FrameWork for the Knee: A 6-Step Plan for Preventing Injury and Ending Pain

by Nicholas A. Dinubile, Bruce Scali

Overview

Musculoskeletal conditions are the #1 reason for doctor visits among Americans.

No one knows the concerns of patients afflicted with these bone, muscle, and joint issues better than Dr. Nicholas DiNubile. As the orthopedist to the Philadelphia 76ers, he presented his plan for treating and preventing general pain without surgery or drugs in his first book, FrameWork.

Now, in the second installment of his Active for Life series, Dr. DiNubile turns his attention to the estimated 21 million Americans who suffer from chronic knee pain. Beginning with an in-depth look at the causes of common knee injuries, Dr. DiNubile provides diagnostic tools for assessing pain. His 7-step plan for treating the injury, rehabilitating the area, eating to aid healing, and protecting the knee allow you to continue enjoying your favorite activities.

Knee pain and injury don't have to mean the end of an active lifestyle. All it takes is a balanced, customized program designed to address patient-specific needs. FrameWork for the Knees provides anyone suffering from these issues with the tools to be active for life.

Product Details

ISBN-13:	9781605295930
Publisher:	Harmony/Rodale/Convergent
Publication date:	09/28/2010
Series:	FrameWork Active for Life
Pages:	224
Product dimensions:	7.40(w) x 9.10(h) x 0.70(d)

About the Author

NICHOLAS A. DiNUBILE, MD, is a specialist in sports medicine. He has been featured on Good Morning America, CNN, NPR, and in the New York Times, the Wall Street Journal, and Newsweek.

Read an Excerpt

Step 1

Knee Deep

Before embarking on any biomechanical training program, having a basic understanding of the parts involved is more than useful—it's critical. You have to know what's involved with movement so you can understand why you should be faithful to the exercises that keep your components humming. And when you know why, your brain will be fully engaged to balance the mind/body component of good health. Yes, the practice of mindfulness can be applied to keeping your knees healthy and functioning optimally.

I know I'm partial, but the knee is truly amazing. When I look at sports players who put up with so much every day, and yet don't get injured, I marvel at how ingenious its design is. They, and their knees, jump, twist, pivot, change direction, and land, often seemingly off-balance, at warp speed. One needs to watch the slow motion replays to fully appreciate what has occurred; in fact, there are computerized high-speed biomechanical analysis tools that we now use to better understand the complex biomechanical movement patterns unique to each sport. When all of the parts are fine-tuned, amazing athletic feats are possible for some and the rest of us can get around reasonably well without toppling over.

So without further ado, and mindful of keeping the academics to a minimum, let's "scope" the knee together.

THE BARE BONES

When people think about the knee, they usually just think about the kneecap, or patella, or a simple hinge structure. However, it takes more than one part to make a hinge, and the knee is even more complex than that. It consists of two distinct joints formed by three bones: the patella and femur (thigh bone) get up close and personal in the patellofemoral joint; and the femur and the tibia (leg bone) do likewise in the tibiofemoral one.

The main part of your knee is where the femur and tibia meet; it's the main hinge that is loaded most of the time when you stand, walk, or run, especially on level surfaces. This tibiofemoral area is made up of two compartments: the inner (medial) and the outer (lateral). The patellofemoral area provides the third compartment of the knee, and this is formed by the kneecap and thigh bone. The area of the thighbone that houses the kneecap is called the trochlea. The patellofemoral joint is loaded and relied on even more when the knee is flexed, like when you go up and down stairs, ski, or do squats and lunges at the gym. The patella is interesting in that it is a bone that lives within a muscle-tendon complex, something we call a sesamoid bone (you have a few others of these around your frame). This is a smart design from a biomechanical standpoint in that it increases tendon leverage on the femur during leg extension. It is also a setup for a variety of unique problems that can occur around the oft-temperamental kneecap.

KNEEPAD

Your health "hinges" on your knees.

When healthy, these three compartments work in unison, smoothly gliding across each other with a coefficient of friction 20 times more slippery than ice on ice. But there are some thorny design problems that are unique to the knee, and when things go wrong, the grinding starts. It can be throughout the entire knee, involving all three compartments equally, or the problem can be selective and isolated to just one or two of the compartments. I'm a perfect example. My main tibiofemoral area is pretty good, but, from my old injury, my patellofemoral articulation is shot, pretty much bone on bone, awaiting the parts department.

In addition to the bony architecture, there are plenty of other "softer" things that can run afoul in the knee.

THE SOFTER SIDE

Ligaments, tendons, and muscles all play a role in knee design, but cartilage tops the list when it comes to picking a lead actor. What will surprise many of you is that there are two kinds: articular cartilage (it looks like the smooth white opaque ball that you might recall seeing at the end of a chicken bone), and the meniscus (fibrocartilage) that most lay people have in mind when they refer to a torn knee cartilage. They are two completely different components. Perhaps this is imprecise terminology, but it's important to appreciate the distinction.