"I kneely made it" – the words you don’t want to be saying this summer.

The diPulse team thought it was time to address knee health, and let’s look at the reasons why…. It’s soccer season. It’s tennis season. It’s outdoor season! Everyone is taking up (or re-taking up) running because the weather says we can - it’s hiking weather, biking weather and skydiving weather. Bungee jumping, climbing, paragliding. Basically the sun is out, and all we see on the any media is sport, sport, sport. It’s time to visit those activities that have been lying dormant for the long winter. You’re ready to go, with a new fix of vitamin D flowing in your system, pumped and primed for ……. a fall.

Image courtesy of Sebastian Marko

Ok so we don’t want to be a downer on getting out there and being physical in whatever shape or form you love, and a fall may not be literally what we are heading for - but let’s be realistic here. Are we really prepared to pick up where we left off a year ago?

 Who is the fall guy?

So when we talk about stresses on the body, what are we thinking of? The back takes its toll very often, with the World Health Organization estimating 60-70% of the developed world experiencing back pain at some point, but this is not news to most people. We are pretty much expecting to have to take care of our lumbar spine – how many times has someone questioned how you lift an item, or how you are sitting in a chair? If your answer is ‘never’ then you really need to change your friends. But what of your knees, the pair of apparent hinges that keep you going in all your activities? Kind of neglected…. Until they make their presence known.

Image courtesy of What the Duck Cards.

Knees are renowned for being a load bearing joint. If you are carrying more weight, your knees will undoubtedly suffer internally. If your knees are slightly angled inwards (knock-knee) or outwards (bow-legs) then they will suffer. If the alignment of your kneecap within your knee biomechanics is out of kilter, then your knees will suffer. There are a lot of variables which impact upon the performance, strength and ultimate health of your knees. Lets even consider the arches of the foot! Too high and your knees suffer. Too flat-footed and guess what… your knees suffer! Have you ever had a biomechanical analysis of your knees? Most of us would answer ‘no’, but it’s probably something we should be thinking about, especially if you are a serious athlete or someone who exercises regularly.

 Image courtesy of Chris Bailey Orthopaedics

Complexity but not perplexity

Knees - just a hinge joint right? Bend, straighten, bend again….exactly like the elbow, right? Wrong. Firstly there’s the added knee cap (patella) which makes sure the quads are exerting the right tension to straighten the knee, but it also takes up some of the stresses of the knee tendons to stop them wearing away directly over the knee joint. But it has to pull in the right direction. That’s where the Q angle comes into play. So what is the Q angle? Basically it refers to the way the patella is pulled up over the knee and into the grooves of the femur when the knee straightens from a bend. If the Q angle is out of line then it can pull the patella over the bony parts of the femur and not in the groove, causing wear and tear behind the knee cap. What we shouldn’t forget is that this can change over time. Perhaps your inner quadriceps aren't very strong so allows your patella to be pulled at the wrong angle? Perhaps your pelvis has widened (think post childbirth) and your patella tracking is out of line.

Image courtesy of Crossfit Cambridge

The natural remedy is to get those quads going. Exercise, run, cycle, train with crossfit, load weights…. It has to create benefit to the knee if we are strengthening the quads right? Well that depends…. It’s how we train the quads that count. What is the outcome of reinforcing a movement which is damaging a knee that isn’t in alignment? Accelerated damage of course!

So patella aside, what of the other knee biomechanics? We know that the knee joint isn’t a simple hinge joint - many people refer to it as a hinge, but it is so much more than that. The femur (thigh bone) and the tibia (shin bone) move against each other in a slide, roll, spin movement, not a simple lever. This makes the knee a bit of a complex joint to understand, and the ligaments involved both around and inside the knee all have a vital role to play in stability - as does the cartilage, which also acts as a shock absorber. The muscles around the knee do help support knee integrity and are therefore even more valuable in keeping the cartilage intact and in reducing stress to the ligaments.

