KNEES

Those cute, knobby, sometimes scabbed protrusions not only offer distinct personality to the lower extremities but allow mobility and provide protection from everyday impact.

The knees are very special structures, hosting a number of ligaments, muscle attachments, shock absorbing "cushions" and lubricating fluid - as well as the infamous "kneecap". The knees put the "bend" in otherwise straight legs. Understanding the important role these structures play in this game we call life, it makes sense to take care of them ... tune in to the early warning signs of overuse ... lighten up the impact from time to time ... ease into a new exercise routine gradually ... and add new activities carefully.

Causes of Knee Pain:

There are probably as many causes and types of knee problems as there are people discussing them. If Mother Nature has been good to you, providing you with a strong, well-aligned, mechanically functional knee joint... you may never know what all the fuss is about. Unfortunately, few are blessed with such perfect fortune. For example, if the knee cap does not line up "just right" on the top of the joint, then an uneven distribution of pressure results between the kneecap and bones of the leg every time the leg is bent. Over time, this malalignment can cause undue wear and softening of the protective cartilage underneath the knee cap resulting in a condition known as "condromalacia patella". If recognized and treated early, this condition can be controlled. If not, the degenerative process will continue, possibly ending with a severely arthritic joint.

What causes this malalignment of the kneecap? A variety of conditions, such as an imbalance of strength in the quadriceps muscles, knock-knees, bowlegs, leg-length difference, tight hamstrings, ankles which roll in, flat feet and... are you ready women? ... even a wide pelvis can change the way the kneecap slides over the joint.

Next to the traumatic injury, "overuse" resulting from increasing exercise intensity and/or changes in exercise technique or equipment is probably the biggest culprit in the development of knee prnblems. Repetitive, high impact exercise on a hard surface, (such as running and jumping) or, for that matter, any abnormal force or twisting applied to the knees will also increase the risk of injury.

In many instances, the well-known "too much too soon" syndrome experienced by many new exercisers or weekend athletes is often responsible for that aching sensation around the knee after exercise. Almost every active individual will experience some degree of knee discomfort at some point in time, whether you jog, walk, Jazzercise, or play football for exercise. A certain amount of muscle discomfort, knees included, is normal when you embark upon a new exercise regime. The trick is to recognize what is normal and what is not, and then to take the necessary steps to correct the problem.

Red Flag Alert:

Be on the lookout for any or all of the following warning signs of potential knee damage.

• Crepitation - a grinding or grating sound.
• Difficulty descending stairs.
• Specific or generalized pain or tenderness lasting longer than 72 hours.
• Swelling or puffiness around the joint.
• A "catching" sensation or locking of the joint.
• Overall weakness or feeling of instability in the knee.
• Stiffness or aching after exercise, beyond the normal muscle soreness which accompanies exercise.

Treatment:

Once the warning signs have been acknowledged, here are the next steps.

1. Seek medical assistance at the first sign of trouble.
2. Rest. Avoid the activity or specific movement that is causing the pain or discomfort.
3. Ice the knee for 10-20 minutes at least twice a day, especially after any activity involving the knee.
4. Correct improper foot posture with an orthotic device prescribed by a podiatrist or orthopedic specialist.
5. Avoid positions which cause unnecessary stress to the knee, i.e., deep plies. Keep plies and lunges "demi" in nature, no lower than 30 degrees. A general guideline is to not let the knees bend past the toes. Keep the heels on the floor and the tibia (shin bone) as close to vertical as possible.
6. Strengthen the thigh (quadriceps, hamstrings, abductors, and adductors). Correct any muscle strength imbalance between the hamstrings and quadriceps.
7. Stretch the hamstrings and quadriceps daily to reduce tension on the knee.
8. Purchase shoes with adequate support and a stiff heel counter, harder leather, and a stable mid-sole.

As with most overuse injuries, prevention is always the best medicine. Why not take a healthy approach to exercise. Wear the right shoes. Practice proper movement technique. Give yourself permission to take a day or two or three off each week. Try a low-impact approach to exercise for the fun of it ... you may just like it. And by all means, listen to those "bony little protrusions" and never ignore the messages they are sending.