The KNEE PAIN Thread

Training Injuries
21

Fone,

I would focus on getting these areas loosened up via some static stretching and foam rolling. Try the glute, calf and hamstrings stretches in my “Hardcore Stretching” piece, as well as using the foam roller in the same areas. EC and I wrote a piece entitled “Feel Better for 10 Bucks.”

Give these a go and then report back as to how you are feeling. Good luck!

Stay strong
MR

[quote]Fonebone wrote:

Mike, I will answer your questions in the order you asked them:

  1. Flexibility in my hams is poor. I’m not sure how to gauge flexibility in the glutes and calves, but I would imagine it too is lacking.

  2. I don’t know if I have any adhesions and I’m not sure how I would be able to tell.

  3. I have not tried foam rolling, and am not familiar with it.

I apologize for the dearth of information, but I hope it’s enough to start with anyway.

Thanks Mike! [/quote]

22

Now we’re getting somewhere!

When you say front of the knee, do you mean above or below the kneecap?

What’s your age?

What does your CURRENT training program look like?

Can you remember a specific incident that led to the injury, or has it been gradually getting worse?

Sorry for more questions, but we’ll figure it out!

Stay strong
MR

[quote]wwatts11 wrote:
It hurts at the front of the knee. My knee tends to click as yours do. Any bending beyond 45 degrees provokes the pain. Walking and standing does not hurt. Performing sprints is very painful. As I mentioned, even sitting causes a pain that is only relieved by stretching out the legs.

I primarily follow any quad exercise with a hip or hamstring exercise, and vice versa. I tend to stretch my hips flexors more than my quads because any bending of the knee involved in stretching the quads causes pain.

I’ve had pain in both of my knees for over a year now. It hurts while squatting and even while sitting in the same position for a long time. I’ve just started taking chondroitin about a month ago, but so far the pain hasn’t ceased. I do need to start icing them though. Any information you could provide would be very helpful.

[/quote]

23

Sometimes being that wide over-recruits the VL/TFL/ITB. As well, you can’t typically go as low, so you don’t get as much VMO recruitment. Have you tried foam rolling the lateral tissues yet?

Stay strong
MR

[quote]TriGWU wrote:
Can wide squats lead to tracking issues?

I’ve been doing wide squats for about 2 weeks and recently picked up some knee pain.

This is the only thing really new with my regimen.

Distances is running/cycling/swimming all the same.[/quote]

24

Thought I answered this, but I guess not!

Unfortunately, when you get the recurring subluxations it can cause a host of issues. I see that you’ve already had the lateral release, did they tighten up the medial tissues as well?

What kind of training interventions have you used? Rehab would be similar to what I’ve discussed throughout the thread: releasing the lateral tissues (TFL/ITB, VL, Lateral Retinaculum) and VMO recruitment/strengthening.

What has your doc/PT had to say about all this?

Stay strong
MR

[quote]sam747 wrote:
I’ve dislocated my left knee 3 times in the last 15 years or so.

I’ve had 2 lateral release surgeries the latest about 2 years ago.

My left leg is significantly smaller and weaker than my right.

Rock bottom squats are hard for me from a technique stand point and sometimes there is some pain and a “creaky feeling” in the joint.

I guess I’m not real sure how to approach rehabbing it or if I should be using some kind of wrap to prevent further injury. Also I guess I get a little scared using it, I don’t want another dislocation. Any ideas Mike? [/quote]

25

I dislocated my left patella two weeks ago. Since it has happened i still cant walk full time without an immobilizer. I have barely any ROM, maybe 45 degrees, and the pain is slightly diminishing as the days go by. I have seen an orthopedist who told me everything is fine and i just have to let it heal and seek therapy. My therapy sessions are supposed to start next Monday.

With that said…

What was the recovery time like for some of you with similar injuries?

Did therapy bring you back to 100%?

How long did it take for you to walk normally?

Did u notice any longterm effects like swelling after sports? pain? ect?

Any help is much appreciated, thank you!

Mark

26

Mark,

Just a quick snippet from me, and then I’ll let the others who have dealt with this head-on chime in.

I’ve read that up to 40% of patellas that sublux once will do so again. That being said, proper treatment/care (as I outlined above) is SUPPOSED to reduce the recurrence rate to 10%. I would take your rehab VERY seriously.

Stay strong
MR

[quote]Mr.Mark wrote:
I dislocated my left patella two weeks ago. Since it has happened i still cant walk full time without an immobilizer. I have barely any ROM, maybe 45 degrees, and the pain is slightly diminishing as the days go by. I have seen an orthopedist who told me everything is fine and i just have to let it heal and seek therapy. My therapy sessions are supposed to start next Monday.

