The knee pain thread shows that many of us suffer from
knee pain.
As an ex GP with F***ed knees ( note medical terminology)
may I offer my two pence worth. IMHO Rant mode on
Lets go back to first principles. The knee is inherently
unstable, unlike the hip. Stability is maintained by the
cruciates, but it is muscle strength, which is important,
your quads and especially vastus medialis, that's the inside
one. Our gait determines the muscle pull through the knee,
overinturning or out turning. I suffer from severe over
pronation as do two of my kids. I f only I had realised when
I was younger, that my queer gait was affecting forces on my
knee I would be not so F***ed now. When you are young, <35,
you can get away with it.
Walkers, mountaineers, skiers and snowboarders, do put
INTERMITTENT stresses on their knees. Its this occasional
use that is the problem. ( No rude comments from the
superfit)." Lets go up to Ogwen for the w/e and have a
blast," yes we all do or did it, great day on the hill, knee
twinges a bit. Next morning, quads a bit tight, knee fine.
Another great day, more than a twinge on the way down. Drive
home, get out of car, twinge becomes pain. Back to work, we
do not notice our gait has changed ever so slightly to
minimise discomfort, this leads to slight quad power loss
and wasting. Pain goes, till the next downhill blast.
And so on and on, the vicious circle starts. Our knee pain
may not be not from an injury, its from misuse, and our
response to it. We all like to think of ourselves as serious
hill persons, we pride ourselves in our feats and baggings.
We are strong, we will finish this circuit, I, ve driven
from London for this w/e. Till our knees complain and we do
not listen, and push onwards. Knee abuse is rampant.
So what is the answer. This is a personal view and may not
be the considered view of the profession.
I f your GP is a climber/skier/mountaineer, your half way
there. We are terribly busy, and many have the attitude,
that its self-inflicted, so stop doing whats causes the
pain.......leading to worsening of the gait etc etc. History
will often point to the diagnosis, and self help and
exercise advice may do the trick. But often does not. Sports
physios are the next step, biometric assessment of muscle
power. Advice re exercises.
GAIT, see a podiatrist, get a gait video, you may be
horrified at what you see...( I was), think about ortotic
inserts. (I wear mine every day, just swap them about).
Orthopod, history and exam, ( mine used to play serious
rugby), advice re the above. Instability may need a MRI to
see cruciate competence. X-rays for old farts like me , >40,
for the dreaded OA. ( my R medial condyle is F***ed) If
indicated, diagnostic arthroscopy. If required, some good
results from cartilage micro transplantation, it worked for
me for 6 years.
The above may require money, but we shell out a few hubdred
quid on the latest kit and GPS etc.........don't we.?
Remember that professional footballers have massive quads,
and thats not just for kicking the ball .
Next time you are walking up stairs, see if your knee pull
is straight through the knee. I bet alot of you will see
inward rotation.
FWIW, I take NSAIDS every day, Vioxx actually, but I go to
the gym three times a week, I think I have superb quads now,
if only I had 30 years ago.
Rant over, I am retired now, have plenty of time, but will
never stand on top of a big hill again, I can do the coast
path, well not the steep downy bits. Just be warned. JT