NATIONAL8 (Spotlight Weekly]

Joint Action

Proper exercise, nutrition and rest provide the best treatment

By AKSHAY SHARMA

You may be tempted to get out your running shoes and become a 'weekend warrior' after months of being sedentary. However, if you do too much too soon, you could pay for it with knee pain, either due to a new injury or to a previously existing condition.

Athletes : For better health

Several rehabilitative exercises can prevent injury of the knee joints and help rehabilitate a previously injured knee, according to experts. Although a plethora of painful knee conditions exists, a high percentage of the problems seems to originate from the patellofemoral (PF) joint, say experts. This is the point at which the patella, or kneecap, joins the femur, or thighbone. So-called knee-strengthening exercises are designed to strengthen the muscles surrounding this joint.

Some of the problems that can cause a painful knee joint include soft-tissue injuries to the muscles, ligaments, or tendons, muscle imbalance, and tightness of the soft-tissue surrounding the joint. Pain that increases during or after exercise is not normal, say experts.

Dr. Prateek Lohani, an assistant professor of physical therapy at Tribhuvan University, says the exercise program should contain a combination of elements that strengthen and stretch the specific muscle groups involved.

Experts caution against focusing on the aesthetic goals of an exercise program without considering the impact on the body. This approach to fitness can lead to overworking the body and injuring a joint.

"We change our exercise regimen because we need physiological changes. We want to burn more calories, or create more muscular bulk," Dr Lohani told SPOTLIGHT. "When we change our regimen, though, we're also going to change the effects of the exercise on our joints and muscles. This physical impact has to be taken into consideration while we're working toward our goal."

Nabin, the manager of therapy services at the Everest Nursing Home, stresses the importance of making changes in small steps. "For example, don't add a new exercise, increase the number of repetitions, and increase the weights at the same time. For runners, this same principle applies to adding miles to a run. This way, you will know which one was too much. If there's pain, you need to know what is causing it, and you will only know if you add one factor at a time to the workout."

Osteopathic medicine is often advanced for such injuries. "Osteopathic physicians are taught to look at the body as a whole. Therefore, in addition to meeting all the requirements of traditional medical schools, we also have incorporated into our program 200 hours of osteopathic manipulative medicine," says Dr. Hira Tuladhar.

Dr. Lohani says the most common sports injuries evaluated in emergency rooms and doctors' offices are low back pain, knee injuries, shoulder injuries, foot and ankle as well as wrist fractures and strains. "Low back injuries may be seen in all types of sports, usually in the weekend warrior, and people advancing in age, after the age of 20."

If you have abnormal swelling or pockets of fluid that can easily be seen or felt, you should see a physician. "If the pain does not slowly go away with home treatments, that means it's time to see the doctor," says Dr. Basanta Silwal, of the Himlayan Nursing Home.

Dr Cavindra Shrestha of the Everest Nursing Home says, "Although I am not a surgeon, and my opinion is thought biased, many orthopedic surgeons will try to operate on these people. Usually conservative management including ice, rest, an anti-inflammatory and a good physical therapy program will often help their symptoms."

What about cortisone injections into the joints? "I have used cortisone injections in my training program as well as in my practice," says Dr. Silwal. "I use them only after the basic treatments have been addressed. I do not have objections to using these medicines although I myself am very conservative in their use."

After minor injuries, is it safe to return to the game when the pain stops? "This is a tricky question," says Dr. Silwal. "Most people are able to return after brief periods of rest, although remember that most sportsm injuries that do not require surgery do require ëdown time' for the body to heal itself."

What is the best way to prevent sports injuries? "Make sure your body is in optimum health including rest, proper diet, a stretching program as well of the use of a good multi vitamin with minerals," says Dr. Shrestha. "Make sure you drink copious amounts of water."

Ultimately, a good strengthening and relaxation program incorporated with diet, sleep and proper nutrition could help you go a long way.