Exercises for strong bones

Many complain of pain in the morning while getting out of bed or going up and down the stairs. The pain goes away with rest or when the knee joint warms up and gets moving. This is normal.

I’m 42 years old and I have been playing tennis for three years. I play on hard courts four days a week for one hour and warm up for 20 minutes. I’ve recently started feeling sore in my knees after playing. It is worse while descending a staircase. Though the pain goes away if I don’t play, I’m worried about long term damage. Please suggest exercises that protect the knees. Should I wear knee supports?
Sujit Bhattacharyya

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This pain sounds like anterior knee pain or patella-femoral pain, which occurs behind the knee cap. Many complain of pain in the morning while getting out of bed or going up and down the stairs. The pain goes away with rest or when the knee joint warms up and gets moving. This is normal. It happens because of an imbalance between the Iliotibial Band (ITB) on the outside of the knee and the quadricep muscle on the inside, called the Vastus-medialus Oblique (VMO).

The ITB has a strong action on the knee cap via the lateral quadricep muscle. So the pain is due to the quadriceps pulling on the knee cap in an unbalanced way. This favours the patella tracking excessively to the outside. Soon the underside of the patella jams up against the outer side of the groove in the thigh bone into which it slides. This leads to swelling and irritation.

The damage is not severe if the pain occurs only once in a while. It becomes a problem if the pain recurs regularly. It can be solved with a few simple exercises and a sports massage. Wear a knee brace initially to alleviate pain, but be careful not to start relying on it.

Get a massage
Get yourself a deep-tissue massage. This involves massage of the upper, outer and posterior thigh. If the therapist hits the right spots, it may be painful! The massage releases tension in the ITB and allows the knee cap to track normally. Hit the gym for knee strengthening exercises such as barbell calf raises, squats, static lunges, deadlifts, knee extensions and hamstring curls.

Apart from the last two, the rest are all closed chain exercises that utilise the muscles of the knee and strengthen the ankle and hip joints. Doing leg strength exercises thrice a week for six weeks will reduce knee pain. Have a look at http:// bit.ly/92yMk0 for a helpful self-treatment technique called Foam Rolling.

Foam Rolling
• Balance on your forearms and the palms of your hands with the top of one thigh on the roller.
• Roll from the hip, down the thigh to the knee.
• Perform the roll with either one or both legs on the roller.
• Experiment with toes turned in, out and straight ahead, much like the hamstring version

This query was answered by Heath Matthews, physiotherapist with the Mittal Champions Trust