The most frequent cause of knee pain in walkers

I have written about this topic some time ago; but the cases continue to roll in, so its time for an update.

I could not count the number of times a walker has come to see me for help with their sore knees following a long hike in the hills, or following an event like the Oxfam Trailwalker 100km.  They may hobble up the path to my office and describe suffering a tightness and diffuse pain in one, or both knees.  It is typical that their knees have been troubling them for several weeks or months and they have had many physiotherapy treatments without relief.

Although they may be complaining of knee pain and although they may have had a diagnosis of, say, wear under the knee cap, or the kneecap not tracking correctly, these often turn out to be "red herrings".  

Swelling and pain affecting the lower inside of the knee

More often than not we will find swelling and pain around about the lower inside of the knee, skirting around to the back of the joint.  The knee joint itself, may be fine.  This kind of injury is most common in walkers but also found in distance runners and cyclists.

The cause of this pain is excessive rubbing of the tendons of the inner thigh at the point where they wrap around the inside of the knee bone.  There may also be pain and swelling at the point of attachment of the tendons to the tibia just below and to the inside of the knee.  In some people, especially women, this may appear as a swollen and soggy mass just below and to the inside and rear of the knee.  

It is quite surprising just how swollen and painful this region can be and even more surprising how long it can go without prior detection.

Knee pain of this kind is more common in women than men, possibly because of their having softer collagen.

Walking seems to be particularly conducive to this injury, although it is present in runners and walkers.  The repetitive straightening of the knee may inflame the inner knee tendons and they consequently swell.  With this swelling, the tendons rub more than ever, causing further swelling.  Its a vicious cycle.  As time passes there is progressive scarring and thickening of the tendons and surrounding tissues.  Rest, on its own, gives little more than temporary relief.

Treatment of knee pain

Treatment consists of deep tissue massage of the inside and front of the knee where the affected tendons slide and where they insert into the tibia and form the knee joint capsule. This must be done by a trained and experienced therapist.

It may also be helpful to give dietary supplements such as vitamin C, zinc, magnesium, manganese and silica which aid tissue healing.

Look for areas that are tender and swollen and concentrate on massaging these. Where there is visible swelling, the massage technique used is "effleurage" to shift the fluid out and towards the heart.

Massage the affected areas firmly but gently for several minutes using a quality massage oil.  Stay within pain limits - you are not setting out to hurt - only to heal.  Repeat the therapy at seven day intervals for as many sessions it takes to be completely recovered. Do not massage hard in between: Stick to gentle effleurage which will assist healing.  

Exercise as per normal, using pain and discomfort to guide just how much to do at a time. While there may be pain when touching the massaged areas, there will be improved function, such as being able walk more freely.  There is usually marked relief by about the fourth session and complete recovery by about eight or nine sessions (weeks).

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The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

A fast runner with painful knees

Hello Gary,

I just thought I would contact you with regard to some knee pain I've been experiencing for the past 2-3 weeks. It is occuring in my left knee and is generally experienced at the beginning of a run i.e. the first 800m to 1km (even at a very easy pace) and when performing strides (both after a warm-up and at the end of a longer run). Often in the course of a long run the pain will ease and won't bother me allowing me to continue, but in a 13km run yesterday I was also aware of it towards the end of the run and during downhill sections. When not running it is generally not an issue, but it is particularly uncomfortable when performing lunges on that side and single leg squats. Furthermore, when performing such exercises (both) knees tend to make rather disconcerting crunching and clicking sounds.
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Gary:
The most common cause of the pain you are describing is "Chondromalacia" (Refer illustration left).  It most often appears in runners in their 20's and is associated with an increase in training and competition, including doing unfamiliar running drills, including over-striding, bounding up steps.  Worst of all is running downhill.  Another cause may be sore calf muscles which cause compensatory flat-footed striding with the backside dropping to the ground similar in appearance to running in a seated position (Bent knees has the patellae grinding hard on their femoral grooves).

Anything that causes excess grinding of the patellae on the underlying femoral groove will cause knee pain and a feeling of grating or grinding under the knee cap.

The cause of chondromalacia is usually never just one thing: It is usually a combination of several things all coming together to cause excess wear that exceeds the body's ability to repair.  This includes lack of recovery time following hard races and following training.  An occupation that involves a lot of bending at the knee, walking down stairs and even sitting for long periods with the knees bent may compromise repair of wear of the underside of the kneecaps.

Nutrition is important.  If there are deficiencies or excesses of various nutrients, then repair may not be speedy and the repairs soft and weak.  Glucosamine and chondroitin may assist and well worth taking for a period of three months at the daily recommended dosage.  A Hair Tissue Mineral Analysis assists with determining any nutritional weaknesses may be contributing to wear exceeding repair.

If your knees are still bothering you, I think it is best to have a break of several days.  Do some swimming and aqua-jogging.  Get going with the glucosamine and chondroitin, ensure your diet is rich with protein and quality fats.  While you are settling the knees down, try to identify everything that might have contributed to the knee pain and work out how to avoid these in the future.  For example: Put in place the rule that you will have a relative rest day for every mile raced.  So, if you raced 10 miles today, you do no running for the next two days then gradually resume to full training over the remaining 8 days.  Got the idea?

Back to now: As your knees settle, resume running with care, just with jogging on a flat grassy surface.  Run tall as if you are held up by a bungy cord attached to the top of your skull.  If you have tight calf muscles, then get them massaged deeply and painfully on a weekly basis for as long as it takes for the deep massage to be pain-free.  Get your quads, hamstrings and gluteals done while you are at it.

It is important to be patient and thorough when dealing with any kind of knee pain.  Your knees have to last you many, many years.  Please don't ruin them while so young.

