CHAPTER ONE THE KNEE CRISIS There is a knee crisis in America. People are experiencing more injuries-- and more serious injuries--to their knees than ever before. The frequency of knee pain and knee joint replacements has skyrocketed, including those in Americans under the age of sixty. As a culture, we're putting a tremendous strain on one of our most important joints, with potentially debilitating results. There are many reasons for the increase in knee pain. Knee traumas in women, especially, have gone up dramatically, and recent statistical analysis shows that women are four to six times more likely to have specific traumatic knee injuries (like ligament tears) than men are. As more and more women experience the joy and health benefits of an active lifestyle and competitive sports, the incidence of injury is only going to increase. Sports like soccer and basketball are rising in popularity, especially in recreational leagues. These also happen to be two of the sports with the highest rate of knee incident. Weekend warriors are pushing their bodies harder and further, past what they can safely do. This is especially true of middle-aged exercisers who, after years of physical activity, have put many miles on their knees on the bike, the road, or the trail. Many of these athletes choose to ignore the first signs of problems and "play through the pain." This puts them at higher risk for serious injury, as well as degeneration later in life. Conversely, we're more out of shape than we've ever been in this country. A large segment of the population is sedentary and under-conditioned. For every "overuse" injury I treat, I see as many problems that are the result of "underuse," in someone so poorly conditioned and overweight that even the normal activities of daily living put an undue strain on the knees. It's not just biking a hundred miles that can wear down the knees; in the wrong circumstances, just walking to the car (or not walking to the car enough) can bring on knee pain. We're also seeing an increase in degenerative knee pain and injury. At least some of this is linked to previous knee injury, whether from trauma or overuse, that puts you at higher risk for degenerative conditions such as arthritis. This is also linked to what has been called "the graying of America"--as the population gets older and lives longer, our bodies have more time to wear down and wear out. The knee injury rate is on the rise in this country and surgery is keeping pace. Making a decision about surgery should be a complicated decision, and one made on a patient-by-patient basis, as both the patient and the physician weigh the particulars of the specific knee problem and the individual's long-term health and goals. Cutting-edge imaging techniques give us fantastic access to the inner anatomy of the knee and can be an invaluable aid when we are trying to locate the source of your pain, and surgery has had life-changing effects on many of my patients. Surgeries have become much easier to perform, with fewer complications and inconveniences. Procedures that used to take hours and require months of immobilization can now be performed on an outpatient basis, so that the patient is up and around in a matter of days. However, these amazing technologies cannot and should not be treated as a substitute for good old-fashioned, hands-on doctoring. These imaging techniques should be used to supplement the information we get from an examination, not supplant it, and surgical options should be used to complement intelligent, active participation in your personal knee health, not as a substitute for it. I know, both from firsthand experience and from seeing thousands of patients over the course of my career, that any pain or injury in the knee is a crisis for the person who's experiencing it. A sore or injured knee directly interferes with our ability to live our lives the way we want to, because the knee is the basis for our mobility. An injured knee can mean you can't enjoy that skiing vacation, or achieve your lifelong goal of reaching the top of Kilimanjaro. When your knee hurts, you can't run to catch a bus, or climb a ladder, or squat to comfort a child. You can't even sit comfortably in front of a computer to do your job--or drive a stick- shift car to get there. Even if it's only slight discomfort, knee pain is a serious matter that should be addressed. A knee injury affects our ability to bend and straighten our leg, something everyone does thousands of times every day, but the consequences extend far past the joint. A knee injury can put the rest of the body in danger by forcing you to compensate for your weakness. And it makes it harder to do the exercise that keeps our hearts and lungs and bodies healthy and strong. Knee injuries aren't cheap, either--from what you spend on braces and orthotics and physical therapy, to the money you lose on a business deal because you're stuck in the clubhouse with an icepack instead of out on the links. And then there's an emotional and psychological cost. We understand our ability to move under our own steam and without pain as a fundamental entitlement. Any restriction placed on that ability affects our confidence and our general state of mind. If you're someone who jogs to clear your head after a tough day, catches up with friends over a pickup game of basketball, or spends the weekend Rollerblading with your kids, a knee injury can drastically interfere with your sense of mental well-being. In the case of a traumatic knee injury, getting the right diagnosis and care is absolutely essential in making a full recovery, and in this book, I will equip you with the information you need to make educated decisions about your care. In many cases, the advent of a serious knee problem is slow in coming, with many signs along the way, and there is much that can be done to strengthen the structures that support this essential joint. One of the keys to knee health, then, is to listen to your body and understand the signs of impending trouble. I can help you do that--and help you to know when you should take action. Doctors may have told you that if your chosen activity causes you pain, then you should give it up. This doesn't have to be true. Your hobbies are an important part of what makes your life enjoyable, and the health benefits of an active lifestyle need to be weighed against the cost to your knee. In some cases, I may advise you to take a break, and I may advise you to modify your activity to address your personal anatomical or physical limitations. In general, however, I believe that the key to knee health is to exercise in a proper and intelligent manner. I want you to be jogging, hiking, or playing tennis twenty years from now without any pain at all. I am writing this book because I know that, one patient at a time, we can put a stop to the knee crisis in this country. The secret is to start treating the underlying problem, not just the symptoms--the whole patient, not just the joint. In order to make this happen, I want to empower you to take control of your knee health. What are the factors putting you at risk for knee injury, and what can you do to offset some of those risks? What sport-specific measures should you be taking to make sure that you're playing as safely as possible? When and how should you seek medical attention for knee pain and discomfort? How will you know you're being guided to the best treatment for your particular injury, or given the right alternatives to surgery? If surgery is the best option, what should you expect--before, during, and after the procedure? What should you look for in a physical therapist, and what exercises can you do on your own to strengthen an injured knee? And, most important, how can you stay as healthy, strong, and pain-free as long as possible? The body has tremendous healing potential. When you take an active role in your knee health, in cooperation with a doctor who understands your personal history and needs, you are taking an important step toward enjoying the rest of your life to the fullest extent possible. Excerpted from The Knee Crisis Handbook: Understanding Pain, Preventing Trauma, Recovering from Knee Injury, and Building Healthy Knees for Life by Brian Halpern, Laura Tucker All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
