A patient came to see me last month complaining about his aching knees. He is an active man in his 50s who plays tennis and golf in the summer and keeps up with his kids on the slopes in the winter, but over the last few years his knees have been giving him trouble.

When he mentioned it to his buddies, they gave him a hard time: “You’re not 18 any more; give those knees a rest and they’ll feel better,” they told him. My patient took the advice and his pain diminished – for a time.

Inevitably, his pain returned and he came to see me.

“It’s getting warmer and I feel like I missed out on an entire ski season. I don’t want my knees to keep me from being active this summer, too,” he said.

For years, physicians were trained to advise patients to rest until their injuries got better and for the most part, that’s not a bad approach. However, it’s not the only approach and sometimes it’s not even the best one. Some people just can’t afford to rest until time heals their injuries, and that’s where a sports medicine specialist can help.

Some of my patients are elite athletes. Their training schedules dictate their workouts for months in advance, and taking a week off for an injury could put them off their training for an entire year. Other people come to me because they have to get back to work or because they’re deploying. For these people, resting is not an option.

For others, like the patient with knee arthritis, resting is not even the best approach. In fact, working out an injured joint is sometimes the best method because bones and tendons have a quality called inducibility, which means that they like to be exercised. Leave a bone without any load and it will wither. That’s why astronauts have to work so hard keeping active in outer space. For the same reason, the best way to make arthritis really get worse is to sit on the couch and rest.

Instead, keeping active and staying strong is the only way that’s proven to slow the progression of arthritis.

Tendons work the same way. It was a common practice to put people in casts to “rest” tendinitis of the Achilles or the hand. Patients would feel great until their casts were removed. Then symptoms would return with a vengeance.

It turns out the best prescription for many chronic painful conditions like tendinitis and arthritis is a carefully coordinated exercise plan. Most sports medicine specialists work closely with physical therapists to formulate exercise programs that help patients rehabilitate sore joints and tendons.

In most cases of tendinitis, a specialized exercise program will help patients recover better than any other approach. If patients keep up the exercises they can prevent the condition from reappearing.

In other diseases, such as osteoarthritis, working on balance and flexibility is key. But what’s consistent is that resting typically doesn’t help in making these conditions get better.

And my patient with the aching knees? He is now doing great in a strengthening program. He works with a physical therapist once a week and completes his exercises at home three other days each week.

He’s getting stronger and more confident that his knees won’t bother him, and he is looking like an age-group favorite in his tennis league this summer.

I’m not betting against him.

 

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the Portland Pirates and the U.S. ski team.