Why surgery is not your only route to keeping on the move with knee pain
Could exercises help eliminate the need for knee surgery? A top physiotherapist shares some of his tips with Kate Whiting.
As Baz Luhrmann told us in his 1999 song, Sunscreen: "Be kind to your knees, you'll miss them when they're gone."
Some two million people around the world have surgery called knee arthroscopy every year to heal meniscal tears,damage to the crescent-shaped cartilage that cushions the joint.
But, according to researchers in Norway, exercise might be just as good at healing these injuries as surgery.
They looked at 140 people whose average age was 50, one half of whom had arthroscopic surgery for degenerative meniscal tears, and half who had exercise sessions for three months, followed by simple daily exercises at home.
After two years, the research team, led by Nina Jullum Kise, an orthopaedic surgeon at Martina Hansens Hospital, found that knee-related quality of life for both groups was the same - and concluded that exercise therapy be given to middle-aged people suffering with meniscal tears.
Steven Berkman, chartered physiotherapist and director of Boost Physio (www.boostphysio.com), supports the findings and says: "On a daily basis, our team work with several patients who have knee problems, who are trying to avoid knee surgery.
"Over the last 10 years, I have noticed the trend that knee surgeons here in London are more frequently referring patients with degenerative meniscal tears for physiotherapy exercise therapy, rather than surgery, in the first instance."
Berkman says accurate diagnosis is key to knowing exactly what type of knee problem a physiotherapist is dealing with.
"Certain meniscal tears can block the normal movement of the knee joint and can cause further damage to the knee joint if not dealt with properly," says Berkman.
"Some of these cases will require surgery to prevent further damage or future deterioration of the knee joint.
"But the vast majority of our patients want to avoid surgery if they can get as good an outcome, or better, through exercise.
"Knee pain or injury causes the knee muscles to switch off from working fully - these muscles should be supporting and protecting the knee joint.
"When these muscles stop doing their job properly, the knee joint and menisci take even more pressure and stress.
"Getting the muscles surrounding the knee joint switched back on and firing correctly is key to successful recovery, as is regaining full flexibility in the knee joint and muscles."
EXERCISES FOR YOUR KNEES
Berkman recommends doing the following exercises if you have knee problems, and says: "These exercises should be comfortable - if not, seek guidance from a physiotherapist."
Cycling: In the early phase of rehabilitation, cycling is an excellent exercise as it strengthens the quadriceps and hamstring muscles that support the knee joint, without placing too much pressure on the load-bearing surface of the cartilage that's been torn. Cycling is excellent for improving flexibility in the knee joint.
Inner range quadriceps:
Sitting on the side of the bed, with the affected leg straight out along the bed, make the knee as straight as possible, pushing the back of it down into the bed - you should be able to raise the heel of your foot off the bed while keeping the back of your knee down on the bed. Hold for five seconds, 20 times. Repeat as above, with the addition of turning your foot and knee outwards slightly so as to engage the Vastus Medialis (part of the quadricep muscle of the thigh).
Sit to stand:
Sitting on a chair with knees and hips aligned, squeeze a small ball between the knees with about 50% of your maximum power, to engage the muscles on the inside of the knees and thighs. Maintaining the squeeze, come to a standing position in a controlled manner, sharing weight equally between the painful knee and the unaffected knee. Maintaining the squeeze on the ball, slowly sit back down. Do two sets of 10.
Una Brankin: The operations that gave my best pal and aunt new lease of life
When my friend Sallyanne announced she had to have her knee replaced, I was horrified. She was only 51 at the time and the operation was going to put her out of action for months.
She runs a Michelin-starred restaurant, L'Ecrivain, in Dublin with her celebrity chef husband, Derry Clarke. It's a gorgeous place, running for 27 years, but it has a flight of stairs which Sallyanne is never off when she's working front of house. As a result, she's had a catalogue of problems with her knees and has been in and out of the Sports Injury clinic regularly over the past few years.
Then she went on holiday to Spain and collapsed 48 hours later. She'd developed blood poisoning and was hospital-bound for the rest of her holiday.
After that, she was in so much pain, knee replacement surgery was the only option. So she bit the bullet and went for it, forcing herself to take time off work to recuperate. She's a good soldier, with a high pain threshold, so she got through the op and its aftermath well enough, but did not do as well with the enforced recovery time.
She went back to work far too soon and ended up back in the clinic with various complications.
Anyway, she seemed to be more concerned with the long vertical scar from the surgery on her leg - she has nice, long, cellulite-free perma-tanned pins - so she applied silicone healing gel religiously and it's barely visible now.
My auntie Bridie has a nastier scar, but she was 86 when she had her knee replaced and her skin hasn't seen the sun in decades.
The whole family circle was concerned at her having to go through the op at her advanced age, but it gave her a new lease of life. Incredibly, she was up parading around the ward six hours after surgery, without her walking aid. The anaesthetic had left her a bit confused and she was demanding to know what all these people were doing in her house, then trying to escape out the window.
But from that day forward, she never complained of pain in that knee, even when she ended up with an infection in it and was put in quarantine for six weeks at Craigavon Hospital.
Given the overall success of Sallyanne and Auntie Bridie's ops though, I wouldn't hesitate if it comes the time for me to have one. If only they could have a bionic function incorporated, so I could cycle uphill faster.