Preventative Exercise – Arthritis & Knee Replacements

A common misconception when it comes to pain of any kind is that massage therapy or surgery is the end all solution. The reason there is a pain in most cases is a muscular imbalance or inefficiency which causes Osteoarthritis. This can be corrected to avoid surgery altogether.

OAcauseKnee replacements are a popular procedure to have done due to degenerative cartilage, the patella (knee cap). 95 percent of knee replacements done are due to Osteoarthritis (OA) of the knee and by age 65, 80% to 90% of people have OA. The procedure and condition can be avoided and treated with proper exercises for the Gluteus Medias and Vastus Medialis (VMO). For preventative exercises refer to the end of this post. The wear and tear leading to OA are caused from kneeling and walking causing degenerative cartilage surrounding the joints.

ITanatomy

What happens is due to repeated use of the knee joint, the knee caves inwards relying on the Iliotibial band (IT band) to support the joint from collapsing entirely.  The IT band inserts at the knee joint, and when the knee caves and then jerks back to neutral position, the patella grinds against the femur and tibia (bones connected at the knee joint) and scrapes pieces off with each step.

Osteophytes begin to grow inside the joints. Osteophytes are small, irregular, bony growths that are also called bone spurs. Bits of broken-off cartilage or bone are also found floating inside the joint. This causes even more pain, swelling, and immobility of the joint.

OA usually occurs after the age of 45, but it can occur earlier in life, and even be seen in the spines of teenagers. After menopause, women tend to get more severe and complicated problems. Weight-bearing joints such as hips, knees, and feet are more prone to OA.

There are four main causes of OA:

  1. increasing age: The cartilage wears down with time. By age 65, 80% to 90% of people have OA, as shown on X-ray, though a much smaller percentage have symptoms.
  2. family genes: Scientists believe that OA may be passed on through families, with the symptoms appearing in middle age.
  3. being overweight: Excess weight puts stress on weight-bearing joints such as hips and knees, and increases the risk of cartilage breakdown. This is the most important risk factor for OA affecting hips, and leg and foot joints.
  4. injury: Trauma to the joint, such as overuse, can damage the cartilage and lead to OA. This is often the cause of OA in younger people.

Repeated minor injuries due to constant kneeling, squatting, or other postures that place stress on the knee joint can cause cartilage to breakdown. Exercise can help reduce joint pain and stiffness.

weightandkneereplacementsFor knee replacements, the majority of patients were classified as overweight and obese, class I (just over 28% in each group), followed by obese, class II (16.4%). The proportion of knee replacement patients in the normal weight group was very similar to that in the obese, class III group.

Hip and Knee Replacements in Canada—2011 Annual Statistics (Clinical Data)

Something as simple as being a healthy weight will reduce the amount of pressure on your joints and can prevent OA and the need for knee replacements.

Key Exercises in Treating and Preventing Osteoarthritis

Crab Walk – Gluteus Medias

GlutMedWrap a resistance band  around your ankles with your feet hip width apart. There should already be tension in the band. From here, lead with your heel and walk sideways standing upright. You should feel flexion in the sides of your bum (Gluteus Medias). This is the muscle in responsible for stabilising your leg at the hip preventing caving of the knee. It is also a great exercise for sculpting your bum.

Key Cue: walk leading with your heel.

Elevated Split Squats – Vastus Medialis (VMO)

VMOThis exercise if similar to a lunge. Step forward and bend with the leading leg forcing your knee outwards activating your VMO. The VMO is the tear drop looking muscle at your knee, one of the four muscle heads in your quadriceps. This muscle is responsible for pushing your knee outwards preventing caving of the knee joint. This combined with the Gluteus Medias will relieve the IT band and stop the grinding of your patella (knee cap).

Key Cue: Maintain your weight on the heel of your leading foot

The Most Underworked Muscle – Trap 3

For those who love to build and define, the muscle always worked on most vigorously is the weakest or smallest. I can tell you right now, that the most under worked muscle in your body is not your pectorals, biceps or deltoids. The most underworked muscle in your body is your trapezius 3.

