Thursday, May 26, 2011

KNEE HEALTH: How To Keep Your Knees Healthy & Heal Them From Injury

"I just don't want to end up on something that bores the hell out of me. Otherwise, I'll fake a knee injury and get out of there." ~Sasha Alexander

Knee injuries. Unfortunately, something I see a lot of in my practice. Particularly in a town like Bend, OR. Bend has been called "Little Boulder" or "Mammoth North." It is a town full of not just "weekend warriors," but everyday gladiators. Residents make the most of having stellar snow conditions 30 mins. from town in one direction, while having access to "Smith Rock State Park" 30 mins. the other direction. Pulling a "double" or a "triple" is not unusual here. What form can that take the shape of? A morning trail-run, an afternoon climb, and an evening mtn. bike ride. Or...a morning of skiing (or snowboarding), a lunchtime kayak sojourn, and an evening road ride. "Bend-ites," as they're known, push their limits to the max., and love every minute of it.

However, with the local love of the outdoors can come a few "battle wounds" along the way. Knees enable "gnarly turns," steep terrain and downhill scrambling. On occasion, however, they rebel. When they rebel, they tend to rebel with a vengeance, making for a very unhappy patient. You see, when a "Bend-ite" is laid up from doing what s/he loves, lower lips begin to protrude and people get cranky (including their loved ones who have to live with them).

I hear it, week-to-week, in my clinical practice. "But, but...I was just getting on a roll with my training!" My practice is focused on sports medicine, and keeping the good people of Bend alive and kicking, so they can continue getting muddy, wet and bruised up. This makes for a very happy Bend-ite. :)

I have a personal vendetta: to get my patients well. Why? Because many of them are either my athletic inspirations or climbing partners. This means I'm emotionally invested, and actually it feels kind of nice to be. I enjoy seeing my patients run pain-free past me on the trails, or climb on the route next to me on the rock. I enjoy hearing their excitement as they recant a story of "the best mtn. bike ride yet!" This makes me happy. To see humans enjoying the Earth they live on. Living it up to the fullest in the beautiful high-desert.

However, for all of this to occur, knee health is paramount. There is no way around this. Maintenance and prevention are crucial for everyone, but particularly for an athlete. How to do this, though? I will share with you some tips to help keep your knees cruising those trails and hiking those hills with ease.

In Chinese medicine we treat "like with like." This is also a homeopathic approach as well. People take glucosamine, MSM and chondroitin supplements. Want the most bio-assimilable ingredients to help protect and treat your knees? Eat them. Sound strange? Indigenous societies functioned on a premise of zero waste. The entire animal was used from the hunt. Where is all the perfect cartilage, gelatin and collagen found that is specific for knee health? In the knees of the animal. Eat substance from knees to treat your own. Ever wonder why grandma made broth out of knuckle bones? Wonder what those bags of knuckle bones in the freezer section at your grocery store are used for? Bone broth (specifically, knuckle bone broth) has been called "nature's penicillin." It is a powerful nutrient source of the perfect collagen/gelatin/cartilage make-up that is a powerhouse for your knees. No man made supplement, or isolated ingredient will compare.

Traditional Chinese knuckle bone broth with lotus root. A staple in rural Chinese homes

By the way, principles of "Paleo" or "Primal" nutrition are the same for animals as for humans. Feeding your dogs a glucosamine supplement is pretty pointless. You're better off buying a bag of knuckle bones from your local butcher. You get 1/2 and they get 1/2. :) Their bodies (like ours) are governed by the same principles. We readily break down whole food compounds. Not isolate ingredients. Your body knows what to do with a lemon, but ascorbic acid that's been isolated from a lemon? Not so much. To isolate compounds, and extract them from the whole is a new thing in dietary history. Your grandmother ingested cod liver oil. She didn't take synthetic vit. D tablets. Bottom line: if grandma did it, its probably pretty good for you. If a lab made it, steer clear. If you're going to do additional supplementation (& I do suggest athletes do), then make sure what you're ingesting is a whole food based product. Otherwise, you're going to have very colorful, expensive urine that is excreting the majority of what you're hoping to absorb out of the body.

YOGA: Bikram Choudry could be considered a master of "therapeutic" or "medical" yoga. The system of yoga (asanas done in a heated room) is what is done in Ayurvedic hospitals in India. I've done an internship in 2 separate hospitals in India, and witnessed this first-hand. Yoga is their version of physical therapy. In America, we want someone else to stretch us, contort us, and and massage us. Why not take the responsibility of doing it yourself? You will begin to feel as though you're a musician tuning an instrument, and become incredibly self-aware of what your body needs, when it needs it. Rarely do mono-sport athletes take the time to incorporate other forms of fitness into their existing training regime. They want to do what they do best: run, bike, ski, etc. This is nice in theory, but relatively unrealistic if you want any form of longevity to your sport-of-choice training. Yoga must become a non-negotiable in your training, no matter what sport you're into. Stretching is always the element of fitness to go by the wayside, and the most important to maintain. You will be more susceptible to injury without it. Guaranteed. I've seen this, time and time again, in my clinical practice over the years. Want to run longer, faster and farther? Do yoga. Want to cycle those hills with greater efficiency? Do yoga. Want to maintain an injury-free lifting program? Do yoga. Period.

Bikram Choudry demonstrates the "Eagle Pose" (Garurasana), which opens the 14 largest joints of the skeletal system, and is powerful for treating knee pain

Having worked in a physical therapy sports clinic, where the U.S. Snowboard Team receives treatment, I've seen consistently the use of heat and stretching. This is "Bikram Yoga." As Bikram says: "Be your own physical therapist. Don't wait until you need one."

