Is the craze for high intensity exercise a cause of concern for our knees?

In our increasingly busy lives, the claim that doing just 30, 15 or even 5 minutes of HIIT at a time was the sure fire way to lose weight and get fit seemed too good to be true. This was a workout that anyone could fit in between work, family and social commitments.

Top flight athletes have known for many years that high intensity interval training is essential to gaining a competitive advantage, but now every gym in the country is offering HIIT classes. However, if you’re not a top level athlete is HIIT safe, particularly for our joints?

HIIT health benefits

A workout that involves intervals of high intensity exercises, followed by short recovery periods, means you get maximum benefits:

  • High intensity training boosts endurance as it adapts the cellular structure of the muscles so you can increase stamina in any type of exercise or sport
  • It boosts your metabolism so you can burn calories and fat in a shorter time period
  • The period after your work out is called EPOC which stands for Excess Post-Exercise Oxygen Consumption. This process of increased fat burning usually lasts for two hours as the body continue to use more energy as it returns to a non-exercising state. The EPOC after HIIT is greater with up to 15% more calories expended than after a standard workout
  • It’s been proven to be beneficial for those suffering from chronic health problems and studies have shown that it might even be better for you than regular moderate intensity exercise. HIIT can lower glucose levels in those suffering from diabetes as proven in one 12-week controlled study carried out in Denmark
  • Rather than putting your heart under intolerable stress, HIIT exercise can actually reduce the chance of developing cardiovascular disease, by increasing peak oxygen uptake and the flexibility of our blood vessels and by strengthening the heart

HIIT typically utilises your own body weight rather than expensive gym equipment so it’s accessible to all and is often seen as far more enjoyable than just pounding away on a treadmill. This means you’re more likely to stick to it, which is really the most important consideration.

High intensity interval training and your joints

A HIIT class will usually be a combination of core, upper and lower body exercises, but many include key exercises such as squats, lunges and short bursts of sprinting. Jumping exercises, known as plyometric movements, can be particularly hard on the knee joint. All can lead to an inflammation of the patellar tendon that connects the kneecap to the tibia, commonly known as runner’s knee. Over time the inflammation can become so marked that it limits normal everyday activities and but very rarely results in a tear of the patella tendon.

It is imperative to avoid high impact not high intensity. Look for low impact exercise classes that minimise the pressure on your joints. If you are experiencing knee pain and stiffness that is affecting your work out, then an orthopaedic surgeon who specialises in treating the knees, such as Mr Jonathan Webb, can offer you assessment and diagnostic tests, before advising you on the appropriate treatment. To arrange a consultation at either his London or Bristol knee clinics please call 08450 60 44 99.

Anterior Cruciate Ligament Tear: the classic knee injury

We lay claim to the title of the world’s greatest sporting nation and it is true that sport is a national obsession, both as spectators and getting onto the field of play at every level. Yet, it is also true that sport and injury go hand in hand.

The knee is the most common joint to incur injury during sport and injuries to the ligament account for approximately 40% of all knee injuries. Of the four ligaments that stabilise the knee joint, the anterior cruciate ligament, commonly known as the ACL, is the most necessary and the most vulnerable, accounting for almost half of all knee ligament injuries.

The ACL is a band of tough, fibrous tissue that connects the thigh bone to the shin bone, running through the knee joint. The cruciate ligament is essential for balancing the knee joint when twisting, pivoting and landing, as it prevents the tibia from rotating and sliding forward.

Here are some of the common questions about ACL injury:

1. How will I know if I have torn my ACL?

An ACL tear is usually the result of a sudden injury. Typically, you will feel and even hear a ‘pop’, accompanied with sudden pain. Once the initial pain abates, it is usually succeeded by stiffness, swelling and discomfort. There is often instability in the knee and it may ‘give way’ or buckle when turning or landing.

2. Why does the ACL often fail to heal?

Unlike the other ligaments that support the joint, the ACL passes through the middle of the joint and is surrounded by joint fluid. Synovial fluid in the joint is designed to dissolve and prevent blood clotting in the joint so scar tissue on the ligament cannot form, making healing of the ACL challenging.