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The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.  Please give me your support by subscribing to my free email updates. Please shop at my Online Store. Please encourage your family and friends to do the same. While we may not always be able to compete with the big operators on price, we aim to more than compensate through personal service!
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I have bruised the bone on the inside of my knee and it won't heal

Image via Wikipedia

Image via Wikipedia

Back in the summer I fell off my mountain bike and smacked the inside of my knee on the top tube, I guess I bruised the bone and it has been sore ever since. It’s pretty boney in there, which is sore to touch. I have rested it, iced it, massaged it, antiflamed it, stretched it just about everything I can think of. It doesn’t appear to be a tracking problem, the actual knee and kneecap seem to be running freely, just stiff and sore on the inside of the knee when straightening. Any ideas?








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Gary:

The injury appears to be either the medial ligament or to the adductor tendon where it wraps around the medial tibial plateau.  Both these injuries can be very slow to heal.  Incidentally, I wiped out on by mountain bike on the weekend and suffered the very same blow to the side of the knee!

Treatment is as follows:

A weight lifter with arthritic knees seeks advice

My name is haseeb I live in U.A.E Dubai; I am peasant of arthritis I am in pain séance last 8 months trying; eating different medicines I have eaten Celebrex but after while it don’t react on my cant affect on my pain so not I am taking this medicine olfen-100 SR ( diclofenac sodium ) but same problem with me is doctor said me to take one capsule in 24 house but taking first dos; after 8 or 9 hours I have pain back so have to take other too so 2 capsule in 24 hours well I have seen your video on YouTube regarding joints supplements for arthritis I want you to prescribe me medicine or; health supplement but I want you to tell you this first that this pain started rite 8 months back when i was working out at gym well one day I push up some over Wight some heavy Wight how, you can see pictures in attachment how I push up some

A young gymnast with Osgood-Schlatters Disease

Boney bump below knee

Hello Gary

I love receiving your newsletter. My son is a 13 year old Level 9 gymnast (Level's go to 10 and then college competition). He has developed O-S and other than the traditional ice and rest (which won't happen) do you have any advice?

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Gary responds:

Prior to the adolescent growth surge, most young boys have excellent flexibility, not dissimilar to that of girls.  With the onset of puberty the surge of testosterone initiates rapid elongation of the long bones of the body as well as a hardening of connective tissue, including the tendons.

Knee Pain - An Update

hi Gary, I can't believe how good my knee feels after only 2 weeks! the instability has pretty much disappeared after your advise of massage treatment. i have slight tenderness sometimes on the outside of the kneecap when i rub that, but feeling heaps better. Cheers R

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Gary comments:

The solution to persistent aches and pains can sometimes be so simple and so obvious as to leave one wondering why on earth was this not picked up earlier and poperly treated by the Dr/specialist/physiotherapist?

The article about knee pain which "R" refers to was written partly to show how simple it can be to treat an injury which one usually goes running (Sorry - limping!) off to the physiotherapist to undergo hours of useless treatment! These mostly useless treatments (Acupuncture, ultrasound, cupping, core exercises, etc) now cost you, the taxpayer, over $130 million per year via ACC - up from a little over $30 million just 10 years ago. For ACC, this huge cost blowout has not demonstrated any improvement in rehabilitation outcomes.

There is plenty of evidence that medicine and physiotherapy are letting the side down badly. There is far too much treatment by numbers and far too little effort being put into understanding the biomechanics causing the pain or injury and correctly identifyijng the real source of the pain and dysfunction.

People with pain are often treated as little more than numbers on a business spreadsheet. In the case of physiotherapy, there may be a cursory examination by an experienced physiotherapist who then hands the bulk of the treatments over to an inexperienced therapist to milk the most profit out of ACC. Whether the patient gets better or not is hardly a consideration.

It does help to have a good understanding of the activity, be that cycling, paddling, running and so on.

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Does Glucosamine really work?

I saw your video on youtube about the different types of glucosamine substances for knee joints. I am 18 and trying to join the military, I have already had surgery on my knee to smooth out rough cartilage, my doctor says that genetically my cartilage is soft and thin, he says they look like the knees of a 40 yr old man (and im only 18 yrs old).

Image: Lorraine Moller - Strong legs from progressive conditioning during her early years.

I've been taking some Glucosamine Sulfate for awhile, it seems to help a little, what i was wondering is what type of glucosamine you would suggest for me, on you video you show the glucosamine for athletes, but since my cartilage is not the same as other young atheletes do you feel I should be taking the glucosamine for older joints? the one with higher MSM in it?

I've tried to do a lot of research on the internet about weather or not Glucosamine actually works, I have found some reports that say it only has a placebo affect, and some reports show that it does regrow cartilage, what do you think?
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Gary responds:
I assume that the surgery was for chondomalacia patella, which is a condition caused by excess wear of the underside of the kneecap. Even if there was roughening, shaving the surface is not the best option. It obviously has been of limited success given that you are seeking further assistance for knee care.

Please start your quest for healthy knees by reading the dozen or so articles here.

The comment that your knees are genetically soft and thin etc is a ridiculous statement to make and unhelpful. You are young. Your tissues are too thin and soft. This has nothing to do with genetics. It is an increasing problem worldwide as children are raised more like caged hens than anything else and fattened with GM corn.

The state of your cartilage is the result of your nutrition and the way you use your body. I have reproduced the photo above of Lorraine to show you a superbly conditioned and nourished athlete who ran huge distances from early teens to her mid 40's. Her early conditioning was tied to her young and growing body and progressive. She never had a significant knee problem. Many young athletes and their coaches throw the kids into hazardous competition situations without regards to the need to first prepare the body with progressive conditioning.

First rule of coaching: Do not injure!

A good coach will set their goal to get their athletes through to maturity (20+ years) without having suffered career limiting injuries or illness.

Nutrition is a badly neglected area and what advice there is tends to have been hijacked by the big food companies who dominate advertising in sports media and sports events. They drive academic training and research by commercial partnerships with academia. So, we end up with athletes being raised on corn syrup and colourings!

With regards to your weak cartilages, you need to look closely at what you are eating and ensure that your diet is nutrient dense by ensuring that most of what you eat is from fresh natural sources and home cooked (there is plenty of advice on this website about this). If you are living on Powerade, low fat milk, instant noodles and chicken for example, then how can you have strong bones? If you are not sporting a light year-round tan then the only outcome is bones, cartilages and muscles simular to those of a caged battery hen - soft!

