Saturday, May 30, 2009

Patellofemoral pain, arthritis, and exercise

First off, an explanation. What's Martha Raye with her toothsome bedentured smile doing in a post on aging knees? If you have patellofemoral arthritis, I think you can relate.

The patella (kneecap) sits in front of the lowest part of the femur (thighbone) at the knee joint. Patella slides over femur as we bend at the knee, and when all is young and working correctly, the cartilage-covered surface of one slides over the cartilage-covered surface of the other.

So with age, cartilage breakdown, misalignment, and saggy old quadriceps (large muscle on the front of the thigh in charge of getting us off chairs and toilets), the patella starts slamming into the front of the femur, and the cartilage frays, tears, and wears away down to bone. So as we squat, plie, rise up, and sit down, one bone grates on the other bone, and...just like Martha Raye fielding a seed between denture and gum...we wince with pain.

Well, that's me. Deep knee bends are yesterday's move, squats out of the question, and I channel Martha Raye during lunges. The first thing I told a personal trainer during a trial session is "I don't do lunges. Period." But she is not taking no lunges for an answer, noting as I have that flexing the weight-loaded knee to heave the rest of me up and down (assuming I'm not in a wheelchair) is what I must do for the rest of my life if I care to remain independent. Is this all about being under 30 and not appreciating how it feels to work-out on aging knees, or is she on to something?

She will feel smugly vindicated when I show her a Dutch study(1) that indicates exercise beats other strategies for relieving patellofemoral pain. The sports medicine practitioners at Erasmus University Medical Center in Rotterdam signed up 131 patients with up to twice that number of painful knees to undergo a 12 week supervised exercise program directed at quadriceps strengthening, flexibility, balance, and coordination or an equal number of weeks under 'usual care' from their physicians. The latter, I'm guessing, means this control group was told "You should do leg lifts and take Advil (or whatever the Dutch equivalent is) and get over it. Next."

On comparing the exercised group with those who motored on without supervision, the researchers found significant improvement in pain and function scores in the former not only at the end of 12 weeks but also on follow-up 12 months later. One can assume that diminished pain means improved alignment and quadriceps strength have improved the tendency of bone to grate on bone and, as a result of this supervised exercise program, wear-and-tear degeneration has been halted.

My trainer has cleverly disguised lunges as other exercises where I hop from bent leg to bent leg as she throws things at me (well, a ball actually), or stand on one bent leg while I do distracting maneuvers with weights in hand, and, well, I hate to admit it but my knees feel better.

So I guess I'll channel Erma Bombeck instead and let Martha Raye rest in peace.
1. American College of Sports Medicine (ACSM) 56th Annual Meeting: Abstract 570. Presented May 27, 2009


Ruth said...

I agree that quads strength is essential in coping with p-f OA, as well as balance and flexibility exercises. However, it is important not to cross the fine line between beneficial exercise and aggravating exercise. As a PT, I have pushed too hard with my own bad knee and now am dealing with plantar fasciitis secondary to overexercising a badly aligned knee. I ignored the warning signs as it was developing. Listen to your body, not only your trainer!

femail doc said...

Hi Ruth, I was hoping you'd chime in on this one. I agree on listening to the (sometimes screaming) body. Had to pass up the jumping jacks yesterday but Trainerwoman modified the exercise into something the old knees could do.

JeanMac said...

The joys of aging, I guess. Glad your plan is working.

Anonymous said...

Watching my 85 year old mother in law slowly but surely lose her mobility, I truly believe that quads strength is the key to the kingdom of independence. It's hard to convince an 85 year old who never exercised of this (or anything else). As for channeling Erma Bombeck, please, no!

KGMom said...

Uh oh--this is me. Bad knees. Misaligned left knee that feels as though it pulls my leg to the outside.
Squats, thrusts, you must be kidding.
I have developed mechanisms to get me up off the floor--roll over and use hands to push up.

Naturegirl said...

Oh female doc I've hit the jackpot in finding your blog!! I also have this
nagging condition! I suppose I should get moving. How about hiking 2050 up a mountain while in Arizona for the winter months..was that good strengthening or more damage?
Great info here! :)NG

femail doc said...

JM: Not so sure it's working; miles of walking in Europe on cobblestones seems to have permanently set me back. Told the perky well-built trainer to knock off the squats no matter what she hides them as.

Anon: I'm with you--quads are the key but 85 is too late. Tried to get my Mom going in her 80s, even with a trainer, didn't work out at all. I thought Erma B. was hilarious.

KGM: I suppose there will come a time when floor is off limits due to the can't get up off of it thing.

NG: I'm still unclear whether pushing on is a plus or a minus. Hiking up a mountain is probably more good for heart/lungs/soul than bad for knees methinks.

ara said...

Thanks for the description and the info! Your sense of humor is a nice touch. p-fOA has led to some dark humor in my house this winter. I am at the end of six weeks of PT for strengthening and flexibility. They are making noises about an at-home program - what should I ask about that? The braces and the strengthening is helping the pain and mobility, but like several others, I don't know where that line is between doing too much and leading to more damage. Nice to have some company on the journey.