5 Minute Facts - Knee Health

This is episode 151 of the Empowered Team Podcast. Welcome to the Empowered Team Podcast where we explore how to optimize your performance in career, sport and life. And now your host, vitality and peak performance coach, Kari Schneider. Today it's five minute facts and we're going with the knee. And I would bet that most of us end up with some sort of knee issue along the way and it could be traumatic or it could be kind of insidious and sneak in. So here are our five minute facts. The most common knee injuries are fractures and ligament sprains. That's going to include acl, pcl, MCL and lcl. Lateral collateral, medial collateral, anterior cruciate ligament and posterior cruciate ligament. Those are all those letters. Also tendinitis and tendon tears. The main tendon you're going to be looking at is the patellar tendon in the knee and patellar tendonitis as well. Those are the two top ones there, the meniscus as well. If you think of this being your femur or your big leg bone and this being the plateau of your tibial shelf, they kind of sit like this. And in between there's going to be two round, kind of almost C shaped menisci. So two of those cushioning in between the big femur and the tibial ledge. So those are going to be also ground and sometimes catch, they get catches or little tears or a big traumatic thing as well. So meniscus. And then lastly is iliotibial band. It band. And this is the iliotibial band where it crosses the knee. So if this is your leg on the outside, that's where your iliotibial band crosses the knee. So those are the most common injuries of the knee. The second fact, five minute facts is that clicking, popping, snapping, all of those things may occur with your knee. If they occur with no swelling or pain, then you're usually fine. There's a lot of clicks, snaps, pops, grinds, all of those things. But if there's swelling involved with that or pain involved with that, that's when you want to go and see someone. That would be a pretty normal thing. You want to have those things pain free and swelling free. So that's number two, number three, weight. Every single extra pound of weight that we carry, that's beyond our ideal weight per se. Extra pounds will add about another four pounds of force onto the knee. So the knee ends up taking a whole bunch extra load and wear and tear. When we carry extra weight, it's a very large Joint that doesn't have a lot of support. Structurally, it has a lot of support muscularly. Number four, posture strengthening and feet and shoes. Joni's smiling tends to be what affects the knee greatly. So if we change our posture just subtly because we have a new work position and we're sitting a whole bunch, then we're going to find that our knees, I always say knees and backs are very finicky. Knees are very finicky. If you sit more, you stand more, you change your chair, you drive longer than you normally do, you are on a different surface than you normally are. All of those things, your knees tend to go red flag or alarm or has a response. Now, if the response is only a 24 hour response, maybe it swelled a bit because you were sitting in a car for 12 hours or maybe it got a little achy because you didn't have the pillow you normally put between your knees when you go to sleep. It can be anything like that. They're very finicky. But if it doesn't resolve in that 24 hours, that's when you take a look at, okay, did my posture, did that change, did that shift in my lifestyle make a difference that I need to address in physio, in changing the posture, in whatever the case may be. So that's number four. Number five is keep moving. Knee pain is one of those things that when we have knee pain, we feel like we need to stop everything. But here's the test. If you warm up and your knee pain decreases, then that's usually your indication that you need to be moving more instead of less. If you warm up and your knee pain increases, then that's usually your indication that. Wait a second, I need to really back off here. What happens with a knee, especially if you have a tendonitis or osteoarthritis, when we get our blood flow up, our temperature up, that releases synovial fluid. The synovial fluid is like joint lube. And so you've got this warmer joint and you've got the lube in there and. And then all of a sudden things feel pretty good. And that's going to be a good thing for the knee overall. So that is number five. So recap that. We went our common injuries, our top five common injuries, the clicking, popping, snapping, weight and that extra force and what it does and our posture and our strengthening and our shoes and our feet, how that affects. And number five, keep moving. Movement is going to be good for the knees overall. So, so now what I'd like to do is open up the questions, Q and A on the knee topic first, and then we will open it up after that for other topics as well. So whoever has a knee topic, please ask it away. And I think Joni had one. So, Joni, would you like to elaborate on your knee question?

Okay. Yeah. So through grade school and high school, I did a lot of high jumping. And just the way I planted and left, My left knee is a lot bigger than my right knee overall. And then as time went and I stopped jumping because my knees were starting to act up, I was diagnosed with patellofemoral syndrome. The kneecap was actually catching and grinding across the top. And then just recently, it's been acting up again and hadn't been for a while, and now it seems to be again. But I have. I went to see about my orthotics because they were starting to bother my feet again, and they said there's a big shift in my feet now. I've lost more of my arch and my feet are flattening out. So it's now affecting my knees again, too.

