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Having run my own diet and exercise classes on a Monday evening since 1972, with many of my current members having been attending for over 40 years, we are now of that stage in our lives where a few body parts are beginning to show signs of wear and tear – with the most common problem being knees.
Several of my members have knee problems and, more recently, I have developed painful issues with my own right knee. For months I could feel myself limping when I walked because it hurt to straighten the knee fully as I stepped out. Gradually, my knee had become more and more painful to the point that it is now affecting my posture – something I try to correct but it seems impossible when, to straighten up and stick my bottom in, my knee really hurts!
A few weeks ago, I decided enough was enough so I booked in to see a physio at Bridge4 where Mike and I go for our fitness sessions. Now, several weeks later, things are improving significantly and the treatment, education and exercises I have been given by physio Jordan have proved not only fascinating but simpler than I expected. Most importantly, they have been incredibly effective – so I thought I would share what I have learned.
Now, it is important to say at this point that if you have a severe problem with your knee, it is of course appropriate to see your GP and if necessary, a specialist to be referred for a scan and ultimately, possibly, for surgery. But in this Newsletter, we are hoping to help you before you get to that stage by doing some simple exercises to help to strengthen the all-important muscles that work your knees. It could save you the need for surgery.
First. Let’s try to understand how the knee works:
- The knee is like a hinge that allows our leg to bend and straighten as we walk.
- Muscles in our thighs and calves are attached to our leg bones (femur and tibia) by tendons that connect to our joints.
- Joints are stabilised by ligaments – there are four in each knee but the one we hear of most commonly is the anterior cruciate ligament (ACL).
- Then there’s a kind of shock absorber (meniscus) between the two bones (femur and tibia) to help keep the bones from touching.
- The quads and hamstring muscles also work to protect the cartilage from wear and tear inside the joint.
- Lastly, at the front of the knee is the knee cap (patella) which sits within the patella tendon which is attached to both the upper and lower bones. The kneecap reduces the friction between the tendon and the bone, and it keeps the tendon from slipping sideways too.
To bend our leg
The hamstring muscle at the back of the thigh contracts to allow us to bend at the knee.
To straighten our leg
It is our thigh muscles (quads) at the front of our thigh (which have been extended when bending) that then contract to provide the mechanism for us to straighten our leg again.
If either of these sets of muscles is weak, our knee will be vulnerable which could cause us to lose our balance or for the knee to give way which could cause a fall. It is therefore clear to see that keeping our legs strong is fundamental to our general fitness and mobility.
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The irony is that as soon as we begin to feel our knee is painful when we walk, we naturally place most weight onto the ‘good’ knee with the effect that the muscles attached to that knee naturally become stronger whilst the muscles attached to our painful knee obviously become weaker. This creates a problem as, with every step, we are hindering rather than helping our knee to recover.
What we need to do then is strengthen our quads and hamstrings to give our knees the best chance they can to serve us well into old age, because they are shock absorbers too.
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After trying various exercises with my physio, we came to the conclusion that the easiest one for me to practice at home was with a toning band which I already use when I teach my classes. I can sit on a chair or our sofa whilst watching TV to do it so, no excuses!
- Place the centre of the band under your foot and take hold of the band in each hand (thumbs upwards) with your hands placed just over half-way down the band. Allow the ends of the band to flop over the top of your hands.
- Keeping shoulders and elbows back, (and static) and your core tight, bend and straighten your leg fully against the strong resistance of the band.
- Repeat the leg bend and straighten exercise in sets of 10 initially and repeat four times a day. After a week, increase the repetitions to 20 each time x four times a day.
- Have a rest day every 4th day. It should feel like hard work so don’t over-do it! But if it’s too easy, make the band shorter.
My knee pain reduced significantly after just a few days of practicing this.
Mary will also give you some great exercises that will strengthen your legs in her section below.
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One of the earliest signs of a knee problem is when the knee joints begin to naturally incline inwards. Have a look in a long mirror and see where your knees go when you bend them. I first spotted this in my own knees in 2008 when I watched the latest edit of a fitness DVD before it was sent into production and I could clearly see my knees slightly caving inwards. It was then that I decided that my Real Results fitness DVD would be my last.
Interestingly, when I started going for fitness training at the gym in 2016, one of the first things my physio-trainer worked on was correcting the alignment of my knees. I had to concentrate in keeping my knees straight and in line with my feet rather than allowing them to ease inwards. Soon I trained myself to keep my knees ‘out’ as I walked up flights of stairs or wherever. It worked and it didn’t take long for a new habit to be established.
Our knees are fundamental to our ability to walk and be independent so it is vital that we do everything in our power to prevent serious issues later. I hope you will be inspired into action! Let’s do it together.
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Serves 2
Per serving: Calories and fat depend on the fish used
Prep time: 20 minutes
Cook time: 45 minutes
For the sauce:
300ml semi-skimmed milk
1 vegetable stock cube, crumbled
I onion, sliced
10 peppercorns
3 dried bay leaves
1 tablespoon cornflour plus 40ml cold milk.
