Getting a Leg Up on Knee Injuries
You see them on racquetball courts and soccer fields, at marathons and on ski slopes--aging athletes wearing high-tech knee braces. A logical question emerges: Does exercise ruin your knees?
Ruined knees are a major concern in our graying society, with the knee now rivaling the back as a prime site of age-associated pain. The largest joint in the body, the knee is also one of the most easily injured, notes the American Academy of Orthopaedic Surgeons, which says that more than 4.1 million people seek medical care each year for a knee problem. A complex joint used for a wide variety of functions--including jumping, kneeling and kicking--the knee has become the most common anatomic area treated by orthopedic surgeons.
Many knee injuries occur during everyday activities, such as slipping on stairs. But some occur during exercise, with certain sports--such as soccer, basketball, skiing and football--harder on the knees than others. Movements associated with knee injury include changing direction quickly, slowing down when running and landing from a jump.
Although running gets a bad rap because it’s a high-impact activity, “running itself isn’t so hard on the knees,” says Ray Stewart, executive director of the Fifty-Plus Fitness Assn., a Menlo Park, Calif.-based organization devoted to research and information about aging and exercise. “But over time, running can bring out structural imperfections that can lead to injury.”
To illustrate his point, Stewart says, “Think of a car with a poorly inflated tire. As you drive the car, the tire will go flat and the car will stop. But driving isn’t the cause of the problem--the flat tire is the cause.”
In a similar manner, running with a structural imbalance--such as uneven legs--over time can lead to knee pain and injury.
“I’m a perfect example,” says Stewart, who started running in his late 40s and ran up to 50 miles a week for nearly 15 years before knee problems stopped him temporarily at age 62. After arthrosconpic surgery to remove damaged cartilage in one of his knees, Stewart had his gait analyzed and discovered that one leg was slightly shorter than the other. With an insert in the shoe of his shorter leg, Stewart started running again at 65. Today, at 72, he runs about 15 miles a week, mostly on a treadmill whose softer surface is easier on his knees.
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Leg-length discrepancies are common, and uncovering them is “a neglected part of most physical exams,” says rheumatologist John Winfield, director of the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill. “Leg-length discrepancy by . . . 1 centimeter or a half-inch can predispose you to osteoarthritis of the knee or hip.”
Just as uneven leg length can, over time, lead to knee problems, any imbalance affecting a joint--including those caused by an injury--can increase the risk of getting osteoarthritis in that joint, noted an article in the September-October issue of Arthritis Today, a publication of the Arthritis Foundation. As aging baby boomers keep playing demanding sports, the article says, “the rise in the number of individuals who will have osteoarthritis because of a sports injury will likely be dramatic.”
But the answer is not quitting sports, since maintaining strength, flexibility and an appropriate weight are essential to healthy knees and a healthy body. Rather, it’s critical to take proper care of any sports injury, rehabilitate it and correct imbalances--with shoe inserts, strengthening exercises and/or stretches--to reduce the risk of future problems.
“Too many people try to run through an injury,” says Perry Esterson, a Vienna, Va., physical therapist and athletic trainer. If you experience a sharp, sustained pain, stop exercising immediately and seek treatment, he says. If you feel a dull, nagging pain, take a few days off and try to figure out the reason. Do you need new shoes? Have you been doing something differently? If the pain doesn’t go away with self treatment--ice, cutting back on workouts--seek professional help.
It’s also important to pick a sport that’s right for your body, says Karl Knopf, president of Fitness Educators of Older Adults Assn., a Sunnyvale-based organization for people involved in senior fitness.
“Some people aren’t biomechanically designed for running,” says Knopf, who notes that people with wide hips or “bowed in” knees are at greater risk of developing knee problems. He offers this advice to keep active knees healthy:
* Never “lock out” your knees; keep them “soft,” or slightly bent.
* Keep the hip, knee and ankle in alignment--don’t bow knees out or in.
* Strengthen muscles that are weak and stretch muscles that are tight to support joints and avoid imbalances. Tight hamstrings and weak quadriceps are often culprits in knee problems.
* Avoid twisting on a planted foot or doing calisthenics--such as full squats or lunges--in which knees extend out over your toes.
* Wear the proper shoe for your sport.
* Maintain an appropriate weight to avoid excess strain on your knees.
* Cross train by alternating activities, such as running and swimming, to reduce the risk of injury from overusing a particular joint.
* Don’t try to play sports to get fit. Older adults, in particular, should get fit to play sports.
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Carol Krucoff writes a column on health and fitness issues for the Washington Post.
