According to the American Academy of Orthopaedic Surgeons (AAOS), over 534,000 knee replacement procedures – which help patients regain mobility and quality of life – were performed in 2005. 335,000 of them were women and 176,000 were men. These numbers are going to increase as the techniques and results are improving.
This procedure has become very common and great emphasis has been placed on the rehabilitation. Pre-hab is however a necessity to improve outcome. If you are seeing an orthopedic surgeon, make sure you get a good sense of what you need to do to prepare for the procedure. It would be wise to see a therapist or educated personal trainer to design a program that will help strengthen your muscles and thus help you bounce back faster after surgery.
There are a few aspects of preparation you need to address: it is going to take some work but the rewards will be well worth the effort. You will need to make some changes that will affect your lifestyle. Diet being one of the first thing to look at. Excess body weight will cause undue stress and pressure onto your knee joints. That means more pain, more stress on the repaired knee. Paying attention to your diet will help you recover by improving your body’s healing capacity and placing less stress on your knees.
Discuss and evaluate your activities of daily living and make the proper adjustments to your environment if possible. Watch for loose carpets, setup a room downstairs if you live in a 2 story house, install support bars in your bathroom if you only have access to a tub etc.. If you are prepared, you will have everything you need following surgery. 
Make sure your hips and ankles are working well. Since your knees are going along for the ride, improve function of both the hip and ankle will decrease the stresses placed upon the knee.
You will need to address flexibility, particularly focusing on the quads, hamstrings, iliotibial band and calf muscles. You can introduce foam rolling and static stretches at this point to help lengthen these tight muscles. Check out the IT-Band rolling example.
You can perform ranges of motion exercises within pain free range of motion. Depending on the extent of the degeneration, you might need to perform exercises in a non-weightbearing position. Seating or laying down will help take some of the pressure off and will probably not aggravate your knee pain.
Learn how to use crutches or a walker, borrow some and practice, You may not realize how much strength you will need to use them! One definitely needs to develop some upper body strength to move around with these sticks…
You will need to strengthen your leg and thigh muscles as well as your gluts. This may be difficult because of the amount of pain you are in but there are isometric exercises you can do that are non weight-bearing. You need to make sure your quadriceps muscles (front of thigh), gluteus (buttocks) and gastrocnemius (calves) activate and work. You need to balance out your quadriceps and hamstring muscles and work your gluteus medius carefully.
Isometric exercises are a good way to start if you have not been able to exercise at all because of the pain. They have been shown to cause little stress on the joint and when performed at least 3 times a week, they will promote an increase in muscle volume and strength.
Your sense of balance has probably already been affected by the knee problems. Balance work will be required to restore your joint positioning sense for your ankle and knee. It needs to be addressed with great care before and especially after surgery. 
For those of you who are not in need of a new knee and are curious about knee health, most of these facts apply. Think about engaging in a knee saving program especially if you are sitting most of the day, starting an exercise program, spending many hours running every week or participating in activities or sports that require jumping, cutting and quick changes of direction.
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Teenage boy with anterior knee pain
At age 13, I remember going up to my dad and complain about anterior knee pain. It had been pretty intense for a while and I was starting to worry a little bit about it. I was playing a lot of soccer and even though it did not stop me, there were times the intense pain would slow me down. As I was mentioning the location of the pain, he barely tapped the upper part of my tibia. The resulting scream and seeing me holding back some tears landed me in front of our family doctor. Osgood who? I was diagnosed with a condition called Osgood Schlatter and was given some anti-inflammatories and the advice to ice my knee down after practices for 10 to 15 minutes. I was lucky to be able to go on without any further visits and the pain ended up subsiding after a few months.
What is Osgood Schlatter? It is a condition that usually affects 12 to 15 year old children who are active and engage in sporting activities involving a lot of jumping and running. It is more common amongst boys although girls are not spared. The tibial tuberosity, a site located on the upper tibia is injured through overuse and intense pull of the patellar tendon at the attachment of the quadriceps muscles (anterior thigh muscles). The child may experience pain, swelling and increased sensitivity in the area. It is often unilateral but may affect both knees. The condition is usually self-limiting and the nsaids and ice treatment coupled with a break from intense jumping routines is often enough to handle this condition. There are however a few other measures one can take to speed the healing process up and decrease the pain.
