Knees....

W

winter2b

Cathlete
Hi all,

I am just getting started with Cathe again and am doing the body blast rotation. I have been modifying when I need to, and have taken the impact out of some moves. Last night before bed, my knees were just aching. This morning they don't hurt, but when I flex and extend my knee, it doesn't feel smooth. Maybe this is normal.

I really want to avoid an injury, but I'm not exactly sure what to look for. On Monday while doing SJ&P, I felt some pulling in one knee, so immediately stopped doing the move and modified. Am I wrong to think that as I work out and get my legs stronger that they will provide more support for my knees?

I'm thinking that I may get the new beginner workouts, but I'm afraid by the time they get here, I'll be beyond them (keeping fingers crossed).

Anyhow - thoughts on knees and keeping them healthy?

Amy
 
Hi Amy. That actually sounds common considering you just started Cathe. Such a high amount of impact/intesity can shake anyone's joints! You are definitely right to modify if something doesn't feel right. You are also right that as you get stronger your knees should do better. I would hold off on the beginner workouts and just modify what you have & see how it goes.


"you miss 100% of the shots you never take"

Debbie
 
Hi Amy,

I've been dealing with a knee condition called Patella Femoral Pain Syndrome (PFPS). My physical therapist diagnosed it after a knee sprain back in February. Prior to the sprain, I would occasioanlly get the "pulling" feeling you're talking about in my left knee.

Basically, what's happening is my patella isn't tracking up and down as it should, but rather being pulled somewhat toward the outside of my leg. In my case, this is being caused by some imbalances in muscle strength and flexibility. The muscle on the outside of my knee is tight (can't remember the name of it), and the muscle on my inner leg, the VMO, is weak. I also have imbalances between the strength of my quads (over developed) and hamstrings (weak).

My PT gave me a bunch of exercises and stretches to help improve strength and flexibility where it needed help. I've been incorporating these, as well as some others, into my workouts.

As an item of note - I've been working my legs with heavy weights for YEARS, and always assumed that they were strong enough to support my knee health. I didn't realize just how much I had really been neglecting some areas, particularly my hamstrings. While it sucked to have an injury, it's really opened my eyes to what I needed to do for my legs and knees. A lot of the exercises that I've been doing for PT use little or no weight, or a stability ball, but I'm really noticing good changes.

This ski season will be the real test. :)

Sorry if this is long winded, I hope it helps. You might consider asking a doctor about the particular discomfort your getting. If you can get a few visits with a good, sports oriented PT, I think it would be money well spent.
 
Amy and Gayle!

Amy, Gayle's SO right about the imbalances that develop in women's legs, especially, even if we've been weight training for years and have strong legs.

I'm actually IN physical therapy this month for the same thing - bilateral patellofemoral pain Also known as "runner's knee." My orthopedist and then the physical therapist have found basically the identical imbalances that Gayle described. I'm on a regimen for the next four weeks that primarily works toward added strength in the VMO and inner thigh, with just enough outer thigh/quad work to maintain their strength. I can't work hammies much, either-- they were relatively strong compared to the VMO and inner thigh. I do this 15-25 minute leg routine 2X a day, and I'm still icing 20 minutes three or four times a day and taking an anti-inflammatory for another week or two. All of that is helping a LOT. My knees feel better and, more important, my gait actually feels a little different and I can tell that my kneecaps are re-aligning. And who knew they were even off???? ;-)

When I went to the orthopedist a couple of weeks ago, I did so because my knees had been achy and it wasn't going away. Now, achy knees is no new thing for me. But they'd usually respond to a day or two of rest and Advil. This time, I think they just decided "uh-uh, she's gotta listen to us this time." ;-) So I did, and the visit was SO worthwhile! I also found out that I pronate far worse than I knew, so I'm getting orthotics to go into my Rykas and the PT and ortho think they'll make a big long-term difference.

Gayle, I'd really be interested in what exercises and stretches you're doing, and what your results have been. My new favorite gadget is my stretching strap -- an AMAZING cheap tool that really gets in there! :)

Amy, it sure couldn't hurt to let an orthopedist take a quick look at your knees, and, as Gayle said, even a few visits with a good sports PT can educate you very well about what's unique about the structure of your legs (I know that my two legs don't even share the exact same anatomical issues -- one's slightly knock-kneed). I wish that I'd done this sooner myself!

Feel better and take care of those knees!

http://www.click-smilies.de/sammlung0304/sport/sport-smiley-003.gif Kathy S. http://www.click-smilies.de/sammlung0304/sport/sport-smiley-001.gif
 
RE: Amy and Gayle!