"Fixed Firm Pose" (Supta-Vajrasana) increases circulation to the knees, prevents varicose veins, and improves flexibility of all major lower joints

To stretch ligaments in a non-heated environment can be hazardous, particularly in the winter. When your ligaments and tendons are cold, they're like taught guitar strings. They can snap. They "open" and become more loose with the introduction of heat. You will be able to go deeper into each asana (yoga pose) with the elongation of muscles, ligaments and tendons due to the heat. People say "But can't you overstretch in the heat?" You will begin to become extremely "body aware," just like when you run, lift, climb or bike. You will know when you've reached, as Bikram says "The pain of stretching versus the pain of injury." Like anything active, to "tune out" is not beneficial. Listen to your body, and fine tune it like an instrument. Then you will be in "dialogue" with it, and you will know. In the practice called "Chi Running," this is called "body sense-ing." Which leads us to our next topic...

FORM: The folks that I've treated the most for knee injuries are runners. This is not to say that knee pain will be inevitable for runners. In fact, I believe it can be quite the opposite. This is also not to say that athletes who do other sports don't suffer knee injuries as well. Good form, in any athletic endeavor, is imperative. Again, a non-negotiable. Only recently, in the past few years, have runner's been discussing the importance of good running form. It is an ongoing practice of listening to your body, and "fine tuning" it as you clock the miles. I begin to feel my right knee if my running form is not in alignment. This, for me, is because I'm not engaging into the lean, referred to in good running form practices. We tune our bikes, re-sole our shoes, and wax our skis. Our body is the most important device to maintain proper maintenance of. If you're a runner, this means, not only finding your "sweet spot" running shoe, but diligently practicing a form of running that puts you in proper alignment as well. There are several forms out there that can teach you methods to maintain good running form. "Chi Running" is one, the "POSE Method" is another. There are others that are also beginning to crop up. The bottom line: they all hint at the same thing. Mid-foot (ball of the foot) strike, proper cadence, proper alignment. The way they may teach these things might vary a bit, but they all agree on these general principles. Talk to your local running store about classes they may offer, or local coaches they may suggest, to assist you with good running form.

VERTICAL FUNCTIONAL FITNESS: We live life moving on a horizontal plane. There is an old adage in Ayurvedic medicine: inversions (handstands, etc.) and vertical movement lengthens life. Why might this be? To give a simplistic metaphor, we are like a snow globe. We too need to be "shaken up a bit" from time to time. When we move purely on the horizontal plane, day in and day out, its like the snow gathering at the bottom of the snow globe. The sediment just collects there, and doesn't circulate properly. We are meant to literally "jump for joy!" as humans. Our knees should be as supple as springs in a mattress. Joseph Pilates often referred to this while training trapeze artists and professional ballerinas. "Use your springs!" he would say.

"Jumping For Joy!" is good exercise

Jumping and vertical movement is very strengthening to the knees. It keeps them supple, and the ligaments supporting them very strong. I recommend watching "YouTube" videos of gymnasts who do rebounding (a fancy name for jumping on a trampoline). Their knees are so strong. They have the legs of a speed-skater with the suppleness of a ballet dancer.

Rebounding strengthens your knees

Children intuitively jump on the bed. Parents instinctually bounce their child on their knee. Vertical movement is powerful, like shaking up the contents of a snow globe. Studies reveal it increases circulation, stimulates the lymphatic system (the garbage service for your body), and keeps your knees very strong.

Box-Jumps In "CrossFit"

Jumping on a trampoline (even a mini one), jumping rope, doing box-jumps, or using a jumpboard are all powerful (and FUN!) ways of strengthening your knees. They will begin to feel strong after only 2 weeks of consistent jumping, 3-4x per week. Due to the power of vertical movement, Joseph Pilates created the jumpboard to add to his reformers. They are fun, and intensive to work with. He knew that for his ballerina clients to be able to maintain proper posture and alignment on pointe shoes for hours, that not only was a strong core imperative, but strong knees as well. Hence, the birth of the jumpboard in Pilates.

Pilates Jumpboard

HILLS: The word gives people a sense of dread. People frequently experience knee pain, whether its going up them, or down. This is all the more reason to work on hills. Work in small increments and inclines, if you have a pre-existing knee injury. But do incorporate hill work, slowly but surely. If you need to use trekking poles to assist you then do. But actually going up and down hills will not only engage your core, versus working on a flat surface, but strengthen your knees over time as well.

Hiking hills, up and down, strengthens the knees

ACUPUNCTURE: You change the oil in your car. You get tune-ups for it. Why should your body be at the bottom of the self-maintenance list? Its kind of strange to go in for a "knee massage." That's not to say you can't have your knees massaged by a professional LMT if you're experiencing knee pain, but acupuncture is extremely effective at getting deep into tendons and ligaments surrounding the knee to not only quell existing pain, but to prevent it. Add electro-stimulation to the needles and you have a very powerful treatment indeed. Remember: Oriental medicine is not a medicine for "softies." Its is a viable part of any sports medicine treatment protocol. It really could be considered the world's first sports medicine. Honed, over the centuries, by sparring warrior monks, who suffered myriad injuries and blows, it is truly a cure for knee pain that is unparalleled.

Electro-stim. acupuncture is wonderful for prevention and treatment of knee pain

"Knee replacement is serious stuff. And it actually could have made me worse." ~Lee Majors


  1. Thanks for sending me here Almine! Very helpful! I try to practice yoga but don't keep up with it nearly as much as I should.

  2. Glad you could check out my blog, Niki. I think of yoga to the rest of my exercise regime like coffee to water. For every run, bike, "CrossFit" class or climbing day, I have to do 2 yoga classes. Its my recovery Rx. of choice. ;-}

  3. Thank you for sharing. You have broadened my knowledge. Keep up the good work!

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