For the fish:
2 portions cod
1 portion of smoked haddock
1 salmon steak
freshly ground black pepper
To make the sauce:
- Chop the onions coarsely and place in a saucepan with the milk, peppercorns, bay leaves and the crumbled vegetable stock cube. Heat slowly and do not allow to boil.
- When almost boiling, remove from the heat and place a lid over the pan to allow the flavours to marinade. Keep to one side.
- Place 1 tablespoon of cornflour in a small bowl or jug and mix with the 40 ml cold milk until smooth. (This is called slaking). Keep to one side.
- Cook the fish as below.
- When the fish is almost ready to serve, strain the warm milk through a sieve to remove the onion, peppercorns and bay leaves to be discarded. Re-heat the milk in a saucepan on a gentle heat.
- Re-stir the cornflour paste to a smooth consistency as it will have settled at the bottom of the bowl or jug.
- When the milk is hot, stir or whisk in the cornflour paste to thicken the sauce stirring continuously. Simmer for two minutes. If the sauce is too thin, add more slaked cornflour and stir continuously as you mix it in to the hot sauce.
To cook the fish:
- Place the fish portions in a large dish in a single layer. Sprinkle with freshly ground black pepper and cover with clingfilm if using in a microwave.
- Place in the microwave and cook on a moderate to high heat 600/800w for 4 minutes or until the fish is cooked. Allow to rest and keep warm. Alternatively, if cooking in an oven, cover with aluminium foil to cook in the centre of a moderate oven for 15 minutes.
- Drain the juices from the fish into the white sauce and stir well. Remove the skin from the salmon and place the cooked fish into a hot serving dish.
- Pour over the hot white sauce and serve with fresh vegetables and new potatoes in their skins.
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Fun, Facts & Fitness from Mary Morris MSc.
The improvement in Rosemary's knee comes as no surprise to me as she has gone down the route of taking action to aid her recovery, on the advice of a physiotherapist, and followed it to the letter. In my experience, all those who follow the advice given and do it consistently will always end up with the best outcome.
I feel I am a bit of an expert on observing recovery from knee replacements. My father had both knees replaced in the 1980s and enjoyed 20 more years of good mobility and I remember vividly the total commitment he had toward his physio. He would be sweating with the pain and effort as he was SO determined for it to work well for him. Unlike his sister, who also had both knees replaced, but was never able to abandon her two walking sticks for the rest of her days. She was never inclined towards exercise anyway and insisted that it didn’t help!
No surprises then that when my husband needed both knees replaced recently that I became his worst nightmare, insisting every day that he mustn't miss a single physio session. I was grateful for the list of exercises supplied by the hospital, and then supervised and made him follow them religiously, three times a day without fail! And it paid off. I am happy to report that he is now back to full strength and mobility and is now able to play two consecutive days of golf. His major goal in life achieved!
Degenerative knee disease (arthritis) has to be one of the most common joint complaints there is. It can start as young as the teenage years, often caused when there is over-use due to concentrating too much on one sport when bones are not yet fully grown. This can result in knee problems that often recur regularly throughout adulthood. Playing netball, for example, involves frequent twisting and turning of the knee joint, often on a hard-tarmacked court. The ideal is to encourage children to be introduced to a variety of sports, therefore making the joints get used to moving differently with each activity, and this may avoid this happening.
With the older generation arthritis becomes the enemy and most active older adults will speak of some joint complaint, with knees being the most common. Stiffness, swelling, tenderness and grinding or clicking are all common complaints and for some, a strong feeling of instability in the knee. Following investigation many are told that having physiotherapy is the first port of call. If you take this line of action, regular physio and following their exercises at home, can dramatically improve your knee issues. However, for some, it may be that in time you may need a part or full knee replacement. Below you will see the three stages that you may be encountering and some suggestions for how you might manage them:
EXERCISES FOR SORE KNEES
In recent clinical guidelines the Arthritis Foundation most strongly recommends walking and swimming as the best activity for those with stiff and sore knees.
When I set out on a walk, I always think my knees won't take me 200 yards never mind 5 miles! But once I have warmed up and the natural lubrication (synovial fluid) of the joint gets going, I find all the pain goes. I put regular walking at the top of the list for mildly arthritic knees.
They also recommend regular attendance at supervised exercise sessions suitable for your age and ability. That way you will no doubt do hip and thigh strength work (vital in supporting the knee joints), valuable stretching to maintain flexibility and hopefully some balance exercises for your stability and to reduce the risk of falling.
Also, very importantly, try to reach and maintain a healthy weight. It makes sense that your knees will suffer more if they are having to carry excess weight. The good news is that losing weight if you need to, can have a significantly beneficial effect on sore knees. It reduces pressure on the knee joints and can make a big difference to your mobility. Follow all our recommendations for losing weight and you will find your knees are considerably improved.
