Exercise and “Water on the Knee”

Knee in PainHi Chris,

I’m a youthful, energetic senior – 66 years of age. I certainly enjoy your articles and responses. I love to jog, walk and am an avid gardener. Lately, however, I have developed “water on the knee”. It sure is curtailing the above activities. My doctor has advised “wrapping it”, applying ice, and I take anti-inflammatories when it is really bothering me. X-rays were done and no arthritis is present. I realize positions and activities which place pressure on the knee joint should be avoided. I cannot recall any trauma to the knee-maybe the repetitious “up and down” motion involved in gardening is the culprit.

Can you suggest some activities or exercises that may be helpful with this problem ? My doctor tells me there is no quick fix and no doubt she is right. Come spring, would love to be able to continue with my gardening hobby. Can you offer some feedback on this problem? Thanks in advance.

Bev in Nova Scotia

Hello Bev

Sorry to hear about your “water on the knee”. It’s good that no arthritis is present as that can often be the case. “Water on the knee” is a phrase applied to a whole host of conditions which cause fluid build-up and inflammation around the knee joint. As a term, it is only descriptive and does not tell you the cause, much like saying you have “dermatitis” or “inflammation of the skin”. The question then is what caused the condition? The answer to the question will not only help you treat it but will also help you know what to do to avoid it in the future. Your doctor has given you good advice about wrapping and icing the joint. You may also try elevating it when there is new inflammation present. Following the RICE principle (Rest, Ice, Compression, and Elevation) will help reduce inflammation.

As to the cause of the condition, you may have torn one of the menisci in the knee or damaged a ligament. Also there can be inflammation of the busa (bursitis) which can also cause fluid to build up around the knee. Since you don’t recall having injured the knee, it may be more of a “wear and tear” problem, perhaps from gardening or quite possibly jogging. Does jogging irritate your knees at this point? The pounding of the foot onto the pavement, especially if you do not have supportive footwear or have weak ankles, can cause a ripple effect up through the shin and into the knee. It’s something you might want to think about. It may be time to give the jogging a break and try something with lower impact such as using an elliptical trainer or recumbent bike. Another good aerobic exercise which is very forgiving on the joints is aqua-fit.

I suggest that you consider visiting a sports medicine clinic. Your insurance may cover this if you have a referral from your family doctor. Either way, it’s good to keep your doctor informed. A sports medicine clinic will have practitioners such as physiotherapists who may be able to help you determine what has caused the condition and more importantly what you can do to avoid a recurrence. They will be able to prescribe specific exercises you can do that involve stretching to increase mobility about the joint and resistance exercises which will increase the muscular strength supporting the joint, for example the thigh and calf muscles. It is important to progress slowly. Employing light resistance with bands or tubing is a good idea but a good sports medicine clinic should be able to prescribe a set of exercises you can follow.

Your doctor may suggest having the knee drained or other surgeries, which can bring relief. The main thing is that if you choose to have the area drained of the fluid, get to the root of the problem so that you won’t just get a recurrence afterwards. Where there is inflammation, there is protection from stress and strain. You will want to find the source of that stress and strain, try to eliminate it or mitigate it, and develop a strategy to support your joint for the future.

Talk to your doctor again or see a physiotherapist and tell him or her that you want to continue being active but want to find out how to treat the area effectively and keep it from coming back.

Good luck and let me know how you’re progressing.

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Be Specific With Your Fitness Goals

Birthday cake with year 2007 candlesHappy New Year!

I resolve to…

What are your resolutions for 2007? How many have you kept or broken? More importantly, are your resolutions backed up with goals and a plan to reach those goals? Perhaps one of your resolutions is to get in shape. Perhaps you’ve thought of joining a fitness club.

If your mailbox is like mine, it has been flooded in the last couple of weeks with gym membership deals-offering 2 for 1, 1st month free, no administration fee and many other tempting reasons to join. Fitness Clubs offer these deals because they know that people make New Year’s resolutions about getting in shape. And fitness centres bank on the fact that when they have a flurry of new member sign-ups, their space won’t be overcrowded for long. The majority of new members will only attend the first month regularly and then will only make an occasional appearance, if any, for the rest of the year. Like not attending the gym we’ve just joined, our resolutions are often broken within the first month.

