Sunday January 27, 2013
Fighting knee pain
By REVATHI MURUGAPPAN and FIONA HO
The knee is a complex joint that is highly susceptible to injuries.
IT bends, straightens and rotates slightly. Sometimes it creaks, and when the situation is bad, it gives way. Such are the workings of the knee joint.
Many of us know at least two persons with a knee problem who complain about the nagging pain. If itís your grandma or grandpa, you can excuse them as over time, the joint gets worn out. But Iíve seen young hikers, runners and dancers wearing a knee brace for support.
Since the knee absorbs 80% of our body weight while standing, it is at a high risk for injury. The knee is formed by the articulation of the femur (thigh bone) and tibia (bone of the lower leg), and is encased in the joint capsule. It contains an assortment of ligaments and tendons, which provide the structural framework for the joint.
The stability of the knee joint and the primary restrictions of action are provided by the complex ligament structure of the knee. The knee joint is surrounded by a large thigh muscle in front of the leg (the quadriceps), an equally large muscle at the back of the leg (the hamstring), muscles at the back of the lower leg (the calf muscles) and a long band of connective tissue that stretches from the hip bone, running alongside the outside of the thigh, down to the outside of the knee (the iliotibial band).
As we age, our fast twitch or explosive muscle fibres (eg hamstring, bicep) which are used for sprinting, atrophy at a faster rate than our slow twitch or endurance muscle fibres (eg quadriceps, triceps) used for marathons.
Activating fast-twitch muscle fibres is the key to improved strength, speed and power. Unlike slow-twitch muscle fibres, which are responsible for most of our day-to-day muscular activity, fast twitch muscle fibres are quite lazy and tend to slumber until called to action. It is also easily fatigued, and if pushed beyond its capacity, gets injured easily.
I always tell my students that if they sustain a back or knee injury, itís going to stay with them for life. Unless itís a simple sprain or strain, the likelihood of injuries recurring is extremely high, but the good news is that it can be managed by strengthening the muscles surrounding the knee.
A few months ago, one of my dance students came to me with incessant knee pain. Every time she did grande plies or landed from a jump, she would feel a sharp pain. She iced the area diligently and sought treatment from a sinseh, but it didnít help much.
The fact that she was dancing at least 30 hours a week compounded the problem. It got so bad to a point she started to limp and could barely take steps down. I packed her off to see a specialist.
The orthopaedist couldnít find anything major and diagnosed it as a soft tissue injury. He prescribed her anti-inflammatory medication and glucosamine supplements. I was shocked. Glucosamine at 21?
My grandmother only started taking it at 80, and this kid was barely out of university. She hadnít even started her professional career!
I had to force her to stop all activities and reluctantly, she agreed. We worked on strengthening and stretching the appropriate muscles and slowly, the pain subsided. Today, among other things, she can leap, take a tumble and do knee spins without pain.
There are many causes of knee injuries, including bursitis, tendonitis, ligament tears, worn-out cartilages, arthritis, sprains, strains and a host of other problems. Postural misalignment such as knock-knees or bowlegs may also predispose a person to knee injuries.
According to fitness trainer Mark Vella, women have a four to six times greater chance of sustaining serious knee injuries than men. In his book, Anatomy for Strength and Fitness Training for Women, Vella says women have a tendency to begin exercising from a knock-knee position, and when they start flexing the knees (bending), this position is aggravated further. Their wider pelvic structures also result in a more acute angle from the femur to the knee joint. Women also have softer ligaments and tendons due to hormonal effects, which are pronounced during ovulation and pregnancy.
Many women are concerned that leg exercises such as squats will cause their buttocks to become bigger, but this is far from the truth. The natural tilt of a womanís pelvis is more likely to be slightly anterior than in men, thus creating an increased lordosis (arched lower back), which then emphasises the buttocks. If less strengthening emphasis on the glutes is desired, then when doing squats, a wider stance should be used. There are always alternatives.
It may come as a surprise but exercise is one of the best remedies to alleviate pain and relieve stiffness among those suffering from knee arthritis.
Here are a few simple exercises I find most effective when strengthening the muscles surrounding the knee. Start off with three sets of 10-12 repetitions.
Wide-stance or duck squats (second position plie, feet turned out)
Stand with feet wider than shoulder-width apart, toes turned out 45į to 75į with hands on the hips or folded in front. Bend your knees (making sure it doesnít go past the toes) until it forms a 90į angle to your thighs. Hold the stance for two seconds and come back up. To make it harder, you can hold on to dumb bells or lift the heels off the ground while in squat position.
Stand with feet parallel, six inches apart, and take a huge step forward with one leg. Bend both your knees (keeping the front foot flat on the floor) so your rear heel lifts off and the knee is almost in contact with the floor. Come back up. Repeat 10-12 times, keeping your body erect. Return to starting position and switch legs.
Stand with your back against the wall, foot shoulder-width apart and about 12 inches or more in front of you. Slowly bend your knees and slide your back down the wall until you knees are bent no more than 90į and are not extending past your toes.
Beginners will probably not able to go past 45į. Hold this position for five seconds. Focus on pressing your heels to the ground as you slowly slide back up until youíre back to starting position. Once you get stronger, try one-legged wall slides.
Standing calf raises
Stand on the edge of a step or elevated platform with heels hanging over the edge. Tuck in your stomach and squeeze your glutes. Rise up, hold for two seconds and come down. I like to do these in three positions. First stand with feel parallel, then with feet turned out and lastly, with feet pointed inwards.
Hamstring curls with stability ball
Lie on your back on a mat, keep your knees straight and place your heel on top of a stability ball. Lift your back off the floor and contract your abdominal and butt muscles. Slowly and with control, bring your heels toward your body as you roll the stability ball underneath your legs.
When youíve moved about 10-12 inches, return your legs to the fully extended starting position.
Not only do these exercises do wonders for strengthening the muscles surrounding the knee, it also helps peel the layers of fat and gives you a great looking tush!
However, use your own discretion when performing these exercises. If at any time you feel pain, then skip it. You can try it again after working on the other exercises for a couple of weeks. The important thing is to listen to your body, to challenge it, but not to overstress it.
The writer is a certified fitness trainer who tries to battle gravity and continues to dance, but longs for some bulk and flesh in the right places.