Please help! I have injured my knee!

"Hi Gary Me again! My old knee injury (sprained or damage to the anterior cruciate ligament & medial collateral ligament) appears to have flared up so was wondering if you could recommend anything to help with the inflammation? and whether you think i should go back to physio?

It is pretty minor compared to what i experienced years ago & was at its worst on Monday but has calmed down a bit thanks to wearing a stocking all day/night. The inside of my knee seems a little swollen & it feels tight at the back to the point that it is hard to completely straighten or kneel. I could still run quite happily on Tuesday but after realising my knee was a bit swollen have decided to stop until its back to normal. In terms of the cause I am not sure as have not had a sprain as such. However, my knee did start to 'click' a lot more (& is clicking quite a bit now) when I started to do single leg extensions where my leg/knee is at a 90degree (sitting on a gym machine) & I lift a 5kg weight with toe slightly pointed out.

This exercise is part of the program that my trainer at the gym (Chek Practitioner with Diplomas in Rehabilitation & in Sports Medicine from Otago Uni) designed & apparently works to strengthen the inside of my knee. She also just started me on a new exercise with the swiss ball where my torso is on the ground but lifted up in the 'bridging' position & my calves are on the swiss ball & i have to lift one leg up at a time & hold it for 5 seconds so as to apparently strengthen my core, butt & hamstring. i have found this exercise really hard & pretty much strain the balancing leg so i can keep the lifted leg up in the air.

The trainer is convinced that these exercises could not have caused my knee to flare up unless i was incorrect in my technique & suggested it might be a hamstring insertion (whatever that is!)& thought i should try antiflam cream & seeing a physio in a few days if it had not self-corrected. but as she has overrided my old physio exercises & your advice to do 1/4 squats (she got me doing full squats with minimal weight)

I'm now confused as don't know if i can trust that she knows what she's talking about or who i should ask....except you! all i know is that my knee has been fine for the past 5 years & now its not!

Pretty gutted as i ran 9k for the first time in 5 1/2 years last week! any suggestions would be greatly appreciated."
"R"
Gary Moller comments:
"R", The swelling is telling you that your knee has been injured somehow and the swelling is your body's way of restricting movement.

Knowing your history of knee injury, it is possible that the damage to your knee ligaments previously and possibly to the knee cartilage makes the joint vulnerable to further damage.

It is possible that some of the exercises that you describe doing could have irritated the knee joint.

Your anterior cruciate prevents forwardsliding of the tibia on the femur, especially when the large quadriceps contract. The medial ligament prevents the knee from buckling inwards. Between all of them, the ligaments hold the knee joint snug and secure. The articular cartilages form a shock absorbing dish between the bones of the knee joint (tibia and the femur). It is possible that you damaged one or two of these cartilages when you sprained your ligaments.

When you are doing any kind of strengthening exercises using the big thigh muscles you should be weight bearing. This is because the knee bones are held firmly in place in the dished cartilages. If you do leg exercises such as leg extensions on a leg extension weight machine, the lower leg will be hanging free, gapping the joint and throwing stress on already damaged or stretched ligaments. The joint cartilage is vulnerable to further damage as the joint is gapped and twisted.

I would be very careful of the Swiss Ball bridging exercise that you describe because the knee could gap and twist. If you want to work the hamstring and butt, do standing dead-lifts with a barbell or dumbells; but make sure you get expert instruction in safe technique, lest you do your back in!

Stick to weight-bearing exercises such as squats and never go beyond right angle knee bends when under pressure. Deep knee bends may strain the ligaments and pinch the cartilages. The best machine in the gym for you for strengthening the quads is the incline leg press. Avoid the hack squat, including wall squats with a Swiss Ball behind your back. These throw excess strain on the front portions of the knee, including the undersides of the kneecaps. You don't need this.

Always get professional instruction by a weights expert and review your technique regularly.

Ice may help with the swelling but I am not a fan of it. Elevation, plus rhythmic exercise is best. Massage the knee, thigh and calf.

Exercise in warm water to manage swelling and to maintain strength, endurance and flexibility.

Take a glucosamine and chondroitin formulation and MSM and take generous doses for as long as there is pain and swelling. Use these in preference to pain killers and anti-inflammatories. Add 2,000mg of vitamin C per day. Copious amounts of fish and flax oil and especially Evening Primrose Oil have natural anti inflammatory qualities while not compromising healing. These natural supplements will assist healing. Continue normal doses for at least three months after the knee has settled.

