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Knee-sy does it... 10 ways you can avoid injuring that vital joint

The pain is often caused by a one-time acute injury or repetitive motions that stress the joint over time, particularly as we age, but there are steps you can take to avoid discomfort, says physiotherapist Jenny Branigan

Careful steps: exercise is good for you, but over-doing it can injure your knees
Careful steps: exercise is good for you, but over-doing it can injure your knees

Knee pain can quickly sidetrack you from your daily routine, and like most things that are taken for granted, you don't realise how much you use your knees until it's too painful to use them.

Firstly, you need to determine the cause of the pain. A traumatic incident, such as a tackle playing football, can cause acute knee pain and may affect ligaments, the meniscus (cartilage), muscle or the knee joint itself. On the other hand knee injury as a result of overuse begins gradually, with no specific incident, and may take many months to develop to the point where pain disrupts activity.

As knee pain can be quite debilitating and restrictive, here are 10 tips to help you prevent or recover from knee injury.

1. Recognise you have a knee injury...

If you have vague knee pain that flares with activity, settles when warmed up so that you can continue and then flares again later or the next day, take note.

This pattern is common and because the pain clears after some rest, a false sense of security sets in and the activity is tried again subsequently, with the same results.

This niggling, aggravating pattern often continues for months, until the point where pain becomes constant.

Knee pain is often triggered by a sudden change in exercise load, such as a longer run or hill running.

2. Gradually increase activity...

When starting a new exercise regime, a gradual approach works best to minimise risk of knee injury. Allow your body recovery time to adapt to the changes you are making.

To that effect, it is not recommended to increase your mileage or your weights more than 10% per week.

It is normal to feel muscular pain or stiffness when you start a new activity, but it should only last for one to two days after the session.

If pain persists for longer than three days, see your chartered physiotherapist immediately. Swelling in the joint after activity is also not normal and needs to be investigated.

3. Be honest about your limits...

If you have not exercised intensely in years, and decide to return, be aware that your body will have aged during the time off. Physical inactivity coupled with ageing leads to muscle wasting, reduced muscle strength and flexibility and reduced balance reactions.

The knees often endure the brunt of a new exercise regime, especially one that involves lots of squats and lunges which are commonly part of a weight loss programme, and the sudden high load is often too much for previously inactive knees to bear.

4. Learn from your history...

Past injury history is significant. Taking up an active hobby with a history of an unresolved knee injury may aggravate your old symptoms.

Tennis and golf are classic examples of this, as the rotation involved in playing both games can flare up old meniscal injuries.

Returning to five-a-side football or embarking on a running programme commonly aggravate past knee injuries as both involve repetitive movements that your knee may not be strong enough to withstand.

5. Muscle weakness...

Knee pain is often accompanied by weak muscles. Maintaining the strength of your gluteal (buttock) muscles and quadriceps (front of thigh) muscles are important ways to prevent knee injury. If these muscles are weakened through previous injury or under use, it can lead to excessive loading through the knee joint. You can keep these muscles strong by walking, jogging, swimming, dancing, cycling, using weights in the gym or attending a strengthening class.

6. Watch your knee position...

Watch your knee position when you move. If you have a tendency for your knee to fall inwards into a valgus (otherwise known as knock-kneed) position, this may increase your risk of developing knee pain.

Focus on pointing your patella (kneecap) over the middle of your foot as you move, to improve your knee position.

This is important in young athletes, particularly females, who have a higher tendency towards knee valgus on landing from a jump, and consequently a higher risk of anterior cruciate ligament injury. There are many preventative programmes available, such as the FIFA 11+, that target knee valgus for knee injury prevention.

7. Is it really knee pain?

Knee pain can be referred from the lower back or sacroiliac joint at the pelvis. Knee pain can be the predominant pain symptom of hip arthritis and often presents in isolation, even though the hip is the underlying problem.

Ensure that any knee assessment involves a thorough lumbar spine (lower back) and hip joint examination.

8. Increase your flexibility...

The quadriceps muscle group is made up of four muscles, one of which, the rectus femoris, crosses both the hip and knee joints. This makes it vulnerable to tightness with the potential to cause injury at both the hip and knee joints.

If sitting on a chair for long periods causes knee pain (known as cinema sign), lack of quadriceps flexibility is the likely reason. Stretching your hip flexor and quadriceps muscles, self massage and foam rolling can all help to improve flexibility of the quadriceps and reduce the risk of knee pain.

9. Cross training can prevent injury...

Cross training refers to different forms of exercise which vary the load your body is exposed to. For example, if you are a runner, you should include cross training in the form of cycling, swimming or pilates in your weekly training plan.

Cross training prevents overuse of muscle groups and reducing load through all your weight-bearing joints and is an important part of maintaining and progressing overall fitness levels.

10. Always check your footwear...

If the medial longitudinal arches along the insides of your feet are flat (also known as pes planus or overpronation), you should pay attention to your shoes. Flat, thin shoes like pumps, flat flimsy boots and flat flip-flops offer no support to the feet and may increase load up the leg to the knee, causing pain. Look out for a strong heel counter when buying shoes to hold your heel and support your medial arches. Prolonged walking in flip-flops on summer holidays is a common reason for knee pain to flare up.

A biomechanical assessment would be appropriate in such cases as well as advice concerning appropriate footwear and the use of corrective insoles or orthotics if necessary.

Knee pain can be frustrating as many people ignore it until the pain starts to restrict normal activities of daily living, such as using the stairs. Exercising through knee pain is not advisable as it will continue to overload already compromised joint structures, causing further pain and movement dysfunction.

Contact your local chartered physiotherapist if you suffer from knee pain. We are movement experts and a comprehensive assessment will allow us to diagnosis your injury and prescribe an individual, comprehensive rehabilitation programme to help you resume normal function and prevent a recurrence of your pain.

Jenny Branigan is a chartered physiotherapist. Visit www.totalphysio.ie for more information

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