I’ve written a few posts about knee injuries, they are one of the most common complaints I see especially since I work with many aging clients. A recent conversation with a client with knee pain encouraged me to write this post.
A Common Scenario
Client, late 60’s, has intermittent knee pain w/walking (sometimes severe) but presents well: minimal swelling, good range of motion (pain at end range of flexion and good quad tone/strength, good knee extension). Two physical evals from orthopedic practitioners had differing opinions on the cause of pain, one suggested meniscus damage. At 60 + years old arthritis is always a concern. The client wanted an MRI to know conclusively what was wrong.
Most patients want to know why they hurt, many seek an x-ray or MRI, it is only natural they want to know the reason. At this point things can get complicated, answers are not clear cut even though an MRI many offer a clear picture of the inside of the body and a hint at tissue damage.
Knees are particularly vulnerable to injury since they are the movement linkage between the foot (ground forces) and the hip/upper body. Body weight, loading forces, age, sports and joint alignment are factors in knee pain. One of the most common pieces of advice knee pain patients are given is to loose weight and strengthen the quadricep muscles.
While an MRI/x-ray may give a picture of what is going on inside the body the real issue is, what do you do with this information? Is the next step cortisone injections, meniscus repair/surgery or exercise?
There are studies that show meniscus surgery can lead to arthritic changes several years later. This is disappointing since relatively soon after meniscus repair the patient may be looking at knee replacement. Loosing weight is a behavioral health/nutrition issue and is never easy – more appointments/time/money. Strengthening the quads sounds good but in reality the quadricep muscles become inhibited (weak) as a result of neurological input from painful joint structures. How do you exercise when the knee joint hurts?
The Long Road
Taking the long road to addressing knee pain means there aren’t quick fixes for degenerative changes such as arthritis, cartilage damage, meniscal tears or more severe ligament damage. For older athletes my goal is to help them stay fit/active and enjoying their body, this is especially true for those who have undergone joint surgery. That said, there are hard conversations about realistic expectations for exercise. They may have enjoyed running their whole life, now they have to look at biking, swimming or walking for exercise. Strength training is a given.
The whole is the sum of its parts. Maintaining overall conditioning can improve the function of the knees, by virtue of the body is an integrated movement system – quad strength is only one component.
