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Supplements That Help Restless Leg Syndrome

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It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men. RLS, also called Willis-Ekbom disease, causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours, and are often most severe at night when a person is resting, such as sitting or lying in bed.

This makes it difficult to fall asleep, thus leading to daytime fatigue, lack of productivity,and compromised quality of life. The chronic sleep deprivation can lead to severe depression and anxiety.1 Here are some of the key dietary / supplement considerations to discuss with your doctor if you suffer from RLS or know someone who does.

Iron

It is well-documented that low iron levels can cause restless leg syndrome (RLS), which is correctable in these cases with simple iron supplementation. However, not all cases of RLS are caused by iron deficiency or a marginal deficiency in iron. In such cases, it’s important to look deeper.

Vitamin D

An important breakthrough study published in 2015 in the journal Sleep and Breathing showed that low blood vitamin D levels can also be a commonly overlooked cause of RLS.7 This study showed that raising vitamin D blood levels to above 50 nmol/L significantly reduced the severity of restless leg syndrome scores in RLS patients who had blood levels below this value at the outset of the study.6

This is an important finding because the drugs prescribed for RLS are associated with potential for addiction and/or significant withdrawal symptoms. Drugs commonly prescribed for RLS include gabapentin, benzodiazepines (e.g., Valium) and opioid drugs (e.g,, oxycodone).1-2

Anyone with RLS should have their blood iron and vitamin D levels evaluated. If serum ferritin is below 20 ng/ml and/or if vitamin D blood level is below 50 nmol/L, these nutrient deficiencies can be corrected through targeted supplementation to get values into the ideal range. Studies suggest this approach will resolve a large percentage of cases.6-7

Probiotics, Prebiotics and Other Considerations

Other natural interventions showing promise in resolving RLS include probiotic and prebiotic supplements, as bacterial overgrowth (often seen in irritable bowel syndrome) is also a common finding in many (perhaps as high as 70 percent of) RLS cases.3-5

Note also that use of alcohol, nicotine (smoking) and caffeine are known to aggravate RLS and thus should be avoided or greatly minimized in RLS patients. RLS is also associated with other health conditions and other factors including:

  • End-stage renal disease and hemodialysis
  • Neuropathy (nerve damage)
  • Use of certain medications such as anti-nausea drugs (e.g., prochlorperazine or metoclopramide), anti-psychotic drugs (e.g., haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (e.g., fluoxetine or sertraline), and some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine)
  • Pregnancy, especially in the last trimester; however, in most cases, symptoms disappear within four weeks after delivery1

 

Talk to Your Doctor

If you suffer from RLS and don’t have end-stage kidney disease, are not pregnant and are not using the drugs I have cited as potential causes of RLS, your serum ferritin and vitamin D levels should be evaluated. If either or both of these values are low, your doctor may use targeted supplementation of iron and/or vitamin D, respectively, to get these values into the more ideal range. As discussed, it is also prudent to avoid or minimize alcohol, caffeine and nicotine, and consider taking a probiotic supplement each day (and possibly a prebiotic supplement to support the growth of friendly gut bacteria).

RLS can be an extremely aggravating, annoying and life-altering condition that can lead to depression, compromised quality of life, and in some cases addiction to narcotic drugs. Patients and doctors should be proactive in the management of this condition as much as possible, with the inclusion of targeted lifestyle and supplementation strategies personalized to the patient’s health profile. Talk to your doctor for more information.

References

  1. Restless Legs Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke, National Institutes of Health.
  2. “Is Neurontin (Gabapentin) a Drug of Abuse?” Addiction and withdrawal side effects of RLS drugs. American Addiction Centers.
  3. Weinstock LB, et al. Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. Sleep Med, 2011 Jun;12(6):610-3.
  4. Soifer LO, et al. [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study] (Article in Spanish). Acta Gastroenterol Latinoam, 2010 Dec;40(4):323-7.
  5. Kwak DS, et al. Short-term probiotic therapy alleviates small intestinal bacterial overgrowth, but does not improve intestinal permeability in chronic liver disease. Eur J Gastroenterol Hepatol, 2014 Dec;26(12):1353-9.
  6. Wali S, Shukr A, Boudal A, et al. The effect of vitamin D supplements on the severity of restless leg syndrome. Sleep Breath, 2015;2:579-83.
  7. Wang J, O’Reilly B, Venkataramen R et al. Efficacy of oral iron in patients with restless leg syndrome and low-normal ferritin: a randomized, double-blind, placebo-controlled study. Sleep Med, 2009;9:973-5.

