Bone & Joint Expert Care

General Knee Health

General Knee Health

Activity Classification,

Chondroprotective Agents,

Conservative Management,

General Knee Strengthening

Methods To Decrease Swelling.

 

Activity Classification

 

In order to help you avoid knee damage, we have classified some of the most common sports and recreational activities into 3 basic levels according to the stress they impose on the knee. Level I activities apply generally safe stress on the knee. Level II activities apply moderate stress. Level III activities apply high stress to the knee and/or involve a higher risk of ligament or cartilage injury. By consulting with your physician and using common sense, you can minimize your risks of knee damage.

Level I:

Bicycling (road), bowling, golf, kayaking, rowing, scuba diving, swimming, walking (level ground), yoga, classic cross country skiing.

Level II:

Aerobics (low impact), skate skiing, diving, racquetball, roller skating, running (soft surfaces, 5-10 miles/wk), hiking/backpacking, horseback riding, hunting, ice skating, bicycling (mountain), sailing, softball (conservative, no cleats), waterskiing, wind surfing.

Level III:

Ballet, baseball, basketball, downhill skiing, football, gymnastics, handball, hang gliding, ice climbing, ice hockey, karate & judo, snowboarding, lacrosse, motorcycle (dirt biking), rock climbing, rugby, running (hard surfaces >10 miles/wk), soccer, softball (with cleats), tennis, track & field jumping events, volleyball, wrestling, wakeboarding.

 

Chondroprotective Agents

 

Articular Cartilage

Articular cartilage, or chondral cartilage, is a smooth, low friction surface that caps the ends of our bones and helps our joints move smoothly. It also distributes forces evenly throughout the underlying bone. When this chondral surface breaks down (chondrosis), either through injury or gradually over time, the joint loses its ability to effectively handle the forces placed upon it. This results in initial degenerative changes in the articular cartilage that lead to osteoarthritis. Chondrosis is graded into four different categories ranging from Grade I (minimal changes to the chondral surface) to Grade IV (significant damage to the chondral surface with underlying bone visible).

To date, treatment for these conditions has included lifestyle changes such as weight loss and activity modification. Medications such as Tylenol, or anti-inflammatory agents (Celebrex, Diclofenac or Voltaren, Ibuprofen or Advil) can also reduce symptoms. Chondroprotective agents such as glucosamine and chondroitin sulfate may provide another effective treatment.

Glucosamine

Glucosamine stimulates the production of proteoglycans and collagen (materials that are building blocks of articular cartilage) and, therefore, increases the strength of articular cartilage. Glucosamine is found naturally in the body. By increasing the amount of glucosamine present in our joints through supplements, we may allow the body to produce more proteoglycans and collagen to make our cartilage stronger. Osteoarthritis occurs when our body’s ability to make cartilage is exceeded by the amount of breakdown of cartilage. Glucosamine may help slow or stop this degenerative process.

Chondroitin

Chondroitin Sulfate is the most prevalent proteoglycan in articular cartilage. As we age, the amount of chondroitin our bodies produce decreases. Though chondroitin sulfate’s main role is to help provide strength to the cartilage, it has also been shown to be effective in inhibiting enzymes which break down articular cartilage. It is also theorized that chondroitin helps to increase blood flow to the bone underlying the articular cartilage, making this bone stronger and more resilient to osteoarthritis.

Recommended Dosage

Glucosamine and chondroitin sulfate together comprise a more effective supplement than either taken alone. Both products have been proven in clinical trials to be safe. These supplements are recommended for people whose cartilage is in the early stages of breakdown. They may also be used after surgery to enhance the healing response. Cartilage protective agents are not as effective when cartilage damage is severe and widespread

 

Conservative Management

 

To improve your knee function, follow the measures listed below. They may seem inconsequential, but together they can improve the quality of your knee and your life.

Achieve an optimal body weight. A reduction of one pound of body weight can relieve four pounds of pressure on your knee.

Wear shock-absorbing shoes and avoid hard surfaces.

1. Plant a SEED (Safe Exercise Every Day) in your life. Avoid any jumping, twisting or contact-related sports. Below is the Top 11 recommended activities. Gradually work up to 30-45 minutes per day.
   1. Swimming
   2. Aquatic exercise/Water Walking
   3. Stationary Bike/Spinning
   4. Elliptical Trainer
   5. Rowing Machine
   6. Walking/Treadmill
   7. Golf
   8. Hiking (light)
   9. Cross Country Skiing/Nordic Track
   10. Low Impact Aerobics
   11. Tai Chi/Yoga/Pilates
2. Proper Nutrition can contribute to healthy knees and a healthy lifestyle. Eat a balanced diet while minimizing your fat intake. Also, nutrient supplementation is advised. The following guidelines are recommended:

1. 
   
   • Calcium 600-1200 mg (supplement) + 3 calcium rich food servings
   • Magnesium 400 mg
   • Vitamin C 800 mg
   • Vitamin E 400 IU (International Units)
   • Multi Vitamin 1 per day that includes trace minerals w/ anti-oxidant
   •  

Methods To Decrease Swelling

 

Modified Rest

Avoid activities that promote increased swelling in the knee and lower leg. It is best to avoid sitting or standing for long periods of time (over 10-15 minutes).

Ice

Ice the knee intermittently during the day for 20-30 minutes. Allow 2 hours to elapse between each icing session. One recommended method is to use the large bags of frozen peas. Place one bag on the top of the knee and one under the knee for 20-30 minutes. Then re-freeze the bags to use again. NOTE: Once re-frozen, do not consume. Caution: Freezer ice packs and peas can be excessively cold at first. Place a wet towel between your leg and the pack to avoid frost nip.

Compression

1. Use a full-length ted hose to provide compression for the lower limb or...
2. Place an Ace wrap from the base of the calf to the mid thigh.

Elevation

Keep the lower limb elevated to avoid pooling of fluids in the knee and lower leg.

Exercises

1. Ankle Pumps
   Actively move the ankle up and down, in and out, and in circles. Use a bath towel to add resistance. Hold the towel with one end in each hand and the middle of the towel around the ball of the foot. This should be done every hour.
2. Quad Sets:
   In a sitting position with the leg straight, slowly tighten the muscles in the thigh. Hold the contraction for 5 seconds then rest 3 seconds. Repeat 10 times per hour.
3. Straight Leg Raises
   In a sitting position with the leg straight, tighten the thigh muscles gradually. Slowly lift the leg up and hold for 3 seconds. Lower the leg back down and relax the thigh. Begin with 3 sets of 10 repetitions 3 times per day. Ankle weights or heavy boots can be added for increased resistance.
4. Cycling
   Begin stationary biking with light resistance for approximately 10 minutes. Increase time and resistance gradually as tolerated.

Medications
Anti-inflammatory medicine (Diclofenac/Voltaren or buprofen/Motrin) as prescribed by your physician.