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Knee Pain Does Not Mean The End To Your Exercise Program

knee-articleKnee pain is extremely common and can really make things very awkward and uncomfortable. Trust me I should know, only 8 weeks ago I tore my ACL (anterior cruciate ligament) in a freak accident that left me on crutches for 2 weeks and limping for the next 1-2 afterwards. My other knee, which I can label as “the good one”, was actually suffering before the accident with some niggles and issues that I was working on. So now I have two knees to find a way to get on top of. The good news is… I’ve already made great progress, (more on that later).

When knee pain sets in the last thing people think of doing is exercise, but what I will show you in this article, exercise is exactly what you need to do! I would go as far to say it is the best way to rehabilitate an injury and the best way to prevent one! Unfortunately many people are stuck in the thinking that a pill or a medical intervention is a better solution than some hard work with exercise or a change in their habits. For if a solution to your problem is not found, you will be set for a lifetime of problems and potential other injuries worse than your knee!

What Is The Cost Of Knee Injury?

Now apart from the monetary cost associated with knee injury, which can be very expensive, let’s consider the psychological, emotional, and lifestyle cost a severe knee injury like an ACL tear can cause. For younger clients this can be psychologically very hard to handle, as a full rupture to an ACL will mean the end of the sporting season, and a full 12 months of rehabilitation. For the older adult it can mean losing a job, changing a lifestyle to accommodate the rehabilitation process!

Starting with the younger person, this devastating injury can potentially mean the end of an athletic career. Imagine a young gymnast preparing for the Olympics who badly damages his or her knee in training and now will miss their dream of competing. Even with surgery to repair the damaged ligament, there is no guarantee that the knee will be anywhere near the same as before.

In my case this is exactly what I am confronted with at the moment, retiring! I am still getting my head around not being able to play sports for the first time in my life. I am now 42 and have played high level basketball since I was 10 years old. Sports have been my entire life for 32 years, and now I am stuck sitting on the sidelines watching my team mates play.

The emotional burden and stress created from such a serious injury cannot be underestimated, and the importance of a strong rehabilitation program, both for physical and emotional recovery is critical. I have managed to stay quite positive as I have great knowledge on what to do, having trained hundreds of rehab clients with this injury before, and know that I can get back to good function if I stick to a plan.

But what about the older adult who does not play sports? Do they still have the same emotional burden? More recently I have seen a lot of older adults who have just put up with their knee pain for years, using NSAID’s to treat the inflammation and pain but not knowing what else to do, and resigning themselves to the fact that surgery, or a knee replacement is what is needed. They had already modified their lifestyle to make up for the loss of function with their knee and even gave up things like playing golf or playing with the grandkids because of the knees. Many also began to gain weight from the lack of activity and the combination of a dramatic lifestyle change and gaining weight starts the ball rolling of a depressive state that could last years.

The cost of a knee injury to someone’s health is much more than you think. But it doesn’t have to be this way.

You Must Strengthen The Body & Learn To Move Correctly

The older adults I referred to in the last paragraph all shared a common theme. At no stage had they tried to use exercise strategies to improve the function of their knee. When they first injured their knee they saw a therapist for treatment to help remove the pain and swelling and get some range of motion back.  Unfortunately once the pain subsided and they were able to move around again that is as far as their rehab went! I don’t actually blame them, it is a real lack of knowledge in the community as to the value of a strength program. In the sports world we know that this works and is essential. But for the average Joe it is not as readily endorsed or stressed how important it is.

With most injuries it is often the lack of strength or poor movement that is the cause of the problem. With knee pain we often trace the cause of the injury back to tight hips, weak glutes and poor single leg movement and stability.

Interestingly, ALL of the clients who had been dealing with knee pain for years who began a strengthening program, found their mobility and function improved significantly, with pain and inflammation drastically reduced. Some even took up golf and sporting activities again that they had given up due to the fact that they felt so great now. All these people lacked stability and understanding of how to move correctly, but most significant was the lack of strength that had created atropy to the muscles supporting the joints. Scar tissue and stiffness had settled in that was now creating a chain reaction of symptoms leading to hip problems and back pain. The good news is… every person was better after the implementation of a corrective exercise program.

What About Surgery?

