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Weight Loss Forum / General Topics / March 2004Exercise & Knee Pain
Crossposted to ASD and MFW for input. Stats: Female age 32yrs 5'3", 135lbs workout with combo of weights and cardio I've been dealing with knee pain for a while now and finally sucked it up and went to the doc. After a 45min wait in the waiting room, another 15 in the exam room, a 10 min consult and doc says: "Chondromalacia" OK, so flash backs to highschool - this is what I had back then. This is what is bothering me know. Treatment: PT, for 4 weeks. Spend lots of time on the stationary bike. If no improvement, off to Othropedic for further treatment. Now, the question is..... What are the suggestions from those in the group? How do I handle workouts? Running/jogging? Biking? Weights? Squats? Lunges or deadlifts? What should and shouldn't I do at this point. I now have to go spend time researching this to determine my next course of action. I had a very serious problem with chondromalacia several years ago. I'm now generally pain-free, but I still get little flare-ups of it now and then. Here are the things I'd recommend, based on my experience. (I should note that I'm not a physician and that YMMV and all that stuff.) * If you're not already doing it, start taking glucosamine/ chondroitin. * Do leg extensions if they don't feel like they aggravate your knees. I find them therapeutic when my knees flare up. I don't bother with them unless I'm having knee pain. * Do deep (below parallel -- a.s to grass) squats. If you don't know how now, learn this. Start with no added weight if you're new to it. Keep doing them after your knees recover, to help prevent future problems. * Do hamstring, quad, and achilles tendon stretches -- religiously, twice a day. * Avoid impact exercises like running or lots of walking, particularly on pavement. Avoid stairs when possible. Avoid jumping (well, at least the landing part :-) ). * Don't do the stationary bike if it hurts. You might find an elliptical trainer more comfortable. Water exercise is also great for someone whose knees hurt. If a repetitive exercise is painful, it's not a good choice for you. * Ice your knees if they're sore. * For always -- not just when your knees are bothering you -- avoid twisting your leg with your foot planted on the ground. Good luck! Chris > Here are the things I'd recommend, based on my experience. (I should > note that I'm not a physician and that YMMV and all that stuff.) Thanks for the input Chris! > * If you're not already doing it, start taking glucosamine/ > chondroitin. I've got it, just don't take it religously. I'm bad about taking drugs/pills. I just don't remember to take them daily... (I posted about this a few months back). But I'm going to give it a try. I know (from what I've read) that it takes a good 2 months of regular use of G/C before the affects take hold. > * Do leg extensions if they don't feel like they aggravate your > knees. I find them therapeutic when my knees flare up. I don't [quoted text clipped - 4 lines] > Keep doing them after your knees recover, to help prevent future > problems. I can do a.s to the grass, but I always get the conflicting info when I do them. So many people are against the A2G and say to only go parallel. Its weird. You read here and mfw and its all about how low you can go, yet you go to the gym and people say otherwise. I started using the leg press machine instead, as it was easier on my shoulders. > * Do hamstring, quad, and achilles tendon stretches -- religiously, > twice a day. Besides the standard (quad stretch by pulling leg behind and calf stretch by doing a lunge, do you have some other good stretches you could recomend? > * Avoid impact exercises like running or lots of walking, > particularly on pavement. Avoid stairs when possible. Avoid jumping > (well, at least the landing part :-) ). stairs is not a problem around here. single story house, single store work place. My only issue now, besides the fact that I like to walk/jog with the dog, is the walking I do at work. we are building a new office 2 building away (about 1/4 mile) and I walk between the 2 buildings multiple times a day (in dress shoes). I now have my sneakers at work, and will start wearing them for the longer walks. > * Don't do the stationary bike if it hurts. You might find an > elliptical trainer more comfortable. Water exercise is also great for > someone whose knees hurt. If a repetitive exercise is painful, it's > not a good choice for you. Actually - it was using the elliptical while on vacation that helped to start this whole thing. I can do the bike now - but even this weekend I tried out an elliptical at the store and it hurt just to try to do a couple circles. > * Ice your knees if they're sore. > [quoted text clipped - 4 lines] > > Chris >I've got it, just don't take it religously. I'm bad about taking >drugs/pills. I just don't remember to take them daily... (I posted about >this a few months back). I know what you mean. I don't always manage to take my pills either :-). >I can do a.s to the grass, but I always get the conflicting