With that said…

What was the recovery time like for some of you with similar injuries?

Did therapy bring you back to 100%?

How long did it take for you to walk normally?

Did u notice any longterm effects like swelling after sports? pain? ect?

Any help is much appreciated, thank you!

Mark[/quote]

27

Mike, most importantly here is that you are being proactive with your knee pain and taking care of things now before more damage occurs. My best advice, as silly as it sounds, is to pace yourself through rehab and of course be persistent. I have had multiple surgeries now but I waited way too long and never fully recovered before stepping back in the action (softball, roller hockey, etc.).

For others that have not gone the surgery route, be in the best shape and strength possible before the surgery and your rehab will go much better (you will be surprised).

My last surgery was the removal of the rest of the medial and lateral meniscus (shredded and none left now) plus 3 screws to hold a new ACL in place. The pics before…the ACL was basically disintegrated! I do have a fair amount of arthritis there now.

After the last surgery, I really wanted to get back to being strong and flexible. I did 3 days per week of rehab and in between I did my own stretching and strength work. I honestly think I got more on my own than in rehab.

The difference between me today (at 36) and 15 years ago is that I tend to have to really listen to my body and I have to cycle exercises and intensity. I still squat and deadlift, etc. but I can’t do them all the time nor always heavy. So, 6-8 weeks heavy followed by no squatting for 6 weeks back to light squating, etc. The aches and pains will let me know right away when it is time to stop. When I can’t walk stairs one day or can’t play with my kids - it is time to stop. I still managed to recently work up to a 425 x 3 squat with only knee wraps on but 2 weeks later I had to call it quits and change my routine. Sucked b/c I was still feeling that I could go heavier. Like everything else in life - you deal with it, adapt, overcome and push on.

Oh, one other thing I did after my last surgery. Once my range of motion was back and I felt ready to increase my workload, I used the original Limping routines by Ian King and had great success. My knee joint felt as stable as it probably every felt in my life…as a matter of fact, its been about 6 years maybe since then - I think I need to revisit that routine!

Best of luck to you Mike!

28

Mr.Mark wrote:
I dislocated my left patella two weeks ago. Since it has happened i still cant walk full time without an immobilizer. I have barely any ROM, maybe 45 degrees, and the pain is slightly diminishing as the days go by. I have seen an orthopedist who told me everything is fine and i just have to let it heal and seek therapy. My therapy sessions are supposed to start next Monday.

Did you have an MRI or anything? Dislocation and still need an immobilizer with no ROM sounds like you did some damage. Make sure you are getting the right info for your sake. I am no Dr. at all but just make sure your Dr. is diagnosing you correctly.

Kinda funny here. Before my last surgery, I went on vacation with my buddies. We were playing stick ball and I was pitching. On the follow through with my back leg coming forward, my knee completely dislocated. Looking down at my right thigh, my knee down was turned to the right and my foot almost sideways on the ground. Freaked me out! Had my friends carry my back to the house and they wanted to take me to the hospital. Eff that! Vacation! Gimme some beers and shots! Waited to loosen up from alcohol with my leg propped up on a bench and forced it back into place. OUCH. But, I made it through the vacation. Man, young and stupid! Now wonder my knee will never be the same.

29

Smit,

Thanks for the kind words and the insight.

Like you said, I’m going to use this time to rehab properly, getting my CORE super strong (EC loves that word), and do some bench specialization stuff.

Again, thanks for the words of support and I hope that people will take your knowledge and apply it!

Stay strong
MR

30

Mike,

Thanks for your reply. I am very serious about taking the proper precautions to work this out. At 22 this isnt something i want coming up ever again (not to mention go through the intense amount of pain). Haha. Hopefully the therapy will be a blessing to end my troubles! Thanks for your support, i will continue with more info as it comes.

31

Thanks for the reply. I had 2 sets of xrays done, once in the ER and another at the ortho. They were both negative, but that doesnt even show the whole picture. My ortho is a relative so im sure hes doing anything in his power, but things can always be overlooked by mistake. During the exam he removed 4 good sized tubes of blood which reduced the swelling a good bit. After that he inspected it with his hands (poking, pulling, squeezing, ect.). He said he didnt feel anything unordinary, torn ligaments, A few hours later i noticed most the swelling came back, so im sure i will need to get the knee drained again. Im hoping the extra fluids are what is causing the intense tight feeling and limiting my ROM.

Any thoughts???

Thanks

32

[quote]Mike Robertson wrote:
Fast forward to this week: The knee was still clicking, so I had an MRI ran. The MRI confirmed a torn lateral meniscus, which the doc said probably happened while skiing 4 months earlier! I’m set to meet with a surgeon next week.