3. Can I live with a torn ACL?

Every component of the knee joint works together; if the ACL tears then there is increased strain on the meniscus. If the meniscus gets worn down then we are left with just articular cartilage to protect our bones and, over time, this can deteriorate, resulting in osteoarthritis.

If you have incurred an ACL injury, then you have a number of treatment options:

  • Live with it! If you modify your activities so you do not engage in sporting pursuits that involve twisting motions then many people find it is possible to perform all normal, everyday activities without an intact ACL. However, patients that partake in competitive sports such as hockey, football and rugby, may find that lack of stability in the knee is hampering their ability to play.
  • A rehabilitation programme aimed at strengthening the supporting muscles can help provide the stability the knee requires.
  • A tear, either partial or total, to the anterior cruciate ligament can be resolved with surgical intervention. Mr Jonathan Webb, an orthopaedic surgeon that specialises in knee surgery, sees many ACL injuries in his Bristol and London knee clinics.

4. What is the rationale for treatment of the ACL?

The approach adopted by London and Bristol orthopaedic surgeon Mr Jonathan Webb is to return the patient to a level at or approaching their former level of activity. This can be achieved either through conservative treatment or, if required, with surgery.

He takes into account your age and activity level, while also assessing the degree of tear and resultant instability. Surgery will usually return you to full participation and may also prevent future problems such as osteoarthritis developing.

5. Who should I see for ACL reconstruction?

An ACL reconstruction is performed by an orthopaedic surgeon who has specialised in treating the musculoskeletal system. A consultant orthopaedic surgeon that has focused on the knee and has an interest in treating sports injuries can also be fundamental to achieving a successful ACL reconstruction. Former England rugby player and orthopaedic surgeon Mr Jonathan Webb only treats knee injuries and conditions. For more information or to book a consultation, call 08450 60 44 99 to speak to one of his team.

Mr Jonathan Webb becomes the RFU representative on the World Rugby Council

All change at the RFU; as a new chairman takes over from Jason Leonard in August, we have the exciting news that Mr Jonathan Webb has recently been appointed as one of two RFU representatives on the World Rugby Council, replacing Bill Beaumont who has become the Chairman of World Rugby.

In the late 1980s and early 90s, Jonathan played club-level rugby at Bristol and then Bath, before representing England as fullback in 33 Test matches, scoring 296 points for the national team. He participated in two Rugby World Cups and in the 1991 World Cup final, which England lost to Australia, he was the only English scorer. Among the honours he received, he was voted the Rothman’s Rugby Player of the Year in 1992 and now joins the RFU board as a representative at World Rugby, the international governing body of rugby union.

The vision of World Rugby is to harness the sport’s character-building values to engage new audiences, young and old, a vision that Mr Webb shares: “I believe the game is still one of the greatest team sports, enriching and enhancing the lives of all those involved. I look forward to doing all I can to help develop and improve rugby not just in England, but around the world, to ensure its future growth.”

Mr Jonathan Webb combines his duties on the World Rugby board with his practice as a Consultant Orthopaedic Surgeon in Bristol and London.

Cricket and the knee


Common-cricket-knee-injuriesThe English cricket season has commenced and all eyes turn to Headingley this month as they host the first of England’s international matches, with the national team hoping to capitalise on last year’s triumph in the Ashes.

Although cricket may seem worlds’ away from the high impact nature of rugby or football, injuries are common in the game. The spine and lower back may be a vulnerable area for bowlers and fast bowlers, in particular, but we take a look at the types of knee injuries that cricketers can incur throughout a lengthy season.

3 most common ways to injure the knee in cricket

Problems with the knee are either the result of a sudden tear or strain or due to years of overuse:

#1 Cartilage tear

The cartilage is the tough, flexible tissue that covers the end of bones and allows the bones in your knee joint to move smoothly as the knee goes through its wide range of movement. The knee also has two cartilage discs called the meniscus, which act as shock absorbers. The medial meniscus is found in the inner side of the knee and the lateral meniscus is located on the outer part of the knee.

The lateral meniscus is less likely to be injured, but it can occur when the knee twists. The medial meniscus is much more prone to injury as it is attached to the medial ligament. A small tear may respond to a non-surgical approach of rest and rehabilitation, but a more severe tear usually requires surgery if you want to return to the game.

