The KNEE PAIN Thread

Training Injuries
81

Beans,

I wrote an entire article on static stretching a few weeks ago entitled “Hardcore Stretching.” As well, Eric and I have a piece on dynamic flexibility in TC’s hands.

For now, I would focus on making your stretching outcome based, meaning don’t stretch for x sets of y seconds. Instead, focus on regaining balance in flexibility between sides.

Once you get that flexibility evened out, then start training again with plenty of single-leg movements to balance strength. Add an extra set or two for the weaker side. On bilateral movements, watch yourself in the mirror or videotape yourself to note any shifting of weights.

As well, you should really get in and see someone knowledgeable in massage or ART, as it will really speed your progress. Good luck!

Stay strong
MR

[quote]beans wrote:
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.

[/quote]

82

[quote]Mike Robertson wrote:
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

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]

Mike,

Thanks for your response.

I think the clicking is kind of underneath my kneecap.

Just out of curiousity, how far down do you squat? Since you are a powerlifter, is it only slightly below parallel? Do you believe there are benefits to squatting ass to grass olympic lifting style? That’s how I’ve been doing my overhead squats. I’ve read many many things stating the multiple benefits of squatting that deep in fact many from your budy Eric Cressey.

83

Under the kneecap could be chondromalacia patella, but it’s hard to tell without an exam. How old are you?

I always squat below parallel (except for now, while rehabbing). Escamilla has done some research stating that a true full squat (ass-to-calves) can be dangerous to the meniscus/ligmanets of the knee as you come out of the hole, but most people don’t have that kind of ROM anyway.

Just squat as low as you can comfortably given your current ROM and you should be fine.

Stay strong
MR

[quote]BPC wrote:

Mike,

Thanks for your response.

I think the clicking is kind of underneath my kneecap.

Just out of curiousity, how far down do you squat? Since you are a powerlifter, is it only slightly below parallel? Do you believe there are benefits to squatting ass to grass olympic lifting style? That’s how I’ve been doing my overhead squats. I’ve read many many things stating the multiple benefits of squatting that deep in fact many from your budy Eric Cressey.

[/quote]

84

[quote]Mike Robertson wrote:
Under the kneecap could be chondromalacia patella, but it’s hard to tell without an exam. How old are you?

I always squat below parallel (except for now, while rehabbing). Escamilla has done some research stating that a true full squat (ass-to-calves) can be dangerous to the meniscus/ligmanets of the knee as you come out of the hole, but most people don’t have that kind of ROM anyway.

Just squat as low as you can comfortably given your current ROM and you should be fine.

Stay strong
MR

BPC wrote:

Mike,

Thanks for your response.

I think the clicking is kind of underneath my kneecap.

Just out of curiousity, how far down do you squat? Since you are a powerlifter, is it only slightly below parallel? Do you believe there are benefits to squatting ass to grass olympic lifting style? That’s how I’ve been doing my overhead squats. I’ve read many many things stating the multiple benefits of squatting that deep in fact many from your budy Eric Cressey.

[/quote]

Almost 29 years old.

I always squatt ass to grass on my overhead squats and I read in one of Eric’s articles (I can’t remember which one) that full squatting actually strengthens the knee and quad/ham. Can you elaborate on that? I’m well aware of the fact that various studies can demonstrate conflicting information but you two usually agree on most everything so did I misunderstand?

Please advise. I really like to learn.

85

I don’t think we necessarily disagree, just that this issue isn’t as black and white as people make it out to be. What constitutes a full squat? What is “below parallel”? You show me 10 guys, and I’ll show you 10 different opinions!

In healthy knees, the co-contraction of the hams, quads and calves stabilizes the knee the way that it should; however, here’s a study by Escamilla (one of the foremost researchers on squatting biomechanics) w/ regards to knee forces:

Knee biomechanics of the dynamic squat exercise.

Escamilla RF.