info when I do >them. So many people are against the A2G and say to only go parallel. >Its weird. You read here and mfw and its all about how low you can go, yet >you go to the gym and people say otherwise. Ignore the people in the gym. The halfway position is very hard on the knee. And the form one usually uses when squatting this way also puts more strain on the knee. A2G is easier on the knees and helps build quad strength, which you need to keep the knee alignment. >I started using the leg press machine instead, as it was easier on my >shoulders. Nothing wrong with that, as long as it doesn't hurt your knees. Don't be afraid to go up in weight, though. Leg press done with an easy weight isn't very useful for adding strength. >> * Do hamstring, quad, and achilles tendon stretches -- religiously, >> twice a day. > >Besides the standard (quad stretch by pulling leg behind and calf stretch by >doing a lunge, do you have some other good stretches you could recomend? Those are definitely the standards. For the hamstrings, sit with legs outstretched in front of you in a v, and reach toward toes on one side and then the other. Or stand and put one foot up on a counter and stretch toward it. I also like the exercise where you sit, draw up your legs, put the soles of your feet together, and gently press your knees down to the sides. >stairs is not a problem around here. single story house, single store work >place. My only issue now, besides the fact that I like to walk/jog with >the dog, is the walking I do at work. we are building a new office 2 >building away (about 1/4 mile) and I walk between the 2 buildings multiple >times a day (in dress shoes). I now have my sneakers at work, and will >start wearing them for the longer walks. Make sure your sneakers are good ones, and not too old or worn. You might want to try some kind of insert for added support. I like Superfeet inserts, and New Balance shoes. >Actually - it was using the elliptical while on vacation that helped to >start this whole thing. I can do the bike now - but even this weekend I >tried out an elliptical at the store and it hurt just to try to do a couple >circles. Well then I'd definitely stay away from ellipticals. If an exercise hurts your knees, this is not an example of "good pain". Don't do it. Chris Oh -- one other recommendation. Take ibuprofen or another anti-inflammatory. It's not so much for the pain -- although that's a benefit too -- but to help reduce inflammation. Chris >Oh -- one other recommendation. Take ibuprofen or another >anti-inflammatory. It's not so much for the pain -- although that's a >benefit too -- but to help reduce inflammation. > >Chris The doc gave me a 1 month supply of an anti-inflamatory, can't think of the name right now, but it begins with a "M" ... (not motrin). Samples are a good thing. And one thing about my GP, he gives samples out readily, which is nice. All good advise, but a couple of comments... > I had a very serious problem with chondromalacia several years ago. > I'm now generally pain-free, but I still get little flare-ups of it [quoted text clipped - 9 lines] > knees. I find them therapeutic when my knees flare up. I don't > bother with them unless I'm having knee pain. If you're talking about starting with your knee bent at a 90 degree angle like this http://www.exrx.net/WeightExercises/Quadriceps/LVLegExtension.html - these are controversial. I understand a lot PT's don't recommend them anymore, even for healthy knees but particularly not for people with PFPS (chondromalacia). One way to alleviate the risk is to only work the upper range and stop with your leg halfway to the 90 degree position. But the standard leg extension for PFPS is the straight-leg raise. See http://www.santerehab.com/hurts/exercise/othr_kne.html > * Do deep (below parallel -- a.s to grass) squats. If you don't know > how now, learn this. Start with no added weight if you're new to it. > Keep doing them after your knees recover, to help prevent future > problems. I'd be very careful with deep squats if you have chondromalacia. OK, if they don't hurt (either while you're doing them or cause a "flare up" within a day or two afterwards) and you do them in proper form. (Of course this is ture for any exercise...) I submit that that many with PFPS will have trouble doing them in proper form due to muscle tightness, etc. > * Do hamstring, quad, and achilles tendon stretches -- religiously, > twice a day. [quoted text clipped - 16 lines] > > Chris >If you're talking about starting with your knee bent at a 90 degree >angle like this http://www.exrx.net/WeightExercises/Quadriceps/LVLegExtension.html [quoted text clipped - 4 lines] >position. But the standard leg extension for PFPS is the straight-leg >raise. See http://www.santerehab.com/hurts/exercise/othr_kne.html Well, as I said at the start of my post, my recommendations are just based on my personal experience. I know leg extensions are controversial, but I have found them extremely helpful when my choondromalacia flares up. If my knees are feeling a bit iffy, I'll also do a few sets as warmup before I start doing my