Mind your knees' needs

Strengthen muscles to prevent serious knee surgeries

Strengthen muscles to prevent serious knee surgeries

August 08, 2005|by JULIE E. GREENE

Robin Moore's knees have hurt for about three years.

If she sits for a long time, the front of her knees ache.

Running, walking, climbing stairs, sometimes even sitting with her legs crossed - all remind her of the pain that could turn into a need for serious knee surgery one day.

Instead of waiting for what might be inevitable, Moore is doing wall slide exercises, working out on an elliptical machine and balancing on one leg on an exercise pillow.

Some of the exercises don't hurt. Others remind her of the pain caused by all the running she does in the Army. This includes running in boots on hard surfaces while carrying gear or heavy objects during training.


Moore, 32, of Hagerstown, decided to seek help to strengthen her knees "before I get to the knee replacement and get to the point where I can't do the things I want to do."

According to statistics provided by the American Academy of Orthopaedic Surgeons, 402,000 total knee replacement procedures were done in 2003 in the United States.

At Washington County Hospital, 613 total knee replacements were done and 36 knee revisions were done from July 1, 2003, to June 30, 2005, hospital spokeswoman Marina Shannon said.

A total knee replacement is when metal implants are inserted at the ends of the leg bones and the undersurface of the kneecap, said Jeanni Moyer, orthopedic program manager for Total Rehab Care at Robinwood Medical Center.

A knee revision is done after a knee replacement, when a piece comes loose or there is discomfort, Moyer said.

The knee is not a simple hinge joint.

Knees allow for some rotation that allow us to pivot or turn like a football player turning up the field, said Dr. Ralph Salvagno, an orthopedic surgeon at the Center for Joint Surgery & Sports Medicine at Robinwood Medical Center, east of Hagerstown. That same freedom of movement makes knees' ligaments and meniscus cartilage more susceptible to damage.

Risk indicators

The biggest indicator of who might need knee surgery one day is genetics, Salvagno said.

"One of the best ways to avoid knee surgery is to pick good parents," said Salvagno, half-jokingly.

Some people have a genetic predisposition for osteoarthritis, which is typically called wear-and-tear arthritis, whereas rheumatoid arthritis is inflammatory, he said. Osteoarthritis is what football players get because they banged up their knees so many times.

In the future, there might be a way, such as a DNA marker, to identify people at risk from a genetic standpoint and interventions could be done, Salvagno said. For now, you have to rely on your family's history.

Another indicator of possible knee problems in your future is obesity, said Salvagno and Laura Blair, a physical therapist at the center.

"The more weight you put on your knees the more likely you are to develop arthritis," Salvagno said. While there are heavy people without knee problems, Salvagno said, from what he's seen in his office, a significant number of people with knee problems are overweight.

Salvagno said people who injure a knee shouldn't put off getting it evaluated and treated.

That doesn't mean people should run to the doctor every time they have a little knee pain. The key warning signs for serious knee problems are a knee that gives out, locks or swells, he said. If any of those things happen, see a doctor.

Sports that tend to have more players get knee injuries are football, basketball, soccer and skiing, Salvagno said.

Strengthening the knees

People who want to avoid serious knee problems or surgeries should work to strengthen the muscles around the knees, Salvagno said.

"So many of these athletic injuries or household injuries are not predictable and preventable," Salvagno said. "You can't predict you're going to fall off the ladder or step in a hole or have someone blindside you with a block."

Strength and agility will help people avoid some injuries, such as the football player who sidesteps a tackler, he said.

If you do get injured, having strengthened your knees will decrease your recovery time, Salvagno said.

He recommends people who want to strengthen their knees ask a trainer, who can design an exercise program based on the person's size, weight and existing conditions. A variety of exercises will be required to hit all the major muscle groups around the knees and avoid muscle imbalance.

The front of the thigh should be stronger than the back, Blair said. You want a two-thirds to one-third relationship in strength, Blair said.

Muscle imbalance can lead to knee injuries, Salvagno said.

Salvagno said he tells his patients who've had knee injuries and are working their way back into an exercise program to start with exercises that keep one foot on the ground at all times. That means no running or jumping.

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