Got Knee Pain? Maybe The Answer Is More Exercise
Orthopedist Popi Gianakouras helps 45-year-old Bob Rothaker with physical therapy to treat his sore shoulder. (Richard Knox/NPR)
Like millions of baby boomers, I've always thought I'd stay active into my later years. That's unlike many in my parents' generation who gave up hiking, biking, running, kayaking and other strenuous pursuits (if they ever did these things in the first place) when they developed aches and pains.
So the last six months have been discouraging. First, there was a painful left Achilles tendon. That was brought on by a gentle two-mile run — after not running for a long time due to bone spur pain that took a year to go away.
A visit to orthopedic specialist Bridget Quinn at Beth Israel Deaconess Medical Center in Boston gave me heart.
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"We're going to get you running again," she said. (I loved her use of the first-person plural.)
A Slippery Slope To Knee Replacement?
Quinn wrote a prescription for two months of physical therapy. That worked. No more Achilles pain. So with the coming of spring, I was all set to get out there again — carefully, this time.
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And then the knee pains started. Suddenly, going up and down stairs hurt. So did the simple act of sitting down and standing up.
Serious bummer. Hard not to think, "Is this the beginning of old age? A slide down the slope toward knee replacement?"
Not necessarily, Quinn says.
"One thing about your history that's very telling," Quinn says, "is this all started after a period of inactivity. Your tissues, when you're not active, get tight and weak. And this can predispose you to this condition, called chondromalacia of the patella."
Basically, it means irritation of the cartilage lining the kneecap. My kneecaps weren't tracking in their grooves the way they're supposed to.
Quinn says it's the most common knee problem she sees. It can result from either overuse or underuse. In my case, it's clearly the latter.
"The good news is you don't need surgery for this," Quinn says. "This is something you can help manage."
A Prescription For 'Aggressive Flexibility'
Once again, she prescribes physical therapy. It will focus not on the knee itself but on the hip, the abdomen, the back, the glutes and the quadriceps muscles. All are important in getting the kneecap to track properly.
Flexibility is key, she says. I'll need what she calls a "really aggressive flexibility program" to loosen up my leg muscles.
And the prognosis? "I would suspect that in the next six to eight weeks, you're going to be back on a good running program," Quinn predicts.
This is great news. I never thought I'd be able to run again.
Next stop is a physical therapy clinic and an appointment with a peppy, can-do therapist named Popi Gianakouras. When I met her, she was working with a 45-year-old bank employee named Bob Rothaker.
Like many of Gianakouras' patients, Rothaker spends hours at his desk, staring at a computer screen. His terrible posture, she says, was causing him a lot of problems.
"By the afternoon, it was really painful," Rothaker says. "From the upper back it would migrate to the chest area and then the shoulder area." He had tension headaches, too.
Making Over The Muscles
But seven weeks of physical therapy have made a big difference. "It's great! I'm almost symptom-free now," he reports. "It's been a tremendous help."
Gianakouras examines me and agrees with Quinn that my problem is not just in my knees.
"It's actually the mechanics of the entire lower extremities, from your core all the way down to your feet," she pronounces. "And you have to address all of those things in order to correct the problem."
"Major makeover?" I say. "Major makeover," she affirms.
She prescribes a program of exercises designed to stretch and strengthen half the muscles in my body, it seems.
It's actually not as bad as it sounds. The routine takes about an hour a day — not necessarily all at once. But I've got to be faithful about it, and so far, I have been. In only a week, it's making a difference. Going downstairs doesn't hurt so much.
Gianakouras says a lot of her patients are like me. We're pretty sedentary in our everyday lives, but nevertheless expect to stay active.
As my knees can tell you, that doesn't work.
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RICHARD KNOX: I'm Richard Knox, and I have a personal story about the bad things that can happen when you're inactive. A few months back, I injured my foot when I started to run again after several years of not running. Dr. Bridget Quinn, an orthopedic specialist at Beth Israel Deaconess Medical Center in Boston, prescribed physical therapy. Recently, I went back to her for a checkup.
(Soundbite of knock on door)
KNOX: Hi.
Dr. BRIDGET QUINN (Beth Israel Deaconess Medical Center): Hi.
