Many people with sore knees have never exercised. Others haven’t exercised in years or have exercised far too little. But a large number have damaged their weightbearing joints, especially their knees, by playing abusive sports with a passion. There is a growing epidemic of knee problems, especially in aging baby boomers who are devoted to running, skiing, basketball, volleyball, or racquetball, and who, because they aren’t built for these sports or haven’t had coaching to learn proper body mechanics, have created knee problems with every workout, race, or game.
Yet they continue to pursue abusive activities with excessive regularity. Running too many miles, playing too much tennis, lifting too many pounds, or skiing too many moguls when your knees are warning you to stop is a sure way to create an increasingly serious knee problem.
Your knees are your responsibility and you must assume all risk for them. By selecting your physical activities more wisely, you can have an injury-free sports or fitness program.
Exercise comes in two flavors: nurturing and abusive. The sports people love most abuse the body’s weightbearing joints, whereas pool exercise, bicycling, ski machines, and elliptical machines remove most or all impact from the weightbearing joints and are therefore nurturing. Most people don’t consider the abusiveness of their exercise routine until pain or physical limitation strikes. At that point, they pay attention. If you’re ready to change the flavor of your exercise program, try using the safe forms of exercise most of the time to maintain and enhance fitness so that you may be able to continue occasionally your beloved sports and activities for years to come.
A pool program is the first choice for a nurturing workout because you can eliminate all weightbearing when exercising in deep water. Put on a flotation belt and run, powerwalk and do deep-water intervals until you get the aerobic and anaerobic intensity of workout you desire. Then stretch and do the kicking series described in details in the NBA blog post. You can keep the belt on or take the belt off and do some sprint intervals in place in chest-deep water if you need more. A full program is shown in the book Heal Your Knees and you can buy a laminated exercise sheet with photos of the exercise to use deckside at your local pool.
Bicycling nurtures your back, hips, knees, feet, and lower legs because you don’t have the full weight of your body crashing into those joints as you ride. The cycling motion uses the hinge joint part of the knee’s function only. It doesn’t place any rotational torque on the knees, which can cause injury to structures inside the knee such as happens in basketball, racquetball and tennis. Further, biking focuses primarily on the quadriceps muscles at the front of the thigh, the source of key protection for the knees.
Athletes generally prefer the traditional bike on which you sit upright. Older people and those with back problems often prefer the recumbent bike, which lets you sit closer to the ground with your legs pumping in front of you. Most gyms have both, so give both bikes a solid try to see how you feel after each. Suggestions for starting and increasing a bike program are in the book Heal Your Knees.
SKI MACHINES AND ELLIPTICAL MACHINES
Both of these machines offer a low-impact weightbearing exercise that is nurturing because you are not picking up your feet and forcing them down. They remain in contact with the machine at all times. Theres’ no jarring of the hips, back, or knees. And they offer a bonus: they strengthen your mid-body, because those muscles are constantly working to stabilize you in an upright stance.
Nearly all gyms have elliptical machines and many have ski machines. Ask a trainer at the gym to help you get start and progress in your program.
Depending on your sports background and training knowledge, you may be able to set your own training limits by planning a wise blend of nurturing activities along with an occasional soul-satisfying foray into your favorite but abusive sport. Most people, however, need guidance identifying and limiting the abusive exercises in their weekly routine.
The Huey-Klapper Activity Point Scale for Knees below lists many popular sports and fitness activities. It will help you identify the sports you should increase in your healthy-knee lifestyle and the ones you should limit. Notice that each workout time unit is given a point value. The most nurturing activities are 0 points; the most abusive ones are 12 points. The other activities fall somewhere between at 3, 6, or 9 points.
