How can I look after my knees?

Identical twin doctors Chris and Xand van Tulleken seem to be popping up everywhere at the moment with their approachable style of communication about health and medical matters. Their new BBC Radio 4 programme and BBC Sounds podcast “What’s Up Docs?” Is very much in this vein and seems to me an easy listen with some useful takeaways.

The episode that has caught my attention most to date is “How can I look after my knees?” which has a relevance not just to our knees but much wider though our bodies. I’ve summarised below and included a link to the podcast too.

Knee pain is incredibly common, second only to back pain. 15% of people experience it at some point with the frequency increasing as you get older.

Chris & Xand seek to disrupt the idea that we use our knees so much that they get injured or wear out and that the way to keep them working for as long as possible is to not use them as intensively.  They suggest another more positive mindset that our knees are strong, powerful, robust joints that get stronger through use and we can build our confidence in our own knees through activity.

Important: The knee pain being discussed is chronic low grade intermittent knee pain many people experience to a greater or lesser extent. If your knee pain is new, your knee locks periodically, is red, hot or swollen, or has an acute trauma injury then its important to seek medical advice and what follows is not a recommendation appropriate for you at the moment.

Knees: the basics

We ask a lot of our knees, they are the largest joint in the human body, they bear more weight than any other joint in the body other than the ankle and we arguably load them more than the ankle - they flex more and we need them to sit down, kneel, jump, move, the list goes on.

Two bones come together at the knee, with smooth cartilage at the surfaces where they meet. Ligaments, tendons and muscles act as supporting and binding structures and the knee cap acts as a protective shock absorber embedded in the tendons surrounding the joint.

A "bad knee"?

In the podcast Chris discusses his “bad” knee and three interactions he has had with people which have changed his perception about it and the symptoms he has.

“Get strong then get fit: improved muscle strength reduces pain”

A professor of musculoskeletal medicine’s input: A lot of joint pain, not just in the knees but throughout the body is driven by soft tissue issues, specifically muscle weakness.

The most common site of knee pain is in the front of the knee when pressure is put through the tendon in which the kneecap is embedded and its attachment to bone. The pressure is exacerbated by muscle weakness as if the quadriceps muscle is too weak to take significant load it results in the tendon having to take up the strain instead.

Additinally it's useful to know that cartilage is living tissue, it can regenerate and when you exercise in a weight bearing way the squeezing of the knee moves joint fluid around and encourages cartilage growth which is really good for the knee cartilage, joint health and bone density.

Studies show that knees of people who run and do use their knees a lot often don’t show high wear and tear in terms of loss of cartilage. If your knee is in good structural shape you can probably keep running for many years with no issues. If you have had some injuries and damage to cartilage repeated loading may not be ideal, but a good starting point is always to strengthen up the muscles surrounding the knees, specifically the quadriceps muscle of your thigh.

“Keep running - you aren’t hurting your knee”

A physio’s input: “This pain will come and go, running won’t make it worse, won’t make it better. Do your strength exercises, keep running - you aren’t hurting your knee.” For Chris knowledge of this made his anxiety about his pain decrease which in turn had a big impact on his perception of pain.  A pain you aren’t worried about is very different to a pain you are worried about.

“Don’t worry about it - just do your squats”

An orthopaedic surgeon’s input when asked why Chris’ knee was creaking: Don’t worry about it - just do your squats.

It’s again important to stress that this advice and experience relates to someone else’s knee, it may not be appropriate for you, but hopefully the idea that your knee has the capacity to be a strong, powerful, robust joint and by building strength in the muscles around it you can significantly alter pain and discomfort levels in it is useful.

How to start strengthening knee muscles:

A lot of quad strengthening exercises don’t overload the knee so it’s safe to do so and highly advised if you have any difficulty getting up from a chair or getting out of a car.

Walking or jogging is great but if you aren't doing strength work too you aren’t getting full benefit of that exercise.

Walking in a pool is great way to start building leg muscles. Using an exercise bike or a cross trainer machine also helps to start developing quad strength while not putting too much force through the knee. Avoid step machines to begin with.

Specific exercises to start building more quadricep muscles strength are below. A progression from these static body weight exercises would be to dynamic body weight exercises and then resistance/loaded dynamic exercises.

Towel squash

The towel squash exercise is a simple, low-impact movement that helps strengthen the quadriceps. While seated, you place a rolled-up towel under your knee and press down with the back of your knee to squash the towel, tightening your thigh muscle. Pull your toes towards your shins and imagine you are bringing your knee cap closer to your hip bone.

Hold the contraction for 10 seconds, then relax and repeat - work up to being able to do this 20-30 times..

Half squat hold

The half squat hold is another isometric exercise that targets the quadriceps and you can move onto when the towel squah becomes comfortable. Stand with your feet shoulder-width apart, lower yourself into a half squat position (thighs at about a 45-degree angle), and hold the position while keeping your back straight and core engaged. Maintain the hold for 10 seconds before standing up. Repeat: work up to being able to do 3 sets of 10 repetitions.

What about the rest of me?

The same principle applies to many other parts of our body ie increased strength can result in less pain. For example improved grip strength can reduce hand & arm pain and tennis elbow symptoms. To achieve this increase in grip strength squeeze a squishy ball for 10 seconds and then relax and repeat.

Want to listen to the podcast?

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For personalised advice or more information, please get in touch by calling Mary on 07909 551191, emailing on mary@marybrooking.co.uk or clicking on the link below.

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