KNOX: Good to see you.
Dr. QUINN: Sorry for the delay.
KNOX: No, no problem. I'm just glad to see you.
Dr. QUINN: So Mr. Knox, how are you feeling?
KNOX: Well, my left heel's OK. It doesn't hurt anymore. It took a while, but the physical therapy seemed to do the trick. But lately, I've been having knee pain that seemed to come out of nowhere. So ooh. See, there it is.
Dr. QUINN: All right. Mind if we take a look?
KNOX: Yeah. Sure.
Dr. QUINN: All right.
KNOX: Dr. Quinn says I have a common knee condition. It's an irritation of the cartilage that lines the kneecap.
Dr. QUINN: This type of knee problem is actually the most common cause of knee pain I see in all - all age groups. If you're a 16-year-old female distance runner, if you are a 40-year-old mother, this is the most common cause of knee pain.
KNOX: It can be either an overuse problem or an underuse problem. In my case, it's clearly underuse.
Dr. QUINN: I think what's happening here is that this tight tissue on the outer part of your knee is tugging your kneecap into a little bit of an abnormal alignment. It's causing the kneecap to mal-track.
KNOX: It's supposed to be - what, in - like, in a groove?
Dr. QUINN: Yeah. It glides in a groove, but it likes to glide perfectly in that groove.
KNOX: But to my enormous relief, she says this is treatable. It's not the inevitable decline of old age. It's just a problem that needs physical therapy.
Dr. QUINN: Your physical therapist is going to be your personal trainer. You want someone who's familiar with this diagnosis working with you initially, and then have them graduate you to your own program.
KNOX: What kind of time course should I - is realistic for getting me past this problem?
Dr. QUINN: I would suspect that in the next six to eight weeks, you're going to be back on a good running program.
KNOX: This is great news. I never thought I'd be able to run again. Dr. Quinn sends me to a can-do physical therapist. Her name is Popi Gianakouras.
Ms. POPI GIANAKOURAS (Physical Therapist): Lie down, please.
KNOX: When I met her, she was working with a 45-year-old man named Bob Rothaker.
Mr. BOB ROTHAKER: I'm in banking. I support corporate communications, media relations, and risk and compliance.
KNOX: So you're at a desk much of the time?
Mr. ROTHAKER: Most of the time, yeah.
KNOX: Like a lot of Gianakouras' patients, staring for hours at a computer screen - with terrible posture - was causing Rothaker a lot of problems.
Mr. ROTHAKER: By the afternoon, it was really painful. From the upper back, it would migrate to the chest area and then the shoulder area.
KNOX: But seven weeks of physical therapy has made a big difference.
Mr. ROTHAKER: It's great. I mean, I'm almost symptom-free now. It's been a tremendous help.
KNOX: Gianakouras examines me and agrees with Dr. Quinn - my problem is not just in my knee.
Ms. GIANAKOURAS: It's actually the mechanics of the entire lower extremity, from your core all the way down to your feet. And you have to address all of those things in order to correct the problem.
KNOX: Major makeover?
Ms. GIANAKOURAS: Major makeover.
KNOX: Gosh, so what do we do?
Ms. GIANAKOURAS: So from what Bridget found, and from what I just see, you need a program of flexibility in your hamstrings, quad strengthening, hip strengthening and core strengthening.
KNOX: It's actually not as bad as it sounds. She prescribes about a dozen different exercises that will loosen and strengthen my leg muscles.
Ms. GIANAKOURAS: You're going to lie on your side, so you're just going to raise your leg up and down, up and down.
KNOX: So how many of these?
Ms. GIANAKOURAS: Ten repetitions.
KNOX: It should take me about an hour a day, but I've got to be faithful about it. Gianakouras says a lot of her patients expect to stay active into their 50s, 60s and beyond. Their parents had different expectations.
Ms. GIANAKOURAS: I really just think if something hurt them, they just stopped doing it. I also don't think that they sat as much as we do. We commute more, we sit at a desk more, we're on computers more.
KNOX: So there it is. We're more sedentary in our everyday lives, but we expect to stay active. As my knees can tell you, that doesn't work.
Richard Knox, NPR News, Boston. Transcript provided by NPR, Copyright National Public Radio.
