Description:
Kevin R. Stone, M.D., discusses the top questions patients ask about
the knee joint: Part 2 of a 2 part series. 7:47 minutes/7.2MB |
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This is Kevin R. Stone, M.D. from The Stone Clinic in San Francisco. This
lecture continues our top, most common, questions asked about the knee.
The next question most commonly asked is, “Should I use
ice, or heat, or both around my knee injury?”
Almost all injuries, musculoskeletal injuries, are best treated with ice
after the injury. Ice decreases the swelling, decreases the blood
flow to the area, and decreases pain. It is very effective as a
pain reliever. We use heat to warm up before exercise so, if you
are going to go out for a run, we’d like you to take a hot tub, or
a shower, or a warm-up before doing that exercise and ice an injured or
sore joint after exercise. We almost never use heat after an injury. Sometimes
we will use contrast baths, which means that we will ice down and then
heat up and then ice down. We will use this when there is a chronic
swelling problem that does not seem to respond to icing alone, although
most will respond to icing, soft tissue massage, and tissue elevation. So,
it is important to remember that ice is your friend. It is a great
reliever of pain, decreaser of swelling, and an important tool to use after
sports or injury.
The next most common question is, “Doc, should I stretch
my knee or my back before I exercise?”
The answer to that question is, “Yes, of course,” but many
of us don’t. The stretch is the time, not only to help loosen
the muscles and lengthen the muscles, but most important to help get your
head into the game, as we say, for you to focus on the fact that you are
about to go for a run, or a weight lift, or a ski and, if you are thinking
about other things when you start out on that activity, you are very prone
to getting injured. So, if you use the stretching time to not only
stretch your muscles but to just start to center down to think about the
exercise you are about to do, and to leave the office behind, then you
will go and have a focused exercise program and, most likely, be less prone
to an injury. The actual stretching of tissues is helpful. We
know that, as the body warms up, with every degree warming of the muscle
there is significant increase in the distensibility or the elasticity of
the muscles and therefore the likelihood of their being torn or stretched
unnaturally during the exercise, if they are stretched and warmed before
exercise. We also recognize that many people not only hate to stretch
but are generally poor stretchers and don’t find relief from it so,
if you can just use that time to get your head in the game, you are less
likely to get hurt.
The next most common question we are asked is, “Does
running hurt my knee?”
The answer to that question is no. You can run all your life and
not injure your knee, if you have normal mechanics - that means that you
have not previously had a cartilage injury, you are not abnormally bowed,
you do not have muscle imbalances that cause an abnormal gait, and your
weight is not above the optimal weight so that you’re putting more
force on the joint than the joint should naturally hold. In a setting
where you have a normal joint and normal mechanics, there is no evidence
that running injures the knee joint at all and so we encourage our patients
and our athletes who have normal joints to run. Those who do not
have normal joints, we encourage to treat the injury if possible by either
surgical repair, or rehabilitation of the muscles, or gait training, or
to focus on non-impact sports, such as cycling, swimming, and soft skiing.
The next common question is, “If I lose weight,
does it matter to my joints?”
The answer is yes. You take between 2 – 3 million steps in
normal walking each year at up to 5 times your body weight, meaning if
you come down from a curb on one leg, the height of that curb onto that
one leg, might equal the force of up to five times your body weight. Therefore,
if you lose 10 pounds, it could be up to 50 pounds per step 2 – 3
million times per year. So, it is an enormous force reduction by
losing and optimizing weight. Also, as you strengthen the muscles
around the knee, more of the force goes through the muscles and the joint
itself goes through a more normal range of motion and a normal gait, therefore
decreasing the force that goes through the joint itself. So, optimizing
your weight, strengthening your muscles, and optimizing your gait make
an enormous difference to the lifespan of the joint.
The next most common question around the knee joint is, “Do
knee braces or specific shoes make a difference to my knee?”
There is no evidence that a knee brace will prevent a specific knee injury
and so we use knee braces for specific reasons. For instance, after
a ligament injury, we will use a knee brace during the healing time but
not usually after the joint or ligament has been healed. We will
use certain types of knee supports if the patella, the kneecap, tracks
abnormally, in order to help retrain the muscles and re-track the patella
itself.
Shoes make a big difference, in terms of not only the shock absorption
of the shoes but also the fit and fit is probably the most important component. If
the shoe fits and supports the arch and is designed to match the type of
foot and type of gait that you have. The forces going through the
foot and then through the knee, hip, and back can be optimized. Sometimes
we do this by manufacturing an orthotics for someone, which is a shoe insert
but many times we will see orthotics that are very stiff, made of hard
plastic or carbon fiber. While sometimes these are helpful, they
are also, at other times, harmful by increasing the stiffness of the shoe
and driving more force through the knee joint. And so, optimizing
your shoe wear, with a well-fitted shoe or sneaker, one that is relatively
new, so that the shock absorption in the insert is not stiff and old but
optimized, one that fits well, one that matches the type of sport that
you’re playing, really can help how your knee feels in life.
This concludes our top, most common, questions asked about the knee.
The Stone Clinic in San Francisco concentrates on returning injured people
to their active lives, fitter, faster, and stronger than they were before.
The Stone Clinic includes Dr. Kevin Stone, physician and surgeon, a staff
of physical therapists, and an x-ray and MRI facility. Our specialties
include the treatment of joint injuries and arthritis with leading edge
surgical and rehabilitation techniques. Elite athletes and everyday people
alike come to The Stone Clinic from around the world for the best in orthopaedic
care. The Stone Clinic is located at 3727 Buchanan St., San Francisco,
CA 94123. For more information, please call us at (415) 563-3110. |
