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Love Your Knees

by Frank Claps

Whether running, cycling or romping around the yard with the dog, your knees take the brunt of all your fun. But they were hardly built for such rude treatment.

Just take a closer look--a hinge joint with four bones connected by five ligaments, two that cross, two on each side and one up front. Add some cartilage and a tendon or two, and you have all sorts of areas ripe for pain and suffering, given how active you are.

However, with the right combination of tender loving care and tough love, there's plenty you can do to avoid injury and keep striding and spinning for the long haul.

The terrible toos

Perhaps the most frequent warning of experts is beware of the "terrible toos"--too much, too soon, too often--without adequate preparation and recovery.

Part of the problem is that athletes often have "less than optimal lower leg, hip and core strength," says Diane Vives, president and director of training for Austin-based Vives Training System.

Couple that with increasing mileage or training hours too quickly and not allowing enough recovery time, and you can wind up with overuse injuries, the major preventable source of knee pain for activities like running and cycling.

In tandem with overuse, the repetitive nature of these sports--knees bending and straightening again and again--can result in injuries both outside and inside the knee joint. For starters, the illiotibial (IT) band, a tendon that runs from the hip down the outside of the thigh to the outside of the knee cap (patella) can become inflamed through overuse, causing pain on the outside of the thigh and knee.

In addition, any inflammation of the IT band can cause the patella to "track inappropriately and can result in anterior (front) knee pain," explains Emil J. DiIorio, orthopedic surgeon and director of Coordinated Health, a Bethlehem, Pa., orthopedic clinic.

Another source of pain from outside the knee is inflammation of the tendon that connects the patella to the tibia, or shin bone. Called patella tendonitis, you'll feel this pain on the knee cap or possibly just below. Repetitive activities can also wear down the cartilage under the patella, resulting in "chrondomalacia," or runner's knee, which causes pain on the kneecap.

Female anatomy

Unfortunately, just being a woman can also contribute to your knee pain. A woman's typically wider hips create what medical specialists refer to as a wider "Q angle," which is measured from the hip to the center of the kneecap and the top of the lower leg.

The wider angle may contribute to patellar tendonitis or illiotibial band friction syndrome, explains Alecia Good, an athletic trainer with the Boulder Center for Sports Medicine in Colorado. The thigh muscles can pull the patella from a wider angle, outside its normal track.

A wider "Q" angle may also be why women suffer more injuries to the anterior cruciate ligament (ACL), one of two crossing ligaments behind the kneecap. Women may also be more susceptible to ACL injury because the area where the ligament attaches onto the thigh bone is narrower than that of men.

Another potential problem for women is an apparently lower hamstrings-to-quadriceps strength ratio. If your hamstring strength is not at least 60 percent of your quadriceps strength, you may be susceptible to knee injury, says Good.

"A weakness in the hamstrings may decrease the body's ability to stabilize unwanted motion, maintain functional joint stiffness, and reduce force at the knee joint," Vives adds.

To keep your knees in shape, do the following exercises at least twice a week, with three sets of 10 repetitions. Use dumbbells where appropriate:

Standing with your feet shoulder-width apart, toes slightly pointed out and keeping your back straight and head up, slowly bend at the hips as if sitting down, allowing some of your weight to shift to your heels. Begin with shallow squats and gradually progress to where your thighs are parallel to the floor. Your knees should pass over your feet but not extend beyond your toes.

Standing straight, bring one foot forward and bend your knee until your upper and lower leg create a 90-degree angle. The knee of the rear leg should be almost touching the floor. Bring the outstretched foot back and switch positions or perform walking lunges. For variety, add backward or sideways lunges.

Standing in front of a stair or bench, step onto that surface with one foot, straightening that leg so that your trail leg is brought up to but not touching the surface, then slowly lower the foot.

Bridges on a stability ball
Lying on your back with your heels on a stability ball, contract your stomach and back muscles to create a "bridge." In that position, use your hamstrings to roll the ball back toward your body. When proficient, perform with one leg at a time.

Side-lying leg raises
Lying on your side with leg weights on your ankles, lift your upper leg upward as high as possible, pause, and return slowly. Then bend the upper leg slightly and lift the lower leg.

Lying on the floor and resting your upper body on your forearms, use your abs to lift your body so you are supported by your toes and forearms.

How much do you love your knees?

With my knee sprained last month, I think I really need to take care of it more. I hope the exercises will help strengthen my knees so that it won't happen again.

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