Bird Flu Guard

As he started the 10th hole, the limp arrived like a rising ocean tide. At first, barely visible, the over weight man in his mid-40's trudged over the fairway carrying his steel-shafted Callaway clubs. But, with each passing hole, his walking speed slowed as his body tilted in an uneven rhythm right and left.

"Hey, Jim - wanna ride? Got plenty of room," shouted Jim's golfing buddy Rob.

"Nahh...thanks. Need the exercise," yelled Jim as he slapped a golf shirt stretched to its limit over a jiggling belly. "My doctor says I need to lose some weight! No kiddin'!"

By the 15th hole, Jim's knee was swollen. It was stiff, and ached. He called to Rob, "Hey, Rob! I'll take ya' up on that lift!". He climbed into the golf cart and rubbed his right knee. "Ahh...man...this hurts...oughta' quit, I guess...just about done..." rumbled through Jim's mind.

Jim finished the round, gulped down two Miller Lite beers with his buddy Rob, and then headed home. His knee seemed a little better.

He never thought about it again until two weeks later when he played another round. He made it four holes before he needed a ride. The following day, Jim called his doctor's office and made an appointment.

"Well, Jim, you've got osteoarthritis and the way I see it is you've got a couple of choices. First, you'll need to take these anti-inflammatories for about a month. Your knee's inflamed. Then, if you want to play golf, you'll have to ride. But, what you really need to do is to lose some weight - like about 30 pounds," said his doctor.

"Yeah...I know..but..I guess.. I need some kinda' exercise, right?" asked Jim.

"Right. You'll need to change your diet and you'll need to exercise more," replied his doctor.

Jim sat slumped on the edge of the exam table, looking down at the floor. "Uhhh..well...I don't know how that's gonna work, Doc. I mean, I..just..," and Jim's doctor interrupted him. "Jim, I've got to get to another patient right now but try a personal trainer or maybe a physical therapist. Here - I'll write you a script for some physical therapy. They'll be able to figure it out," and in a nano second Jim's doctor was gone.

How do you exercise hard enough and long enough to lose weight when something as simple as walking hurts?

No question Jim needs to change his diet, but without adding cardiovascular training and muscle training to ramp up his caloric burn, he won't lose an ounce of weight. If he goes to the gym and tries either of these exercise options, his knee will hurt.

Some people believe that strengthening the muscles around the knee is Jim's answer for his stiff, achy joint but the physical forces required to truly fatigue the muscles will be greater than the joint can withstand. The result is a sore knee with little to no muscular fatigue. After a few rounds of this kind of exercise, Jim will quit, maybe play golf but settle for riding in a cart, fail to lose weight, and compromise his long term health and happiness.

The answer for Jim's knee pain is is to strengthen the joint cartilage first then strengthen the muscles. If Jim does this, he stands a good chance of being able to lose weight and reclaim his health.

You're probably wondering, "How do I do that?" I've written about this topic before but, in a nutshell, your body adapts to physical stress in very specific ways. Joint cartilage needs a different form of exercise than muscles; a different prescription. The unique intensity, frequency, and duration of the exercises for joint cartilage create a strengthening effect in the same way that lifting weights creates a stronger muscle. Using a muscle training prescription on a joint cartilage problem is like taking a drug that lowers your cholesterol and expecting it to lower your anxiety. The solution needs to match the problem.

People who have knee osteoarthritis like Jim can do something about it if they act quickly. The early signs of joint trouble include stiffness and aching that comes and goes and sometimes a sense of fullness in your knee. Ignoring the symptoms allows the disease to take hold, erode your cartilage and then begin eroding your bone. You then may end up in surgery yet still have all of the health issues associated with being over weight.

If you're like Jim, your knee pain is an invitation to a healthier life. You need to RSVP.

Will you?

Doug Kelsey

I was about fifteen when I first heard the phrase, "Take a knee". I had no idea what it meant. I just stood there on the basketball court and watched as the other players all knelt down on one knee. The coach blasted his shrill whistle and yelled, "And, just what's so special about you? Start running! Now! And, don't stop until I tell you to!"

A few of the other players started laughing. They soon found themselves jogging with me around the gym. I learned. "Take a knee" is a phrase coaches use when you need to shut up and listen; when your coach is trying to tell you something important. He has a point; a lesson to apply in the game. You're supposed to pay attention.

