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Hey everyone, welcome to the stay healthy El Paso podcast. I'm your host, Dr. David Middaugh, expert manual physical therapist, and I'm the owner of El Paso Manual Physical Therapy.

I am going to talk to you today about the top six reasons for knee pain and four ways to start fixing it. We see knee pain here in the clinic all the time, and if you haven't had any sort of trauma, such as an accident where you fell, somebody fell into you, then you developed knee pain.

Usually, for most people it comes on without any sort of reason, it comes on what we call insidiously. That's what they say in the medical field. But all that means is that there wasn't a clear reason why you started to have knee pain, it just came out of nowhere. Oftentimes, people say it's related to their age, they say “I hit 50, I hit 60, and my parents had the same problems as they were getting older. Now that's why I'm getting issues too, it's just age catching up with me.” But we are going to talk through some of the main causes of knee pain that comes on without any sort of reason and dispel some of the myths along the way.

Let me just talk about age right away. As you age, of course, time passes in order for you to age, and one of the things that you have to keep in mind, that sure your body won't heal as fast, and you have put more wear and tear on it over the years. But what is affecting people, that are older, is that they have put more wear and tear on it in a bad way. In other words, if you think of a car, the longer you drive it, the more maintenance you have to do on it.

You have to fix your tires, get your oil changed, you get other things changed out and repaired, and all that tune-ups. But if you make sure that your tires are properly aligned, if you go get your tires rotated, if you manage your tires, they will stay good for a long time. But if you don't go get your tires checked out, then they start balding. In other words, the treads start to disappear and that's because you wore down the tires, the rubber on the outside of the tires way faster than you should.

Same thing happens inside the body. We are talking specifically about the knees today. If you are doing things that are harmful to your knees, unknowingly most of the time, then it's going to wear down your knees faster, and it's not a function of age.

An interesting thing that we see is, people that are just generally more active, they are very into running or cycling, they are just getting lots of reps. They get knee problems younger than somebody who is less active, just like if you were to, put 200,000 miles on your car really fast, you are going to go through more tires. But if you aren't as active as other people, maybe you are not into running or cycling or heavy exercise. Maybe you are more of a leisure exercise person you like to work out, walk and do other things.

Those people that still tend to get knee problems will get it later in life, like 60s, 70s or beyond. It's just a matter of how many reps they put their body through the bad reps, reps that affect their knee joints improperly. I just wanted to dispel that myth really quick. We will go through more here in a second.

Let's get into the top six reasons that knee pain happens.

Reason number one, worn down cartilage.

It's along that same thread that I was talking about. There is cartilage right behind your kneecap. If you feel your knee right now if you reach down and feel the front of your knee, there is a little bone that is called the kneecap and it sits against the end of your thigh bone.

The thigh bone, it's called the femur, it is the longest bone in the body, and it is the top half of the knee. The knee joint, and that little kneecap slides up and down against the end of the thigh bone. And between the surfaces of the kneecap and the thigh bone, there is layers of cartilage. That cartilage is supposed to allow for frictionless movement.

In other words, the bones are supposed to slide on each other real nice and easy, without any sort of grinding, without any sort of noise. Of course, if you have any children around or youngsters, they probably never complain about knees cracking and popping, as they bend them or straighten them. But your knees might make noises, and that's usually because you have worn down cartilage somehow, some way.

The cool thing about the human body is that we have nice thick layers of cartilage, that take a long time to wear down all the way, to where it's harmful for you. If you are concerned right now, because you find that your kneecaps are crunchy, they make noises whenever you bend them and straighten them out. As long as it doesn't hurt, you are okay. It is a sign that you have worn down your cartilage to some degree. I would get concerned to make sure you manage it because it can lead to other problems that we will talk about in a second.

You have to make sure to keep your cartilage healthy. Now, how to keep your cartilage healthy? That depends on a lot of things. The most basic level of advice I can give you, on keeping your knee cartilage healthy, the one right behind your kneecap and on the end of your thigh bone, is to make sure that you get some form of regular consistent exercise.

Some interesting facts about cartilage are that it's a very active tissue. A lot of people think it doesn't have a blood supply, it doesn't have much of a nerve supply, and that's true, but that doesn't mean that it doesn't do anything. It's a cushion in the cells inside the cartilage, cartilage cells, they respond to how much force you put through them, and if it's the right amount of forces, it can actually start fixing itself and fortify itself, make itself more dense, so that it's protective against wearing down too fast, and appropriately so that you don't have any problems later on in life.

Regular exercise stimulates these cartilage cells to behave normally and protect themselves against bad stuff happening to your knee cartilage. Regular exercise depends on your fitness level, your ability. If you haven't worked out in a long time, that doesn't mean start running three miles every day. You got to do a little bit at a time and work your way up. Of course, you have to figure out what works well for you.

