often times the cause of weight gain is diet. Plus, if there are specific things we can eat that can help our knee injury, then there has to be specific things that we are eating now that can be making our knee injury worse.
The first person to highlight this to me was Dr. Peter Osbourne.
Above was an interview I did with him at a conference that we were at. When he told me that, it got me thinking a lot about how what we eat can be slowing down our knee injury recovery.
I will be seeing him again next month so I will work on getting another interview for you.
Plus Dr. Peter Osbourne has a great article on “Foods that Contain Gluten” which is eye opening.
The Last Word
I hope you enjoyed this article and got as much out of it as I did putting it together.
I think I have focused so much on exercise helping injuries and have not spent enough time looking at other things that will help with injury recovery. I am always challenging what I am doing, learning new things, testing things out and sharing what has worked.
If you do have any feedback or insight, please do let me know.
Rick Kaselj, MS