Personal Finance

Ignore that knee pain during workouts at your own peril

knee

Before we talk about knee pain and one of the most common overuse type injuries: cartilage and meniscal issues let us first define and highlight the role of menisci.

Put simply, cartilage is a thin, elastic tissue that protects the bone and helps joint surfaces slide easily over each other. It comes in two forms:

•Articular (joint) cartilage, which covers the surfaces of the knee joints

•Hyaline (meniscus) cartilage, which sits in two distinct thickened, disc-like shapes within the tibio-femoral joint. This acts as a shock absorber providing structural integrity and spreading load.

In addition, the meniscus have an important proprioceptive role, providing lots of functional joint stability feedback.

Various factors affect how well the meniscus and cartilage function. Anything from foot or knee position, your stance and posture or what sport you are doing through to your age, weight or previous injury…the list goes on.

Because Cross Fitters, athletes, yogis and gym goers come in all shapes and sizes and often carry previous injuries, it is quite possible that your knee pain is from damaged cartilage in a past injury from playing sports. This can be fairly insignificant and heal quickly. Larger trauma like fractures and tendon or ligament injuries can cause meniscal damage, but may be a less significant problem at the time. However, minor these injuries may seem, they do add up over time.

Unfortunately, like any machine, the joints of the human body are subject to wear and tear simply through the numbers of repetitions performed.

Just like a mechanical component, if something is off line it will cause an unequal pattern or wear. In the same way, poor technique when doing squats, lunges, jumps, dead lifts etc can create that same wear on the meniscus. Over time this leads to a learned dysfunction and then inevitably to pain!

Trainers, physical therapists and class teachers consistently drill about technique when performing complex movement. Their aim is that we carry on this correct form into our capacity work, strength training and most importantly during sport or competition. Unfortunately for many people with injuries, usually they can pinpoint the start of their problem back to an intense training session or sporting incident.

When we fatigue, our form lapses and injuries can happen. Continued poor mechanics and pain lead to further ‘shearing’ of the articular surfaces (this can go down to the bone) and meniscal tears.

The menisci are relatively avascular (lack of blood vessels) therefore it is thought they do not repair and regenerate very well (with the exception of the outer rim) – another reason why careful attention to pain and symptoms is recommended!

If you suffer with any of the following symptoms, it may be worth getting your physical therapist to take a look at your knee:

•Locking or popping of the knee

•Instability of the knee

•Persistent swelling-exercise or activity related

•Pain or inability to fully squat (sit on heels)

•Pain/pinching with your leg fully extended

•Pain on twisting, turning or change of direction

What can you do?

•Work out what movements/exercises cause problems and try to correct faults

•Talk to the trainers and get others to watch you perform movements

•Do not ‘bounce’ on your knees during movements or reps! We are all looking for a nice deep squat below 90 degrees but you must maintain muscular control through the full range

•Look at your alignment with all knee movements-is left the same as right? If not, why?

•Wear the correct footwear! There are adequate training shoes in the market! Do you over pronate (feet turning inwards) or under pronate, and does it worsen when you squat or lunge? If you cannot correct it then consider an orthotic

•Check the mobility of your hip, ankle and big toe–is there a restriction on the problem side?

•Check the flexibility of the main muscle groups on the affected leg – hamstrings, quads, glutes, etc. Fix this with stretches and foam rolling

•If the knee is swollen, rest it. You do not have to stop training! There are hundreds of exercises for you to do, so be smart and work around the knee

•Do not ignore it! Most musculoskeletal problems can be fixed if you get at them early – the right advice and management can save you a lot of pain, money, missed training and a meeting with an orthopaedic surgeon!

Nellie Nthiga, BDMC & P Health Centre.