model of person holding knee in pain from an injury

My Knee Hurts. Who Should I Go See?

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On first appearances, your knee is a simple joint. It doesn’t move as much as the hip or shoulder. It’s got fewer bony parts to worry about than the elbow does. And it’s built to hold your body weight, all day every day, so it’s pretty sturdy. But many things can create knee pain, and when this happens, it can sometimes be tough to figure out what to do about it.

  • If you are one of the almost 20% of the population experiences knee pain, it’s worth finding out what’s going on. Here’s how to take the first step (no pun intended):
  • Did you recently have an accident or injury where you twisted, jammed, jerked or otherwise injured your knee? Go to the doctor (or the emergency department).
  • Is your knee swollen, red, and/or hot? This can be a sign of an infection, especially if you also have a fever, excessive fatigue, or are having hot or cold flashes. Go to the doctor!!
  • Does your knee click, lock out, give way when walking or standing? This may be a sign of a past injury that didn’t heal well. Get yourself to an orthopedic doctor or a physiotherapist/physical therapist. You may need a referral for these, but not always. If you aren’t sure, call the offices of the doctor or therapist and ask them.
  • Current or old injuries to the knee joint and other types of knee pain can also lead to compensation patterns in the way your muscles work and develop tension. This can be helped with soft tissue therapy – i.e. some type of massage.
  • Do you have the sensation of joint weakness, especially in conjunction with a history of injury or a low-activity lifestyle? Go see an exercise physiologist to help you rebuild strength and control in the muscles that surround the knee. (If you can’t find an exercise physiologist, go see a personal trainer or strength coach that specializes in late-stage rehab and injury prevention.)

Want to know why? We’ll talk in more depth about this in our next post. Be one of the first to see it by following HealthFit via email below (you’ll only ever receive notifications of new posts on the website).

model of person holding knee in pain from an injury

Caring For Chronic Knee Pain

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Your knees do so much work for you. What can you do to take care of them?

Ongoing, chronic knee pain is a common complaint, and made more common by numerous causes. Whether you have stiff and slightly swollen knees from osteoarthritis, referred pain from tight muscles in the hip and thigh, or an old injury like a meniscus or ligament tear that still bothers you, there are a few easy things you can do to help yourself out and better manage your knee pain.

If you’ve had a recent injury or flare up of knee pain, put some ice on it!

Ice is great for managing pain and promoting the healing process in almost every situation, from a referred pain point that’s just occurred to a decades old knee sprain that lets you know when it’s going to rain. Ice has an excellent pain-numbing effect, so it’s a great option for pain management when you don’t want to take painkillers, and is also useful in managing how the body responds to pain and injury, minimizing the effects of swelling and speeding the healing processes.

While there are no set-in-stone rules for the use of ice, guidelines suggest use for at least 10-20 minutes, though these numbers can vary based on the type of ice treatment you’re using, such as ice bath, ice massage, or ice pack. If you’re applying ice to help manage an injury to deeper tissues – like if you have a diagnosed ACL tear, which is deep, and you’re working to manage the swelling throughout the joint – you may need to leave the ice on for a longer period. The same applied to icing a body part that has greater levels body fat. In either case, more time is needed for deeper tissues to decrease in temperature.

Feeling stiff, tense, and spasmy? Throw a heat pack on that!

Heat is a great option for knee pain that’s stemming from stiffness or muscle spasm.  Like ice, heat treatments can have a painkilling effect, and will also improve circulation to an area, increasing oxygen and nutrients and helping eliminate cellular waste products and speeding the healing process. It’s also an excellent way to relieve muscle spasm, which can indirectly decrease knee pain by decreasing tension in supporting muscles.

Like ice, heat applications need 10-20 minutes to be effective, and may need even longer to be effective when target tissues are deeper under muscle or fat layers. Also like ice, heat can be applied directly to the knees, or to the muscles surrounding them. And it’s common sense, but bears repeating: Always use heat or ice with a towel between the heat or cold and your skin.

