PT Monthly Magazine


Avoid getting Dodgy Knees In Midlife Knees………

New research suggests that knees aren’t simply ‘worn’ down – and that squats and lunges are their best protection

The list of life’s inevitables is long. It includes death, taxes, sagging skin and the gradual inability to understand how modern television remote controls work. Dodgy knees used to be on the roster for millions of us too. New research, however, provides a glimmer of hope for potential future knee replacement patients. Squats and lunges may be your saviours.
A study presented at the Radiological Society of North America conference looked at scans of 134 adults with knee osteoarthritis taken over a four year period and found that those with the strongest quadriceps, or quad muscles, were less likely to need knee replacements.
The quads are the large muscles on the front of the thigh and are the body’s strongest muscles. The analysis showed that strong quads were the most important factor in reducing the risk of needing knee replacements, leading the study authors to recommend exercises such as squats and lunges, which can be easily done at home, to help build strength.

Why stronger muscles lead to sturdier knees

Osteoarthritis (OA) is the most common type of arthritis and can cause joints to feel stiff and painful. It is more common in older people but can also affect the young, especially if there has been an injury to a joint. OA can cause joints to swell and change shape and make creaking or cracking noises.
Experts say that building strength in leg muscles helps to reduce stress on the knee joint and improve the stability of kneecaps. This can stop arthritis progressing.
Martin Lau is a dietitian and services development manager at Arthritis Action. He explains: “One of the ways to protect our knees in midlife is to strengthen them. Weak things break. Regular strengthening helps to build the muscles around the knees. Providing a strong scaffolding of the musculature will help to support the integrity of the knee joint.”

‘Wear and tear’ isn’t the problem

The full range of causes of arthritis are not known but the formerly held idea that it was caused by ‘wear and tear’ of joints, with the associated belief that all joints eventually wear down, has now been discounted. It is known to happen when the degradation of the cartilage inside the joint exceeds the rate of repair, and it is thought that it may be due to repeated small injuries that happen as part of daily life that don’t heal completely. In other cases, however, it can develop due to broken bones or sporting injuries. It can also be hereditary.
“One cause is ageing, and it also affects women more. Carrying more weight than you should have also increases the risk factor,” Lau says.
Dr Benjamin Ellis, Senior Clinical Policy Advisor to Versus Arthritis, and consultant rheumatologist adds that instead of immobilising joints for fear of wear, movement is one of the most important factors in keeping joints healthy.
He says: “Joints are complex living tissues that get stronger the more we use them. Using your joints builds up muscle strength and improves the blood supply and nutrition, all of which can help keep your joints in good shape for longer.”

Move more to future-proof your knees

The experts agree that while squats and lunges can play a role in a preventative capacity, in order to future-proof knees, exercise should be more varied and include elements of three types of movement – plyometric, isometric and resistance training.
Plyometric training is a form of training that, in its simplest form, involves jumping and rebounding off the floor. The most basic move called a plyo jump, involves jumping or stepping from a box or step, landing and then jumping. Other plyometric exercises include single leg hops and ice-skaters (jumping from side to side using a speed-skater motion). This type of exercise has been found to increase tendon stiffness and so reduce the risk of potential injuries of the knees especially the anterior cruciate ligament.
Isometric exercises involve the static contraction of a muscle without any visible movement in the angle of the joint, often using bodyweight as resistance. Examples of isometric exercises include wall sits (back pressed against the wall in a sitting position) and planks.
Resistance training involves strengthening movements such as squats and lunges. Resistance can be added with weights and resistance bands. The strength machines commonly found in gyms such as leg presses, lat pull downs and cable rows are examples of resistance training.
Martin continues: “All these techniques add benefits to the knee joint structure. In resistance training, in order to gain strength, progressive overloading is a must. But be careful. Don’t try to run before you can walk. Be sensible. Perhaps hiring a personal trainer or a strength and conditioning coach to guide you would be a good idea in the initial stage of your training.”
Physical trainer and founder of London’s Vive Fitness EMS studios, Fraser Smith, says that concentrating on strength, balance and functional movement is the best way to future-proof and build resilient knees, but advises caution at first, particularly if you are overweight as you could be placing undue stress on the joints.
He explains: “The muscles, tendons and ligaments all act as shock absorbers that lessen the forces going directly through the knee joint. Having a sound functional range of motion allows the articulation of the joint and all the parts of the body to work together. If everything is balanced and moves in the right way the weight transfer and force when you move and land will go through the joints at the right points, whereas if one point is weak or stiff there’s a good chance undue shock will be absorbed into your knees.”
A good example of how the body works holistically, Fraser offers, was the introduction of ankle strapping and larger ankle-high boots in basketball to try and reduce the incidence of ankle strains. The shoes had the effect of locking the ankle in place, which unintentionally led to an increased risk of certain knee injuries.
He also advises single leg exercise and movements that involve a degree of twisting, landing, squatting down and reaching in different directions to better mimic day to day movements, as most gym machines are one-directional.
“Make sure you have good mobility. Incorporate movements that move you from side to side, backwards and forwards and have a little bit of rotation, such as clock lunge variations where you lunge in multiple directions,” he says. “Good exercises to help with functional movement and balance include single leg balances, where you balance on one leg and add an element to test stability such as a shoulder press in different directions or adding rotation side to side. 
Low level plyometrics such as hops in different directions to test your landing and stabilising are also beneficial. You do need some form of impact because that promotes regeneration and growth but you don’t want to cause injury – find the balance.”
A few regular leg exercises in midlife are worth the investment as they could save you from the surgeon’s knife in years to come.