I have covered the trapezius 1 in a previous post, for follow through (i.e. over hand passes), this only concerns the trap 1. For full range of motion, your shoulder girdle will be retracted and depressed fully. It is at this point that you have the maximum potential energy before launching forwards.

The Trap 2 and 3 will be the muscles in charge of supporting and balancing your shoulder girdle throughout the motion. Your shoulder girdle consists of articulations between the clavicle, scapula and proximal end of the humerus. For the sake of child birth, our shoulder girdle float within our bodies, supported by nothing but the surrounding muscles, otherwise we would not be as flexible. It is for this reason, that muscle control in this region of the body is crucial. Without the trapezius, there is no shoulder girdle coordination.

Exercising the Trap 2

Exercise Muscle focus Function Equipment
T raises Trapezius 2 Shoulder girdle support and balance 0-5 lbs dumbbell

Your trap 2 are located laterally inwards from your latisimus dorsi, between your trap 1 and 3.

In order to isolate your trap 2, you need to stand with your torso on a 90-degree angle as you would for a bent over row. Retract and depress your scapula (shoulder) on the side you intend to work, and raise your arm laterally, maintaining your shoulder position and straight, but not locked, elbow. Raise until it is on par with your torso, forming a ‘T’. Once you have reached the top, slowly return to the starting position.  Repeat 10-12 times.

This will isolate the horizontal muscle fibres in your trap 2, which run horizontally along your back.

Be sure to reset your shoulders after each repetition to ensure optimal results.

This will isolate the horizontal muscle fibres in your trap 2, which run horizontally along your back.

Exercising the trap 3

Exercise Muscle focus Function Equipment
Y raises Trapezius 3 Shoulder girdle support and balance 0-5 lbs dumbbell

Your Trap 3 are located just below yout trap 2, right and down from your latisimus dorsi.

Stand with your torso on a 45-degree angle and once again, retract and depress your scapula (shoulder). With your thumb pointing upwards to the ceiling, laterally raise your arm on an angle to form a ‘Y’ with your body. The muscle fibres run diagonally down your back, as would your arm in the ‘Y’ formation. Bring your arm to ear level or just past, then slowly control the descent. Repeat 10-12 times.

These exercises are also excellent for rotator cuff rehabilitation and increase in range of motion. Due to the minimal amount of activation these muscles get on a regular basis, to start, your body weight should suffice, progressing to 5 lbs if it is too easy.

If you have a desk job, overly developed trap 1 are not encouraged. This will cause you to hunch and therefore deteriorate your posture. Trap 2 and 3 however will improve your posture as well as range of motion.

Recovery – Aches & Pains

I love that deep burn during an intense workout, but who wants to be feeling it hours, even days afterwards? You have stuff to do besides workout. Tightness and soreness following a workout is not a must if you take the appropriate steps for recovery.

There are a several things you should do in order to avoid soreness. Follow this checklist and you will be well on your way to being prepared for the next workout.

Pre-workout Dynamic Stretching – A proper warm up is essential when doing any kind of workout (build, burn, strength). The reason being that if your muscles are not properly prepared for dramatic movments, the muscle will be brittle when going into the workout. A stick of gum can snap when refrigerated, if warmed between your hands, it bends and stretches without snapping.

Your muscles work the same way. A workout with cold muscles results in injury and shortage of oxygen during the workout. Shortage of oxygen results in lactic acid build up, leading to cramps and aches.

Post Workout Static Stretching – Have you ever scraped your knee and the scab formed when your knee was straight but when you bent it the scab cracked and tore? When you workout, you are tearing muscle fibre so that they build back stronger and larger, in preparation for the next workout.

When you workout, your muscle contracts thus tightening the muscle fibres. This is your knee skin when it is extended, close together and compact. When you then move your joints after your muscles have healed, they will strain the fibres, which are now repaired. If you have not stretched after your workout, the muscle fibres will have healed at a shorter length then your range of motion. This is your knee scab ripping open.

After you workout, you should do some static stretches as a cool down on the muscles you used during your workout. Your muscles will rebuild at full length and will result in a more efficient recovery while also preventing aches and injuries.

Eat – Now that you have had time to get home. Your muscles are going to need proper nourishment to replenish the muscle fibres you have torn. A proper serving of protein (25 – 30 g on average) is necessary since during the workout you have torn muscle fibre membranes and protein filaments due to repetitive, intense muscle contractions.

