Weight-less ideas for Weakling Legs? (patellofemoral pa...

[shauny]

Howdy lovelies,

I've been having [a href="http://www.physioroom.com/injuries/knee/patellofemoral_maltracking_full.php"]patellofemoral problems[/a] with my right knee for about 18 months now. It was intially triggered by taking up running so I gave that up and just stuck to weights and Spinning. However earlier this year I discovered Cathe and tried step for the first time. For a month I naievely went too nuts too soon, ignoring niggling pain before finally admitting that step aerobics and plyo and leg presses were perhaps not ideal for my knee! After that I couldn't do any lower body work at all, was just too painful.

After months of physiotherapy my knee has finally calmed down but it is still quite unstable and sensitive - I am still limited to upper body work and "cardio in a straight line", ie walking, some cycling - no lateral movement, and very little resistance.

ANYWAY. I've been doing a lot more reading on the subject and gotten some advice and realise I need to work more on my leg. It seems the key with patellofemoral problems is to increase the strength and flexibility of the muscles around the knee, which tend to be weak - particularly the inner thigh but also the hip flexor and hamstrings.

So I am trying to put together a simple wee non-weight routine for my legs and was wondering if anyone out there has ever had a similar problem and knew of some exercises to do? Just gentle stuff I can do at home. At the moment I do basic straight leg raises as prescribed by the physio. I think Cathe described these during her injury - you just sorta lay back with your legs out straight, tense the quad and lift up and hold.

Specifically to help the inner thighs, I can't think of anything aside from the usual inner thigh lifts a la L&G or GS Legs. Maybe the KickMax leg conditioning drills would help? I tried the adductor machine at the gym but that's too much at this stage. I'm always unsure of ideas for the ol hip flexor and hamstring; I'm just doing extra stretching at this stage which seems to ease the tightness I always seem to feel.

Apologies for such a rambling post but I really want to put more effort and structure into my recovery. Cheers in advance for any ideas!

 

[kathryn]

Hi, Shauny!
I've had problems with PFP, and have gone through PT (actually made it worse because of a machine one of the PT's put me on), and done my own reading and rehab. I've gotten a pretty good hold on it now, after some trial and error (and trying new PT's).

You're right about the strentheniing/stretching bit. One good exercise for PTP is quad sets, which you are already doing (but just for anyone else who may have the same question): Sit on the floor with your legs in front of you. Bend one leg and keep the other straight (you can either lean back on your elbows or lie down, whichever is more comfortable). Flex the straight leg, feeling the quad engage, and keep it flexed as your raise it to about 45-degrees. Hold for a beat, then lower under control. Repeat for reps. When you can do about 25 reps, add a light ankle weight. You can focus more on the vastus medialus (the inner knee) by turning the toes out to about a 45-degree angle and keeping the leg in that position throughout the move. You can also do a less advanced version by putting a folded towel under the straight knee and just pushing down into it with the knee, which will engage the quads.

Also good for the inner knee muscle are squeezes done with a ball. A somewhat squishy child's play ball will work, as will some small weighted balls that are mushy. Either seated or standing, hold the ball between your knees and press in. Test for activating the right muscle by touching the muscle as you squeeze, and adjust your position as necessary to engage the muscle. You can also use a stability ball or pilates ring for these, though it's easier to get more tension with a smaller ball.

You can also do squats (as far down as comfortable, up to a 90-degree angle in the knees) with a ball between the knees, standing so that there is slight pressure on the ball all the way through the move.

One thing to watch for, if/when you start doing squats and lunges again, is that the knee doesn't buckle inward. Also, avoid using ankle weights when doing side leg lifts (for inner or outer thighs) as this can put lateral stress on the knee, which is a week angle for the knee. Instead, do these exercises with a weight strapped around the leg, just above the knee, or while holding a weight on the thigh above the knee.

Isolate leg extensions are an exercise that is best avoided, as they can put too much shearing force on the knee.

Working on stability of the knee is important, so exercises like 1-legged squats (done with one foot on a stability ball---Susan Harris does these in TLT's "Finding Your Core" ) are tough, but very beneficial. When you do them, pay a lot of attention to the stability of the working leg, and make sure the knee doesn't buckle in. You may only be able to do a very shallow ROM at first, but these are worth the effort. They work alot of small, stabilizing muscles that more traditional exercises don't.