Why is it that so many of us make resolutions we fail to keep? Is it that we are weak-willed or want to set ourselves up for a fall? Or is it that we have good intentions but lack the tools to fulfill those intentions?

I believe that for many of us, it is the latter. We want to lose weight, eat better, become stronger, increase our stamina, and a whole host of other things but we just don’t know how to do it. Sure, we take the first steps by going on a diet, throwing away the pack of smokes, start walking, and joining a gym but we have no real plan because we have no specific goal. We say things like “I want to lose weight” or “I want to get in shape” but we don’t specify what exactly that means and how we will reach that goal. If our goal isn’t specific, our steps to reach that goal won’t be either. And without specific steps, we’ll just be walking aimlessly.

A key to defining your fitness goals and sticking with them is to remember the SMART formula. SMART stands for:

 

  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Timed

Specific:

Make sure your goals are specific so that you can plan for and carry out the necessary steps to reach them. Rather than just saying you want to be fitter or be stronger, formulate your goals around functions and activities of daily living. For example, “I want to be able to get up from a chair without anyone’s help”. In order to realize this goal, you will need to exercise the specific muscles involved in that activity, namely the front of thigh or quadriceps muscles. Specific exercises to strengthen the quadriceps include wall squats and leg (knee) extensions. As those muscles get stronger, they will help you function easier. Functional strength can be greatly improved, even in older age. As you impose specific demands on the body, it will adapt in direct response to those demands. This is the SAID principle which stands for Specific Adaptations to Imposed Demands.

Measurable:

Goals set at the outset of your program must be measurable. If you don’t include measurements in your plan, you’ll have no way to gauge your progress. I recommend using specific measurements such as number of sets, repetitions, and weight (or resistance) to log your progress. Using the example of strengthening the thigh, let’s say you define your goal as 2 sets of 8-12 repetitions of 50 lb. on the leg extension machine. As you increase from 8 to 12 repetitions and beyond, you’ll want to revise that goal to a higher intensity, such as increasing the resistance to 55 or 60 lb. You will undoubtedly see that the number of repetitions you can perform will drop back at first but this is OK. You have now imposed a higher demand on your muscles. Soon, you will see that you can do more and will have to increase the intensity level once again.

However, the most important measurement you will have of your progress will be that you can now get up from a chair without assistance.

Attainable:

Make sure that the goals you set can be attained. Being able to get up from a chair with without assistance is an attainable goal if you’ve previously been inactive, your muscles are weak, and your joints have been taking all of the load. Being able to get up from a chair without assistance if your legs are paralyzed from a spinal cord injury may not be. Talk to your doctor first about your the feasibility of your fitness goals and then talk to a personal trainer who works with older adults to design a program to get you to realize those goals. Prioritize your goals and set markers to know when they’ve been attained so you can gauge your progress. You should expect improvement over time as long as you challenge yourself. Remember the SAID principle!

Realistic:

Along with being attainable, goals and expectations must be realistic. If you’ve never gone mountain climbing before, don’t attempt Mount Everest! Despite commonly held beliefs to the contrary, older adults can progress their training of the cardio-respiratory (heart and lungs) and muscular systems at the same rate as younger individuals, although they may need to start at a lower level than someone younger and account for weaker bones and joints if they’ve been inactive. Part of being realistic in your goal setting is to look at your current level of health. If you suffer from illnesses such as coronary heart disease, emphysema, or osteoarthritis, then keep in mind that you will need to progress more slowly than a peer without any chronic conditions.

Timed:

Set your goals within a specific time frame. Exercise goals which stand to be most attainable are those which are set within a period of no more than three months at a time based on 3 days/week for muscle conditioning and 5 days/week for cardio-respiratory, flexibility, and balance. Especially if you are new to regular exercise, the first month or so will be a period of “waking up” the body to exercise. You may not see much gain during this period but you should notice an increase in stamina. Provided you stick with your plan, you should notice that it becomes easier to get through your program. In the remaining 2-3 months, you should notice that you are adapting to those new demands – you will be able to do more and you will benefit from the fruits of your labour. Getting up from that chair will be easier and you will be spurred on to set higher goals for yourself.

So this year, make your resolutions count. Be Specific. Set your goals with a plan in mind. Talk to a personal trainer if you need some motivation and guidance. Be good to yourself. Make this year your year to get fit and remember to be SMART with your goals.

To your health,
Chris