Squats causing pain - What are you doing wrong?

Building up the quadriceps muscles protects the knee joint, slows the progression of osteoarthritis, and can decrease pain.

Squats are one of the more popular quads exercises but many people try them and quickly stop when the cause an increase in pain.

Squats are a common gym exercise but you need to do squats differently if you have osteoarthritis. Like any exercises for arthritis, it is important to do them in a pain free range of motion.

Everyone's knees are different so you may need to do a little trial and error but the following points should help:

• When starting squats you should be doing shallow squats. Very shallow squats. This means your head should drop only 1 or 2 inches throughout the squat. Deep squats puts a lot of pressure on the knee and are nearly guaranteed to cause you pain.
• When extending the knees after a squat you should not completely straighten you knee. Again, this is likely to cause aggravation.
• Your aim is to fatigue the muscle without increasing your pain. The muscle is fatigued when it starts to wobble a little. 
• Do squats slowly. You will find this harder and fatigue the muscle quicker. Aim to do your squats at roughly the speed you breathe.
• You will usually be able to fatigue the quads in less than a minute. If you have to do more than 30 or 40 to fatigue the muscle, make the squats more difficult. You can do this by doing one legged squats. Keep them shallow and slow and hold onto something for support.
• Since it only takes a minute to do, you can integrate these exercises into your everyday routine.  While you boil the kettle, squat. Toast on? Squats. On the phone, waiting for a lift, brushing your teeth - do all of these and you will be building strength without aggravation before you know it. Every time you fatigue you are sending a message to your brain to build more muscle. It doesn't matter how old you are, if you use them more, they get bigger, you use them less, they get smaller.

Scams - When its too good to be true

Osteoarthritis is a chronic condition. That means it is a persistent disease that continues over a long period of time.

Chronic pain will eventually wear anyone down. This is what makes osteoarthritis so enticing to scammers. It is a common condition that has plenty of people desperate for any relief.

Understanding osteoarthritis helps arthritis sufferers avoid becoming a victim of scammers. If you remember the following points you will easily avoid those who prey on people in chronic pain.

• Osteoarthritis is physical wear and tear of the joints
• There is no known supplement or medication capable of re-growing the articular cartilage of the joints.
• Pharmaceutical companies spend millions of dollars researching osteoarthritis as there is a huge market for any effective treatment. If any common plant, mineral, or other concoction was effective, they would be selling it to you and be making a killing.
• The only non-surgical treatments clinically proven to help are not very glamorous. Weight loss, exercise and pain killing medication are (on average) effective but either require hard work or have side effects.

My recommendations remain the same:

If you are going to spend money spend it on either exercise or information. Apart from surgery, lifestyle modification, exercise and weight loss are the things you can do to decrease your pain. Don't waste money looking for the magic cure. Spend $10 on a book on osteoarthritis and get a gym membership or buy a bike and do something positive to combat your arthritis.

Life wasn't meant to be easy, but you don't have to accept you pain. Empower yourself and get motivated.

Arthritis Knee Pain - Does Hot or Cold help?

Another question I am commonly asked is about heat or cold therapy.

Many people are confused as to which to use and why they work.

To correctly use these types of treatments, you need to know why you are using them.

Pain is not the answer I am looking for here, it is the cause of pain that is important.

Inflammation is part of the body's healing process. It is a reaction to tissue damage and is one of the first steps in repairing the damage. Unfortunately, the body often goes overboard and the inflammatory response is excessive leading to increased pain and swelling. Heat encourages inflammation as blood vessels dilate in response to heat. Putting heat on an already inflamed area makes the problem worse.

Cold on the other hand helps to prevent inflammation and can decrease the pain associated with it. This is why any sporting injury is initially treated with ice, and never heat.

So which do I use for my arthritis?

Simple question, not so simple answer.

Inflammation can be a component of osteoarthritic pain, especially after a flare up. For many people though, pain is a result of joint stiffness. Stiffness will respond well to heat and can be made worse by cold. This is why it is common for people to complain more about their arthritis in winter and why retirees live in Florida.