Make sure you have a long warm-up before working out, so that there's a lot of blood circulation and warmth in the area. After working out, ice the area to reduce chances of swelling. You might also consider adding some anti-inflammatory foods like cherries, flax seed and mangosteen to your diet (I take a whole food supplement made from dried mangosteen and blue-green algae that is a good antiinflammatory).

 

[shauny]

Kathryn, thou art a legend! So many great ideas, thank you so much!

I never thought about anti-inflammatory foods, will definitely look into that.

It is so hard to be patient after so long, especially when you read about everyone doing the new workouts. I bought them all even tho I'll only be able to do the Upper Body premixes But I guess I need to take it slow and re-think my definition of a lower body workout. Getting healed as opposed to getting ripped, hehe!

Now, must go find a small child and steal their ball!

 

[brendazzzz]

bummer... I lost my previous post. Does that ever happen to you? Anyway, basically I just wanted to know the symptoms that you experience with this. I have sharp pain under my knee cap when I squat and have been trying to self-diagnose... Thanks!

 

[Gayle]

Hi shauny,

Kathryn has given you a lot of good advice. I went thorough PT for PFP last year.

After getting comfortable with some of the basic/stable ground exercises (ball squats, basic front lunge on the floor, etc) my therapist suggested trying to work the stabilizer muscles as much as possible. For example: squats while standing on a BOSU or a piece of cushy matting to add a little instability, front lunges onto a BOSU/mat, unweighted walking lunges.

For hamstrings, she had me doing a standing rear kick with a resistance band wrapped around my foot. This one is really hard to describe, so I'm going to try and find a picture. It really hit the hamstring nicely. She also had me working into hamstring roll-outs on the stability ball that Cathe does in L&G and other workouts. As a prequel to that, she suggested bridge work without the ball.

Actually, after getting past the beginning PT stage, I started working in a lot of the Cathe floorwork that I had been skipping, like the inner thigh lifts, roll-outs, etc...guess she put that stuff in there for a reason.

Also, if your patella is tracking to the outside, it's possible that your iliotibial(sp) band is tight. I was assigned stretches for that as well.

Lastly, since this has been going on for a while, and you're experiencing instability, have you had your knee checked to see if there could be something else wrong with it?

The reason I ask, is that the PFP that I was working on turned out to be both a torn ACL and meniscus. While the PT I did helped tremendously to fix some muscle imbalances I had, these are still requiring surgery to get back to normal.

Hope this helps.

 

[shauny]

RE: Weight-less ideas for Weakling Legs? (patellofemora...

Howdy brendazzzzz! My pain is pretty much as described on the link I put in my original post - sore when going up or down hills or stairs, sore after running. sometimes it reaches a point where kneeling is painful. there's also a crackling sound (called crepitus) when I straighten my knee, like you stuck your hand into a box of rice krispies! it also hurts when i sit for too long, it gets very stiff. and when i go to stand up it is often awkward to straighten my leg. i guess the pain is mostly on either side of my knee, but when it gets bad it feels tender all over if you press on it. hope that helps somehow! it's a really tempremental knee and depends on what activity i've done on a particular day.

Hiya Gayle - cheers for such helpful info! i will have to look for one of those bosu thingies! i did try the floorwork on L&G yesterday, but when i did those hamstring thingies (where you put your foot on the step and your other leg in the air) it really hurt my knee, it just can't bear the slightest amount of weight right now. i think i will try your bridge suggestion for the moment!

i'm not sure if my knee tracks to the outside, this is probably a dumb question but how do you tell? i know when i ran i was an overpronator, and when i squat my knees tend to wander to the outside...

as for there possibly being something else wrong, i'm not sure. i asked my physio if he thought i needed an arthroscopy to see if anything weird was happening, but he said he honestly didn't think it was "anything more sinister" that patellofemoral pain. i think the main problem is until now i haven't been dedicated and systematic enough with my rehab exercises! you and kathryn have inspired me to be smarter about it!

i think if i do a few solid months of exercises and it's still no better then i will definitely go see someone else about this...

thanks a bazillion for your insights, it gives me hope