8. CMs: The open secret about maintaining health and achieving recovery

It is no secret that I believe it is critical to ones’ overall health and safety to avoid surgical intrusions into the knee to begin with.  Intrusions include those “Quick and easy”, “Simple”, “Just a cleaning” surgical strategies that require incisions and insertions of metal ranging from exploratory arthroscopies to partial knee, total knee and eventually, revision knee replacements.  Successfully avoiding a knee replacement until it is absolutely your last recourse is worth any effort and energy required.

“Easier said than done when you have knee pain!” you may understandably reply. True, if every step or two you take leaves you wincing then something is wrong and something needs to be done. My last blog (#7) discussed the need to review all options to ensure that you have a fair and decent diagnosis of your pain before making potentially life-changing decisions. But, what do you do in the meantime, before, during and after a decision? Invest your time in building up and maintaining your core muscles, or CMs.  I would also add-in calf and ankle muscle strengthening exercises for full-measure.

The core muscle group includes all muscles in your back, abdomen, hips and upper thighs.  They enable you to balance, to remain stable or resume stability after a twist, a leaning, or a fall.  Core muscles support and stabilize the spine while also enabling the shoulder, spine, pelvic, hip and knee joints to fulfill their duties, and usually with less pain (among others: Journal of Orthopedic and Sports Physical Medicine,  www.jospt.org/doi/full/10.2519/jospt.2018.7365).

core-muslesBy their large group sizes, CMs offer the illusion of leading us to believe that they are in decent, if not excellent shape.  They continue holding us up, keeping us walking, allowing us to lift and twist.  Aqua gym, carrying groceries while closing the car door, and lifting the grandchildren seem to offer few or no problems.  Hmmm…Knee pain has a way of seducing our minds, as well as our CMs, into believing they are strong when, in fact everyday that they are not specifically exercised their strength diminishes. If you suffer knee pain and naturally reduce your activity level but do not maintain specific CM exercises, you will soon learn that these diminished muscles contribute to your knee pain and affect knee rehabilitation, especially after a surgical intervention. This fact became painfully clear to me when I was ordered to lift my leg after knee revision surgery. For three days,  I not only struggled with this simple exercise, I strained a groin muscle trying to activate my thigh muscles and then lift my leg.  I had been protecting my knee from pain for so long that I neglected the rest of my body, and especially my core muscles.  Better to keep your CMs fit and ready for anything than to allow them to rest along with your painful joint.  Like throwing the babe out with the bathwater, too much is at stake and too much is lost by ignoring this vital group of protectors when you have specific knee joint pain.

Simple Quick CM check

Lay on a firm surface. Bend one knee and place that foot on the surface next to your other straightened knee. Keeping your feet 90 degrees from your ankle, lift the straight leg about 30 degrees and hold it for ten seconds.  As you lift pull your navel back towards your spine,  Slowly bring the leg down all the way to the floor.  Repeat ten times.  If your thigh muscles begin to shake, if your lower back begins to ache, if your stomach muscles feel the strain, then you know more attention to your CMs is required.

Better to know now than later so you can do something about it.

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I have been relearning over the course of these past nine months that building up and maintaining my core is what allows me to walk, and then to walk evenly. Core muscles have ensured that my thigh muscles can lift and hold my leg, bend my knee and bear weight at different angles. Core muscles compensate when the joint is loose, offering balance and leverage.  My tendency to fear being jostled or pushed, actually tripping, or worst of all, falling (Blog 4) has decreased the more I have increased time building my core muscles.  Four months after my knee revision surgery, I have actually begun forgetting my cane occasionally since my CMs are – now- doing their job. Twice this week, I had to walk back to get my cane that, for so long, was an extension of my arm.

Many core muscle exercises are offered online and at your local gyms, YM/WCA’s etc. Your physical therapist will certainly be able to show you a collection of exercises tailored to your particular therapeutic needs.  The investment needed to get that kind of advice, and the discipline you will need to maintain your exercise program will not let you down.  Without trying to be cute, ‘get a leg’ up on self care by paying attention to your CMs.  Doing so will bring a certain kind of agility, strength and physical confidence that can make the difference between suffering and repairing.  Slowly but surely.

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Additional Resources among many:

Author: amartinelbehri

Retired from working for large non-profits. I now write, take care of extended family, tutor English, and manage all aspects of living abroad while my husband works. I am recouperating from my 14th knee surgery and have some thoughts to share on many aspects of managing trauma, healing and starting over.

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