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“My orthopedic surgeon took only five minutes to tell me I needed to replace both knees. He didn't even explain what other options I could try… He just said, ‘come back and see me when you can not stand the pain any longer,’” Keith* explained.
In someone with strong, healthy knees, the end of the bones are covered with a layer of cartilage. Cartilage is a substance that protects the bones and provides a smooth surface for motion to occur.
When someone is told they need a knee replacement, their X-rays typically reveal significant arthritis, which means their cartilage is not as thick and strong as it once was. Frequently the degeneration inside their knee is considered grade 4, on a scale where grade 1 is mild and grade 4 is severe.
Sometimes people facing a knee replacement have been told their X-rays indicate their knee is “bone-on-bone.” This means that, at best, there’s very little cartilage remaining.
When I talk with people in these situations, I am very clear about what to expect. It’s unlikely their X-rays will change dramatically. And it can be difficult to predict how much improvement they’ll be able to make-- even if they carefully follow the personalized plan that I design for them.
When I explained this to Keith*, he was not deterred. He wanted to work with me, and he assured me that any improvement was worth it to him. Most of all, he wanted to avoid knee replacement surgery.
Keith acquired a Variable Incline Plane, a Gray Cook Band, and some household items before we began meeting. Since he lived in Australia, Keith typically scheduled his online video sessions early on Saturday mornings (which corresponded with mid-afternoon on my Fridays).
Perhaps the most critical part of his initial assessment was identifying his Squat Load Tolerance for each leg. (Squat Load Tolerance is the percentage of body weight that someone can squat five times with good control of the movement and without pain.) Keith’s right leg tolerated 23% of his body weight; if he tried to squat with any more weight than that, it caused right knee pain. The Squat Load Tolerance for his left leg was also 23% body weight.
In an effort to increase his Squat Load Tolerance-- so he could enjoy a more active life with less knee pain and ultimately avoid knee replacements-- Keith needed to do two things: (1) temporarily limit activities that required him to use more than 23% body weight through each leg, and (2) perform exercises that would strengthen his joint surface.
Keith had a morning Qigong practice. He continued this practice, but he limited how much he bent his knees as he stepped onto each leg. He also avoided taking the stairs and walking more than was absolutely necessary.
In addition to these daily adjustments, Keith performed an isometric Quadriceps exercise several times a day. (Research supports that this exercise thickens the fluid inside knee joints. And thicker fluid provides more shock absorption and better protection for the cartilage.)
He also completed gentle knee motion periodically during the day. He sat down and placed his foot on a skateboard to assist him in achieving this motion. (Some of my clients use a furniture mover instead of a skateboard.)
During the week following his initial online video session, Keith meticulously kept track of these exercises on a chart I provided:
Ten days later, his left knee Squat Load Tolerance had increased to 28% body weight. And his right Squat Load Tolerance remained at 23% body weight. I added some additional exercises, and sent Keith updated charts to continue to track his exercises.
Within 6 weeks, both knees had improved to 36% body weight. This wasn’t rapid improvement, but Keith’s knees were definitely getting stronger and more resilient.
The isometric Quad exercise continued to be a cornerstone of his daily routine. And in addition to the skateboard exercise, Keith’s gentle knee motion included using his Variable Incline Plane-- positioned at a relatively low angle-- to perform squats with less than a third of his body weight.
I prescribed exercises that strengthened Keith’s knee joint, as well as his hip and core muscles. I divided these exercises into two separate routines that he performed a total of three times per week. One group of exercises included the Plank Sliders and using his Variable Incline Plane to squat on each leg at a specified level.
After working together for 3 months, Keith’s right Squat Load Tolerance was 56%, and his left was 43%. He was pleased with how his knees were feeling and had no plans to schedule surgery. He understood what exercises he needed to continue to maintain his improvements.
Seventeen months later, I contacted Keith. He had just returned from a cruise in Japan, where he walked roughly seven kilometers each day without knee pain.
Keith’s opinion of his knees is very positive; however, his knees are not perfect. When he walks down stairs, he has some knee pain-- not as bad as it was before we worked together, but it is still noticeable.
He admitted that he had been “a bit erratic lately” about performing the exercise program that I designed for him. But he quickly added he was “getting back into the routine.”
Keith was initially told the only option to address his knee pain was knee replacement surgery. But instead, he learned how much of his body weight that his knees tolerated, temporarily avoided activities that overloaded his knees, and performed exercises that increased the strength and resiliency of his knee joints. He was able to resume his Qigong practice and walking longer distances without knee pain-- provided that he continued performing his joint conditioning exercises. Keith’s story reveals the commitment and perseverance necessary to avoid knee replacements.
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