How to Avoid Surgery and Stay in the Game

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The growth of organized amateur sports over the past 30 years has spawned an unexpected and unwanted increase in sports-related injuries. Many young athletes suffer sports-related injuries that can turn into lifelong problems. Here are some basic facts about knee injuries and how they are handled in the world of modern medicine. I am not passing judgment – just pointing out some facts.

The American Academy of Orthopedic Surgeons reported that in 2003, 9.5 million people visited orthopedic surgeons because of knee problems. By now, this staggering number is probably even higher, considering a greater number of children and adults are participating in athletics every year. The most common recommendation regarding knee injuries is to avoid the activities that take place when the knee is injured, such as activities that require stopping and starting or quickly changing directions. It is thought that these extreme forces on the knee can result in torn ligaments; however, they don’t result in torn ligaments in everyone, which means there could be some pre-existing contributing factors.

To learn why our knees are injured so frequently, it’s important to know how the knee works. The knee joint is composed of four bones: the femur, the tibia, the fibula and the patella (see image on facing page). Cartilage covers the joint and provides a smooth, lubricated gliding surface so the knee can move. The shape of the knee joint is stable, but to function properly, the ligaments have to be in good shape, too! Those ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL).

While the ACL works as the main stabilizer when the knee is bent, the PCL works as the main stabilizer when the knee is extended. The collateral ligaments are used when you move from side to side. The medial and lateral menisci are located within the joint and act as “shock absorbers” and also influence knee stability. The most commonly injured parts of the knee are the ACL and the medial meniscus. Tears of the meniscus usually take place during twisting, pivoting, or decelerating movements, or as a result of direct impact.

When you look for information regarding treatment of knee injuries, you will see two basic categories of medical care: surgical and nonsurgical. Surgical intervention has certainly improved over the past 20 years and typically involves arthroscopic surgery for severely sprained or ruptured ligaments or torn cartilage. The new procedures are far less invasive than techniques used many years ago, resulting in less scar tissue and faster recovery time. Nonsurgical intervention typically involves improving the stability of the knee joint with rehabilitative exercises, focusing on the quadriceps (thigh) muscles and the hamstrings. Bracing is also a common practice to enhance stability by limiting motion in the knee joint.

To summarize, the way knee injuries are handled in today’s world is to stop doing things that tear ligaments, like running, jumping, twisting and stopping quickly. If you do want to continue doing those things, the common recommendation is to get surgery or do rehab and put on a brace to limit motion in the joint. The resulting lack of motion will likely cause degenerative arthritis over the next 20-40 years, which will result in the need for a knee joint replacement.

OK, so where’s the good news? Simply put, a chiropractor has the ability to do a better job than that! Their knowledge of the foot, knee, hip, and spine connection, combined with practical experience, affords an alternative to the “shoot the dice and hope for the best” theory. The first thing to understand is that healthy knee function is not possible without a healthy foot function. The medical model of health care does not take that into consideration because the foot rarely presents itself as being painful. Even if the foot does hurt, treatment only takes care of the symptom and does not address abnormal joint function.

A vast majority of people, young and old, excessively pronate. This means that when the foot hits the ground, it flattens out or unlocks, rolling inward and creating a twisting stress up the leg and into the knee. These twisting stresses do three things to the knees: stretch the ACL, stretch and twist the medial meniscus, and inhibit contraction of the quadriceps muscle.

Every time we take a step, jump, pivot, stop quickly and run, those three things take place. A torn knee ligament is not a one-injury event; it is a multiple micro-injury event. These abnormal forces take place perhaps thousands of times, creating microtrauma to the support structures of the lower leg until the ligament fails catastrophically.

