ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, August 20, 1996 TAG: 9608200014
SECTION: EXTRA PAGE: 3 EDITION: METRO
SOURCE: JANE BRODY
When it comes to knees, women are indeed the weaker sex.
The very design of their bodies makes them more vulnerable than men to serious knee injuries and chronic knee problems.
Growing numbers of young women strive for excellence in sports that were once played by only a few women. And millions of women engage in health-promoting exercises that can overstress knees.
As a result, specialists are seeing more women with nagging knee pain that impedes even the routine demands of life, such as climbing stairs, getting up from a chair or walking.
However, when it comes to seeking medical help, women are not much better than men about going to a doctor. They often continue to do the activities that caused the problem, hoping it will cure itself. Many presume surgery is the only solution, and they dread the time away from activity.
Either way, they often postpone the inevitable until the discomfort makes it impossible for them to live normally. This delay can result in a more serious knee problem that involves more extensive treatment and disables them for far longer.
I admit to being one of those women. Instead of giving in to my knee pain, I tough it out - taking ibuprofen, wearing knee supports, icing my knees and continuing to play tennis, cycle, walk, dance and garden - rather than see a doctor.
My knees always hurt during even routine activities to a greater or lesser degree, prompting me to change the way I walk, the shoes I wear and how much I carry; but, so far at least, I have refused to give in to the discomfort.
That is a big mistake, orthopedic surgeons tell me.
In part, I am writing this column to persuade myself not to postpone an examination any longer. Perhaps surgery will not be necessary. Maybe all I need to relieve the pain in my knees are special inserts in my shoes and exercises to strengthen the muscles that support those spindly joints. Maybe that is all you will need, too.
Why knees hurt
Women are more susceptible than men to serious injuries to the ligaments that hold the knee together and to chronic problems involving the kneecap and the cartilage that cushions the contact area between the upper and lower leg bones.
The width of the female pelvis results in a sharper angle where the bones meet, which can create alignment problems for the kneecap. Women's ligaments tend to be more lax than men's, and the muscles that support the knee are not as strong.
And women may be using the wrong muscles during strenuous activities, a new study has shown. Researchers at Medsport at the University of Michigan found that, unlike men, female athletes rely more on the quadriceps - the muscles in the front of the thigh - to stabilize the knee than on the stronger hamstrings behind the thigh. The result is greater vulnerability to ligament injuries.
The Michigan researchers, Laura Huston, a research engineer, and Dr. Edward Wojtys, an orthopedic surgeon, said that in moving from noncontact sports to very physical games such as basketball, hockey and soccer, women have experienced an ``alarming rise'' in serious knee injuries, to an injury rate at least twice that seen in men.
The most common injury has been to the anterior cruciate ligament, the fibrous band of tissue in the center of the joint that is its main supporting link. When that ligament is torn, the joint is unstable, and slippage within the knee when it is stressed can cause crippling pain.
Huston said the problem results from the ``mistraining'' of women athletes at all levels, from high school to the Olympics. Women are encouraged to strengthen their quadriceps, she said, but they also need to do ``activities that increase the quickness of the hamstring response,'' such as hamstring curls and jumping rope.
Women who participate in activities such as running, tennis, skiing, cycling or dancing are more likely than men to develop wear-and-tear knee injuries.
Kneecap problems are especially common in women, said Dr. Ronald Grelsamer, chief of hip and knee surgery at Maimonides Medical Center in Brooklyn.
The kneecap is a cartilage-lined structure, in front of the joint, that meets the end of the femur, or thigh bone. In many people, especially women, the kneecap and femur fit together poorly, and the kneecap tracks improperly.
``Like a misaligned tire, a kneecap that is chronically in a bad position will wear out in time, especially if someone is very athletic,'' Grelsamer said. Sometimes the very exercises prescribed to relieve knee pain aggravate kneecap problems.
Especially stressful, the orthopedist said, are leg curls. These exercises, which can be done against a resistance machine or while sitting in a chair with a weight on the ankle, involve straightening the bent leg against resistance, which Grelsamer says places too much force on a small contact area in the knee.
Doing repeated deep knee bends, using a stair-climbing machine and participating in step classes when the steps are too high also risk injury to the kneecap, he said.
A kneecap in trouble is likely to cause pain in the front of the knee, prompting the victim to rub the knee with the palm of the hand, Grelsamer said. Another sign is pain after sitting on the floor cross-legged.
What to do
Foremost, keep your weight down. When walking, every extra pound of body weight adds four pounds of pressure to the kneecap. When climbing stairs, that pound adds 20 pounds of stress; when running or doing high-impact aerobics, that pound places up to 25 extra pounds of stress on the knee.
The American Physical Therapy Association recommends that good muscle balance be maintained in the legs. That means strengthening both the quadriceps and hamstrings so that neither is overdeveloped, relative to the other.
The association also urges that muscles near the knee be warmed up and stretched before beginning your activity.
Properly fitting shoes appropriate to your sport also are important, as is replacing worn shoes often; ``worn'' refers to the condition of the inner and outer sole, not the top of the shoe.
Avoid twisting the knee and squatting, and when using a leg-press machine or lifting something heavy while standing, avoid locking your knees.
Probably the most important and universal bit of advice is to listen to your body. Knees that hurt are knees in trouble. See an orthopedic surgeon who specializes in knees, maybe two specialists, because the advice may differ.
Perhaps all you will need to correct the problem are orthotic inserts in your shoes or knee braces and individually prescribed exercises to stretch and strengthen the muscles that support the knee.
You may also benefit from advice about less stressful ways to engage in various activities.
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