Knees: How to Avoid Surgery and Stay in the Game

By Greg Owens, D.C.

Okay, so tennis involves tons or running, starting, stopping, changing directions, sliding, jumping, and just about every other motion possible. It is no wonder that so many playing these days have some sort of knee problem. Rafa Nadal, currently ranked #2 in the world, is a classic example of how tough tennis can be on our knees. Mr Explosive on the court, he runs down shots the likes of which no man has before. Yet, he too has slowed down due to knee problems. His knees are taped, his game has slowed, and he appears almost human giving hope to the rest of us.

Does this have to be so? Are we weekend warriors destined to be doomed with knee pain? Of course not! We can do something about it if we learn more about the knees and learn how to take care of them so that they last a lifetime. Look at Rafa, why did his knees all of a sudden begin bothering him? Was it that he began playing more? Began playing more on hard-surface or was it that he suffered from years of abuse? I bet it was all of these. In fact, I'm sure of it. You see, the knees suffer from an accumulation of trauma. The more accumulation, the more damage and, of course, the more damage the more likely you are to hurt, to have your game slow, or perhaps need surgery. In fact, according to The American Academy of Orthopedic Surgeons, some 9.5 million people visited orthopedic surgeons because of knee problems last year.

So what can be done to STAY IN THE GAME? First, we have to learn how the knees work and then how to take care of them. The knee joint is one of the largest joints in the body. It is composed of four bones; the femur, the tibia, the fibula, and the patella. Cartilage smoothly covers the joint and provides a lubricated gliding surface so the knee can move freely. The knee is held together by both ligaments and muscles which have to be balanced in order for the knee to work properly. Ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). Meniscus are located between the upper leg bone (the femur) and the lower leg bone (the tibia) and act like shock absorbers. Tears of the meniscus often occur while twisting, pivoting, decelerating, or as a result of direct impact.

The ACL stabilizes the knee when it is bent while the PCL does so when it is extended. The MCL and LCL both stabilize the knee during side-to-side movements. When these ligaments are intact, they snuggly hold the knee together. Muscles affecting the knee are the quadriceps, hamstrings, calf, and an assortment of other muscles. These not only provide for the movement we enjoy on the court, but also for stabilizing the knees when we do. Lastly, although most don't think about it, the foot, ankle, hips, and spine also affect the knee. If any of these are out of alignment, the knees suffer and so do you.

Pronation viewed from the back

Knowing how the knees are built, how do they get injured? First, a vast majority of people, young and old, excessively pronate (the foot rolls inward) when striking the ground stressing the knees, stretching the ACL and medial meniscus. Thigh muscle weakness is one of the results of excessive pronation. Since both muscles and ligaments stabilize the knee, pronation destabilizes the knee. Second, every time we take a step, jump, pivot, start/ stop quickly, and run, the knees are stressed. Healthy knees recover, unhealthy knees swell and don't.

So what is one to do to keep his/her knees healthy and stay in the game? Many things like getting your feet checked to see if they pronate and, if they do, get shoes and orthotics (available from podiatrists/ PT's/ "GoodFeet") to minimize it. Get your feet, ankles, knees, hips, and spine checked (regularly done by chiropractors) for alignment and correct any misalignments through adjustments and exercises. Stretch your muscles to keep them balanced. You should maintain a healthy diet, exercise regularly, keep to your ideal body weight, REST between workouts, and get checked regularly for any misalignments. Another thing is to play with softer socks, shoes, and even the surface you play on. Using shoes and socks designed to dampen impact help prevent knee injury. Playing on clay courts definitely benefits the knees. Wasn't Rafa fine when focusing on playing clay courts?

Okay, that sounds great, but what do I do if I get hurt? First thing, get evaluated. Your knee pain may not be a "knee problem" but a "muscle or misalignment problem." If that's the case, get it checked by a licensed professional. If there is any swelling, applying the principles of PRICE (Prevention, Rest, Ice, Compression, and Elevation) often prove helpful. While many people take anti-inflammatory medications like Ibuprofen, Aspirin, Motrin, etc., many alternatives exist like Glucosamine, Chondroitin Sulphate, and Bromelain. Many people use creams containing Cayenne pepper or Arnica. For tight muscles, get massaged. Knee supports, taping, and bracing often provide the support needed to stabilize the knees in order to play at your best. Make sure that they are of the right size and support needed.

It is best to be proactive to the needs of your knees and to avoid knee injury altogether. Preserve the health of your knees, hips, and spine. After all, an "ounce of prevention is worth a pound of cure." The pound of cure could be surgery and we all know that surgery should be the LAST OPTION and is to be avoided if at all possible. Take care of your knees and you will get a lifetime of enjoyment out of them.

By the way, Cathy Nicoloff, Tennis Director of Wailea Tennis Club, would love to get two clay courts put in at the Wailea Tennis Club. She is looking for someone to spearhead a drive to raise funds to do it. Should you be interested, please contact her at (808) 879-1958. If say, 500 members each put in about $100 (which would be applied to court time on the new clay courts), there would be enough to put in two (2) nice juicy red clay courts which would be great on the knees, both young and old alike. Imagine sliding around on the terra batu yourself just like Rafa. Just a thought!

Enjoy your knees and may you have years of enjoyment with them on the courts!

Greg Owens, D.C.

Anatomy of the Knee from Gay's Anatomy
Pronation is the inward rolling of the foot and ankle
Misaligned spine throws off the knees
Tennis ball on a clay court