If thigh muscle weakness is one of the results of excessive pronation, doesn’t it make sense that the muscle loses its tone to a point that it can no longer stabilize the joint efficiently? Remember, muscle is the primary stabilizer; ligaments are secondary. If you weaken the muscle and traumatize the ligament a few thousand times, you have all the ingredients for the classic knee injury.

Common sense tells us to prevent the excessive damaging motions by supporting the foundational structures (your feet) so they function within the functional range of motion.  Many chiropractors now evaluate the quality of the arches of the feet. If the arches aren’t supporting the legs and pelvis sufficiently, it can create stresses that lead to injury or joint wear and tear. It’s just like the foundation of your house; if it settles too much, it creates stress in other parts of the structure.

Take a proactive step to avoiding injuries and preserving the health of your knees, hips, and spine. After all, you know what they say about “an ounce of prevention.” Ask your doctor for a thorough foot evaluation, particularly if you’re experiencing knee pain or participate in activities that put you at risk for a knee injury.

Managing Sports Injuries Without NSAIDs / Painkillers

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As an active person, your favorite sport or exercise is an important part of your life. It gives you energy, it challenges you and it makes you come alive. You can’t imagine a day without it until the day you get injured.

Sports injuries are a natural consequence of the choice of being active. Keeping informed on how to manage an injury is just as important as taking precautions to avoid them.

The Standard Protocol for Managing Injuries

The first line of treatment and the standard protocol for managing acute injuries is a method known as RICE, which stands for Rest, Ice, Compression and Elevation.

Rest means reducing physical activity in the injured area, for example, by using a crutch or some other method of taking weight off the injured part of the body. Ice is applied to the area to reduce inflammation to the muscles. Compression refers to compressing the area using any means like an elastic wrap to help reduce swelling, and Elevation refers to raising the area, also to help reduce swelling.

Painkillers Help With Pain, But They Aren’t for Everyone

During the course of rehabilitation, doctors sometimes prescribe medication that can relieve pain. Common medications include opioids like morphine and methadone, which, despite their benefits, can lead to addiction and a number of side effects; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin and naproxen. NSAIDs reduce swelling and help patients return to activity more rapidly than with the RICE method alone. The way NSAIDs work in the body, however, can be problematic:

  • They are contraindicated for patients with a history of gastrointestinal bleeding and must be used cautiously in those with chronic kidney disease.
  • Some patients can’t tolerate the adverse effects, which may include stomach upset, vomiting and abdominal pain
  • Others may have medication interactions that prohibit use of oral NSAIDs.

Two Scientifically Backed Alternatives to NSAIDs/ Painkillers

1. Precut Kinesiology Tape is an option that uses and supports the body’s own natural neurology to deliver drug-free pain relief. These tapes work by lifting the skin to create a small space between the muscle and dermis layers of the skin. That extra space takes the pressure off injured muscles, allows muscle movement, and provides space for drainage and blood flow to muscles and joints, thus reducing swelling; while also soothing overworked muscles and strengthening weak or fatigued muscles.

A recent study conducted at the University of Toronto and published in the Clinical Journal of Sport Medicine found that using precut kinesiology tape was as effective as using NSAIDs for relieving pain and improving function when used alongside physiotherapy for patients with shoulder injuries. In fact, the precut kinesiology tapes were better tolerated than NSAIDs because there weren’t any chemical side effects.

Furthermore, using these precut tapes is convenient because one application of a precut tape lasts several days, which means, unlike medication, there won’t be any hassle of retaking or reapplying the treatment every few hours. Additionally, because precut kinesiology tapes are designed keeping in mind human anatomy, you can apply them easily yourself after instruction by a health care professional.

Health care practitioners are increasingly using precut kinesiology tapes as a means to standardize patient care and provide drug-free pain relief option to patients. Professional athletes are turning to kinesiology tape, as it provides a DIY knesiology solution for performance enhancement and pain relief.

2. Chiropractic Care: Millions of people visit chiropractors every year for all kinds of sports injuries, including injuries to their back, neck, arms and legs. In the sports setting, chiropractors work by manipulating joints that are restricted due to muscle injuries. They help to improve joint alignment so the body can heal itself without surgery or medication.