That's number one, worn down cartilage. It is probably one of the most common reasons that we see people here in the clinic with knee problems and it's very fixable. There are a few things that need to happen, and they all tend to get better. The noises don’t go away completely, but it doesn't hurt and it's not getting worse. That’s the most important thing.

Number two is loose ligaments.

You have a bunch of ligaments in your knee. Some are very popular. A lot of people get surgeries on these. Just to make sure that everybody's on the same page here. A ligament connects a bone to a bone. In the context of the knee, there are four main ligaments, I'll mention a fifth one as well, but the four main ligaments that connect the thigh bone to the shin bone, the thigh bone is the femur, and the shin bone and the tibia. You have the ACL anterior cruciate ligament, the PCL posterior cruciate ligament, the MCL, the medial collateral ligament, and the LCL, the lateral collateral ligament.

The ACL is probably the most commonly torn one or affected one. That's the one that you hear about in sports. High school kids might have their ACL torn or affected somehow. If you ever watch basketball or football, knee injuries are commonly stemming from some sort of ACL injury. If you have a completely torn ACL, it's actually possible to function without one. But you have to make sure that you are very strong, and that you learn how to move properly. But that is a surgery that is commonly done for knees.

If you have a torn ACL, there are great surgeons out there that can go into your knee and repair it. There are a bunch of different ways to repair it, and those surgeries work out pretty well. The rehab is not fun. In order to get all your knee motion back and strength back, it typically takes about a year. But most people returned to sports just fine, as long as they don't have too many other associated injuries.

Because usually, when you tear your ACL, there are other things that get affected too. In the context of this podcast, we are talking about knee injuries that come on without any sort of trauma or accident. If you had a sports injury, and tore your ACL, then this wouldn't count.

But let's say that you are in your 50s, 60s or older, and you had some old high school injuries, or you fell once or twice or more, and kind of tweaked your knee and it's never been the same since. We hear that story here in the clinic so many times and they will tie it back to “Yeah, this one time I was coming down the stairs and took a bad step, kind of stumbled down and my knee has never felt the same since.”

When we see people here in the clinic, one of the first things we go to check is their ligaments, because we can actually feel here in the clinic, how lose their ligaments are or how tight they are. They should be tight. They shouldn't really move. Ligaments are not stretchy structures, they have a certain length and they are supposed to remain that length all the time. They do have some plasticity. In other words, that's what they call it in the medical field, but that just means that over time, they can stretch and shorten, but they should normally have a good amount of tightness to them so that it keeps your joints together properly.

But in some cases, we have people that have a loose ACL, or a loose NCL, or other ligaments as well, ad that can start affecting the knee really badly. They will get alignment issues in their knee, meaning the shin bone doesn't line up properly with the thigh bone. That's because the ligament is loose, it's just not as tight as it should be. Over time that causes other issues, usually the ligament itself doesn't hurt a whole lot. It's the side effects of having that loose ligament.

The cool thing is, if you have a loose ligament in your knee, like an ACL, or an MCL, or one of these other ligaments, you typically don't need surgery. You actually need to brace it, you need to put a knee brace on. The hard part with it though is how long to wear the knee brace, when to wear the knee brace, and how do we not have the knee brace. There is a whole treatment approach to this, that we walk our patients through here in the clinic, because it is very confusing.

The information out there, on the internet or even for medical professionals, they really by and large don't know how to feel that these ligaments are loose, and how to guide somebody on how to wear a knee brace properly so that it keeps the knees stabilized long enough to let the ligament scarred down and shrink to its normal size, so that it keeps the position of the thigh bone in the knee bone in its proper alignment.

If you think that you have a loose ligament injury, if you feel like you fit into one of those stories, that could be a reason for your knee problem.

Let's go on to number three…

Next, we are going to talk about a torn meniscus.

This is very common here in the clinic. In our clinic here at El Paso Manual Physical Therapy, we focus on helping people avoid unnecessary surgeries, injections and medications. Some cool research that came out with the meniscus, and before I go into the research, let's talk really quick about what it is the anatomy of it.

You have two meniscuses in each knee. You have four in your body. You have two in each knee that column, the medial meniscus in the lateral meniscus, a meniscus on the inside of your knee, and a meniscus on the outside of your knee. These are huge chunks of cartilage, and they act like a cushion a lot like the discs in your spine. They are shaped differently, and they are a little different in their makeup.

