Treat Your Own Knees: Simple Exercises to Build Strength, Flexibility, Responsiveness and Endurance by Jim Johnson, James R. Roberson, Alexandra Mummery (Editor), James R. Roberson (Foreword by)

From the Publisher

Treat Your Own Knees shows how to reduce or end knee pain by improving knee function. In easy-to-grasp language, author Jim Johnson covers the physiology of the knee and the kinds of pain that affect it, along with the psychological aspects. He offers a series of straightforward exercises based on current medical data and tested in his practice. Black-and-white drawings show exactly how to do the exercises and pinpoint the precise muscles responsible for the problem. This concise, simple guide provides an effective do-it-yourself program.

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Table of Contents

Read a Sample Chapter

Treat Your Own Knees

Hunter House Inc., Publishers

Chapter One

Each time someone with knee pain comes to see me, I keep one thought in the back of my mind: The pain is most likely the result of something that is functioning improperly. My job as a physical therapist is not necessarily to come up with the exact cause of someone's pain (which can often be either elusive or controversial), but rather to figure out what the knee isn't doing that it normally should do. Using this approach during my evaluation, I test the various knee functions-such as how strong the muscles are or how far the patient can bend the knee-so I can determine what is or is not working up to par. Once the improper function has been identified, I can then choose a treatment that will restore it.

Consider the following list of the possible treatments for knee pain:

* hot packs

* arthroscopy

* manual therapy

* total knee replacement

* range-of-motion exercises

* proprioception exercises

* strengthening exercises

* electrical stimulation

* ultrasound

* ice packs

* whirlpool

* exercise bike/treadmill/walking

* massage

* mind-body techniques

* joint aspiration/injections

* pain medicines

As you can see from this rather lengthy list, medicine has developed quite a wide range of treatment options when it comes to solving the problem of knee pain, and I am sure that many more will evolve as time passes. Although some of them appear to be markedly different from others, they all have a common thread running through them: Each of them is designed to restore or enhance the functioning of the knee area.

Take a moment to think about this. Ice reduces the swelling in your knee so you can bend it easier (and in turn, it hurts a lot less). Strengthening exercises provide stability to the knee by making the muscles stronger. Walking improves the ability of the muscles to move the knee repeatedly. The most radical treatment, total knee replacement, improves the function of the entire knee area by putting in a new joint that can bend and straighten with ease.

Thinking in this manner about treatments for knee pain can be quite useful when one is trying to figure out which is the best treatment method to use. As an example, if a knee is unable to bend as far as it should, a treatment is needed that will improve the knee's range of motion. And if one of the leg muscles is found to be weak, then a strengthening exercise would be in order. These, then, are the underlying principles upon which this book is based.

Most knee pain is the result of dysfunction. Restore the function with the proper treatment and your pain will be relieved.

Proper Knee Function: The Four Abilities of Your Knee

Although your knee may seem like a simple hinge joint that swings back and forth as you go about your daily routine, it is really one of your body's more complex joints. If you were able to look beneath the skin and underlying fat near the knee, the first thing you would lay your eyes on would be the muscles around the knee. Figures 1.1 and 1.2 (on the facing page) are drawings of the major muscles in the upper leg. These are the muscles that primarily affect knee movement.

As you can see from these diagrams, many different muscles surround your knee. Think of these muscles as the "engines" that make it possible for you to move your legs. For instance, when you want to stand up, your leg muscles respond by quickly contracting and getting shorter. As this happens, they pull on the bones they are attached to, thus enabling you to move to a standing position. This brings us to the first ability your knee must have: strength. A knee with good muscular strength can adequately perform what it is being called upon to do (such as climbing stairs), while keeping the joint in a safe and stable position.

Let's say we continued with our anatomical investigation and removed all of the leg muscles. What would we be looking at then? We would be looking at the bones and the actual knee joint itself. Figure 1.3 (on the next page) is a close-up view of the knee joint and all of its major ligaments:

Looks a little more complicated than just a plain old hinge, doesn't it? While the knee joint itself is made up of some sophisticated-looking structures, it really has one simple job: to allow movement freely in several directions. This motion, although smaller in range than that of the hip or shoulder joint, is essential in order to accomplish many of the things we do each day. When I worked full-time on an orthopedic floor in a large teaching hospital, I occasionally treated patients who had their knee joint surgically fused due to trauma or an infection. It was then that I began to appreciate just how important the motion at the knee really is and how much we take it for granted. For these patients, performing even the simplest of tasks that most people effortlessly do each day, such as walking or rising from a chair, became very cumbersome due to this lost motion. The next time you get out of bed in the morning, try doing it with your knee perfectly straight and you'll see what I mean. This makes flexibility the second requirement for a healthy, functioning knee.