Chiropractic care not only restores function; it also helps prevent future injuries, in addition to providing relief from pain. Research shows chiropractic treatment is safe, effective and helpful in treating sports-injury-related pains and is a great alternative to NSAIDs.

Professional athletes use chiropractic treatments as a regular part of their training. In fact, studies have shown that regularly incorporating chiropractic care enhances athletic performance and lowers the amount of subsequent injuries athletes experience.

Tip: Chiropractic care is complemented by the use of precut kinesiology tape. The two treatments are increasingly used together to provide further relief, hasten recovery and enhance performance.

The possibility of getting injured while being active is not a reason to avoid exercising or playing sports. Injuries are part of the deal and professional athletes and active people know this for a fact. You should stay active and have fun, while striving for prevention and keeping informed on all the options available to you for treatment and management of sports-related injuries.

Lifetime Chiropractic

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One of the most exciting aspects of being a chiropractor is helping people on a daily basis. I have been in practice now for more than 11 years, and I still get excited every morning when I go to work because I have so much fun working with my patients.

Once your pain and discomfort are gone, it feels as if you have your life back again. You are able to go out and perform your everyday activities like exercising, playing golf or going places with your family. We, as chiropractors, are extremely pleased when our patients begin feeling better, and eventually they tell us they feel “normal” again. But our responsibility to you, the patient, does not end there.

In my practice, I start a relationship with my patients – one deeply rooted in trust and understanding – on the first day I meet them. I explain and educate them on their ailment, the treatment and what they are expected to do outside the office to help get them better. This expectation I have of patients taking care of themselves follows them throughout their lives, even after we have stopped active care.

As much as we hope our adjustments hold forever and our patients continue to feel better, the reality is that, inevitably, your body will need checkups every so often. Life circumstances often arise that can cause your spine and other joints of the body to become stressed and thrown back out of alignment.

Did you know you could benefit from regular spinal checkups – just like you benefit when a dentist cleans your teeth or a mechanic changes the oil in your car? Regular chiropractic maintenance can help you avoid major problems before they happen.

Lifestyle Stress

Lifestyle stress or injuries can happen to your body simply as a part of living your normal life. Think for a moment about your average daily activities. As you retrace your steps from the time you wake up until the time you go to bed, you can probably identify numerous tasks that potentially could cause stress on your body. There are so many different types of activities we perform during the course of a day, week or month. Here are a few of the most common scenarios I hear when a patient comes in seeking treatment.

If you are a parent of young children, your activities can include much of the following: bending over and using your arms to pick up, hold and carry your children; driving multiple times daily; pushing strollers; and changing diapers. Do you think any of these activities can put stress on the spine and other parts of the body?

Workout Stress

Even engaging in activities that are good for you, such as regular exercise or sports-related activities, can lead to stress on your body.  Think of your average exercise workout. Run through it in your mind from start to finish and visualize what you are putting your body through. It can be as simple as going on the treadmill or elliptical machine, or as complex as intense weight training. It can involve a nice, slow stretching class or a high-intensity spinning class. Pilates/mat classes, yoga, balance ball, foam roller, or exercise ball: What’s your cup of tea?

Now think about specific athletic events in which you still might engage. Is it basketball, tennis, golf, running, racquetball or softball? Whatever you prefer to play, do you think it could put a strain on your body? The answer, of course, is yes it can!

Why Can’t Chiropractic Last Longer?

One of the questions patients ask me is, “Why can’t you just put me back in alignment and have it stay that way? Why do I have to come back every so often?” The reason your chiropractic adjustments do not hold forever is because you go out and live your life. When you do the things we described earlier, your muscles, spine and joints react to the stress over time.

When you think about it, almost every single job or daily activity can have an effect on the alignment of your spine and extremities. Even though we encourage you to exercise to stay healthy, it can cause stress on your body that needs to be addressed. Your body reacts by moving out of alignment and your muscles spasm, which causes swelling, pain and discomfort to return. Does that mean you shouldn’t exercise? No! Stress is a normal part of life. The point I want to make is that you can do something to keep it from negatively affecting your body and your health.