In some cases surgery is necessary, but in some cases it does not solve the underlying cause of the problem. It just treats the symptoms. This brings me to a conversation I had with the surgeon who evaluated me 2 weeks after my injury and again 6 weeks later. The first consult he advised me that it would be best to treat my injury without surgery. He explained there is always risks with surgery and that there is no guarantee it will prevent my knee from going again, and potentially it can cause new problems because they need to graft the tendon from either my hip or hamstring, which can cause problems for my hip or hamstring muscles. The best thing to do is to strengthen all the muscles that support all the joints in my leg and learn to improve my movement patterns to avoid injuring it again. If I was able to do this, there is a good chance I will prevent further damage and be able to do most things without pain or limitation. He then explained to me that out of all the people he sees for surgery, or gives the advice he just gave me, only 5% ever rehabilitate their knee to a point where the knee is strong enough. 95% of people have the belief that surgery will “fix them” and they do not follow through with either enough training, or intense enough training to fully strengthen the knee. And when it gets hurt again, or they experienced a loss of function, the first person they point the finger at is……the surgeon! I could see the frustration in his face as he must deal with this every day. In the book “Surgery The Ultimate Placebo” by Dr Ian Harris says

kneearticle2“But at the heart of this question is a reflection of society’s overreliance on surgery as the preferred way of fixing the physical breakdowns that occur in our body – we must look at the body like a car in need of a mechanic. And I must admit that it still surprises me when I discover that treating the body like a machine, by removing torn cartilages, repairing torn tendons, unblocking arteries and veins and catching clots in a net, patching holes in the heart, doesn’t work or doesn’t work any better than leaving it to the body to sort it out”.

Surgery or no surgery, the loss of muscle mass due to the injury must be addressed, along with changing of any faulty movement patterns that set the person up for injury in the first place. And this can only be done through a strength training program. Unfortunately it is not a quick fix and takes a long time if you want to do it right. The surgeon was so impressed with my results after only 6 weeks that we exchanged business cards and set up a referral program for him to send patients to me.  More on my program later.

What Type Of Exercise Program Should You Do?

Well this is like asking me “how long is a piece of string”. It would be impossible to give you specific instructions without knowing your exact injury and details about your body. Having said that, here are some guidelines you can follow.

  1. Start with assessing your flexibility and range of motion through all the joints, paying close attention to your hips and ankles as these are often areas that create limited movement and inhibit powerful muscles like the glutes from working.
  2. Learn how to move correctly with squats, lunges and single leg movements. Getting a trainer or therapist again to assess your movement will be needed to help identify weakness or compensation. In this step I also look at improving balance and stability to prepare for the next stage. Strengthening!
  3. Now you are ready for the strength training stage and you can use simple exercises like bridges and clams to start but you must progress to more difficult movements like lunges and single leg squats. If you can master a single leg squat with load, the chances of re-injuring your knee are minimal. This particular exercise is key to preventing the injury in the first place.
  4. Lastly, you must learn how to move quickly which we refer to as power. This is true for older adults as much as an elite athlete. For everyday tasks such as walking up stairs, require a fast timing. Any loss of power results in muscles and joints being overloaded as the timing is all out of sequence. It is in this stage that you can reset your automatic movement patterns permanently. It is also this stage that many people never get to. Which is why the knee is never really ever the same. For examples of specific movements that are often linked to knee injury click here to see a video where we show you good technique versus poor technique.

My specific program included elements from all of these phases. While in pain and with lots of swelling still present I had to focus on getting my range of motion back and getting rid of inflammation. Once this was done I was able to progress quickly through the balance phase. I found that I had developed a compensatory movement in a single leg stance and am still working on changing this. After 9 weeks I am now able to run, jump and complete most activities in the gym setting. I have no pain and my range is about 95% of what it was before. I still have a long way to go but I have not had to change any of my lifestyle other than playing sports. But I know with hard work I can get this back. (If you want to see my full program click here)

Conclusion

To sum up what I think you can guess is quite a passionate topic to me,  far too many people change their lifestyle or rely on medication or surgery to address a problem that really needs an exercise program. The benefits of exercise are more than just removing pain. Improved health, loss of weight, more energy and less stress just to name a few. We must strive to educate more people about the need to address the underlying cause of their injury by implementing a corrective strength program. It does not mean the end of exercising, but actually doing more than ever!

References:
Surgery the Ultimate Placebo by Ian Harris
Understanding & Preventing Non Contact ACL Injuries by Human Kinetics
The ACL Solution by Robert G Marx MD with GretheMykelbust PHD and Brian W. Boyle


Nick Jack is owner of No Regrets Personal Training a Rehabilitation & Sports Training Studio located in Melbourne Australia. Having worked as a Trainer for over 10 years and has qualifications as a CHEK Exercise Coach, CHEK Golf Performance Specialist & Master Rehab Trainer and Twist Conditioning Sports Conditioning coach he specializes in working with rehabilitation and injury prevention programs. You can check out his website at www.noregretspt.com.au

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