Too detailed to include in the above illustrations are all the tiny nerves that go to the knee area. Without giving you an anatomy lesson, let me say that the nerves in your body are divided into two kinds: sensory nerves and motor nerves. Motor nerves travel from your brain down to your knee (as well as to other areas of the body) and allow you to control the muscles so you can move your knee (or other body parts). Sensory nerves, on the other hand, go in exactly the opposite direction from the motor nerves. They travel from your knee (or other areas of the body) back up to your brain. Since their job is to carry and report sensations-such as hot or cold-they must travel to your brain so you can be constantly aware of what is going on in your knee (or elsewhere). Some of the most important information that these sensory nerves carry are messages regarding the position your knee is in. Small nerves in your knee's muscles, tendons, and joint capsule (the covering around the knee joint) all provide information to your brain as to the position and movement of your knee. This is known as proprioception.

To get a better idea of what proprioception is and its purpose, try this simple test: Sit or lie perfectly still. Close your eyes. Can you tell if your knee is bent or straight? If your legs are crossed, is the right over the left, or is the left over the right? Like most people, you probably have a good idea of what position your legs are in and how bent or straight they are-even with your eyes closed. This is a good example of proprioception in action, and it is made possible by the sensory nerves in your knee. Because they send precise information to your brain about your knee's position, you are able to correctly determine its position. Since every knee needs this ability to properly function, proprioception takes an important spot at number three on our list of requirements for a healthy knee.

Completing the list is endurance. Endurance is the ability of your knee to do its job not just one or two times, but over and over and over again. Examples are numerous and include activities such as walking, running, and stair climbing. While we are doing these kinds of tasks, we ask our knees to bend and straighten many times in a row. If our knees fail to keep up with the job, several things can happen. The muscles will start to tire and might become unable to keep the knee joint within a safe range of stability while it is moving. The knee can then start to buckle (or snap back too far, for that matter) and stress the delicate structures. Given either enough time or a poorly conditioned knee, the muscles can grow fatigued and simply give up. It is at this point that you will be unable to walk the whole distance you want to or make it to the top of the stairs. Thus, endurance is a must-have for full knee functioning and becomes the fourth ability your knee must have.

The Four Abilities Your Knee Must Have

* good muscular strength

* adequate flexibility

* working proprioception

* enough endurance to allow it to perform

* movements over and over again

The Game Plan

As stated in the beginning of this chapter, most knee pain is the result of a loss of function. That is, something in your knee is not working as it should. Therefore, if we restore the function, the pain will subside. This is where the four abilities your knee must have fit into the picture. Chapters 2 through 5 are each devoted to one of the abilities of a healthy knee. By doing the specific exercises included in those chapters, you will be able to restore any of the four abilities that your knee has lost, directly improving the functioning of your knee. Doing so in turn will equal relief from pain. Chapter 6, titled "Some Things You May Not Have Thought About," addresses a few additional issues regarding knee health and knee pain, and offers a mind-body technique proven to help ease pain. Chapter 7 pulls everything together into an easy-to-follow weekly program.

The following is a diagram that represents the overall approach you will be using when treating your own knee:

[ILLUSTRATION OMITTED]

Chapter Two

It would be quite hard for you to do much at all without the help of your muscles. Even something as basic and simple as walking requires the forces from no fewer than twenty-eight of your leg muscles in order for you to carefully control the pull of gravity as you try to move forward. As stated earlier, muscles act as "engines" that your body uses to make itself move. The following is a list of some of the muscles that are situated in and around the knee area:

* sartorius

* gracilis

* adductor magnus and longus

* the quadriceps-vastus lateralis, medialis, intermedius, and rectus femoris

* the hamstrings-semimembranosus, semitendinosus, and biceps femoris

* gastrocnemius

* popliteus

You can see that there are many leg muscles with unusual names. They all play a part one way or another in the functioning of our knees. However, many studies over the years have pointed out that some of these muscles clearly deserve more attention than others when it comes to knee problems. It appears as though some muscles, for various reasons, are "hit harder" when you have a problem with your knee. Strangely enough, some muscles are able to continue working adequately in the face of swelling or sudden injury to the knee, while others respond by getting weaker or smaller, or by shutting down altogether. For the purposes of this book, you can take this as really good news. It means that you will not have to spend a lot of time doing countless exercises to strengthen each of the individual muscles in the knee area.

