In this Wednesdays With Will episode, Dr. Harden discusses the most common causes of knee pain and how you can relieve it.
Plus, he answers a listener question about improving digestion after a partial colon removal.
Please keep reading for the full transcript.
In This Episode You Will Learn
- Patella Tracking Disorder
- Foam Rolling
- Kinesio Tape
Links and Resources for This Episode
- Dr. Harden’s Supplement Shop
- Born To Run by Christopher McDougall
- Merrell Barefoot shoes
- Dr. Will Bar (delicious, nutritious food bars)
Transcript of This Episode
Glenn: Alright, Will. I have a question for you. Is there anything you as a chiropractor would do if somebody comes in with knee pain?
Chiropractic and Knee Pain?
Will: Well, you know honestly, you’d probably be shocked at how many people tell me they have knee pain. In truth, most people don’t think to go to a chiropractor because they have knee pain. And most patients that I see for knee pain are not initially coming here to address that because they make an assumption that that’s not the kind of thing that a chiropractor addresses. And yet I… I end up treating knee pain issues with great regularity, on a daily basis. And it’s just ever so common to see and hear about knee problems. The typical scenario is someone is, let’s say, under care for a low back issue or they are under wellness care where they see me once a month and they say that they do that because it just makes them feel more stable. It keeps their old problems from cropping up whatever. And they might mention “I’ve been noticing that I have knee pain lately when I get up from a stoop position or when I try to run.”
So the first in our business in any knee condition is to make sure it’s not some kind of pathology, some kind of potential surgical problem, something for which is critically necessary that the patient undertakes some physical therapy, et cetera. So a knee exam, which is not all that complicated a procedure, involves assessing of the integrity of the ligaments, the menisci. And I’m sure you’ve heard of the medial and lateral meniscus. Those are little pads of cartilage between the femur and the tibia, in other words, the weight bearing cartilage of the knee joint. And then of course, we want to verify that there’s no indication of something like bone tumor, bone cyst, joint infection, et cetera. And those things generally fairly easy to ascertain by way of physical exam or at least to rule out by physical exam. And in otherwise, healthy and athletic people, the most common cause for knee pain that I see is… I could give this multiple different names. Some practitioners would say “Oh you have patellar tendinitis.” Someone else might say, “You have a condition called chondromalacia patella.” And someone else might say, “You have a patellofemoral tracking syndrome.” And I would really classify those, without breaking each of those down, all as one condition.
The Structure of the Knee
So picture the anatomy of the knee. The underside of the knee cap is triangular. The knee cap is a more or less free floating bone in front of the knee. The triangular underside of that patella meets up with the triangular femoral groove. That is to say, there is a triangular groove within the front of the lower portion of your thigh bone, your femur that matches the triangular shape of the patella. And every time you straighten your knee, you can tract your quadriceps muscles and it pulls that hinge, that knee cap up the femoral groove and that straightens your knee. In many cases, particularly of runners but also people who have flattening of their arches, people who wear poor footwear, certainly those who have a tendency for a condition called genu valgus. Think of it as being slightly knock-kneed. If the femoral tibial angle, in other words the angle between the upper and lower leg, is altered in such a way you have a slight knock-kneed position; then the knee cap moving squarely up through that femoral groove and instead it’s kind of grinding and exerting friction on the outer portion of the femoral groove and the outer underside of the patella. It’s easier to tell you some visual aids how to picture this. But I think you can get your mind around that.
Glenn: I will put some on the show notes page so people can see.
Will: Perfect. So in runners, and those other individuals that I just cited, the outer quadriceps are almost always too strong compared to inner quadriceps which should be balanced in their strength. The balance strength of the inner and outer quads allow that patella to move straight up and down instead of off to the inside or outside aspect of the knee. So 19 out of 20 times when you encounter an athlete or a runner with knee pain that was not related to trauma, is not associated with arthritis or meniscal tearing, is not associated with anterior cruciate ligament tear; a patellofemoral tracking syndrome exist. And this overtime, leads to tendinitis of the tendon that attaches the patella to the tibia, and that would be called patellar tendinitis. And if you ignore this condition long enough, then the cartilage on the underside of the knee cap becomes worn and that’s called chondromalacia patella. But I… I don’t usually see it in… I don’t see chondromalacia patella frequently because most people won’t endure that kind of pain that long before they do something about it.
