How to Cut Your Odds of Future Knee Pain

What if I told you that there was one thing you could do that would cut your odds in half of developing knee pain from osteoarthritis in ten years? Would I have your interest? Would you sit up and listen?

Maybe not if you don't know about knee osteoarthritis which causes your knees to become stiff, achy and painful, but as the Baby Boomer generation reaches middle age and beyond, the number of people at risk for knee osteoarthritis (OA) will rise substantially. And, knee OA, if left unchecked, will dramatically lower your activity level, help you gain weight and generally steal your joy.

Osteoarthritis is classified as a non-inflammatory, degenerative joint disease. But, the classification is a mistake. Because the condition is non-inflammatory, the proper label would be osteoarthrosis ("itis" means inflammation "osis" means abnormal condition). A degenerative condition is one that progressively worsens causing a slow, steady physical decline.  This leads many people to conclude that if the condition is going to worsen over time, there must be nothing you can do about it. Why bother? Well, there is a lot you can do that will give you dramatic results: lose one pound per year over ten years. You will cut your risk of OA by 50%.

Sounds simple enough. One pound per year. To lose just one pound per year, you have to either cut your caloric intake or increase your energy expenditure by just 10 calories per day. By walking for 10 minutes each day, you can easily lose one pound in a year (you'll actually lose more than one pound). But, if it's so simple, why don't more people do it?

Just because something is simple doesn't mean it's easy. Most of us have a well-oiled habit machine that is in high gear by the time we reach thirty years of age. You may be married, have a career and perhaps children. Your day starts the same way, is filled with duties and responsibilities and then ends often the same way. Unless you exert extra psychological and physical energy, the way you spend those days becomes the way you spend your life.

Changing your diet is hard. Changing your physical activity level is hard. Everything is hard...at first. The secret to making substantial changes in your life is to start with small changes. My friend and colleague, Christine Springer once said, "If you want to see a change in your life, you have to make a change in your life". Pick one thing. Try walking once a day for just ten minutes. Write it down on a calendar. And, do this one thing for three months. Just ten minutes per day. After three months, you will have ingrained a new way of doing things in your life (most research on forming or replacing new habits agrees that the critical time frame is three months. Maybe that's why the drop out rate at fitness centers is so high in the first 90 days. People never form the habit of going to the gym). And, you may find that your success in this area leads to a change in your diet (if you would like to learn more about how to use exercise and diet to lose at least one pound per year, click here).

You can do something about your knee pain and greatly reduce you risk of future knee pain. It's simple but not necessarily easy. Lose just one pound per year. I know you can do it. What do you think? Are you ready?

Doug Kelsey
Chief Physical Therapist

PS - Have you checked out Ready Radio, the newest way to get plugged into Sports Center? This is Sports Center's online radio show and podcast where Christine Springer and I share more secrets to rebuilding your body. And it's free! You can go to Ready Radio's website and listen to each episode or you if you use iTunes, you can click here to go our page in iTunes and download the episodes into your mp3 player. Check it out!

PPS - Early registration ends this Wednesday for our next professional seminar, The Shoulder: Rehab for Rotator Cuff Tendinitis, Tendonosis and Repair, coming February 9-10th. Register by Wednesday and save $50. As always, Sports Center graduates get 20% off. Call Angie at 512-206-0433 today to register.

References: Felson DT. Does excess weight cause osteoarthritis and, if so, why? Ann Rheum Dis 1996;55(9):668-70

Comments

[dieting for weddings]

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[rru2s]

Update: HYPEREXTENSION/RANGE OF MOTION: ROM is still 3 degrees less in left leg than right, but does not affect daily activities. No accidental hyperextension incidents in 7 weeks. I am still cautious, for example, I keep my knee slightly bent and PLAN where I step when carrying heavy objects up or down stairs or when carrying a 42 pound child, and protect my knee when playing by keeping it slightly bent so that dogs or children don't run into and push back the kneecap while my leg is fully extended and planted on the ground. Also, careful to not suddenly jump out of bed onto a fully locked knee.

RUNNING PROGRESS/REHAB: The Pose method seems to alleviate knee impact shock very well. It has been almost 3 months since I started, and so far no knee pain related to running. I started with 0.33 mile intervals times 5 sets (1.65 miles per session), and I am now up to 3.2 miles per session, including 2 warm-ups of 0.4 miles and a longer run of 2.4 miles.

WEIGHT LOSS PROGRESS: I am also dropping weight to make running easier on my knees. About 5 years ago when I was racing a dozen times a year I determined my optimum racing weight of 142 to 147 lbs (I am 5' 8 1/2". I haven't raced since 2000, but my weight has varied from 157 to 162 for the last 4 years).

I have always controlled my weight and worked out, but as I get older a slowing metabolism demands tighter dietary regimens.

For many years I have not eaten any desserts or between meal snacks, limited my intake of fried foods and carbohydrates with most meals, and strictly limited breakfast and lunch to a routine.

But I had room for improvement to further control my calorie intake regarding avoiding excessively large dinner portion sizes or second helpings.

Workouts: 300 minutes per week elliptical (5000 calories) plus running (6 to 8 miles per week, 600 to 900 calories).