Contact me if the knee does not settle significantly by next week.

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Will glucosamine & chondroitin assist an athlete with a bulging disc?

Hi gary
I'm an athlete and have a bulging or herniated disc. Are there any supplements I can take to help heal the disc? I was thinking glucosamine and chondroitin with high strength fish and msm, if so in what amounts? Thank you for any help Paul
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Gary Moller comments:
I always wondered myself if joint food preparations containing glucosamine and chondroitin were of any benefit for a herniated lumbar disc. After all, the joints of the spine are exactly that: joints. The only difference between them and, say the knee joints, is they are semi mobile with a thick fibrous outer sheath and a gel-like internal that provides shock absorption and flexing, extending, gliding and twisting. The physiology is the same, including the reliance on movement for nourishment. There are other joints in the spine: small articular joints of the spinous processes which can become worn and inflamed.

Chondroitin may assist with manitaining hydration of the spinal discs which tend to dry out as we get older and with damage such as suffered by Paul.

Several years ago I was working with a retired shearer who had had two spinal operations over the years, including a spinal fusion of L-4/L-5. He was suffering repeated severe bouts of back pain that had him buckled and bent to one side in spasms. After about a year of these disabling episodes, I suggested he try a course of Nutra-Life Glucosamine and Chondroitin which he dissolved in a drink bottle and sipped throughout the day having a steady infusion of about 8 rounded teaspoons per day.

To his and our immense delight, his back pain eased almost completely within about three months and I can report that he has not looked back since, despite suffering other though unrelated health problems since. I often recommend glucosamine and chondroitin - plus MSM for back pain nowadays and the results are generally very positive. It is a harmless and relatively cheap therapy. Even if there is no obvious benefit for the spine, at least the person is ensuring other joints like knees and hips are kept in good nick. After all, back problems can cause extra strain to go on these other hard working joints and the last thing a person with back pain needs is a crook knee!

So, I have no hesitation in recommending glucosamine and chondroitin preparations such as Nutra-Life Joint Food for back pain. I would add some MSM, preferably separately such as Kordel's MSM. MSM has a natural anti inflammatory effect and builds healthy collagen such as found in skin, hair, nails, ligaments and joint cartilage. An athlete can take extra a few days before, during and after anticipated extreme exercise and competition to aid recovery and healing.

How much should one take for a bulging disc? I recommend taking between 1500 and 3,000mg of glucosamine per day, spread through the day for about three months before backing off to a sustenance dose of about 1,000-1,500 per day. Doses of chondroitin are generally a few hundred mg less per day. MSM can be taken at about 2,000mg per day and then drop back to about 1,000mg after three months.

Once the three months are up, the idea is to fall into sustenance mode and step up the amounts around anticipated periods of stress or when pain is felt. After several months, relax and take some here and some there. I personally go in fits and starts with all supplements just for the sake of it.

Finally, exercise is essential for management of a bulging disc beginning with ensuring that the hips are strong and flexible. My book on Back Pain is a good start for exercises. If your hips are tight, then the stress of athletic exertion is transferred excessively onto the lumbar spine, so ensure you work on the hips. All the core exercise under the sun will be of no avail if the hips are tight and weak.

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What kind of joint food preparation should I take following knee surgery?

"Gday Gary, I just watched the video on your website as to which glucosamine supplement to take, but I am still a little confused.
I am 22 and have had a knee reconstruction. I just recently had a meniscus repair operation on the same knee, and was told that my articular cartilage is beginning to wear out.
I was thinking about taking the Balance joint food for athletes supplement, to possible help aid my cartilage in regaining some strength, however I am worried about the low levels of chondroitin present. Is this the supplement I should take , ore one of the other ones? \
I appreciate your help with my situation. "
Garry

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Gary Moller comments:

Garry, I appreciate the situation you are in, having had two major knee ops myself in my 20’ s and facing the prospect of early arthritis. Fortunately, a sensible approach to exercise and the use of good nutrition means the prospect of arthritis seems further away than it was 10 years ago.

I recommend that you use the straight Nutra-Life Joint Food because it is high in Glucosamine which will help cartilage repair. Because you are still young, you do not need huge amounts of Chondroitin which hydrates the cartilage.

You need lots of MSM. MSM is highly beneficial for cartilage repair as well as being surprisingly effective for managing joint inflammation and pain. Kordels MSM provides a pure and cost-effective source of MSM.