As far as what the tissues actually made of. It is a type of cartilage, but they are different because your knee joint has to bend and straighten, and you have to be able to walk and run and go up and down stairs and all the things that you normally do. The meniscus in your knee are really interesting structures. There are a lot of people that don't know that they are not solidly attached to your bones. They are attached to your tibia, the shin bone, the very top of it where it connects to the thigh bone. They are loosely attached so they are attached by the ends.

They have the ability to swivel and shift, and move around in order to accommodate the femur, the thigh bone sitting on top of the shin bone. If you have had a meniscus injury, then likely you had a knee alignment problem that has caused the thigh bone to pinch the meniscus. That's what usually causes a tear.

A torn meniscus happens over time, most of the time, it doesn't happen right away. There are a lot of people that say “Well, I had this accident and I tore my meniscus.” But you have to always consider, how do you know it wasn't torn before and maybe it just didn't hurt at that time. Either way, if you have a torn meniscus, what you will feel in the knee is usually a pretty loud clunk or click. That happens when you bend your knee at the same angle every time. In other words, if you look down to your leg and you are sitting right now, and you straighten out your leg, and at the same angle, you feel a little bump or a click inside your knee. That could be a torn meniscus.

There are a lot of other things that could be too. But here in the clinic we have special test to find out is this more of a meniscus problem, or some other cartilage, like the kneecap and thigh bone. If you do have a meniscus problem, typically you will get swelling along the joint lines, where the thigh bone meets, the shin bone, and it's associated with a lot of pain.

People will be in pain for days at a time when it flares up. That's another concept these meniscus injuries will flare up so they can get better. When they are not flared up and then you do something, you are too active, you are on your feet too much and then it flares up. You get swelling, and it hurts, and usually you lose some motion too, where you can't bend your knee or straighten your knee out all the way. In extreme meniscus injuries, you get locking, where you lose a lot of motion and you feel like you can't straighten it or bend it all the way.

Some people will force it and then it'll pass that restriction it'll unlock, it'll pop loose. Or they feel like they have to shake their knee or twist their foot and get the right angle and then their knee will move all the way. The idea with that is that there might be a flap, or a section of the meniscus that is in the way of the of the motion of the knee and it blocks it.

Whenever you have a torn meniscus, the common medical procedure is to go get a surgery to clean up the meniscus, where they called a meniscectomy, and what that means is they will go into the knee with the scope, so they will just make tiny incisions, and they will clip off the pieces that are torn and in the way of normal motion.

I think that's definitely necessary for some people, depending on how effective their meniscus is and other factors. You will have to talk to your surgeon about that. But there are some interesting studies that are coming out of the United Kingdom, the England area, where they have done placebo meniscus surgeries. What they did is they took people that had meniscus tears that were diagnosed via MRI, so they had an MRI, they found the meniscus tear, and half of them had a normal meniscus surgery where they cleaned up the meniscus. The other half had a placebo surgery. They actually did make cuts on them and they went in, they did everything they normally would, except they did not cut off the chunk of the meniscus that they needed to cut off. They left the meniscus alone. What they found is that in the recovery, in the months after having the meniscus surgery, both groups of people that had a normal meniscus surgery, and the people that had the placebo meniscus surgery, recovered the same. All improved, they all got better, and they all had a good outcome.

But now the question is, how necessary is that meniscus surgery? Because, of course, that costs more money and the rehab associated with that it takes more time. They are looking at ways to make sure that they heal meniscus injuries without surgery.

One more thing before we leave the meniscus topic, because it is very common, and we see it here in the clinic all the time. We have people that have the swelling issues, they have limited motion. It looks like a meniscus injury, but then they go get an MRI and find out that it's normal. The MRI showed that there is nothing wrong with their meniscus. Now there are problems with MRI, sometimes they don't show everything that's happening. There are times where the doctors go in and they realize that they do have a tear just didn't show up on the MRI, or the opposite can happen where they see a tear on the MRI and then they go in and it's fine.

This is guru level stuff. I don't have any research to back this up. But based on my experience with patients and how they improve pretty quickly, sometimes I think that there is such a thing as an irritated meniscus. Now, follow me here. Think about skin for a second. If you look at your skin, say look at your hands right now. If you were to scratch your skin lightly, but enough to irritate your skin, where you get a red mark, that is irritation, and it goes away within minutes, at most a day. But if you were to scratch your skin so hard that it cuts it open and you start bleeding, that's a skin injury. That's different from irritation.

Because what needs to happen in order for your skin to heal from from a cut that opens it up and you bleed from, you need to go through the normal healing process which requires you to get a scab and develop a scar, and that takes a week or more at times. It's a longer recovery time for your skin versus just a light scratch that causes some redness.