Although plagued by a variety of different injuries throughout his career, Freddie Flintoff was finally forced to retire from Test cricket due to a meniscus tear.

# 2 Ligament tear

During sporting activities, the knee is subjected to extreme forces and it is the ligaments that surround the knee joint that resist this force, keeping the knee secure and stable. The most vulnerable of the ligaments is the anterior cruciate ligament, commonly known as the ACL, and it can tear, either partially or completely as a result of twisting or a sudden change in direction. Surgical repair of the ACL can restore stability.

In 2014, Australian batsman Usman Khawaja was forced out of international games for nine months with a torn anterior cruciate ligament in the left knee, but returned to the national team after undergoing surgery.

# 3 Patellar tendinopathy

This can be the bane of bowlers as their patella tendon is continually put under strain during the delivery action, leading to the tendon fibres breaking down.

The patella tendon is positioned just below the knee cap and attaches the patella to the tibia or shin bone and it is put through the maximum stress when running or landing. Over time, the pain and discomfort felt when playing cricket will continue when at rest, with stiffness and lack of mobility that is often worst first thing in the morning.

Patellar tendinopathy usually doesn’t get better without intervention and there is rarely a quick fix for this knee condition and you may require a lengthy period of rehab. In 2014, South African batsman JP Duminy was sidelined for six weeks, missing internationals against Australia, due to chronic patellar tendinopathy.

However, one of the most horrific injuries in sport was the knee injury that ended David Lawrence’s cricketing career in 1992. In the middle of his delivery stride, his left patella shattered, with spectators hearing the ‘spine-chilling’ crack across the ground.

The lengthy nature of cricket games, coupled with the bursts of acceleration and deceleration and twisting action of bowling and batting, means that a cricketer’s knees are as vulnerable to injury as high impact sports such as football and rugby. Mr Jonathan Webb, orthopaedic adviser for Gloucestershire County Cricket Club, offers treatment for a wide range of knee conditions. To arrange a consultation at either his Bristol or London clinics call 08450 60 44 99.

The God Pill: has a cure for ageing been found?


arthritis-cure-for-rebuiling-knee-cartilageScientists have spent many years and many millions, trying to find a ‘cure’ for ageing, whether that’s reversing progressive hair loss or erasing wrinkles. However, these are just the visible signs of ageing and a more exciting proposition would be to discover a panacea for the aches and pains that plague us as we grow older.

Osteoarthritis is a progressive condition, caused by wear and tear, and it’s thought that over 8.7 million people in the UK have sought treatment for osteoarthritis, with just over half of those presenting with arthritis of the knee . And, the cost of osteoarthritis to the UK government is staggering. In a study entitled ‘The Global Economic Cost of Osteoarthritis: How the UK Compares’, it was estimated that costs of non-steroidal anti-inflammatory drugs (NSAIDs), typically the first line of defence, exceed £44.85 million. Further, indirect costs include the impact on the country’s economy, thought to exceed £3.2 billion and the many further millions devoted to community and social services for those suffering from osteoarthritis.

What is osteoarthritis of the knee?

Arthritis of the knee is a result of the cartilage within the knee, the tough, flexible tissue that covers the end of the bones, thinning to the point that the ends of the bones rub against each other. Cartilage works like a shock absorber to spread load evenly across your joint and as your knees have to work extra hard bearing your body weight, the knee joint has extra cartilage rings between the bones called the menisci.

This can be an incredibly debilitating condition with a great deal of pain and loss of mobility. So, the news that a US pharmaceutical company was developing drugs that could reverse a number of ageing concerns, including the possibility of regrowing knee cartilage, is very interesting.

A new arthritis drug breakthrough?

At the end of last year, Samumed announced to the annual meeting of the American College of Rheumatology that they had seen success with clinical trials of a drug that regenerates knee cartilage in animals, slowing down joint space narrowing, one of the markers of osteoarthritis.

The drug works by inhibiting the Wnt signaling pathways that control how different tissue cells regenerate, whether that’s hair, bone or cartilage. Wnt stands for ‘wingless integration site’ because when you tamper with it in fruit flies they never grow wings. The data that Samumed presented at the meeting showed, in rat models, that a single injection of SMO4690 grew cartilage in the knee joints. A further limited study of 61 patients, with 49 taking SMO4690 and 12 taking a placebo, found it to be potentially effective in slowing down or reversing the narrowing of a joint space.

