The Aging Athlete: Raise Your Hand if You Have Knee Pain

The Aging Athlete: Raise Your Hand if You Have Knee Pain: Come on now, don't be shy...raise your hand!  I know some of you who are reading this are currently having knee pain...and many of you hav...

Raise Your Hand if You Have Knee Pain

Come on now, don't be shy...raise your hand!  I know some of you who are reading this are currently having knee pain...and many of you have had knee pain in the past six months.   There are various types of knee pain experienced by both athletes and non-athletes. One of the most common causes is  patellar tendonitis or patellar tendonopathy. Patellar Tendonitis is one of the most prevalent overuse injuries in America, accounting for nearly 20% of injuries in the overall athletic population (North American Journal of Sports Physical Therapy).

Patellar tendonitis (PT) is also widely known as 'jumper's knee".  This condition, however prevalent among jumping athletes, is not isolated to jumpers.  Runners, cyclists, tennis players, hikers...you get the picture, right?  If you are active, and especially if you are an aging athlete like me, well then... you stand a pretty good chance of suffering from some degree of good 'ol jumper's knee.

I'll try to keep this as short as possible, but to have a fair understanding of what is happening with PT, we need to do a quick review of human anatomy.  Ok, here we go...

Starting from the ground up, Maestro, please...the foot bone's connected to the ankle bone.  The ankle bone's connected to the shin bone.  The shin bone's connected to knee bone.  The knee bone's connected to the thigh bone...and we can actually stop right there.  How simple was that?!

That's really all you need to know about the anatomy to understand what I am going to share with you about this common problem.  The 'knee bone' or 'knee cap' is actually called the patella, and it essentially floats atop the joint created by the 'shin bone' and 'thigh bone'.  It 'floats' by way of the patellar tendon and other tendinous attachments...which is why, when your leg is relaxed, you can easily push your kneecap from side to side - something that, as a kid, always fascinated me.  Come to think of it...it still does!

So where in the world does the patellar tendon come from?  Looking at the picture below (which I borrowed from the Mayo Clinic), you can see that the patellar tendon is a relatively small, tendinous  attachment that extends from the patella to the top of the shin bone (Tibia).  Those of you who have a bit of knowledge in this area might be saying to yourself "I thought ligaments attached bone to bone, and tendons attached muscle to bone."  Brownie points and gold stars to those of you who were thinking that!  The patellar tendon is actually an extension of the quadriceps tendon, as you can see in the second picture, which I also borrowed.  I promise to give them back...really!

In the second picture, you can see that the patella is encased within the quadriceps tendon and the patellar tendon...which, as we just learned, is essentially the same thing...sort of.  In my last post we learned the basics of human movement, and how force is transferred from muscle to bone, by way of muscle contraction.  Based on that knowledge, we know that when we contract our quadriceps muscle(s)...which by the way, are our thigh muscles...we put tension on the quadriceps and patellar tendons, which results in the straightening of our leg...we also call this knee extension.  

Now you know what the patellar tendon is - you know where it is located - so let's look at why it hurts.

I mentioned earlier that PT is an overuse injury, so let's define that term before moving on.  An overuse injury can be defined as a sports- or occupation-related injury that involves repetitive sub maximal loading of a particular musculoskeletal unit, resulting in changes due to fatigue of tendons or inflammation of surrounding tissues.  Big words huh?  Basically, tendons, ligaments, muscle tissue, and even bone can become inflamed due to repetitive use and stress.

It is important to know that during these repetitive actions, small micro-tears occur in the tissues, which ultimately leads to an inflammatory response, and pain.

So what kinds of repetitive stress can cause PT?

Obviously, in light of the common term jumper's knee, those individuals who participate in sports or other activities that involve jumping are highly susceptible to knee pain, via PT.  Like I mentioned earlier however, jumping athletes are not the only one's susceptible.

Let's take runners for instance.  While, technically speaking, they are not jumping per se, they are bounding.  Take a look at the photo below.  You will notice that there is light visible under each foot.  What does that mean?  It means that they are airborne for moments at a time, and must land on a single leg/foot, stabilize those forces, and then create power to do it again...and again...and again.  