Some patients are able to hold their adjustments longer than others. Certain patients might only come in for an annual checkup because they exercise and do things that keep them strong. Other patients might come back every two weeks because their daily routine is so physically demanding that they are quickly thrown out of alignment. It all depends on your genetics, your commitment to your home exercises and your lifestyle. You and your chiropractor will be able to discover what your optimal frequency should be for coming back to the office for spinal tune-ups.

Preventing ACL Injuries in Female Athletes

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For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.

What Causes an ACL Injury?

An ACL injury is usually caused by sudden, abrupt change in force to the knee. This can occur during an unexpected cutting move made during a sporting activity, or while landing following a jump in an athletic activity. Most ACL injuries occur in a non-contact setting and do not involve a collision with another player.1

What Does an ACL Injury Mean to an Athlete?

When an athlete injures the ACL, it may mean losing an entire season of play. If the injury is severe enough, it could also lead to surgery, resulting in long-term rehabilitation, a possible loss of scholarship, and emotional and mental strain. ACL injuries also could pose a lifelong potential for arthritis in the injured joint.2

Why Do They Occur More Frequently in Female Athletes?

For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.

What Causes an ACL Injury?

An ACL injury is usually caused by sudden, abrupt change in force to the knee. This can occur during an unexpected cutting move made during a sporting activity, or while landing following a jump in an athletic activity. Most ACL injuries occur in a non-contact setting and do not involve a collision with another player.1

What Does an ACL Injury Mean to an Athlete?

When an athlete injures the ACL, it may mean losing an entire season of play. If the injury is severe enough, it could also lead to surgery, resulting in long-term rehabilitation, a possible loss of scholarship, and emotional and mental strain. ACL injuries also could pose a lifelong potential for arthritis in the injured joint.2

Why Do They Occur More Frequently in Female Athletes?

ACL injuries typically occur at a four- to six-times higher rate in females because they are more quadriceps dominant. Another factor may be decreased neuromuscular performance and increased ligamentous laxity during menstrual cycles from the fluctuation of female hormones.3-4 A study in The New England Journal of Medicine found differences in leg ailment of males vs. females, noting females have an increased rate of knock-knee (valgus deformity5). The intercondylar notch width is smaller in females, creating less space for the movement of the ACL and resulting in increased risk of injury. Women also typically have a wider pelvis, resulting in thigh bones angling downward more sharply (Q-angle).6 This leads to increased valgus stress and potential injury.

ACL Injuries and Hormones

Fibroblasts lead to collagen synthesis, which enables ligaments and tendons to heal. Estrogen (especially estrodial) inhibits fibroblastic proliferation. Collagen synthesis is significantly reduced with increased local estrodial concentration. Many high-school and college female athletes take birth-control pills, which are all estrogen-based and contribute to the potential for injury.

The National High School Sports-Related Injury Surveillance Study, currently in its fifth year of online data collection, has found that one ACL tear occurs every 15,000 times an athlete practices or competes. On average, athletes are eight times more likely to suffer ACL injuries in competition than practice. Data was collected from a national sample of nine girls’ high-school sports, including soccer, basketball, lacrosse, track, volleyball and softball.2

Most Common Sports for ACL Injury in Practice / Competition

  • Injuries occur in girls’ soccer 1 out of 6,500 times an athlete practices or competes.7
  • In girls’ basketball, injuries occur 1 of every 11, 000 times an athlete practices or competes.7

ACL Injury Rate Per Sport

A study in the American Journal of Sports Medicine (2009)8 concluded the following with regard to ACL injury prevalence by sport:

  • An ACL sports injury prevention training program improved strength and flexibility in competitive female basketball players who were tested.
  • The training program also improved biomechanical movement patterns associated with ACL injury as compared with pre- and post-training parameters in the control group.

Of clinical relevance is the conclusion that the prevention program lowered the athletes’ risk of injury.

A later study in the American Journal of Sports Medicine (2013)9 concluded that neuromuscular and educational interventions appear to reduce the incidence rate of ACL injuries by approximately 50 percent.