The combination of all three nutrients (MSM, Glucosamine and Chondroitin) gives a powerful nutritional effect on that damaged knee joint of yours. I recommend that you commence by taking 6 rounded teaspoons per day of Joint Food and three capsules daily of MSM for the first three months, then lower to the recommended levels on the label thereafter. Boost the dosages of both at any time if there is any joint pain or swelling.

Take extra of both around periods that you know will be throwing extra stress on the joint, such as when doing competitive sport or a long hike with a back pack. I would commence these two days before the anticipated stress and strain and continue the regime for about three days afterwards to aid a full recovery.

While Nutra-Life Joint Food contains generous amounts of vitamin C, a total of 2,000mg per day or more may assist joint health.

If your knee flares up or hurts for any reason, then take extra MSM (up to 4 capsules per day) for 3-4 days along with extra Joint Food (six teaspoons per day). By having the MSM separate you can better use it for managing any episodes of joint pain and inflammation.

Always take these nutritional supplements with food, spread them over the day and never use as a substitute for quality food.

Here are the links to the products. Delivery is usually within a week to Australia.
Kordel's MSM

Nutra-Life Joint Food

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Which Joint food formulation is the best one for you?

In this video, I explain the differences between the three commonly available glucosamine and chondroiting joint food powder formulations.

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Walking a marathon, rheumatoid arthritis and glucosamine

I would like to walk the Rotorua Marathon in 2008, and am trying to find some training advice. I notice that you have free on-line training for a marathon which just seems to be for runners, and I wonder if there is anything more specific for walkers.

I'm almost 62 and started walking when I gave up smoking some 6 years ago. At first I just did it to get fit, but then I started entering events - have done the Wellington Round the Bays a couple of times, and the Waitarere Great Forest walk most every year since 2002, initially just the 10 km event, but did my first half marathon in 2005. I've also done the Harbour Capital half marathon, and generally I've completed in under 3 hours, fastest one was around 2hr 53 min.

I had a bit of a set back towards the end of 2006 when I developed rheumatoid arthritis, and for a while I thought I would never be able to walk any distances again. However, it is now under control and I'm back out there again - did 10k Forest Walk last week in 1 hr 33 min so think I'm getting better again. I hope to do the Harbour Capital half marathon distance in June, and then would like to start thinking about doing a full marathon, and especially the Rotorua Marathon in April.

I don't belong to a club, and have used the training schedule on the Harbour Capital web site to prepare myself for doing the half marathons. However, I think I probably need a bit more help with training for a marathon, not just the schedule, but also some ideas about nutrition, and any tips that might help, both in building up fitness and during the event.

If you don't have specific training advice for walkers I wonder if you can point me in the direction of where I might find some.

....................... At the moment I'm taking methotrexate - 7 x 2.5mg tablets once a week, plus 1 folic acid 5mg tablet two day prior.



When my symptoms first started to appear, my doctor gave me synflex and referred me to the Rheumatology clinic at XXXXX. After quite a wait to get an appointment the doctor I saw there gave me diclofenac and referred me for more test (xrays, bloodtests) before he would make a diagnosis. In January when my symptoms had worsened to the extent that I could hardly walk due to pain in my feet and knees, and was also having difficulty with my hands, I finally went private and saw ......... He diagnosed rheumatoid arthritis and put me on a course of prednizone plus the methotrexate (5 x 2.5mg). The prednizone was like a miracle and within a fairly short time, the pain was gone and I was almost functioning normally again. I finished the prednizone around the 6th March and am now just on the methotrexate. When I saw Dr XXXX again early in April he felt that my arthritis was not as well controlled as he would like and so increased the methotrexate.

As far as any other medication is concerned, I took glucosamine tablets, and Omega 3 Fish Oil for a while, stopped the Glucosamine when Dr XXXXX didn't support it as being of any value, but continued with the fish oil which he said research supports as being beneficial for rheumatoid arthritis sufferers. I sometimes take Codalgin if I've been doing a bit much and find my feet or hands are a bit sore.



Once the pain was more under control I started back walking again, just taking it fairly easy, and also doing a bit of bike riding, as I found this was less stressful on my feet and legs. However, I have gradually increased my walking and have done two 10 km walks now - the Waitarere Forest walk on 31 March (where I managed the 10 kms in 1 hr 33 mins), and the Moonshine Walk on 15 April (did this 10 km in 1 hr 26 mins). I try and walk two or three times a week, using some of the training programes that I've found on the Harbour Capital Marathon web site, and am thinking of building up my training again to do their 1/2 marathon in June.