I think the same thing can happen in a knee meniscus, a medial or lateral meniscus in the knee, where you can irritate your meniscus, not necessarily tear it because you didn't have any findings on the MRI. The reason why I believe that happens is because normally, cartilage takes months to heal. You are talking three to six sometimes 12 months, depending on how severe the injury is.

Yet, we have people here in the clinic that look like a meniscus injury, and they are better within a month or two. I have to think that it is an irritation, especially if they have MRIs with them, that show that there is no tear. After a month or two of treatment, their meniscus looks completely normal. I really think that it's an irritation, and that's excellent news for a lot of people, because when they come and get treatment for an irritated meniscus here, we'll tell them if it's irritated or more likely torn.

They can avoid having an MRI which can be costly, and not really give you the best information always. Then they can also avoid potential unnecessary meniscus surgery and injections, which often just mask pain, they don't really fix the problem for the long term. They can avoid having that as well. So there you go. There is all the details on why a meniscus can cause pain in your knee.

All right, we are halfway through all the reasons.

Let's go on to number four, arthritis.

There are different types of arthritis. The most common is osteoarthritis, osteo just means bone. And arth means joint. An itis means swelling. Bone joint swelling is what osteoarthritis is. There are other versions of arthritis, psoriatic arthritis, rheumatoid arthritis. There is more than that. But the most common problem that people have is osteo arthritis. This is the age-related changes inside your joints.

This is associated with a meniscal tear, usually a loose ligament, and you can also have worn down cartilage. This tends to affect people that are older. What happens in it. Let's go to the extreme what happens in extreme arthritis is you have a loss of motion on an X ray. You will see that the bone ends just look different than normal. There is been small, repetitive problems that have continued for a long time and never been fixed, and it has changed the joints so much that the joint does not move.

Normally, there is swelling associated with this sometimes, and getting better from extreme arthritis, you are not going to get 100% better. Likely you are looking at more like getting 50 75% better, and if it's not that severe, then I think you can get it in the 90s for sure. But there are usually some more permanent changes. I'm an advocate of the body is very malleable; the body can change. If you put it in the right situation, it can morph into a healthier situation. But when you have been working on some bad knee problems for decades, for 50, 60, or 70 years. You know how fast it's going to morph back into normal is questionable, if it's going to happen in your lifetime. I just always keep that in mind.

Let's talk about arthritis that's just starting. The way that this typically presents in somebody is, they will have some knee pain, they might ache and throb. They may or may not have swelling, sometimes they will get swelling, they will have grinding in their knee, usually clicking and popping, and they usually won't like exercising or moving. You won't feel good in their need to go for a walk. You won't feel good in there to even get on a bike or elliptical machine. Their knee just doesn't like to do stuff.

As a result, people with knee arthritis typically avoid doing exercise, because it's uncomfortable to do so. They tend to get stuck between a rock and a hard place, because they might be out of shape, maybe putting on weight, and they know that they need to go exercise in order to maintain their body weight and their fitness. But using their legs just flares up their knee. They get stuck in this vicious cycle of putting on more weight, being less healthy, and also increased knee pain. Then they start to think, well, it's my weight that's affecting my knee. That might be true. That's extreme, though, you got to be like 70-80 or more than 100 pounds overweight for it to really be affecting your knee.

But most of the time, if you can increase the mechanics in the knee, if you can improve the alignment, make sure the knees bending all the way, and straightening all the way, and strengthen certain muscles around the hip and knee. That usually creates more space within the knee joint, which allows for improved motion. Somebody that has more mild-to-moderate arthritis can usually recover quite well and get back to exercising and be able to manage their weight.

We have had people here in the clinic that come in knowing that they have arthritis, they have gotten an X-ray, and the doctors have told them, the classic is a doctor says you have  arthritis in about 15 or 20 years, you are probably going to need a knee replacement, if you don't take care of this. And then many patients are thinking, “Oh my gosh, I'm following in the footsteps of my mom or my dad, who is in their 80s or 90s, and they had a knee replacement a while back, and I don't want to deal with that because, I want to stay active and healthy, and make sure that my knees are able to carry me into my 80s and 90s just fine.”

I can tell you right now that more often than not, people, elderly people in those situations have not been able to get the strength in the space needed inside their knee joint. They could have probably prevented being in a walker or having to rely on a cane. If back in their 50s and 60s, they properly addressed it and kept up a few things as they aged over time. I can't give you clear specifics on how to treat arthritis, the ideas that I can share with you about it are, that you need to stay strong, and you need to make sure your knee moves all the way. You might need help for that, or you might not. It just depends on your specific situation.