So how does this help you all? Since that time I’ve done even more research on the anatomy and injuries of the knee joint. My goal is to help ANYONE who has knee pain so that they can train pain-free and feel good again. Nothing has felt worse than not knowing what was going on.

As well, I’m going to document my entire treatment and rehab process so that the T-Nation members will have an idea of how I get myself fixed up.

So there it is; if you have any questions regarding knee pain, feel free to post them here. Who knows, if this goes well maybe we can even start other threads for different injured areas…sound good?

Stay strong
MR[/quote]

Well aside from the bad news about the knee, this is good idea Mike!

I’ve just done major damage to my knee as well, playing football (Aussie Rules). I’m in for a reconstruction in a week to repair posterior lateral meniscus and ACL. I’ve got other damage as well but that’ll heal itself apparently.

As I had just started into getting that squats and deads into some good poundage territory (well for me) it really feels like I blow that I can’t even bend my knee.

I’ll have a long road back, so I could do with all the good info on knee rehab. Last thing I want is 150lb Johnny personal trainer telling me how to squat for rehab.

33

What’s up Mike?

My knees are a train wreck! So I feel your pain(pun intended). In Nov 1998 I had reconstructive knee surgery on my left knee (torn ACL) and then in April 99 had arthroscopic surgery on the same knee to clear up scar tissue that built up during the time I was Immobile.

For some reason, my doc said I was one of 10% of people with extended ligaments so he had to add a screw and said I had to stay in a stiff brace for 10 weeks! Most people start PT and the CPM machine (continuous passive movement) within days after the surgery but I didn’t start either til 10 1/2 weeks later! I was a mess.

By that time, so much scar tissue built up around the knee that I had no ROM. Maybe 10 degrees. So he had to break up all that scar tissue by just forcing my knee back. It was one of the most painful experiences I ever went through, and I’ve been through quite a bit. After several months of PT, there were still problems. I had to go back under the knife and get it all cleaned out.

After 9 friggin months I was finally able to go back to work. I started working out again and it took over a year from that point to get back to being able to sprint without a limp and getting my size and strength equal to my other leg.

Since then though my knees ache all the time, even my good knee. But my left knee is so much worse. It sounds like a bowl of rice krispies (snap, crackle, pop!) I’m in pain all the time especially if I’m standing up for long periods or sitting with my knees bent for long periods.

I’m in the fire academy right now and I recently injured the same bad knee doing ladder drills. I didn’t realize I did anything til I got up the next morning and couldn’t bend my knee. I had an MRI last week and I go to the doctor on Mon to get the results. I have a feeling it’s a torn meniscus. So I’m probably looking at surgery #3 on my left knee.

But my right knee aches all the time too! No clicking or noises like my bad knee, just severe, severe aches. Actually, all my joints severely ache! Knees, elbows and shoulders are all in severe pain lately and I don’t know why. Hopefully I will know more on Mon after I see my orthopedist.

Good luck Mike with your Rehab.

34

[quote]Mike Robertson wrote:

Stay strong
MR[/quote]

Thanks for replying so quickly Mike,

I don’t know precisely what level it is, I’ll ask for the rapport of the scans next time I’m at the hospital.(a new scan is being done in 2 weeks, maybe that’s more helpful)

My physical therapist is correcting my imbalances on a weekly basis, and according to him I am pretty much okay. Perhaps I should have him work on my flexibility?

Warming-up definately helps. I prefer walking for 5-8 minutes(it’s boring)at a decent pace over a treadmill or a bike, for some reason my knees feel much better and more filled with blood afterwards.

I wore knee sleeves in winter this year, because the cold made the pain unbearable, especially in the morning.(I’m not a pussy or something, but I had so much injuries over the past I’m starting to acknowledge a connection between pain and not being able to train properly…)
Now it’s pretty warm over here, should I start back with wearing them?

I also think it’s scar tissue, in that case it’s just a matter of time before it’s gone, right ?

If it means anything to you, the biggest lesson I’ve learned in the past 7 months(and a major injury is a tremendous learning experience apparantly), is that staying active daily is the best thing you can do.
I had the bad luck of having to heal right through my exams this christmas, and sitting down for a month made me very unflexible, and I think this is where the scar tissue was given a chance to build up.

Swimming also helps a lot with recovery, water walking and such.

Thanks a lot Mike, wish you the best of luck with recovering

35

Cool thread Mike, thanks for starting it. Now to pick your brains.

I have problems with mostly my right knee. When I lunge or squat on it, it sounds like somebody crunching lettuce. It doesn’t hurt but the noise is rather disconcerting. It’s been like that for years and hasn’t really worsened, so I’ve left it slide. Any ideas what it could be?