Dr XXXX has said increasing my walking again is fine as long as I don't overdo it, and ease up if I get more pain at any time. And so, I'm still keen to try and do a full marathon, and this was what led me to contacting you after I found your training for runners, when I was looking for some infromation about walking training for walking on the Rotorua Marathon web site.

I still intend to go and see my GP Dr XXXXX to see about getting my vitamin D levels checked as you recommended, and will let you know the results of this.

Regards
"C"

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Feedback from a Happy Camper

"Hi Gary. My husband and myself have been taking your Joint Factors 4500 for several months now, and I wanted to tell you how thrilled we are with the results. I did have just a twinge of pain in my knees when climbing up steps before taking it but now I have no pain at all. I have told lots of friends about it, Its easy to recommend something that you know really works. I would advise anyone to give it a try. We certainly have no regrets and will continue to take it on a regular basis.

Wishing you a Merry Christmas and all good wishes for the New Year

Kind regards. "
"M"
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Gary Moller comments:
It is always good to get feedback from people and to learn what works and what doesn't. If you go onto any website of the services of private hospitals that do Government contract surgery and look at the specialities of the surgeons, you will see that it is wall-to wall hip and knee replacements.

While many of these operations are undoubtedly necessary, my experience is that the surgical option is exercised far too early in many cases. Furthermore, the non-surgical options for preventing or slowing progression of arthritic conditions through diet, supplements, exercise and modifying lifestyle receives little more than passing reference.



These people are production lined through and there is little post surgical attention beyond restoring basic mobility, aided by a heap of medication in many cases. This is unsatisfactory because incomplete rehabiliation eventually results in further medical interventions being required later on. Once on the medical conveyor belt it is difficult to get off and that conveyor takes you down - not up.

The money is in the surgery - not in the prevention, or the post operation management.

Here is the direct link to joint support products.

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Don't sit up straight - its bad for your back

"It seems that sitting up straight, something many of us are taught from a very early age, is not good for your back, say researchers from Scotland and Canada. They found that sitting up straight strains your back unnecessarily. Ideally, you should lean slightly back, at an angle of about 135 degrees, they say".
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Gary Moller Comments:
The spine is made up of a complex series of muscles, ligaments, bones and fibrous joints. The joints have a poor blood supply. The joints rely on movement to squeeze nutrient-rich fluid into the tissues while removing the metabolic toxins. Lack of movement causes pain and stiffness by a buildup of toxins that swell the intervertebral disc. Without movement, the joints gradually degrade, stiffen and weaken over time and may open the way to chronic and sometimes catastrophic back problems. This is why any form of exercise tends to give some relief for back pain sufferers.

Sitting is worst because the protective abdominals relax within seconds of sitting. Standing is a little better; walking is good as is jogging - so long as these are coupled with various toning and mobility exercises.

Like other joints, I have found that including Joint Food in the diet can give lasting relief to back pain. The nutritional needs of the spinal joints are probably more important than joints like the knees because of their poor circulation.

I have published a book on back pain which has practical advice for prevention, treatment and recovery; including a series of exercises.

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Link

Does glucosamine and chondroitin work for runners?

Glucosamine assists the repair of worn or damaged cartilage while chondroitin assists the hydration of cartilage, thus improving shock absorption and reducing wear and risk of injury. Their actions are supported by a growing body of research and the experiences of clinicians, including vets.These substances are best taken with various other nutritional co-factors, including MSM, copper and vitamin C which are beneficial to joint health. Many formulations, including the two listed here have these additional nutrients in them.

The benefits may be noticed within days, but it is usual to undergo a course of supplementation taking the maximum dose daily over a 3 month period before easing off. As with most nutritional strategies to maintain health and to be inury free, the effects are subtle to the point of being impossible to measure. In answer to queries about benefits for connective tissue other than joints: the answer is "Yes". they are beneficial for tendons and even the skin, nails and hair.



Should a runner take them? My recommendation is to do so if you are over the age of 35, or have had a history of joint problems or injury, a family history of arthritis, if you are in a job that is stressful on your joints or if you are doing particularly heavy training or intense competition - or all of these!

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