Gaitway to Health Blog

Fixing Your Knees Without Surgery Part 1

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I have received a request for help to unravel knee problems. I'm going to tackle this in 3 parts, because I know, if I give out all the information at once, most people will ignore the foundational information and skip to the cherry on top of my corrective sundae, causing themselves more injury and pain. If you're serious about fixing your knees, give yourself some time to master what follows. It's not as easy as it looks!

If you are moving correctly, your knees will never bother you. If you have ever even felt a twinge in the knee, then this post is for you. Remember that no matter what you've been told in the past, your knee problems are NOT due to aging, except that your age determines how long you've been misusing your body. Also, don't blame your genes.Your problems are user-induced.

The first and easiest adjustment for knee health is your stance. A vertical leg loads the knee evenly in all directions and as a bonus, eliminates strain on the plantar fascia. Sore feet anyone? 

These legs are vertically stacked, and the load is evenly distributed across the joint in all directions.

Illustration of forces on bones in a vertical leg

 

The wear pattern on the knees illustrated below will be uneven. If you are just walking now and then in these positions, expect your knees to hurt in your golden years, but if you are loading the joints in this way, while running, for example...ouch! You might be contemplating surgery right now. Adjust your stance and feel immediate relief.

forces on bone in narrow stanceforces on leg bones in wide stance

Next, we have to address the position of the feet. The foot is a lever, and it is designed to point forward. It is in this position that the hinge of the ankle works with the least friction, the arch can support the most weight, the toes articulate properly and blood flow of the shank is maximized. 

In our CULTURE, we prefer the look of outward pointing feet and externally rotated shank. It could be the influence of ballet training, military training, emulating your favorite relative—all mine ended up with one leg amputated at the knee—wonder if there's a connection...? (YES. Yes there is!) 

As I was saying, because we find this foot position aesthetically pleasing...

pretty lady with foot out position

we'd better start telling ourselves this...

is smashing too, as one out of 200 hundred people in the U.S. will have a limb amputated, and 80% of those will be of the lower leg. This prosthesis is aptly named "Outfeet," by the way. I thought you'd like to know. And the cause of rising below-the-knee amputation rate? Impaired blood flow. 

Now, I know you're going to tell me that those amputations are due to Type II Diabetes. 

Well, Type II Diabetes is closely related to the level of​ insulin resistance in muscle and fat cells. As cells become more and more resistant to insulin, their glucose uptake and storage ability is reduced, creating elevated levels of glucose, insulin and triglycerides in the blood stream. Poor circulation in general, is a factor in insulin resistance, as well, since the insulin needs to get to the cell to deliver the glucose. Less flow, means less chance of the insulin colliding with the correct receptor on the membrane of the cell.

Muscle cells' sensitivity to insulin is increased when said cells receive a signal from the brain to generate force (a.k.a. innervation). Standing and walking with legs aligned vertically can only happen if all the muscles in the feet, legs and hips are generating some force. When skeletal muscle contracts, it compresses the blood vessels running through it, which respond by dilating. This vasodilation draws a higher volume of blood to the area, increasing the delivery of insulin to the surrounding cells. Hence, if your patient is diagnosed with diabetes, require a half hour of exercise to temporarily lower insulin resistance. Of course, more muscles would be innervated, more of the time, if that patient was just taught to be in correct alignment throughout the day!

The other, suboptimal stance and gait options above, rely heavily on the elastic properties of passive tissues, with much less active force generation in the muscles. This means that blood flows against the resistance of non-innervated muscle tissue, decreasing insulin sensitivity of the surrounding cells. 

So it is very important to understand the role of skeletal muscle not just in mechanical aspects of joint health, but in how something as simple as foot position can determine whether or not you succumb to the ravages of a so-called disease of affluence.

"But," you say, "after a whole lifetime of pointing my feet outward, it is uncomfortable to turn them in!"  Don't worry. I have two simple correctives to make it easier.

calf stretch.top of foot stretch

For the exercise on the left, stand with vertical legs, that is, your knees stack vertically over the ankles and the hips stack vertically above the knees in a nice plumb line. Feet point forward, aligned by the outside edge of the foot, not the second toe. Then place the ball of the foot on the apex of a half dome or tightly rolled towel, while keeping the knee straight and the heel on the floor. The model has tight calf muscles and you can see that her knee buckled a little. If that happens to you, or you find you have to lean your upper body forward, then slide the opposite leg back a bit, until the stretch is more comfortable and you can maintain your vertical alignment.

The exercise on the right begins with the same alignment stance, but now reach one leg back at the knee, (if your foot is tight), or from the hip, (if you have more flexibility). Press the tops of the toes into the ground. Take a look at your ankle and make sure it is nice and straight, not rolling out to the side. 

Work up to a one minute hold on both of these, and cycle through the series 3 times.

Click to purchase a printable version of this protocol. Of course, it is always available on the blog for free!

In the next knee post, I'll focus on ankle mobility, hamstring extensibility, and learning to turn-off overworked quads.

 

 

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