How Treat a Bad Knee
So there are a lot of things you can do to totally arrest this condition. First, I suggest daily foam rolling on the outer thigh tissues specifically the outer quadriceps. And it’s called the iliotibial band. I’m sure you have encountered so many people with iliotibial band pain syndromes. I don’t know if I ever met someone who foam rolled their outer thigh on the iliotibial band and not complained of horrific pain. It’s absolutely intolerable at least initially. So you can’t put all your weight on the outer thigh on top of a foam roll, you got to take some of the weight off by putting the other leg on the foam roll at the same time. Do you understand what I mean by that?
Glenn: Yeah, I… I’ve done that but when I do it, I put my upper leg up and my foot down on the ground.
Will: Yes, that’s your other–
Glenn: and that helps in supporting weight.
Will: That’s your other option. But I find that that and sometimes I’ll do it that way. I used to recommend it that way but I found that you’re probably not gonna foam roll for a good 4 or 5 minutes which an iliotibial band needs. If you’re exerting effort by putting that other foot down and lifting with your hand and if you can somewhat relax while you’re on the foam roll by shifting yourself in to kind of a side posture position while drawing the other leg up and resting it on the foam roll, that helps.
Glenn: Got you. That makes sense.
Will: And then for rolling the quads, I suggest laying face down on a foam roll underneath your thighs. Toes turned in. So picture yourself laying there pigeon toed so that you’re changing the trajectory of the downward force toward your outer thighs. And then rolling, foam rolling, both quads at the same time. It’s more tolerable that way. And you can really relax for it that way.
Second. So first, foam rolling. Second, kinesio taping your patellar condition, namely, by taping essentially the quads and the iliotibial band. Almost always give instant release of knee pain with athletic endeavors in those with knee pain. And this is just so fascinating. Ten years ago, kinesio tape was rendered only by professionals who were certified kinesio tapers. And you couldn’t buy it anywhere except through a professional’s office. Now, you can buy at the sporting good store and I think even Walgreens. And you can find out exactly how to apply it on YouTube. So if you YouTube patellar tendinitis key taping, you would find out how to tape your knee very effectively.
Glenn: Oh, that stuff is great. I love the technology. I love that you can find how to do all kinds of things on your own through YouTube and something like that.
Will: Oh, I so agree.
Glenn: And I don’t really see what would be the harm in somebody didn’t do it right.
Will: The worse that would happen is that it wouldn’t say to give you much relief.
Glenn: Right, but no real harm.
Exercises for the Knee
Will: But it will not induce some mechanical irregularity that leads to other problems. No, it won’t. You’ll simply say “I tried kinesio tape, didn’t do much good.” Well, chances of good, it’d probably wasn’t being applied right if it was for knee pain that you were using it because one of the most predictably responsive conditions there is for a kinesio tape. So in the meantime, if the outer quad is too strong compared to the inner quad, it would be wise to strengthen inner quad musculature or the vastus medialis. And the way that you would do that to keep it really simple would be to lay on your back with — let’s say you have left knee pain — and it’s determined that it’s a patellofemoral tracking problem. You would lay on your back and bend your right knee about 90 degrees. Now with a straight left leg, the symptomatic leg, turn your toe out as far as it can go. Then raise that left leg until your knees are side by side. Then lower the straight left leg back down, not quite down to the floor. Then repeat. And do 12-15 reps of that 3 to even 6 sets a day and your target strengthening those inner quads. And that will help to reestablish balance of inner and outer quads.
Glenn: I’ve heard of a very similar exercise but then seated up on the floor up against the wall. Is it okay if you’re sitting versus laying?