Eating habits: Breakfast-- 3 slices toast/jelly, plus juice; lunch-- plain bread and 3 slices cheese plus 2 pieces of fruit; dinner-- limit protein plus carbos to one helping of controlled portion size (no heaping platefuls !!!), protein equivalent to 0.5 to 0.7 lbs very lean meat, all fat removed (usually avoid fried foods), ALWAYS large bowl of vegetables or 2 huge salads with vinegar dressing or zero fat dressing, sometimes zero starches or carbohydrates, or otherwise limited to no more than one potato or one hamburger bun. Ater dinner-- only fruit, juices, green tea, or diet soda; Never any dessert or snacks between meals.

This very effective diet is the same one I used when training for races. In 3 weeks I have dropped from 162 lbs (before workout weight) to 159 lbs (before workout weight). Over the next 2.5 months, I plan to drop to 145 to 150 lbs range and keep it there.

I hope to not only decrease my chances of developing knee osteoarthritis but also resume long distance running, despite having had an injury to my lateral meniscus last summer that compromised the shock absorption properties of my knee.

[rru2s]

I'm trying to rehab my knee for a torn lateral meniscus 7.5 months ago. ALMOST there, but here are the problems:
(1) I want to get back to long distance running (for 26 years, I ran 3X week, 10-15 mi. each run.
(2) Since injury, ROM only goes to 2 or 3 degrees, can't fully extend without anterior joint line pain. I keep reinjuring in middle of night about once every couple months, when muscles are relaxed I step out of bed and straighten fully and it hurts the LCL and anterior joint line pinching feeling. Then for next several days it have residual pain deep in knee, tibial plateau where condyle contacts. Also LCL slightly sore.

REHAB SO FAR:
First week after injury: On crutches for displaced tear, severe pain on weight bearing, can't straighten leg beyond 20 degrees, can't go up stairs without crutches.
DID "air bicycles" - simulated bicycle motion, fast RPM, leaning back in plastic chair. Started with 3 min. X 5 sets, 2 sessions/day. Worked up to 60 min. X 1 set every day. Air bicycles effective. Others tried my idea on www.kneeguru.co.uk.

After 5 days, tear went back into place. Could walk pain free but joint capsule weak, LCL hurt. After 14 days started elliptical, 100 minutes per session, 3X per week. Tear would slip out of place and catch once or twice a week for up to 3 weeks post injury.
Worked it back in place by air bicycles.

From week 3 to week 6, only one incident of catching. After 6 weeks, no more catching.
After 4 weeks, used CYBEX ARC TRAINER (front wheel drive elliptical) with 60 percent resistance. On ARC Trainer burn 1600 to 1900 calories in 100 minutes, 3 X week, at 63percent resistance, and 88 to 115 RPM. Continued 60 minutes every other day air bicycles through approximately 6 weeks, then phased out. Started walking short distances (1.5 miles) 3 to 4 times a week, improved gait somewhat.

At 6 weeks, tried to jog 100 feet. Severe pain inside planar contact surfaces of joint.
At 6 weeks, OS read MRI and stated "oblique tear of lateral meniscus." Still had to go down stairs one leg at a time. Gait uneven because ROM only 2 to 3 degrees from fully extended. Quads felt tired from not being able to lock knee extended.

After 3 months, started jogging on treadmill 11 min./mile, 0.3 mi.X 8 sets, 3X week. Plus continued 100 min. elliptical 3X week and walking 1.5 mi. 2 or 3 times week. Jogged ("heel striking") and elliptical for 1 month. No jogging pain. Gait got better, going downstairs easier.

After 4 months, increased jogging to 0.8 mi. X 5 sets, did this two days separated by one day. Didn't feel bad jogging, but afterwards strong achy pain where bones contact (tibial plateau and condyle). Pain continued for 7 to 10 days, moreso when walking. Also, entire joint capsule suddenly felt "loose", less stable.

From month 5 through month 6, gave up jogging for two months, just did elliptical 3X week and walking 2 or 3X week. No pain, ROM same.

Beginning of 7 months, began running by the Pose Method (www.posetech.com), which uses ball-of-foot landing, bent knee landing, forward lean, heel pull-up instead of heel push-off, and rapid cadence, all of which create less shock for the knee. Still doing elliptical Arc Trainer 100 min.3X week, on alternating days doing Pose intervals 0.33 mile X 5 sets, 2 days per week, plus strengthening exercises for calves and Achilles. Cadence 180 strikes/min. and pace 7:30 to 8:00 per mile. No pain running or afterwards during one month (month 7). Quads and calves both feel very strong, very confident. ROM same, but legs strong enough I don't even notice.

Rcently, I got overconfident and careless and hyperextended leg (or actually just extended it fully) in middle of night when muscles were relaxed and I stepped out of bed, felt sharp anterior joint line pinch and pain flash near LCL. Residual pain there for 5 days. Also for 3 days had pain from tibial plateau when walking or standing, so I stopped Pose running for 2 weeks to recover. Continued elliptical.

Ready to restart Pose running again. This time I will be more careful to not hyperextend again, since the knee is susceptible to this setback at odd moments when I am off-guard.