Question
my question is about clicking in the knees,
i had an incident at 15yrs old where my knee was twisted
(the top half of my leg went one way and the bottom part went the other way)causing my knee to pop out,
i had physo done after that to take the swelling go down but the knee has not been the same since.It has poped out since then 2 or 3 times and with extreme pain for 15mins,
i am now 27yrs old and both my knees click when i go up stairs or do any strenuous exercise and because of this i cant really do too much exercise so i find it had to keep fit.But they seem to get better when i apply deepheat to them.Can u give me your advice/suggestions.


Answer
Disclaimer: please do not take any of my advice without at least consulting with your doctor(s) first. If necessary, print this email in its entirety for your doctor(s) to read. In addition, please do not attempt to use this website or my advice as a substitute for your healthcare needs, as a substitute for the advice of your doctor, or as a substitute for any legal advice. There is no way a thorough health evaluation or assessment of any medical condition can be properly made via email. Please only use the contents discussed as a guide or tool to address your health matters with your doctor(s). If any of the information I provide conflicts in anyway with the information your doctor(s) provide, it is always best to default to the information provided by your consulting doctor(s) or to seek additional opinions from qualified, licensed healthcare providers as needed.

Dear D.,

The most important thing to help an unstable knee is to strengthen the muscles that support the knee.  Knees are problematic for so many people as they age because they are mechanically very vulnerable.  Consequently, the weaker the muscles are that support the knee, the more problems a person is likely to have.  I can抰 say if this is your scenario or not, but typically, most people have tight hamstrings (the muscles on the backside of the thigh) and weak quadriceps (the muscles on the front portion of the thigh).  Some people also have problems with tight adductors (the muscles on the inner thigh between the legs), or the tensor fasciae latae and iliotibial band can be too tight on the outer portions of the thigh, which can also create knee problems.  All of these muscles are very important for both proper stabilization and biomechanics.  Though the calf muscles (gastrocnemius muscle) are not usually the primary culprit for knee problems, they do insert into the back of the knee as well and are worth considering in the complete workup of a patient抯 knee instability.

These are just the beginning of assessing poor knee stability.  However, everything mentioned above and below may or may not directly pertain to you.  It might be worth investing a little money into an extremely knowledgeable personal trainer, physical therapist, or chiropractor, to help you assess these muscles so that you can better target your rehabilitation.  Typically, a basic rehab program will incorporate stretching the tight muscles and strengthening the weak muscles so that they are in proper balance when they tug on the knee as you walk/run/climb/etc?br>
Again, this may not be your case ?I would need to evaluate you to know for sure ?but starting with a good quadriceps strengthening exercise is great.  You can do leg extensions at the gym.  If you don抰 go to the gym, I抦 a huge fan of lunges.  They are very difficult to do, but so long as they are done properly, they are a great place to start.  As you advance, you can throw in some weights by holding weights in your hands as you do them.  (Make sure you have gone over these with a knowledgeable practitioner so that you are doing them properly and do not injure yourself).  Also makes sure to stretch all of the tight muscles or roll the tight muscles across a foam roller.  (You may need to have a personal trainer or healthcare practitioner show you how to do this with all of the muscles).

After you抳e had an intense workout, I usually recommend ice (10-15 minutes at a time, once an hour, 3-4 times after each session, through a thin towel to protect the skin) instead of heat.  The heat will probably be ok before the workout, such as when you抮e stretching/warming up, but using ice after the cool down is usually better than the heat because it flushes out the inflammation.

Here are pictures of the stretches/exercises and a place to buy a foam roller:

Lunges
http://etrueschler.files.wordpress.com/2008/11/lunge.jpg

Quadriceps Extension exercises
http://www.shapefit.com/quadriceps-exercises-leg-extensions.html

Hamstring Stretch
http://www.velogirls.com/resources/publications/stretching101/standing_hamstring...

Adductor Stretch
http://www.yourzone.com.au/CONTENT/Health_lifestyle/physical_activity/images/str...

Calf Stretch
http://www.girlshealth.gov/fitness/images/stretch_calf.gif

Tensor Fasciae Latae and Iliotibial stretch
http://fammed.washington.edu/residency/sports/images/ITB%20rehab%20pics/Iliotibi...

Foam Roller
http://www.walmart.com/catalog/product.do?product_id=10270005&sourceid=150000000...
(There are much cheaper places to buy online if you look around a bit).

Make sure you go over this information with a trainer or knowledgeable practitioner to make sure it is appropriate for your needs.  The above is just a basic start, but there is much more that you can do, so find a practitioner or trainer to help you as you advance.  I hope this helps a bit and gives you a good start.

JR Strecker, DC