Chapter List

• Introduction to Doctors Home Remedies
• Acne
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• Athletes Foot
• Backache
• Bad Breath
• Bed-Wetting
• Belching
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• Canker Sores
• Carpal Tunnel Syndrome
• Cellulite
• Chafing
• Chapped Hands
• Chapped Lips
• Cholesterol
• Colds
• Cold Sores
• Colic
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• Cuts and Scrapes
• Dandruff
• Denture Troubles
• Depression
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• Diabetes
• Diaper Rash
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• Diverticulosis
• Dry Hair
• Dry Skin and Winter Itch
• Earache
• Ear Infection
• Earwax
• Emphysema
• Endometriosis
• Eye Redness
• Eyestrain
• Fatigue
• Fever
• Fissures
• Flatulence
• Flu
• Food Poisoning
• Foot Aches
• Foot Odor
• Forgetfullness
• Frostbite
• Genital Herpes
• Gingivitis
• Gout
• Hangnails
• Hangover
• Headaches
• Heartburn
• Heat Exhaustion
• Hemorrhoids
• Hiccups
• Hives
• Hyperventilation
• Impotence
• Incontinence
• Infertility
• Ingrown Hair - 10 Ways to Get a Clean Shave
• Ingrown Nails
• Insomnia
• Intermittent Claudication
• Irritable Bowel Syndrome
• Jet Lag
• Kidney Stones
• Knee Pain
• Lactose Intolerance
• Laryngitis
• Menopause
• Menstrual Cramps
• Morning Sickness
• Motion Sickness
• Muscle Pain
• Nausea
• Neck Pain
• Night Blindness
• Nosebleed
• Oily Hair
• Oily Skin
• Osteoporosis
• Perfect Posture
• Pet Problems
• Phlebitis
• Phobias and Fears
• Poison Ivy and Oak
• Postnasal Drip
• Premenstrual Syndrome
• Psoriasis
• Raynauds Syndrome
• Restless Legs Syndrome
• Scarring
• Shingles
• Shinsplints
• Side Stitches
• Sinusitis
• Snoring
• Sore Throat
• Stained Teeth
• Stings
• Stress
• Sunburn
• Swimmers Ear
• Tachycardia
• Tartar and Plaque
• Teething
• Tendinitis
• Tmj
• Toothache
• Travelers Diarrhea
• Triglycerides
• Ulcer
• Varicose Veins
• Vomiting
• Warts
• Wrinkles
• Yeast Infections

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Knee Pain

Knee Pain

16 Ways to Handle the Hurt

Call it God's mistake. Of the 187 joints in your body, probably none brings about more suffering than the knee.

Now that America has become more active, the problem with knees has grown in response. An estimated 50 million people have suffered or are suffering knee pain or injury. But you don't have to be a fitness buff to know about that. One out of every three automobile injuries is an injury to the knee. Other hazardous activities or environments? Look around: climbing stairs, scrubbing floors, slippery sidewalks. The list seems endless.

Part of the problem is design, or rather the inability of knee design to change whenever human beings place new demands on it. "It is, without question, ill-suited for the jobs we ask it to do," says James M. Fox, M.D., director of the Center for the Disorders of the Knee in Van Nuys, California, and author of the book Save Your Knees. "It wasn't designed for football, soccer, automobile accidents, being a carpenter or plumber, or squatting and kneeling all day long. It was well designed originally, but there was no way to anticipate all the things we would end up asking it to do." If you're one of the countless felons of knee abuse, here are a few things you can do to make amends.

Take a load off. "Body weight is a major contributor to knee problems," says Dr. Fox. "For every pound you weigh, that's multiplied by about six in stress placed across the knee area." If you're 10 pounds overweight, that's an extra 60 pounds your knee has to carry around. And, as Dr. Fox says, "You don't put a Mack truck on Volkswagen tires."

Save the braces for teeth. Knee braces can be purchased at just about any sporting goods store, but the experts we spoke to say you should leave them on the shelf. "Some braces are truly meant to be preventive, but these are typically very complex and designed just for you; they can cost from $300 to $1,000," says Dr. Fox. "The wraps or braces you buy off the shelf at a sporting goods store shouldn't be used for anything more than to remind you that you have a bad knee."

Marjorie Albohm, a certified athletic trainer and associate director of the International Institute of Sports Medicine at the Indiana University School of Sports Medicine, is a bit more direct. "Forget knee braces or knee wraps you buy off the shelf" she says. "Some of them—by pushing your kneecap into the joint—can do more harm than good."

MEDICAL ALERT Accidents That Need a Doctor's Care Yesterday you were out shooting some baskets or maybe playing some touch football when you made this sudden turn and heard a soft "pop." Soft popping sounds don't usually get you excited, but this one came from your knee. The next thing you knew, your hands were wrapped around that rascal and your eyes were filled with tears of pain. Today you woke up with swelling, tenderness, radiating pain, and perhaps some discoloration and loss of motion. What kind of damage could have occurred? Well, there are basically three common forms of destruction to choose from: torn cartilage, a torn ligament, or both. What should you do about it: That's easy. Put it on ice and go to a doctor—today.

