I’ve read a lot of articles out here on knee injuries and what to do.
The problem I’m having is being born with bad knees (this isn’t me at all, it’s someone I am trying to help, a woman BTW). This isn’t from lifting too much or too often, the knees are just put together wrong.
Right now even a body weight squat is painful. So squatting, forget it, dead lifts, forget it, sprinting, forget it. This person wants to get fit but I am at a loss of what to do for her. She can’t even jog for any reasonable amount of time. Walking is fine, but there are only so many hours in the day and walking doesn’t seem to be increasing her strength or knee stress tolerance (which is her goal). Doctors indicate that someday she will probably need knee surgery simply because of the grinding and cartilage loss from daily activity.
Looking at her, it seems that her tibia and femur are just misaligned and her patella doesn’t track correctly.
I do understand that this would fall under the “medical problem” umbrella, it’s just that she has had no luck with this avenue and doctors don’t really see it as an issue that needs to be addressed now. This does however keep her from achieving her goals and by extension her quality of life.
Even months of PT didn’t help the problem.
Thoughts on any kind of starter exercises to get he going would be great. Stats: 5’5" about 117lbs.
If she is just looking to do cardio I’d have thought cycling and swimming would place the least stress on knees. I get sore knees from squatting and sprinting (not a serious problem or anything, just a small pain) and cycling and swimming never affect me.
Oh also box squats for some reason are waaaay better for my knees than any other type, I imagine because they go through a shorter ROM. So she could try that.
If she knows in which direction her knees are off-tracking, she can do partial ROM leg extensions with toes pointed in opposite direction, as well as working on stretching and foam rolling the side that’s pulling it off track.
She also may have some hip/pelvic tilt issues that exacerbate her knee’s structural problems. If she has a job that requires hours of sitting, she might try keeping her knees together, and higher than her hips while sitting back against the chair back. Tell her to avoid sitting cross-legged, as well as avoid sitting “indian-style” on the floor.
I’m sure there is a multitude of problems going on and have been for many year. So the damage may still aggravate even if she starts doing the correct exercises. Guess it’s trial and error for you. Find exercises that she can do correctly without aggravation and go from there. Guess that was the idea of your post hey!
I would start by looking at her glutes, weak glutes will allow internal rotation/adduction of the femur causing malalignment at the tibiofemoral joint along with shortening of the ITB and malalignment of the patella. More likely than the mixed evidence VMO theories anyway. Shame PT didn’t fix the problem but then maybe she had the wrong treatments. Of course it sounds like there could be a lot of damage and as i said before if she’s older with lots of degeneration then her goals may need to be adjusted, but i really can’t tell you right now.
It’s very difficult to diagnose and treat a complex condition like this one over the internet, I mean she has had hours with a PT who couldn’t fix it and diagnosing over a paragraph on the internet a little bit more complicated. If she allows you could post a video of her when she is jogging and squatting and I’m sure someone will be able to point out anything substantially wrong with her biomechanics. Otherwise she could get a proper diagnosis from someone and go from there.
[quote]Mr Stern wrote:
I would start by looking at her glutes, weak glutes will allow internal rotation/adduction of the femur causing malalignment at the tibiofemoral joint along with shortening of the ITB and malalignment of the patella. More likely than the mixed evidence VMO theories anyway. [/quote]
I don’t think we are disagreeing.
Except maybe one should start with looking at possible overpronation of that foot?
(In the spirit of starting from the ground (foot) and working up (quad - lengthen ITB and activate VMO) and glute activation (including lateral rotators) along with adductor lengthening.
Insofar as we can say stuffs over the net without even seeing a vid of her.