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2002/09/25, 09:15 PM
Here's an EXCELLENT article about how knee pain occurs and how to properly treat it. I know some FT members have posted various questions about the knees and hopefully this will answer some questions...
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Knee Pain in Athletics
By Clay Hyght, DC, CSCS http://www.drhyght.com/
Unfortunately, it's not hard to find an athlete who suffers from knee pain. A whopping 75% of sports injuries requiring surgery are knee related. A paradox exists in the fact that exercising, the very thing that is supposed to keep your body strong and healthy, could be contributing to your knee pain. In the next few paragraphs, let's look at the most common causes of knee pain associated with overuse and what can be done to fix them.
A faulty extensor mechanism is the primary cause for overuse knee pain. The extensor mechanism includes the four quadriceps muscles on the front of the thigh, the patellar tendon, which the four quad muscles blend into, and the patella or kneecap. An inherent problem lies in the fact that our hip joints are farther apart than our knee joints. In other words, our legs angle in. The angle is greater in women because women have wider hips than men, generally speaking. Due to this inward angle, the patella has a tendency to be pulled laterally, or out to the side. This creates a problem because the patella is designed to track in a very precise groove when the knee flexes and extends. Even the slightest lateral deviation can cause premature wear and tear on the cartilage that lies on the back of the kneecap. This is called a Patellar Tracking problem. If left untreated, the cartilage could advance to Chondromalacia - excessive wear of the cartilage.
Because a squat can subject the back of the kneecap to a force seven and a half times greater than your bodyweight, it's easy to see why even the slightest problem with the extensor mechanism can cause a lot of damage. Pain with these injuries usually begins by hurting after an exercise session, then during, and eventually all the time. It may even progress to the point of clicking or popping, usually as a result of cartilage damage. People with this condition usually exhibit a positive theater sign, meaning they can't sit with their knees flexed for too long without causing pain. This pain is usually rather vague and described by sufferers as "inside the knee" or "behind the kneecap."
To learn how to fix the problem, let's first look at what caused it. The vastus medialis muscle, or "teardrop" muscle of the quadriceps group, is designed to oppose the lateral displacement tendency of the patella by pulling it medially (toward the center), keeping the kneecap tracking in its precise groove. If the vastus medialis is weak, the patella is allowed to shift laterally. Therefore, the best prevention and rehabilitation of a patellar-tracking problem is to strengthen the vastus medialis. A good way to do this is to do simple knee straightening exercises. Sit with your leg straight and fully extend the knee by contracting the quadriceps muscles. Hold each contraction for about ten seconds.
To enhance the contraction of the vastus medialis, place a finger or two on the muscle and really feel it tighten up under your fingertips. Do a few of these isometric contractions up to once per waking hour. Another way to strengthen the vastus medialis is to do leg extensions one leg at a time with your foot pointing laterally (outward) about 30 degrees. When doing these, don't go all the way down with your knee bent to 90 degrees. Just do the last 15 to 20 degrees of the movement, which keeps tension on the vastus medialis. At full extension (knee angle of 180 degrees), hold the contraction (squeeze) for at least three seconds. Again, facilitate the muscle by touching it with your fingers.
Another common chronic knee injury is Patellar Tendinitis, also called jumper's knee. Someone who has pinpoint pain right at the base of the kneecap most likely suffers from this condition. Although a weak vastus medialis can contribute to this problem because of the subsequent misalignment, patellar tendinitis is most likely a result of tight quadriceps, in addition to overuse. Treatment of patellar tendinitis can be rather difficult and long term. First of all, begin by stretching the quadriceps. This will help to provide a long-term solution. In addition, you should consider having some soft-tissue work like Active or MyoFascial Release done on your quadriceps to help loosen them up.
As with most overuse injuries, pain from patellar tracking problems and patellar tendinitis are also a result of either a sudden increase or change in activity. Exercising with these problems can be tricky. A good rule to follow is, "if it hurts, don't do it." I don't want to be one of the doctors who always says, "Oh, just stay off it for a few weeks and take these anti-inflammatories." I am very pro-exercise.
However, if an exercise really causes your knee to hurt, it's probably doing more damage to an already injured knee. Hack squats, lunges, and full range-of-motion leg extensions tend to exacerbate these conditions. Although not an exercise per se, going down stairs tends to be painful as well. Leg presses with your feet fairly high on the platform and partial leg extensions like described above, tend to be tolerated well by most people.
If you suffer from either of the above conditions, you should be icing your knees on a regular basis, at least once per day and especially after exercise. When icing any area, place a damp cloth between your skin and the ice pack. Leave the ice on for up to, but no more than, 20 minutes - more is not better. After 40 minutes without ice, feel free to repeat. In addition, the above conditions may respond very well to Labrada's Elasti Joint. (Forgive me for sounding like an advertisement, but I have seen first-hand how well it works. My wife, Michelle, would probably not have been able to continue her training for the Figure Nationals had it not been for the pain reduction she got with Elasti Joint. Not only did she compete, she took third which earned her Professional status in the IFBB's new Figure division. In retrospect, I would have paid $1,000 for each container of Elasti Joint!)
If you can't bear weight on your leg because of a knee injury, do not pass go or collect $200 - see your doctor immediately! If you have a knee injury that causes the joint to lock, see a doctor immediately. If your knee feels unstable or is obviously very swollen, guess what you need to do - see your doctor.
When in doubt, see your doctor. If you don't have a doctor, get one. If you live in Houston, contact me and I'll be your doctor. The above information is for educational purposes only. Don't think that after reading this article you know as much about knee injuries as your doctor and therefore don't need to go see him or her. Have I made my point?
Train hard and train smart.
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--JBennett
"I've up-ed my intensity.... now up yours!"
"Pain is only weakness leaving the body."
"Never think of how weak you are; think of how strong you're going to be."
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