As a physical therapist, I see patients with knee issues every day, and I am seeing a scary trend in the boomer population in the form of the early onset of mild to moderate osteoarthritis (OA) due to the kneecap wearing out at faster rates than previously seen. The American College of Rheumatology reports that 27 million Americans suffer from OA with individuals having a 46% chance of developing OA of the knee in their lifetime. I wish I could say this is due to Americans having overactive lifestyles, but, sadly, that is not the case.
There are a lot of epidemiological reasons for this phenomenon such as bigger waistlines, sedentary lifestyles and longer periods of sitting. Still, it doesn’t explain the uptick in the more active persons. Repetitive stress, muscle imbalance and tightness and even nutrient deficiencies can lead to rapid progression of arthritis. But one often-ignored factor to consider is the mere anatomy of the knee and how one can protect it.)
The anatomy of the knee
As one of the primary weight bearing joints of the body, one would expect wear with age. While most people think of the knee as comprised of just one joint it is actually comprised of two: the tibiofemoral joint (TFJ) and the patellofemoral joint (PFJ) . The TFJ is what most people think of as the “knee”; it is where the femur, or thigh bone, and the tibia, or shinbone, connect. The other joint, the PFJ, is where the kneecap and the femur connect. Both joints are essential to the health and function of the knee, but the latter is often neglected.
How strength and flexibility play a role
The PFJ plays a very important role in the overall function and health of the knee. First, it is an attenuator for forces produced by the powerful quadricep muscles. The PFJ also helps to lock the knee into place to minimize the stresses on the TFJ. Additionally, the hamstring muscles act as a decelerator as the knee moves from a bent to a straightened position. Weaknesses of the inside part of the quadriceps (known as the VMO) and hamstrings, as well as tight ligaments around the kneecap, place tremendous forces through the PFJ as the knee straightens and bends. The combination of additional sheering forces poor alignment, and muscle imbalance cause OA to develop earlier in life and progress more rapidly due to chronic inflammation. The result is a decreased mobility, more inactivity and lower quality of life.
What you can do about it
When I counsel my patients on improving the health of their PFJ we talk about:
1. Maintaining a healthy weight.
2. Regular aerobic exercise including low-weight bearing activities.
3. Stretching and strengthening the hip flexors, thigh muscles, and hamstrings.
4. Keeping the knee cap mobile by massaging the perimeter and stretching it in all directions while tightening the top of the thigh with a straight knee.
5. Maintaining good posture in the pelvis and hips when standing, walking, and exercising.
6. Using natural health products such as glucosamine/chondroitin sulfate and methylsulfonylmethane (MSM) supplementation.
I place a particular emphasis on the use of natural health products, as they are already used with success by 30% of individuals with OA pain. In particular, several promising studies tout the benefits of MSM, a powerful natural analgesic and anti-inflammatory, including one study that showed a reduction in pain and improvement in function in as little as 12 weeks.
However, while the benefits of massage and MSM are essential to the biomechanical health of the knee joint, it does not work in isolation.
Remember to incorporate all the tips outlined above and you’ll have the greatest changes of minimizing pain and maximizing your movement.
1. American College of Rheumatology (2012).
2. BMC Complementary and Alternative Medicine. 2012; 12:98.
3. BMC Complementary and Alternative Medicine. 2011; 11:50.
Dr. Corn is a licensed physical therapist with over 14 years experience in helping people reduce pain and restore fuction. He is clinical provider with The Corvallis Clinic located in Corvallis, Oregon.
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