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How to save your knees without giving up on your workout


Few nuggets are so broad and have little supporting evidence in the chronology of unsolicited advice. “If you keep doing all this, your knees will be ruined.”

The latest salvo in the knee and running debate — Systematic review Of the 43 previous MRI studies for which no evidence was found that running causes short-term or long-term damage to the knee cartilage, at the Thanksgiving table, I swear that the buttock knee was caused by a wind sprint. It is unlikely to persuade a former soccer star.But considering that Nearly half Many Americans are expected to develop painful knee osteoarthritis at some point in their lives, but the findings raise persistent questions.

Researchers have recently begun to rethink long-standing doctrines about the properties of cartilage, a smooth layer of tissue that protects the bones of the knee and other joints, which is the main cause of osteoarthritis. Michaela Khan, a postdoctoral fellow at the University of British Columbia and lead author of a new review on running, said: And cartilage was published in Journal Sports Medicine.

But that’s not the case. Periodic weight-bearing activities such as walking and waiting for it squeeze the cartilage of the knee joint like a sponge, expel waste products, and replenish nutrient- and oxygen-rich water at each step. Instead of the inactive shock absorbers destined to become brittle and eventually fail with age, Ms. According to Kahn, cartilage is a living tissue that adapts and thrives with regular use. It is, for example Small study from 2010Non-runners who followed the 10-week running program showed a 1.9% improvement in cartilage strength and quality markers.

It also helps explain why you should replace one Form of exercise For others, the first signs of knee pain may be counterproductive. “People with early knee problems believe that they protect their joints, so less impactful activities such as swimming and cycling,” said Jackie Whitaker, a physiotherapist and arthritis researcher at the University of British Columbia. I often switch to. What I’m doing is starving my cartilage. “

Still, there are limits to how quickly joints can adapt to unfamiliar stress. Jean-François Esculier, Principal Investigator Running clinic Tosan. Khan’s co-authors suggested that knee pain that lasted more than an hour after exercise or appeared in the morning after training indicates joint overload. That doesn’t mean you need to stop exercising, but he said you should adjust what you’re doing.

Consider shorter and more frequent workouts. According to Keith Barr, a physiologist at the University of California, Davis, who studies the molecular properties of cartilage and other connective tissues, cartilage cells respond positively to about 10 minutes of exercise. After that, you are only accumulating more stress and damage in your tissue, with no further adaptive benefits. Therefore, if your knees hurt during a two-hour tennis marathon each week, try switching to a one-hour session twice a week.

Of course, no training is done in a vacuum. What you can do with your knee today depends on what you have been doing with your knee over the past few weeks or months. That’s why the arrival of the ski season is a predictable source of genocide for physiotherapists, as enthusiastic weekend warriors hit the slopes after months of inactivity.

Dr. Whittaker suggested taking the first day on the slopes easily and willing to cut the short days after feeling enough leg muscles and joints. “It’s a pace,” she said. “It adapts to your ability to handle the load on your body.”

Even better, she strongly suggested doing strength training to prepare the foot before putting new stress on the foot. A simple and common program of squats and lungs Strengthen muscles It stabilizes the knee and stiffens the tendons and ligaments around the joints. As a starting point, I did 3 sets of 10 to 15 repetitions, lifted the weights to make the muscles quiver, and felt I was able to repeat 2 to 3 more times as needed.

After all, the most serious long-term risk of activities such as skiing is not long crouching. Instead, it’s a traumatic knee injury that looks like the ACL has been torn. About half of the case It leads to osteoarthritis within 5 to 15 years. This is partly due to prolonged joint damage and instability, but also because people tend to slow down and gain weight as a result, even after the knee has healed.In fact, one study found that the risk of knee osteoarthritis observed among former elite athletes in sports such as soccer is high. explanation Due to a history of traumatic knee injury, not accumulated damage.

Fortunately, implementing a so-called “nerve muscle” training program can halve the risk of acute knee injury, said Ewa Roos, a researcher at the University of Southern Denmark for osteoarthritis. Specific exercises tailored to each sport promote excellent exercise patterns that stabilize joints and can be performed alone for 15 minutes three times a week or as a pre-workout warm-up.

Dr. Roos recommends website fittoplay.orgSponsored by the Oslo Sports Trauma Research Center in Norway, it offers a detailed neuromuscular program for over 50 sports. For example, alpine skiing begins with exercises such as weight squats, weight shifts, boss stacks, and forward jumps, and goes on to be even more challenging.

For athletes, the benefits of such a preventive program are clear. It’s more controversial for the average person who has no knee pain so far. “It’s also a philosophical issue,” he said. Roos said: By spending all your energy to prevent problems that haven’t happened yet, you run the risk of over-medicalizing your life.

But even if you are currently healthy, there are some relatively unobtrusive ways to tilt the odds in your favor. Dr. Roos suggested focusing on high-quality movement patterns during routine activities such as getting up from a chair. He uses both feet, hands-free, and keeps his knees and hips on his feet. He has a similar focus when climbing stairs and sitting on the toilet. If you can’t align your joints, it’s a sign that you need to strengthen your leg and hip muscles.

According to both doctors, there is no high-quality evidence that supplements such as glucosamine and chondroitin make any difference. Ruth and Dr. Whitaker — Neither seems harmful.

“It doesn’t matter if you want to take it because you’re okay to pay for it and you think it’s doing something to maintain your joints,” he said. Whitaker said. “In addition, could you do periodic weight-bearing activities?”

There is one interesting exception. 2011 small survey Researchers at the Tufts Medical Center have found that the quality of knee cartilage improves six months after ingesting 10 grams of collagen daily. Recently, Ph.D.Bar study Ligaments raised in the laboratoryLike cartilage, which is made primarily of collagen, it also supports the idea that consuming collagen before exercise can trigger new collagen synthesis in the body. But so far, the actual benefits of this approach have not been proven.

To Dr. Whittaker, the most important priority is to clarify the idea that you should stop working as soon as you notice knee pain. She said that continuing activity, strengthening the muscles around the joints, and developing good movement patterns could change the trajectory and in some cases vice versa. “Many people think that osteoarthritis is a normal result of aging, right? It’s not inevitable. There’s a lot to control.”


Alex Hutchinson is a columnist for Outside magazine and author of “Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.”



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