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Dr Jean-Marc Parisaux is a doctor of sports medicine and traumatology with expertise in manual medicine, osteopathy and rehabilitation. He is a specialist at the prestigious Monaco-based sports medicine center, IM2S, which helps world-class athletes and ordinary folk with their goals towards attaining optimal physical performance. Send your health and fitness questions to: askthedoc @

When knees start to hurt

Dear Dr Parisaux,

As much as I'd like to ignore it, it looks like age is catching up with me. The first sign is that I have a great deal of pain in my knees whenever climbing up or going down stairs. What can I do to ease the pain and be more agile again?

- Sunity

Dear Sunity,

Your problem is a very common one, which is often due to osteoarthritis or sometimes tendinosis, or it may be a meniscus problem. Clinical examination and x-rays will help your doctor confirm osteoarthritis and the stage of it in order to propose the best treatment. If your problem is a cartilage one (osteoarthritis), you can take painkillers and non-steroidal anti-inflammatory drugs to help you for a few while. On the other hand, you should begin taking pills which will help to preserve your cartilage (such as chondroitine, glucosamine). Physiotherapy can also help you.

But the treatment I really advise for osteoarthritis is an injection of hyaluronic acid (viscosupplementation). This will help your synovial fluid to re-establish good elasticity and viscosity properties, and avoid cartilage deterioration. Don’t wait until it's too late, otherwise you will need a prosthesis!

Eat right to ski right

Dear Dr Parisaux,

I'm going to ski for one week with my children...and I read that good food choices could prevent sports injury. Intriguing! Could you elaborate on that.


Dear Jeanette,

Indeed, proper nutrition can help to prevent sports injury. Let's look at the opposite scenario: with poor nutrition, your muscle don't have enough energy and power, mainly at the end of the ski session, to enable you to prevent bad falls and, so, possible injury.

I asked Severine Olivie, our dietitian at IM2S, to help you with some advice and a typical menu you should use. Here is the recommendation she emailed to me:

Practising intensive physical activity in cold weather (skiing, snowboarding, etc) increases energy expenditure. Here are some nutritional tips to recover properly and prevent early exhaustion, falls and injuries:

1. Increase your energy intakes in the form of a rich carbohydrate diet to ensure the replenishment of muscle glycogen stores.

2. Spare your muscle glycogen stores by having quickly available glucose snacks regularly throughout the day. This is particularly important for children whose glycogen storage capacity is lower.

3. Drink small amount of fluids as frequently as possible throughout the day to compensate sweat increased by exercise.

4.Eat fruits and vegetables regularly : they provide the micronutrients (vitamins and minerals) that play a role in many metabolic functions (including energetic metabolism).

Example of a day “on the slopes”:

Breakfast (from 7.00 to 7.30 am):
Tea or coffee
Half-skimmed milk or natural yoghurt
Breakfast cereals
Whole wheat bread
Fresh fruit
Jam or honey (optional)
Ham (optional)

Snack (11.00 am):
Cereal bar

Lunch (from 12.30 to 01.00 pm):
Club sandwich
Fruit juice

Snack (3.30 pm):
Gingerbread or jelly rolls

Snack (5.00 pm):
Hot chocolate
Finger biscuits

Dinner (8.00 pm):
Vegetable soup
Grilled lean meat or steamed fish
Spaghetti (“al dente”) with low fat tomato sauce
Green salad, olive and canola oil
Natural yoghurt
Apple pie


1. Drink the equivalent of one or two drinking cups (125 to 250 mL maximum) every 15 minutes approximately, according to self tolerance and exercise intensity.

2. Always drink before you get thirsty.

3. If you have regular carbohydrates solid intakes, water is sufficient. On the other hand, if this is not the case, sugar must be provided by soft drinks (syrups, fruit juices) following these proportions: for one litre of beverage, mix the equivalent of 33 cL (to 50 cL maximum) of sugar-free fruit juice or 50 (to 75 mL maximum) of syrup and fill out with water.

Important: In order to ensure quick energy availability and good digestibility, avoid fats (hot dog and French fries, chocolates bars, etc).

Enjoy !

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