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HOW TO WORK OUT WITH KNEE PAIN

So you're trying to do your Combat Endurance workout, but you're frustrated by a pain in your knee-it's keeping you from getting all the benefits you should, and besides, it hurts. How are you going to work around it, so you can get the most from your exercises? I'm going to teach you a few little tricks to relieve your pain, maintain your ability to exercise, and help you to heal.

First, you need to understand that we're talking about a chronic pain, not a sudden acute episode, which would indicate an acute injury, that signals that you first STOP what you're doing and then, rest, ice and elevate the knee. The first step is to identify where it hurts. This seems simplistic, but very often, when the whole knee is sore, it's actually hard to pinpoint exactly what part is causing the problem. So, first you need to try to determine in general terms if the pain is mainly in front, on either side, or in the back.

In general, if the pain is in front, the probability is the pain is from the kneecap. The inside or outside of the knee suggests a meniscal (cartilage) injury, chronic ligament sprain, or degeneration (arthritis). The back of the joint implies a Baker's Cyst, or strain of the hamstrings or calf muscles. This is too brief a forum to discuss each of these problems in detail.

In my experience, the vast majority of painful knees involve the kneecap. When the kneecap (patellofemoral joint) is the source of pain, several simple measures will help to give you relief, and are equally effective for knee pain from other causes.

• First, limit the depth of any squatting movements. Deep squats compress the PFJ an increase pain (see Figure 1). Stop short of the painful point in any squat.

• Second, in the short term, try to alter the path of the kneecap in its trochlea groove, with either a patella brace, or with taping (see Figure 2).

• In the longer term, do strengthening exercises for the VMO muscle. This will pull the kneecap inward, back into the groove, where the compression forces will be dispersed over a larger surface area. In other words, it won't keep rubbing in the same sore spot.

• Compression of the knee will reduce any swelling, or fluid buildup, and provide general support and comfort to the joint. An elastic or neoprene sleeve brace, or an ACE bandage wrap, is an effective method to do this (take care to wrap from the toes to above the knee if using an ACE wrap, to prevent a "tourniquet effect").

• OTC anti-inflammatory medications, like Advil or Aleve, are effective in reducing pain and swelling. Be sure to take them with FOOD or MILK, without fail, to protect your stomach from acid reflux, gastritis, bleeding, ulcer disease, perforation, etc. Obviously skip this step, if you already have any of these signs, stomach pain, or allergies to these medications. Also, don't take too many, too often. If in doubt, check with your doctor.

• Moist heat applied to the knee, for 20 minutes, 4-6X/day brings blood to the region and will help to soothe the pain and dissipate any swelling.

Follow these recommendations and you will be surprised at how well they work to relieve your knee pain, in the short and long term, and how they will help you to maneuver around that painful knee, so you can get the most from your workout for the rest of your body.