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  • Dr. Bob

Take Care Of Those Knees

Your knees are marvelous living instruments for motion. They are designed to last you a lifetime, and they probably will with a little care.

This comes up now because we have seen a number of knee injuries recently. They are sometimes easy to treat and recover quickly. Others need more intervention. Here are some typical issues.

Believe it or not, falling arches in the foot affect the knees profoundly. If you don’t see that immediately, try this: stand up and shift your weight to the insides of your feet. Stand like that for a few moments. Note the fact that your knees are bowed inward. Do you feel the burning on the inside of the knees yet?

This is called pronation, and it is typical of falling arches. Walking day in and day out with the foot in pronation causes significant wear and tear for some of the cartilage that cushions the knee. If this has been happening for a while, it shows up on x-ray as the cartilage on the inside of the knee thins. Many times we can improve this by addressing the arches with custom orthotics.

Many of our patients exercise to maintain or improve health. Jogging and running are great for cardiovascular health, but very hard on the knees over time. The high impact nature of the exercise puts considerable strain on the knees—more than your body weight when moving uphill. Several people I have known who have jogged or run for a matter of years have required knee replacements in their “mature” years. To their credit, though, their hearts were in good shape for the surgery. I am a big fan of walking instead of running, as it provides the same cardio workout without the knee damage.

About two years ago a hairdresser came to see me on crutches following a skiing accident. The snow and the mountains were all she’d dreamed they would be as she headed down a slope. The first turn was unfortunate, as she fell awkwardly in a twisting motion. The right knee buckled and she was in agony. She was a trooper about it, though, and tried to get back up and ski so she could enjoy her investment of time and treasure. When I examined her, it was apparent that the medial collateral ligament that stabilizes the knee from the inside was completely torn. We got her a surgeon quickly, and in six months or so, she was able to stand to cut hair.

Falls are common as causes for knee injuries, particularly among seniors. Falls are the most frequent source of injury, both fatal and non-fatal, for people over 65 years of age. I have seen several of these recently, including some freaky falls while getting out of bed.

To prevent as many knee injuries as possible, warm the muscles in your lower extremities before exercising. Consider doing some lunges and squats to stretch the hip flexors, calves, and thigh muscles. Stand with your feet and knees together and, keeping the knees together, move the knees in circles to each side several times. This stretches the ligaments that hold the knees together.

Look at your shoes. Do they support your arches properly? Do they fit properly? Of course, if you have custom orthotics, the shoes are less important because the most critical part of the shoe is under your foot.

If your knees are bothering you, a history and physical exam focused on the knee is in order. Major ligaments can be checked for patency. Sometimes x-ray imaging is indicated when there is a trauma history.   If there are positive findings, imaging may progress to an MRI to assess the soft tissue, such as the menisci (the pads that separate the femur and tibia) and the various ligaments that tie the joint together.

Most knee injuries can be addressed conservatively by adjusting the joint to maximize joint function. Additionally, we use ultrasound, electrotherapy, and even lasers to assist with pain control, reduction of swelling, and facilitation of healing. Many times we will support the knee with athletic taping or external bracing.  

If there is severe damage, or if these measures do not alleviate the problem, we have a discussion about surgical consultation. Surgery is always a last resort if there is a chance for conservative care to address the problem, but we do not hesitate to consult when surgery appears indicated or possibly indicated.

So take care of those knees. You never know when you will need them.

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