While I and a couple of other players jogged, the coach explained a few things to our teammates. When he finished he said, "Any questions? Got it?" No questions. He blew the whistle and practice resumed. About 30 seconds later, four other guys started jogging around the gym too. They took a knee but not the lesson.

Sometimes in life, you have to "take a knee" too.

A friend found himself unable to brush his teeth at the sink. He couldn't stoop over because holding himself in this position caused his back to tighten and hurt. So, he knelt down in front of the sink on one knee while resting his forearm on the edge. He could then brush his teeth because he was supporting some of his body weight on the sink. He did this everyday until he came to a seminar I gave on lower back pain when he realized that what he was doing was not normal.

His back blasted its whistle, but my friend didn't understand it. Like my team mates who took a knee in practice but didn't really know what the coach meant, he didn't know why he couldn't brush his teeth (even though he was a physical therapist - just because you help other people doesn't mean you can help yourself). He just gradually accepted that what he was doing was normal. He worked around his problem rather than solving it.

Because he didn't understand the lesson, he kept the cycle going: back pain, kneel down, back pain, kneel down, back pain, kneel down. Just like the players on my team running around the gym because they didn't get the lesson the first time.

Whenever you're trying to work around some physical ailment, like my friend, things like icing your knee everytime after you run, popping your neck so you can work comfortably at a computer, eating Advil like its hard candy, or wearing a funky back brace so you can swing a golf club, your body is trying to tell you, "Hey, take a knee and listen up." 

The question is, "Will you?"

Doug Kelsey

P.S. - For those of you who find yourself in my friend's predicament where your back pain is driving your life instead of you, sign up for our upcoming, free lecture or purchase the CD. Discover the Secrets to Beating Back Pain.

We receive a number of questions from readers around the world so starting this Sunday, November 12, 2006, we will begin posting our answers to some of the questions that get submitted (we'll do our best to answer all of them but depending on the volume and topic, we may not be able to). You'll also get the latest news and updates on injuries, healing, and health in the View so you'll hear from us more often than on just Sunday evening.

Thank you for subscribing to the View and sharing it with your friends, family, and colleagues. As always, we would love to hear from you. If you have any suggestions for topics, ideas, or just would like to voice your opinion, you can do it through our blog, The View from Sports Center (http://www.sportscenteraustin.blogs.com).

Make today count.

Doug Kelsey

You wake up one morning to look in the mirror and discover a bloated and swollen face, especially around your eyes. You think, "Man, I need to back off the wine. This is bad." After splashing cold water on your face hoping to shock yourself into an semi-alert state, you take one more look. Better, but still a little swollen.

As the day goes on, your face seems to shrink to its normal size and shape; your energy comes back up. You feel fairly good. But, the next morning it's back. The puffy, swollen eyes look like something out of a horror film. You finally decide after a week of this scenario, you had better find out what's wrong.

There's something awry in this story. Something bad. And, it comes disguised as puffy eyes.

The culprit is Superior Vena Cava Syndrome secondary to cancer. You have lung cancer and it shows up as a puffy, swollen face.

So, imagine how you would feel to hear your doctor say, "It's just some swelling. Just rub your face a few times a day and it'll go away."

Not so good. Right?

A similar story plays out thousands of times per day all over the world but the characters are different. Instead of a puffy, swollen face, you have back pain. Instead of cancer, you have disc disease. But, patients with back pain are often told, "You'll just have to learn to live with it," or, "Try some ice or stretching or maybe acupuncture." The back pain is treated with just about anything imaginable to get rid of the pain and without regard for the underlying cause. Just like rubbing your face when you have cancer.

Pain from a musculoskeletal injury or disease is a symptom that deserves as much attention and as much thoughtful decision making as the pain from cancer. But, it doesn't. Why? Who's fault is it? Everyone's. From the clinicians who tout a quick fix to the the patients who want one. But, fundamentally it's the clinician who makes the call. It's the clinician who's the patient's agent; acting in his or her patient's best interest. It's the clinician who understands that pain is a symptom and the course of action is derived from the cause of the symptom. And, when a clinician doesn't know the cause, you keep searching, visiting other specialists until you have exhausted every avenue, every possible answer. The treatment of symptoms is important, of course, but it is like fixing a flat tire with a rubber patch. When the road gets rough, you're in trouble. What you need is a comprehensive solution that you understand and can implement over the course of your life; not a patch.