The good news is that SMO4690 seems to be very safe for human use, but, in terms of efficacy, the patient numbers of the clinical trials are far too small for any definite conclusions to be drawn as to whether this is a long-term solution to osteoarthritis.

For more information on the treatment options that are currently available, please call 08450 60 44 99 and arrange a consultation with Mr Jonathan Webb at either his Bristol or London clinics.

New study finds birth control pills can lessen chance of knee injury in female athletes


female-athletes-at-higher-risk-of-ACL-tearsA new study published in Medicine and Science in Sports and Exercise, the journal of the American College of Sports Medicine, found a link between birth control pills and often sports career-ending knee injuries.

The researchers at the University of Texas evaluated data on over 23,000 female athletes, aged between 15 and 19, who had incurred an ACL injury. They discovered that those on birth control pills had less serious injuries to the anterior cruciate ligament (ACL) and were 22 per cent less likely to require reconstructive knee surgery.

These findings follow on from a number of previous studies that have found a link between oestrogen levels and the chance of incurring knee injury, with females two to eight times more likely to injure their ACLs than their male peers. It’s long been known that the ACL contains hormone receptors and one school of thinking is that a surge in oestrogen levels, which typically happens during puberty or your monthly cycle, weakens the ligaments, therefore making a knee injury more likely.

Why women are more likely to incur an ACL injury

There are a number of reasons why women are at more risk of developing an ACL sprain or tear. The ACL is one of four ligaments that supports the knee joint but women’s ACL are proportionally smaller than men’s. As well as the ligaments, the knee is braced by the surrounding muscles and women have typically less muscular strength which leads to more potential for joint instability.

Furthermore, there are many anatomical differences between men and women, including the pelvis width that affects the angle that the leg bones connect; this is greater in women meaning more stress on the knee joint. Women also have a narrower notch where the ACL passes through the thigh bones. Biomechanical differences, in terms of landing, jumping and pivoting, can also play a role.

So, hormone levels may only be one factor in women being at more risk of an anterior cruciate ligament tear. Oestrogen medication, used as birth control, lowers levels of this hormone and also makes it consistent throughout the month, but the degree of protection afforded by taking the contraceptive pill has not been conclusively proven and it is important to realise that this is a prescription drug with known side effects.

If you think you may be suffering from an anterior cruciate ligament tear then call 08450 60 44 99 to book a consultation with knee specialist Mr Jonathan Webb. He offers consultations at the Nuffield Hospital in Bristol and the Fortius Clinic in London.

Growth in European knee reconstruction device market reflects increasing demand for knee surgery

eplacement-knee-surgeryThe market for knee reconstruction devices in Europe will show a compound annual growth rate of 4.5% to 2021 it has been estimated by a new research report.

The biggest growth area will be in preliminary knee reconstruction devices as technological advances in prostheses has reduced the need for revision surgery later on in life and improvements in surgical technique means less downtime and quicker recovery, making knee surgery an increasingly popular solution to osteoarthritis of the knees.

Knee surgery: a growth market

According to Arthritis Research UK, 4.71 million people in the UK have sought treatment at some point for osteoarthritis, a figure that is set to rise to 6.5 million by 2020, due to the rapidly ageing population and increasing problems of obesity and physical inactivity.

Ninety-seven per cent of initial knee replacements are due to osteoarthritis. This often debilitating condition is the result of attrition over time, causing the cartilage that protects the knee joint to wear down until the bones grind against each other. Eventually, the knees become stiff and painful to the point that even basic everyday activities can become difficult. You may experience problems with just one knee or both and symptoms can include joint tenderness or pain that becomes worse when walking up an incline or stairs, knee instability, problems fully straightening or bending the knee and you may even hear a grating or popping sound.

What are my options for dealing with knee osteoarthritis?

Osteoarthritis is a long-term disease so can’t be cured, although it is possible to manage the condition so it doesn’t become progressively worse. In your consultation with leading knee surgeon Mr Jonathan Webb at his clinics in Bristol and London, various treatment options can be explored. If your symptoms are mild then simple lifestyle changes can help, including losing weight, taking up regular exercise or wearing different footwear.