And get moving!

While somewhat counterintuitive, movement can work quite well to decrease knee pain. Your knees (and the other major joints in your body) keep themselves “well oiled” with a particular body fluid called synovial fluid that found within many major and minor joints. This fluid is the “oil” that keeps the joint moving well, and movement stimulates the body to create more of this fluid. This is still the case even when movement is painful. Work around this by keeping movement to a non-painful range. Maintaining the movement you have is an important step in moving towards being pain-free.

Movement (especially the right kind of movement) also builds strength through the muscles surrounding and supporting the knees. This is where a physiotherapist, physical therapist, or exercise physiologist comes in: These professionals can help identify the pieces of your movement patterns that might be creating joint stress leading to your knee pain. They can provide you with the right exercises to reset those patterns and get you feeling better. The ultimate goal: Move well, get strong, and get on with enjoying your life!

Red Emergency sign at the entrance to an emergency room

Do you really need a doctor’s clearance to start exercising?

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You might. And you might not. Getting a doctor’s clearance prior to starting an exercise program has one purpose, which is to answer this:

How much will your health status place you at risk for a medical emergency during exercise?

To some degree, common sense applies here. How healthy are you right now? Do you have any physical concerns, or anything going on with your body that doesn’t seem quite right? Anything you honestly can’t explain?

These are things that should prompt a visit to your doctor prior to starting an exercise program. Major exercise science and medicine associations agree on this. (including the American College of Sports Medicine, the National Strength and Conditioning Association, Exercise and Sports Science Australia, and Sports Medicine Australia, among many others). The results of an examination or testing are used to provide guidelines. The overall goal is to decrease your risk of a sudden, serious medical event. Or in layman’s terms, a medical emergency that could lead to disability or death.

That’s scary stuff, and it makes sense to limit your risk. Good news though – for most people, that risk is actually really low. While these risks are elevated during and shortly after high-intensity exercise, it’s important to bear in mind the following:

  • There is a wealth of current and historical data show that heart-related events (those that are highest risk, and that you might be most worried about) are associated with exercise in only about 5% of cases. To put it another way, they happen to about 20 people out of every million.
  • Low- and moderate-intensity exercise is even less likely to trigger anything but improved fitness.

So if you’re ready to start an exercise program, what should you do to get started safely?

Gauge how hard you plan on working. According to current recommendations, low to moderate intensity exercise is a great place to start no matter what your current health status is – it’s actually high intensity exercise that is most likely to lead to problems during or immediately after a session. If your plan is to start high intensity workouts, you should examine the following points in a little more detail.

Intensity is relative. If you’re not used to much physical activity, you’ll likely find that as you start out, many things feel harder than you might expect. Use the talk test – can you comfortably carry on a conversation during activity? – to help keep yourself to an appropriate work intensity. And ease into exercise. For example, consider starting with a long walk rather than a short run.

Be smart about how you start. If you think you might have more than two risk factors for cardiovascular disease, or if you have another diagnosed health condition, including conditions like asthma or Type 2 diabetes, definitely go talk to your doctor. While your GP or PCP probably won’t be the ultimate expert in exercising with health conditions, they definitely are the experts in who you should see for that information, whether that be an exercise physiologist, a cardiologist, or another specialist. Plus, with the right referral from your doctor, you may have insurance options that help cover the costs of learning to exercise with expert guidance.

An additional point on this – if you haven’t been to see a doctor in some time, and have a sense that you may have some health risks, making that appointment and getting there can be scary. I know that, exactly and personally. But even if they have not-great news, there’s a lot you can do about it.

Self-diagnose (just not with Dr. Google). Use a pre-exercise readiness questionnaire (PAR-Q) form like the one here to help determine whether you are at higher risk of an exercise-associated medical emergency, and if you need talk to a doctor before starting high-intensity workouts. If you’re starting an organized (or even semi-organized) program, like personal training, exercise physiology, and programs like Crossfit, F45, HIIT training, and others, you should definitely be using this and your personal trainer or program coach should provide some version of it. If they don’t, or if you’re more likely to exercise on your own, it’s still worth using. Just print off your own copy and fill it out (it takes about a minute). It’s generally deemed safe to start with a low or even a moderate intensity exercise program. Just listen to your body, and if says stop, then stop!