The Huey-Klapper Knee-Point Scale
All point values shown are for one hour of that activity. For longer or shorter periods, modify points accordingly (divide in half for thirty minutes of activity, etc.)
|Aerobics class||1 hour||9||9|
|Ballet class — barre work||1 hour||6||6|
|Ballet class — floor work||1 hour||9||9|
|Bicycling — stationary||30 minutes||0||0|
|Bicycling — road bike, flat||30 minutes||0||0|
|Bicycling — road bike, some hills||30 minutes||3||6|
|Bicycling — mountain bike||30 minutes||6||12|
|Body boarding — no fins||1 hour||0||0|
|Body boarding — fins||1 hour||3||3|
|Elliptical training machine||30 minutes||6||12|
|Football — contact||1 hour||12||12|
|Football — touch/flag||1 hour||12||12|
|Golf — riding in cart||1 hour||0||0|
|Golf — walking||1 hour||6||6|
|Hiking — mostly flat||30 minutes||3||3|
|Hiking — some hills||30 minutes||6||6|
|Hiking — steep hills||30 minutes||9||9|
|Martial arts||1 hour||12||12|
|Pilates — mat||30 minutes||0||0|
|Pilates — reformer||30 minutes||6||12|
|Pool workout||30 minutes||0||0|
|Run — asphalt, concrete||30 minutes||9||18|
|Run — grass, dirt, track||30 minutes||6||12|
|Run — striding on track||30 minutes||6||12|
|Ski machine||30 minutes||0||0|
|Skiing — cross-country||30 minutes||3||6|
|Skiing — downhill, bumps||30 minutes||12||24|
|Skiing — downhill, groomed, no bumps||30 minutes||6||12|
|Stair-climbing machine||30 minutes||12||12|
|Step aerobics class||1 hour||12||12|
|Stretching (non-weightbearing)||30 minutes||0||0|
|Surfing (no knee paddling)||1 hour||3||3|
|Surfing (knee paddling)||1 hour||6||6|
|Swimming — crawl||30 minutes||0||0|
|Swimming — breast stroke||30 minutes||9||18|
|Tennis — doubles||1 hour||6||6|
|Tennis — singles||1 hour||12||12|
|Therapy exercises for knees||30 minutes||0||0|
|Treadmill walking||30 minutes||6||12|
|Volleyball — beach||30 minutes||6||12|
|Volleyball — indoors||30 minutes||9||18|
|Walking — flat||30 minutes||3||6|
|Walking — hills||30 minutes||6||12|
|Weight training — total body||30 minutes||12||12|
|Weight training — lower body||30 minutes||12||12|
|Weight training — upper body||30 minutes||0||0|
|Yoga — standing poses||1 hour||9||9|
|Yoga — lying, sitting poses||1 hour||3||3|
Start a list to keep track of the points in your weekly workout routine. Write the day at the top of the page and list everything you did that day whether it was planned exercise or unavoidable exercise such as walking fifteen minutes in a parking garage to find your car. Look at the Huey-Klapper Scale to assign a point value to your activities. Add or subtract more points depending on how long you continued. Keep this list going for one full week, then tally all your points for a grand weekly total.
Your point total may be as high as 130 to 190 points. If so, that’s a clue to your current problem. You’ve probably been hurting your knee with too much abusive activity. So how many points are right for you? Your age, your weight, your knee alignment, your good or bad form while performing your activities, and your history of knee problems or surgeries will tell you how much you should limit your activities. Think of it this way: just as people count calories to control their weight, you can now count activity points to see if you’re nurturing or abusing your knees. The chart below shows you how to determine your weekly recommended point total. Start with 100 points, then add and subtract points as they apply to your current situation today. The number you arrive at is your critical threshold for the week: stay under that number to maintain optimal knee fitness.
Huey-Klapper Knee-Point Assessment
Circle numbers in each column that describe your current condition.
Total each column in boxes A & B (be sure to include 100 base points).
Keep your goal firmly in mind: you want to be able to continue the sports you love on an occasional basis, so keep them that – strictly occasional – and do nurturing exercises for your daily fitness maintenance. This may sound like a huge sacrifice at first, but as soon as you realize you’re saving your knees for years to come, you’ll start savoring your once-a-week run, or basketball game, or tennis match as pleasure enough in exchange for your knees.
Lynda Huey, M.S., founder of CompletePT and Huey’s Athletic Network, is a former athlete and coach whose own injuries led her into the water to find fitness and healing. She was educated at San Jose State University where she starred on the track and field team during its golden years. Lynda has helped dozens of patients prevent knee surgeries with her pool rehabilitation program.