Eating protein post workout (fish and chicken breast is best) does not ease the pain, but will make the recovery stage faster and more efficient in replacing the protein chains in your muscles.

Active Recovery – During the recovery stage, your body delivers the needed nutrients to your muscles through your blood stream. The more blood flow, the faster the nutrients are delivered. Therefore, instead of complete rest the evening after your workout, do some low intensity exercises to raise your heart rate. The exercises should use the muscles you exercised earlier that day (i.e. if you worked your quads, gluts and hamstrings, do some body weight squats or lunges). Your recovery will be faster and your body will be more efficient at rebuilding itself.

Sleep & Rest Days – The night after your workout, your body needs a chance to regroup and rebuild without any strain on the muscle worked. Getting a good 8 hours of sleep is essential for athletes.

Your muscles will not be completely repaired the following day, so if you are going to hit the gym again, work a different muscle group. Feel free to stretch yesterday’s muscle however, don’t let them go stiff!

Follow Through – The Trapezius

The standard exercises cover the essentials when working out your back and shoulders. Latissimus dorsi with the lateral pull down,  Rhomboids with seated rows,  the medial deltoids with the military press, anterior with back flys, but what completes the back to shoulder flow of motion? This applies to rowers, football players, hockey players to name a few. A fluid motion through a slap shot, a long distance pass or stroke requires a full follow through for optimal athletic efficiency. It also provides a strong base for a level head when tackling another player (wrestlers read this!).

Exercise Muscle focus Equipment
Clean & Press Trapezius Olympic bar + plates or dumbbells

The clean and press is the first step to achieving this which will develop not only your anterior and medial deltoids, but that connective muscle to your rippling back, the trapezius. Its primary purpose is to hold your shoulders in place. Now, if you are to follow through on a long distance pass for example, and you have well developed shoulders, but no stability to guide your rotator cuff and surrounding muscles, your aim will be less than accurate.

With your hands grasping the barbell, palms inwards and knuckles to the ground, pull the bar vertically parallel up your body by bending at the elbow. Your elbows should be pointing outwards from your body until there is a straight line from elbow to elbow, with the bar in between (Keep your elbows up!).  From here, shift your elbows beneath the bar (a swift jerk may be necessary for heavy lifters, shifting their entire body beneath the bar; the clean and jerk). Once your elbows are underneath the bar and pointing outwards, press the bar up above your head as you would do when executing the barbell shoulder press. Then reverse the movements until the bar is once again hanging from your straight arms in front of you. This is one repetition.

This is a portion of the complete clean-and-press which involves a thorough full body workout. I will be covering that in my next post.

How to Cope with Knee Injuries

Without proper support, most exercises will be removed from your repertoire if you are unable to support your body weight. Knee impairment (arthritis for example) does not only effect your quadriceps, hamstrings and gastrocnemius (calf) strength, but cuts out essential exercises for a strong core, bicep, latissimus dorsi, trapezius and pectorals to name a few.

The clean and jerk, dead-lift, standing barbell curls, cable cross-overs, lunges, squats, are all untouchable while in recovery. This however does not mean that you stop working out and you’re doomed to the iso-kinetic machines for the rest of your athletic career. In the recovery phase, strengthening your legs is vital, however you must also avoid re-injuring yourself.

The benefits of strengthening your legs following a knee injury are:

  • Reduction of pain and inflammation from over use on a daily basis
  • Prevention of second injury
  • Faster recovery for those awaiting knee surgery
  • Freedom to exercise the rest of your body with stable joints

Here are three basic exercises adapted for those who are unable to perform standard leg workouts. Before you begin these exercises, you should consult your physician.

Swiss ball leg curl: Hamstrings

Position your feet about 1’ apart on a medicine ball while lying on your back on the ground, knees bent, feet planted on the ball. Using your core raise your back up off the ground, balancing on your arms, hands pronated (palms down). Slowly extend your legs, allowing the ball to roll away from your body. Do not lock your legs, just before your legs are completely straight, begin to roll the ball back towards your gluteus maximus (rear end) to the starting position. Inhale while extending your legs, exhale while flexing.

