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My dad is 60 this year, he has been running at least 4-6 times each week for past 10 years. He usually ran 10km and occasionally 20km, but has reduced to 5km distance ever since his knee injury. He had seen a sports doctor long ago and was told that he had some issues with the ligaments in his knee(he forgot what the doctor told him exactly). Now, he complains about feeling discomfort/pain on the front/sides/back of the knee. He does standing heel to butt stretch, squats and forward lunges to try to strengthen the knee.
What should he do to heal his knee? He isn’t keen on seeing a sports doctor again because he thinks that the doctor is just going to prolong his consultation sessions unnecessarily and make him pay more than he should.
Dear Aaron, thanks for getting in touch! I think my colleagues have given you excellent answers, and there is plenty to work off at present.
When I read about your dad’s case, there are some things that come to mind.
Firstly, how long ago did he injure (if indeed he did) his knee? If it’s not in the too distant past, then most polyclinic doctors should be able to access the scan report (via the national electronic health database) and advise you on the nature of the injury. This in turn may prompt you both to take up a particular course of treatment.
Also, there may be some mileage in seeking an opinion from an independent physiotherapist who might be able to give some straight forward exercises.
Equally, I often refer patients with chronic, grumbling knee pain to our in house TCM acupuncturist – it’s not for everyone but if it helps then I believe it’s an option.
Other options include ultrasound therapy, over-the-counter medication as needed and finally looking at alternative sports.
Cycling and swimming are great ways of keeping fit. If your dad has a competitive side, he might even sign up to a duathalon or triathalon.
Overall, I think there is lots that can be done with knee pain now, and it really depends on what his aims are.
Sport Medicine Consultant
I see many seniors who wish to remain active and enjoy running. Unfortunately many in this age group have degenerative change and osteoarthritis in their knees and other joints. This is often due to several factors like a previous injury, genetics, and mechanical wear and tear over time.
I often explain to my patients that their knees are like the moving parts of a car engine. Over time the parts may wear out, particularly if they are used for heavy activities such as long distance running. To help with symptoms, physiotherapy exercises to strengthen the quadriceps muscles (at the front of the thigh), weight loss and sometimes joint injections may be prescribed by your doctor.
Sometimes however the damage is so severe that your doctor may recommend replacing part or all of your knee joint.
I would suggest to your dad to consider taking up another activity such as brisk walking, swimming or cycling which has less impact to the knees.
If he does insist on running then an elliptical trainer in the gym may place less stress on his joints.
Dr Alan Cheung
Consultant Orthopaedic Surgeon
Hello Aaron – I’m in awe of your dad! Kudos to him for his commitment to keeping fit and healthy. If only the rest of our population could do that – we would certainly have much less people in hospital.
In the absence of any other information leading up to his knee injury (ie did he suffer any knee trauma, suffer a fall while running, hear a pop and twist his knee etc), his injury sound like it’s training volume-related, or an overuse injury – he’s clocked up quite a lot of miles, and it seems like even with his injury, he hasn’t actually held off with his training. (Reducing the load is not equal to rest).
Unfortunately, doctors will be unable to diagnose your dad’s injury without examining him and from the limited history you’ve described.
What should he do to heal his knee?
At this point, the most immediate thing is that he should really lay off his running and give his knee some proper rest. I know that it’s probably not the news he’d be best pleased to hear!
Even exercises like squats and lunges are likely still to be stressing the knee (although your dad is absolutely right in that he needs to strengthen the knee, and it may even be prescribed as part of a rehab programme) – he should lay off this for now as the pain is still on-going, unless he had been specifically instructed to do these exercises by his previous doctor.
If he needs to keep up with the cardio, I’d highly recommend that he switches over to a low impact sports like spinning or swimming for the time being.
He isn’t keen on seeing a sports doctor again because he thinks that the doctor is just going to prolong his consultation sessions unnecessarily and make him pay more than he should.
I can understand when patients do not want to go back to a doctor – it may just be a lack of rapport, lack of trust, failure in seeing any improvement after treatment etc etc.
As a first step, I’d still encourage you and your dad to see the same doctor together to highlight and explore these problems. Especially with the older generation, I sometimes find that patients are not satisfied with a consult because they feel the doctor doesn’t address their main problems. The issue with that is older patients sometimes don’t bring the problems up in the first place, unless specifically asked!
If he’s adamant that he doesn’t want to go back, then the next best thing you can do is to ask for a copy of all the medical records and images that have already been done, which will help greatly if and when he decides to see a different doctor for the same problem.
If cost is an issue, he can obtain a polyclinic referral letter to visit the sports medicine specialists at CGH; besides sports doctors, they also have physiotherapists who will be able to work with your dad in a comprehensive rehab programme.
If he DOESN’T want to see any more doctors, the next best thing would really be to visit a physiotherapist to structure a proper recovery and rehab programme for him. This is not ideal as they will not know his medical issues.
He shouldn’t return to his old level of activity again until:
- He can fully bend and straighten his knee without pain.
- He feels no knee pain when he walks, jogs or jumps.
- His knee is as strong as his uninjured knee.