Michael W. Krzyzewski Human Performance Laboratory, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. rescamil@duke.edu

PURPOSE: Because a strong and stable knee is paramount to an athlete’s or patient’s success, an understanding of knee biomechanics while performing the squat is helpful to therapists, trainers, sports medicine physicians, researchers, coaches, and athletes who are interested in closed kinetic chain exercises, knee rehabilitation, and training for sport. The purpose of this review was to examine knee biomechanics during the dynamic squat exercise. METHODS: Tibiofemoral shear and compressive forces, patellofemoral compressive force, knee muscle activity, and knee stability were reviewed and discussed relative to athletic performance, injury potential, and rehabilitation. RESULTS: Low to moderate posterior shear forces, restrained primarily by the posterior cruciate ligament (PCL), were generated throughout the squat for all knee flexion angles. Low anterior shear forces, restrained primarily by the anterior cruciate ligament (ACL), were generated between 0 and 60 degrees knee flexion. Patellofemoral compressive forces and tibiofemoral compressive and shear forces progressively increased as the knees flexed and decreased as the knees extended, reaching peak values near maximum knee flexion. Hence, training the squat in the functional range between 0 and 50 degrees knee flexion may be appropriate for many knee rehabilitation patients, because knee forces were minimum in the functional range. Quadriceps, hamstrings, and gastrocnemius activity generally increased as knee flexion increased, which supports athletes with healthy knees performing the parallel squat (thighs parallel to ground at maximum knee flexion) between 0 and 100 degrees knee flexion. Furthermore, it was demonstrated that the parallel squat was not injurious to the healthy knee. CONCLUSIONS: The squat was shown to be an effective exercise to employ during cruciate ligament or patellofemoral rehabilitation. For athletes with healthy knees, performing the parallel squat is recommended over the deep squat, because injury potential to the menisci and cruciate and collateral ligaments may increase with the deep squat. The squat does not compromise knee stability, and can enhance stability if performed correctly. Finally, the squat can be effective in developing hip, knee, and ankle musculature, because moderate to high quadriceps, hamstrings, and gastrocnemius activity were produced during the squat.

Now keep in mind this is one study, by one guy. If you have healthy knees and squat ass-to-calves, then that’s great and maybe you will never get hurt. BUT, most people don’t have the flexibility to go this deep, or the desire to go this deep. When Escamila is saying deep squat, he means like full flexion of the knee joint (~135 degrees), not just slightly below parallel (~110 degrees, which Eric referenced in his article).

Regardless, just because you squat this way doesn’t mean you WILL get hurt, simply that you MAY have an increased risk to get hurt. Like everything in life, weigh your options and choose what fits in best for you.

Stay strong
MR

[quote]BPC wrote:
Almost 29 years old.

I always squatt ass to grass on my overhead squats and I read in one of Eric’s articles (I can’t remember which one) that full squatting actually strengthens the knee and quad/ham. Can you elaborate on that? I’m well aware of the fact that various studies can demonstrate conflicting information but you two usually agree on most everything so did I misunderstand?

Please advise. I really like to learn.

[/quote]

86

Mike,

Thanks for the study and response.

I squat ass to calves (about 2-3 inches from the ground) on my pistols and overhead squats. I really don’t even back squat and I don’t squat heavy. For example, I’ve been squatting w/80 lbs for 8 reps on the overhead squat trying to work up to 135 lbs. No pain so far just don’t want any to start:)

Most people I’ve encountered can’t even squat ass to calves w/just bodyweight which is very odd to me!

87

Hi there!

I recently had issues with my right knee as well.
Thought I tore my menisci medialis but MR diagnosed an ulcerative chondral defect (retropatellar).
(Felt like a little marble comming out right next to the patella - kept comming and going, now that I paused my leg routine, I got no probs at all)

I’m supposed to see my orthopaedist in a few days.

Could anyone give me infos on that kind of diagnostic findings. Any implications on my future training?

Thx!

88

I just started my ACL rehab, and at the moment everything aches! But I’m looking forwards to (eventually) having a stable knee again…

89

I got a question, I have been having knee issues for a while. I don’t have any pain in my knee, but it certainly does not feel right, it is usually swollen. It’s as if I can ‘feel’ my patellar tendon during movements.

If there is no significant pain, is there any harm in continuing to train (sprints, lifting)?

I’m thinking it is tendonitis, but it is not getting any better over the past 4 months.

90

I just wanted to chime in on the discussion between Mike and BPC. I haven’t read the study, but I would be interested in knowing if this greater injury potential in a “deep” squat is a result of relaxing and “opening up” the knee joint in the bottom. When I do a hamstrings to calves squat, I have to really concentrate on not resting the weight momentarily by basically sitting on my calves and instead using only muscular tension to reverse the weight. Any thoughts on this?

BTW, I have a “slight tear” of my patella tendon right now so I am being especially aware of my form. I am still doing most of my full range movements with no pain, but I am not pushing the weight. I have been receiving some physical therapy to help with some tendonitis before I see the surgeon again at the end of the month. I am focusing on trying to work the VMO…with great results using 1 1/4 squats (the PT’s want me to do slow 4-6" step-ups, but I feel that this will only exacerbate the problem). Since my knee caps seem to be “high”, I am also receiving “Graston” treatments on my quads to try and relieve some tension/tightness on the patella tendon. It hurts like hell!