A Selective Problem

Over the years, I have spent a great deal of time in the medical library, trying to find out exactly what knee conditions affect which muscles. When I initially started my investigation in this area, I expected the research to show, for example, that arthritis caused problems mainly for one or two muscles, while a torn ligament took its toll on a completely different muscle. What I found, however, was rather surprising. It quickly became apparent that for just about every single knee condition I was checking out (such as arthritis, ligament tears, etc.) the same muscle kept cropping up over and over as being the one most affected. And just what muscle was it?

In the cadaver lab back in physical therapy school we learned the muscle's Latin name, musculus quadriceps femoris. Most doctors and physical therapists, however, commonly call it the quadriceps, which literally translates into "four-headed muscle." If you're like me and prefer nicknames, you can just call it "the quads."

The quads are indeed made up of four distinct muscles. They are the following:

* vastus lateralis

* vastus medialis

* vastus intermedius

* rectus femoris

The first three muscles, vastus lateralis, vastus medialis, and vastus intermedius, all attach themselves to the bone of your upper leg, cross your knee in the front, and then attach to the big bone in your lower leg. The last one, rectus femoris, attaches itself a little bit differently. It starts your hip area, just below your belt line in the front, and then continues down to cross your knee like the other three vastus muscles.

Figure 2.1 is a close-up illustration of the quads, looking at the right leg from the front. Note that you can only see three of the four muscles of the quadriceps, as the vastus intermedius lies neatly buried under the rectus femoris.

So just what do the quads do? Well, if you're sitting in a chair at the moment, kick out your leg. This action is one of the main jobs of the quads; that is, they help you straighten out your leg. Now try this. Stand up from a sitting position, and as you do so, put one hand onto the front of your thigh. You should be able to feel the muscles under your hand (the quads) tighten and firm up as you begin to rise. This is yet another important function of this muscle. With your foot fixed on the floor as you stand up, the quads work to pull you into a standing position. Along with these activities, your quads are also largely responsible for your ability to walk, run, jump, and climb stairs. Additionally, the knee joint itself depends heavily on the quads to help stabilize and support it.

Knee problems tend to cause isolated muscle wasting and weakness, specifically in the quadriceps group.

Effects of Various Knee Problems on the Quads

Let's take a brief look at the evidence from peer-reviewed journals that have shown the quadriceps to be selectively affected by a variety of knee conditions. (Peer-reviewed journals are magazines that only publish articles that have been reviewed by experts in the field.) The chances are good that most readers will fit into one of the following categories.

* * * Knee Swelling and the Quadriceps

Experiencing swelling in your knee has been shown to be a major reason why your quads might not be working like they should. If you were to lie flat on your back as I injected a harmless saltwater solution known as saline into your knee, you would find that after a certain amount of this fluid entered your knee joint, you would no longer be able to lift your leg off the table. Then, as I removed the saline a little at a time, you would slowly start to regain control of your leg once again and be able to lift it. Here's what some of the studies that have looked into this unusual effect of having extra fluid in the knee joint have found:

* One study took patients with chronic (long-term) knee swelling, removed the excess fluid using a needle, and measured an immediate increase in quadriceps strength (Fahrer 1988). * Another study demonstrated that even if you have as little as 20 milliliters of fluid in your knee (which is just over a tablespoon), it's enough to decrease the strength of your quadriceps muscle (Spencer 1984).

As you can see, it takes a whole lot less than a huge, swollen knee in order to prevent your quadriceps muscle from working properly. According to the research, having just over a tablespoon of fluid in the knee-probably too small an amount for most people to visibly notice-is sufficient to trigger a problem.

* * * Knee Injuries and the Quadriceps

Several studies have taken a close look at how the muscles of the leg respond to a knee injury. Two physical therapists from the University of Delaware, Tara Manal and Lynn Snyder-Mackler, specifically examined people who had recently fallen on their knee or sustained a direct blow to their kneecap (such as being hit with a hockey stick or striking the knee on the dashboard during a car accident). Their results showed that only about two-thirds of these individuals had a properly contracting quadriceps muscle following the injury.

(Continues...)

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Excerpted from Treat Your Own Knees by Jim Johnson Copyright © 2003 by Jim Johnson, Inc.. Excerpted by permission.
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