Repeat this 8-10 times, 3 sets Do not continue if too painful

Raised lunges: Quadriceps

A

B

Place one of your feet planted squarely on the platform in front of you. Shifting your weight forward, slowly bend your front knee until it is above your ankle. Your rear leg will bend towards the floor, with the respective foot rolling onto your toes. Be sure to maintain square posture, shoulder retracted and torso perpendicular to the floor at all times. Inhale on the way down, exhale on the way up.

Once at 90 degrees, push back on your front foot back to the starting

position.

Repeat 10-12 times. Do not continue if too painful

Heel Raises: Gastrocnemius

A                  B

Feet square beneath your hips, slowly raise your heels off the ground until you are on the balls of your feet. Then control you descent back down onto your heels. Your body should be straight and level, completely perpendicular to the floor. Exhale on the way up, inhale on the way down. Using a wall for balance may be helpful. A way to regress the intensity is to be seated, feet planted on the ground in front of you, and raising your heels.

Repeat 10-12 times. Do not continue if too painful

The Prison Yard Build

For the first few years of my workout regime, it involved alternating between arms/shoulders and chest/back. That left my lower body with rather disproportionate muscle strength. The truth is guys, girls don’t go for Schwarzenegger pectorals when they’re held up by foghorn leghorn’s legs (he’s a chicken for those who don’t watch Bugs Bunny).

This is known as the “Prison Yard Build,” based on the goal to look as intimidating and powerful as possible by puffing out your biceps and pecs to enormous sizes. Good news! You’re not in prison and no one is looking to usurp you in the food line! Plus, you will want to wear shorts one day, and your bathing suit probobly cuts off at the knee at least…

The most powerful muscles in your body are your quadriceps. This does depend on your dedication to strengthening them but on average, if you are working out your legs as much as the rest of your body, you should be squatting twice as much as you bench press.

The fact of the matter is, for a fit form, the lower half is vital for a healthy body. Bodybuilders do neglect their legs to a certain extent, but they keep them on par with their pectoral muscles.

Here are a few good examples to get your legs fit quickly:

Exercise

Muscle Worked

Squats Quadriceps, Hamstrings, Hip Adductors, Gluteals, Erector Spinae.
Leg Extensions Quadriceps (Front of thigh)
Leg Curls Hamstrings (Back of Thigh)
Dumbbell Heel Raise Gastrocnemius, Soleus (Calfs)

Put in a few extra leg exercises before your cardio workout, or after your chest workout. Do squats and calfs one day, and the isolation exercises the following. This isn’t going to detract from your regular Schwarzenegger regime; it will give you a sturdy base to show off that trophy torso of yours!

Power Chest – Endurance

Oh Yeah! Every meat-head’s favourite day, CHEST DAY! For all of you who are looking for muscle growth for a sizable bust, this is an exercise you need to incorporate into your chest workout.

Muscle worked Pectoralis Major (Chest)
Function Endurance, strength, fat burner, improved power
Reps Until failure
Type Drop Sets
Equipment Bench Press and Olympic bar (45 lbs.)

Muscle Focus

This is a Drop Sets exercise, also referred to as Stripping. It’s ideal that you have a workout partner for this.

Load up the bench press with 4-5 10 lb. plates on each side. I personally like four 10 lb. plates with a final 5 lb. plate on each side. (If you’re not up to that weight, you can always use 5 lb. plates).

Pick up the bar just you would for a regular bench press, hand just over shoulder width apart, evenly spaced, with the bar over the middle of your chest. Bring the bar down to your chest and push back up. Remember to never lock your elbows. Repeat this until you cannot lift anymore. Put the weight down and have your partner remove one plate from each side. Pick up the bar and lift until failure again. Repeat this until you have an empty bar.

Benefits:

This exercise is an excellent way to end a chest workout. It will but up any fat stored in your chest to give you a nice toned look to your already bursting bust. The high rep low weight gives your body a chance to work at the oxidation level, allowing your muscles to more oxygen thus burning calories stored up in fat as opposed to protein after your hard workout. If you perform the exercise at a high rhythm, you will vastly improve your power as well.