Waiting too long a pain in the knee
Posted on Monday, June 30, 2008
After years of skiing, hiking, biking and tennis, Ann Dickerson knew the pain in her knees meant she needed treatment. But she didn’t expect the doctor to tell her she needed partial joint replacements.
Like the more than 20 million people a year who visit a physician because of knee problems, Dickerson learned that she should have come in sooner.
Experts say that had she worked on preventing problems by following a plan for overall strengthening, flexibility and conditioning, her story might be different.
Dickerson, a senior counselor at a public relations firm in Denver, thought she was helping her knees during her avid cycling through the Rocky Mountain foothills. But her physical therapist said she overworked some muscles, such as her calves, and neglected others required for the full range of movement.
“You don’t have much control over what happens during an injury,” says Dr. Richard Steadman, an orthopedic surgeon specializing in knee injuries at Steadman Hawkins Clinics, which has its headquarters in Vail, Colo. “But you can do things to prevent the injury.” The first line of defense is to maintain flexibility and a good range of motion, Steadman says. The muscles that go across the knee have a stabilizing effect. Keeping them strong and functioning smoothly keeps the joint safe. “Aim for good strength in the thigh muscle in the front and back of the femur to protect the ligaments that guide the kneecaps.” Biking up and down hills, longer durations on elliptical machines and walking uphill on a treadmill are good strengthening choices for healthy people. But injured patients should concentrate on protecting the joint and strengthening the surrounding area. Cycling, uphill walking, elliptical training and squats are beneficial; just be careful not to extend the knee beyond the toes.
It is also important to vary the activity. For instance, a lifelong runner is far more at risk of premature knee wear than a person who runs, bikes and skis, says Andy Pruitt, director of the Boulder (Colo. ) Center for Sports Medicine. “Shared stresses are the key to knee health,” Pruitt says.
Physical therapist Pete Sanzio of Performance Health Technologies in New Jersey recommends doing squats and lateral lunges to strengthen hip-abductor muscles. But he cautions that knee pain could be a symptom of an underlying movement problem.
“What we find is the problem is really coming from a bad hip or ankle,” Sanzio says. “The knee hurts because it has to compensate.” You can have great mobility but lack strength and get hurt, he says. Or you can have super strength and lack flexibility and get hurt.
“Finding out the right combination of limb control will help you prevent injury and excel at the sport you want to play,” Sanzio says.
Another nonsurgical method involves biomechanical movement training. Research suggests that more women than men have problems with sore kneecaps, an ailment called patellofemoral pain syndrome, says John Martin, international business manager at DJO, one of the country’s largest knee bracing companies.
Women tend to land more straight-legged when stopping, pivoting and jumping in sports such as basketball, volleyball and skiing. The force of the straightlegged landings causes the tibia to shear forward, rupturing the anterior cruciate ligament, or ACL.
“Through biomechanical training, we can train athletes how to land by wearing a force point brace that causes the knee to be slightly flexed during activity,” Martin says.
Sometimes surgery is the best option. A traditional knee replacement that uses metal and plastic for joint reconstruction is a valid choice for older patients, Dr. Wayne Gersoff says. But because those artificial joints last for only 10 to 15 years, the procedure wouldn’t be a good option for young patients.
A new treatment called “biological knee replacement” preserves the knee longer. It involves using a paste of natural tissues to regrow the surface of the articular cartilage. Many patients who undergo this procedure often have a concurrent treatment that replaces the meniscus with one transplanted from a cadaver donor.
Gersoff performs biological knee replacements, but he says few patients are good candidates for them. The procedure is difficult for patients whose knees are bowed or who already have bone grinding on bone.
“But if you are a candidate, no words can describe what it’s like,” says former World Cup free skier champion Alison Gannett, 43, of Crested Butte, Colo. She qualified for the procedure three years ago and says she is “pain-free for the first time in eight years” after having already undergone seven previous surgeries to repair torn ACLs and worn-away cartilage.
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