Olympic lifting training (which involves jumping and squatting). Others' experience may differ. >I'd be very careful with deep squats if you have chondromalacia. OK, >if they don't hurt (either while you're doing them or cause a "flare >up" within a day or two afterwards) and you do them in proper form. >(Of course this is ture for any exercise...) I submit that that many >with PFPS will have trouble doing them in proper form due to muscle >tightness, etc. I think that deep squats take some learning for most people, so I just suggested that Jayjay work on learning to do them, if she doesn't already.. I have found them extremely beneficial, whereas I find that 90-degree squats are painful and aggravate my knees. But I agree that if these -- or any other exercise -- result in knee pain a day or two later, they should be avoided. Again -- just my personal experience. Chris > Well, as I said at the start of my post, my recommendations are just > based on my personal experience. I know leg extensions are [quoted text clipped - 3 lines] > training (which involves jumping and squatting). Others' experience > may differ. Chris: When I moved to the states during high school after living in Australia and Jamaica, I had to meet all the requirements for graduation at my new high school. This included so many hours of phys ed which American students were allowed to carry over from Jr. High school. Alas, we did not get credit for 'sports' as they were called in Australia so I had to take additional courses. The only one available to me was weight lifting. I played tennis several times a week down under but because I have long legs and the stress of tennis, I came to weight lifting with very weak knees. Our coach encouraged me to work the muscles directly below and above the knee. He said it would add stability. As an adult, I wonder if I should have trusted his word about knees, etc., but it worked. He was very careful about the angle that my knee was bent and he wouldn't let me do certain things like squats with heavy weights until I could do lighter weights without bending my knees more than 90 degrees. It worked. I am 43 with the same knees. I suspect I will have knee replacements one day but until then, I will strengthen muscles directly above and below my knees and I make it a point to never bend them more than 90 degrees. I also avoid stairs if possible and wear flat shoes if appropriate. j > >I'd be very careful with deep squats if you have chondromalacia. OK, > >if they don't hurt (either while you're doing them or cause a "flare [quoted text clipped - 11 lines] > > Chris >> Well, as I said at the start of my post, my recommendations are just >> based on my personal experience. I know leg extensions are [quoted text clipped - 28 lines] >90 degrees. I also avoid stairs if possible and wear flat shoes if >appropriate. It sounds like this coach did good things for you -- definitely not something one can count on :-). I agree entirely about strengthening the muscles above and below the knees. That's what helps keep knees in alignment. And it's one of the reasons that many people do recommend leg extensions. The 90 degree squat limit is widely propagated, but there are many who disagree. I'm one of those, I guess. For me, higher squats put a lot of stress on my knees that is relieved by going lower. I wouldn't have thought this possible either until I learned it. I think the form is actually different when you go lower -- you sit back more into the lift, as though you were going to sit in a chair, which takes stress off the knees. However, this does take learning. And I think we all have to be guided by what works for us. I have pretty crummy knees also, but I'm maintaining them pretty well for now (and for age almost-56). Chris > The 90 degree squat limit is widely propagated, but there are many who > disagree. I'm one of those, I guess. For me, higher squats put a lot [quoted text clipped - 3 lines] > the lift, as though you were going to sit in a chair, which takes > stress off the knees. However, this does take learning. And stretching! I have to stretch my ankles, hip flexors and hamstrings before I can keep my pelvis tilted back in the right way. I was dipping my butt in at the bottom of my squat and that's bad. But I agree with you that low squats are easier on my knees that mid-level squats. I'm having a twinge in my knees these days from my sumo deadlifts. I'd love to get my form checked but when I hired a trainer (and specifically told him it was to learn deadlifts) he thought sumo deadlifts were "straight leg deadlifts with a really narrow grip" and he demonstrated holding the hands together on the barbell. Um, no. Dally >I'm having a twinge in my knees these days from my sumo deadlifts. I'd >love to get my form checked but when I hired a trainer (and specifically >told him it was to learn deadlifts) he thought sumo deadlifts were >"straight leg deadlifts with a really narrow grip" and he demonstrated >holding the hands together on the barbell. Um, no. I don't deadlift much anymore -- just too much else to do -- but when I did I always did sumo. It can be