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This blog is purely informational and not meant to take the place of individual medical nutrition therapy (MNT). For serious medical conditions, ask your doctor for a referral to a dietitian. 

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Q: I have recurring knee pain. How can I stay active?

A: If your doctor has evaluated your knees and cleared you for physical activity, here are some important things to know about treating and preventing knee pain when exercising.

I thought I had to give up running. For the runners out there, you know how devastating that feels.

I am not a trained athlete. But like most runners, my passion runs deep. From the runner's mile to the runner's high, it is more than just exercise. It's meditation. It's stress relieving. It's achievement. It's addictive. I can't stop myself from doing it, even when I should. Like when I am recovering from injury.

My initial injury happened two years ago during a backyard basketball game against my 12-year-old and his friends. Caught up in the game, I forgot my age. It had been over 20 years since I last played. The years of running in a forward direction didn't train my body for the agility required in basketball. Shuffling on D. Cutting through the key. Pump fakes. Apparently, muscle memory doesn't last decades. As such, I nicked some cartilage in my knee. Adrenaline fought off the pain, and the constant movement kept the inflammation away. So I stayed in the game.

The next morning, I could barely put weight on that leg. The swelling set in. My quad shut down. Reality hit. I was benched.

Fortunately, I did not need surgery. However, being in my mid-40s, recovery took longer than I expected. I attended physical therapy for about three months. Over that time, my therapist zapped my quad with electrodes, set me up with resistance bands and physioballs, and piled more and more weight on the leg press. Then he graduated me to home exercises and advised me to slowly ease back into running.

And slow it was. I was faithful about my PT exercises and walked regularly, but it was a few more months before I could advance to a short, slow jog. Those initial runs usually started with a couple jolts in the knee before my joints acclimated to the impact. Every step I took was cautious, careful, and--I was soon to find out--unbalanced. My injured leg was still not as strong as my other leg. And my fear of re-injury further threw off my gait. Imagine my surprise and disappointment when my so-called "good knee" started to hurt more than the recovering knee. Several more months went by where the pain would come and go. I would try to resume running, only to re-aggravate one or both knees.

During this time, I started studying to become a certified personal trainer. In my work as a registered dietitian and a diabetes educator, physical activity is a topic I discuss regularly. I wanted to learn more.

While studying for the certification exam, I gained insight about why I was personally susceptible to injury, and why the physical therapy exercises were so important to keep up. I realized that the exercises were not just helping to heal my injury, but to prevent injury as well. When I kept up with my PT exercises, my runs got better, stronger, and more pain free. When I slacked, my knee pain would recur, interrupting my routine again.

To be honest, my injury didn't just occur two years ago. It resulted from years of inadequate training. Fortunately, the body is resilient. It's never too late. And you can teach an old runner new moves. These days, I'm back in the game, running a 5K a week. Walking down stairs no longer hurts. And with my new training regimen, I'm more fit than ever.

I wish I had understood these concepts 20 years ago. While I cannot turn back time, I can share what I learned to help others stay active and keep doing what they love.

Below are 5 things you should know about protecting your knees:

  1. Injuries are not limited to falls or twists. You may develop pain over time from repeated, improper movements. Improper movements result from poor form and/or imbalanced muscle strength.

  2. Strength training matters. I mistakenly believed--and others may too--that running and walking were enough exercise for my lower body. Further, when I started to develop knee pain, I thought the root of the problem was the impact on my aging joints. While high impact exercises certainly can be jarring, and there can be wear and tear over time, joint pain can occur when the surrounding muscles are not strong enough to support them. As such, the structures of the knee are not stable enough to properly take the hit of the impact. Muscle weaknesses can also cause improper alignment of the body, which can lead to improper movements in the joints. For example, a weakness in the hips can cause a tilt in the pelvis, which in turn can cause misalignment along the leg and instability in the knee. Similarly, a weakness in the ankles can affect the positioning of the lower leg, thus destabilizing the knee joint from below. Thus, exercises that target the core and lower body--from abs to toes--should be included at least twice a week. Some popular exercises include: Planks and ab curls Squats and lunges Floor bridges Step ups Leg curls with physioball Clam shells with resistance bands Calf raises and toe raises

3. Form matters. Some of the above exercise, and others, can worsen knee pain or cause other problems if done improperly. Plus, we may not realize when our natural movements are unbalanced. For example, I complained to my physical therapist that my knee hurt when I did squats. After demonstrating my form, she pointed out that my knees bowed in when I lowered myself. She simply gave me a light resistance band to place above my knees and instructed me to squat while keeping the band taut--essentially keeping my knees from folding inward. To my surprise, I was able to perform the move without pain. Over time, I was able to perform the squat and other exercises without pain as I was more aware of my form.

4. Shoes matter. The shape of your foot can affect the alignment of your leg. Stores that specialize in running gear often have staff that can evaluate your foot and recommend the right shoe for you within your budget.

5. Personal trainers and physical therapists are worth the investment. After just a few sessions with my trainer, I learned about my personal muscle imbalances, form mistakes, and a variety of exercises to address these issues. For less than the price of a night on the town, or a fun pair of shoes, or a new outfit, a session with a trainer can teach you information that you will use for life. If you are treating an injury or chronic pain, your insurance may cover physical therapy sessions that can help get you back on your feet faster and stronger. You will also learn how to prevent further injury in the future. See your doctor for a referral.

If you and your doctor conclude that running is not for you, stay active with lower impact exercises, such as walking, biking, swimming or elliptical training. A personal trainer or physical therapist can help develop a strength training program that is right for you.


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