 

Repetitive stress.

How about a tennis player?  Take into consideration the repetitive acceleration and deceleration necessary to move about the court.  The forces sustained by the knee, and specifically the PT, are enormous...especially with repetition.  Looking at the photo below of Roger Federer, it is easy to understand how the sport of tennis can precipitate various forms of knee pain...often due to patellar tendonitis.

Well...I think that's enough for one day.  I'll let your brain digest the large amount of information that it just took in before moving on.

In my next post I'll discuss some common reasons why patellar tendonitis occurs, and what you can do to reduce your chances of becoming yet another victim of PT!

Yours in Health and Performance

John

Let's Get Our Move On!

move·ment

/ˈmo͞ovmənt/

1.  An act of changing physical location or position, or of having this changed.

We live in a dynamic world - people and things are moving all around us...all the time.  In fact, the world on which we live is in a state of perpetual movement...it has to be.  Without movement, we would cease to exist.

Have you ever thought of movement in this manner?  

Movement is something we take for granted...it just happens.  I performed a Google search for "how often does the human body move"...amazingly, there was no clear response.  Let's look at this from a different perspective...

The average human blinks their eyes approximately 12-16 times per minute.  This equates to roughly 17,000-23,000 blinks per day.  What creates this movement?  Three muscles are required to blink...the orbicularis oculi, the levator palpebrae superioris, and the superior palpebral muscle.

It has also been said that we touch our faces between 2000 and 3000 times per day!  Once again, muscles are used to control these relatively subconscious movements that we take for granted every day of our lives.

Where am I going with this?  Am I simply on another of my tangents?

My point here is that movement is a necessary part of life, yet we pay little attention to addressing our ability to move.  As we age, we notice small changes in our movement such as our ability to simply squat down to pick up an object.  We accept it to some degree...we write it off as part of the aging process.

Take a look at the photo below.  We were created to move freely, and when we were young...we could.  A variety of factors begin to take a toll on our bodies over time, and limit our ability to be highly mobile.  Mobility plays a role in performance...especially when we are talking about high-performance.

 

Now look at the pictures below.  Do your see any problems?  Over time, muscle imbalances have resulted in movement dysfunction among both of these women.  Dysfunction of this sort can decrease athletic performance and increase the risk for injury.

 The issues are quite apparent...knees collapse inward, excessive forward lean at the waist, inability to descend deep into the squat, arms falling forward, etc.  These movement deficiencies are due to both strength imbalances as well as abnormal length-tension relationships of the muscle tissues surrounding our joints.  Length what?

The picture above is a very simple example of a muscle imbalance and abnormal length-tension relationship.  The blue lines in the picture represent a joint in our body, such as our knee, or our hip joint.    The bulbous, tan objects are muscles, and the white areas at the end of the muscles are the tendons that attach muscle to bone.  Every joint in our body is controlled by muscles or muscle groups that oppose one another.  These are referred to as agonist and antagonist muscles, and they have a 'push-pull' relationship with one another.  Tension created by the contraction of the muscle tissue is converted into movement as the tendon(s) push and pull on the joint, causing the bone to move.  Voila...human movement!

Muscle imbalances are created by our daily actions such as exercising, sitting in front of the computer, repetitive unilateral swinging of objects such as hammers, tennis rackets, and golf clubs.  The human body is an amazing machine capable of adapting to climates, stressful situations...and even things like swinging that hammer, time and time again...day in and day out...using the same arm,  controlled by the same muscles...over and over.  

Or maybe it's the golf club for you, or in my case, pedaling a bike.  Sooner or later, the body adapts to these repetitive stresses by increasing tension in one muscle, and releasing tension, or relaxing the opposing muscle.  As is represented in the picture above, this imbalance causes the normal, resting joint angle to change.

 

The combination of aging, sports training/competition, and muscle imbalances often leads to acute or nagging, chronic injuries and pain.  One of the goals of this blog is to help you identify muscle imbalances that may be creating movement dysfunction, and provide you with corrective exercise techniques designed to help restore proper movement.