Okay, hang tight one second. Okay, so with patellofemoral or patellofemoral, either one, it is a. What you're looking at here is, unfortunately, it's a cover term. It's not specific, so it's an overall cover term. And what it usually means is that underneath the kneecap, if this is your patella underneath the kneecap, there's kind of like a little groove on one side and a little groove on the other side in order for it to sit nicely between the condyles of the femur. Don't want to get too anatomical here. But sometimes, if that kneecap is tilted one way or the other way, or it's just translated to one side just a little more. So say, for instance, if you're jumping off that plant leg, that left leg, and it's plant eccentric load huge and then drive. And that patella might have been pulled laterally or to the outside a little bit. I'm speculating this is what happens in a lot of jumpers. I've seen hundreds, maybe thousands of jumping knees, especially in volleyball and track. So what often happens is that plant leg gets really strong on those outside quad muscles, those vastus lateralis, and that it band gets tight and it just slightly pulls the kneecap to the outside just a little bit. And when that happens underneath here, there's this articular cartilage sometimes that gets ground a bit or a little wearing and tearing, or just because the kneecap is sitting A little bit differently. It's just getting some grinding and it's just not doing as well as you'd like it to. So what you want to know from your physio or somebody who's looked at your knee, what you want to know is do you need more strengthening on the inside of the quad? So if this is, I keep using my arm as my quad on the inside of the quad. If you look at your leg, if this part was stronger on the inside of the quad, is that part going to be more needed in terms of the strengthening? That would be the question. That would be one thing to take a look at. The other thing is sometimes it takes a bit of work to get that kneecap tracking where it needs to be. That is more than just an ultrasound. That takes some actual exercises and sometimes some manual pulling on that patella. Lastly, I'm not going to obviously suggest surgery because I'm not an orthopedic surgeon. But what often happens is when there's long term wear and tear, sometimes a scope can be a faster cleanup. If there's been long term wear and tear, an MRI can tell that. But the scope alone can clean up a lot of those shaved. What it looks like in there is snowy when somebody goes into a scope and they go and clean it up a bit when they go in with that. I've been in on many knee surgeries. I've seen a lot of the actual film of the knee surgery and I've seen Paul's multiple knee surgeries as well. So I've seen lots of knee surgeries, although I'm not the doctor. But when they go in, it looks snowy. When they clean it up, it's not so snowy because they've cleaned up all of that wear and tear and floaty stuff. So when it comes to your foot and your foot now, you know your arch going flatter. What I would suggest there is some of the work with the toes. So here are your feet, here are your toes. You're doing crunching movements in order to work the arch and have it start to get stronger. You may need some support with some taping or some orthotics. And then eventually once those. The tape or the orthotics holds the arch up a little more and you get. Then eventually you don't need the orthotics or the tape or some people rely on the orthotics long term. So either way those can. But sometimes you throw orthotics in and then your knee pain goes up or your back pain goes up because it affected your whole chain of posture. So you have to be really aware of those things where you might only wear them an hour at a time, increase it an hour the next day, increase an hour the next day. So those are some really key things that are often overlooked that we think, okay, throw the orthotics in, throw the tape in. But then you may see an increase in pain because it's too much too fast in the change in posture because the posture does have a big effect overall. I know that was a lot of blah, blah, but did that answer a lot of what's there for you? There's probably going to need to be more strengthening on the inside of the, the quads. So what it might mean is squeezing a ball while you squat. So if you take your squat, squeezing a ball while you squat. And the other thing to do specifically with knees, when you have knee pain and you can't go into a lunge or a deep squat, what has to happen are some hip movements. Because the quad, the rectus femoris, is a two joint muscle. That means that if you strengthen it at the hip, you can go a long way with helping it at the knee. If you strengthen the hamstring and the glutes, you're going to go a long way, especially with your hamstrings because they cross the knee as well to help the knee by strengthening those hamstrings. So those are going to be your ball hamstring curls, your hip extensions or bridges when you're raising your hips. Those are going to be your, even your hip flexions where you're just moving your hip forward and back and hip extensions when you're squeezing your hip back. All of those things will support the knee by strengthening the muscles at the hip, but they also cross the knee as well. And then you can expand into deeper movements. But also if your hip flexors are tight, you're going to have pain at the knee. Everybody, everybody will have pain at the knee if the hip hip flexors are too tight and they will automatically get too tight from long periods of sitting. I could talk a lot about the knee, as you can tell, and I know there might be some other questions here. So I want to make sure that there's either add on to your question there, Joni, or add other questions in for other people who are here. So go for it. What else you got? You can unmute.

