My knee hurts, I hope I don't need surgery. Three things she needed to do differently Sometimes you cannot help but hear the conversation at the table next to you, especially in a communal place like Panera, a great sandwich and soup chain. I hear her telling her work colleague about the problem she had been having with her right knee, and the typical approach of seeing the orthopedic, going to the rehab therapist who addresses the knee and then the hope begins. Hearing her say, I don't want to have surgery, I don't want it to get worse, I don't want to have the difficulty I am having walking up a flight of stairs. Being nosy, especially as she continues to speak about her difficulties, I looked down and noticed her right foot turned out. For anyone who has read my book, Cheating Mother Nature, What you need to know to beat chronic pain, they know that having a body style like this can cause knee problems since the knee will tend to roll in with someone whose foot flares out. It will also tighten her core muscles inappropriately and tighten the calf as well, straining the knee. This type of compensation will tear a knee apart and cause it to become arthritic after years of poor function I could't help over hearing the conversation you were having, I said to her after excusing myself for barging in on the conversation, but it sounds like you could use some help. I stated I could not help but notice how her foot flared out and I explained that I deal with runners. Do you wear inserts in your shoes I asked? Yes she said, the doctor gave them to me but to be honest, I haven't been wearing them because they do not fit in my shoes and hurt my feet. She explained that she has been going for rehab to strengthen the muscles around the knee. This is a common approach that addresses the symptom and not the reason she cannot go up stairs. I never told her my name but recommended black superfeet which would easily fit in her shoe and solve some of the problem of her body mechanics. I recommended she stop in at Roadrunner sports across the street and pick up a pair since they were inexpensive and could offer instant relief. I then wished her luck and said goodbye. Many of us have had similar conversations with people regarding similar issues either at work, out with friends or in other social situations. Many of the stories are indeed similar. Here is how you can help them help themselves, even though they believe they are doing the right thing since their doctor suggested it. Three things she could have done differently for a better outcome. 1. Be compliant with foot orthotics. Foot orthotics can change how the body works while you are wearing them, making your body work much more efficiently and take stress off the knees. I call it Cheating Mother Nature (that is how we came up with the title of my book). If you do not wear them, they have no benefit. They need to be worn all the time you are standing or walking. There are many ways of making an orthotic work for you, and they should fit in all your shoes. If they do not, your healthcare provider was not thinking of how to make this work for you and ensures failure of your being compliant. Failure also comes when you do not understand that they do more than just relieve pain and that after the pain is gone, they are lost to the closet. That will not help preserve your knees and hips, and increases the likelihood that years later, you will be looking for joint replacements. The originals are always better. 2. Look for a healthcare provider who understands body mechanics. Treating a painful knee after running tests on it does nothing to understand why it hurts, even if it has become somewhat arthritic. If your doctor did not look at you instead of just the painful parts, it is time to look for someone who thinks differently. The same goes for your therapist. The therapeutic world is moving away from evaluating just the painful area because we have thousands of joint replacements that were done because this does not adequately diagnose the problem. The problems with the way you walk end up in the knee, rather than begin there. Bottom line, your healthcare provider needs to look at you, not just your symptoms and they should be able to explain things to you in a way that makes sense. 3. Train your core for stability When you walk, the mid section around your pelvis is supposed to stabilize you and create most of the force as the leg secondarily moves forward and backward to move you forward or backward. The problem is when there is an imbalance in the core, and it distorts the hips, the forces become imbalanced, tightening the legs into the calves and secondarily into your buttock. The effect is your stride becomes shorter, so do the muscles surrounding the knee and the knee is subjected to forces that will damage it. This is why you need to stabilize the core. Some proven methods include Pilates, Roman Chair exercises and Yoga Bridges. If the myofascia (connective tissues surrounding the core) have tightened, you may require professional help from massage, Rolfing or a sports chiropractor who does fascial release and manipulation. The reason I include this last option is because looser core muscles with poor functional movement is not instantly restored when you loosen the core muscles and manipulation improves movement and will markedly improve the way you walk and function compared to just myofascial work alone. What do you think? As always, I value your opinion.