Treatment: a conservative approach should help the child regain normal activities in a short period of time. The following actions are recommended to speed up the recovery.
- Special attention should be placed on managing the inflammation. Applying the RICE (Rest, Ice, Compress and Elevate) concept after each practices is paramount.
- The hamstrings should be stretched
- The quadriceps muscles should be stretched and strengthened
- The calves muscles (gastrocnemius and soleus) should be stretched
- Strategically applied Kinesio tape can be used to decrease the pull on the tibial tuberosity
- A Patellar tendon strap can also be worn to dissipate the forces applied on the tibial tuberosity
In case you are wondering what happened to my knee? I did not stop playing soccer and all that is left to remind me of this condition is a slightly enlarged tibial tuberosity and a memory of my dad’s startled reaction after he tapped my tibia…
If your child has been complaining of knee pains, you can contact us at (650)858-1213 and schedule a consultation.
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If you think that personal training is geared for athletic kids only, think again. Although the number of children participating in sports at an early age is growing, too many of our kids are becoming sedentary. Time that was spent running around, riding bikes or catching polliwogs has been replaced by watching too much television or playing video games. I understand that personal safety is much more of a concern than it used to be but there is a great need for children to move and reach their necessary physical milestones. Yes, training is as essential to the couch potatoes and the boy or girl with special needs than it is for the young athlete.
We have a chance to send our children on the right path by teaching them how to move correctly, eat and stay healthy! A few hours at the gym may create a life long passion for movement and exercise. Most kids will not become pro athletes… but preparing their bodies and minds will benefit them their entire life regardless of their athletic abilities.
It is very important not to lose sight of the fact that we are dealing with kids, back talk and all… so keep it fun and train them applying sound, age appropriate exercises and games. It takes 300 to 500 repetitions to develop a new motor pattern but it takes about 3000 to 5000 repetitions to correct a bad motor pattern. Learning to move and lift the right way from the very beginning will prevent future problems. A purposeful strength and conditioning program can not only be safe and effective, it will also promote motor development and help prevent injuries.
Organized strength and conditioning programs improve self-confidence, mental discipline, performance or coordination.
I recently joined the International Youth Fitness Association and got my first certification as a Youth Fitness Specialist, Level 1. As a long time soccer coach and assistant baseball coach, I wanted to add more specific training to complement my physical education and chiropractic degrees. I look forward to applying these principles and develop as many young kids and athletes into well rounded, active young men and women.
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Repetitive Strain Injury
Written by Dominique Biner, D.C. ACSM Certified
What is RSI?
Repetitive Strain Injury (RSI) is defined as a cumulative trauma disorder (CTD) stemming from prolonged, repetitive, forceful or awkward hand movements. It is a disease of the musculoskeletal system produced by gradual build up of micro-injuries and damage to the muscles, tendons and nerves of the neck, shoulder, forearm and hand. Perpetuating factors such as poor posture, poor conditioning, ill-fitting furniture, inadequate nutrition and stress of an increased workload can make a bad situation worse. Symptoms of RSI may include fatigue, weakness, pain, tingling, numbness and even impairment of motor control.
Do you often experience the following symptoms? [click to continue…]
You have just injured yourself and are wondering what the next step should be. Is ice or heat the treatment of choice?
If you have suffered a sprain or a strain, the first thing you should remember is PRICE (Protect, Rest, Ice, Compress and Elevate). Think about what is happening to the injured tissues and you will know why applying the price principle will help. You will have micro-tears resulting from an acute injury, blood is seeping through, swelling sets in and inflammation will ensue. Ice treatment is most commonly used for acute injuries and its application within the first 48 hours is critical. Limiting the swelling will allow for quicker recovery, ie. Less clean up to do! Check these numbers and notice how prompt icing will reduce a grade 2 or 3 ligament sprain healing time by more than half the time. [click to continue…]
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