So I have trouble with my meniscus and you were saying that they can see the floaty stuff. Can they see that on an mri or is it strictly through a scope?

The mri, they'll usually see something more significant like a tear. They can also see some wearing down, so they can see how much is left of a meniscus if it's really worn down, but they won't see the detail like a scope will provide. Sometimes I've seen with lots of athletes where they couldn't see the problem. They could see some things, but they couldn't see what they were looking for in a scope. They could see a lot more. So the mri, it's kind of like if you had to get some diagnostics, there might be. Somebody assesses you and they go through special tests and do a lot of figuring some things out. Then a special test might be equal to or greater than an X ray. It depends on what they're looking for. So the special test that the person does might be a little better. The X ray might be a little better, but the MRI is much better. It's going to tell you a whole lot more than an X ray will and. And more than someone's assessment, usually depending on the practitioner and the practitioner's experience. And then the scope sees all things because it's a camera inside your knee. So they can actually see if there are portions of an ACL still attached. They can see if there are. You know, there's a number of things that they'll be able to see that way. Okay, and are you. Have you had an mri?

No, I haven't. I've had. I have a meniscus tear, or what they believe was a meniscus tear. And it's been fine for a long time. It's just, you know, now I'm getting a little older and it seems to be bothering me a little bit more. So I've been working with a chiropractor and a physiotherapist since October, and it seems to be doing well. I'm doing all the strengthening things that you're suggesting, and there's a couple there that I'm not doing, so I'm going to try those, too. But they believe that that's what the problem is, that the tear might just be, you know, have a little bit sticking out and maybe catching or something. But it seems to me that when it is painful, it's excruciating. And so I'm not sure if that's necessarily the. The thing or not and whether or not I should have an MRI just to make sure that that's what I should be working with.

So with meniscus, if it got caught at one point and there's a catch or a little bit of a tear then oftentimes, depending on the person's activity, depending on a number of things, oftentimes, given the time, it can heal. And like you said, there's a lot of influence from the muscles themselves. So a lot of time, you can get a lot of success with just doing the physio, giving it time to heal and then going forward. And it's going to be the really deep knee bends that catch the meniscus. That's the deep, deep squats, the stuff where you're actually sitting on your calves or you've gone really low onto the ground. That's when it really. Both the femoral condyles and the tibia are really grinding together now. However, if that meniscus has a bigger tear in it and it's catching a lot, it's likely to get bigger and bigger. And because the meniscus has such poor blood flow, it doesn't heal like a tendon does or a muscle does. It takes a really long time. And that's where they would want to go in and they would want to stitch it up and do a little bit of repair work in order to have it not catch anymore so that it's not sticking out and catching. Because the more. The more it catches, the more it's likely to catch, and so on and so on. And that's where your physio. At some point, if it's not getting better, then they may refer you to the physician and may refer you to an MRI as well.

Thank you.

No problem. Okay, next question. What do we got? Knee Q and A. Any knee questions? Patellar tendons. Anyone need any patellar tendon question? The patellar. Just to be clear here, most of us are going to get patellar tendon pain. You would feel this right underneath your kneecap when you go down the stairs. Has anybody had that? No, not so much. If you feel pain above the kneecap, right below, that's quadriceps tendinitis. That one can be more painful, and it can be. It can take longer to deal with. One of the things that's really, really important is to stretch the hip flexors out and to keep stretching the quads, because the shorter the hip flexors and the tighter the quads, the more that quadriceps tendon is going to stay tight. And what is the reason you feel pain anywhere the tendon comes from the quad. If this is your quad and it goes over the patella, the kneecap and Then it attaches on your shin bone, on your tibia. So at any portion of this whole tendon that's holding the kneecap, any of it gets tight, that creates friction. And it's the friction and the tightness that's causing the pain. So that's important to understand that sometimes when we go to stretch, it's really painful, but the stretching is actually going to be what lengthens that tendon. The easiest way to stretch is when you're really warm. You've either showered, taken a bath, so passive warmth, or you've walked a little more. Passive warmth. Sometimes walking isn't enough to get the warmth you need. Sometimes you might feel stiff stretching after walking, but biking a little more synovial fluid in the joint, but that warmth, stretching after you're warm is going to be really, really important to get that quadric or the patellar tendon able to lengthen a bit more. Then you're going to have that synovial fluid in there and you're not going to be as likely to be in pain. When you do stretch, the warmth makes a huge difference. Hot tubs, baths, showers, walking, biking, anything that gets it warm. Make sure you're taking that opportunity to stretch the quad and stretch the hip flexor as well. I know I went on the tendon there. Other questions as well. What do we got for the knee? Anything else for the knee? Ok, bring on the other topics. Anything. Nutrition, exercise, training, health, food, you name it, whatever you got. Supplements. What's there for you for your best, best topics? What do you got? The nagging question. The thing that's a fad, the thing that you've wondered about when people are on the spot and they're like, what? Okay, I have someone. Go ahead, go ahead.

