Publications

AMC Outdoors, July/August 2003

By Michael Lanza

Curse the ankle and knee — they're the Achilles heel of hikers. Then again, without knees and ankles, we couldn't hike, climb, ski, run, or do many of the activities we enjoy. The obvious solution? Take care of those leg joints and muscles. And if an injury does occur, take care of it so it doesn't come back to haunt you later on.

I tossed a few of the most common questions I hear about knees and ankles to Dr. Joshua Siegel, the Sports Medicine Director at Access Sports Medicine & Orthopaedics in Exeter, N.H. A respected authority on sports medicine, he treats professional, Olympic, and Division I college athletes, but the majority of his practice is made up of recreational athletes ranging in age from elementary school up to the 90s.

How common are knee and ankle injuries?
"By far, lower leg injuries are the most common recreational injury, including knee and ankle, with the ankle being much more common, but also a lot less severe. You see many ankle sprains, which tend to heal [on their own], while with a torn ACL [anterior cruciate ligament], you'll see much more treatment needed."

Why is it that fit people suffer knee and ankle injuries so often?
"There are a lot of theories on that, but it's pretty well accepted in the sports medicine world that a majority of people who get injured tend to be [out of shape] when the injuries occur. We see skiing and hiking and running overuse injuries early in the season. These people go out when the weather turns nice and they just go gung-ho. They go too fast for too long. Their fervor catches them off-guard."

Injuries also stem from simple things like wearing shoes that are not supportive enough for your activity, or not paying attention to ground conditions when ice, wet rock, or mud can cause a slip and fall.

What type of injuries do you commonly see?
"Ankle sprains and Achilles tendon ruptures. You see stress fractures in people who continue on through pain, mostly in the metatarsals of the feet. Above the knees, we see a tremendous amount of patellar tendinitis and quadriceps tendinitis, and cartilage tears and ligament sprains. We see more tendinitis in people who are poorly conditioned."

"We happen to see certain [injuries] more in women than in men, [such as] stress fractures. Stress fractures are associated a lot with nutrition and training, which are more commonly [misused] by women."

"An acute injury can turn into a chronic injury if it's not treated properly. People who go out and walk on a sprained ankle before it's healed properly are going to develop chronic ankle problems."

How long do these injuries take to heal?
Healing time varies greatly, Siegel says. "We tell most people the average time for tendinitis or a stress fracture to even start to resolve is four to six weeks, and it can be much longer."

Are injuries more common as we advance in age?
"It depends on how much people learn as they get older. The main theory is that every time you're out there doing something, you get a breakdown in the tissues. As [you] age, the ability of your body to repair itself takes longer. If you don't give your body ample time to recover between episodes of activity, eventually your breakdown is going to far exceed the ability of your body to heal. I tell my patients that for roughly every 10 years of age, it takes your body twice as long to recover."

Siegel sees Olympic athletes who, with age, have cut their training regimen in half, yet are still able to perform at a top level. By following a schedule called active rest or cross training, they rest the muscles and connective tissues used in their sport by engaging in a different activity, without being entirely inactive. "Recreational athletes would benefit greatly by using that as a model."

How can recreational athletes avoid ankle and knee injuries?
"One of the more important things to do is called proprioception and neuromuscular training." Proprioception, Siegel explains, means your brain knowing where your joint is in space — for example, with your eyes closed, being able to bend both elbows at the same angle. "In your knees and ankles, that's critical. As you start to roll your ankle, if your body knows what's occurring, your neuromuscular receptors will fire to protect that ankle as long as they know what's happening." We can train those receptors with things like balance boards. (Learn how to make your own balance board.)

"The buzzword now is 'functional training' coupled with aerobic capacity. Instead of looking just at weight training, we try to get people more sport specific and utilize muscles the way they're used in a specific activity. A good example is plyometric training. It's essentially taking a muscle and causing it to contract immediately after it lengthens, allowing for a much more forceful contraction. As an example, if you jump, when you land, your thigh muscles are lengthening to slow you down. For a split second after that lengthening occurs, you can contract your quadriceps again with much more force than you could had you just started from the initial bent-knee position. We try to exploit that lengthening-contraction relationship, allowing the muscle to train itself."

"A majority of injuries occur when a muscle is lengthening rather than contracting. But when we weight train in a gym, [doing] bicep curls or leg presses, these things are shortening the muscles rather than lengthening them. We need to get away from that."

Siegel says there's also now a "huge movement" toward strengthening and conditioning the body's core — the torso and back — "because without those being conditioned, your body isn't. In our society, people are well built up in their fronts, but their backs are in terrible condition. If you can't control your back, stomach, and torso, you'll have no control."

Lastly, Siegel emphasizes the importance of stretching before and after exercise. "All the muscles tend to fire better when they're at their optimal lengths. Stretching should occur in a 'warm phase,' meaning you do a little bit of a warm up and then stretch, rather than cold stretching. If you have little time, focus on sport-specific stretching."

How should people treat injuries?
As soon as possible after the injury occurs, implement RICE (rest, ice, compression, elevation) — icing immediately will greatly reduce the healing time of many injuries — and continue with RICE for a day or two, Siegel says. See a physician, who will probably take an X-ray. Early initiation of physical therapy, even for a simple ankle sprain, will cut in half an injury's longevity. Surgery is a last resort, to be considered only when an injury fails to heal with time. Most ankle and knee injuries are treated with therapy and time.

What are some useful resources for people who want to learn more about proper care of their knees and ankles?
Siegel suggests the websites www.knee1.com, an associated site www.shoulder1.com, and the non-commercial American Academy of Orthopedic Surgeons website, which has a wealth of information on treating such injuries. Your local physical therapist can refer you to many books on the subjects, too.

—Michael Lanza is author of The Ultimate Guide to Backcountry Travel, from AMC Books.