Why Do My Knees Crackle?

Scott Sherman from Panther Sports Medicine answers this question...

Typically, most individuals knees begin to make some noises at some point in their lives. Truth is that most of our bodies tissues are made up of fluid and water. This is particularly so of cartilage that covers the ends of the articulating surfaces of bones that make up our joints. When cartilage begins to lose its water content, it dries out somewhat and becomes less flexible and smooth. With movement occurring over the drier less smooth surface, noises begin to emerge.

In the case of the knees, it is usually the patello-femoral joints that are responsible for all the cracking and popping. In some who develop significant osteoarthritis, we may also begin to notice similar sounds arising from the main knee joint -- the tibiofemoral joint. Medically, these noises are referred to as "crepitus." Many people have crepitus all their lives without any other adverse symptoms, whereas in others, it may be the first sign of degenerative changes.

Supplements like glucosamine, chondroitin, keratin, are hydrophilic compounds naturally found in our cartilage and soft tissues. Hydrophilic means they attract and bind water molecules to keep our soft tissues supple and functioning properly. Taking these orally is theorized to improve the water retention ability of our joint cartilage and thus improve the longevity of our joints and potentially stave off arthritis.

Clinically, the jury is still out on whether these compounds taken orally actually make their way to the affected joints. Some of these molecules are too large to pass through the wall of the gut and are therefore, never even absorbed. My advice to patients is to go ahead and try them for a 3 month period and then see what changes.

Crepitus in knees particularly can also be the result of a flexibility or strength imbalance in the lower extremity. Most of us have heard of the IT band? The iliotibial Band (IT) is a very large, strong, sinewy tendon running along the outside of our thigh terminating at an attachment side on the upper end of the tibia. It is the main attachment for our gluteal musculature and has contributing attachments from the quads and to the patella (knee cap).

If any of the muscles attaching onto the IT band get too tight, this can result in the patella being pulled more laterally resulting in crepitus at this joint. The gluteals often become hypertonic (tight) as a result of lumbar spine dysfunction even though there may not be any overt signs or symptoms here.

Finally, crepitus at the knees often results from sub-optimal foot mechanics. If the foot overpronates (pes planus) or is too rigid (pes cavus), then this can also affect the rotation of the whole lower limb with weight-bearing activities. This alteration can then influence how the patella moves and crepitus is often a sign.

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Sponsor Spotlight -- Maryna Massage

As athletes, training consists of increasing loads of physical exertion and adaptation to these loads, with the happy result of achieving new levels of fitness. Of course, this all depends on the athlete remaining injury-free...

Think about your training schedule and what your body undergoes on a week-by-week, month-by-month basis: You are not only using your muscles; your bones, ligaments, and tendons are also involved. Constant physical training takes a toll on soft tissues, and if you neglect (like many of us have experienced) a self-care routine, this toll can lead to an injury.

What am I trying to say here?

Regular massage can actually decrease your chances for injury as well as speed up recovery.

Yes, you read that right.

How? Read on...



Some common injuries are strains and sprains, muscle fatigue and tenderness, trigger points and overly tight (hypertonic) muscles.

Strain = When you inure a tendon
Sprain = A ligament injury
Deep massage can alleviate the pain of micro tears caused by heavy exercise. Maryna from Maryna Massage often sees triathletes with bicipital tendon injuries (from swimming) and ankle ligament injuries. Left untreated, bicipital tendonitis can lead to a permanent tear (OUCH) and weak ligaments in the ankles can lead to an ankle sprain (another OUCH). Then, the athlete is faced with a lengthy recovery time and physiotherapy. Massage can nip this kind of thing in the bud.

Muscle fatigue and tenderness = Tight tissue constricts blood flow (and oxygen) to muscles
Massage loosens the muscles and breaks up the connective tissues surrounding them. Your circulation system resumes its course bringing fresh blood flow and oxygen to the muscles.

