P.S. My quad flexibility is much more limited now, it’s a stretch when my heel is 6 inches from the ‘top’ of my posterior chain. : )
[quote]Mike Robertson wrote:
Fone,
Menisci can be damaged via a direct blow, but non-impact injuries are typically rotational in nature (e.g. plant and twist movements). The femur compresses against the menisci and rotates, which tears the cartilage.
Stay strong
MR[/quote]
Mike, thanks for the replies. I clearly need to improve flexibility. Stretching is something I have to admit I have neglected pretty much, well, always. If I do have meniscus damage it would most likely be from “plant and twist” type movements due to my background. I’m sure the fact that I will be 40 (good God!!) in September is also a consideration…
I have done a couple of lighter squat workouts since my last post and my knee feels much better after a couple weeks’ rest and some regular stretching. The “Hardcore Stretching” routines are now a part of my life! Thanks again…
P.S. Love the Tony Montana avatar!
[quote]Mike Robertson wrote:
Flynnie,
The knee cracking could be chondromalacia patella, crepitus, or patella malalignment. Did you have this as a child? You mentioned you had had it for a while. Let me know!
Stay strong
MR[/quote]
Nope, not as a kid. I don’t know when I first noticed it. It’s more of a crunch (I call it Lettuce Knee) than a crack. I would hazard a guess that I noticed it about 6-8 years ago, simply because I would have been squatting in an empty gym and therefore had a chance to hear it.
Sorry for the delay in replying, it just occurred to me to search for my own posts today to see if any had replies!
Thanks.
Fonebone,
Good luck with the stretch routines, and keep us posted on how things are going!
Stay strong
MR
[quote]Fonebone wrote:
Mike, thanks for the replies. I clearly need to improve flexibility. Stretching is something I have to admit I have neglected pretty much, well, always. If I do have meniscus damage it would most likely be from “plant and twist” type movements due to my background. I’m sure the fact that I will be 40 (good God!!) in September is also a consideration…
I have done a couple of lighter squat workouts since my last post and my knee feels much better after a couple weeks’ rest and some regular stretching. The “Hardcore Stretching” routines are now a part of my life! Thanks again…
P.S. Love the Tony Montana avatar! [/quote]
Another injury is IT Band Syndrome (ITBS). Your IT Band is the big tendon on the outside of your thighs. IT Band syndrome is usually an overuse and imbalance injury that results in it being swollen and tight, thus causing pain.
Oddly enough, it usually will not hurt on the sides of your leg or knee, it hurts right underneath your kneecap. Thus, if you go in they’ll x-ray you to make sure you don’t have a torn meniscus since the symptoms are the same (except no clicking, if you have clicking that is probably something torn).
Other symptoms are pain when lowering/raising yourself from a squat. Also if you just feel it on the outside just above your knee, it will feel tight and stick out more. If you ignore it long enough you will just feel pain all the time, like I did.
I got this 2 years ago. It kept me doing physical therapy and could not do any leg work AT ALL for 6 months (it hurt too much), and kept me from running for a year. It is that bad. It usually affects runners.
I learned the hard way not to ignore pain in my knees anymore.
Treatment: RICE and stretching if you catch it early. Also need to strengthen whichever part of your leg is weak and causing the imbalance.
Here are two stretches that help: Plus just stretch quads, calves, and hamstrings.
www.itbs.info/html/body_stretches.html
another stretch involves rolling on a foam roller on your side, with the roller placed near the bottom of your thigh. Pics:
www.runningtimes.com/04may/itb.htm
www.physsportsmed.com/issues/2000/02_00/fredericson.htm
Strengthening hip abductors helps some people. Again it is an injury of imbalance so you have to know what is out of balance. Sometimes it’s caused by your hamstrings not being strong enough compared to your quads.
So, if you have pain under the kneecap, and the big tendon on the side of yur knee feels tight, start stretching more is what I advise. I also have to ice my knees after any intense cardio session as well. It takes several months for the pain to subside so don’t ignore it.
Lowering the seat on your bike helps not to aggravate it as much.
Also, if you feel it worse after cardio (running), try changing shoes. You may need less lateral support, or more support. (I had too much lateral support keeping my feet from moving naturally when running). If you can find a place that will video you run and play it back that is the best.
Mike, Why is that everytime people do squats or even the leg press they automaticly point to there VMO and say, “it hurts my knee” is that just because of lack of VMO development
Mike,
I am trying to write my own strength programs using the guidlines you laid out in your article on program design.