I'm definitely going to go on the side of get help, because it will. It will shortcut your time and make sure that you are on the right path to not allowing your arthritis to get any worse and possibly reversing it. But if you wait, you might flounder around trying different things that may or may not work all the way. Meanwhile your arthritis is just progressing over time. You are unhealthy over time, this could contribute to other side effect, health conditions like your blood pressure being too high, your cholesterol being too high, because you can't exercise because your knee hurts.

A lot of people just don't connect it that way. Osteoarthritis is one of the most common knee problems that people face as they get older because it just it builds up over the years. Now, the other way that I say this is muscle imbalances, that if you think of your knee joint, you have muscles on the front of your leg called the quads, the quadricep muscles, and then you have muscles in the back of your leg of your thigh called your hamstring muscles.

This is a really simplistic explanation. There is way more complicated things that we look at here in the clinic and in way more precise ways to fix this problem, but I'm just giving you the bird's eye view of things. If your quad muscles are way stronger than your hamstring muscles, it's going to change the way that your knee joint moves. It's going to yank on your patella more, your kneecap. Because the quads, move the kneecap, and it's going to shift the shin bone too far forward on the thigh bone. This could feel like your quads are always tight. It could feel like you get knots in your quads, you might get the cartilage in the knees wearing down quicker, you might get the meniscus problems, you might get all the other issues that I talked about. Arthritis could come in, and the ligament issues could feed into this as well.

If your thigh muscles are way too strong, that's what we commonly see. That could be causing knee pain right away. Some of the misconceptions that people have is they think, “Well, my knee hurts, so I need to get stronger quad muscles.” At face value, that seems like it makes sense. But if you look deeper into it, it's going to yank the shin bone too far forward on the thigh bone, and then it increases the pressure of the kneecap against the thigh bone. It just changes the forces in a bad way inside the knee. That's a simple way to put it.

Most of the time, the reason why people will get, where their quads are too strong, is they are doing exercises that dominate the quads, that make the quads a dominant muscle in the leg. The feedback is terrible because people think “Look at these massive quads that I've got. That means I'm healthy.” I see pictures online often if people show it off their quad muscles, and if you ever look at their hamstrings, or the glutes, or other muscles that contribute to this muscle imbalance, they don't have much there.

Exercises in the gym that I would definitely stay away from, if you are dealing with a knee problem right now, and you think that a muscle problem could be affecting it, are knee extensions. The way this exercise looks is, there is typically a machine, you sit in it, and it has a pad that goes in front of your shins right above your ankles, and then you straighten out your knees and it makes your quad muscles tighten up real hard.

A lot of people love doing this exercise because it's straightforward. It's easy. The machine is easy to operate, and there is usually a stack of weights and you put a pin in the weight that you want, and you do your exercise. It gives you that instant feedback that my quads are tight, they feel like they worked out, they are burning and it makes you think “Wow, I really got a good quad workout!” and then some people will go get on the hamstring machine and they can't lift nearly as much, or don't get the same effect that they get on the quad machine.

There is a huge muscle imbalance. This is a big problem over time. Typically they don't get knee pain right away. They will get knee pain as time goes on over the years, but it starts years before the knee pain comes on, and when they have been working on their quads a lot.

Another time that people get quad problems, or quad dominance issues, where they are working out their quads too much, is doing free weight exercises like lunges, squats, and deadlifts. Exercises that are intended for your legs they are missing working other muscles, and they are targeting inadvertently the quad muscles.

CrossFit is an amazing exercise in my opinion. I have a CrossFit background. I love doing weightlifting, powerlifting, all that stuff. I've worked with tons of coaches over the years. I work with some awesome coaches and some coaches that could probably brush up on their mechanics and anatomy and all that. I don't blame them. I think they are all the coaches have the best intent. They are helping out all their clients with the best knowledge that they have possible. But they just don't understand certain things at certain levels. Of course, you know, I'm an expert in this kind of thing.

They will have their clients do certain exercises like squats and lunges, for example, and the clients will report they will say, my field is working in my quads and everybody's smiling about it because they are saying great, you are getting an awesome workout, you are burning calories, you are going to get more fit, this is good. Little do they know over time, they develop these massive quads and they do feel healthier, they are more fit, their blood levels are normal as far as blood pressure, all that other stuff. Blood values that are important for your heart health.

Meanwhile, they are generating all these massive forces through their knee joint, and they are harmful for the knee joint. They are wearing down their cartilage. They are loosening up ligaments, they are messing with the meniscus. What typically happens, after years of doing these lifts that are quad dominant, where they keep working out their quads, then they have a knee injury that that kind of comes on abruptly and they are like, I just been doing my squats like I always do. I've just been doing my knee extensions, like I always do and all of a sudden, my knee just blew out.