Will: I would rather you were laying because the seated position is probably going to promote an increase likelihood of hip stress by over engaging the soleus muscle.
Glenn: Yeah, I can see that. That’s why I wanted to ask you because I was seeing—
Glenn: –that there is a difference between the two positions.
Will: Yeah, you’ll… You’ll probably get a lot more burn in the quad versus in the hip by doing it laying on your back. Another consideration, if you have dropping of let’s say in the case of that left knee pain, slight dropping of your left arch than as you dropped them medial or inner portion of the foot, you are also dropping the inner or medial portion of the knee. You’re kind of creating a knock kneed state on that left side. An if you were to took down on your knee while doing that, you will see that you were directing the knee cap more toward the outer portion of the leg, the thigh. Therefore, with the patellofemoral tracking issue, it’s very important to ensure that you have adequate arch support. So with this condition particularly in those who are fairly athletic on their feet — runners, hikers, hard core walkers — it’s really important to either wear shoe that has a good arch port or even go to the running store, have a basic arch assessment done. You’ll be amazed how many people I refer for just the basic arch support at a running store whose feet and knees improved. And the way they do that at the running store now have you get on the treadmill barefooted, walk and then take a 10 second run while they video it. Then you step off. They play it back in slow motion and you watch what’s happening to the mechanics of your feet, ankles and sometimes knees to see if there’s a breakdown in the gait that’s stressing those knees. And then they’ll recommend an off the shelf kind of fit by size arch support. And many people do really well with those and see immediate improvement in knee problems.
Glenn: Wow. That’s amazing.
Will: Now, I’m gonna paint for you a bigger philosophical picture. Running really became a craze in the 60’s. And within about a decade, there was a marked increase in the incidence of arthritic problems within knees. And over time as running became more and more popular, more and more premature arthritic conditions of knees began to be seen; until ultimately, some said “Okay. We have a knee arthritis epidemic directly as a result of running.” I will submit to you that during the first 35 years of our lives, we are anabolic. That is we are getting bigger, faster, stronger, more and more capable or bearing young as we approach our prime. Remember that we are nonstopped making you know we’re… Cells are dying and being replaced. And the way a cell replicates itself is basically it makes a copy of itself. So we are making copies of copies of copies. And during the first 35 years of our life while we’re anabolic, each copy is bigger and badder than the last. This is a kind of a sad reality but after 30 to 35 years of life, we become more or less catabolic. That means we’re slowly breaking down. And therefore, each new copy of copies of copies is less big and bad and strong and tough and resilient. And therefore, I reluctantly tell patients I’ll support them in whatever they choose but given the choice, if they’re past 30 to 35 years of age, I would prefer that they not choose running as their primary athletic endeavor, a hobby, stress reducer, et cetera. And instead try to sway people to switch to swimming or cycling because of the non-weight bearing nature of the sports which do not have the same degenerative implications to knees.
Glenn: Yeah, I agree running can definitely can be very harsh. And one of my past times is to watch people run. I find it really interesting—
Glenn: –how many different gaits there are.
Will: Styles, yeah.
Glenn: Some just look beautiful and poetic and you can watch them forever. And it’s like just a beautiful Mozart’s symphony and others—
Glenn: –are like a train wreck and you just want to cover your eyes and duck.
Born to Run?
Glenn: Have you ever read the book Born to Run?
Will: I’ve not read that.
Glenn: I read it several years ago. And it was a fascinating story. It was talking about the Tarahumara natives in Mexico and they run all over the place barefoot while they make some sandals out of tire threads but they’re essentially barefoot. They don’t have thick wedges of padding under their heels. And I thought you know that makes a lot of sense because we as humans have been running like that for a millennia until Nike came out.
Will: Yes, that’s a reasonable… Reasonable assumption, yes.