Emulate the lifestyle of a free range hen - sun, daily exercise and a wide variety of healthy grubs!

Which Glucosamine is best?
In your case, the best one is Balance Joint and Cartilage Repair for Athletes. This is formulated for young joints that are being subjected to damage. It contains higher ratios of MSM and glucosamine and less chondroitin as compared to other formulations. The MSM and glucosamine are the principal nutrients for cartilage repair. Chondroitin helps hydrate the cartilages. A young joint does not need much of this nutrient, so there is not as much in this athlete formulation.

On the days you do not get sun I recommend that you take 4,000iu of natural vitamin D. If you are low in vitamin D (most people are very low nowdays) you will be prone to tendon, cartilage and bone problems.

Does Glucosamine work?
Yes it does. I have been prescribing these nutrition supplements for about 15 years and I have seen countless cases of benefit - benefit more often than not. Experts who say it does not work need to be challenged. For a start; does a surgeon or even a general doctor know much about nutrition? Not if they happened to fall asleep during the one hour of training they had on the subject and that might have been 20 years ago. When you read any research discrediting these products there are many questions to be asked, such as how advanced the arthritis was among the subjects, how much were they given and for how long, what about combinations of supplements, what measures were used and so on and so on.

Be consistent in taking the right glucosamine supplement for you for at least three months and to support this with a healthy diet and sensible exercise that does not do further damage to the joints.

Is the military the right career for you?
Basic military training, consisting of forced hikes with heavy gear on your back, leaping out of trucks and running obstacle courses and lots of squatting down, is hard on the knees. Having done my own stint in the NZ Army as a foot soldier and having a daughter who has recently completed a year in the army, I am familiar with the stresses and strains on the legs of the kind of basic military training which you will have to undergo without complaint.

My gut feeling is that it is better to avoid this kind of situation in which you are compelled to push the limits of your knees without respite. You may end up being one of the recruits who get medically pushed out. It may be better for you over the longterm to give your knees a couple of years of careful nurturing through progressive strenghtening and nutrition. You can review the military career once you are super fit and pain free.

If the military force you are considering joining has a history of torture, indiscriminate killings of civilians, assasinations, propping up of dictators and despots and planting itself in oil rich countries where it is not welcome, please reconsider your choice of career for our sake.

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An enthusiastic Novice Runner with Runner's Knee (Chondromalacia)

I'm just turned 32, 5' 11", 178lbs. I played gaelic football (similar to Australian Rules) many years ago but never at a really competitive level and my main exercise through life has been at the Gym - my fitness therefore peaks and troughs considerably.

Photo: Grete Waitz - Almost unbeatable over from 5km-42km

Recently my brother in law enticed me to get involved in road running and on April 17th this year I took it up in earnest. At the beginning I struggled to manage 2 - 3 miles in a session but very quickly have found my fitness increase and can now run 10 miles (once a week), my normal run is around 5/6. All of this led me to needing some major goal or focus, because I know that using fitness alone as a goal will be a short lived thing. I had therefore decided to run a half marathon in september with the possibility of a, slow, attempt at the Dublin Marathon in October.

A recent Gait analysis showed that while my right foot was more or less normal, my left foot noticeably over pronated, and I bought the relevant pair of supportive runners. However, my last two runs (Saturday was circa 9 miles, and today was circa 11 miles) have left me in pain in my left knee. A dull ache below the knee cap which intensifies when I walk down stairs for example. On sturday it vanished after a nights sleep but today i fear differently.

The dilemma I face is that while I can comprehend the possibilty of over use - is this now destined to be a weakness which will prevent me from achieving that goal? (I only want to do one!! 10k races will satisfy me after that!)

I'm attending the physio on Thursday, but would be interested in another persons opinion based on experience. Is this generally a case of let it recover and take the right preventative actions or a sign that what I'm trying to do is just going to be beyond me.

John
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Gary responds:
(Please have a good read of the many other articles related to this injury by following the keywords at the base of this article and heeding the treatment and training advice).

John, I have been running competively for more than 40 years and my favourite race distances are between 5km and 15km. While I have run more than a dozen marathons, all sub 3 hours, the reason I am still running well is that I gave up the longer races about 20 years ago.

Short races, especially the off road ones, are thrilling ways to thrash the body without doing lasting damage. Marathons are the modern version of the Middle Ages past-time of Monks who travelled the countryside in public displays of whacking their heads with planks of wood.

It takes about 8-10 years of solid training and racing over short distances before one can undertake the modern equivalent of Mediaval flagellation (the Marathon) without risk of lasting harm.

And there is lasting harm like worn out hips and knees, shot tendons, gristled muscles and chronic fatigue. Running is like anything healthy: There is an optimum level and too much of a good thing can do more harm than having too little. The marathon is too much for all but a few freakish elite. These elite usually weigh less than 60kg and have at least 8 years hard training behind them.

John, I am not telling you to not do a half or full marathon; what I urge you to do is to plan a very gradual buildup in strength and fitness over several years. Muscles and cardiovascular responses to running are quick; whereas strengthening of bones, cartilages, tendons and ligaments are very slow - years in fact. So, stick to the short, sharp distances and never exceed your capacity to heal and grow stronger between runs. If you get the cart before the horse and run a marathon too early, your knees may never be quite the same again, compromising your plan to then stick to the shorter distances.

Photo: Olympian Steven Ferguson

Finally, John, make sure you have a few alternative exercise forms that you do each week: Cycling, swimming, canoeing for example. Have these and you will never need to visit the physio ever again. As soon as you feel a niggle - STOP and switch to your alternative exercise for a few days before carefully resuming the offending activity. This is the best physio.

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I have severe pain on the outside of my knees right below the knee cap

Hi Gary,
I recently viewed a YouTube video of you addressing a mans question about his knee problem.

I am very active in sports, mainly basketball and football, but not until recently have I ever had any kind of knee pain or problems. Im 21 years old and have been involved in sports since about 6 years of age. I have severe pain on the outside of my knees right below the knee cap. The pain is towards the outsides of the knee and hurts when jumping as well. My knees or legs never swell after or during activity, they just hurt immeadiatley after.

I recently had a pair of shoes in which the outer bottom soles were not very stable, but due to financial issues continued to play basketball in them - this is where I believe the pain is coming from. Is it possible that poor shoes could cause this to happen to my knee? Can I reverse this pain with new shoes?
Angelo
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Gary responds:
Angelo, the good news is your knee joints are probabaly in perfect health! From what you are describing, you may be suffering from irritation of the iliotibial band (ITB) where it runs over the bony prominences of the outer knee and inserts. This is not an uncommon problem in sports that involve repeated and vigorous jumping, sprinting and lunging. Shoes that throw the weight even slightly to the outside borders of the feet may cause added strain on the ITB. If you still have the offending shoes, throw them out.

The treatment is straightforward:

• Please read the many articles on this site about muscle cramp, active elements salts and nutrition for tendons and follow the advice (vitamin C, etc)
• Get a once weekly deep tissue massage on the low back, buttt and muscles of the legs, concentrating on the ITB. The massage therapist will be able to locate areas of extreme tenderness and some swelling on the sides of the knees. Despite their tenderness, these areas should be massaged to soften the areas and to shift any toxic fluid that has been accumulating. If the massage is done just right, any feeling of bruising should be gone by about 5 days. Repeat every week. Significant progress will be noticed by three weeks. Continue untill you are pain free.
• Similar issues of pain, swelling and knotts will surely be found in other areas of the length of the ITB.
• If the injury is as suspected, please continue to exercise normally from the day after the first massage therapy session. Exercise will aid the healing and recovery.

If you fail to recover within about 4 weeks of this therapy, please get back to me with an update and we will see what else can be done.

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Training for Rotorua but can't run because of sore knees

I'm 43 years old and was training for the Rotatrua Marathon (first one). Everythinbg was going fine, running approximately 45km a week,and then did a very stupid thing and increased up to 85-90 km a week. No problems aerobically, but after 10 days developed pain in my knees and haven't been able to run for 2 1/2 weeks. Symptoms suggest 'runners knee'. I have been taking joint factors 4500 for 6 days along with cod liver oil and magnesium tablets, also doing your foot strengthening exercises.

I am really frustrated as I am enjoying the running so much. Is there anything else you can recommend and typically how long is the recovery period?
Any help would be greatly appreciated.

Many Thanks
Paul

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Gary

Paul, to be honest I am not keen on encouraging first time runners to go into marathons.  Marathons were traditionally the doamin of older competitive runners who were coming to the end of long years of big training miles and damn hard races over distances of 10 miles and less.

My sister, Lorraine, for example had been running big miles and hard, short races for over 10 years before she ran her first marathon.  I did the same, covering the distance in 2hr 37mins for the first time.  After 13 sub 3hr marathons, I gave up.  That was the best decision of my life.  Now 55 years old I am proud to say that I still have my knees.  Last season I ran comfortably under 20 minutes for 5 km.  If I had stuck to running marathons after I turned 30 years, I would not be running fast and free today.  I may not be running at all.

The point is that marathon training and marathon running is tough on the knees.  Knees are irreplaceable.  Do not bugger them up Paul.  Look after them.  Care for them as you would a child.  You can never fully replace your knees.

In the meantime, while you mull over the above, there are a number of measures you can take to care for your knees starting with ensuring your body is rich with all the nutrients for healing and for strong collagen and bones:

• Complete an Active Elements Assessment
• Ensure you boost your vitamin D levels are high by careful sunbathing
• Continue to take daily joint food formulations
• Ensure each meal has small amounts of quality proteins
• Add fish oil, flax oil, evening primrose oil (no need for any more cod liver oil). Get these off my website store
• Eat lots of bright coloured fruits, veges and berries and maybe a combined vitamin C supplement - the best one for strong tissue is Phytocare C-Max (refer my web store)

Exercise and Running

• If an exercise, including running, hurts the knees then give it a break for as long as it takes to be pain free
• Take up aquajogging twice a week
• Get properly set up on a mountain style bike and ride it two or three times a week
• Do only three runs per week spread over the week between the other exercises.  You may do daily early morning jogs of about 15-20 minutes if no knee pain
• Only increase running distances by a few percent per week and never more no matter how good you may feel - do more of the other exercises instead
• If you ever feel a running injury coming on - Stop running!  Go and do more of the other exercises and resume running once pain free
• Seek out some short races of about 5km and do one each week or so but do not run them all hard out - play with them.  Join a club and run cross country over winter to harden the body and mind while not doing damage
• Get 5 years of this kind of training and racing under your belt then dabble in a few long events, like a half marathon, then a marathon if you are still keen.

Two other things you can do

• Get a pair or two of Formthotics Shock Stop inner soles off my website store and wear them in all your shoes, including your running shoes.
• Get a weekly deep tissue massage of all the leg muscles with emphasis on the thighs and knee regions

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Advice about partial knee replacement surgery

I am 1 58 year old female.

I have had problems with my left knee since June, 2003. I have a lot of difficulty walking and I actually waddle to compensate for the lack of cartilage on the inside part of the left knee.

I am a candidate for a partial knee implant (the Oxford knee.) I am absolutely terrified of undergoing this operation.

I have taken Glucosamine, Chondroitin and MSM compunds for years. There may have been improvement but i still can only walk a block or two at a time.
I was reading about the Glucosamine you recommend?
What is your opinion of this situation? Keep trying alternative treatments of go for the operation?
Any advice would be appreciated. Thank you very much.

Sincerely, Barbara
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Gary Moller comments:
Barbara,
Sometimes a knee replacement is necessary and it may be that you have reached the point of no return with regards to your knee arthritis. Or, perhaps you have not. Knee replacement is the best option if the pain is seriously affecting your quality of life and all conservative options have been thoroughly tested. If this is the case, then replacement surgery can be a huge relief. and not to be terrified of. Let's look at the conservative options, giving these the best part of a year or longer to work their magic (Cartilage and bone heal very, very slowly):

• Give the glucosamine and chondroitin a fair go. In the case of your knee pain, you should take the maximum recommended dose daily for at least 3-6 months. Most people take far too little nowhere long enough for there to be much benefit. Please refer to this article here for more details.
• Do a course of mineral therapy such as the Active Elements programme.
• Add healthy omega3 oils including flax oil, evening primrose oil and fish oil to your daily diet and take lots of it (Most people take far too little for there to be much benefit).
• Add methysulfonlymethane (MSM) to the diet - up to 7,000mg/day
• Take about 2,000mg of vitamin C per day for several months
  
• Have a nutrient rich daily Super Smoothie to ensure you get a rich daily supply of proteins, fats and vitamins.
• If you have been on a low fat diet, now is the time to get off it. Your joints require a rich supply of fatty acids and the fat soluble vitamins and low fat foods supply none of these. In addition, add a little daily cod liver oil and plenty of vitamin D if you get little sunlight to the diet for at least 3-6 months.
• Get vitamin K into your diet by eating a serving daily of lightly cooked greens such as chard, broccoli or spinach with a dollop of grass fed butter or coconut oil mixed in.
• If you are overweight then you must lose that extra weight; but do so through daily exercise of a form that does not stress the knee - swimming is great. Do not lose weight by calorie restriction. Lose weight by healthy eating and exercise.
• Review any medications. Medications such as statins can cause muscle weakness and joint pain.
• Get a weekly deep tissue massage of the butt, thighs and calf muscles of both legs. Tight knotted muscles do not support the joints effectively.
  

Barbara, while you are doing this, you can remain on the waiting list for the surgery; but do not rush the operation. While you explore and exhaust the conservative options, your surgeon gets in plenty of extra practice on others! In the meantime, the replacement technologies improve and you benefit from this. With surgery, there is no turning back.

If surgery becomes inevitable because the pain is not alleviated enough, then rest assured that the time spent getting fit, strong and well nourished will leave you perfectly prepared for the surgery and recovery will be quick and without complication.

Please let us know how you get on both short and longterm.




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I have a seafood allergy: alternatives to glucosamine and chondroitin for knee pain

Hi Gary I have watched with interest your video re joint pain. Nutralife joint food would seem to be the best for me but I have a seafood allergy. I have bad joint pains in my knees and have been reading about MSM. As I cannot take glucosamine & chondroitin because I have a seafood allergy, would MSM be any good on its own? Regards "C"
____________________________

Gary Moller responds

Do you know for sure that the ingredients in the joint food formulations definitely affect you? The seafood part is refined from shrimp shell.

The Kordel's MSM is a very good alternative that I would recommend without hesitation. You can take up to 4 capsules per day. You should add up to 2,000mg of vitamin C per day and a multi mineral. You can also add some daily bone broth (Refer to the recipes on this website). If you ensure the broth is made from bones with lots of cartilage then the resultant gelatine broth is a rich source of chondroitin.

Does gelatin reduce joint arthritis and joint pain?

Dear Gary,
I have a friend with a background in food technology. He has had some severe arthritic problems with his knees and began taking doses of gelatine. After several months of taking this he maintains that he has had considerable improvement both in his mobility and a big reduction in pain.

Have you heard of this as a treatment of arthritic problems?
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Gary Moller comments:

Athol,
Your friend is definitely on the right track. It depends on how refined the gelatine is. I would assume that there are quantities of chondroitin, one of the constituents of joint cartilage in the gelatine. Of course, there are other constituents of cartilage that may be in the gelatine from the rendering process. The less refined it is the better. Home made is best. Read on!

The best way for people to get these and many other valuable nutrients for joint and general health is via bone broths such as those that Grandma swore by. Get a kilo of beef, lamb or free range chicken bones from the butcher and simmer for a few days to render them down, boiling out all of their goodness into a rich broth of proteins and minerals – and gelatine. Here is the recipe.

Gelatine has several health benefits, including aiding digestion and soothing the gut. It holds water in the digestive tract and helps soothe and keep the intestinal wall in good health. It aids the absorption of nutrients from the digestive tract. Gelatine is a constituent of collagen which is the material that holds us together at the cellular level! As we age, we sag. We need more gelatine in our diets as we get old.

In addition to the gelatinous broths, I would not hesitate to add a commercial glucosamine and chondroitin formula to the mix. These preparations are concentrated sources of the nutritional substrate that makes up healthy joint tissue: glucosamine, chondroitin and nutrients such as trace minerals and vitamin C

Wishing you good health

Please help! I have injured my knee!

"Hi Gary Me again! My old knee injury (sprained or damage to the anterior cruciate ligament & medial collateral ligament) appears to have flared up so was wondering if you could recommend anything to help with the inflammation? and whether you think i should go back to physio?

It is pretty minor compared to what i experienced years ago & was at its worst on Monday but has calmed down a bit thanks to wearing a stocking all day/night. The inside of my knee seems a little swollen & it feels tight at the back to the point that it is hard to completely straighten or kneel. I could still run quite happily on Tuesday but after realising my knee was a bit swollen have decided to stop until its back to normal. In terms of the cause I am not sure as have not had a sprain as such. However, my knee did start to 'click' a lot more (& is clicking quite a bit now) when I started to do single leg extensions where my leg/knee is at a 90degree (sitting on a gym machine) & I lift a 5kg weight with toe slightly pointed out.

This exercise is part of the program that my trainer at the gym (Chek Practitioner with Diplomas in Rehabilitation & in Sports Medicine from Otago Uni) designed & apparently works to strengthen the inside of my knee. She also just started me on a new exercise with the swiss ball where my torso is on the ground but lifted up in the 'bridging' position & my calves are on the swiss ball & i have to lift one leg up at a time & hold it for 5 seconds so as to apparently strengthen my core, butt & hamstring. i have found this exercise really hard & pretty much strain the balancing leg so i can keep the lifted leg up in the air.

The trainer is convinced that these exercises could not have caused my knee to flare up unless i was incorrect in my technique & suggested it might be a hamstring insertion (whatever that is!)& thought i should try antiflam cream & seeing a physio in a few days if it had not self-corrected. but as she has overrided my old physio exercises & your advice to do 1/4 squats (she got me doing full squats with minimal weight)

I'm now confused as don't know if i can trust that she knows what she's talking about or who i should ask....except you! all i know is that my knee has been fine for the past 5 years & now its not!

Pretty gutted as i ran 9k for the first time in 5 1/2 years last week! any suggestions would be greatly appreciated."
"R"
Gary Moller comments:
"R", The swelling is telling you that your knee has been injured somehow and the swelling is your body's way of restricting movement.

Knowing your history of knee injury, it is possible that the damage to your knee ligaments previously and possibly to the knee cartilage makes the joint vulnerable to further damage.

It is possible that some of the exercises that you describe doing could have irritated the knee joint.

Your anterior cruciate prevents forwardsliding of the tibia on the femur, especially when the large quadriceps contract. The medial ligament prevents the knee from buckling inwards. Between all of them, the ligaments hold the knee joint snug and secure. The articular cartilages form a shock absorbing dish between the bones of the knee joint (tibia and the femur). It is possible that you damaged one or two of these cartilages when you sprained your ligaments.

When you are doing any kind of strengthening exercises using the big thigh muscles you should be weight bearing. This is because the knee bones are held firmly in place in the dished cartilages. If you do leg exercises such as leg extensions on a leg extension weight machine, the lower leg will be hanging free, gapping the joint and throwing stress on already damaged or stretched ligaments. The joint cartilage is vulnerable to further damage as the joint is gapped and twisted.

I would be very careful of the Swiss Ball bridging exercise that you describe because the knee could gap and twist. If you want to work the hamstring and butt, do standing dead-lifts with a barbell or dumbells; but make sure you get expert instruction in safe technique, lest you do your back in!

Stick to weight-bearing exercises such as squats and never go beyond right angle knee bends when under pressure. Deep knee bends may strain the ligaments and pinch the cartilages. The best machine in the gym for you for strengthening the quads is the incline leg press. Avoid the hack squat, including wall squats with a Swiss Ball behind your back. These throw excess strain on the front portions of the knee, including the undersides of the kneecaps. You don't need this.

Always get professional instruction by a weights expert and review your technique regularly.

Ice may help with the swelling but I am not a fan of it. Elevation, plus rhythmic exercise is best. Massage the knee, thigh and calf.

Exercise in warm water to manage swelling and to maintain strength, endurance and flexibility.

Take a glucosamine and chondroitin formulation and MSM and take generous doses for as long as there is pain and swelling. Use these in preference to pain killers and anti-inflammatories. Add 2,000mg of vitamin C per day. Copious amounts of fish and flax oil and especially Evening Primrose Oil have natural anti inflammatory qualities while not compromising healing. These natural supplements will assist healing. Continue normal doses for at least three months after the knee has settled.

Contact me if the knee does not settle significantly by next week.

What kind of joint food preparation should I take following knee surgery?

"Gday Gary, I just watched the video on your website as to which glucosamine supplement to take, but I am still a little confused.
I am 22 and have had a knee reconstruction. I just recently had a meniscus repair operation on the same knee, and was told that my articular cartilage is beginning to wear out.
I was thinking about taking the Balance joint food for athletes supplement, to possible help aid my cartilage in regaining some strength, however I am worried about the low levels of chondroitin present. Is this the supplement I should take , ore one of the other ones? \
I appreciate your help with my situation. "
Garry

_________________________________
Gary Moller comments:

Garry, I appreciate the situation you are in, having had two major knee ops myself in my 20’ s and facing the prospect of early arthritis. Fortunately, a sensible approach to exercise and the use of good nutrition means the prospect of arthritis seems further away than it was 10 years ago.

I recommend that you use the straight Nutra-Life Joint Food because it is high in Glucosamine which will help cartilage repair. Because you are still young, you do not need huge amounts of Chondroitin which hydrates the cartilage.

You need lots of MSM. MSM is highly beneficial for cartilage repair as well as being surprisingly effective for managing joint inflammation and pain. Kordels MSM provides a pure and cost-effective source of MSM.

The combination of all three nutrients (MSM, Glucosamine and Chondroitin) gives a powerful nutritional effect on that damaged knee joint of yours. I recommend that you commence by taking 6 rounded teaspoons per day of Joint Food and three capsules daily of MSM for the first three months, then lower to the recommended levels on the label thereafter. Boost the dosages of both at any time if there is any joint pain or swelling.

Take extra of both around periods that you know will be throwing extra stress on the joint, such as when doing competitive sport or a long hike with a back pack. I would commence these two days before the anticipated stress and strain and continue the regime for about three days afterwards to aid a full recovery.

While Nutra-Life Joint Food contains generous amounts of vitamin C, a total of 2,000mg per day or more may assist joint health.

If your knee flares up or hurts for any reason, then take extra MSM (up to 4 capsules per day) for 3-4 days along with extra Joint Food (six teaspoons per day). By having the MSM separate you can better use it for managing any episodes of joint pain and inflammation.

Always take these nutritional supplements with food, spread them over the day and never use as a substitute for quality food.

Feedback from a Happy Camper

"Hi Gary. My husband and myself have been taking your Joint Factors 4500 for several months now, and I wanted to tell you how thrilled we are with the results. I did have just a twinge of pain in my knees when climbing up steps before taking it but now I have no pain at all. I have told lots of friends about it, Its easy to recommend something that you know really works. I would advise anyone to give it a try. We certainly have no regrets and will continue to take it on a regular basis.

Wishing you a Merry Christmas and all good wishes for the New Year

Kind regards. "
"M"
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Gary Moller comments:
It is always good to get feedback from people and to learn what works and what doesn't. If you go onto any website of the services of private hospitals that do Government contract surgery and look at the specialities of the surgeons, you will see that it is wall-to wall hip and knee replacements.

While many of these operations are undoubtedly necessary, my experience is that the surgical option is exercised far too early in many cases. Furthermore, the non-surgical options for preventing or slowing progression of arthritic conditions through diet, supplements, exercise and modifying lifestyle receives little more than passing reference.



These people are production lined through and there is little post surgical attention beyond restoring basic mobility, aided by a heap of medication in many cases. This is unsatisfactory because incomplete rehabiliation eventually results in further medical interventions being required later on. Once on the medical conveyor belt it is difficult to get off and that conveyor takes you down - not up.

The money is in the surgery - not in the prevention, or the post operation management.

Here is the direct link to joint support products.

Runner's Knee

"Hi Gary
I was hoping you could help me. I did the XYZ Half Marathon last year and I finished it feeling great however I thought I would then go on and help a friend of mine finish the marathon (just the last km) however I suddenly got a bad pain in my left knee – since then I have had physio, acupuncture, pediatrician, I even had my leg measured and found my left leg was 4mm longer than my right leg so I had orthodics put in. I did rest for awhile (about a month) however it seems that when Im running I can get to the 10k mark then the pain starts and gets worse as I go along – going up hill seems to help it but its going down hill or on the straight that it is really bad. The physio said that it was runners knee however not sure what that problem is. The pain seems to start on the outside of my knee then goes further under my kneecap and sometimes above my knee. Im usually sore for the rest of the day and depending how far Ive run it may even be a bit sore the next day. I am trying to strengthen it up at the gym by using weights and sometimes even swimming or cycling to help.

I am at my wits end and I love my running and Im sick of this problem, do you have any other idea as to what my problem could be or what I should try next.
________________________________________
Gary Moller comments:
You can now see why marathons and 1/2 marathons are a huge windfall for therapists of all persuasions - even pediatricians! The aftermath can be both financially and emotionally expensive.

If the injury is what you have described and what your physiotherapist says, then you have damaged the very delicate under surface of the knee cap. This is not good; but the good news is you will recover – eventually.

First of all, I think you can throw away the orthotics and replace them with a good quality innersole like Formthotics. I have never in 28 years seen an athlete benefit, other than briefly, from these and you are unlikely to be the exception. Your feet are shock absorbers; if they are not allowed to do their job properly, the energy gets transferred further up the legs to structures like the knees. They can actually cause worse problems down the track by accentuating weaknesses and imbalances. You need strong feet - not weak ones. And do the exercises that you see in the last few pages of the Guide – the ones that stretch and open up the runner’s hips. Do these every time before and after a run. Tight hips throw huge strain on the knees, especially when running downhill. If you have a short leg (most of us do), (or is it a long leg??) the cause is most often in the pelvis and not the leg itself. The attention of a chiropractor might be beneficial along with regular practicing of the hip stretches recommended here. Consider purchasing a new pair of running shoes if the ones you have are worn, or are in any way uncomfortable.

When you go for a run
When you go running, keep the knees warm before, during and after. A long hot bath and a self massage about the knee caps is wonderful and will help healing.

• Stay off hard pavement, especially during winter. Run on trails, that twist and undulate, thus eliminating the relentless pounding monotony of running on pavement.
• Keep close to home by running in circles rather than out and back. Murphy's Law dictates that you will seize at the most remote point far away from Home!
• STOP running before your knee hurts and gradually build minute by minute, run by run no matter how long it takes to fully recover.
• Do not run every day. Have a rest day between runs (rest days can be active - go and swim or lift weights).
• Do fartlek and intervals that stretch, strengthen and get the run over and done with quickly; rather than your runs being a sucession of bland drawn out plods.
• Before you do your next marathon, or anything over 15 km, do a proper buildup of at least 12 weeks, as outlined in our marathon training guide along with plenty of races over short distances no longer than 10km. Join a running club, so you can do their race programme, even if you consider yourself a completly social runner (You will not be alone).

Doing strength work in the gym might help; but you must be very careful with the weights exercises not to stir the injury up. Make sure that you get instruction from an experienced instructor who has the appropriate qualifications. The key is to eliminate ongoing harm and to assist your body’s healing processes - not to stir it up.

You need to do the exercises in here whether you have weak feet or not and take a good, long look at your posture – how you place your feet, how you stand and how you walk and run and sit. If necessary, go do a few sessions with a posture expert like a person qualified in the Alexander Technique.

Go and see a sprint running coach who you can find via your local running club and get some lessons at the running track on doing running drills including bounding. Learn how to run tall, lightly and strong. Even if you consider yourself a social runner, this is one of the best actions any runner can take to have a long, enjoyable and injury-free time running life.
Nutrition to assist the body with healing itself

• Purchase some joint food here and take 6 teaspoons per day until finished.
• Also take 3 teaspoons of this daily until finished.
• And take 2 per day of these until finished.

These will help your body get its healing processes ahead of the ongoing damage that is happening. Take all of these with food and spread throughout the day, rather than all at once.

• Take a course of magnesium – one daily until finished.

Low magnesium may cause the muscles to be slow in relaxing, causing the thighs to pull on the knee cap when they should be relaxed. This is one reason for the painful seizing up towards the end of long, hard runs.

Knee Pain

Mike wrote:
"This product (Nutra-Life Joint Factors 4500 - Ed) has been brilliant. The problem I have is with my left leg, which was twisted in a skiing accident when I was 15. While it always made its presence felt, it only threatened to become incapacitating when I reached about 55. The joint factors has allowed me to keep on exercising as I always have done. I am running up to 50 minutes about twice a week at the moment.

Another thing I have appreciated since your talks at last year at our company is the advice on diet. In particular, the change I made to breakfast (now muesli, fruit and tea only, (except for now and then!)) and stopping taking sugar in coffee and tea, have been very beneficial."
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Gary Moller comments:
Knees, knees, knees - I get so many inquiries about painful knees nowadays! Is it because of the tsunami of active Baby-Boomers now hitting that age when injuries of old are starting to fester their way to the surface? Is it because keyhole ops for niggly knees are flavour of the month? Is it because commonly prescribed medicines for knee pain only deal with symptoms and not the cause? Is it because contract health providers are mostly focussed on outputs rather than outcomes? Or is it all of the above?
The answer is "YES" to the lot!

So, your knee(s) hurt for some reason? If you go to a surgeon, you will be operated on. If you go to a rheumatologist, you will be prescribed a powerful medicine. If you go to a physio, you will be given utra-sound and strange exercises. If you go to an osteopath, you will be massaged and manipulated. If you go to a podiatrist, you will be given $500 orthotics, if you go to a personal trainer, you will do lots of funny exercises and go on a diet. Sounds uncomfortably like a lottery to me, I reckon! Currently, in NZ, if you have a knee problem, you will probably be sent to the surgeon. Heaps and heaps of knee ops are happening.

With the focus on surgical outputs (ie: number of ops performed this year as compared to last year) patients are being recorded as successes whether pain-free post-op or not. There is generally no followup at all once the stitches are out and no way the patient can provide useful feedback to the surgeon and funding agenices - like Mike (above) has provided me several months down the track. This is an extremely unsatisfactory state of affairs: My impression is that there are legions of people out there who are not fully recovered from their knee ops and some are, in fact worse off! But, by all accounts, they are recorded as "successes" of a system that is working well. No proper feedback loop = bad service and much waste.

Body heal thyself
During my training years ago, we were told that joint cartilage is incapable of healing itself. The standard procedure with a cartilage injury was to cut the whole thing out. This was a terrible action, in retrospect, condemning many to plastic joints about now.



What we do know nowadays is that cartilage, even in old age, is capable of self repair. Even in the case of tears (so long as they are small) healing can happen - so long as the joint is protected from further injury and given the right nutrition and exercise to help the healing processes.

Cartilage in mature adults does not have a direct blood supply so it heals poorly when damaged, be that from overuse or direct trauma like twisting the joint while under pressure. But it still is living tissue that is constantly being replaced by new tissue. It will heal with time and the right care. This process of repair relies on the supply of oxygen and nutrients to the cartilage cells and the removal of wastes via the fluid inside the joint called "synovial fluid". This exchange and tissue repair is enhanced by:

• Rhythmic movement of the joint through its full range of movement
• Oscilating compression and decompression of the cartilage
• Keeping the joint warm
• A diet that is rich in the ingredients that build healthy cartilage tissue
• A diet that is rich in anti-oxidants to soak up free radicals before they can harm the healthy cartilage cells
• Avoiding medicines, including anti-inflammatories and aspirin, that inhibit cartilage cell activity

So, you will gather that dealing with knee pain is not via a single one off solution like surgery or drugs. It is a multi-factorial and long term project.

Repair has to exceed wear

This is the name of the game - the game of life, in fact: even several hours after you die, tiny cartilage cells are still beavering away building new tissue to replace the stuff that you have damaged through sport and normal activities of life. While you still breathe, you must do everything to assist these busy little fellas with their job of keeping you mobile and upright. This consists of:

• Minimising harm by avoiding excess wear and injury
• Giving sufficient time for repair and healing before the next assault
• Ensuring optimum nutrition and circulation for joint health
• Doing full range joint movement to spread the synovial fluid, thus aiding nutrient exchange

So, here is a list of what you can do for joint health:

• If you statically stand or sit for long periods at work, break these up at every opportunity by striding about, lying down, sitting, pulling knees to chest, jogging and squatting. Wear shock absorbing shoes, fit quality inner soles. If surfaces are hard, get soft non-slip matting fitted
• Take the joints frequently through their full range of motion. For the knees; try repeatedly pulling the knee to the chest, then extending fully, tensing the thigh hard. This can be done sitting, standing or lying on one's back
• Keep the knees warm in cold weather by heating the room and wearing warm leggings when exercising. A long hot bath does wonders for aching joints
• If you do a really punishing thing like running a marathon, rest 5-10 days after and do not repeat this kind of abuse for at least another 3-6 months. Read our Guide to Running a Marathon
• Do aqua-jogging once or twice a week the way recommended here
• Add a machine-based Pilates session once or twice a week to your exercise programme. This will strengthen the muscles that support your joints as well as taking them through their full range of motion
• If you are over the age of 35 or have ever had surgery on a knee, consider taking a quality formulation of glucosamine and chondroitin (joint food). This supplies the nutritional substrate for healthy joint tissue. Take the maximum recommended dose for at least 3 months before easing off regardless of whether or not any benefit is noticed
• Take a multi vitamin, anti-oxidant and multi-mineral with the joint food, including vitamin C (A quality joint food formulation will also contain some of these essential vitamins and minerals)
• Take fish oil, flax seed oil and cook using a quality olive oil. These improve circulation, are essential for healthy joint collagen and have a mild anti-inflammatory effect. They might even help lubricate the joints
• If you are carrying excess body weight, gradually lose it over several months through exercise and healthy eating
• If you get knee pain from activities like cycling and running, your style or setup might be faulty. Get it checked by an expert.
• Feet are a common cause of knee pain. Read this e-Pub about the subject
• If you are diabetic, ensure the condition is absolutely optimally managed
• Only take anti-inflammatories, including aspirin if absolutely necessary (I'll write about this matter including non-drugs pain management measures in a future article)
• Do not have cortisone injections into joints. Read this article about this subject

On the question of joint surgery: If you are earmarked for an op or have been advised to have one, you are welcome to give me a call to discuss this and possible options. While I do recommend the surgical option now and then, there are many cases where this option has been prematurely exercised. Surgery does not always work out over the long run and may compromise the benefits of more conservative measures like nutrition and exercise.