Mike, any suggestions/thoughts on this. Anyone else have experience with “Graston”. BTW, I have had ART before on my hip flexors and I LOVED IT…although it hurt a lot too.

BTW, I am in Indianapolis. Mike, where are you located?

91

Webeye,

I would recommend asking Dr. Ryan when he’s on; I don’t have to do much radiological stuff. Have you tried a google search on the topic? I’m always amazed at what that search engine comes up with!

Stay strong
MR

[quote]WebEyE wrote:
Hi there!

I recently had issues with my right knee as well.
Thought I tore my menisci medialis but MR diagnosed an ulcerative chondral defect (retropatellar).
(Felt like a little marble comming out right next to the patella - kept comming and going, now that I paused my leg routine, I got no probs at all)

I’m supposed to see my orthopaedist in a few days.

Could anyone give me infos on that kind of diagnostic findings. Any implications on my future training?

Thx![/quote]

92

Good luck Olly!

Make sure to keep us posted on how things are going. Did they hook you up with a CPM machine?

Stay strong
MR

[quote]OllyB wrote:
I just started my ACL rehab, and at the moment everything aches! But I’m looking forwards to (eventually) having a stable knee again…[/quote]

93

Kilo,

I guess I’m typically one to err on the side of caution. Have you tried cutting back your training? If so (and it’s still swollen), I would get it checked out.

Sometimes it can be something as simple as extra synovial fluid in the joint, and sometimes something else is going on. With the duration that you described, I would seek out a qualified sports chiro/ortho/PT to at least give you a thorough exam. As well, check out EC’s article on the differences between tendonitis and tendinosis; it’s a good read and could help you out.

Good luck!

Stay strong
MR

[quote]KiloSprinter wrote:
I got a question, I have been having knee issues for a while. I don’t have any pain in my knee, but it certainly does not feel right, it is usually swollen. It’s as if I can ‘feel’ my patellar tendon during movements.

If there is no significant pain, is there any harm in continuing to train (sprints, lifting)?

I’m thinking it is tendonitis, but it is not getting any better over the past 4 months.[/quote]

94

It could well be that the people aren’t “tight” in that bottom position. Couldn’t tell for sure, though, since I wasn’t there to watch the trials!

If the patellar tendon is the issue, I would check out what’s going on up the kinetic chain: Are your hips tilted forward? Do you have anterior weight bearing? Glutes not firing well? Something is causing the patellar tendon to take more of the load, so you need to figure out what the cause is and address it.

BTW, you might talk to Dr. Ryan about Graston Technique; I believe we talked about it a while back on a phone call.

I’ll be moving to the Fishers area of Indy this weekend and start my new job as the Director of Custom Athletics this Monday. I’ll also be doing some online consulting, giving seminars, and starting Robertson Training Systems in my “spare” time. Where are you currently training at in Indy?

Stay strong
MR

[quote]bjaffe wrote:
I just wanted to chime in on the discussion between Mike and BPC. I haven’t read the study, but I would be interested in knowing if this greater injury potential in a “deep” squat is a result of relaxing and “opening up” the knee joint in the bottom. When I do a hamstrings to calves squat, I have to really concentrate on not resting the weight momentarily by basically sitting on my calves and instead using only muscular tension to reverse the weight. Any thoughts on this?

BTW, I have a “slight tear” of my patella tendon right now so I am being especially aware of my form. I am still doing most of my full range movements with no pain, but I am not pushing the weight. I have been receiving some physical therapy to help with some tendonitis before I see the surgeon again at the end of the month. I am focusing on trying to work the VMO…with great results using 1 1/4 squats (the PT’s want me to do slow 4-6" step-ups, but I feel that this will only exacerbate the problem). Since my knee caps seem to be “high”, I am also receiving “Graston” treatments on my quads to try and relieve some tension/tightness on the patella tendon. It hurts like hell!

Mike, any suggestions/thoughts on this. Anyone else have experience with “Graston”. BTW, I have had ART before on my hip flexors and I LOVED IT…although it hurt a lot too.

BTW, I am in Indianapolis. Mike, where are you located?[/quote]

95

Hi Mike, I’m having a knee problem that’s similar but different than one that was posted earlier.

For the past few years, my right knee has made a popping sound that would be similar to scrunching a piece of celophane plastic into a ball on the eccentric phase of quad dominant movements, particularly squat variants. There is no pain associated with it, although it feels like my right quad isn’t activating correctly, like it’s getting “jammed up” around the patella.