Glenn: So I decided to try it. So I’m trying the barefoot style of running. I’m actually wearing barefoot shoes and they’re my favorite shoes I’ve ever owned. I have Merrell Barefoot shoes. And there’s no padding underneath them. It has a sole and a thread which protects my foot from sharp objects but I’m still able to feel grounded and I can feel the different new ounces of the—
Will: Contours of the surface.
Glenn: –different walking on contours from one piece of carpet to another, that sort of thing. And it gives me much more traction. It’s great with any sort of agility things I’m doing. But you have to run completely differently. You can’t heel strike.
Will: Oh, no don’t.
Glenn: You cannot heel strike, which I don’t. And it took me… After I read born to run and I watched some videos on how to run barefoot, and it took me about a year to fully, completely transition where I didn’t have to think about it all the time where I just go out and run. And I land with my forefoot directly below my body. I don’t stride out in front of me.
Will: Yes, so shorter gait is way better.
Glenn: Yes, and it’s… I ahh… It looks a lot like a skateboard. Like if you have one foot on a skateboard, your other foot that’s propelling you, goes straight down and then pushes back—
Glenn: –which propels you forward so all of your energy is used to send you forward instead of up and down—
Glenn – or stopping you and then speed you up again. I stopped running for probably 10 years until I read this book and then I started again. And I stopped running because my knee would hurt.
Glenn: And this is when I was young. Even in my 20’s, it would bother me. My knee has not hurt in, well, more than 10 years.
Will: Very neat.
Glenn: Ever since… From when I wasn’t running, it didn’t hurt. And when I did this, it does not hurt. I can… I’ve not run more than 5 miles at any one time. No, 7, I ran 7 once. But my knee doesn’t hurt.
Will: Very neat. And you hit on something I think really important to me the up-down motion of the body. So I always tell people to run. The next time you are running when you pass in front of a building with glass walls, you’ll see your reflection. And ideally when you run, you would see very little up-down movement of your body and your head. Watch your head and attempt to get that to have a very slight wave to it. But it should be essentially kind of moving along a straight line instead of up and down because if you put a pressure gauge on the sole of a shoe and you measure the amount of pressure absorbed by foot at heel strike, the heel absorbs several hundred pounds per square inch of pressure on heel strike, literally several hundred pounds. That is not an amount of force that the human frame: knees, hips and lumbar spine are meant to withstand.
Glenn: You know I’m glad you mentioned that because when I run, I imagined that I am a marionette essentially that I’m being… That I’m dangling above the ground.
Will: Oh yeah.
Glenn: I’m hovering on a cloud you know several inches—
Glenn: –a couple of inches above the ground and that allow me to glide and float rather than pound, pound, pound. I used to run like an elephant. And now I feel like I run like a cheetah.
Will: Very cool. I’m almost compelled to take up running again but no way. (Laughter)
Glenn: Will say I don’t love running. I am not a runner. I’m not built to run. I do not love it but it’s very functional. It feels good. It gives me a really good work out in a short period of time.
Will: In the shortest period of time you can possibly get from a workout, agreed.
Glenn: Yeah, I generally run about a mile and a half at a time so I’m not a long distance runner but it does the job.
Will: However, since this is beginning to sound like an argument in favor of running, I harken back to my firm assertion that we are not meant to run past 35 years of age.
Glenn: And I am not… I’m not contradicting that. I’m simply saying my experience with running…
Will: Okay. That’s excellent.
Glenn: I will also say that if you don’t like running, don’t.
Glenn: Get on a bike.
Will: Agreed. And even if you do like running, consider cycling at some point in the future to reduce the likelihood of degenerative changes prematurely.
Glenn: Or running in a swimming pool.
Will: There you go. Perfect.
Glenn: Right. Thank you, Will.
Glenn: Alright, Will. We have a listener question now from Doug.
Doug: Hello my name is Doug and I just listened to episode 69 with ‘Will on Digestive Health.’ And I have a question if you have any suggestions for someone who had a right hemacolectomy after a colon cancer. I’m doing healthy and stuff but my digestive system isn’t like it used to. And I was wondering if there’s any suggestions, any supplements or… Or anything that would help me get a little healthier. So thanks again. This is Doug from South Dakota.
