Photodisc/Valueline/Getty Images, April 4, 2011  —  When you suffer a kneecap dislocation injury, the patella—a bone shaped like a triangle over the knee—shifts out of its usual position, usually toward the outside of the knee, according to the National Institutes of Health‘s MedlinePlus website. Likely causes include turning suddenly without moving your leg in the same direction, a blow to the joint or a sports injury. Exercise can help to prevent and treat this injury.


Stationary Cycling

It’s not surprising that riding a stationery bike is a common exercise for knee rehabilitation. Done correctly, it can also help prevent knee injuries. According to the American Journal of Sports Medicine website, cycling strengthens the quadriceps, which is the muscle group at the front of your knee. Cycling is also low-impact and the stress on your knee ligaments and tendons can be controlled when you’re doing it. Cycling also increases your knee’s range of motion to improve function and mobility. For best results, adjust your seat so you can comfortably pedal without having to bend your knee too much or lift your foot off the pedal.


Strengthening and Stabilizing Exercises

Exercises that strengthen the muscles connected to your knees ease the stress on your knee joints, states the American Academy of Orthopaedic Surgeons. Less stress on the joint helps to control improved stability and movement, and wards off injuries to the knee. As the AAOS explains, strong quadriceps and hamstring muscles also improve your knee’s shock-absorbing abilities. Effective knee strengthening and stabilizing exercises include leg lifts, wall squats, lunges and hamstring curls. As your knee begins to regain strength, your physiotherapist will recommend adding weights while performing some of these exercises.


Flexibility Exercises

Strengthening exercises tighten muscles, which can reduce the mobility and function of your joint, thereby putting the muscles at risk for injury. Stretching exercises help to keep muscles loose. However, you should never stretch cold muscles; the AAOS recommends performing gentle stretches after you do strengthening exercises. Good flexibility exercises include quadriceps stretches and hamstring stretches performed sitting on the floor rather than standing.



Chronic Muscle Pain

Regular exercisers should expect their muscles to feel sore on the day after they exercise intensely, but if the soreness doesn’t go away, they need a medical evaluation. When you exercise vigorously, your muscles are injured. Muscle biopsies taken on the day after intense exercise show bleeding into the muscle fibers and disruption of the Z-bands that hold muscle fiber filaments together as they slide by each other. The soreness you feel should usually disappear within 48 hours, and even with the most severe workouts, it should disappear within a week or two.

If the soreness remains after a few weeks, you should check with your doctor. You may have an infection anywhere in your body, an autoimmune disease or other treatable condition. Doctors may call your chronic muscle soreness fibromyalgia, chronic fatigue syndrome or multiple chemical sensitivities. These diagnoses are an admission by the physician that he hasn’t the foggiest idea of the cause. There are reports of people with muscle pain and normal liver tests who are then found to have hepatitis C, which can be effectively treated. If you have urinary tract symptoms in addition to your muscle pain, you may be infected with mycoplasma or other bacteria which can be treated with antibiotics. You could have Lyme disease or some type of reactive arthritis. Don’t accept a diagnosis of chronic fatigue syndrome or fibromyalgia until you have a thorough evaluation for a hidden infection or other treatable causes.


Glucosamine and Chondroitin Sulfate for Arthritic Pain


By Gabe Mirkin MD, April 4, 2011  —  One in 10 Americans suffers from osteo or degenerative arthritis, a disease in which the currently used medications, acetaminophen, aspirin and nonsteroidal antiinflammatory drugs, do not slow or reverse the progressive destruction of joints and no cause is known. Over the last decade, reports have shown that pills containing chondroitin sulfate and glucosamine, two components of cartilage, may help alleviate the pain. Three major reviews in the scientific literature claim that the three studies showing that glucosamine relieves pain were poorly designed and therefore cannot be offered as proof of benefit. On the other hand, six studies from Europe and another from the United States show that chondroitin sulfate does help to slow joint destruction and pain caused by osteoarthritis (journal references for these studies).

One study in Rheumatology showed that glucosamine is not more effective than a placebo in controlling arthritic pain (8).

Several studies show that glucosamine helps control pain, but it is very difficult to test the effect of any drug on pain because a very significant number of people will benefit just as much from placebos. The authors performed a double blind study over six months in which they gave either 1500 mg glucosamine or placebo pills daily to patients with arthritis. Neither the doctors nor the patients knew who received glucosamine. One out of three patients receiving glucosamine had excellent control of their pain. but one out of three people receiving placebos also had the same excellent response.

Another study in the British medical journal, Lancet, showed that glucosamine helps to retard the breakdown of cartilage. Up to then, studies showed only that glucosamine helps to relieve pain. People with arthritis received either 1500 mg of glucosamine or placebo. X rays of their knees showed that the placebo group lost more distance between the bones of their knees than the glucosamine group.

