Knee pain is usually the result of stiffness brought on by inactivity or immobilization of the knee joint.  Many who suffer from osteoarthritis complain of joint stiffness and pain.  Knee pain is especially felt when bending over or squatting.  So what can one do to alleviate stiffness and the accompanying pain that results?  Losing body weight will certainly help to reduce the load placed on the knee joints.  Each pound of body weight lost subtracts four pounds of pressure on the knee joints.   Performing joint movements will  certainly help lessen joint stiffness.  Exercise will help to lose body weight and increase joint mobility.   As a result, exercise can also bring relief from pain.  The key is to perform exercise on a consistent basis (i.e., at least 3 times per week).  Since exercise initially tends to cause knee pain, most people would rather avoid it.  But this is a mistake!  Not being active will only exacerbate stiffness, pain and immobility.
     So what exercises should you do to bring about relief from knee pain?  Any low-impact aerobic exercise such as swimming, biking, walking, and water aerobics are ideal.  Aim for 30 minutes of low-impact aerobic exercise on most days of the week.  Strength training is also highly recommended.   Try Tai Chi, yoga and exercises like leg extensions and leg curls.  Stretching every day is essential to reduce joint and muscle stiffness.  Perform quad, hamstring and calf stretches daily.  Be sure to hold each stretch up to 30 seconds and repeat two to four times.  Refer to the exercise portion of this blog for how to perform certain stretches.  Most importantly, listen to your body and know your limits!  Never push through bad pain!  Apply an ice pack to an aching joint for up to 15 minutes to reduce inflammation.   Taking a nice hot bath may also relieve sore joints.          

     When you lose bodyfat a whole multitude of positive healthy outcomes takes place including:

• Reduction in migraine headaches
• Decreased cholesterol levels
• Decreased bodily inflammations
• Decreased risk in fatty liver disease
• Lessening of metabolic syndrome
• Decreased risk of type-2 diabetes
• Decreased risk of polycystic ovarian syndrome
• Reduction in depression
• Lessening of obstructive sleep apnea
• Reduction in asthma
• Decreased risk of cardiovascular disease
• Decreased risk of hypertension
• Decreased risk of GERD (Gastrointestinal Esophageal Reflux Disease)
• Reduction in urinary incontinence
• Decreased degenerative joint disease (e.g., arthritis)
• Reduction in gout risk
• Decreased mortality
• Increased quality of life

     BOTTOM LINE:  Exercise and a healthy diet can resolve many chronic conditions plaguing  humans today.  Instead of reaching for quick-fix medications which may have side-effects, reach for a dumbbell and eat your broccoli.  

     The answer is simple although the people who use these machines probably are not aware of why they use them.  The reason people tend to opt for the elliptical machine rather than most other machines is because it's very easy on the joints and does not require much resistance to move the body.  In other words, the elliptical machine is the easiest cardio activity to do.  Because it is easy, people naturally want to use it rather than to try a machine that might take them out of their comfort zone.  
    The elliptical machine can be very useful for older adults or those with arthritis, but for most people it's not a very efficient tool to burn calories.    The winner in the caloric expenditure department goes to the treadmill, followed by (from highest to lowest caloric expenditure) the stairstepper (stepmill), the rowing machine, the upright bike, and finally the recombinant bike. 
    The reality is that, in general, the elliptical machine does not elevate the heart rate nor does it burn bodyfat adequately.   This is due to the fact that movement on these machines relies primarily on momentum rather than resistance.  Momentum is simply the product of a body's mass and its velocity.  Just as in weight training, if you move the joints quickly (increasing velocity), momentum increases while resistance decreases.  The net result is essentially less real work being done since less force (resistance) is exerted.  Now you know why people like to move quickly on the elliptical machines:  it makes the exercise easier!  
    No matter which machine you choose, be sure not to lean most of your bodyweight on the hand rails for support.  These railings are designed for your balance, not for support.  By leaning predominantly on these railings, you'll reduce your caloric expenditure because your lower body will not be working as hard as it should.   Straighten your posture by pulling your shoulders back and looking straight ahead.  Rest your hands lightly on the rails to get an optimum workout.   If you still cannot resist leaning heavily on the rails, you need to reduce the intensity on the machine--you're pushing way too hard.  On the other hand, if you can read a book or comfortably breathe through your nose while doing cardio, your intensity level is way too low.  Step up the intensity!
    