Muscle tenderness = Micro tears in the muscle belly and/or post activity lactic acid build up
Massage promotes a resting state for muscles, giving them time to repair and remove chemicals like lactic acid. It can also help elongate and straighten muscle fibres in the right direction.

Trigger Points = Muscle spasms on a cellular level
If you are overusing a muscle and over-stimulating the nerve that innervates it, or perhaps the muscle isn't receiving the appropriate nutrition (potassium etc), you may experience a muscle cramp/spasm. Trigger points are similar to to muscle spasms; however a spasm happens on a cellular level. Decreased circulation, insufficient hydration, stress, injury, body misalignment, lack of sleep, exercise, and tension can all lead to trigger points. Massage lengthens the muscle tissue, soothes the nervous system, and brings fresh blood full of nutrition to the area.

Hypertonicity = The muscle is contracted and does not fully relax
Every athlete can relate to this one! When you are muscle-building, hypertonicity can be a great thing. Other times, it is a side effect of training and actually slows down an athlete's training progress.

This was a key lesson I learned from Maryna. Think of your muscle as a tight fist. If you keep working a muscle with a limited range of mobility, the chances of injuring that muscle increases. If the muscle is relaxed -- think of an open hand -- you can work that muscle the way it was meant to be worked.



This leads to the notion of massage as a recovery tool and two common massage myths:

Myth #1: Massage is a luxury, why pay more when Advil does the trick?

WRONG.

I admit, I was guilty of this mindset. No one had ever explained to me how and why massage was an integral part of proper recovery, as opposed to my interpretation of recovery as lying on the couch and watching TV. (Think of the closed fist analogy above.)

My first visit with Maryna was a real eye-opener. I honestly believed that training with chronic sore muscles was par for the course. As the weeks would go by, my back for example, would get tighter and tighter. Usually when it reached the point where I could hardly bend over to put on a sock, I'd know that a rest day was near. I was in disbelief after my session with Maryna, my pain was gone, my muscles were relaxed and I could bend over. I'm a convert.

For triathletes, Maryna suggests a regular massage regime of at least once a month. Maryna's rule of thumb is, "Come when you are sore!" This is the time when you want to get a massage to aid in recovery.

Myth #2: Massage is just a relaxing, fluffy, rub-a-dub -- its only real benefit is calming the mind.

WRONG.

Again, I was guilty of this. A good athletic massage is very different from a relaxation massage and will be felt the next day. (Think of it as a 3 out of 10 on a pain scale. You feel it, but you should not be DYING from it.)

Athletic massage focuses on deeper tissue work -- getting into each muscle and working it until it becomes its normal length, decreases in tightness, and is trigger point free. Passive stretching of the muscles is often incorporated into the treatment, but the patient always remains lying down and relaxed.

Massage does not always have to be painful, but some tenderness should be expected afterward. This slight tenderness is an indication that the muscles have been worked on, lengthened, and are going into recovery-mode. Your muscles are now healing and getting the nutrition and healthy cell recovery they need. The soreness also serves as a reminder not to overuse the muscle too quickly.

So....is massage something you should do?

The questions you need to ask yourself are:

• Do you want to be a better swimmer, cyclist, runner?

• Do you want to be faster? Stronger?

• Do you want to recover more quickly so that you can jump back on the bike and keep training?
  

• Do you NOT want to be sore all day long after your training sessions?

Maryna's clinic focuses on getting you to answer YES to all these questions. Every treatment is tailored to the individual athlete taking into consideration the time spent massaging an area, specific stretching, which techniques will be used, and the amount of pressure applied. Maryna has a 100% focus on her clients -- no one ever leaves an appointment with an unaddressed issue.

The massage session doesn't end at her clinic. Maryna gives you home-care maintenance recommendations like a personalized stretching routine.

To book an appointment, call Maryna at -- 403-604-6339 or email her at info@marynamassage.com. Maryna Massage is located at 9624 Academy Drive Southeast Calgary -- near Southland Drive and Blackfoot Trail in the Acadia community.