More severe symptoms can be tackled with the use of painkillers and a specially designed exercise programme administered by a physiotherapist. However, if the discomfort and stiffness you are experiencing are not improving, knee surgery may be advised. This can be aimed at strengthening or repairing your existing knee joint or replacing it entirely.

To discuss your knee surgery options in more depth, call 08450 60 44 99 to book a consultation with Mr Jonathan Webb.

6 tips on how to prevent knee injury on the slopes


skiing-and-knee-injuriesThe news that Lindsey Vonn has crashed out of this year’s ski season – for the third time in four years – puts the spotlight on skiing and knee injuries.

At the beginning of the month she was racing in Andorra, holding her position as the woman’s overall World Cup leader, when a nasty fall resulted in three hairline fractures in the tibial plateau. Vonn announced on her FaceBook page that they were significant enough to mean that her leg would not be “sufficiently stable to permit me to safely continue skiing”.

Since 2013, the list of injuries Vonn has suffered while competing is impressive, with three torn knee ligaments resulting in two knee reconstructive surgery ops and she has also broken her tibia twice and her ankle once. Vonn has pulled out of this year’s season as her aim is to race in the world championships in St Moritz in 2017 and the Winter Olympics the following year, but even for those that enjoy less competitive skiing, this is a sport that has a high risk of incurring knee injuries.

The most common knee-ski injury is damage to the anterior cruciate ligament. The ACL is one of the ligaments that hold the knee together and a severe twist – easily incurred when skiing – can instantly result in a partial or complete tear. Quick-release bindings on skis have helped but here are some tips on how to minimise incurring a knee injury on the slopes:

# 1 Be prepared

Being near or at your ideal weight and being fit and strong in advance of your ski holiday will lessen the chance of incurring an injury.

# 2 Book a ski instructor

Even if it’s not your first time, a ski instructor can improve your technique, therefore putting less pressure on the knee.

# 3 Make sure you’re set up properly

Badly-adjusted skis or bindings are more likely to cause injury so be honest about your ability – and weight – when hiring skis.

# 4 Beware skiing slowly!

Whilst you need to be vigilant at all times, people naturally concentrate when they are going fast and, in reality, most injuries occur when skiing slowly because the bindings don’t release, especially in slushy snow. So be extra careful and maintain concentration at all times.

# 5 Don’t overstretch yourself

When muscle fatigue sets in then you’re more likely to injure yourself so ensure you get plenty of rest. However, don’t opt for the apres-ski; alcohol or a hangover will slow your reaction times.

#6 Or take up snowboarding…

Although studies have found that learner boarders are more likely to occur injury than beginner skiers, the knees are less likely to be affected because both feet are strapped onto one board and they are pointing in same direction which prevents the knee from twisting. Snowboarders are actually more likely to occur injury to the upper limbs; shoulder injuries as a result of falling forward or wrist fractures and head injuries from toppling backwards.

The best advice for those that have incurred a knee injury on the slopes is to immediately seek expert advice. To book a consultation at either Mr Jonathan Webb’s London or Bristol clinics call 08450 60 44 99.

New study finds no value in vitamin D and fish oil in treatment of osteoarthritis


fish-oil-and-osteoarthritisAnyone suffering from pain and lack of mobility as a result of knee osteoarthritis will be keen to explore treatments that could possibly alleviate discomfort and restore full movement without the need for extensive knee surgery. One complementary approach which is widely thought to be useful in reducing inflammation and slowing down the disintegration of knee cartilage is the use of vitamin D and fish oil supplements, but in a study published this week these supplements were found to have no distinguishable impact on knee osteoarthritis.

Published in the Journal of the American Medical Association (JAMA), the study was performed by a team of Australian researchers at the University of Tasmania. Half of the group of 413 osteoarthritis sufferers were given vitamin D supplements and the other half were given a placebo. When re-examined two years later, using MRI scans for cartilage volume and the WOMAC pain score to measure knee pain, researchers found no marked difference between the the two groups.

Ding Changhai, the lead researcher, stated that: “This data suggests a lack of evidence to support vitamin D supplementation for slowing disease progression or reducing knee pain in osteoarthritis.”

This follows on from an earlier study performed by the same group into the efficacy of fish oil that found it to be ineffective for both relieving pain and increasing knee mobility.

