Knee Pain and Rehab?

archive_Mr. Nobody · 10-01-2002, 06:00 AM

Well, its my turn to be the hurt one. I had been suffereing some nagging knee pain for a while now. I can describe it as someone trying to drive a nail through the the top of ky knee cap, where it connects to my quadriceps. However I only feel it when I approach parallel in my squats or leg presses. i had been using ice and ibuprofen, both of which work wonders for keeping inflamation in check, but I am ready to deal with the root causes of my problem. Any suggestions?

PS: Could it be arthritis, I am 36 afterall [img]/infopop/emoticons/icon_frown.gif[/img]

I do feel the pain when sitting too long with my knees bent as well.

Disclaimer:
Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner.
The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advise.

[This message was edited by Mr. Nobody on 10-01-2002 at 08:11 AM.]

archive_Killer · 10-01-2002, 01:37 PM

Let us assume that it is not age related for our purposes.

Sounds like it is good old fashioned quad tendon tendonitis (or pre-patellar tendonitis).

Can you palpate the painful spot?

How is your flexibility? Make sure you strech hips, calves, hams, and most importantly quads. When stretching your quads make sure you stand upright or even lean back some. This will make sure you hit the rectus femoris, which also crosses the hip joint (hip flexor). If you lie on your stomach, someone should be able to grap your foot and make it touch your butt (such as a leg curl). Also make sure you are following a proper warm-up, but I am sure a vet such as yourself is already doing all of this. You may also want to throw in some unilateral movements to correct any imbalances associated with the pain. One leg squats and deads are pretty good.

When it first started, did you increase volume or weight a lot? This can set off the inflammation and cascade into a long cycle of pain. I once got a nasty case after only 2 GHV sessions that lasted for months.

When it comes to treating tendonitis, there are several things you can do. Try to minimze or adjust the lifts that cause the pain through diff foot position, angles, ROM, no lock outs,pausing, ect. You may also try alternating squat and leg press or deads.

One of the best things you can do is perform cross friction massage on the painful spot. However, this does hurt - bad. Find the spot and take your thumb and massage in straight strong motions (back and forth) across the tendon (do not try to move the skin, but the tissue underneath). You can do this EOD, for around 5 minutes. Ice right afterward for 30 minutes. Obviously, you would want to do this after cardio or legs.

By adjusting lifts for a while, along with cross friction, ice and NSAIDs (if you desire) you may find the pain disappears. Still continue to ice even when it goes away, as a preventive factor.

The pain after sitting is called "movie sign pain" and is a bitch. It is a postitive sign of patellar tendonitis/patellar femoral pain. Mine is really painful in stop and go traffic. By 20 minutes I am hating life.

I usually have patellar tendonitis around 80% of the year, due to some biomechanic factors. Never stops me from working out, just nagging pain, such as yourself. It comes and go for no real apparent reason, as long as I do not participate in any jumping activites. Then it is there and much worse. I ice and try to manage it the best I can. Recently,it has went away, I believe due to alternating squat and leg press on leg day and doing deads every other ham day.

One more thing, do you wrap your knees? I hope not. The knee wraps compress the patella as it moves in the patellar femoral groove and can cause a host of problems

archive_Mr. Nobody · 10-01-2002, 02:46 PM

Wow, thanks killer, that is a very nice reply with some solid advise.
Let me answer a few of your questions;

I do stretch and warm up prior to engaging in weights and it has helped some.
The pain started 10 years ago (after heavy leg extention) and has come and gone; Lately I have been doing more squats than usual and with higher reps and full motion. Higher weights seem to aggrevate it more and full range motion is actually making it feel better(except in the parallel position). The bottom part of my ass to grass squat does not bother me at all.
I can't believe wrapping is making it worse, when going heavy it definatly helps. However most of the time I do not wrap but apply capsicum cream underneath a "knee sleeve"....WATCH OUT FOR THE HEAT....yeah baby

Thanks Killer, I definatly will try the cross friction massage.