How to Prevent ACL Injuries

The key elements of a clinical program to prevent ACL injury include the following (see examples of each element below):

  • Nutrition – supplements and proper diet
  • Dynamic warm-up
  • Stretching
  • Strengthening
  • Plyometrics
  • Agility drills
  • Cooldown

1. Dynamic Warm-Up

  • Jog line to line (cone to cone)
  • Shuttle run
  • Backward running

2. Proper Stretching (Click here to learn how to stretch properly.)

  • Calf stretch
  • Quad stretch
  • Figure-four hamstring stretch
  • Inner thigh stretch
  • Hip flexor stretch

3. Strengthening (See descriptions / images of how to perform these exercises below.)

  • Glute-ham raise
  • Squat
  • Leg curl
  • Jump squat
  • Single-leg, stiff-legged deadlift
  • Bosu plank
  • Walking lunges
  • Assisted Russian hamstring curl

Glute-Ham Raise

  • Raise or extend hips until torso is perpendicular with legs
  • Raise body by flexing knees
  • Lower body until horizontal by straightening knees
  • Repeat

Squat

  • Head straight, arms overhead
  • Feet pointing straight or slightly toed-out
  • Feet slightly wider than shoulder-width apart
  • Knees in line with toes
  • Squat back, not down

Seated Leg Curl

  • Seated vertical, back flat, chest out
  • Place lower calves over pad with legs out in front
  • Brace upper body, use handles to assist
  • Without moving back or hips, pull the pad down and back as far as you can
  • Slowly return to starting position

Squat Jump

  • Start the same as the squat, descend slightly above parallel
  • Propel body upward to max height
  • Land in similar position, making certain to be soft on the knees
  • Note: Do not adduct knees (bring knees together) upon landing

Single-Leg, Stiff-Legged Deadlift

  • Stand on one leg, holding weight in both hands
  • Keep back flat, lean forward at hips and lift free leg to the rear, in line with the torso
  • Touch weight to the ground
  • Return to starting position

Bosu Plank

  • Keep back flat and form straight line from head to heels
  • Tilt pelvis and contract abs
  • Hold for 20-60 seconds

Assisted Russian Hamstring Curl

  • Start on knees with arms up and partner holding your feet
  • Keeping body straight, slowly lower yourself toward the ground in front until you can no longer hold yourself up
  • Push back up with your hands to the upright position
  • Repeat 20 times

Things to look for: Brace stomach while moving forward and back. Make sure not to arch back when returning to starting position.

4. Plyometrics

  • Lateral hops over cone
  • Forward / backward hops over cone
  • Vertical plyo jumps

5. Agility Drills

  • Shuttle run with forward / backward running
  • Diagonal run
  • Bounding run

6. Cooldown

  • Bridging with alternating hip extension
  • Crunches
  • Single / double knee to chest
  • Piriformis stretches

The athlete’s fitness and desired level of performance will influence which of the above exercises are performed. Talk to your doctor before initiating any of these exercises to ensure proper / safe performance, particularly if you are have suffered an ACL injury of any type.

Rehab That Knee the Right Way

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An injury to the anterior cruciate ligament (ACL) of the knee, particularly one that requires surgery, can sideline even the most dedicated athlete for months, if not longer.

Straighten Up: While lying on your back, straighten your leg, then slowly raise it as high as possible and hold for a few seconds. You may not be able to elevate the straight leg very high in the beginning, but stick with it. In fact, you can simply place the foot / ankle on a support and straighten it without lifting if necessary.

Contract the Quad: Again lying on your back, straighten the knee and tighten the quadriceps (the large muscle group located in the front of the upper leg) for 10 seconds. Release and repeat 10 times several times a day.

Hang ‘Em Low: Lie on your stomach on an elevated surface such as a bed or table, with the edge of the surface just above your knee. Let your legs hang off the edge for 1 minute or as long as you can, whichever comes first.

Take a Slide: Lying on your back on the bed or a comfortable surface, slide the heel of the foot toward your butt, attempting to bend the knee while keeping the heel flat. Hold whatever position you can achieve for 10 seconds; then slowly slide the foot back to the starting position. Repeat 15-20 times, several times a day.

If you’ve recently suffered an ACL injury and/or undergone surgery for an ACL injury, your doctor should be providing you with these and similar exercises to start you on your road to recovery. And if you’ve never suffered a knee injury, but want to make sure things stay that way, your doctor can teach you simple stretches and strengthening exercises to keep your knee out of trouble.