Check out her website: www.marynamassage.com. To ensure a preferred date and time, call a week in advance. If your schedule has a bit more flexibility, call anytime! Maryna Massage is open from 9:00am - 9:00pm Monday to Friday.

Breakthrough swim workout alert!

A big congratulations to MRT athlete, Sarah Miller on swimming her first 1:30/100m!!

Doing The Double

For many iron-distance triathletes, the transition from finisher to competitor is often years in the making. Training, recovery, tapering, racing. Lather, rinse, repeat. But every once in awhile something challenges the way we view our sport in terms of recovery and performance. Outside of the box kind of stuff -- like racing two Ironman races only 1 week apart for example.

In November 2011, professional triathlete Sara Gross (http://www.saragross.ca/ and http://www.saragross.blogspot.com/) did just this. (Keep in mind that Sara gave birth to her daughter Rosalee last year. So, not only did Sara train to regain the fitness required to compete at an elite level, she did so with all the challenges of being a new Mom!) On November 20, 2011, Sara competed at Ironman Arizona. One week later she raced Ironman Cozumel.

The following is an interview I had with Sara about her successful execution of the Ironman Double:

1. How did you feel after IMAZ? In other words, do you feel as crappy as the rest of mortals after an IM race?

How I was going to feel during the week between races was actually one of my main concerns going in. After Ironman Canada this year, I felt terrible for more than a week, so I worried this would happen again. Before deciding to do the double, I talked to Chris McDonald (and wife Marilyn) to pick his brain and get the low-down on doing the double. (Chris was very successful at it and actually won the second race, Ironman Wisconsin 2008, ed.) He told me that recovering from the first race is all about what you do (or don't do) during the first 72 hours after the race. This includes getting hydrated, massage, using compression, recovery food, and the little bit of exercise that you do to keep things firing. To answer your question, I felt great after IMAZ. A lot better than after most IM races, and I contribute that to being more diligent with my recovery. I was also in a very positive frame of mind, which always helps.

Sara blasting out a 3:07 at Ironman Arizona 2011

2. Why did you decide to do another IM only 7 days after IMAZ? Have you ever done this before?

I have never done back-to-back Ironman races before but I did race two long-course distances (4k-120k-30k) 8 days apart in 2005. I finished 2nd at the first race in Gerardmer, France and won the second race in Sweden 8 days later. So, I had a good feeling about racing back to back. I am not sure exactly what made me decide to do both this time. I was signed up for both races and was having trouble deciding which race to do. Arizona is always very competitive and I really love racing against a tough field. That always motivates me, though it isn't a wise choice if you are after Kona points! Once the idea of doing both popped into my head I just couldn't shake it. I was worried that Clint (my husband and coach) wouldn't go for it, but he got completely behind me. I guess the short answer is; because I wanted to. It really is as simple as that. I thought I was fit enough to pull it off and it was a challenge that excited me.

3. In terms of recovery after an IM, what did you do differently, if anything, to prepare for IMCoz?

The differences in what I did after IMAZ compared to what I normally do after an IM were subtle. It was more a mindset that kept me focused after the race. I did everything a little bit more quickly and efficiently. I ate the post-race pizza immediately even though I wasn't hungry. I went to the massage tent right away instead of hanging around and chatting with my friends. It was mostly little things like that. I had my Zoot compression socks ready to put on in the car on the way home. I ate lots of protein. I went to bed and actually slept for 8 or 9 hours. I stretched the next day. I had multiple massages. I walked around and didn't allow my muscles to seize up.

Post-race pizza-eating recovery

4. Racing 2 IMs only a week apart goes against the widely held notion of training, tapering, racing and recovering. Do you think you were fully recovered for IM Cozumel?