    Bottom line:  if you want to burn serious calories, you have to work hard to do it--sorry, working out on the elliptical machine does not qualify, in most cases, as hard work.  Get out of your comfort zone and hit the treadmill, stairstepper or rower instead.

    In order for your joints to last a lifetime you need to take care of them now.  How?  Here are some tips:

• Lose weight if you're overweight
  

    Joints get overburdened with too much stress when excessive amounts of weight are put on them.  By losing some bodyweight, you'll remove some strain on your joints such as your hips, knees and back.  Every pound you lose can take off four pounds of pressure from your knees. 

• Stay active by exercising

    Regular exercise helps to maintain joint function by strengthening surrounding muscles, reduces stiffness by the secretion of lubricating fluids within the joint capsules, and relieves fatigue.  The important thing is to move!  The more you move, the less stiffness you'll feel.  That means if you're sitting for periods of time (i.e., watching TV, reading, etc.), be sure to move around to keep your joints engaged.  Choose low-impact exercises such as swimming, cycling, walking, rowing, dancing, light weight-lifting, etc.  Like your muscles, bones respond to exercise by growing stronger.  Stronger bones means less risk of fractures.  Other benefits of exercise include improved flexibility, a healthier heart, better ability to perform daily activities, increased sense of well-being, reduced stress, improved mood, increased energy, and better sleep.

• Be sure to stretch daily

     Stretch each joint through its full range of motion to reduce stiffness and maintain flexibility.  Be careful not to stretch beyond what feels comfortable.  

• If you smoke, stop!

    Smoking can make treating arthritis more difficult and therefore allow more joint damage.  

• Use assistive devices (e.g., cane) as needed

    These devices can reduce joint stress, particularly at the hip or knee.  

• Apply ice for your joint pain

     The ice will numb the pain and relieve swelling.  Be sure to wrap the ice in a towel to avoid direct contact with your skin and apply for no more than 20 minutes at a time.  A frozen pea bag wrapped in a towel works great.

• Use your larger joints to do more work

    Avoid placing excessive strain on any single joint by using your larger, stronger joints.  Examples:  carry shoulder bag rather than handbag; carry grocery bags in your arms near the body rather than clutching them with your hands; hold small items in your palms rather than your fingers; use your body or both hands to open heavy doors rather than one hand; and hold items with two hands rather than one.

• Practice good posture

    Proper posture spares joints like your shoulders, hips, and knees by protecting them.  When lifting, be sure to keep your back straight, spread your feet apart, and bend at your knees and hips (not your waist).  When sitting, keep your feet flat on the floor and your knees and hips bent at about a 90-degree angle.  Sit upright and lift your chest.  Swimming can improve posture.

• Eat healthy foods

    There is more and more evidence that Omega-3 fatty acids found in fish (e.g., salmon, mackerel, herring, tuna, and sardines) and fish oil supplements can alleviate inflammation at the joints.  Don't forget about calcium and vitamin D as well.  Both of these micronutrients are essential for strong bones and healthy joints.  Older adults need more calcium and vitamin D (1200 mg of calcium and 800 IUs of vitamin D daily).  Besides milk, good sources of calcium include kale and broccoli.

     Contrary to recommendations in the past which indicated rest, nowadays exercise is considered better medicine for those suffering from arthritis.  Why is this?  Because exercise helps to reduce joint stiffness and pain.  For those suffering from the debilitating symptoms of arthritis, it's imperative to resist the urge not to exercise!  Why?  Because being sedentary will only make your symptoms worse such as more stiffness and pain.  Exercise serves to strengthen muscles and protect joint integrity.  Contrary to popular opinion, exercise will lessen pain, increase mobility, and help control your bodyweight.  Here are recommended exercise guidelines for those with arthritis:

• Consult with a physician before exercising
• Begin exercising at a conservative intensity level
• Get adequate rest between exercise sessions
• Consider exercising at least twice daily
• Have a structured exercise plan (e.g., time and place)
• Exercise during the latter portion of the day (i.e., less joint stiffness and pain)
• Exercise using full range of motion at the joints to increase flexibility

• F:  resistance training:  2 to 3 days/wk; cardio training:  3 to 5 days/wk

• I:  resistance training:  less than 90% 1-RM (3 to 10 reps/set); cardio training:  40 to 60% HRR

• T:  resistance training:  15 to 30 mins (8 to 10 exercises); cardio training:  5 to 30 mins

• T:  resistance training:  focus on muscles surrounding affected joints, isometric exercises, yoga, stretches; cardio training:  walking, swimming, cycling, rowing, stair stepping