Nobody wants to have knee surgery. Nobody. And while surgery is a part of what I do, I see it as my calling to help keep you out of the operating room and keep your knees working as perfectly as possible for as long as possible.

I also know that anyone I see in the office really doesn’t want to be there. Your knee pain or instability or limitations must be severe enough to want to come in and discuss your options.

Nearly everyone has tried a few basic things: Rest, some over the counter medication, or some home remedy their mother suggested. If it was working really well you wouldn’t be seeing me.

So let’s start by reviewing the basics of knees, how they work and where to start. This will be the first in a series of blog posts about knee pain and how to keep them going and stay out of my office !


Knees are similar to a hinge joint between the femur and tibia bone. Your kneecap is a special bone that ‘floats’ in the tendon that lets you straighten out your leg and walk. For many reasons, knees take a lot of abuse when we walk, run, jog, jump and twist – more so than ankles for example.


Your knee is held together by strong ligaments. When these are injured your knee will feel loose or unstable with simple walking or stepping off a curb. Some ligaments can heal and some can’t.


The ends of the bones are covered by cartilage which is like the tread on your car tire. This tread has a lifespan determined by your genetics and how you use your knees. Like tire tread, carrying more weight increases the stress to the joint and increases the chance you will wear it out.

A little more on this: A law of biology (and orthopedics) is…

Wolf’s Law: The human body will change based on the forces applied to it.

This means that an overloaded joint may breakdown and your body will try to fix it. A little more physics for you:

Stress = Force divided by Area
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The force (YOU) presses down on your knees. The surface of the joint is only so big. A bigger joint results in less stress. As a result, when a joint starts to break down, according to Wolf’s Law, your knee will try to get bigger to compensate. Bone spurs are your body’s attempt to fix the problem. It never really works, but its does it’s best.

Weight loss (sorry)

A key part of lowering the stress on your knees is the force applied —your body. Carrying a few extra pounds means your knees (and other joints) have to work harder than they can handle, to carry you around. Eventually, your body will not be able to compensate and the ‘tread’ on the end of the bone will start to fail. Getting a handle on this before it happens is important. Carrying more than a few extra pounds (like 40-80 pounds!) is a huge stress to your joints. While easier to say than practice, weight loss is essential to a healthy joint.

Strength and Conditioning

Knee PainStrength and conditioning are also key factors. If your muscles are weak, your joints don’t always move like they should, and can cause changes in the forces across them. Keeping yourself in shape will make a difference. Good conditioning includes light strengthening and ‘neuromuscular control’. This means a muscle that has been trained fires when it should better than one that isn’t. Studies have shown that a well conditioned yet mildly arthritic knee is less painful than the knee that is weaker.

Stay tuned. In the next post we will discuss and review more things you need to understand and ways to improve how your knees work and feel.