hard on the knees, but probably less so than conventional form. Have you ever tried using knee wraps? They can help protect your knees from undesired rotation. Also, experiment with the amount of turnout in your feet. (Obviously, the trainer was wrong :-) .) Chris >>I'm having a twinge in my knees these days from my sumo deadlifts. I'd >>love to get my form checked but when I hired a trainer (and specifically [quoted text clipped - 9 lines] > > (Obviously, the trainer was wrong :-) .) Yes, I did catch that part. (Right away, it's not like I hadn't looked up Krista's deadlift page first!) I'm unfamiliar with knee wrapping. Can you explain? Dally, who had never heard of singlets until you posted a link >I'm unfamiliar with knee wrapping. Can you explain? Knee wraps are long stretchy cloth bands that you wrap around your knee tightly (and secure by tucking under an end). They provide support for squatting and deadlifting -- especially helpful for those with knee issues. They can also improve your squat poundage because they give you a little more strength out of the hole. (They're legal in competition -- even raw meets -- because they're viewed as safety gear.) I use the Titan Gold wraps, seen here: http://www.titansupport.com/products/wraps/wraps.htm. Here you can see some pictures of people using them: http://www.usapowerlifting.com/newsletter/17/results/womens_art.html Chris I think you need to talk to your physcial therapist and see what they recommend!!! They will be able to better evaluate what your limitations will be so you don't keep re-injuring your knee. Do you have an appointment set up? Also, avoid Health South! They will rip you off and not help. > Now, the question is..... What are the suggestions from those in the > group? How do I handle workouts? [quoted text clipped - 7 lines] > What should and shouldn't I do at this point. I now have to go spend > time researching this to determine my next course of action. >I think you need to talk to your physcial therapist and see what they >recommend!!! They will be able to better evaluate what your limitations >will be so you don't keep re-injuring your knee. Do you have an appointment >set up? Also, avoid Health South! They will rip you off and not help. I have about 10 places to choose from, so I'd love some advice on how to choose a physical therapist. Non of the ones my insurance cover are in the "sports medicine" area. Also, the one that my doc recommended is also not on my list. I've got 5 options that are about 2 miles from my house. And 4 options that are less than 10 miles from work. The thing is - work & home are about 30 miles apart. So, its a matter of who can get me in, in a fashion that will be least disruptive to my work schedule. (late lunch or something along that lines). "Jayjay" <jjf_71@notmail.com> wrote in message > I have about 10 places to choose from, so I'd love some advice on how > to choose a physical therapist. > > Non of the ones my insurance cover are in the "sports medicine" area. > Also, the one that my doc recommended is also not on my list. ***does your insurance cover out of network phys. therapists? You may pay a higher fee, but not full cost. > I've got 5 options that are about 2 miles from my house. And 4 > options that are less than 10 miles from work. The thing is - work & > home are about 30 miles apart. ***It does depend on scheduling... for morning appts, the one closer to the house, for lunch, the one closer to work. At least you are lucky enough to have so many options. > So, its a matter of who can get me in, in a fashion that will be least > disruptive to my work schedule. (late lunch or something along that > lines). ***One thing I can say, in addition to not going to Health South, is that you want to go to a phys therapist that works directly with you. I've been to a p.t. that showed me exercises or stretches, but then they don't monitor me to make sure I was following correct form. I've also been to a p.t. that worked very closely with me and seemed to "want" to get me better and not just collect a paycheck. If you can't get any referrals for p.t. that are on your insurance, the only way to know is to try a few out. I have a knee with nerve damage and thinned cartiledge. I just live with it and adjust my weight routine accordingly. There have been times where it hurts like hell to walk. Knock on wood... so far I am fine as long as I don't strain it too much, stand for a long period of time (it goes numb) or climb excessive stairs/steps. That is one of the reasons I bought a 1 story house last year! Good luck and I hope it helps. >I have about 10 places to choose from, so I'd love some advice on how >to choose a physical therapist. I'd look for one who is experienced working with athletes. You can ask them, but a better approach might be to ask people at your gym. That's where I get recommendations for things like that. This has helped me find a chiropractor/acupuncturist who is treating my shoulder with the understanding of what I want to do with it, not just trying to tell me to stop lifting. Chris |
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