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Knees

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One of the main chapters in our book on officer health is about exercise and what we can do to maintain our bodies while avoiding injury. The chapter consists of a long Q & A between Darren and police physiotherapist Mark Heffernan about all kinds of issues. In the extract below they talk about those pesky knees and problems associated with them.

Darren: “As we’re on the subject of things wearing out, why am I surrounded by forty-somethings at work with buggered up knees?”

Mark: “It tends to be down to either the amount of mileage that has gone through the knees from various forms of exercise or, at the other end of the spectrum, the fact that the person’s done no reasonable exercise. Either way it ends with the same result – sore knees. The body needs ‘sensible’ exercise to function properly. If you’re going to run excessive mileage then eventually your knees will complain. The main problem, especially with runners, is that our brains are extremely good at masking the pain that our knees are suffering. If you think about it, when you first go out for a run you’re in pain for the first couple of minutes but carry on plodding away, thinking you’re ‘warming up’, and after a while don’t notice the pain anymore and so think that everything’s hunky-dory. Wrong! What’s happened is that the brain, noticing that exercise is taking place and aware of the soreness to various joints, orders a release of enkephalins and endorphins into the blood stream – very powerful natural painkillers, stronger than opiates actually, and carries on releasing them all the time you exercise. As soon as you finish, however, your brain switches off the pain relief and you start noticing that soreness again.”

Darren: “Which explains why when I used to run a lot, the run itself was great but then as I tried walking up or down the stairs the following morning I’d be really suffering.”

Mark: “You’ve got it. Of course, it doesn’t help that the simple process of walking down those stairs puts something like the equivalent of four times your body weight through those poor crumpled knees, so they’re probably entitled to moan a bit if you’re mistreated them the previous day.”

Darren: “You’re full of jolly information; what about walking up the stairs?”

Mark: “Even worse – about seven times your body weight. Knees are funny things, it’s well worth trying to understand them. One oddity is that in the presence of pain the muscles surrounding the knee joints tend to weaken so you find over a period of time that the pain actually gets worse. It’s tricky I know; just like yoga, people love running – I used to love running – but from a physiotherapist point of view it doesn’t make a lot of sense as you get older. A good way of preventing or reducing such joint pain and muscle wastage is to use cycling as your main aerobic exercise instead of running. That keeps the muscles strong and rests the joints.”

Darren: “How do you feel about other static cardio devices like ski-machines and that type of thing? How do they impact on your joints?”

Mark: “There’s loads of different machines out there so it’s hard to talk about them all. The golden rule I use is if the exercise doesn’t hurt your joints when you start – as what happens with running – then it isn’t causing those joints a problem. If you do feel sharp pain for the first couple of minutes then perhaps the exercise is not for you. But instead of leaving the gym defeated just try another piece of equipment – maybe a rower. It’s also important whenever trying out some unfamiliar piece of equipment to talk to one of the gym staff and get them to explain to you how to use the thing properly and safely. If you use that rower, for example, then correct technique is vital because otherwise you’re going to cause problems to your lumber spine. But, yes, going back to your original point, steppers, ski-ers, cross-trainers, recumbent cycles – they’re all more sympathetic to your knees than running on the road. And for those of you who can’t do without your running fix – the obsessives – you might want to consider using a flex-deck treadmill instead which is a lot more spongy and sympathetic to your poor knee joints than pounding away on the road with all its strange contours and pot holes. Also check out an anti-gravity treadmill – they’re hilarious to use and will reduce the weight you put through your joints, so allowing you to run relatively pain-free. However, you really should intersperse all of these exercises with static cycling – that’s the thing which really helps maintain the strength of the muscles around the knee. If you coupled cycling with hamstring curls and calf raises, you’ll be working the majority of muscles that cross and support the knee joint. Check out the videos on the website and I’ll show you how they’re done.”

Darren: “There’s a load of die-hard runners out there – those ‘obsessives’. Why does running cause so much damage to their knees?”

Mark: “Quite simply it’s down to the amount of foot strikes and weight that goes through the knee joints. The example I use is that if a ten stone runner does maybe three hundred steps per mile then that will mean that they are putting something like the equivalent of four and a half thousand stones of weight through each knee, each mile. If we then start multiplying that by maybe a five mile run or perhaps a marathon distance of over twenty six miles then you can understand what wear and tear they’re inflicting on those knees. Our knees are a splendid piece of engineering, really, but they can only put up with a certain amount of pounding; let’s face it nature only designed us to live until we were forty.”

And so it goes on …

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