Hi Kathy,

My former leg routine used to consist of mostly basic exercises with heavy weight – squats, static lunges, deadlifts, calf raises – think PS Legs. I’ve stopped doing static lunges completely, as I found that, for me, all of the emphasis ended up being on the quads instead of the glutes and hamstrings. I also stopped going as low as 90 degrees on squats, I do those much shallower now.

My PT set me up with some exercises to specifically strengthen the VMO, hamstring, and hip, as well as some general stuff that was geared toward balance and all of those little stabilizer muscles in the whole leg. She had me using a BOSU for some stuff, which was WAY cool. I have to get one of those!

Here’s what she gave me:

Stretches:
* Lying Hamstring Stretch with a strap (your right, Kathy, that strap DOES help get in there)
* Cross Legged Forward Bend for the iliotibial band (ITB, outer thigh) – cross the left leg behind the right, then bend forward toward the left foot. Hold 30 secs. Repeat for other leg. This gets the ITB and some hamstring.
* Side Lying ITB Stretch – On the edge of a bed or table, lie on your right side. Lower your left leg behind you until you feel a stretch in the outer thigh. Hold 30 secs. Repeat for other leg.

Exercises (usually done in sets of 10-20 reps):
* Ball Squat – With feet hip to shoulder width apart; place a ball (something like a play ball or kick ball that’s 8” or so in diameter) between your knees. Squat to a comfortable level, squeeze the ball for a count of 5, come back up to starting position.
* Ball Squat on a BOSU – Do the above on a BOSU. YOWZA!!
* Ball Squeeze – Lie on back. Place a small ball between knees and squeeze for a 5 count.
* Inner Thigh Raise – Like Cathe does in the floorwork section of PS Legs, but no weight.
* Forward Lunges
* Forward Lunges on a BOSU
* Power Step Up – From more of a static lunge position, do a step up on an 8” step, but with a knee raise.
* Power Step Up on a BOSU
* Clam Shells with or without weight – description and picture here:
http://www.triathletemag.com/story.cfm?story_id=9496&publicationID=92&pageID=1705
* Side Lunge
* Balance on One Leg for 30 seconds
* Balance on One Leg for 30 seconds with your eyes closed
* Do either of the above on a thick foam mat or a BOSU
* One Legged Ball Toss – Stand on a thick foam mat, and have someone toss a play ball to you from the side. Throw it back. My PT always made me do these last and I felt it in my whole leg, from ankle to tush!
* Roll-Outs on a Stability Ball – Just like Cathe does ‘em in BB Legs & Glutes.
* One Legged Bridge on a Box or Stability Ball – Like Cathe in PS Legs & Abs or GS Legs.
* One Legged Squat or Speed Skater Squat – I can’t remember the exact name of this, but it’s a great exercise. Stand on your right leg, with the left leg bent behind you. Slowly bend the right leg while extending the left leg behind you until you reach a sort of “speed skater” posture. Slowly and smoothly raise yourself back up to starting position. You can also add onto this by touching your left hand on floor by you right foot. Tony Horton has two exercises in P90X Legs & Back that are just about this exact exercise. I’ll post a picture of this if I can find one.

There may have be one or two more that I'm forgetting, but this was most of it.

Since finishing PT, also added in walking lunges (all kinds), and have been much more religious about doing floor work, particularly moves for the adductors, abductors, and hamstrings. I really like the stuff in GS Legs. I also really like the leg exercises in P90X Legs & Back – most are done with body weight only. I've also started adding a barbell when I do the ball squats.

As for results, I’ve noticed that I don’t get that “pulling” feeling like I used to when doing cardio. I used to get it every time I did step (which I love), but lately I’ve been able to do stuff like Imax and Imax 2 and it’s felt fine. I am however trying not to do step more than once or twice per week, and mix up my cardio with low or less impact options.

Kathy – What cardio do you find is the least knee aggravating? This is the one area where I’m still feeling somewhat limited.

I hope this info helps. :)
 
RE: Amy and Gayle!

Mary -

I just sent you email...having trouble getting aol to go through, so I emailed using this forum.

Amy
 
I am at work and I just found out that our Sports Medicine department offers free athletic injury evaluations. I feel a little silly calling a sore knee an athletic injury, but I guess it is...or at least has the potential to be!

Thanks for all the advice!
 
Thanks so much Gayle!

Wow, that is GREAT info! Thank you SO much -- I've bookmarked this and will read it over several times.

