Any NBA fans watching last night’s game must have winced to see Paul Pierce lying on the ground in such severe pain that he had to be carried off the court by 4 others. I thought for sure he had done some serious damage to cartilage in his knee, though none of the replays gave a good angle to see exactly what happened. To say I was surprised when he returned to the court only a few minutes later is an understatement. And the fact that with a sprained knee (where the ligaments that stabilize the knee get overstretched and partially tear) he went on to score another 11 points and help lead the Celtics to victory, with the aid of a Neoprene sleeve, is not typical!

This type of performance following such an acute injury is certainly an exception. First, he’s an elite athlete. He’s highly motivated to win an NBA championship (especially given the Celtics record in the past 2
decades) and adrenaline can work wonders to get you through certain situations. He also has a team of athletic trainers, physical therapists, massage therapists, and chiropractors who can give him very intensive treatment following last night’s game and over the course of this series.

My point here is that most of us aren’t Paul Pierce. For even a good, non-professional athlete, continuing to run and jump on a sprained knee is not a wise choice and not worth the risk of sustaining further injury to the knee. The steps to take following an injury such as the one he sustained would be to:

1. Protect
2. Rest
3. Ice
4. Compress
5. Elevate

Seeking emergency medical attention if you find yourself needing to be carried off a field/court would also be recommended to ensure there is not a fracture or injury requiring surgical correction.

Let’s keep our fingers crossed the Pierce’s knee holds up for the remaining games. Go Celts!

The knee is a common site for osteoarthritis and various other joint and soft tissue injuries. If you have intermittent aching in your knees, the first thing I would recommend (if I wasn’t able to see you to look at it) is to start to work on strengthening and stretching the quadriceps.

The quadriceps are a group of 4 muscles that run along the front of the thigh and over the knee cap. When they contract, the knee straightens and the knee cap glides up towards the hip. Strong quadriceps help to improve the stability of the knee joint, encourage proper function of the knee, and allow us to easily walk, go up and down stairs, and stand up and down.

When the quadriceps are tight, the degree of flexion, or bending of the knee can be restricted. Tight quadriceps also create undue stress on the kneecap and cause a compression at the knee joint. The result may be pain with activities such as stairs, squatting, running, and prolonged sitting.

Try these quariceps stretch and strengthening exercises and you may notice your knees start to ache just a little less.

Growing up I loved the Wizard of Oz. The combination of the music, costumes, and the absurdness of it was really so entertaining. In my work, I often think of the poor Tin Man, who was so stiff and constantly needed to oil his joints to keep mobile. That’s really not too far off from our bodies in a way. We have special lubricating fluid in our joints that helps the joints move smoothly.

The joints in the body bend and straighten, but they also glide in multiple directions. For example, the knee bends and straightens, but as it bends, the tibia (shin bone) glides backwards on the femur (thigh bone). And at the same time, the knee cap glides down. There’s a lot of complexity to that really, and if any part of the bending or gliding is limited, pain can occur.

I’m going to stay with the knee as an example because it’s an easier joint to explain. If you sit with your legs straight out in front of you and relax your thigh muscles, you can use your hands to gently wiggle your kneecap up and down and side to side. If the joint capsule (which is essentially like saran wrap around the joint) here becomes tight due to a new or old injury, a disease process, or disuse, knee dysfunction could occur. In addition, tight muscles can restrict the kneecap’s ability to glide. For example, a tight IT Band will tend to pull the knee cap out to the side, decreasing it’s ability to glide inward and altering the resting and functional alignment of the kneecap. This can cause wearing on the underside of the kneecap which would inflame the joint. Injuries to the knee such as chondromalacia patella, IT Band syndrome, patella dislocation, and patella tenndinitis can all be related to a disruption in the gliding mechanism of the kneecap.