How many days a week do you recommend training a lift and or bodypart? Thanks.
It depends on what you are training for, how high your volume/intensity are, and what you are currently used to.
In other words you could train squats up to 3 times per week, assuming you aren’t trying to go hard and heavy each and every day.
If you have an example, I could probably explain this better.
Stay strong
MR
[quote]basementD wrote:
Mike,
I am trying to write my own strength programs using the guidlines you laid out in your article on program design.
How many days a week do you recommend training a lift and or bodypart? Thanks. [/quote]
Could be a host of problems; unless they have an underlying or previous knee pathology, I would say it’s d/t muscle imbalances and poor flexibility in the quads/hip flexors.
Stay strong
MR
[quote]bigpump23 wrote:
Mike, Why is that everytime people do squats or even the leg press they automaticly point to there VMO and say, “it hurts my knee” is that just because of lack of VMO development[/quote]
Ok I am one week out of surgery and I am starting PT today. Now that I am getting a little ROM in my knee I and I am more able to get around what would be a good gym routine to keep from loosing too much muscle and more importantly not getting fat. I can’t drive for another 5 weeks so I have to rely on other people to get me to the gym. I also don’t want to thrash my arms or I will be a mess on crutches. Thank you for the info.
-Will
Yes I did. I was never put out before so it was quite a trip. It happened just like I was told. You fall asleep on the table and then wake up in the recovery room. It was like I blinked. Crazy. But back to the real topic here.
When I woke up from surgery, they let me get my wits together and then made me walk to a chair about 15 feet away. So no, they did not immobilize me, they just wrapped my knee and sent me home with a cane.
I was in the hospital at 7:00AM, on the operating table at 9:30AM and then home by 12:00PM.
I had three choices of physical therapy. (1) 30 minutes on a stationary bike a day OR (2) 30 minutes swimming a day OR (3) physical therapist everyday. any option for 3 weeks. I opted out on the physical therapist because it was trouble to get to. I have no access to a pool or the beach, so I chose the bike at home for 30 minutes a day.
Now going into the surgery the doctor told me that normally when people get the surgery on a Friday, they are back to work on a Monday. Not thinking that people have different types of jobs I was excited and though that this was going to be a breeze. What a mistake. i did not take into account that most people have desk jobs and do not need to be on their feel for more than 5-10 minutes a day. So I had the surgery on a Wednesday and did not return to work until one week later.
A little on the timeline to recovery.
Days 1 - 7: I did little walking throughout the day. Only did the bike for 30 minutes a day and spent the rest of the day resting and icing.
Days 8 - 13: Still doing 30 mintues on the bike a day. After each session I would do 5-10 mintues worth of stretching (lying on the floor with my thigh perpendicular to the ground and simly moving my lower leg for increased ROM - very painful, but worth it.) Now days 8-10 (first few days back at work) were very tough because those were the first days walking. I am a NYC commuter, so I do a lot of walking a day, just to get to work. Probably 2 miles. Day 11 was the first day I was able to get around real good - So I went to a Met game. That night the stiches in my knee was rubbing against my pants and causeing some annoying pain. So I removed them.
Day 14 - 15: Here is where I starting to take it up a notch. I started to add some weight to my work outs. I basically tied a 5 pound weight to my foot and did leg curls, leg extensions and knee lifts. I also started to do some assisted bodyweight squats in the stairwell at work.
Day 16 (today): Pain has greatly decreased. I have slight pain when I move my lower leg laterally or twist it. I have been able to do deeper in my stairwell squats.
So I have the post op appointment one week from today. My goal is to be able to do an unassisted squat for my doctor. So we’ll see what happens. Everyday it is noticably better. So I would have to say I expect another 3-4 weeks to be close to 100% recovery.
Hit me with questions! I will post some pictures soon!
-Machine
[quote]Mike Robertson wrote:
You got the repair, eh? What kind of time frame did they give you for full recovery? Also, did the immobilize you and/or put you on crutches?
Good luck with the rehab!
Stay strong
MR
machine514 wrote:
Sounds great. I just had my medial meniscus and lateral meniscus repaired. I am one week into recovery.
-Machine
[/quote]
So on day 19 of my recovery (yesterday), I am able to do bodyweight squats. To be safe I did them facing a handle just in case I ran into some trouble. I can not do ass to the grass, so that is my next hurdle.
-Machine
Having just completed a bulking cycle where I was working legs a little harder than I probably should of I am now experiencing slight anterior/more medial aspect knee pain with the following features.