Try the rub that soothes. "Some wintergreen lotions produce heat, and heat can be a symptom reliever and make you feel more comfortable," says Dr. Fox. Sometimes, by covering the knee in plastic after applying the lotion and then wrapping it, you can make the liniment hotter. "But you need to be careful that you don't burn the skin or cause irritation," Dr. Fox warns. "But as far as being curative, lotions are not."

Reach for an OTC. Ibuprofen (Advil, Medipren, Nuprin, etc.) is the over-the-counter painkiller of choice recommended by our experts. It reduces inflammation and provides pain relief without causing the stomach problems associated with aspirin. Acetaminophen (Tylenol) is a fine painkiller and causes fewer stomach problems, but it does little to reduce inflammation.

Recent studies have also shown ibuprofen can significantly improve joint mobility in those people with acute knee ligament damage. When compared to either aspirin or acetaminophen, "ibuprofen may be the best of both worlds," Albohm concludes.

Strengthen with exercise. "The only things holding the knee together are the muscles and the ligaments," says Dr. Fox. "Building up the muscles is critical, because the muscles are the real supporting structures. If they don't have their power or endurance, you're going to be in trouble with you knees."

That means a certain amount of exercise for knee pain sufferers, even for those who detest it. Stronger muscles provide you with a stronger joint, one that's better able to withstand the considerable strain that even walking or stair climbing places on the knees. As Dr. Fox notes, "You've only got two knees, and the replacement parts that are out there are not that good." So let's get going. The following are not hard to do and hurt a lot less than aching knees.

Isometric knee builder. "The quadriceps and hamstrings are the muscles you need to build," says Dr. Fox. For the former (those thigh muscles in the front), here's one the doctor really recommends.

Sit on the floor with your sore knee straight out in front of you. Place a rolled towel under the small of the knee, then tighten the muscles in your leg without moving the knee. Hold that contraction and work up to where you can keep the muscles taut for at least 30 seconds, then relax. Repeat this tightening and relaxing process up to 25 times.

Sitting leg lifts. Here's the best way to do leg lifts for those who are weak of knee.

Sit with you back against a wall and place a pillow in the small of your back. (Sitting against a wall ensures that the leg muscles do the lifting, and this type of leg lift won't aggravate back pain.) Once you're in position, do the isometric contraction described above for a count of five, then raise your leg a few inches and hold it to a count of five, then lower it and relax for a count of five. Work up to doing three sets of ten lifts each, always using the five-count for pacing.

Hamstring helper. Not only do you have to build the quadriceps, but the hamstring muscles in back of the thighs must be developed for real knee strength. "They have to be in balance," says Dr. Fox. "If just one or the other is developed, then the joint is going to pick up stress."

To build the hamstrings, lie on your stomach with your chin to the floor. With an ankle weight (you can use a purse, or a sock filled with coins and draped over the ankle works fine) and your knee bent, slowly lift the lower leg 6 to 12 inches off the floor, then slowly lower it back down, stopping before you touch the floor. Repeat the movement again, always working slowly and steadily through each repetition. Work up to doing three sets of as many of these as you comfortable can (largely determined by the amount of weight you use).

A word of caution: "The most important thing to understand is that if an exercise causes increasing discomfort or pain, then stop," Dr. Fox advises. "You have to listen to your body and not simply assume that you need to 'work through the pain.' God gave you pain for a reason."

Try to modify. "If you're an athlete and you have a chronic knee problem, you're going to have to modify your level of training or daily activity," says Albohm. But that doesn't mean turning into a couch potato. "If you like racquetball and you've got this chronic knee condition that racquetball gradually made worse, you're probably going to have to get away from that," she says.

Options? Try swimming, biking, or rowing, all activities that are beneficial to health without placing great strain on the knees. The key phrase is "non-weight-bearing" activity. In fact, by helping to strengthen thigh muscles, such non-weight-bearing exercises as biking and rowing can give you better knees without sacrificing aerobic capacity or caloric burn.

Whatever you do, don't give up a healthy lifestyle because of knee pain. "No one should have to step being active," Albohm says. "What you want to do is simply avoid anything that causes pain in that knee."

Change to a softer running surface. For the dedicated runner, first the bad news: "A lot of runner's pain is caused by tendinitis and results from poor training habits," says Dr. Fox. Now the good: "These are not significant mechanical problems," he says, "and they can usually be minimized by a change in the running shoe or running surface."

We'll deal with shoes in a minute, but for now let's talk running surface. Basically, it comes down to this: Run on grass before asphalt, run on asphalt before concrete. Concrete is the hardest surface of all and should be avoided like the plague. Don't make a habit of jogging on sidewalks, and if you can find a golf course to run on without getting beaned by a wayward duffer, do it. "Remember, when you run a mile, your foot is striking the ground between 600 and 800 times," Dr. Fox adds. Enough said.