So sometimes when you stretch on your own and don’t see an improvement in flexibility, it may be because the joint isn’t gliding correctly and that is what is limiting your motion and progress. The only way to restore normal flexibility in that case is by mobilizing the joint and stretching the joint capsule. This could be done by a chiropractor or physical therapist. There are also self mobilization straps and wedges you can be instructed to use for mobilizing the neck and back. It’s important to maintain the flexibility of both muscles and joints in order to keep from getting stiff and creaky like my friend the Tin Man.

This is the time of year when many of my patients express frustration at not being ableto enjoy gardening because of pain or an injury. Personally, I look forward to making changes to my perennial garden and planning our vegetable and herb garden each spring. And though I’m careful and try to be safe, there are evenings where I find myself sore from a day’s worth of digging and planting.

The back, neck, knees, and shoulders are often taxed with the various motions and positions assumed while tending to a garden. Kneeling, for example can be hard put a lot of pressure on the knee joint and bursa. Squatting repeatedly or for sustained periods can be aggravating to the knees, low back, pelvis, and hips. Raking, weed pulling, and digging require the neck and shoudlers to do a lot of work. So what’s a gardener to do?

I always promote the use of proper body mechanics, however I am realistic too. It’s often difficult to keep the joints in neutral alignment whn working in the garden. In situations where the body is under stress or working in a less than ideal alignment, the following tips may help prevent soreness and injury:

1. Vary your position every 5-10 minutes. Alternate between half kneeling on one knee, kneeling on both knees, and squatting when working low to the ground. It’s also a good idea to vary between standing and squatting to minimize the likelihood of strain to the joints and overuse type injuries.
2. Stretch often. Every 10-15 minutes, do a few simple stretches. Since a lot of positions I find myself in when gardening involve bending forward, I try to do stretches where I bend backward. Placing the hands on the lower back and gently arching back while standing is a nice way to stretch the front of the body. You can also do various stretches for the neck, chest, hip, and hamstring. This gives the muscles a well deserved break, allows better circulation to reach the tissues, and helps restore symmetry and balance to the body.
3. Don’t overdo it. (This is where I often go wrong.) I sometimes get on such a roll and can be in the garden for hours working. Try to limit the length of time you spend to perhaps one hour, maybe more or less, each day.
4. Sit back and enjoy. Allow yourself time to relax and take in the sights and sounds in your garden, even if you aren’t finished.

Sitting with the legs crossed is something many people do. If you have any back, hip, or knee problems, it may be best for you to try to break this habit and there’s a few reasons why.

1. It creates an imbalance in the pelvis. When you sit with let’s say the right leg crossed over the left, the right side of the pelvis shifts higher than the left. This creates an uneven alignment throughout the lower spine that translates all the way up to the neck. Anatomical imbalances such as these, particularly when prolonged or sustained, can eventually contribute to dysfunctional posture and pain. Sciatica, sacroiliac instability, and low back pain can be caused or exacerbated by this way of sitting.

2. You probably always cross the same leg on top. The majority of people always cross the same leg on top. It’s a habit, the body gets used to it, and the muscles around the hips, knees, and pelvis change in response to this. This also applies to when you sit cross legged on the floor. If you sit down on the floor without thinking about it, then change which leg is positioned in front, it will most likely be a very obvious difference in how comfortable you are. (I always have students in my yoga classes switch which leg is in front to create better balance in the body.)

3. Crossing the legs places strain on the knees. When the leg that’s crossed is positioned with the top knee out to the side and the ankle resting on the opposite knee, the ligaments on the knee can be stressed. There can be compression of the cartilage within the knee which can also be damaging over time.

4. Circulation is compromised when the legs are crossed. The compression that occurs from the legs being crossed makes it more difficult for the veins to return blood from the legs back to the heart. This is why the legs can sometimes be felt to “fall asleep” if the legs are crossed for prolonged periods.This can be problematic especially for individuals with vascular disease, diabetes, and other problems with circulation.

So if you find that you cross your legs and you’re having a hard time breaking the habit, be aware of your body and switch which way you cross periodically to restore symmetry and reduce your likelihood of pain or injury.