Exercise is generally awesome for your health, and while getting a medical clearance and/or a clinical exercise test can be beneficial, requiring this step can actually keep a lot of people from getting started in the first place. Going to the doctor for a medical or other testing can range from a painful waste of time to a frightening appointment with a lot of scary information that you previously lived with in blissful ignorance. On the other hand, is avoiding this clearance an unnecessary risk? Use the PAR-Q and be honest with yourself, start easy, and always always always pay attention to what your body is telling you!

For more information:
Pescatello, L. S., Arena, R., Riebe, D., & Thompson, P. D. (Eds.). (2014).  ACSM’s Guidelines for exercise testing and prescription (9th ed.). Philadelphia: Lippincott Williams and Wilkins.

HealthFit Coaching’s Exercise Physiology in-home and in-clinic programs provides expert guidance in safe exercise programs for existing health problems. Exercise is powerful medicine. Get healthy, feel better. Start now.

Microscopic view of heart muscle cells

If exercise and high blood pressure both lead to an enlarged heart, why is one good and the other bad?

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Before we get into the answer, it’s helpful to remember that your heart is actually a muscle, and like any other muscle, it responds to the demands of hard work by getting stronger and larger. So while an enlarged heart – known clinically as cardiac hypertrophy – might not sound good, it can actually be great for your long term heart health.

Let’s break down the anatomy and physiology:

The heart has four chambers, and the size of these chambers determines how much blood the heart can pump with each beat (volume). The thickness of the chamber walls determines how forcefully the heart can beat, or to think of it another way, how fast the blood is moving when it is pumped from the heart. The elasticity of healthy blood vessels helps accommodate changes in heart beat volume and blood speed, allowing the whole system to work efficiently with minimal health risk.

Regular cardiovascular exercise stimulates changes in both the chamber size and the wall thickness of the heart, as the working muscles will need more oxygen and nutrients to continue exercise and the heart will beat faster to accommodate. This stress can be good for your health, as over time, these changes allow the heart to pump more efficiently, using fewer beats to move the same amount of blood.

High blood pressure can also cause heart enlargement, however in this situation only a thickening of the walls occurs. This is primarily seen in the left ventricle, the last chamber of the heart before the blood is pumped into the vessels. This specific enlargement is called left ventricular hypertrophy, and is actually stimulated by a loss of elasticity in the blood vessels. Stiffer blood vessels require the heart to pump harder to move the blood, as there is more resistance from the blood vessel walls that prevents the blood from flowing as easily. Because the overall needs of the body don’t change, the volume of blood pumped per beat will remain the same and no change in chamber size will occur. Overall, thicker walls without a concurrent change in chamber size will complicate good heart function, as the heart chambers may not fill as well and the volume of each heart beat will be decreased.

If you have might blood pressure, it’s worth talking to your doctor about your risk of left ventricular hypertrophy, as it has been associated with sudden cardiac death. If you already have this condition, it’s really worth talking to your doctor because there is evidence that exercise and changes to your diet and body composition can have a positive impact on the heart structure, and you want to be able to make these changes safely.

 

References
Cohen J. L., Segal K. R. (1985) Left ventricular hypertrophy in athletes: an exercise-echocardiographic study. MSSE, 17(6):695-700. 
Pluim, B. M., Zwinderman, A. H., Laarse, A. V., & Wall, E. E. (2000). The Athlete’s Heart : A Meta-Analysis of Cardiac Structure and Function. Circ, 101(3), 336-344. doi:10.1161/01.cir.101.3.336
Smith, D. L., & Fernhall, B. (2011).  Advanced cardiovascular exercise physiology.  Champaign, IL: Human Kinetics.

 

Image by OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons