Q: I am in my early 40’s and have pain in my knees, what can I do to keep it from getting worse?
There are many causes for knee pain in this age group. These include early degenerative changes, overuse injuries of the soft tissues, trauma or infection. Most often the pain is caused by strain of the muscles, tendons or ligaments around the knee; but in cases of previous trauma or athletic injuries, the pain can be due to developing arthritis.
Overuse injuries, such as tendonitis or ligament strain can be relieved or prevented by cross training so that one particular structure is not excessively stressed and the exercise program is spread over the entire knee joint. Excessively high impact training, such as marathon training, can also cause breakdown of the cartilage which may lead to pain caused by arthritis. If this occurs, one should reevaluate continuing that sort of high impact program. An evaluation by a board certified orthopedist, including a physical exam and appropriate imaging studies will provide the most specific treatment program.
William P. Cook, M.D.
Q: I have arthritis, is it safe for me to exercise?
Not only is it safe for arthritis sufferers to exercise, it is recommended as part of the treatment. It is, however, important to figure out what specific actions are aggravating the arthritic joint and modify the frequency and intensity of those activities. Stretching can help restore lost range of motion and stimulate increase circulation to help the joint recover. Strength training can bolster muscle strength and enhance the “shock absorber” effectiveness of the joint. Endurance training can improve the muscles ability to provide support over long periods of time and increase cardiovascular health and pain tolerance. The key is to find exercises that will increase strength while remaining “joint gentle”. Your physician or a licensed physical therapist is your best bet in discovering which exercises may be best for you.
Brian DeMuth, MD
Q: Why do I need to stretch before I exercise and what should I do?
Stretching is important because it makes the muscles more flexible and therefore less prone to injury during exercise. It will increase circulation in the body and reduce the amount of soreness you might feel as a result of your workout. Before stretching, you must warm up your muscles. A brisk 5 minute walk can do this. Then start your stretch routine slowly, hold each stretch to the count of 10 and don’t bounce the stretch. It is important NOT to push your muscle to the point of pain. This will only result in injury to the muscle. It is just as important, and some say even more important to stretch after exercising. Repeat your stretch routine again after you are finished with your work out as part of your cool down. You can find many simple, fun and effective stretch routines on the Internet.
Benjamin Diffenderfer, PA-C
Q: How can I avoid knee injuries as I get ready to get out and enjoy the spring weather?
Knee injuries are common and are most often the result of overuse combined with low muscle strength and sometimes alignment problems. Coming out of winter, a typically less active time for most adults, you can injure your knees by doing too much too fast. Be patient and prepare your knees and entire body for increased activity by starting a proper stretching and strength training routine a few weeks before you plan to start your warm weather activity. Start slow and then gradually increase your level of exercise as tolerated. Be sure to wear the proper shoe for the type of activity in which you are participating. Maintaining a healthy weight for your size will also reduce the stress on your knees during activity. If your knees bother you after activity, use ice for 10-15 minutes and take a non-steroidal, anti-inflammatory (NSAID) to help with pain. Suspend activity and seek medical attention if the pain worsens.
Edward O’Mara, MD
Q: What shoulder injuries can young athletes experience and how are they treated?
The most common shoulder injuries in young athletes are sprains and contusions. These generally affect muscles and tendons around the shoulder including the rotator cuff. These injuries are treated conservatively with a period of rest, ice, anti-inflammatory medication, and a gradual return to activity.
The next most common injury is shoulder dislocation. This occurs when the ball (proximal humerus) comes out of the socket (glenoid). It will often reduce or go back into the socket spontaneously, but occasionally requires doctor assistance in the emergency room. Either way, these injuries require and orthopaedic evaluation and could require surgery to stabilize the shoulder.
Young athletes also experience overuse injuries of the rotator cuff. Sports such as tennis, volleyball, baseball and swimming involving repetitive overhead shoulder movement, are the common culprits in this type of shoulder injury. With repetitive motion, the rotator cuff can become inflamed causing pain, weakness and loss of range of motion/flexibility. Treatment can start with rest, ice and anti-inflammatory medications. Physical therapy is often recommended as well. Steroid injections and surgery may be indicated in the most severe cases.
Mark V. Clough MD
Q: What is a stress fracture and who is most likely to get them?
A stress fracture is an overuse injury that may develop into a break in the bone. The most common bones involved are the lower leg and foot. Typically, athletes participating in running and jumping type sports are at higher risk of developing a stress fracture. These injuries occur at all ages; however, statistically women experience stress fractures more than men.
Pain with activity is the most common complaint with a stress fracture. Typically, the pain will subside with rest. The diagnosis is made by obtaining a history from the patient, physical examination, and supplemented by imaging which includes x-rays and occasionally MRI or a CAT scan.
Treatment of a stress fracture involves rest and restriction from those activities that may have caused it. Typically, it takes six to eight weeks for most stress fractures to heal. Occasionally, when the injury involves the lower extremities, the patient may be required to be on crutches. Rarely, surgical intervention is required particularly when the hip is involved.
D. Burke Haskins, MD