I was just gonna say. So I injured my ankle back in January and I'm still obviously in the rehab stages of things, but I don'. Like, I'm making progress because I'm just, I'm just keeping on going. But I don't really know, like, there's not really activities that I can do that don't actually really hurt my ankle besides swimming. But like, I can't. I don't really know other activities that I can do that is not too extreme on my ankle.

When you say hurt your ankle, what, what does that mean? Does it mean you, you, it aches or there's sharp. Does it mean there's sharp pain when you do it or it aches after you're done or it swells?

Yeah, it will swell and ache after I'm done. But also if I've been exercising, like I went for a big walk or something, and then I'm. I'm driving later that day or that week. The front of my ankle here, it will be like a shooting pain up the front of my ankle.

Okay.

It will be like, for an instant, like three seconds, but it will be so painful. And I. I have no idea why, because I didn't even break my ankle on the front. I broke it on the side, so I have no clue why it's so painful on the front.

And you fractured it. Like, you broke the. What bone did you break?

Yeah, I. What bone did I break?

I don't. I don't.

I don't know what it's called, but I'll show you what it is.

Outside bone, just above her ankle.

Okay. The fibula. Yeah, she broke the fibula. And you probably had a high ankle sprain as well.

Yeah.

Yeah.

Okay. So consider that in that kind of injury, and there's a few sport people in here in that kind of injury, for that kind of force to break the bone, there's also going to be the soft tissue damage. So that's probably what's also going on. There is this fatigue. And you've got compartment. So if you're feeling a lot of pain in the front, that's the front, the anterior compartment of your lower leg. The questions I would go with on this, because you're six months post injury. What I would look at on this is that what we forget about the lower leg and our feet, and this will go for your feet, too, Joni. What we forget about our lower leg is that we're on our feet or they're down low all of the time, even a change in humidity or shoes, those will be things that we don't think of normally. But when we've had an injury, it doesn't matter whether it's a toe or an arch or an ankle. We've had an injury, and then everything is easily annoyed or aggravated or inflamed. So what you want to start to do. One of the things I did with a. I had a triple jumper who had all kinds of old Achilles injuries and arch issues. And what we had to do, we had to get so specific that we monitored her step count every day so that we could progress her increase very carefully. So what I would suggest is that if you know that you can go 3000 steps in a day or 5000 or 8000 or whatever the number is in your day without any aching and without any pain, then you literally are adding no more than 1,000 steps a day to progress it. Because my instinct says that when you are getting that after swelling and after pain, it's probably because it was too big of a change. Even if your steps stayed the exact same, it was too big of a change of surface or shoes or humidity, any of those things, or too big of a jump to the next level of impact or number of steps. So there's all of those metrics. I would start to get really specific on those metrics and controlled and instead of thinking, okay, I am at the six month mark, I can now go for a hike, you think in terms of, OK, on my day to day basis, I normally walk 5,000 steps. I am trying to build to 10,000 steps, but I just went for a hike or I went for a longer walk, I just tripled my step count. And that is why my ankle or the front of my ankle is upset at me because there is. It's just too much without taking the middle steps in between. That's my guess because that's usually what happens. And just really consider all the things that we don't normally think of. Like I said, humidity, impact, surface types of shoes and volume. All of those things are going to make a huge difference. And not only on the ankle, like, like you're pointing to, but also for the knee. So for anyone who's got the knee stuff going on, all those same things apply. Okay, any quick last question before we hop off? We're good. Okay. So I hope that gives you some great knee and lower leg tips because all of those will apply. And, and if you think of other ones, pop them in our communication and we will address them. Have a great rest of your day everyone. Bye. If you enjoy listening to the Empowered Team podcast, you'll love being on the team. The Empowered Team runs year round. It is our group coaching and accountability program where we take mindset and physical performance concepts and break them down to usable action steps that optimize results. To join, email us@info powerconditioning.com with subject line team. That's info powerconditioning.com we can't wait for you to be on the team.