 This is John Vreslin with you on Around the Northwest. It's time to talk knees we all have a couple and They invariably give us bother at some stage When we're younger that tends to be injuries of one sort or another and then as we go on a bit in the years It can be osteoarthritis or you know other ailments, but Johnny Lowry hopefully is going to put us right on perhaps how we can and sort of front-load and how we can Work towards Not just easing the problems when they arise but also maybe avoiding the problems and they're not getting there in the first place So Johnny and I joined us on the show Johnny. Good afternoon. Afternoon John. Thanks for having me Yes, you are indeed. How are you John? Good. Thanks. Good. Thanks. Yeah, we're live on socials as well By the way, just if anybody wants to tune in and by the way if anybody wants to get in touch You've got a problem with your knees or if there's something that's in niggling you in Particularly in that department then let us know and then maybe we'll be able to help out but Any problems? Very common John. Yeah, it's one of the most common things we'd see in a clinic aside from probably backs and necks You know, we know kind of knee injuries are very prevalent We know kind of from the research about one and three men and one and two women will experience knee pain You know and the incidence increases with age as well So most of those particular figures are in people above above 50 But you know, we know kind of we can get knee injuries like sprains and an impact injuries and different things like that Or we're going to talk about today. It's just those kind of more generalized Types of knee pain that we'd see frequently in the clinic and those kind of from middle middle-aged and up So because When we have a problem with our knee the first thing we think oh, what did I do that? I twist it or you know that I overwork it and sometimes it might not Might not be the case and it might just be something creeping up and you like rusty or arthritis Especially, you know if they're moving on years. Yeah, and where there's not kind of an obvious thing It can often be like a supposed multiple little factors that are all merging in together And those are probably the more frustrating injuries for people if they can't link it back to something specifically You know, they come in and say look this pain has been getting a little bit worse for for a number of months I can't think of what I did to actually hurt the knee And there there are a number of different knee conditions that cannot present like this as well So we would have Probably the most common one aside from osteoarthritis would be a thing called patellar femoral syndrome Where your kneecap Has a little groove in your shin bone and a groove in your thigh bone and it's designed to track Up and down through there when you bend and straighten your knee and so if there's any little issues with that It can give you kind of generalized pain to the front of the knee as well And I mentioned before just the osteoarthritis thing which obviously, you know None of us in life can avoid wear and tear as we as we get on in the decades Decades start to accumulate so that would give you more kind of pain then and around the inside and outside of the Knee joint and again those both those conditions It can be very difficult for people to kind of trace back, you know, why they started And for both those conditions ultimately does it does it lead to a knee replacement or an intervention to leave the surgery? and you know cancer G be successful without Needing a new replacement So the the osteoarthritis thing definitely would kind of be the one that would just as kind of the years go on lead to Possibly the likes of a partial or a or a complete knee replacement total knee replacement So that would be where the the joint basically it's like an engine in a car where it kind of runs out It's been nearly and and over time. It's it's not able to do its job because it's so kind of There's so much deterioration there so that that would be where you would get the replacement There are other types of surgery as well when there's kind of I suppose a lesser degree of wear and tear they have a menisectomates called where Say for example, if you have the meniscus if you imagine like a ham sandwich and the ham is the is the inside filler When you have two bones in the knee you have like a meniscus, which is a spongy kind of cartilage type substance in the middle you can get little tears in that And up to 50% of us walking around every day will have little tears in it and have absolutely no issues and the majority of those can be treated with physiotherapy, but sometimes if there's a It's called a bucket handle tear if you imagine a smooth surface If the surface is no longer smooth and it's almost like a fingernail that's kind of sitting And it's not congruent and it's creating clicking or locking A surgeon kind of has two options there where they can either go in with nearly a little set of clippers and and clean off the surface there to make it smoother Or the other option is they can actually stitch it which which is a longer recovery time but they try and kind of not take the the meniscus out but Just repair it a little bit the patelefemoral type stuff I was talking about earlier with the kneecap typically in Nearly all scenarios we we manage that with physiotherapy just and there's no surgery needed for that type of knee pain Well, I was that soldier because I've had I've worked on on both knees and everything from torn cartilage to A full ACL repair and Lump removed in another knee the so-called good knee. So, you know, I've been down the surgery route but the It can be it can be irritating. I've found that If there's a problem you need especially if you've lost maybe a little tear in the cartilage it can go from Something as simple as irritating to very painful or even your knee locking up Yeah, yeah, they can progress and that's why it's you know, it's important when you identify that there's an issue there to Uh to get it looked at and and seen because like you were saying there depending on the on the presentation Some things can can kind of go downhill a little bit quicker and when you catch these things earlier Say if there is a little minuscule tear that needs to be Treated the sooner kind of it's it's looked at the better Early intervention is always is always best and in most cases There's kind of nice simple things we can do and in daily life even to take pressure off the knee You know, I've kind of got a little list of things that we can go through But if we talk about kind of overall pressure on the knee, there's a there's a few kind of simple bits of advice that we can That we can use to try and try and take pressure off the Let's talk about them. I suppose the the obvious one is, you know, try and try not to have excess weight on because More weight we have on more pressure. We're putting on our knees Yeah, like we we know when we're doing anything and we're just using running as an example But if I go out and jog up to between three and five times my body weight has to be absorbed through My knees with every step. So if you think about the average person might take 80 to You know 70 to 80 steps on each leg and every kilogram of body weight that I that I have has a huge impact on how much Pressure my knees are going to be under. So, you know, even when we talk about body weight there We're talking about adipose tissue. So kind of fatty tissue So if you