That's how this develops over time. So watch out if you are out there exercising right now, and you have been focusing on your quads and maybe neglecting other leg muscles. Make sure that you have a more well-rounded exercise routine. Make sure that you fix your squats if you like squatting and dead-lifts as well. What you should feel on squats and deadlifts is actually your bottom muscles working out, the glutes should feel like they are getting more of a workout.

Okay, let's go into number six. This is the last reason that knee pain comes on for most people. And this is related to the squats and deadlifts bad movement.

Number six is bad movements.

A lot of people don't get that their knees should work in a certain angle relative to their body. If you are female, typically you might have wider hips than a male. It's not 100% true, but it just depends you have to adapt and figure out the way that your body should be moving, to get the right muscles to work to take pressure off your knees. This is something that we go into depth here in physical therapy, to make sure that everybody knows and understands how their legs should properly move, so that their knees are healthy for the long term. This is not something that's taught. Oftentimes when we go into movement patterns here in the clinic, people think to, well, I know how to walk. I know how to run. I've been running for years and years, I've ran marathons. In fact, I know how to squat. I've been doing CrossFit for years, and I can pick up hundreds of pounds, or I know how to bike. Another one is cycling that people say it's no big deal. You just get on the bike, whether it's stationary, or road bike, or mountain bike and you just pedal that's all there is to it.

There is definitely more precise mechanics that need to be considered., ad they are just small tweaks most of the time, that if we can fix that bad movement, it turns into good movement. Think about this. If you have spent years and years, decades of your life moving bad, little by little, you have been worsening your knees over time. If you make it as small as a few degrees, shifting your knee position, it all of a sudden turn into good movement and you can keep doing those things that you love without having any injuries down the line.

The way that you move is needs to be taken into consideration. I can't give you more details on how to move right now, because it depends on your genetics, it depends on your activity, there is so many variables that we have to take into account. When we give people advice here in the clinic, we would have already figured out what they like to do, what kinds of exercises they are looking to do once they get out of pain. If they are not looking to do exercises, what their activities are like at home and at work, we have to factor all these things in so that they can properly exercise.

Alright, let's go into the four ways to start fixing your knee problem.

These are general answers here. Like I said, it depends on your specific situation, but some preliminary things that you can look at, to make sure that you start to go in the right direction to fix any problem. We are going to go over four of those.

Number one is your footwear.

I think that you should be able to walk barefoot and be able to have normal knee mechanics. But if you are dealing with an active knee problem right now, having comfortable footwear helps tremendously. If you can, depending on your work environment, the people that you are around, the social context, all that stuff. Having comfortable supportive athletic shoes is a big deal, it will definitely help reduce your knee pain right away.

Wearing dress shoes, heels, or sandals as well can affect your knees. Let me just go through each of those dress shoes, because they tend not have a whole lot of support. If you are on your feet a lot, and you are wearing shoes that have minimal support, the impact isn't absorbed in the shoe, it's transmitted up into the knee. If you have already got an irritated meniscus, or bad alignment in your knee, or these other problems that we talked about, it can just make it worse. It can exacerbate the knee problem.

If you like to wear heels, even just a small heel, like an inch or two inches, of course people talk about the extremes, the big stilettos the four or five inch, six inch heels. Obviously, that's going to change your ankle position and your foot position, and it's going to influence your knees, and even hips and back. But even the small heals, if you are on your feet for a long time, that does put a small influence on your knee, and they can aggravate knee problems, the more that you are in your feet. If you are able to get into some comfortable athletic shoes, I would recommend doing that.

Now sandals tend to not have a lot of support either. Certain sandals don't wrap around the heel so they can slide off your foot really easily. And that can cause you to walk and move inappropriately. I think sandals are fine if you are not going to be on your feet a whole lot. But if you are going to go to the store, especially a big store that you have to walk around a lot, I would definitely wear shoes that have the wrap around the heel, so that you are not having to change the way that you walk.

The second way to start fixing your knee right away, exercising.

Find exercise that does not aggravate your knee. Typically, a light cardio exercise is good for you. If you can get some advice on how to proceed in exercising, of course, but if you haven't really tried exercise, if you don't know if it's going to hurt you or not, I would venture into some stationary cycling.

Go to a gym that has the bikes, the ones that you sit on and you can watch TV, something like that. Or you might have a bike at home, even if it's an outdoor bike, that could be beneficial for you. The idea with this is, if you have a cartilage problem, meniscus problem or ligament problem, light, repetitive motion, like you might have encounter on a bike, or an elliptical too can begin to heal those tissues.