More info: I’m flat-footed. If I try to down a one-legged squat (negative only) the right knee falls in and I experience a twinge on the inside, under the knee cap. Doesn’t hurt while squatting. Knees used to hurt every day but the more I squat and deadlift, the better they work.

In the NNM article, you specified one exercise, holding the Bulgarian squat with weights for 90 secs. I can do it weightless for about 20 sec, with a gun to my head.

For what it’s worth, I already know that I need to get my squat and DL up to normal standards. Working on it. Thanks for any info.

36

[quote]Fonebone wrote:
Oh, thank you, thank you, THANK YOU! OK, I will now try a third time to get some input here (I was apparently a little late to Dr. Ryan’s Q&A thread).

I have been having pain in my right knee for several weeks now that seems to be primarily associated with squatting. After a squat workout the pain lingers for several days before fading.

I have been able to pinpoint it to the ligaments behind the right knee (lateral and medial collateral ligaments, I believe). When I bend the knee under weight, as in a squat, I can feel increasing discomfort in that area as I go down. The discomfort continues from there down into the calf, primarily on the lateral side. Again, this is most notable under knee flexion.

I haven’t squatted in two weeks hoping that it will heal, but I’m going to try again soon. Any thoughts or recommendations on possible causes and remedies would be most welcome![/quote]

The pain that I felt in my knee would start dead center in the back and then radiate outward/around as I continued to bend it. I am not sure if this is similar to what you have been feeling but I just had surgery to repair a medial meniscus tear yesterday. In fact my brother in law had pain originating in the center back of his knee also and he ended up loosing 40% of his meniscus. I always thought that my pain was a ligament issue as well since it would hurt in the center back only when bent but would continue to ache on the lateral side afterward, but it turns out that it wasn’t. Knee pain sucks.
-Will

37

[quote]wtagye wrote:
The pain that I felt in my knee would start dead center in the back and then radiate outward/around as I continued to bend it. I am not sure if this is similar to what you have been feeling but I just had surgery to repair a medial meniscus tear yesterday. In fact my brother in law had pain originating in the center back of his knee also and he ended up loosing 40% of his meniscus. I always thought that my pain was a ligament issue as well since it would hurt in the center back only when bent but would continue to ache on the lateral side afterward, but it turns out that it wasn’t. Knee pain sucks.
-Will [/quote]

It does sound somewhat similar, but to be honest I hope that’s not what I’m facing. Were you and your docs able to pinpoint a cause of your meniscus damage? It sounds like something that could be impact-related, which is not an issue for me. What kind of recovery timeframe are you looking at? What happened to your brother in law after he lost half of his meniscus?

I thought I would try some of Mike’s stretches and foam rolling to see if that helps. If not then it will be alphabet soup time (ART and MRI).

Thanks for the reply.

fonebone

38

Well the knee clicking thing you talked about struck a chord with me. For the last year or so, perhaps the last 16-18 months actually, my left knee has clicked when doing anything forcing my knee to go beyond 90 degrees. The first time I tried one legged squats I managed one with my right leg, tried it with my left and it clicked and just buckled. I have continued playing soccer etc throughout this time and have had no problems when running or sprinting etc. I can even do full squats my left knee just ever so slightly comes in at the bottom and clicks. What could the cause be and what should i do about it? Could I be doing myself permanent damage without realising?

39

Perfect thread timing Mike!

So, about one week ago I started to get knee pain. Initially it just felt a bit funny, but caused me intense pain when I flexed my quads to straighten my leg completely (no pain partial). That has since left, had I have more constant pain underneatht the kneecap, and more clicking/cracking than usual. The pain comes and goes, I could probably do max lifts on it pain-wise, but I suspect it wouldn’t be good for it. No traumatic event took place. The triggers I can think of - walking in crappy sandals for the past month (now ditched) and starting up softball. The softball has given me a lot of leg soreness from the sprinting and lateral movement that I’m not used. My right quad (injured side) is particularily tight, along with just about every other muscle in that leg.

After reading Ian King’s article Endless Knee Pain it seems like this is the cause, and I’ve just started treating it (massage, stretching etc) for that yesterday. No imaging done yet, but I am in medical physics (masters) so I know some people with access to MRI’s, so I might try to jump in there one night. Do you think I should be more concerned? Stats: 24 yr old, 6’3, 225, 13% BF. Training age - 10 months (first 4 years don’t count!). Thanks Mike.

40

BTW, if any of the other experts reading this have time, feel free to chime in.

I’m at work all day, but will try to respond to all these later this evening!

Stay strong
MR