Corrective-based exercise is defined by the National Academy of Sports Medicine (NASM) as "the systematic process of identifying a neuro-musculoskeletal dysfunction, developing a plan of action, and implementing an integrated corrective strategy."  If you hang in there with me, and follow along regularly, I promise you...we're gonna talk corrective exercise!

Self Myo-fascial Release (SMR) is a flexibility and self massage technique designed to aid in the release of overactive muscle tissue, and help return proper muscle balance to dysfunctional joint complexes.  These techniques utilize a variety of tools such as foam rolls and tennis balls to provide the muscle stimulus.  In my role as a Performance Enhancement Specialist, working with both athletes and firefighters, I use SMR tools produced by the Trigger Point company.  

If you intend to follow along and learn these techniques through this blog, I highly recommend that you click on the Trigger Point Performance Therapy advertising link at the top-right of this page.  You will be taken to the TP website where you can learn more about these high-quality and highly effective tools.  If you are an elite level athlete, or just a weekend warrior like me, I encourage you to spend the money of one of these SMR kits by Trigger Point.  It may be some of the best money you have ever spent on your sport.  And yes...I do get a kick-back from this company for each purchase made through my blog...I am part of the Trigger Point Performance Therapy Affiliate Sales program.  Sure, I stand to make a little money here - but believe me, these are the exact SMR tools I use on myself, my athletes, and my firefighters...I highly recommend them!

Thanks for reading!  There's more great stuff to come!

Yours in Health and Performance,

John

It's All About Performance

Whether we are working or competing, our performance is truly what matters...isn't it?  There are other aspects of our lives where performance matters...or is it size? I always forget.  It's kind of like the chicken and the egg...depending on who you ask, the answer varies.  In either case, we wont be discussing topics of that sort here...you'll have to look elsewhere for that kind of help.

Okay, let's get back on track here...I've barely begun this post, and I'm already off on a tangent.

Where were we?  Oh yes, performance.  I can honestly say I have never heard an athlete, at any level, say that they were completely satisfied with their performance.  Whether during training or competition, we always want to do better.  Why is that?  Why can't we be satisfied with what we accomplished on any given day, during any given training session...during any given moment of competition?

Potential.  That's right...we all have more to give.  We have the potential to accomplish more than what we did.  Human potential may not be limitless, but for most of us...we have barely begun to scratch the surface of what we are capable of.  Our unlocked potential is what provides motivation and incentive to push against those intrinsic, self-imposed limits.  Or better yet, those limitations that have placed upon us extrinsically...what we have been told we are capable of, or not capable of.

As athletes, we are driven by the desire to push the limits of our potential.  We throw around terms such as Personal Record (PR) or Personal Best (PB) to describe what we were capable of...at our best.  At our best?  What is our best?  Can we be better?  Do we have the potential?  Are we willing to push the limits of our unlocked potential so that we may proclaim a new personal best?...that's really what it's all about.  Potential.

A smart man once said "If we did all the things we are capable of doing, we would literally astonish ourselves".  That man was Thomas Edison.  Very profound indeed.

Whether in work or sport, there are a variety of factors that limit our performance.  Rest/Recovery.  Nutrition. Movement.  Strength.  Power.  Endurance...I could go on and on.  Interestingly, I chose to list rest/recovery first.  Many athletes are led to believe that rest is for the weak.  To truly push the boundaries of their own potential, and improve their performance, they must train...relentlessly.  Are you one of those athletes?  If so, I am here to tell you that you are wrong.  It's not just my opinion...it is fact.

As adaptable as our bodies are, and as much untapped potential as we have, the human body is still only capable of doing so much...across a given amount of time.  Gains in performance, those that stay with us for the long haul, are developed incrementally...through progressive-based training that incorporates not only stress, but rest.  You see, it is during these periods of rest and recovery that the gains made during highly stressful training sessions really take hold.  This is when the body makes physical changes as a result of training stresses.  During rest.