Image courtesy of Professor Adrian Wilson

So after all of this doom and gloom about knee vulnerability, what should we do to look after our knees? There are four general principles to think about in looking after the knee, regardless of your age, sport or biomechanics. Have a read and make sure to take heed so that you can take part in your summer activities safely:

• Don’t overdo it! As we know loading joints has benefits for muscle development but is also highly detrimental to the joints themselves. Carrying extra weight is included in this – weight through a barbell is just the same as carrying weight within the body. But we know that loading joints is an efficient way to build muscle (creating muscle hypertrophy). So how can we do this without loading the joints? This is where diPulse muscle stimulation comes into its own. We can exert as much muscle power from non-resisted exercises with muscle stimulation than we can when pressing huge weights - so the ability to do this and not cause joint stresses lies in muscle stimulation. Using diPulse with exercise to challenge those muscle fibres AND keep the joints stress-free. The diPulse SMARTKNEE can help give you additional quadriceps recruitment to challenge the muscles that support the knee and allow for their development without harming your joint.

• Do your exercises properly! This goes for any training and fitness routine. Make sure you are contracting the right muscles in the right way and with the right joint position. Let look at squats for instance. Many therapists and coaches recommend not squatting past 90 degrees of knee flexion. This is particularly relevant if you are using weight as a resistance. Why? Well the depth of a squat puts enormous pressure on the shearing forces at the knee. This renders the knee susceptible to ligamentous or cartilage damage. However, using diPulse to provide the additional resistance through muscle stimulation will place the same demand on the muscle without needing the greater depth of squat. Win win! The SMARTKNEE can activate the quads while you perform a moderated squat, and create a full muscle challenge, also in half the time. The diPulse SMARTTIGHTS are also designed to recruit both quads and hamstrings so you can achieve complete balance of muscle recruitment while you perform your knee routine.

• Pick the perfect shoe for exercise. Yes it’s true! High instep? Flat footed? Wide feet, narrow feet? We all have different forces acting through our feet. If you stand barefoot and have someone photograph your Achilles tendon from behind, you will likely see it isn’t perfectly vertical. This usually signifies that your foot placement is creating stresses upwards, through the knee, as far as the hip and spine. Having a professional analysis of your feet, in addition to a gait analysis wherever possible will help identify the shoes that are right for you. If you also want to work on the smaller muscles around the ankle and foot to counteract any imbalances in foot position, then try using the SMARTRECOVERYKIT from diPulse which can allow electrode placement on the muscles exactly where you need it, reinforcing and supporting a natural foot positioning.

• Listen to your knees! Yes, they can speak to you. Talking from experience, I used to run hills 6-10k daily, do high impact aerobics sessions four times a week and compete in half marathons. And yes, my knees ached - particularly going up and downstairs, pretty constantly. But even as a physio, I ignored them, telling myself that exercise is great and aching knees is probably normal. Well, newsflash. It isn’t normal. What had been happening is the cartilage behind my kneecap had been wearing away (a very small Q angle misalignment but with too much repetition), and my knees were beyond rescue. Lesson learnt, but a little too late. Nowadays, I know that I need to look after my knee joints, and I also need to keep them mobile and strong. After hiking, cycling or skiing I tend to use the diPulse SMARTKNEE for sensory stimulation – relieving feelings of stresses and strain directly over the knee. But I also use capillarization and lower limb wellbeing programs on the quads to keep them in prime condition to support my knees. Using the SMARTTIGHTS in hypertrophy or resistance mode will also ensure the quads are strong and performing their supporting role for the knee and encouraging good patella alignment.

Image courtesy of Colorado Centre of Orthopedic Excellence

So what is the moral of the story? Ultimately it comes down to being knee ‘aware’ – aware of weights and too much loading, aware of alignment and posture, aware of discomfort as an early warning sign and aware of how you can support and supplement your knees through correct training and muscle stimulation. Taking note of these will help you achieve the happy ending your knees deserve. Choosing muscle stimulation over heavy weights and using direct stimulation to reeducate a normal movement pattern will ensure your knees will only be screaming thank you!

Dr Victoria Sparkes is a physiotherapist, researcher and educator with experience of using diPulse muscle stimulation to achieve muscle strength, joint stability and in facilitating normal movement. 

References

World Health Organization accessed at: https://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf