The aging athlete and knee pain
The advice I give is mainly for chronic, overuse injuries. Accidents and acute injuries are for orthopedic doctors who do a fantastic job putting you back together after you’ve failed to execute your latest “epic move.” My goal for you all is to understand that you have options for healing yourself, especially chronic issues. No therapy will work if you don’t understand what’s going on. A little effort and education goes a long way.
Knees are affected by structures above and below them. Poor foot mechanics and weak hip muscles are some of the major causes of chronic knee issues that I see on a daily basis.
Poor foot mechanics can mean many things. What I see mostly is duck feet and blown-out arches. Duck feet is when your hamstrings and lower leg muscles are so tight that they are literally rotating your feet outward. This causes stress and pain on the inside of your knee — medial meniscus (the little cartilage shock absorbers between you upper and lower leg bones), medial collateral ligament (MCL helps to hold your upper and lower leg bones together) and all the fascia around these structures.
“Blown-out arches” is not a medical description, but you get the idea. The duck-feet problem is partially to blame for this, but it’s difficult to tell what causes what. Junky footwear, weakness, obesity, walking barefoot on hard surfaces and overuse are some of the causes of arch failure.
Weak hips – It’s “all in the hips” — Knee pain and everything else. Gluteus medius, the upper butt cheek muscle, gets weak and fails to stabilize the knee via the IT band. Your IT band is a long tendon on the side of your leg that allows you to walk upright, among other things. As this structure fails, your quads are forced to take over, which adds even more stress to your knees, especially the inside part of the knee. Then magically, out of thin air, you become diagnosed with a medial meniscus tear or worse, the MCL-ACL double whammy. Again, you can’t prevent accidents, but about half of all injuries are from overuse and improper mechanics, so it pays to minimize mechanical issues.
By the way, please stop foam rolling your IT band for 10 minutes and then forget about everything else. Tendons are white mainly because they have a poor blood supply compared with muscle (red) and because of the cell structure of the tissue. This means that this tissue heals a little more slowly than muscle, and the heavy, blunt, direct pressure (foam rolling) we use for large muscles will not always help. In fact, it often irritates the IT band, making the problem worse.
This is great for my business, but not for your knees. My advice is to fix muscular structures like glute medius and quads with stretching and foam rolling, then see a pro to fix chronic irritation and fraying that happens to the IT band. I would also recommend some better education on foam rolling and self myofascial release. Sometimes we are adding to the problem with good intention.
The fix is easier done than said. Here is a short list of a few things that you can do to help:
Fix 1 – Good footwear: Invest in good shoes. Get some objective advice on this. Your opinion of what is good footwear may be different from what somebody that understands proper mechanics thinks. The most common mistakes I see are: Wearing the wrong shoe for the wrong job, making fashion the priority, wearing high heels, wearing ill-fitting shoes, over-bracing the ankle and foot with braces, and high-top shoes.
Fix 2 – Shoe inserts: If you are already demonstrating mechanical problems with hips, knees, ankles and/or feet, a well-fit insert will help. The majority of mechanical improvement should come from exercise, but inserts give you an advantage. It’s not as simple as arch support or cushioning; the whole footbed should be addressed. Athletes have long worn shoe inserts for a reason.
Fix 3 — Strengthen glutes: Weakness, particularly in glute medius, causes a lot of knee dysfunction because the knee joint must work harder. Kind of like you have to work harder to make up for your co-worker who is texting all day. Strong glutes help in just about every situation. Most people avoid exercises like deep squats to avoid reinjuring their knees. This is a mistake. A good trainer can scale exercises for any ability level or just about every injury. The goal should always be to slowly maximize mobility through intelligent conditioning, otherwise injury will reoccur.
Of course there is much more to fixing chronic knee issues. I’d bore you to death telling you about each one. The point is that you have options. Do something about it while you still have options.
Steve Wells is and aging athlete and personal trainer at Midland Fitness. Feel free to contact Steve with comments, questions, rants, complaints, funny anecdotes or anything else at 945-4440.
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