IFA News and Opinion
Issue Date:  August 1, 2003

Knee Joints

The knees provide stability and support for motions like walking, and running. The knee joint system is composed of various supporting and moving parts, including bones, cartilage, muscles, ligaments, and tendons. Knees can develop two types of knee problems, mechanical or inflammatory.

Mechanical knee problems result from injury, such as a direct blow or sudden movements that strain the knee beyond its normal range of movement. Other problems, such as osteoarthritis in the knee, result from wear and tear on its parts. Inflammatory damage occurs in certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus.

Bones and Cartilage

Three bones form the knee joint, the tibia (upper leg bone), femur (thigh bone) and patella (knee cap). Each of these three are covered with articular cartilage, a tough, elastic material that helps absorb shock and allows the knee joint to move smoothly. Separating the bones of the knee are pads of connective tissue called a meniscus (muh-NISS-kus).

The two menisci (muh-NISS-sky) are divided into two crescent-shaped discs positioned between the tibia and femur on the outer and inner sides of each knee and act as shock absorbers, cushioning the lower part of the leg from the weight of the rest of the body as well as enhancing stability.

Tendon and Ligaments

The quadriceps tendon connects the quadriceps muscle to the patella and provides the power to extend the leg. Four ligaments connect the femur and tibia and give the joint strength and stability:

  • Anterior Cruciate Ligament (ACL), center of the knee, limits rotation and forward movement of the tibia.
  • Medial Collateral Ligament (MCL) provides stability to the inner (medial) knee.
  • Lateral Collateral Ligament (LCL) provides stability to the outer (lateral) knee.
  • Posterior Cruciate Ligament (PCL), center of the knee, limits backward movement of the tibia.


    Both the meniscus and the ACL are easily injured by the force of rotating the knee while bearing weight, also known as "torqueing the knee."

    The PCL is usually injured by direct impact such as an automobile accident.

    The LCL and MCL are often injured by an outer (lateral) impact to the knee.

    Tendon injuries range from tendinitis (inflammation of a tendon) to a torn tendon. This is usually caused by overuse, in which the tendon stretches like a worn-out rubber band and becomes inflamed.

    To read more about knee injuries including symptoms and treatment, go to Knee Questions and Answers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse website.

  • Travelling

    Not all hotels are created equal. I have developed a sort of paranoia about hotel stays. As they say though, "Just because you're paranoid doesn't mean that no one is after you."

    Hotels sheets and pillow cases are usually changed everyday and after a guest leaves. However, it is fairly well known that bedspreads and blankets are not. You can request on check-in that you be provided with cleaned items. Carpets are usually vacuumed. However, never go barefoot in a hotel room. It's basically the same as going barefoot in a public locker room. Wear sandals or slippers when you get out of the shower.

    I rarely go into hot tubs or pools for various reasons. Firstly, I never quite accepted the idea of a hot bleach bath, especially when there are various microorganisms that thrive for days in such tepid conditions. Cryptosporidium is usually the word for the day. I had one General Manager of a luxury hotel comment to me that they check the pool and hot tub every morning. However, by 4 PM the pH was always off due to urination. See Safe Swimming. He also told me to be careful if I ever smelled too much chlorine in a pool, they were probably trying to kill something. However, what if you don't smell the chlorine? Could it be that they haven't checked and treated the pool yet?

    I'm not advocating to never go into a public pool. Our bodies are under a daily onslaught everyday from airborne as well as waterborne microorganisms. Always shower with soap after a stint in the pool or hot tub. Open cuts are especially susceptible to infection. Think of as taking a intimate bath with complete strangers. I mentioned my concern to my doctor. She admits never getting into a hot tub for reasons that I can't pronounce, however, her fiance (also a doctor) readily does indulge.

    Auto Accident

    Since we are on the subject of travelling, have you ever driven for a long period of time and it feels like you've been in an accident but the car is fine? It usually has to do with the way we sit for long periods. Some cars have lumbar support, which helps. However, try sitting up straight with your back in full contact with the seat. We develop a sort of kyphotic tilt sitting for long periods. Shoulders and head drooped forward can not only cause lower back discomfort but headaches as well. Keep a loose grip on the wheel. After a while we tend to tighten our grip on the wheel as if we were trying to bring a DC-3 in for landing in a hail storm. This ads to the fatigue. Relax, drink plenty of fluids and make regular stops to stretch it out.

    Knees are usually well tucked and torqued. Remember, no matter which way your knees are pointing, the toes should always be pointing in the same direction. You should also be aware of the hazards of disrespecting the airbag. In my travels, I have seen a few passengers, especially with the warmer weather, riding with their feet up on the dash. I'm sure that it is comfortable and breezy. I wonder what a crash dummy would look like after an airbag went off. Would it fold the crash dummy's legs around it's ears or would it be completely unrecognizable as a dummy?

    Enjoy the summer and drive healthy.

    Q & A

    Q: Last weekend I ran my first full marathon. I followed a training program prior to the event that has a huge sucess rate. Anyways, during my training I had no injuries, I completed several long runs of up to 20 miles and felt great. Near the end of my training I was averaging over 35-45 miles per week. I had run a few 1/2 marathons prior to this and had no problems. The week prior to the full marathon, we tapered our running. Well on mile 18 I had a pain in my groin. After wrestling with the pain I decided to walk it in. The next day I went to the doctor's and had an x-ray done on my pelvis. It appears that I have slight fractures. Thanks.

    A: This is the result of overtraining. Many training programs push to the excess. Any sport to excess will wreak havoc on the body. The goal then becomes to win not to maintain a healthy body. Once damage is done and ignored, it can become chronic. That means it will last maybe forever. You will not only no longer win but you will no longer be healthy. Excesses are bad whether they are smoking, drinking, working or working out. They are the result of personality misadjustments. Something is out of balance. Use common sense. Humans were not meant to run 20 miles a day over long periods. first of all we are bipedal, not an indication of adaptation for speed or balance.

    Q: It appears that the Cyber Trainer™ gives inaccurate information regarding the amount of calories that should be disributed to one who is trying to reach a particular goal. For instance, if you were to weigh 165 lbs, you would need to eat at least 1650 calories a day excluding the amount of calories to be eaten in addition to those calories needed to burn energy. I also suggest that you have a break down of how many calories per meal in addition to what is needed for weight loss according to protein, carb and fat intake. It is those numbers which make the nutrition part of any excercise program accurate.

    A: The minimum safe calories per day recommended by the American College of Sports Medicine and the USDA is 1500 calories per day. It is generally believed that going below this amount wreaks havoc with the basal metabolic rate. In addition, we don't break down the calories per meal so as to leave you some flexibility. Some people prefer to have the bulk of their calories at lunch time others prefer to spread it out over the day. It also varies according to culture, country and even the shift that you work. I prefer to eat the meal with the least amount of calories at dinner time. However, dinner engagements will throw that schedule off. Many people choose to eat six meals or so a day just in smaller quanitities. So we leave the flexibility to you. There is enough regimentation in our daily life as it is. Eating should be a time of relaxed enjoyment without overindulgence or guilt.

    Q: I taught my first class and it was miserable. I really feel like I failed.

    A: Failure is only a deterent to the weak minded. Many great people failed miserably at first. The only difference is that they tried again and learned from the experience. There are no mistakes, only lessons learned. The fact that you attempted such is commendable and very rare indeed. Most first classes are expected disasters. Teaching is not something you can take a test and expect to do. It is a process by which you continue your learning experience through another senior level instructor. It is standard in the industry to have a senior instructor bring you up to speed. Most instructors are more than willing to help.