Let's say you go and try this, and you feel like it aggravates your knee problem, then it might not work out for you right now. But I would start there, you could start out with some easy light exercise. When I say light, you can still burn a lot of calories, you have to play around with the intensity. I wouldn't put any resistance on the machine to start off, and I would go for like 10 to 15 minutes at the very beginning. The first time you do this, if you feel okay, see if you can do another five to 10 more minutes. You could potentially get up to an hour or more and burn quite a bit of calories to improve your health, which will also improve the knee if it doesn't aggravate it.

You can start out with some light cardio exercise. But where I want to warn you, let's say this works out for you. You start going to go cycle, you start doing the elliptical, and you are like wow, my knees are actually getting better. They still hurt. There are still some things that I can’t do, but I actually feel better. The more that you cycle, and do cardio, like the elliptical machine, maybe even some walking in order to protect your knees even more, and make sure that you are reversing a cartilage problem a meniscal problem, or a ligament problem, you eventually need to get into strengthening. You need to make sure that the right muscles are strong.

A lot of people only make it halfway through this, they only work their way through the cardio and don't ever get into the strengthening, because they are afraid to they have associated knee injuries with squats or with using that knee extension machine or other exercises, lunges that have hurt their knees. Typically, those are good exercises, they just need to be done properly so that they are helpful for your knees rather than harmful.

Number three, and this goes in line with the strengthening, in about eight to nine out of ten knee problems, in order to improve the knee problems for the long term, essentially the cure, we are talking about the cure here, you need stronger butt muscles.

The glutes need to get stronger. The glutes are key, because they properly position the knee. If you think about your hip joints, which you know the glutes are on the back of your hip, they can rotate your knee in and out, and they can change the way that your knee is positioned. For normal everyday activities, like walking, maybe running or this exercise that we are talking about cardio, your glutes are key and making sure that you are able to position your knee properly.

Also, the stronger they are, they tend to set up your other muscles down your leg to operate properly. Now let's take this to the extreme. If you have a relative that's elderly, or you know somebody that's elderly, maybe yourself and they have a chronic knee problem. More often than not, they tend to not have a but, they just don't have muscle back there. We see it all the time, we see people that as they get older, they lose their poor butt muscles. That's associated with having increased knee problems. They will have other problems along with that. They will have back problems, hip problems, maybe even sciatica problems, sciatic nerve problems. But if you have any problems, and you are older, more often than not, we see that they are lacking some serious butt muscles.

When we rehab people, when we get people better from their knee, if we are going to go down the pathway of strengthen their glutes, a nice side effect is that they actually get more firm back there, and they sometimes even increase the size of their butt muscles, which is a good thing. I strongly encourage you to start working on your glutes. There are tons of different exercises out there. You need to eventually get into resistance exercises, the ones where you have to have some weights to make it challenging, and it doesn't take a lot of time. It just needs to be done right. Get help on working out your glute muscles.

Number four, here's the last and most secure way to make sure that you start to fix your knee problem. Get specialist help.

If you go find somebody that knows what they are doing to fix the problem, especially somebody that can do it without a surgery, without more injections, without pain medications, I think that is your best long-term bet. I'm not in any way knocking off doctors, physicians, people that give surgeries, injections and medications, because that is definitely very helpful in certain circumstances.

If you have a completely blown up knee, more often than not a surgery is recommended. There are cases here in the clinic where we see people for the first time and I say Hey, you got to go talk to the surgeon about this. Don't do it, they can help you out. This is beyond my help. But for milder to moderate cases, and in some extreme cases can be salvaged as well. We can help them out, and it's a process that takes time, in order to get them to the point where they know they are educated. They are also helped out, hands on wise, to make sure that they have full motion, and all the mechanics are restored in their knee. The strengthening is also done properly, the exercises done properly so that they are safely getting there.

Here in the clinic, we speed up that process big time, a lot of people like to go try things out on their own, and that's fine, of course. But they might try different things that don't work, things that don't help, things that actually make it worse, or they give up that they don't have that consistent feedback on if they are doing the right thing or doing the wrong thing. We try and dig here and make sure that everybody's on the right path to fixing their knee problem for the long term. The experience most people have, here in the clinic whenever we are helping them out with a knee problem, is that they get better little by little.

There isn't a big change right away on the first or second visit, they will notice more of a change after the first month. Then it gets even better into the second month, and if we need to go beyond that, the third or fourth month or beyond, we'll see them for that. What tends to happen is they are better for a long, long time. There might be a few things for them to keep up long term, as far as some exercises. But if that's easy, and that's simple compared to getting a surgery, injection, or having to rely on pain medications.

Let's talk about those for a second. If you go have a surgery, we have amazing surgeons out there, and surgeries have changed so much in the past decade in the past 20 years. They are amazing and they do a great job with doing meniscectomies, knee replacements, and ligament repairs and all that stuff. If you have to have that done, that's great. But surgeons aren't necessarily teaching you on how to keep your knee healthy for the long term. They help you if something's torn, if something needs to be repaired or cleaned up, and that will typically allow your knee to feel better right after the surgery.