-
I do not get any pain/discomfort once warmed up and working legs in the gym
-
Both knees make a crunching noise during the first 30 degree or so of flexation, much more so on the negative of a squat type motion than the positive.
-
I get pain on the medial aspect of the knee and to a lesser degree around/under the patella when walking down stairs (when not warmed up and not when going up stairs)
-
After sitting for a while if I go to stand up I get the above pain but more noticeable as I push up off the chair. I find myself using my arms now to push myself up.
-
Occasionally if I hold my right leg straight for a while and put my weight on it (whilst standing) when I go to move off it feels like it’s locking slightly then clicks.
Sports doctor told me I had PFS syndrome he told me both patella’s had lateral laxity, tibiovarum and compensatory hyper pronation as my feet are relatively flat (have also had a medial reticulum repair on the my left knee nears ago, but funnily enough my right is more painful now).
His recommendation was to reduce ROM of squat to 90 degrees and take a week off. Things improved only minutely if at all following these recommendations.
Physical therapist has had me doing the following. PT mentioned that my VMO was well developed and this was unusual for people with PFS.
-
Lying face first on groundone leg bent at 90 degree’s, foot placed under other knee, then driving the hip side with the bent leg into the ground (targeting the glute medius) holding for 3 seconds x 10 reps once a day.
-
Bodyweight squats with volley ball between legs, squeezing in, slow tempo 10 reps once a day
-
Foam rolling ITB on both legs, 20-30 repetitions per side.
-
Basic lower body stretching routine 2-3 20sec holds 3x a week.
After almost a month of this stuff, things are not getting better.
What should I be doing?
Should I be dropping the leg work at the gym?
Currently I am doing
Sumo deadlifts 5 reps x 3
Bulgarian Split Squats 5 reps x 3
Front Squats 12 x 1
Leg Curls 12 x 1
Alternating the exercises/rep ranges around, hitting legs twice a week. I switched to low impact cardio only, bike or elyptical on the my off days. Taking glucosamine/chondritin/omega 3 as well currently.
Things I have noticed when analyzing my squat form/bio mechanics that may help
-
If I stand up straight ankles together (touching) there is a gap between my knee’s and calves
-
My left leg is ever so slightly weaker/worse proprioception/balance wise than my right (it had a medial reconstruction 9 years ago)
-
My left hip/glute is slightly tighter than the right (no amount of stretching seems to even this up however)
-
My left foot is flatter than my right and pronates more.
-
When squatting the most crunch free position is with feet shoulder width pointing ahead how I notice at the bottom of the squat my feet feel like they want to turn out more roll inwards (and probably do when I am under heavey loads to as much degree as my footware will allow.
Mike,
I have no knee pain but my left knee clicks when I squat ass to grass. It doesn’t click if I squat to parallel. However, I don’t believe in squatting to parallel only and never do when I lift.
I play a lot of basketball and have recently upped my overhead squat to 100 lbs for 8 reps w/no pain using ass to grass rom.
Thoughts? Should I be worried about the clicking noise if there’s no pain?
Mike,
the clicking noise is only on my left knee on the way down not on the way up.
OK, I just typed up a post and sent it in, but then I saw this KNEE Pain thread and its exactly where the post should be instead. So, I’ll re-post it here.
Original Post:
I am looking for any information anyone has on increasing post-surgery knee flexibility.
Here’s my situation. I’m 29 yrs old, and I blew out my knee (left Posterior Cruciate Ligament) receiving a direct kick to my upper shin in a soccer match 3 years ago. I got it reconstructed 1.5 years ago. I’m having the hardest time getting my strength and flexibility back.
I used to have great flexibility and strength in my legs. My regular full (butt to heels) squat workouts finished up over 300 lbs and I had a 4.4 sec 40 time. My strength is slowly returning in squats, but my flexibility has been a bitch to get back. I can’t get my heel close to my butt anymore without a lot of painful stretching, and then only momentarily. And then as soon as I stop stretching, I can’t get it back that far during any kind of athletic activity like squating or sprinting.
I haven’t tried any professional soft tissue manipulation like ART yet (mainly for $$ reasons), but does anyone have any ideas about improving flexibility like these dynamic stretching programs or isometric stretching? Or does anyone have any experience with regaining post-surgical flexibility through different kinds of stretching, massage therapy, etc.?
I’m talking some serious rehab, T-Nation style. I’m used to all the normal crap the physical therapists give you. They’re just happy if you can walk up and down stairs, go for a nice jog, and squat down far enough to get your ass on the toilet. I want to get back to serious performance strength and flexibility again. Thanks for anyone’s insight.
