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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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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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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Runner's Knee

"Hi Gary
I was hoping you could help me. I did the XYZ Half Marathon last year and I finished it feeling great however I thought I would then go on and help a friend of mine finish the marathon (just the last km) however I suddenly got a bad pain in my left knee – since then I have had physio, acupuncture, pediatrician, I even had my leg measured and found my left leg was 4mm longer than my right leg so I had orthodics put in. I did rest for awhile (about a month) however it seems that when Im running I can get to the 10k mark then the pain starts and gets worse as I go along – going up hill seems to help it but its going down hill or on the straight that it is really bad. The physio said that it was runners knee however not sure what that problem is. The pain seems to start on the outside of my knee then goes further under my kneecap and sometimes above my knee. Im usually sore for the rest of the day and depending how far Ive run it may even be a bit sore the next day. I am trying to strengthen it up at the gym by using weights and sometimes even swimming or cycling to help.

I am at my wits end and I love my running and Im sick of this problem, do you have any other idea as to what my problem could be or what I should try next.
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Gary Moller comments:
You can now see why marathons and 1/2 marathons are a huge windfall for therapists of all persuasions - even pediatricians! The aftermath can be both financially and emotionally expensive.

If the injury is what you have described and what your physiotherapist says, then you have damaged the very delicate under surface of the knee cap. This is not good; but the good news is you will recover – eventually.

First of all, I think you can throw away the orthotics and replace them with a good quality innersole like Formthotics. I have never in 28 years seen an athlete benefit, other than briefly, from these and you are unlikely to be the exception. Your feet are shock absorbers; if they are not allowed to do their job properly, the energy gets transferred further up the legs to structures like the knees. They can actually cause worse problems down the track by accentuating weaknesses and imbalances. You need strong feet - not weak ones. Read the relevant sections about shoes and foot care in here. And do the exercises that you see in the last few pages of the Guide – the ones that stretch and open up the runner’s hips. Do these every time before and after a run. Tight hips throw huge strain on the knees, especially when running downhill. If you have a short leg (most of us do), (or is it a long leg??) the cause is most often in the pelvis and not the leg itself. The attention of a chiropractor might be beneficial along with regular practicing of the hip stretches recommended here. Consider purchasing a new pair of running shoes if the ones you have are worn, or are in any way uncomfortable.

When you go for a run
When you go running, keep the knees warm before, during and after. A long hot bath and a self massage about the knee caps is wonderful and will help healing.

• Stay off hard pavement, especially during winter. Run on trails, that twist and undulate, thus eliminating the relentless pounding monotony of running on pavement.
• Keep close to home by running in circles rather than out and back. Murphy's Law dictates that you will seize at the most remote point far away from Home!
• STOP running before your knee hurts and gradually build minute by minute, run by run no matter how long it takes to fully recover.
• Do not run every day. Have a rest day between runs (rest days can be active - go and swim or lift weights).
• Do fartlek and intervals that stretch, strengthen and get the run over and done with quickly; rather than your runs being a sucession of bland drawn out plods.
• Before you do your next marathon, or anything over 15 km, do a proper buildup of at least 12 weeks, as outlined in our marathon training guide along with plenty of races over short distances no longer than 10km. Join a running club, so you can do their race programme, even if you consider yourself a completly social runner (You will not be alone).

Doing strength work in the gym might help; but you must be very careful with the weights exercises not to stir the injury up. Make sure that you get instruction from an experienced instructor who has the appropriate qualifications. The key is to eliminate ongoing harm and to assist your body’s healing processes - not to stir it up.

You need to do the exercises in here whether you have weak feet or not and take a good, long look at your posture – how you place your feet, how you stand and how you walk and run and sit. If necessary, go do a few sessions with a posture expert like a person qualified in the Alexander Technique.

Go and see a sprint running coach who you can find via your local running club and get some lessons at the running track on doing running drills including bounding. Learn how to run tall, lightly and strong. Even if you consider yourself a social runner, this is one of the best actions any runner can take to have a long, enjoyable and injury-free time running life.

Nutrition to assist the body with healing itself

• Purchase some joint food here and take 6 teaspoons per day until finished.
• Also take 3 teaspoons of this daily until finished.
• And take 2 per day of these until finished.

These will help your body get its healing processes ahead of the ongoing damage that is happening. Take all of these with food and spread throughout the day, rather than all at once.

• Take a course of magnesium – one daily until finished.

Low magnesium may cause the muscles to be slow in relaxing, causing the thighs to pull on the knee cap when they should be relaxed. This is one reason for the painful seizing up towards the end of long, hard runs. Read this latest article on the subject.

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Knee Pain

Mike wrote:
"This product (Nutra-Life Joint Factors 4500 - Ed) has been brilliant. The problem I have is with my left leg, which was twisted in a skiing accident when I was 15. While it always made its presence felt, it only threatened to become incapacitating when I reached about 55. The joint factors has allowed me to keep on exercising as I always have done. I am running up to 50 minutes about twice a week at the moment.

Another thing I have appreciated since your talks at last year at our company is the advice on diet. In particular, the change I made to breakfast (now muesli, fruit and tea only, (except for now and then!)) and stopping taking sugar in coffee and tea, have been very beneficial."
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Gary Moller comments:
Knees, knees, knees - I get so many inquiries about painful knees nowadays! Is it because of the tsunami of active Baby-Boomers now hitting that age when injuries of old are starting to fester their way to the surface? Is it because keyhole ops for niggly knees are flavour of the month? Is it because commonly prescribed medicines for knee pain only deal with symptoms and not the cause? Is it because contract health providers are mostly focussed on outputs rather than outcomes? Or is it all of the above?
The answer is "YES" to the lot!

