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A Plea For Your Knee

In our physical therapy clinics, we treat patients with knee pain on a daily basis.  It has become more common to train younger clients with a history of knee injury and ongoing knee pain.  Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems.  I have some further suggestions and clarifications.

Less Mass

The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy.  Carrying extra body fat creates an environment that invites knee wear and tear.  The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat.  If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball.  Start with strength training and low impact cardio.  Lose the fat first, and even then, the lower impact activity will be healthier for your knees.  From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest.  I am sorry, but fat loss is primarily a function of dietary alteration.  Exercise has very little impact on body fat levels if you do not eat properly.

Train the Way You Wish to Play

A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity.  The training must be tailored to your activity goals.  If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program.  Yoga will not prepare your knees for tennis.  If you want to water ski, then you must perform strength training for your back, hips, and knees.  Distance running will not prepare your knees for water skiing.  If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion.  Long duration recliner intervals will not prepare your knees for hockey.

Look Above

If your hips do not move well, your knees will pay the price.  In this age of all day sitting and minimal physical activity, hip function is at an all time low.  Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength.  If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement.  Learn how to perform some remedial gluteal activation drills.  Learn a proper hip hinge, squat and a pain free lunge pattern.

Think First

Participation in a single inappropriate activity can produce a lifetime of knee trouble.  That box jump workout of the day- maybe not.  The warrior, electric shock, mud hole, death run–bad idea.  Trampoline with the grandchildren–what were you thinking!

Be Proactive and Seek Treatment For Knee Pain

“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper.  The presence of pain changes the way your brain controls movement.  Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved.  Live with enough cycles of inefficient movement and you develop early breakdown in the knee.

Michael O’Hara, PT, OCS, CSCS

*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017

Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0

Training Modifications That Help With Your Medication

Statin medications are amazingly effective at lowering blood lipids and have, undoubtedly, lengthened lives.  More doctors are recommending their patients start on these drugs at younger ages.  For a long time, we have known that a common side effect of cholesterol lowering statin drugs is severe muscle soreness after exercise.  Recent research on animal models has demonstrated that statin medications inhibit the beneficial muscle adaptations that occur with exercise.  If you are taking a statin drug, take the time to read Gretchen Reynolds’s interesting article in The New York Times, “A Fitness Downside to Statin Drugs?”  Over the years, I have found certain exercise modifications help reduce the muscle soreness symptoms in physical therapy and fitness clients who are taking statins.  The following recommendations may work for you.

Delayed onset muscle soreness is more pronounced with two types of training:  eccentric type muscle contractions (the muscle lengthens against resistance) and deceleration activities (landing from a jump, hop, or stride).  I have found that managing eccentric muscle contractions and reducing deceleration activity allows clients taking statins the ability to perform beneficial training with less discomfort.

Manage Eccentric Muscle Contractions

Eccentric contractions (the muscle lengthens against resistance) create more micro trauma to the muscle fibers, and it takes longer to recover from a bout of training that involves more eccentric repetitions.  Controlled pace, bodybuilding type muscle isolation training delivers eccentric loading in an effort to stimulate a hypertrophy response in the muscle.

Performing isometric strength training (no movement of the joints) completely eliminates the eccentric portion of an exercise.  Sled pulling and pushing has no eccentric component and many statin medicated fitness clients say this fairly intense fitness activity is well tolerated.  A suspension trainer works well to preferentially unload the eccentric portion of a squat or lunge movement pattern.  Strength training with resistance tubing creates an accommodated force curve that reduces eccentric loading of the muscles.  At FFAC, we have a Surge 360 that is a concentric only device that works all directions of a push or pull with no eccentric muscle stress.  A good fitness coach can find multiple ways to reduce the eccentric involvement of an exercise activity.

Reduce Impact

Impact activities produce high intensity, eccentric muscle contractions.  Land from a jump off a box and your quadriceps, hamstrings, and gluteal muscles must create a quick, coordinated contraction that slows your interaction with gravity.  Deceleration eccentric exercises create more muscle damage and repeated deceleration events are notorious for creating higher levels of delayed onset muscle soreness.

If you want to perform “cardio exercise,” choose the elliptical, Ski Erg, or one of the many types of bikes.  If you possess the mobility, use a Concept 2 rower.  Stay away from the impact of treadmill running and avoid jumping rope, jumping jacks, and any activity that involves both feet leaving the ground.  Medicine ball throws can be performed with minimal impact and produce an excellent muscular and neurological training response.  Avoid box jumps, Olympic lifts, and any other activity that creates an impact on your body.

Talk to Your Doctor

I have worked with many people who had a discussion with their doctor and a simple alteration of their statin medication resulted in far fewer side effects.  I am always surprised by how often patients are reluctant to report their symptoms of severe muscle soreness to their physician.

So those are the hints that have come from years of my work with physical therapy patients and fitness clients.  Stay off the wheel and stay healthy.

Read the NY Times article here: https://www.nytimes.com/2017/01/04/well/move/a-fitness-downside-to-statin-drugs.html

-Michael S. O’Hara, P.T., OCS, CSCS

Intensity Know How

Exercise Intensity Is a Mystery For Most Fitness Clients

Cheryl trained in the gym three days a week and went to yoga class twice a week.  At the gym she used the elliptical machine for thirty minutes and did the “ab circuit”.  The yoga classes lasted an hour and she was always very tired after a session.  Despite six months of this program, she had not lost any fat and her blood pressure remained elevated.  After recovering from a heel pain problem, Cheryl began training at Fenton Fitness.  After her first session, it was evident what was stopping Cheryl from reaching her goals.  She had no idea what constitutes effective exercise intensity.

Cheryl’s problem is not an uncommon one.  Many fitness participants overestimate how hard they are exercising.  What they perceive as a moderate or intense work level is actually a low exertion level.  As the body accommodates to the same exercise stress repeated day after day, the intensity level falls even further.  A recent article by Gretchen Reynolds in the June 12, 2014 issue of the New York Times discusses a recent study on the overestimation of exercise intensity.

Many fitness clients and rehab patients are not comfortable with being uncomfortable.  They stop an exercise activity well before they reach a level that will produce a training effect.  They require guidance and reassurance that the feelings they get when heart rate and body heat elevate are normal and necessary.  Heart rate monitors are often the solution for these clients.  Gradually introducing ten second intervals of exercise at 70% of age adjusted maximums on a bike or treadmill followed by a fifty second recovery will get the client accustomed to the feeling of more intense exercise.  Having the client wear a heart rate monitor while walking and monitoring sensation while making an effort to push up the rate with faster paces and uphill walks is effective.

Cheryl felt lightheaded and short of breath during her first five exercise sessions but, after using a heart rate monitor and becoming accustomed to the intensity of each session, she started feeling better.  Four months later, she was able to stop taking one of her blood pressure medications, and she had lost eight pounds.  Cheryl now knows what mild, moderate, and intense exercise sessions feel like and no longer uses her heart rate monitor.

To view the New York Times article, click the link: http://well.blogs.nytimes.com/2014/06/11/judging-badly-how-hard-we-exercise/

Michael O’Hara, P.T., OCS, CSCS

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