Prepare for Spring Exercising

by Dr. Rob Jones
March 2009

Dr. Rob Jones

A recent weekend provided a glimpse of spring weather, and people were outside exercising in droves. As I moved through various parts of the city during my long run, I saw bikers, walkers, and joggers. But it takes more than just a good pair of shoes. Healthy knees are crucial if one is to continue exercising on a regular basis, with minimal pain and avoiding damage. Approximately 30 to 60 percent of runners will experience an injury over a year and almost 50 percent of those injuries will involve the knee and its surrounding tissue. Brian Halpern, M.D. author of The Knee Crisis Handbook is a sports injury specialist in New York and says we’re in a "knee crisis. After surveying over 15,000 households, the knee was the number one body part injured in sports. That said, trainers, coaches and fitness experts all recommend regular walking as a great exercise routine. Runner’s World says, "A long term study of the 50+ Runners Association of Stanford University has revealed that its 70, 80, and 90 year old members have few arthritis and joint pains, fewer than non-runners, in fact."

Let’s start at the bottom — your shoes. Most experts recommend changing your shoes every 300-500 miles, as the integrity of the shoes break down and provide less protection for the foot. Are your feet flat, high or low arches, rigid or flexible, pronating or supinating? Most of these issues can be addressed with the proper shoe and occasionally an off the shelf or custom insert. A high arched foot is typically more rigid and less flexible. A neutral cushioned shoe will provide maximum mid foot cushioning and therefore less impact on your knees, hips, and back. For those whose arches are low and pronate, (heel/foot rolls inward), a motion control or stability shoe will suit their needs best. Consult runnersworld.com and look at reviews and their shoe-buying guide. The proper shoe cannot be underestimated.

The burning, aching pain in the front of the knee is called Anterior Knee Pain or Patella-Femoral Syndrome. Many runners I see in the office have weak legs. Sure, they can run or walk forever but that suggests endurance, not strength. Are the quads much weaker than the hamstrings? The VMO (vastus medialis oblique) is many times the culprit. This is the small tear-dropped muscle just above and inside of the patella (knee cap). This muscle is important in helping the patella track properly in the grove of the thighbone. When the patella tracks improperly it’s similar to driving with your tires out of line. Over time the treads (cartilage behind the patella) will begin to wear unevenly and the result is knee pain. Targeted exercises along with proper shoes decrease knee pain by 50 percent in one study.

Another very common cause of pain is Iliotibial Band Syndrome (ITBS). The iliotibial band is a thick band of tissue that extends from the outside of the hip to the outside of the knee. When the band is tight, there is increased friction and irritation over the outside of the knee joint. The most common causes are an increase in mileage, mechanical problems with the running gait, leg length discrepancies, and/or bowlegs. Treatments consist of icing, proper footwear, stretching and addressing any mechanical issues. Cortisone injections are sometimes helpful and surgery is extremely rare.

Soft tissue structures around the knee that cause pain do not cause fluid to build up in the knee joint — "water on the knee." If a runner/walker is experiencing fluid build up after exercise, the source of this inflammatory fluid is a cartilage issue until proven otherwise. If after a period of rest the swelling returns, it is unwise to continue exercising. The meniscus or shock absorbers could be torn. The cartilage-coating surface that provides a smooth surface on the ends of the femur, tibia or patella could be damaged. If the cartilage is frayed, torn, hinged or even loose, the damage could be worsened if one continues to engage in weight bearing exercise like running or walking. A medical professional can assist in determining the cause.

Spring is around the corner. Make a commitment to begin an exercise program. Try the following:

• Begin with the proper shoes
• Begin the day with proper stretching and strengthening
• Don’t neglect core strengthening
• At the onset of pain, stop running/walking for several days
• Ice several times a day/wrap with an Ace bandage
• Take an over the counter anti-inflammatory for a week if you are able
• Cross train if you’re able (cycle, swim, yoga, elliptical, etc.)
• If the pain persists and prevents you from returning, seek out proper medical care.

Robert G. Jones, M.D., owner of Impact Orthopaedics in Raleigh (919.876.6755, impactorthopaedics.com), is a Baby Boomer and has qualified for the Boston Marathon this year. Dr. Jones is a seasoned athlete who practices what he preaches