Will: Doug, great question. I’m sorry that you were confronted with a daunting task of dealing with colon cancer. I’m sure that was, at least for a period of time, overwhelming. So what you’re asking is as a result of having a portion of your colon or your large intestine removed, what might you do to enhance your colon or digestive health. So if I could refer back to my basic description of digestive process, you consumed food and your system subjects it to digestive enzymes so that foods are adequately broken down to the extent that they passed through your smaller intestine, you have an adequate absorption of nutrients. By the point that food… By the time the food gets to the large intestine, essentially, what you’re doing is your ridding yourself of waste. You’re absorbing a minimal amount of additional nourishment in the beginning portion of the colon. And you’re also regulating water balance.
So in the large intestine, to ensure good health: one, you must remain well hydrated. And I’m sure you already pay attention to that in that you’re well aware of digestive health and apparently you’re making efforts to enhance that. So you should stay hydrated. What that means is you should shoot for about one-half of your body weight in pounds in ounces of water of each day.
Next consideration for colon health, particularly, as it relates to supplementation, would be the used of probiotics. So I’m sure you’re probably well aware of this but you have a natural flora to your intestines particularly your large intestines. By natural flora, what I mean is a natural growth of bacteria. And you’ve probably heard acidophilus lactobacilli perhaps bifidobacterium, these are types of probiotics. So by that, I mean naturally occurring bacteria that should be lining the large intestine and to some extent, the small intestine. So one, I would suggest that each morning and again in the evening or even at bedtime, so I like one dose after eating and one dose before bed, in other words, on an empty stomach of a probiotic. And when you go to the grocery store or health food store, can be overwhelming the sheer variety of probiotics you can buy. The goal would be to buy a probiotic that is bioavailable. That means it’s live bacteria to concentrated bacteria. So by that I mean one billion or more bacteria, live bacteria, per dose. Take one in the morning. One at bedtime or evening. So hydration, probiotics.
#3 GI Tract Fortification
Third, I would strongly recommend that you consider using something to fortify the GI mucosa. That is to ensure that the lining of your small and large intestine are sound. The perfect supplement to do that – and this is something I probably dispense two bottles a week of – is called Glutagenics. You do not have to use Glutagenics, which happens to be a supplement made by a company called Metagenics. But I give the supplement to all people with history of colectomy, irritable bowel syndrome, ulcerative colitis. It’s a combination of 3 things all of which would be good for you.
One is aloe. It contains a powdered. This is a freeze dried formula. It’s powdered supplement. You add water. You drink it two times a day, a teaspoon twice a day. Aloe – which has a cleansing soothing effect on the GI lining. It contains something called deglycyrrhizinated licorice or DGL – and we talked about that during digestive health – that promotes a proper mucus secretion by the lining of the GI tract. So it’s protective in nature.
And I would say that the most important of all 3 things as it relates to having a partial colon removal is glutamine. Glutamine promotes the rapid replication of the cells that lined the GI tract. Now it just so happens that glutamine is also great for athletes because there’s nothing better for recovery of over exertion of muscles and therefore nothing better for reducing the likelihood of muscle soreness after athletic endeavors than glutamine. So somewhere in the neighborhood of 5-10 thousand milligrams of glutamine that is usually sold as a powder that you add to water. It’s essentially tasteless. You can even add it to a morning shake. You can put in water. You could add it to rice milk or almond milk. Almost tasteless. That twice a day. And I’m gonna… I’m gonna say that within week, if you are symptomatically digestively speaking, that you would see improvement right away.
So that combination: 1) adequate hydration; 2) probiotics; perhaps 3) digestive enzymes when you eat but that’s only when you’re having absorption issues, that is a tendency for GI upset, gastritis or belching or gassiness after eating. Provided those are not a problem, I wouldn’t by any means suggest that you would add that. But definitely something containing glutamine. I know that more than thoroughly probably answers your question. If you have any request for twiddling that down, please do ask.