Disclaimer:
Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner.
The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advise.

jimmydean · 10-01-2002, 06:17 PM

Killer, Mr. Nobody and I have similar problems. We have talked at length about solutions and rehab. I had to take almost a year off squatting but have made a great recovery. Besides the normal rehab of ice therapy and special exercises, I began taking alfalfa tablets which are a natural anti-inflamatory. In addition to helping my knee, my elbow and shoulder symptoms disappeared within two weeks. I will definitely begin the cross friction massage. My painful spot is on the top left corner of my left patella. To complicate this, I have a calcium deposit on that spot. As far as wrapping, the only time I do this is when I compete. Thanks for the advice. Sounds like you really know your stuff.

archive_Mr. Nobody · 10-02-2002, 05:55 AM

Alright, I'll give alfalfa another chance, they are dirt cheap afterall.
JD forgot to mention that you need to take handfulls of that stuff....but then again its really cheap.

Disclaimer:
Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner.
The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advise.

archive_Killer · 10-02-2002, 08:07 AM

Another thing someone may want to try is to avoid exercises that pitch the knees forward, not allowing you to sit back on the heels. These would include hacks, smith machine, and sissy squats. The reason being, the further the knee is towards the toe, the more stress put on the patellar tendon. If I just happen to brush up against a hack squat I fall down in agony. That being said, for the healthy knee trainer, I think these exercises are fine. I am not one of those people who thinks your knee will explode if it goes over the toes. I remember seeing pics of Tom Platz with his legs below and behind the actual platform on hacks, but obviously he is a freak.

I also can't stress enough to experiment. If I due static or even in place dynamic lunges on the ground, I really feel pain. But if I perform walking lunges, I am fine. I can also perform dynamic elevated lunges, no problems.

For a mild NSAID effective one can also try glucosomine/chondrosin, but it may take up to 3 months to see any benefit.

Wrapping shouldn't increase the pain in tendonitis, but it can be very bad for the patellar femoral joint (compression) and possibly lead to damage to the articular cartlidge and increase degenerative changes.

Surgery is usually only performed in the most extreme cases, usually on pro athletes, primarily basketball players (which is why it is often referred to as jumper's knee). They go in and clean out all the scar and and dead tissue, then make cuts in the tendon to promote healing. The one athlete I worked with that had this operation did not have very positive results in the short term (6 months)

jimmydean · 10-02-2002, 08:17 AM

When I started taking Alfalfa, I would take about 6 to 8. Whatever ended up in my hand when I opened the bottle. Now I take 3 in the am and 3 in the pm for maintainance. Haven't had any major problems since.

10-01-2002, 06:00 AM	#1 (permalink)
archive_Mr. Nobody Senior Member Join Date: Nov 2000 Posts: 5,080 Rep Power: 11837	Knee Pain and Rehab? Well, its my turn to be the hurt one. I had been suffereing some nagging knee pain for a while now. I can describe it as someone trying to drive a nail through the the top of ky knee cap, where it connects to my quadriceps. However I only feel it when I approach parallel in my squats or leg presses. i had been using ice and ibuprofen, both of which work wonders for keeping inflamation in check, but I am ready to deal with the root causes of my problem. Any suggestions? PS: Could it be arthritis, I am 36 afterall [img]/infopop/emoticons/icon_frown.gif[/img] I do feel the pain when sitting too long with my knees bent as well. Disclaimer: Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner. The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advise. [This message was edited by Mr. Nobody on 10-01-2002 at 08:11 AM.]

