So we're not talking about the upper body here (because what makes the old person look old in the upper body is being stooped forward like a boomerang – bottom at the back and head bent low at the front). Here we're talking about what it is in the leg department that characterises an old person’s walk. There are three joints to consider – the ankles, the knees and the hips. But in the modern era it is the knees that give us the most bother (and that wear out first). And believe it or not, in a typical case of chicken and egg, it's very much the way we walk as we get older that speeds up knee breakdown. Specifically, it's old people walking on bent knees that gives that incredibly old and decrepit look.To explain this further I have to go into the mechanics of walking. Walking is broken up into the weight-bearing and swing-through phases. As you swing the leg through and strike the ground with the heel, the knee should take your weight slightly bent. This is a good thing as it allows you to absorb shock coming up from the pavement. But then, as you go to push off in the weight-bearing phase that follows, it's really important that you push the leg back at the knee into a fully extended or locked-knee position. This action of the knee occurs simultaneously with the thrusting forward action of the gluteal muscles at the hip.
So, strange as it seems, the knee going back fully straight, at the same time as the hip is thrusting forward gives you a duality of push off from both hip and knee of the same leg. What happens as you get older is that you inadvertently forget to push off with the knee by bracing the knee back hard. Before you know it, you have lost this propelling forward function of the knee straightening. The vastus medialis muscle - the medial quadriceps muscle on the inner side of the thigh – wastes away and get weak incredibly quickly (this is why you have wobbly knees when you get up after spending a day or so in bed with the flu). After failing to walk by squeezing the knee back you find you can’t, because the inner quads muscle has wasted away. Not only does this give you a plodding, trudging walk typical of lack of propulsion, but the knee imperceptibly wobbles left to right as it fails to lock, which dramatically accelerates the knees wearing out. The good news is that you can regain a youthful walk easy as pie. It’s best to practice it on a seemingly endless flat pathway. As you relax and literally get into your stride, you will become aware at the sheer magic of it all. (Forget about the miracles of walking on water; he miracle is plain walking!). Focus but don't concentrate too hard – because if you do, everything will go clunky and discordant. All you have to think about is pushing the knee back straight as you push off. If you're doing it properly you will feel the inside of your thighs working hard to brace the knees back. Make sure to relax, let your shoulders down, let the arms swing, let the hips swing . . . . and enjoy the magic. To read more about exercises to keep the hips young see
Whatever the surgery, it is very common for a knee never to be quite the same, even after some of the less intrusive procedures such as arthroscopy (indeed, the broadly-held cynical view is that arthroscopy makes knee replacement more likely). The usual subjective manifestation of post-op knee is a general feeling of ‘ickyness’; that if put under duress the leg won’t take your weight (the knee could buckle or give way). In a broader sense, the leg tires easily with prolonged standing. The major objective findings are twofold: a slight fixed loss of extension (the leg won’t fully straighten) and persistent weakness (and wasting) of the quadriceps muscles at the front of the thigh. Unfortunately, this is a real case of chicken-and-egg and it’s all to do with walking. That’s right, walking. Because what happens after surgery is that you imperceptibly keep on keeping-on protecting the knee. In subtle ways, you let is take the easy options, while making the good leg do the hard yards. This is never more obvious than with the push-off phase during walking. Sensing that the knee is slightly uncomfortable so you fail to push the leg back to ram-rod straight at the knee as you propel your body forward. (Let’s look at this action a little more closely because is seems kind of counter-intuitive that you are pushing forward at the hip (using your gluteal muscles of your butt) while at this same time to get maximum propulsion you need to fully straighten the knee, by pushing it back.) Of course, with some of the reconstruction surgeries there’s a fair bit of nipping and tucking, transplanting, drilling and shortening but even so, the knee will try admirably well - and will often succeed - in getting back to normal if you deliberately and steadfastly treat the knee normally by keeping making it do ‘knee things’. In other words if you treat it like a normal knee from quite early days post-op.
Instead, people are a bit ginger with the bad knee; never making it power through and never fully straightening it (extending) it as they push forward - in other words, perpetually walking on a slightly bent knee. And the chicken and egg is that if they fail to invoke the muscles that do this (vastus medials on the inner side of the thigh) it wastes away and gets far weaker in its ability to fully straighten the knee. The declining spiral picks up. To correct this you have to stop; slow down and fix the walking - and here’s how. In the push-off phase on the bad leg (that is, while the other leg is swinging through) you have to push the bad knee right back, at the same time as your glut muscles are pushing you forward. You can feel your butt contract with your hand, while at the same time you are extending the knee, braced back, fully, with EACH STEP. Make sure this is happening all the time, whatever then terrain: on all steps, all stairs.When changing direction, make sure you never totter; never try to hurry off the bad leg. Make it work like a normal leg . . . . and in no time at all the muscles will bulk up and you’ll lose that feeling of an ‘icky’ weak knee. This knee here shows a 36 year old man who had major reconstruction after traumatic ACL and cartilage damage 5 years ago (the surgeon said “it looked like a bomb had gone off in there”). You may observe marked wasting of the R quads and lack of full knee extension compared to the left.
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