HELP FOR KNEES
Many of the people who come to work with me are having difficulty managing pain and disability from an old injury. Some even have medical issues that date back dozens of years and have lived with their condition for nearly as long. When they finally seek assistance, they are considered a medical exercise client — someone with an injury or condition that was diagnosed and treated more than one year ago. When they call me, their situation is usually somewhat vague. As a Medical Exercise Specialist working with an MES client, my job is to provide the proper sequence and dose of exercise in terms of intensity, duration, frequency and recovery.
Last week I addressed the Primary Medical Exercise Training Conditions (Primary MET) of the shoulder. This week, I’d like to feature the knee.
The screening process that I use with someone complaining of undiagnosed “achy” or “sore” knees includes an assessment of their strength and endurance, both muscular and cardiovascular. In particular, I’ll pay close attention to the muscles that surround the joint itself and help to stabilize it. This would include those in the front of the thighs called the quadriceps and the muscles at the back of the leg called the hamstrings. We’ll also assess flexibility and range of motion and then move on to examine the muscles of the buttocks, hips and calves.
The overriding idea of medical exercise is that it does not “cure” or eliminate a condition like painful knees. Rather, it helps to stabilize the joint as much as possible to allow it to function with as much efficiency and as little stress as possible.
There are two principle MET conditions associated with chronic knee pain. Patella Femoral Syndrome; pain that comes from the contact of the posterior surface of the knee cap rubbing against the femur (thigh bone). The other common MET condition is pain and disability related to the arthritic changes in the knee following a meniscal tear.
From the perspective of an MES, these conditions are managed in very similar ways, focusing primarily on balanced strength, stability and endurance of the surrounding muscles of the thighs.
Here are 4 exercises that can be part of a total fitness plan and can help to manage knee pain.
1. Straight Leg Raises. Lie on your back with one leg bent at the knee and the other leg straight. Tighten the muscles of the thigh of the straight leg and raise it up about 10 inches while maintaining
the contraction. Lower and repeat for the prescribed number of reps, keeping your thigh flexed throughout. Repeat with the other leg. 2. Standing Terminal Knee
Extension. Face a step and place one foot on top of it (6 inches or less). Step up with your other foot onto the step and then lower to the floor with the same foot. Repeat, slowly, for the specified number of repetitions. Note: the foot that starts on top of the step, remains on the step for the entire set before switching and repeating
with the other leg.
3. Mini Wall Squats. Place your back against a wall with your feet 12 to 15 inches from the wall. Lower yourself to 45 degrees of hip flexion. You’ll know that you’re there when you look down and can’t see your toes!
4. Hip Bridges. Lie on the floor with your knees bent. Squeeze the muscles in the buttocks and lift your hips until there is a straight line from your pelvis to your knees. Slowly return to the starting position before repeating.
Perform these exercises 3 or 4 times per week for 10 to 20 repetitions. Start with one set and work up to 3 rounds of all of the moves.
An exercise program designed and supervised by an MES is not meant to replace a thorough evaluation by a physician or licensed physiotherapist. If knee discomfort persists, discontinue the exercises and seek medical attention.