For the majority of people with osteoarthritis of the knee, heat will be the place to start. There will need to be a bit of trial and error but if a hot bath helps, a hot pack will too. If you find that heat makes your knee pain worse, it is likely you have an inflammatory component to your pain and cold is worth a try (combined with anti inflammatories if possible).

once again there is no blanket answer for everyone. You are an individual and your knees are too. Once you have learnt about them however, you will know what works and be able to do whatever you can when your knee pain is bad.

Knee pain - What if it isn't your knee

The body is a complicated thing. All is often not what it seems to be. Take pain for example.

Pain itself is a many faceted experience. Its perception can be heightened or dampened by our emotional state. Like other forms of sensation, it travels along our nervous system to reach our brains. This is why spinal injured people have no sensation and no pain. If the message doesn't get through, the pain is not felt.

The system of nerves that carry the messages of pain are also susceptible to mistakes. This is known as referred pain.

Our nerves leave our spine and provide sensation to a specific area of the body. This has been mapped out as displayed in the picture on the right, each area corresponding to the level of the spine the nerves come out of.

The L4 dermatome passes over the front of the knee and the back of the knee is covered by S1 and S2.

When the nerve roots are aggravated as they leave the spine, the body can not determine where the pain has come from. The result is pain felt throughout the area covered by that nerve.

This means that if you had a disc bulge in your spine at L4 on the left, you would feel a band of pain from the outside of your left hip sweeping down over the front of your knee.

Your knee pain could in fact be coming from your back.

Any new leg pain that is associated with back pain, pins and needles, numbness or an increase in pain with coughing or sneezing, should be discussed with your doctor.

A pain in the knee is not always a pain in the knee.

Medial Compartment Osteoarthritis

The most common place to have osteoarthritis is in the medial compartment. This typically causes pain at the front and inside of the knee joint.

Over time, as the cartilage covering the joint is eroded, the joint space narrows on the inside. This changes the angle of the knee joint causing what is known in medical terminology as a varus deformity. A varus deformity is what is commonly called bow legged.

The deformity starts off very slowly and usually is only noticed after a number of years with an arthritic knee. In the later stages however, the increasing angle of the joint can place even more force on the inside of the knee. This can see the deformity increasing over a matter of months.

Total knee replacement surgery allows the surgeon to correct the angle of the knee. It is not uncommon for a post operative patient to have a straight leg for the first time in decades.

In extreme cases, when the angle is large, normal knee replacements are no longer suitable and a special prosthesis is required. There is also a limit to how much correction a surgeon can achieve. If you notice a rapidly increasing deformity (over a matter of months) you are advised to discuss it with your surgeon.

In most cases it is not the deformity that bothers you but the pain. A large varus deformity is usually very painful and it is this pain that sees you knocking on your surgeons door.

Lateral Compartment Osteoarthritis

Much less common than medial compartment arthritis, lateral compartment osteoarthritis is no less severe.

Lateral arthritis results in a valgus deformity, or knock knees, in layman's terms.

It is more common is obese people and the valgus deformity combined with excess weight can lead to rapid disease progression.

Treatment includes weight loss, high tibial osteotomy, unicompartmental knee replacement, and total knee replacement.

Lateral compartment arthritis can also be treated with an off-loading knee brace, particularly in the early stages.

Arthroscopic surgery

Here is another good animation on knee arthroscopy by British private health provider BUPA.
It give a good general overview of how key hole surgery is performed in easy to understand terms.
One point to note is that the animiation states that 3 incisions will be made. It is also common for the entire procedure to be completed using only two.
The benefits of key hole surgery are easily seen by the size of the incisions. In years gone by this type of surgery would have required a large incision, often greater than 6 inches long. This of course led to much more pain and patients having longer hospital stays.
Today, the vast majority of knee arthroscopies are day case operations.

Overview of Osteoarthritis Animation

Here is a great computer generated animation of the comparison between the normal knee and the osteoarthritic knee.