So, your knee(s) hurt for some reason? If you go to a surgeon, you will be operated on. If you go to a rheumatologist, you will be prescribed a powerful medicine. If you go to a physio, you will be given utra-sound and strange exercises. If you go to an osteopath, you will be massaged and manipulated. If you go to a podiatrist, you will be given $500 orthotics, if you go to a personal trainer, you will do lots of funny exercises and go on a diet. Sounds uncomfortably like a lottery to me, I reckon! Currently, in NZ, if you have a knee problem, you will probably be sent to the surgeon. Heaps and heaps of knee ops are happening.

With the focus on surgical outputs (ie: number of ops performed this year as compared to last year) patients are being recorded as successes whether pain-free post-op or not. There is generally no followup at all once the stitches are out and no way the patient can provide useful feedback to the surgeon and funding agenices - like Mike (above) has provided me several months down the track. This is an extremely unsatisfactory state of affairs: My impression is that there are legions of people out there who are not fully recovered from their knee ops and some are, in fact worse off! But, by all accounts, they are recorded as "successes" of a system that is working well. No proper feedback loop = bad service and much waste.

Body heal thyself
During my training years ago, we were told that joint cartilage is incapable of healing itself. The standard procedure with a cartilage injury was to cut the whole thing out. This was a terrible action, in retrospect, condemning many to plastic joints about now.



What we do know nowadays is that cartilage, even in old age, is capable of self repair. Even in the case of tears (so long as they are small) healing can happen - so long as the joint is protected from further injury and given the right nutrition and exercise to help the healing processes.

Cartilage in mature adults does not have a direct blood supply so it heals poorly when damaged, be that from overuse or direct trauma like twisting the joint while under pressure. But it still is living tissue that is constantly being replaced by new tissue. It will heal with time and the right care. This process of repair relies on the supply of oxygen and nutrients to the cartilage cells and the removal of wastes via the fluid inside the joint called "synovial fluid". This exchange and tissue repair is enhanced by:

• Rhythmic movement of the joint through its full range of movement
• Oscilating compression and decompression of the cartilage
• Keeping the joint warm
• A diet that is rich in the ingredients that build healthy cartilage tissue
• A diet that is rich in anti-oxidants to soak up free radicals before they can harm the healthy cartilage cells
  
• Avoiding medicines, including anti-inflammatories and aspirin, that inhibit cartilage cell activity
  

So, you will gather that dealing with knee pain is not via a single one off solution like surgery or drugs. It is a multi-factorial and long term project.

Repair has to exceed wear

This is the name of the game - the game of life, in fact: even several hours after you die, tiny cartilage cells are still beavering away building new tissue to replace the stuff that you have damaged through sport and normal activities of life. While you still breathe, you must do everything to assist these busy little fellas with their job of keeping you mobile and upright. This consists of:

• Minimising harm by avoiding excess wear and injury
• Giving sufficient time for repair and healing before the next assault
• Ensuring optimum nutrition and circulation for joint health
• Doing full range joint movement to spread the synovial fluid, thus aiding nutrient exchange

So, here is a list of what you can do for joint health:

• If you statically stand or sit for long periods at work, break these up at every opportunity by striding about, lying down, sitting, pulling knees to chest, jogging and squatting. Wear shock absorbing shoes, fit quality inner soles. If surfaces are hard, get soft non-slip matting fitted
• Take the joints frequently through their full range of motion. For the knees; try repeatedly pulling the knee to the chest, then extending fully, tensing the thigh hard. This can be done sitting, standing or lying on one's back
• Keep the knees warm in cold weather by heating the room and wearing warm leggings when exercising. A long hot bath does wonders for aching joints
• If you do a really punishing thing like running a marathon, rest 5-10 days after and do not repeat this kind of abuse for at least another 3-6 months. Read our Guide to Running a Marathon
• Do aqua-jogging once or twice a week the way recommended here
• Add a machine-based Pilates session once or twice a week to your exercise programme. This will strengthen the muscles that support your joints as well as taking them through their full range of motion
• If you are over the age of 35 or have ever had surgery on a knee, consider taking a quality formulation of glucosamine and chondroitin (joint food). This supplies the nutritional substrate for healthy joint tissue. Take the maximum recommended dose for at least 3 months before easing off regardless of whether or not any benefit is noticed
• Take a multi vitamin, anti-oxidant and multi-mineral with the joint food, including vitamin C (A quality joint food formulation will also contain some of these essential vitamins and minerals)
• Take fish oil, flax seed oil and cook using a quality olive oil. These improve circulation, are essential for healthy joint collagen and have a mild anti-inflammatory effect. They might even help lubricate the joints
• If you are carrying excess body weight, gradually lose it over several months through exercise and healthy eating
• If you get knee pain from activities like cycling and running, your style or setup might be faulty. Get it checked by an expert.
• Feet are a common cause of knee pain. Read this e-Pub about the subject
• If you are diabetic, ensure the condition is absolutely optimally managed
• Only take anti-inflammatories, including aspirin if absolutely necessary (I'll write about this matter including non-drugs pain management measures in a future article)
• Do not have cortisone injections into joints. Read this article about this subject
  

On the question of joint surgery: If you are earmarked for an op or have been advised to have one, you are welcome to give me a call to discuss this and possible options. While I do recommend the surgical option now and then, there are many cases where this option has been prematurely exercised. Surgery does not always work out over the long run and may compromise the benefits of more conservative measures like nutrition and exercise.

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