Preventing Knee Pain as You Age: Myths, Facts, and Practical Solutions
Our last blog entry focused on ways to optimize the health of our foot and ankle. We listed common injuries that adults should try to avoid, since they are so common and often stubborn to recover from. Those conditions included metatarsalgia, plantar fasciitis and achilles tendinopathy. Moving upward to the knee, it would be wise to try and minimize the chance of common knee conditions that affect aging adults and make every effort to get our knees more athletic as we age. The most common conditions would include osteoarthritis (and degenerative meniscal tears) and patellofemoral pain. But can we prevent these conditions?
A Common Myth
A common myth is that more activity wears down your knees. Many people still believe that marathon running (for example) will wear down the joints, so it isn’t good for your health. Other than extreme cases (like doing numerous ultra marathons each year), this isn’t true. Generally speaking, for most people, running doesn’t increase the likelihood of degenerative arthritis. You won’t wear your knees down. In fact, if done with some proper planning and being aware of how you respond to training, you will more likely keep the joint more capable and athletic, preparing it well for the reduced demands of our day-to-day activities that we enjoy later in life.
Strengthening is Key
Squats, lunges, step-ups, side lunges and split squats are all examples of great strengthening exercises for the knees. Personally, I’m not really picky on what specific exercises people do. I’m more curious as to how that person responds. Will those exercises build strength for that person? Do they like doing those exercises? Are they comfortable doing them? Does the exercise generate any pain or symptoms for that person? There really isn’t one exercise that you “must” do, but if there is, it would be a squat. Squatting is an essential movement for our lives. Getting out of a chair, getting off the toilet and being able to get off the floor all require squatting to some degree. Squatting is functional and a great way to keep the quadriceps and hamstrings strong. Recently, I had a patient in his seventies show me how he can squat all the way down to the ground so that he was sitting on his heels with his feet flat on the ground. Although this is exceptional, being able to squat to ninety degrees and exercise in that range is a reasonable movement goal to maintain as we age.
Delaying Knee Arthritis
Knee arthritis is the primary knee condition to try and delay. The reason I say “delay” is that, technically speaking, knee arthritis will be present in virtually everyone if they live long enough. If we can see some sign of wear and tear on a joint surface (on an x-ray), you have degenerative arthritis. Like a little bit of wear and tear on a relatively new pair of shoes, it doesn’t have to be something to worry about, though and mild to moderate degenerative arthritis isn’t persistently painful for most people. Knee arthritis becomes more concerning when someone is at the extreme end of the degenerative spectrum. In these cases of severe degeneration, joint replacement is a consideration. For most people, though, knee arthritis is something that can be managed through careful exercise, modifying movements and wearing good footwear.
My right knee might be a good way to explain the challenge of knee pain and arthritis as we age. Over the span of my life, I have had three surgeries on my right knee. The first two were to repair meniscal tears and the last one was to try an experimental procedure to address a unique tear of the cartilage on the lateral femoral condyle (the end of my femur). Essentially, this last injury has accelerated the joint degeneration on the outside of my right knee, so I have “early” arthritis on that spot. For a few years, I had to stop running since the joint just couldn’t tolerate it. It would swell and be painful for weeks after only a short shuffle around a track. Over time, however, I have slowly built up its tolerance and I can run 5 kilometres with no pain.
Doing Nothing is Not a Solution
I train soccer with my daughter on a regular basis, mountain bike, snowboard and workout with little to no pain. It would have been a mistake to give up, saying that I have “arthritis” and not exercise. On imaging, the knee still shows a considerable amount of degeneration, but I’ve learned how to manage the symptoms and continue exercising. I’m still working on making the muscles around the joint stronger and I keep the joint flexible. At the same time, I don’t plan on doing any ultra marathons or anything to the extreme. I don’t play soccer any longer because I’ve found that the unpredictable movements irritate it and then prevent me from doing the other things I enjoy. In short, I modified my activities slowly over time, and now I’m back to a reasonable level of exercise that I am happy with. I’ve slowly built capacity for the future in a way that has minimal risk of flare-ups or irritation. This is where practitioners can help. If you have knee pain that is preventing you from running, cycling or strength training, then it might be wise to consult with a suitable practitioner (chiropractor or physiotherapist) who can assist you in building a gradual, progressive plan that gets you not only back to regular exercise, but a program that keeps pushing to make you more athletic as you age.
Our last blog gave us some ideas for the foot and ankle. Balance, strengthening exercises for the muscles in your feet, good footwear and calf strengthening to support your achilles were all recommended ways to build up the area for the future. Adding to that list for the knee, we would consider strengthening of the quadriceps and hamstrings and reminding ourselves that, in general, exercise doesn’t wear down our knees. Doing nothing is not a solution. If your knees are painful, consult with a practitioner who can tailor a specific program to your ability level that allows you to keep healthy for the future.