But I always have to ask the question of how did you get there? If you have any sort of trauma or accident that injured your knee, if it just came on without any sort of major problem, there is something that you are doing or not doing that led up to this. If you don't address that, you are going to end up having that problem again, even if you had a surgery to repair something that was torn or worn down or replaced.

You need to make sure that you learn how to take care of your knee problem. Another way to think about this is think of liposuction. Let's say somebody who's heavyset, everybody knows that if you eat better, if you eat less, depending if there are any sort of hormone problem or thyroid problem. But if you are just overweight because you eat too much, and you don't exercise, and you know it. If you know that if you start exercising and if you start eating better, you are probably going to lose weight.

But some people like to shortcut it, they like to go get liposuction and that's fine. That's your personal decision. Once you have liposuction done, you will look thinner instantly right away. But if you keep eating the same way, if you don’t exercise, it actually does come back. You will put the weight back on and you will grow again.

It's the same idea with getting the knee surgery done. If you don't learn how to manage it, it's just a matter of time before you need another knee surgery, or you have some other knee injury. We commonly hear people say they went in for a meniscectomy because they had a meniscus tear or meniscus problem. The surgeon told them afterwards, after they finished all the therapy and the follow up. They said well, you might need a replacement in 15 or 20 years. You will probably need a replacement in 15 or 20 years, come and visit me again.

When that happens, and that’s just some thinking in my head, I hope you don't have to have another surgery, let's figure out how to fix it, how to move better, how to get stronger, how to improve your alignment, how to take care of your cartilage, so that you don't have to have any other procedures later down the road.

The other one is pain medications. Whether it's injected or you are taking pain medications, that eats up your liver, and other organs, your kidneys, and it doesn't teach you how to move better and get stronger. It just takes away the pain temporarily. If you get an injection, typically those the relief will last anywhere from a month to several months. Some people get cured because their irritation goes away, and they don't get back to that activity that got them there in the first place. They think the injection fixed it. But if the pain comes back after having an injection, it's because you are doing something to aggravate it.

Still, you can't expect the injection to cure the knee problem. Notice I said problem, not pain, because it will take care of the pain. But it won't take care of the problem that caused the pain. That's what we look to fix here in the clinic with manual physical therapy. Same thing with medications. Of course, those just last hours, maybe a day and you really can't rely on it. They have some serious side effects, addiction problems for the prescribed medications, you can have addiction problems and doctors will limit you nowadays on how much medication you can have.

Also, it affects your normal function. I mean, some people they say they feel like they are drugged all day. They feel like they can't operate vehicles, they can drive, they feel drunk, they feel like they can't work, they can't think clearly. That's not cool. Then the over the counter medications like ibuprofen, they can rip up your stomach, they can really cause some serious problems inside your guts. Some people feel it instantly, they will feel nauseous, they feel like they can't eat after taking ibuprofen. But some people don't feel anything instantly. I'm more concerned about those because if you are taking ibuprofen around the clock, like the bottle says every four to six or eight hours, depending on the dosage, and you go for weeks like this, then it can seriously mess you up.

Some people get hospitalized for this, some people even die from side effects of taking ibuprofen. It is not a good idea to be taking ibuprofen for the long term.

That being said, when people come into the clinic here, I'll tell them, hey, how's your home life? How's your work life if you are pretty grumpy because you are not sleeping enough because your knee doesn't let you sleep? Or you are just aggravated, maybe taking some pain medication or asking your doctor for an injection or pain medication is wise at this point. But please be sure that you are working on a plan to fix the long-term problems so that you are not having to Rely on injections or medications for the long term.

There you go guys, you have the top six reasons that people get knee pain, and I've also giving you four ways to start fixing it right away. I hope that this podcast was helpful for you. I hope that you are more knowledgeable and educated about why the problem is happening, what to do about it, and what next steps to take.

If you are thinking that you want professional help right now, I encourage you to reach out to us call us at 915-503-1314 and talk to us about getting help for your knee problem. If you are in the El Paso area, we are open here to help you out. If you want more tips more help go to our website at www.EPManualPhysicalTherapy.com and there are free resources on there, you can find our blog, we have tons of knee help there, as well as other body parts that we commonly see.

You can download a knee pain tips guide, it's a PDF document that you can get sent right to your email. As soon as you give us some details, your email information, all that stuff. We'll send it to you right away and you can begin to read through the knee pain guide so that you can learn more about other ways to help out your new problem. I wish you have the best day today and stay healthy and stay safe. Bye.

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