3.03.2015

Knee Pain Boogeyman

For the last year I've dealt with some anterior knee pain around the front of my knee caps (also known as jumpers knee), and occasional, acute pain in my medial right knee. It didn't seem to have a direct cause, but the usual prescription of rest, ice, compression, elevation (RICE) didn't do the trick. If I rested for a few days my knees wouldn't hurt so bad, but after any amount of increased activity the pain would return. It made it hard to climb stairs, and even sitting still my knees would just ache.

I saw a physical therapist, and read all kinds of things online. I tried intense MobilityWOD mobilizations and joint distractions, and sometimes even felt worse afterwards. The pain didn't seem to make sense. I kept thinking ,"I have strong enough leg muscles to squat my bodyweight with a barbell, so why should bodyweight PT strengthening exercises help?" and "I have good range of motion in my knee joints and no matter what stretches I do it doesn't seem to do anything, so that's not it." Something was clearly off.

However, I didn't realize until much later that what was off was my mindset. I was continually searching for something that would "make my knees feel better," and was constantly trying to think my way through the problem. I started to find myself avoiding physical activity, being very cautious when I did do something physical, and mentally preparing myself to feel pain after I finished a workout or a long hike. I was in a defensive, reactive posture when it came to my knees, and I really felt hopeless and desperate at times. The pain wasn't so bad that I couldn't go about my day, but it was bad enough that it was constantly on my mind. 

The next phase of the story is a little more cheerful. After months of haphazardly trying one thing, and then another, I started to realize the flaw in all of my efforts was my lack of consistency. At one point I thought back to the month in the summer last year where I went walking almost every day, with my knees hardly hurting. I realized that it was likely that I was vastly overcomplicating the problem and ruining any chance of making real progress by changing tactics too frequently. A very important part of this process was a conversation I had one day with a PT at the clinic I work at. I told him, "My knees had been feeling ok, so I did a workout with squats. My knees felt fine during the workout but afterwards really hurt. What could possibly cause that?" The answer he gave me, I now realize, was staring me in the face. I had gone too hard during the workout and caused some minor trauma in my knees. The trauma wasn't noticeable at the time, but caused local swelling in the area which put pressure on the nerves and caused pain after the fact. He then gave me a new model for determining whether a pain is acceptable or not. It's like this:
  • If it hurts, stop.
  • If it hurts a little bit while you were doing it, but doesn't hurt afterwards, you're OK.
  • If it doesn't hurt while you're doing it, but hurts afterwards, you did too much and need ease up on either the load or the intensity next time.
  • If it doesn't ever hurt, great!
This model of recognizing my pain and being able to categorize it put all the possible solutions I had already been given into a new light. The important thing to recognize here was that I was being given solutions, but I wasn't making proper use of them, until I learned to consistently apply those solutions along with properly recognizing the nature of the pain I was feeling. 

After that conversation I started doing my PT exercises much more consistently and with a new outlook. I also started walking more frequently, stretching, and slowly progressing in load and intensity with all three elements. After literally only a few weeks I've noticed serious change. One thing to note is that I was wrong about already being strong and mobile enough. While some of my major muscle groups are strong (quads, hamstrings, calves) they aren't strong enough to support the loads I was putting them under without causing extra stress on my knee joints. In addition, my glutes, adductors, and other small supporting muscles of my knees are very weak. These are all areas that I've been tackling through targeted strengthening exercises, and with consistency and understanding, I've been making good progress. 

Here's an example of the exercises I've been focusing on:

For this one you want to start very close to the ground on something like a phone book or a single barbell plate. You start off balancing with one foot on and the other foot off. You keep the off leg straight and bend at the other knee until you touch the ground with the off leg. They key here is to focus on keeping your entire body aligned up and down and to not let your knee drift inwards. To do this, focus on keeping your working knee outwards for the entire duration of the movement. One you just barely touch the ground extend your working knee and stand back up. Over time you can increase the height of the object until you're doing a full ass to grass pistol squat!

3 sets of 10-12 reps











It helps if you have access to a bosu ball which I happen to have both at my local gym and at work. Essentially, this is similar to the above exercise except you just stand on the ball and balance for 1-5 minutes and try to increase your time. I usually go until it really starts to burn in my ankle and calf. You can also do this at home on a pillow, a mostly deflated kickball or just on the hard floor. The point is to practice balance and build up the capacity of your stabilizing muscles. You can also add an element to this by rotating your off leg out the side while keeping your working leg in good alignment. It's a big challenge.

5 minutes each leg or slightly past muscle burn
This one is just a simple leg raise, but with the foot rotated out to bias the vastus medalis muscle on the inner part of the knee. Keep your leg stiff and engaged through the whole movement and move up and down at a slow pace. Sometimes I'll do hold for 5-10 seconds at different points in the movement. This one is great if your knee pain is great enough that you can't do either of the other exercises without producing pain. This is an unloaded movement and so it won't put stress on your knee, but it will get you stronger. Eventually you can progress to the other exercises. I've kept doing it because it's damn hard and I can get more volume in along with the other exercises without continuing to load the joint. For a tough test of your abilities with this try writing the alphabet in the air (while keeping your leg stiff) twice through without stopping. It took me weeks to get there, but consistent effort pays off.

3 sets of 5-10 reps + 2 times through of the alphabet.









Finally, I want to note that with doing these exercises it's been important to give myself the proper recovery time. I started out wanting to do them every day, but found that my knees hurt more and more, so I cut it down to every other day and that gave me enough recovery time to start really seeing results. If you're having a similar experience to mine I recommend that you experiment to find what works for you, consistently put in work. and break the mental mold/victim mindset you've been stuck in. Good luck!

8 comments:

  1. It is so awful when your body hurts and so dreadful to wait out the recovery of an injury. Looks like your PT exercises are making things better.

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  2. I used to swim, and water exercise is supposed to be beneficial in recovering from any joint injury.

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  3. Great post on recognizing what pain is telling you! I'm fortunate that in my strength training classes there are usually several balance exercises that force me to focus, but instead of a barbell plate we stack a Step platform with a couple risers, and with the bosu we try to close our eyes!

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  4. Great post about listening to your body and being proactive about taking care of yourself. Glad to hear these are helping you make progress.

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  5. Great guidelines from that PT! It's a good reminder that sometimes your body needs a minute to realize it's hurting—and that we should listen to those delayed messages, too.

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  6. Thanks for sharing this! I really like when you said "consistent effort pays off." I think that's true with most things in life.

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  7. It's surprising how hard small movements like those knee bends/stabilization and spelling the alphabet are! I should get into a routine of those, see if I can make progress getting through the alphabet easier.

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  8. Good post. Glad it is helping. Also I'm happy that stretching is in the mix. Had I been able to build stretching into my routine when younger (I do now) - I might still be jogging.

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