I am printing out your exercise list to show my PT on Monday. At this early point in my therapy he has me doing far fewer exercises than you have listed, and very little quad work -- no lunges, no squats. It'll probably be a while before I do walking lunges! I am doing all three of your stretches as well as a kneecap stretch that I like alot. And for the ITB side-lying stretch I use the strap. (Here's a link to the strap I use -- it's fantastic):

http://www.fwonline.com/sstrap.htm

As for cardio, I wish I had a great answer for you, but I've found like you that even when my legs are strong and balanced, most cardio is somewhat knee-risky. We'll see how I do after this month of PT -- this is the first big-time knee relapse I've had in 7 years. I won't be cleared for propulsion cardio until the end of the month or even Labor Day, I'd say, and I told the PT that I don't care if I'm cleared to run again EVER, but I do want to do advanced step and kickboxing. He felt those would be no problem and that I might even be cleared to run on SOME surfaces.

Here's my list of the best cardio for my knees, in order from "hardly ever bothers my knees" to "50/50 chance of bothering my knees":
(1) my Precor elliptical trainer which most of the time I really like -- I get on it and watch TV or listen to my iPod, and when my knees aren't "acting up" I can use pretty heavy tension and lots of elevation changes to keep it interesting;
(2) tied for 2nd, my recumbent bike at moderate tension and my Nordic track at moderate tension -- neither one EVER bothers my knees, but I never use either one because they bore me to tears and for that reason alone they didn't make it into a tie for 1st place ;-);
(4) kickboxing which I LOVE (I have to be careful with my form on kicks, especially side and roundhouse, to avoid knee torque);
(5) step or step-based interval training, which I LOVE -- at no higher than 6 inches, with reasonably limited propulsion moves and/or done no more than 2 or 3 times a week; and last,
(6) running on my treadmill (which I find boring, but sometimes do because it's time-efficient and a nice variation.)

By far the worst cardio for my knees -- they ALWAYS hurt afterwards -- is running, anywhere except on a flat, shock-absorbent surface. (In other words, no hills of even the mildest kind, and no neighborhood streets running). On a great, strong day I can run with no danger of injury on the dirt path by the river near my house. But for my knees to enjoy this, the stars have to aligned with Jupiter and Venus has to be in the Seventh House, if you know what I mean. ;-) So running has pretty much left my list of options and, as I said, I told the PT that was okay with me. I'm 50 years old and would REALLY like to be walking and climbing stairs when I'm 90. :)

Next worst and almost as bad is any kind of propulsion move that puts the knee into a forward-flexed motion. For example, plyo jacks, or (the absolute worst) power scissors a/k/a plyo lunges. Genie hops fall into this category too - I have to do them 2-legged and very shallowly.

Certain step movements are risky-- torquey things like ricochets and up-and-backs, and pivots on the floor since I've got carpet in my w/o room. I DON'T pivot, in fact, and I have to choose my step tapes carefully so that I don't do too much ricochet-type stuff in one week. Another step move that is guaranteed to make my knees hurt the next day: slam-its -- even the low-impact kind in LowMax. LowMax, by the way, is NOT a knee-friendly workout for me even if I leave out the slam-its. I really like this tape and it irks me that Ic can't figure out what it is that my knees don't like other than slam-its! :-(

Hi/lo is not something I enjoy at ALL, but I don't think it's specifically knee-unfriendly. It just makes everything in my lower legs, ankles and feet have that "pulled" feeling you described. And my shins are always sore, no matter what.

Wow, this got long, but I hope the info is helpful! :) Keep me posted on how you're doing!!!

http://www.click-smilies.de/sammlung0304/sport/sport-smiley-003.gif Kathy S. http://www.click-smilies.de/sammlung0304/sport/sport-smiley-001.gif
 
RE: Thanks so much Gayle!

I'm glad this helps, Kathy.

One detail I forgot to mention: Early on in my PT sessions (like during the first week), my PT had me doing the squats, lunges, and balance stuff on the floor. Once she saw that I was an experienced exerciser and that the knee could handle it, she had be doing all of those things on the BOSU only. I think we did 7 or 8 exercises (2 sets) per session, plus a warm up on a bike or slide board. It usually took about an hour. She also had me do these about every other day on my own, as long as it felt okay.

I think we're in very similar boats as to what cardio is bothersome. I'm also finding LowMax to be a little aggrevating - I think it's the 8" step height that you have to use in order for it to be challenging. Plyo lunges are the absolute worst for me. I had my knee sort of "pop out of alignment" a few times before I started seeing my PT, and it was a very icky and scary feeling. I can do them okay now, but I'm doing them VERY gingerly, as I still a little afraid of them.

It's great that your PT feels you'll be able to get back into advanced step and kickbox, and maybe running. The most frustrating part of this has been the feeling that I won't be able to do what I love anymore. For me, that's skiing. My PT kept assuring me that I'll be able to ski just fine this year, but I won't feel totally confident until I can get out and do it. I must be an optimist, because I already bought my season pass. :)

Please keep me posted, too! I hope your therapy progresses quickly. Good luck!
 
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