Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
Monday, January 26, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
A common myth is that injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles.
Early studies showed poor ratios of quad to hamstring strength. It was concluded that because of this, when the athlete would kick, for example, the overly strong quadriceps would overstraighten the knee, and the overpowered hamstring behind the thigh would not be able to stop the powerful straightening. The knee would overstraighten and hyperextend the joint, injuring it.
Athletes were put on hamstring strengthening training. Then they went back to kicking with the same bad habit of overstraightening as before.
The problem was simply that they athlete would hyperextend the knee. They were allowing it through bad training habits, not being made to do it by a strong quadriceps. Your muscles do not make you move. You learn though training and practice how to move in healthy ways.
What to do? When you kick, don't fling your leg out and hyperextend (overstraighten) the knee. Control the end point position.
When you land from jumps or descending stairs, don't step down on a locked, straight knee. Control the end point position.
Muscle use is not automatic from muscle strength:---
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Labels: anterior cruciate ligament/ACL, hamstring, injury, knee, leg strength, meniscus, myths, practice of medicine
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Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function
Monday, January 19, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Good news. If you don't like or want knee surgery for most arthritis or meniscus injury, you don't have to have it. Lack of need for surgery has been demonstrated over many years in rehabilitation populations, and in a mostly ignored older clinical study. Recent studies confirm you can stop most pain and restore function just as well without surgery through good physical rehab.
Millions of Americans undergo arthroscopic surgery for knee pain every year. Over the last 30 years, arthroscopic surgery has been routinely accepted and prescribed for knee pain without undergoing rigorous evaluation.
Even when a 2002 study published in the
New England Journal of Medicine (NEJM) found that results of arthroscopic surgery for knee osteoarthritis were no higher than medicine and physical therapy alone, the surgical community "remained unswayed."
Dr. Brian Feagan, co-author of a study in the Sept. 11 2008 issue of the NEJM stated, "It really didn't change practice that much. That's why this second [study] was really important."
Feagan's randomized, controlled trial involved 178 patients, average age 60. All had moderate-to-severe osteoarthritis of the knee. Half underwent arthroscopic surgery plus medical and physical therapy. The other half used medical and physical therapy alone. After two years, both groups' scores on a measure of arthritis severity were about the same.
A second study also published in the same journal issue, found that meniscal tears are common in the general population and, "may not, in fact, be responsible for painful symptoms." That means that if you have knee pain, and have scans and imaging which show a meniscus tear, it may not even be the tear that is causing the pain.
"There's going to be a swing in practice," said Dr. Feagan.
Study authors stated that meniscal tears detected on MRI may confuse matters and lead to unnecessary therapy. This is a similar finding to back pain where patients with pain are shown to have a herniated disc, stenosis, or other finding, but the pain is not from the anatomical finding, but the same bad movement habits, slouching, and lack of good movement that make anyone hurt. Discs also often appear herniated, and spines compressed by stenosis on scans of people with no back pain. Don't base your treatment and future on a picture. Scans are not tea leaves.
Supportive and inflexible shoes are often prescribed in the belief that they restore healthy tracking, but studies show that these shoes increase knee load and tendency to arthritis. You may do rehab for the meniscus that shows up on x-ray, but still have pain that may only be from the from hard "supportive" shoes. You can "support" and align and stabilize your own feet and ankles and knees using good mechanics and your own muscles.
Poor knee stability increases risk of developing arthritis, and increases wear on the meniscus. Studies tracking results for years following surgery are finding that surgery "adds no benefit over rehabilitative training alone." That means you don't need the surgery to fix or prevent possible future arthritis.
You don't have to have surgery to stop knee pain:How to fix and prevent knee pain from arthritis and most meniscus injury:Next:---
I make posts from fun mail and success stories. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and
the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. For answers to personal medical questions -
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Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, martial arts, meniscus, practice of medicine, repetitive strain, surgery
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What Works Better Than Knee Surgery?
Monday, December 15, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
New studies have been making big health news. These studies conclude that knee surgery is not needed to rehabilitate after several kinds of knee injuries, and that
"question the benefits of the surgery." This information is not new. How do I know this? Because of years of previous studies concluding that surgery "worked." Here is what those previous studies often meant:
About 10 years ago, I attended a sports medicine conference. A new line of knee surgeries had come out, and the surgeons and manufacturers of the products used were anxious to have their surgery accepted and endorsed. One of the clinical presentations of the conference was the results of a study that compared patient outcome after knee surgery to the outcome of physical rehabilitation without surgery.
The patient group receiving physical therapy had improvement of function and reduced pain over time. The sample undergoing surgery went through the risks of anesthesia and surgery, lost work and wages, pain controlling narcotics during surgery and recovery, reduced activity for a minimum of 2 months following surgery, and pain from the surgical area. They then underwent months of physical therapy to regain function lost from the surgery. Many had permanent reduction of knee range of motion, considered
"standard and acceptable" for that surgery. The loss of range can reduce function of the area, and reduce ability to stretch the hip, which can cascade years later into further restrictions. The physical therapy group had improvements that started soon after beginning treatment. The surgical group initially had decreases in all measures of strength and function, then months of painful recovery, and further months of reduced physical condition while they worked to "get back in shape."
Patient outcomes of muscle strength and pain levels were compared after two years and found roughly equal. The conclusions of the study were that surgery was effective, since two years afterwards, patents in the surgical group had made gains equal to the therapy group. I raised the question to the presenters about the initial painful recovery, then months of recovery, which the therapy group never had to experience. They were angry that I could not see that the outcome measures were equal, so "all's well that ends well." They pointed out that their surgical patients often thank them because they, "wake up and the pain is gone." They omitted that post-surgical patients are on pain relieving drugs, often narcotics.
I do not judge my own patients to be fine, or a method to be worthwhile, if they have to endure loss of mobility and physical levels at all, let alone over two years.
What works better than knee surgery? - Physical retraining of how you use your knees in daily life when walking, bending, running, and other activities.
- Checking other causes of knee pain such as hard "supportive" shoes, and many prescription drugs with pain as side effects.
- It is common to do exercises to strengthen the legs, then walk away from those same exercises allowing the knees to sag inward, slide, or twist in directions different from the line of the joint. The chronic unequal loading grinds, stretches, and wears at various bands of cartilage that connect upper and lower leg bone (ACL and PCL), meniscus cartilage, can grind the inside of the kneecap causing pattelo-femoral pain, and can even wear away at the shiny smooth cartilage covering bone ends (the articular surfaces), predisposing to arthritis.
- This is why much supposed knee rehab isn't " working" - it is being undone the rest of the day by continuing the causes of the problem. Physical retraining is for all real life, not just a bunch of "sets and reps."
You don't have to have surgery to stop pain. Here are Fitness Fixer posts on fixing knee pain without surgery:Coming next Monday - Surgery for anterior cruciate ligament (ACL) repair found to be not needed to restore function or prevent later injury -
Anterior Cruciate Ligament (ACL) Surgery Unnecessary.
Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, meniscus, practice of medicine, surgery
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