Prebiotics vs Probiotics
Glenn: Thanks, Will. I’m curious about probiotics and prebiotics. You mentioned the probiotics and you gave some examples of what to look for. Are there any bad ones out in the market? Is there any way to tell? I mean you may not know any brand names but is there any way of looking at the bottle of one’s more worth it than the other?
Will: There’s a few ways you might ascertain whether or not you are getting a good probiotics. One, expiration date. Two, whether or not it’s’ refrigerated. Not all probiotics have to be refrigerated. That is they remain bio-inactive until you consume it. And then when it warms up body temperature, the bacteria begins replicating and becoming active. But you’re more assure of that if you buy a refrigerated probiotic.
Glenn: So it’s a liquid then?
Will: No, it doesn’t have to be. It can be an encapsulated or a freeze-dried but refrigerated probiotic. And that’s still more likely bioactive or at least, you are more assured that it’s bioactive.
Will: Especially if it does have an expiration date on it. And many companies will literally independently certify that the bio availability and the quantity of bacteria within their supplement outside of their own lab, and that’s an almost guaranteed way to assure that you are getting a live, concentrated, bioactive probiotic. So also you want to pay attention to quantity. Some will have one or two hundred million live bacteria per dose but there are some now that have over a hundred billion live bacteria per dose. Don’t try to count.
Glenn: That’s a lot. That’s all zeros.
Will: That’s a lot of bacteria. And yet, bear in mind that there is more than ample research that showing many beneficial properties to your health by taking probiotics. And I don’t even mean just to digestive health. You know two-thirds of your immune system is contained within the GI tract. You have so many mechanisms occurring within your GI tract affecting your immune function even to the extent that we now know that there are particular bacteria within probiotics that have particular effects on your immune system. For example, I carry a type of probiotic that is specifically to aid upper respiratory immune functions. It’s called immune booster. And those who take that, one a day, will almost state that “Wow, every single December I get sick. And I took that stuff starting in November and I didn’t get sick this year.” And I’ve had many, many people convey that. So it’s really quite incredible how many independent pieces of researcher coming out showing that probiotics really can be critically important to your overall health.
Glenn: That’s great. Thank you for that information.
Glenn: I have another question too. What the difference between prebiotics and probiotics?
Will: A prebiotic is typically a food that promotes more growth of the probiotics or the natural flora of the intestines. So for example, there is a type of long chain sugar called fructooligosaccharides or FOS which you can actually take supplemenatlly that promote good probiotic growth. Fiber tends to improve floral growth in the intestines. That would be considered therefore a prebiotic. There’s a type of fungus called saccharomyces that promotes increase floral growth in the intestines. So that would be considered a prebiotic. And that could be amazingly effective at terminating a very chronic and severe case of diarrhea by taking that prebiotic.
Glenn: So that fructooligosaccharides will not increase the growth of Candida?
Will: No, not in the least. No, that is not a sugar that Candida will thrive on. It much prefers simple sugars which is why someone with a chronic Candida Infection is advised to go literally sugar-free in their diet relative to all refined sugars.
Glenn: Right. Right. Yeah, and that’s why I asked that question ‘coz those—
Glenn: –other sugar names. Alright. Well, thank you very much, Will.
Will: Yes, indeed.
You Might Also Like
- Ep 69 Wednesdays With Will – Digestive Health
- The Truth About Candida Overgrowth
- Ep 64 [WWW4] The Benefits of a Periodic Cleanse, Weight Loss
Ask Will A Question
These special Wednesdays With Will episodes are a series with Dr. Will Harden, chiropractor, creator of the Dr. Will Bar, and health and fitness guru. He will discuss health, fitness, nutrition, and chiropractic issues that have the potential to improve your health and life. Dr. Will Harden has been a chiropractor for 26 years. He graduated first in his class from National College of Chiropractic in Chicago, IL and moved to Portland, OR in 1989 and owns a practice called the Corbett Hill Wellness Center.
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