Another note:
For a while (10-14 months post-surgery), I was having lots of problems with what I thought was meniscus. It was giving me lots of problems from 10-30 degrees ROM. It would flare up about once a week and cause me to have to take 2-3 days off from any activity, even bike riding. I got another MRI and my doc thought there was no meniscus damage.
I started researching about digestive enzymes. I took serrapeptase (or serrapeptidase) and bromalain enzymes for about 2 months. They’re supposed to help the body break down scar tissue naturally from the inside and act as sort of natural NSAIDS. I don’t know if it was the enzymes or the continued pushing through the pain after I found out there was no meniscus damage evident. But whatever it was, I broke through that scar tissue and have no problems from it anymore.
Has anyone heard anything lending any credence to this?
I would check out EC and I’s Neanderthal No More series. If you are having that many issues, it sounds like you need a full posture overhaul.
Stay strong
MR
[quote]champs wrote:
Having just completed a bulking cycle where I was working legs a little harder than I probably should of I am now experiencing slight anterior/more medial aspect knee pain with the following features.
-
I do not get any pain/discomfort once warmed up and working legs in the gym
-
Both knees make a crunching noise during the first 30 degree or so of flexation, much more so on the negative of a squat type motion than the positive.
-
I get pain on the medial aspect of the knee and to a lesser degree around/under the patella when walking down stairs (when not warmed up and not when going up stairs)
-
After sitting for a while if I go to stand up I get the above pain but more noticeable as I push up off the chair. I find myself using my arms now to push myself up.
-
Occasionally if I hold my right leg straight for a while and put my weight on it (whilst standing) when I go to move off it feels like it’s locking slightly then clicks.
Sports doctor told me I had PFS syndrome he told me both patella’s had lateral laxity, tibiovarum and compensatory hyper pronation as my feet are relatively flat (have also had a medial reticulum repair on the my left knee nears ago, but funnily enough my right is more painful now).
His recommendation was to reduce ROM of squat to 90 degrees and take a week off. Things improved only minutely if at all following these recommendations.
Physical therapist has had me doing the following. PT mentioned that my VMO was well developed and this was unusual for people with PFS.
-
Lying face first on groundone leg bent at 90 degree’s, foot placed under other knee, then driving the hip side with the bent leg into the ground (targeting the glute medius) holding for 3 seconds x 10 reps once a day.
-
Bodyweight squats with volley ball between legs, squeezing in, slow tempo 10 reps once a day
-
Foam rolling ITB on both legs, 20-30 repetitions per side.
-
Basic lower body stretching routine 2-3 20sec holds 3x a week.
After almost a month of this stuff, things are not getting better.
What should I be doing?
Should I be dropping the leg work at the gym?
Currently I am doing
Sumo deadlifts 5 reps x 3
Bulgarian Split Squats 5 reps x 3
Front Squats 12 x 1
Leg Curls 12 x 1
Alternating the exercises/rep ranges around, hitting legs twice a week. I switched to low impact cardio only, bike or elyptical on the my off days. Taking glucosamine/chondritin/omega 3 as well currently.
Things I have noticed when analyzing my squat form/bio mechanics that may help
-
If I stand up straight ankles together (touching) there is a gap between my knee’s and calves
-
My left leg is ever so slightly weaker/worse proprioception/balance wise than my right (it had a medial reconstruction 9 years ago)
-
My left hip/glute is slightly tighter than the right (no amount of stretching seems to even this up however)
-
My left foot is flatter than my right and pronates more.
-
When squatting the most crunch free position is with feet shoulder width pointing ahead how I notice at the bottom of the squat my feet feel like they want to turn out more roll inwards (and probably do when I am under heavey loads to as much degree as my footware will allow.[/quote]
BPC,
Where does the clicking occur? Under the kneecap? Laterally? Where it clicks can help us determine the cause.
However, if you aren’t having any pain, it may not be too big of an issue. A lot of people have pain-free crepitus.
Stay strong
MR
[quote]BPC wrote:
Mike,
I have no knee pain but my left knee clicks when I squat ass to grass. It doesn’t click if I squat to parallel. However, I don’t believe in squatting to parallel only and never do when I lift.
I play a lot of basketball and have recently upped my overhead squat to 100 lbs for 8 reps w/no pain using ass to grass rom.
Thoughts? Should I be worried about the clicking noise if there’s no pain?[/quote]