A bad hip, knee, or ankle can make climbing up and down stairs difficult and at times unbearable. The weight bearing, changes in range of motion and strength required to coordinate the shifts in balance are demanding on the joints and muscles, and an injury can greatly affect the ability to perform this everyday task.

If climbing stairs is a problem, try this: go up leading with the good foot, and down leading with the bad foot. By doing a “step to step” gait pattern (as opposed to step over step), the amount of weight carried by the injured leg can be reduced, thereby reducing pain.

If you’re at all like me or my running friends, at some point you’ve probably been off the road due to some type of injury, ache, or pain. Whether it be knee pain, hip pain, back pain, or foot pain, these injuries can be frustrating and halt your training or fitness routine. It’s highly advisable to discontinue running if you have an injury, as the high impact and repetition of running can cause more harm. That doesn’t mean, however, that you need to discontinue all activities. Here are a few alternative things you can try:

1. Swimming or Aqua jogging

Getting into a pool and swimming laps or using a water belt to do some aqua jogging is a great way to keep fit and active while minimizing strain to the muscles, joints, and ligaments. You will be able to maintain strength, flexibility, and cardiovascular health so once your injury heals, returning to running will be less difficult.

2. An elliptical trainer

Using an elliptical machine partly simulates running, but without the high impact. Since your feet stay planted, you eliminate impact but can still work for speed, strength, and endurance. Depending on the type of injury, the elliptical may still cause you pain. Adjusting the incline up or down may be a way to eliminate discomfort for some people.

3. Speed Walking

If you’re a runner through and through you may scoff at the idea of speed walking. This low impact workout still provides an excellent cardiovascular workout and promotes muscle strength and joint mobility. Speed walking up hills or on an inclined treadmill can be more difficult than running if you’re unaccustomed to such a routine.

4. Power Yoga

This form of yoga gets your heart pumping and works to challenge the muscles and the mind as you move through various poses. In addition to helping improve joint and muscle flexibility, it provides a wonderful opportunity to strengthen the lower body in multiple planes and directions.

As hard as it can be to stop a sport you love, it is so important for your rehabilitation and recovery to allow your muscles and joints some rest and protection. Finding alternative ways to exercise may help bridge your return to running, and also may open a new door to cross training, which may lessen your chance for injuries down the road.

Swimming is recognized as an excellent form of exercise, particularly for individuals with joint pain or musculoskeletal injuries. It has many benefits including the following:

• It’s a great cardiovascular workout, which can help lower blood pressure, cholesterol, and body weight, improving overall health and well-being.
• It works all the major muscle groups for a total body workout and toning.
  The hydrostatic pressure helps reduce inflammation and pain, allowing someone with a swollen knee, for example, to do gentle range of motion or even shallow water walking with less pain.
• The properties of buoyancy allow individuals with significant mobility loss, pain, or obesity to exercise with limited risk for injury.
• It’s non-weight bearing and non-impact so any conditions that are aggravated by weight bearing, such as certain cases of back, hip, knee, or foot/ankle pain, can benefit.
• The water helps promote range of motion. You don’t have to swim in the traditional sense of doing laps to use water to help encourage movement in the joints. Standing in shallow water and gently moving the affected area can be of great help.

• Various tools are available for use in the water, such as water weights and flippers that help increase resistance for additional strengthening. In addition, aqua joggers are buoyancy belts that keep you afloat and can be used to do deep water jogging for runners (and non-runners too) who are off the road due to pain with high impact activities.

If you are NOT a swimmer, meaning you don’t know how to swim the various traditional strokes (such as the crawl, freestyle, breast stroke, or backstroke) I don’t recommend swimming if you have back, neck, or shoulder pain. Faulty mechanics could actually cause more problems for you. If you’re unsure where to begin in the water, consult with a physical therapist who has experience with aquatic therapy. They can help you establish a safe program for your specific needs.