Lol! Well, you only have to look at my bike time to see that I was not fully recovered! I was however, recovered enough to finish in 6th place, so I consider it to be a success. So many things can go wrong in an event that takes all day that a little fatigue was not a great concern for me on race day. You know, this little experiment has really challenged the way I see myself and our sport. My performance at IM Cozumel was pretty much exactly what I would expect it to be if I were to do a full Ironman in the middle of a big training block (ie, with no taper). Its amazing how it panned out in such a predictable way. And, the fact that I wasn't fully recovered sort of makes me want to try it again. The whole challenge of racing back-to-back Ironmans is about how well you can recover in 7 days. I think I could do better. I could use my compression clothing from Zoot more effectively or try to get my hands on some of those compression boots that people are using. My daughter really kept me on my toes in the week between the races, so I would recruit more people to help out with that. There are a few bits and pieces that I would change.

On the bike in Cozumel.

5. Did you do any "training" in the week between the two races?

Based on advice from Chris, I kept moving in the days after the race and also listened to my body. The morning after IMAZ I rode my bike for 30mins. On Tuesday I did an 800m swim and a short water run and on Wednesday I did a 1200m swim and was able to do some short surges of 15m or so. I also did a fair bit of walking (with my daughter in the stroller). If I did this again, it might be entirely different, but this was the right amount for me that week. My legs and energy levels started to come around on Thursday and from there on I proceeded with my normal taper week. I ended up taking Friday off and did the "biggest" day of the week on Saturday with a 20min swim, 1h bike and 20min run. My total volume for the week between the races was 4h30mins.

6. How much food did you eat after IMAZ? Did you eat even more (the day after and the days following) after IM Coz?

Lol!! Yes, Julie, if you do 2 Ironmans in a row, you can eat as many bananas and sweet potatoes as you like!! Seriously, one of the things I was thankful for was that I had a good appetite the night after IMAZ. I often feel too sick to eat after an IM. Clint took me to Chipotle after the race for a giant burrito. During the week after Ironman, I normally eat whatever I want. And I did that this time as well, but I also made sure I was eating enough protein for my muscles to recover. I thought that I would be painfully hungry for weeks after the second race, but shockingly, I just had a "normal" post-race appetite after Cozumel. Actually this applies to how I felt after IMCoz in general. It really felt like I had just done 1 race. I had been warned that I may feel a lot of systemic fatigue in the weeks after the second race, but its been weeks now and I feel great! I am very happy about that.

7. How on earth did you run a 3:07, and then a 3:18 in an IM only 7 days apart? WOW!

Ok. You always have to see things like this in relation to how fit you are and what you are capable of. So, in Arizona I ran 3.07 and had a couple of minutes of walking break in there. In Cozumel, I had a low patch that lasted 4-5hours smack in the middle of the race, so I was running slowly at the beginning and built into it until I was running at a more suitable pace. The same would apply to the difference in my bike times when compared with my ability, the conditions etc.

Gutting it out on the run at Ironman Cozumel 2011

8. Did the new Hawaii qualification system effect your decision to race back-to-back? Will we see more of these double IM races in the future?

To be honest, the points system was a factor, but not the main reason I decided to try the double. If I had done only Cozumel, I would have likely had a faster day, got decent points from that race and made more prize money. For me, it was mostly about the challenge of it. I love Ironman and just really liked the idea of the double. I don't know if we will see more o fit in the future as many people worry (and rightly so!) that they would not recover in time for the second race. Though I did feel that by playing my cards right it was easier than I thought it would be. I was excited about it and had fun executing it. The race in Cozumel just felt like a celebration to me. It was the right thing to do.

9. Anything else you would like to say?

First of all, thanks for the questions Julie! At the risk of sounding a little cheesy, doing back-to-back Ironman races has had a subtle effect on my worldview. It has reinforced the idea that we really can do anything we set our minds to. Once I got my mind linked to the idea of doing the double, it was easy to just follow the path and get the job done. It stretched me as a person and as an athlete. It has had a positive effect on how I feel about my future and on the attitude I bring to my coaching as well. All in all, it was a great experience.