The ends of bones at the knee joint are covered with cartilage, so the greater the distance between the bones on X ray, the greater the amount of cartilage. There is a serious problem with the study. People with arthritis often cannot fully straighten their knees, so it is impossible to use distance between bones to determine how much cartilage is lost. For example, if a person bends his knees a little, he will have the bones closer together than when he holds his knees straight. That means that anything that blocks pain will allow person to straighten his knees and have a greater distance between the bones at the knee. You should get the same benefit from any pain medicine. Furthermore, the study was sponsored by Rotta Research Group, who could gain billions of dollars from sales promoted by this study.

An earlier editorial in Lancet raises questions about the safety of glucosamine (2). Most research shows that glucosamine can help to relieve some of the pain associated with arthritis (3), but does not help to prevent cartilaginous damage and has not been shown to heal broken cartilage. Therefore, it is no more effective in treating arthritis than aspirin, but costs more than aspirin, but less than most brand name arthritis pain drugs that your doctor prescribes.

Glucosamine helps form aggrecan, the part of cartilage that allows cartilage to swell and shrink, acting like a shock absorber to help protect your knees from the trauma of running and walking. Adding glucosamine to cartilaginous cells in a test tube causes them to increases production of aggrecan (4).

However, in light of this good news, you should know that glucosamine can block the effects of insulin, causing blood sugar levels to rise (5,6,7), increasing likelihood of suffering the side effects of diabetes in susceptible people.


1) Lancet, January 27, 2001

2 )Mark Adams: editorial The Lancet, July 31, 1999, 354(9176):353-354.

3) Muller-Fabbender et al. Glucosamine compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.

4)Bassler et al. Stimulation of Proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritis articular cartilage in vitro. Osteoarthritis Cartilage. 1998;6:427-434.

5) Am J Physiol Cell Physiol 1996;270:C803-11.

6) Diabetes 1995;45:1003-10089.

7) Proc Assoc Am Phys 1998;110:422-432.

8) A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Rheumatology, 2002, Vol 41, Iss 3, pp 279-284. R Hughes, A Carr. Hughes R, Ashford & St Peters Hosp Trust, Dept Rheumatol, Guildford Rd, Surrey KY16 0PZ, ENGLAND

Preventing Loss of Muscle Strength with Aging, April 4, 2011  —  As you age, you lose muscle size and strength much faster than you lose endurance or coordination. Researchers at the University of Nottingham in England show that a major cause of loss of muscle is that aging prevents muscles from responding to insulin and that exercising helps to slow this loss of muscle size and strength (The American Journal of Clinical Nutrition, September 2009).

Insulin drives amino acids into muscles to help them recover from exercise and maintain their size. Researchers traced radioactive amino acids and showed that insulin drives the amino acids into muscles much more effectively in 25-year-olds than in 60-year-olds. They also showed that the blood flow in younger people’s legs is much greater and supplies far more nutrients and hormones. However, three exercise sessions per week over 20 weeks markedly increased blood flow in the legs of the older subjects, enough to reverse muscle wasting.

People of all ages can use this information to help themselves become stronger. Athletes in all sports train by stressing and recovering. They take a hard workout, damage their muscles, feel sore the next morning, and then take easy workouts until the muscles heal and the soreness goes away. The athlete who can recover the fastest can do the most intense workouts and gain the most strength.

Eating a high carbohydrate-high protein meal within half an hour after finishing a workout raises insulin levels, increases amino acid absorption into muscle and hastens recovery (Journal of Applied Physiology, May 2009). The carbohydrates cause a high rise in blood sugar that causes the pancreas to release insulin. Insulin drives the protein building blocks (amino acids) in the meal into muscle cells to hasten healing from intense workouts. Muscles are extraordinarily sensitive to insulin during exercise and for up to a half hour after finishing exercise, so the fastest way to recover is to eat protein- and carbohydrate-rich foods during the last part of your workout or within half an hour after you finish.

Here’s how Diana and I (ages 67 and 74) use this information on insulin sensitivity. We ride hard and fast for about 20 miles on Tuesdays, Thursdays and Saturdays. On our recovery days, we ride slowly for one to three hours. Mid-day we go to a buffet restaurant and eat a large meal with fish, shrimp, vegetables and other sources of protein and carbohydrates. After eating, we ride slowly for one or two more hours. Riding before we eat makes our muscles very sensitive to insulin. This causes insulin to drive amino acids rapidly into our muscles and help them recover faster. Riding after we eat helps us to avoid a high rise in blood sugar that damages cells. You can use either plant or animal sources of protein; both contain all of the essential amino acids necessary for cell growth.


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