put on a kilogram of muscle, you know that that muscle will give you strength and help you Whereas it's really the the extra kind of body fat if we can, you know Lose it, you know, even up to a kilo of that it ends up taking a lot of pressure off the off the two knees over the course of a whole day What other measures can we take to uh, you know to try to ease the pressure on our knees or over the years over You know sort of day to day So day to day What we would kind of be Preaching I suppose in the clinic is to increase activity Slowly and consistently so the body doesn't like kind of sharp changes to lifestyles at all So if you're taking up kind of a new sport or you're trying to get involved in more exercise Um, just to be looking at kind of introducing that, you know In a in a slow and consistent way, whether it's walking or cycling or or running or swimming or doing whatever it is So trying to avoid kind of sharp increases or decreases in what we're doing That gives the body a chance to adapt and get used to the load that we're under Um and I mentioned running there But you know often people think that you have to stay away from from impact in order for the for the body to be I suppose healthy, but what we know from the research is that If you don't use it you lose it so uh to a large extent when we keep fit and we keep strong And even exposing the body to a little bit of impact isn't isn't a bad thing at all You know where it's where it's appropriate because it keeps the joints nice and nice and fresh and healthy And and kind of trains them to be able to cope with that type of load And I suppose you need to look at how you're doing activities as well So if it's an activity that involves a specific technique or something that you're looking And maybe get get involved with a coach or get a physio to look at the way that you're doing things To maybe take a little bit of pressure off the knees whether it's uh You know squatting or lunging or cycling or doing different things Um, so make sure that you're doing it in the correct in the correct way Um, we know strength is massively important So, you know engaging in strength exercises and the bit of flexibility Um, you know training is really important for keeping the knees healthy as well Uh, and and I suppose just being smart about what you're doing So, um, if you have a pre-existing knee issue that you know is there, you know Get a bit of advice about you know, what type of exercise you should be doing or what type of sport you should be doing whether whether, you know Exercises that involve a lot of impact or appropriate for you or not as I say to some degree They're they're definitely important to be uh integrating into things when it's when it's appropriate But you know, everybody's different so and your own knees might not be able to Uh, to cope with that. So just being being smart about what you're what you're putting the knees under a common sense approach And and keeping and keeping the the knees strong Important as well Someone says I ran a marathon at the weekend on the 23rd mile. I hurt the outside of my left knee I punished the marathon Um, if it's the outside of the knee one of the things that we would see a lot It's actually term runners knee But it's you've got an iliotibial band, which is basically a thick piece of connective tissue Um that goes from the outside if you're hip down the outside if your leg and attaches down onto The outside if you're off your knee there now without kind of seeing or assessing It's difficult to to diagnose and and you know But this would be on the if we're talking about pain and runners on the outside of the knee This would be the the most common one that we would see now Obviously in 23rd mile you're going to have done a lot of kind of bending and straightening of the knee and taking a lot of steps there Um, so I'd say probably the pace that you were running at and the distance that you covered just uh was a new experience for the knee You know and the likelihood is that it's an inflammatory response So the tissue has got a bit agitated and angry with you. Um, so the best thing to do there would be to reload it So obviously a lot of people post kind of marathon will go out for recovery runs and do different things like that I wouldn't advise running on that knee if it's sore in the outside Um, you could look at going to the gp and getting some anti-inflammatories Maybe just get in touch with you know a physio and get somebody to have a look at it and and give you a concrete diagnosis But in the meantime, I would be using a little bit of ice for symptom relief Um and just taking taking pressure off that knee and giving it a bit of relative rest And that applies I suppose the most injuries if you have a wee niggle that's come on or into your knee in any way Ice and rest is the first thing Yeah, yeah until you know until you know more about it I would say definitely if you're if you're experiencing a new type of pain that wasn't there before Um, you know, you're you're better kind of knowing why it's why it's happened there before you kind of push it any further. Yeah Finally, johnny a question about An Achilles injury and I'm gonna do it the knee. Well, they're probably nothing It's slightly torn Achilles, but it's very slow to heal any suggestions. Well, Achilles can be slow any attitude Yeah, and what what can often happen is um, because a tear is typically uh, you know a fresher type of injury. So Basically, if a if a piece of tissue is strong enough to tolerate a certain load and then we ask it to work harder Then it's it's strong enough to tolerate. You'll get a tear in a structure And and those so we would grade tears normally so it can say a grade one could be anything from seven to ten days A grade two anywhere from kind of four to eight weeks Um, you know, so they come in different stages depending on We don't kind of have an idea of how long this has been happening But when when kind of the injury is as long a lasting and can become chronic or there for a number of months What can often happen as it changes into a thing called a tendonopathy? So rather than the tear being a problem, it's now the fact that the tissue is weak and painful Um, you know as a result possibly if a tear air layer on but the best way to treat that would be the likes of Uh a progressive strength program So actually retraining the tendon to be able to To tolerate more with the likes of you know, heavy heal raises and and getting the tissue in the Achilles Nice and strong and robust and you can do other treatments for pain relief in the interim And shockwave therapy is also very effective for it as well. But I'd say if it's their long term And really it's not the type of thing. You'll kind of rub your way out of pain You're going to have to exercise that tendon and make it make it nice and strong Okay, okay. Well, that's helped the listener and thanks johnny knees We uh in order what stage in life and no matter how active we are We all need them and we need them in good shape. So like after an easy only we only have the two of them and Thanks, thanks a million for uh, sort of for the advice appreciate it. Johnny a little bit from jt. I said, thanks johnny. Thanks john Chef, why not treat yourself to a spot of lunch today at kelly's diner in that mechanic? Good man, john. Thanks for having me on and a lunch served to you at this award-winning family diner We discover lunch time Thanks, johnny Thanks john. I appreciate that. No problem. Look after yourself