Get enough RICE. "Following any activity that causes knee pain," Albohm says, "immediately rest the area and apply ice, compression, and elevation for 20 to 30 minutes." That advice is commonly called RICE, short for rest, ice, compression, and elevation. It's a handy acronym to remember—especially the I part.

"Don't underestimate the power of ice," says Albohm. "If you're conscientious, you might also want to ice later that evening, or the next morning when you get up. Ice is a tremendous anti-inflammatory and will really help the condition."

Keep your icing routine simple, she says. When you return from working out, just prop the leg up, wrap an Ace bandage around it, and plop the ice pack on for 20 to 30 minutes. "That should always be your first try at relieving pain."

Use heat with caution. When there is no swelling present, using a heating pad before an activity may let you exercise with less pain. "But," Albohm cautions, "if there's any swelling, or if you have any doubt that there might be swelling, don't use heat."

And, she says, don't use heat after an activity. "We're assuming the area is becoming irritated by activity, and heat is only going to increase any irritation that's there."

Update your shoes. "If your shoes can't take the shock anymore," says Gary M. Gordon, D.P.M., director of the running and jogging programs at the University of Pennsylvania Sports Medicine Center in Philadelphia, "well, that shock has to go someplace."

Where it goes is through your foot, up your shin, and into the knee. Sometimes it keeps on going, up to the hip and back as well.

"I tell runners that if they run 25 miles a week or more, they need new shoes every two to three months," Dr. Gordon says. "If they run less than that, they need new shoes every four to six months. Aerobic dancers and basketball and tennis players who work out twice a week can probably get by on new shoes every four to six months. If they're doing it up to four times or more a week, they also need new shoes every two months. Most people don't want to hear that."

Get into low gear. Many experts like bike riding, either stationary or freewheel, as an alternative to the knee strain and pain that can be caused by running. But biking is only a great way to stay in shape and take a load off your knees if you do it with caution. Cyclists also damage their knees, typically by thinking that the harder it is to pedal, the more exercise you get.

So, depending on the type of biking you do (steep hills are not advised), riding may still be too strenuous. Fast pedaling in gears that feel easy is what you want. "In general, a lower gear [easier to pedal] is a better gear," Albohm says.

Find the trigger point for pain. "There's a trigger point on the inside of the thigh that contributes to what's called weak knee syndrome," says Rich Phaigh, co-director of the American Institute of Sports Massage in New York City and the Institute of Clinical Biomechanics in Eugene, Oregon, and a masseur for the likes of running stars Alberto Salazar and Joan Samuelson. "That trigger point's responsible for a lot of generalized pain on the inside of the knee, too."

To get rid of that pain, move your hand straight up from the kneecap along the front of the thigh for about 3 inches, then move it inward for another 2 to 4 inches. Using the tip of your thumb, press in firmly and hold until you feel the muscle release its tension. "That can be anywhere from 30 to 90 seconds," Phaigh says. "Then release."

First and finally, stretch. Lisa Dobloug is a private fitness consultant based in Washington, D.C. Many of her clients are older individuals who have special needs when it comes to protecting their knees. Her emphasis is on the quality—not quantity—of exercise and the importance of stretching.

"It's very important to warm up and cool down properly," she says. "Take about 10 minutes and do very light stretching before. Not stretching to accomplish flexibility, just light stretching. Perhaps go through the motions of whatever exercise you'll be participating in without really extending it. Then do a little aerobics—jogging in place or walking around. After you're done working out, then you should really stretch. Try to counteract the pounding that the exercise put your knees through."

Here's one stretch that Dobloug likes for post-workout stiffness. "Lie down on your back and pull your knees into your chest, then start to straighten one leg," she says. "Act like you're trying to press your heel toward the ceiling." Hold the stretch for a count of ten, then relax. Repeat with the other leg.

PANEL OF ADVISERS

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Marjorie Albohm is a certified athletic trainer and associate director of the International Institute of Sports Science and Medicine at the Indiana University School of Medicine in Mooresville. She served on the medical staff for the 1980 Winter Olympics and the 1987 Pan American Games.

Lisa Dobloug is a private fitness consultant in Washington, D.C. She is president of Scandinavian Fitness Corporation. Many of her clients are older people who wish to remain active and who appreciate her sound advice about warming up, stretching, and cooling down.

James M. Fox, M.D., is director of the Center for the Disorders of the Knee in Van Nuuys, California, and author of the book Save Your Knees. He was also a member of the medical staff for the 1984 Summer Olympics.

Gary M. Gordon, D.P.M., is director of the running and jogging programs at the University of Pennsylvania Sports Medicine Center in Philadelphia. He specializes in podiatric medicine, foot surgery, and sports medicine.

Rich Phaigh is co-director of the American Institute of Sports Massage in New York City and the Institute of Clinical Biomechanics in Eugene, Oregon. He is also a massage instructor at East-West College of the Healing Arts in Portland. Phaigh is the author of Athletic Massage and has worked on the likes of running stars Alberto Salazar and Joan Samuelson.