The quickest way to determine if a proposed course of treatment is a solution you should follow is to ask this question: "Is this what you would do for your mother?" Cuts right through the craposphere. Any hesitation, fumbling, or lack of clarity, keep looking. Bottom line, folks - if you hurt and someone tells you, with about as much care as you can put in a thimble, to "live with it" or "rub it a little" or "take this and call me if it still bothers you.", then keep looking. Don't just "rub your face".

Doug Kelsey

PS - We have an awesome seminar on back pain. If you have back pain or know someone who does, call now to get your seat. This is a standing room only talk every time we hold it.

Doug, I've read several of your articles and I appreciate you giving us this information. I have a few questions.

1. You say "You cannot make the VMO contract by itself." This is true, however, just as you can develop the outer quads more than the inner quads by certain exercises, isn't is also possible to develop the inner quads more than the outer quads based on specific exercises?

2. You say the standard exercises used in attempt to strengthen the VMO can cause more harm. You make a good point about added pressure under the knee, but are you saying that the standard array of exercises used to strengthen the VMO have no affect on knee cap alignment? In other words, has no one succeeded in improving lateral knee cap "pull" through the standard exercises you've debunked?

3. In your various posts about the knee you allude to hip strengthening as the means to improve patellar related knee pain. Can you point us to some information on this?

Thank you again for providing this information.
David

Hi David -
Thank you for your excellent comments and questions. My answers to your questions are below in the original order:

1. I don't know of a study proving that one can develop the inner or outer quadriceps by using certain exercises. There have been studies that have shown using exercises that try to isolate the inner quadriceps (for example, using the hip adductors or turning the leg in or out) do not work; the entire muscle becomes stronger and the ratio of muscle activity from outer quadriceps to inner remains the same. Here's a section of another I article that might help (to read the entire article, click here.

"The challenge is to change physical function not from "strength" but from neuromuscular learning. The good news is that practically anyone can do it. To better understand this, I conducted a small experiment a few years ago. I asked a student (a great resource for experimentation by the way) to serve as a subject for my study of the quadriceps mystery. I attached surface EMG electrodes to the right quadriceps. I then asked my student to perform a maximum, volitional isometric contraction of the quadriceps to produce a baseline EMG reading. I used this to later reference electrical activity during other tasks.

Next, I instructed my student to step up and down a 9 inch step while I recorded the EMG activity. I discovered that to step up and down the step, my student used about 50% of her maximum volitional capacity. She had therefore a considerable amount of "reserve" capacity if she needed it. I then recorded EMG activity during the following exercises:

Quad sets - EMG activity was 20% of maximum

Straight Leg Raises - EMG activity was 25% of maximum

Full arc open chain knee extension with 10 lbs resistance - EMG activity was 38% of maximum

Stepping up a step with a 5lb force pulling to the right applied at the waist - EMG activity was 80% of maximum

I discovered when I applied a second line of force, a vector, the EMG activity was much higher than any of the other tasks. When I tried this with patients, I found many of them with "anterior knee pain" were initially unable to step up and down a 9 inch step. But if I applied the second line of force, the step became pain-free. I was then able to "push strength" but do so in a functional and pain-free manner. I had found a way to take advantage of the body's inherent learning ability and accelerate it. This technique has worked literally hundreds of times in my clinic as well as others around the country."

2. While exercises like quad sets and straight leg raises may be helpful and may improve patellar tracking, what I've found is that few clients tolerate the exercise when performing it at the proper dosage. In other words, their knee hurts, they perform an insufficient number of repetitions and quit. And, in most cases, the problem is not primarily muscular weakness but cartilage weakness or osteoarthrosis. Muscle weakness is a symptom of the disease. The classic exercises (quad sets, short arc or limited knee extension, straight leg raises) fail to improve the quality of the joint surface sufficiently to permit pain free exercise on their feet. We use quad sets in our programs since a quad set has been shown to improve the quality of synovial fluid in the joint but it is a small component.  Our emphasis is pain free, weight bearing exercise to promote improved joint health prior to entering any muscle training. The truth is, most people that I have met with knee pain have learned to "work around" their pain or dysfunction, reduce their overall activity level and settle for a less active life.

3. Hip strengthening - in the article I mentioned above, I used a "vector" applied to the body at about waist height (so, a belt with an elastic tube attached to a fixed point pulling to the left if attempting to strengthen the right hip) - as an example of one hip strengthening drill. This extra pull increases the work load of the right hip while performing such tasks as a single leg squat or stepping up a step. The key is actively keeping the pelvis level during the drill. Of course, the exercise should not create knee pain. if it does, then the exercise is too difficult.

— Next Page »