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10-01-2002, 01:37 PM	#2 (permalink)
archive_Killer Senior Member Join Date: Feb 2001 Posts: 2,195 Rep Power: 7838	Let us assume that it is not age related for our purposes. Sounds like it is good old fashioned quad tendon tendonitis (or pre-patellar tendonitis). Can you palpate the painful spot? How is your flexibility? Make sure you strech hips, calves, hams, and most importantly quads. When stretching your quads make sure you stand upright or even lean back some. This will make sure you hit the rectus femoris, which also crosses the hip joint (hip flexor). If you lie on your stomach, someone should be able to grap your foot and make it touch your butt (such as a leg curl). Also make sure you are following a proper warm-up, but I am sure a vet such as yourself is already doing all of this. You may also want to throw in some unilateral movements to correct any imbalances associated with the pain. One leg squats and deads are pretty good. When it first started, did you increase volume or weight a lot? This can set off the inflammation and cascade into a long cycle of pain. I once got a nasty case after only 2 GHV sessions that lasted for months. When it comes to treating tendonitis, there are several things you can do. Try to minimze or adjust the lifts that cause the pain through diff foot position, angles, ROM, no lock outs,pausing, ect. You may also try alternating squat and leg press or deads. One of the best things you can do is perform cross friction massage on the painful spot. However, this does hurt - bad. Find the spot and take your thumb and massage in straight strong motions (back and forth) across the tendon (do not try to move the skin, but the tissue underneath). You can do this EOD, for around 5 minutes. Ice right afterward for 30 minutes. Obviously, you would want to do this after cardio or legs. By adjusting lifts for a while, along with cross friction, ice and NSAIDs (if you desire) you may find the pain disappears. Still continue to ice even when it goes away, as a preventive factor. The pain after sitting is called "movie sign pain" and is a bitch. It is a postitive sign of patellar tendonitis/patellar femoral pain. Mine is really painful in stop and go traffic. By 20 minutes I am hating life. I usually have patellar tendonitis around 80% of the year, due to some biomechanic factors. Never stops me from working out, just nagging pain, such as yourself. It comes and go for no real apparent reason, as long as I do not participate in any jumping activites. Then it is there and much worse. I ice and try to manage it the best I can. Recently,it has went away, I believe due to alternating squat and leg press on leg day and doing deads every other ham day. One more thing, do you wrap your knees? I hope not. The knee wraps compress the patella as it moves in the patellar femoral groove and can cause a host of problems

10-01-2002, 06:17 PM	#4 (permalink)
jimmydean Junior Member Join Date: Jan 2002 Posts: 6 Rep Power: 5029	Killer, Mr. Nobody and I have similar problems. We have talked at length about solutions and rehab. I had to take almost a year off squatting but have made a great recovery. Besides the normal rehab of ice therapy and special exercises, I began taking alfalfa tablets which are a natural anti-inflamatory. In addition to helping my knee, my elbow and shoulder symptoms disappeared within two weeks. I will definitely begin the cross friction massage. My painful spot is on the top left corner of my left patella. To complicate this, I have a calcium deposit on that spot. As far as wrapping, the only time I do this is when I compete. Thanks for the advice. Sounds like you really know your stuff.

10-02-2002, 05:55 AM	#5 (permalink)
archive_Mr. Nobody Senior Member Join Date: Nov 2000 Posts: 5,080 Rep Power: 11837	Alright, I'll give alfalfa another chance, they are dirt cheap afterall. JD forgot to mention that you need to take handfulls of that stuff....but then again its really cheap. Disclaimer: Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner. The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advise.

10-02-2002, 08:07 AM	#6 (permalink)
archive_Killer Senior Member Join Date: Feb 2001 Posts: 2,195 Rep Power: 7838	Another thing someone may want to try is to avoid exercises that pitch the knees forward, not allowing you to sit back on the heels. These would include hacks, smith machine, and sissy squats. The reason being, the further the knee is towards the toe, the more stress put on the patellar tendon. If I just happen to brush up against a hack squat I fall down in agony. That being said, for the healthy knee trainer, I think these exercises are fine. I am not one of those people who thinks your knee will explode if it goes over the toes. I remember seeing pics of Tom Platz with his legs below and behind the actual platform on hacks, but obviously he is a freak. I also can't stress enough to experiment. If I due static or even in place dynamic lunges on the ground, I really feel pain. But if I perform walking lunges, I am fine. I can also perform dynamic elevated lunges, no problems. For a mild NSAID effective one can also try glucosomine/chondrosin, but it may take up to 3 months to see any benefit. Wrapping shouldn't increase the pain in tendonitis, but it can be very bad for the patellar femoral joint (compression) and possibly lead to damage to the articular cartlidge and increase degenerative changes. Surgery is usually only performed in the most extreme cases, usually on pro athletes, primarily basketball players (which is why it is often referred to as jumper's knee). They go in and clean out all the scar and and dead tissue, then make cuts in the tendon to promote healing. The one athlete I worked with that had this operation did not have very positive results in the short term (6 months)

10-02-2002, 08:17 AM	#7 (permalink)
jimmydean Junior Member Join Date: Jan 2002 Posts: 6 Rep Power: 5029	When I started taking Alfalfa, I would take about 6 to 8. Whatever ended up in my hand when I opened the bottle. Now I take 3 in the am and 3 in the pm for maintainance. Haven't had any major problems since.