If you believe that at some point you will require a knee replacement then you can help your recovery by investing some time to prepare your knee before surgery.
THE 6 PRE-REPLACEMENT EXERCISES
These exercises are ideal for preparing your knee for surgery, but start them a few weeks before your operation. Do these exercises religiously and you will then have prepared your knee for the best possible outcome post-replacement. It will give you a speedier recovery because the muscles surrounding your knee will be significantly stronger and more able to support your new knee.
INSTRUCTIONS:
Start with 3 sets of 5 - 10 repetitions twice a day
Build up to 3 sets of 15 - 20 repetitions twice a day
- SEATED LEG EXTENSIONS
Sit on a stable chair and raise your leg off the floor until it is straight. Hold for 5 seconds and then slowly lower.
(This helps strengthen the quadriceps [thigh muscles] through a full range of motion.)
- CHAIR PUSH-UPS
Sit in a sturdy chair with arms. Hold firmly on the arms of the chair and push down on them while lifting the body off the seat. Try to straighten your arms and elbows. Slowly lower back down again.
(This strengthens the triceps [the 'pushing' muscle at the back of the arm]. The triceps are important muscles for using a cane, crutches or walker.)
- SIDE-LYING LEG RAISES
Lie on your side, hips stacked on top of each other and with your lower leg slightly bent. Now lift the straight top leg about 2 feet from your other leg. Hold for just 2 seconds and slowly lower. Do this on a bed if getting onto the floor is too difficult.
(This exercise builds up the abductor muscles [outer thigh muscles] which stabilise your pelvis when standing or walking.)
- HAMSTRING CURLS
Lie on the floor or bed on your front with hands by your side. Bend the injured knee, bringing the heel towards your bottom and then straighten again.
(This helps strengthen your hamstrings [the muscle behind your thigh] and helps maintain a good range of mobility in the knee joint.)
- STEP-UPS
Step up with the right leg on the first step of a flight of stairs and bring the left leg up beside it, then step down with the right leg then the left. Keep starting with the right leg for the first set of repetitions then change legs and lead with the left leg for the next set.
(This works both the quadriceps [thigh] and the gluteal [bottom] muscles and will raise the heart rate improving your stamina.)
- STANDING ON ONE LEG
Stand in front of a worktop or a sturdy chair and take one leg off the floor. Count how many seconds you can manage without holding the support. Aim to hold for a minimum of 20 seconds on each leg.
(This exercise is crucial for maintaining balance and reducing the risk of falls.)
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For further advice and exercises watch this video where physio Judith Pitt-Brooke talks about the importance of preparing your body ahead of knee surgery.
Judith demonstrates some simple exercises that will strengthen the muscles around the knee that will help you toward a speedier recovery afterwards.
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POST KNEE REPLACEMENT EXERCISES
You will be given all the best post-operative exercises to help you enjoy the best outcome of your surgery. I urge you to be very diligent and follow them religiously. In my experience those who are dedicated and make the effort to practice them, are significantly more likely to enjoy many years of good mobility and a physically active life.
Like all physio exercises they work but only if you do them!
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This Week's Fitness Challenge
- Your daily 30+ minute walk is a must to help us stay healthy and a great way to stay in good condition particularly if you are waiting to have an operation. Ensure this week that you achieve a minimum of 7,500 steps and then 10,000 on as many days as possible.
- Do 3 strength workouts this week. Alternate between Resistance Band Workouts and Weights Workouts for a change of routine.
- Practice your Balance. Stand on one leg every day this week and try to increase the time you can hold it. If you need to work on this try our Balance Exercises.
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Did you know... 
Why do we give Easter Eggs?
The practice of decorating eggshells is quite ancient, with decorated, engraved ostrich eggs found in Africa which are 60,000 years old. In early Egyptian history eggs were associated with death and rebirth, as well as with kingship, with decorated ostrich eggs, and representations of ostrich eggs in gold and silver, commonly placed in the graves of the ancient Egyptians 5,000 years ago.
Following these themes, eggs, in general, were a traditional symbol of fertility and rebirth, and in Christianity, for the celebration of Easter, eggs can symbolize the empty tomb of Jesus, from which He was resurrected. In addition, one ancient tradition was the painting or staining of Easter eggs with the colour red "in memory of the blood of Christ, shed as at the time of his crucifixion."
Nowadays, of course, most people would be very disappointed to receive a painted hen's egg and are much more likely to be looking forward to receiving a lavishly boxed chocolate Easter Egg.
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And finally...
When we are young we never even consider having any joint issues when we grow older. We think we are invincible. Sadly, we soon learn that we are just ordinary human beings and if we want to be able to live a long and independent life, we need to invest in our wellbeing – not with money but with a little effort to protect and care for ourselves. We all know it makes sense – we just have to do it!
Have a great Easter and try to go steady on the Hot Cross buns and the Easter Eggs!
With love and best wishes,
Rosemary Conley CBE DL
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LIVE LONGER | LIVE HEALTHIER | LIVE HAPPIER
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