I’ve recently found a competent chiro, and we found that the right side of my pelvis is about 3cm inferior to the left side. This may be due to fallen arches - I’m getting custom orthotics made this Friday, and we’re going to see if that clears up any problems.

I’ve been stretching religiously for the past 4 months (kind of half-heartedly prior), focusing on my hamstrings, IT band, back, and hip flexors. When I’m done stretching, the knee doesn’t quite pop as much, but it still does on the eccentric. And, the effect of the stretching seems to all but disappear after an hour or so.

My question then is, if the knee problem was caused by the unevenness, how do you think I should go about correcting the problem? Using the orthotics seems like a bandaid, and I want to get this cleared up and healthy so I eventually don’t have to rely on them (or replace them - I imagine training for strongman is going to beat them up pretty quick).

My right VMO is noticably weaker, so I’ve been doing Peterson stepups and a Jumpstretch band moonwalk kind of thing to bring it up - it feels stronger, and is larger, but the popping hasn’t reduced.

Any ideas? :slight_smile:

-Dan

96

Dan,

Is your right leg actually shorter in length, or functionally shorter d/t muscle imbalances? Obviously, this will, to some extent, determine how I answer the question. Let me know!

Stay strong
MR

[quote]buffalokilla wrote:
Hi Mike, I’m having a knee problem that’s similar but different than one that was posted earlier.

For the past few years, my right knee has made a popping sound that would be similar to scrunching a piece of celophane plastic into a ball on the eccentric phase of quad dominant movements, particularly squat variants. There is no pain associated with it, although it feels like my right quad isn’t activating correctly, like it’s getting “jammed up” around the patella.

I’ve recently found a competent chiro, and we found that the right side of my pelvis is about 3cm inferior to the left side. This may be due to fallen arches - I’m getting custom orthotics made this Friday, and we’re going to see if that clears up any problems.

I’ve been stretching religiously for the past 4 months (kind of half-heartedly prior), focusing on my hamstrings, IT band, back, and hip flexors. When I’m done stretching, the knee doesn’t quite pop as much, but it still does on the eccentric. And, the effect of the stretching seems to all but disappear after an hour or so.

My question then is, if the knee problem was caused by the unevenness, how do you think I should go about correcting the problem? Using the orthotics seems like a bandaid, and I want to get this cleared up and healthy so I eventually don’t have to rely on them (or replace them - I imagine training for strongman is going to beat them up pretty quick).

My right VMO is noticably weaker, so I’ve been doing Peterson stepups and a Jumpstretch band moonwalk kind of thing to bring it up - it feels stronger, and is larger, but the popping hasn’t reduced.

Any ideas? :slight_smile:

-Dan[/quote]

97

[quote]Mike Robertson wrote:
Webeye,

I would recommend asking Dr. Ryan when he’s on; I don’t have to do much radiological stuff. Have you tried a google search on the topic? I’m always amazed at what that search engine comes up with!

Stay strong
MR
[/quote]

Thx Mike, will ask Dr. R!

Goolged my ass off already but nothing ironsport related. If anyone got the same findings pls share it yr experiences.

Cheers!

98

[quote]Mike Robertson wrote:
Dan,

Is your right leg actually shorter in length, or functionally shorter d/t muscle imbalances? Obviously, this will, to some extent, determine how I answer the question. Let me know!

Stay strong
MR
[/quote]

You know, in all the hubbub of the orthotics, I think we forgot to check that.

I’ll get back to you :slight_smile:

Thanks-

Dan

99

might of tore my meniscus, have to wait til i get an mri …

100

As I got into my gear phases I
thought the knee was 100%; 10 days
out from the meet I’m warming up for
my last heavy squat workout, and
every time I hit the hole my knee
would click.

May I ask: does (or did) your knee “click” all the time? My right knee clicks occasionally, usually after it’s been in another position and I straighten or twist it to the left. I have no pain, but I don’t like the sound. Also, the same knee has a weird sound (sorta like a dull tearing sound?) when I squat (with just body weight).

I’m doing more flexibility stuff and I think it’s helping (i.e. not clicking as much), but it’s hard to know. I do believe that some days the clicking frequency is worse than others, and my legs as a whole feel stiffer at that time - so I wonder if it’s an imbalance of muscle strength / tension?

I know we all look forward to learning of your reasearch on this, coz it’s a major fear of most folks! Good luck with your research and recovery.

WiZlon