How is fish oil and vitamin D thought to help alleviate osteoarthritis?

Fish oils (either body or liver oil) are rich in omega-3 essential fatty acids. These are required by the body to boost the immune system and they help to fight inflammation of the joints by blocking production of protaglandins, as well lowering levels of cholesterol and triglyceride in your blood. Fish oil is also rich in vitamin D which is needed for maintenance of our joints, in particular the production of proteglycan in cartilage.

Anecdotal evidence suggests that fish oils may improve rheumatoid arthritis symptoms but its use in alleviating osteoarthritis has not been clinically proven and this study further undermines its claims.

What are the treatment options for knee osteoarthritis?

Pain killers, either analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) are typically prescribed for those suffering from knee osteoarthritis, thought to affect approximately 10 per cent of men and 13 per cent of women over the age of 60. They can help to relieve pain and stiffness, but will not be able to repair damage. Steroid injections are sometimes prescribed. When other treatments are not providing adequate relief, joint replacement surgery may be advised. For advice on knee osteoarthritis, book a consultation with Mr Jonathan Webb at either his London or Bristol clinics.

“I felt looked after by Mr Webb throughout”

Knee Surgery Patient Testimonial

We talk to one of Mr Jonathan Webb’s previous patients about her experience. An enthusiastic rock climber, she suffered a torn meniscus that was repaired by Mr Jonathan Webb at the Fortius Clinic, London.

“The video was recorded in November, two months after my surgery. The video was shot during the female Boulder eliminator. I started very slowly trying to have every move under control. The roof section was the most demanding one but someone I managed to climb further than my three other rivals and so I won the eliminator!”

I am a 27-years-old journalist working as implementation consultant. I have always been a very active person. I hiked in the mountain every time I had an opportunity and, as a kid, I practiced tennis, handball, judo, swimming, table tennis and for the last ten years, I’ve enjoyed canyoning and rock climbing.

I’ve been living for the past three years in London. London is a rushed, fast-paced city, but my routine is pretty much 40 hours a week sitting at my desk, so in my spare time I climb between two to four times a week. My session in the climbing centre lasts between one to three hours. Climbing makes me feel alive and I love the muscular effort that the sports requires. I generally feel energetic, fit and strong. I also like to do climbing competitions and that requires a regular training practice.

A week before I tore my meniscus I had been climbing in Sardinia. I believe the continuous physical strength and endurance that those days required meant the beginning of my knee deterioration. Then I was doing rope climbing in London with a friend and everything was going fine but when he was belaying me down with the rope and I touched the ground with my feet I instantly felt that my left knee wouldn’t stand my weight.

I sat down and looked puzzled at my friend as I hadn’t felt anything while climbing up and now all of a sudden I was unable to walk. I put some ice on the knee and went to A&E. At that moment the knee wasn’t swollen so their advice was to go home and follow up with my GP for a MRI. They sent me home with crutches.

The GP referred me for an MRI which revealed a torn meniscus. Options were to do surgery or not.

Surgery for torn meniscus

At the beginning I was unsure so I started doing some physiotherapy which helped to get my quadriceps stronger. From not being able to walk without limping, I was able to walk normally. However, as a rock climber I felt that if I didn’t have surgery, I would not be able to return to the same level of climbing, as climbing demands all sorts of contortion and weird angles.

I received the date of the surgery within a week of my decision and on the day of the surgery I was a little bit nervous but everything went really well. Mr Webb and his team were incredibly professional and at all time I felt looked after.

Rehab after surgery

The same day of the surgery I was home walking. I stayed at home for a couple of days icing and resting the leg as much as I could. I started physiotherapy straight away with the goal to improve quadriceps strength. My physiotherapist, Martina Kheoe, helped me to recover at the exactly right pace.

Returning to pre-injury activity level

I don’t have any pain in my knee and I was back to climbing after five months. I am weaker than before and it is taking me a little time to recover my strength. I’m climbing with a solid knee support and now that I know I have been fixed it is a case of trusting the knee and focusing on improving my climbing.

If you’re worried you may be suffering from a torn meniscus or other problem relating to the knee, book a consultation with Mr Jonathan Webb at either his London or Bristol clinics.