Garbage in, garbage out.  It's a phrase repeated by many an athlete, and is used (most of the time) to describe the importance of proper, performance-based nutrition.   Performance-based nutrition...now there's a term you don't hear everyday, and one that most likely has different meanings to different people.  We'll talk about performance-based nutrition within this blog of mine, and I'll promise you two things:  I promise to give you my thoughts on what performance-based nutrition is, and I promise to provide you with sound, evidence-based information...not just the latest fad-based perspective on what we should and should not be eating.  I'll come clean right now...I am not a nutritionist.  I am not a dietitian.  In my profession as a trainer and strength coach, it is considered 'out of my scope of practice' to prescribe specific dietary guidelines to my clients.  It is not however,  out of line for me to share information about nutrition and nutritional concepts in an attempt to provide my client a foundation from which to make an informed decision.  I will help you develop or bolster your nutritional foundation through this blog.

Performance is also limited by our ability to move.  Human movement is the foundation for physical performance.  There are many factors that affect our ability to move, and the overall quality of our movement.  Poor movement quality equates to poor athletic performance...right?  You might be surprised by my answer...which by the way is "not necessarily".  Over the years I have been very surprised by the physical performance levels of athletes who had extremely poor movement quality.  Despite their movement limitations, these athletes were highly successful in their respective sports.  Power development, agility, speed, strength...they had all the tools, and they could use them.  

Have I peaked your interest yet?  Do you have questions?  I hope so.

Check back often as I will be posting weekly on the topics that we just discussed, and more.

Yours in Health and Performance,

John

Welcome to The Aging Athlete's Blog!

I'm an athlete.  I have been for the better part of my life.  Now don't get me wrong here, I'm not what you would consider an elite athlete...more like a weekend warrior.  I never competed at the college level...and it goes without saying that I was never a professional athlete.  For the past twenty-three years however, I have been a professional 'industrial athlete'.

"What in the world is an industrial athlete" you ask?  Well, there are numerous forms such as police officers, military personnel, etc...I am a professional firefighter.  Throughout the years however, I have also participated in a wide variety of competitive sports such as baseball, basketball, softball, golf, tennis, and others.  My current passion is mountain biking.

I compete in mountain bike races throughout the year, both endurance and short track.  My favorite?  Endurance events, such as twelve and twenty-four hour races.  I have competed many times as a member of a four man team, but my true passion is to compete in the solo category...where it's just me and the bike, riding nearly non-stop for 12-hours.  It's a sickness I think.

In 2011 I made the decision to race my mountain bike in the World Police and Fire Games.  I chronicled, in my blog Getting Race Ready, my nine month journey to prepare myself to compete against police officers and firefighters from around the world,.  The journey was long and arduous, and unfortunately did not have a story book ending.  I encourage you to check out my journey by clicking on the link above.

Aside from my career as a professional firefighter, I have been training elite level athletes for nearly fifteen years.  I have had the opportunity to work with some amazing young men and women, many of whom are fulfilling their dreams of competing at the college and professional levels.  It is truly an honor to be a part of the these athletes' lives, and watch them progress in their chosen sport.  I am thankful for those opportunities that I have been given over the years, but recently, I made the difficult decision to call it quits...no more training of young athletes for me.  I feel it is time to share my knowledge and passion for performance, with athletes my own age. 

I considered working one on one (just as I have with my young athletes) with the aging athlete population, but have decided to 'coach' via the online medium...blogging.  This blog will serve as my vehicle to share valuable information with others who, like me, have a passion for fitness and sports competition...men and women looking to improve their performance and reduce their potential for injury as they get older.

The tips and techniques, as well as information about nutrition and injury prevention that I share with my readers will be evidence-based, rather than just my opinion.  I give you fair warning however, there will be opinions shared on random topics...that's the reason we bloggers blog, isn't it?  I have years of practical experience training athletes, but I also possess advanced level education in the field of exercise science at both the undergraduate and graduate level.  The focus of my graduate work was human performance and injury prevention therefore, much of my effort centers on correcting faulty movement patterns that can predispose an athlete to injury...especially an aging athlete.

So...if you are an aging athlete like me, and are looking for some sound advice regarding training, nutrition, flexibility, movement...or just some random thoughts here and there, let's take a journey together into the world of the aging athlete.  I think you'll be happy you did!