Knee's gone bad

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Ulc
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Knee's gone bad

Postby Ulc » Wed Jun 22, 2011 6:38 pm UTC

So, this thread isn't actually about me, but a friend of mine (I swear on everything I hold dear that this isn't a "doctor, my friend have [X]")

About 5 months ago he started working out with me, 2-3 times per week (I'm usually there 3-4 times per week, he doesn't make it every time), his right knee quickly started to hurt a lot. Even when just walking in the daily life.

He got a time with his doctor that just said "exercise the knee".

So far he has mostly done biking for cardio training, and free weights for strength training, but avoided squatting as it hurt quite a bit. He's probably about 85 kg by this point, but used to be really, really unfit and about 100 kg. But while his weight has dropped, strength improved and cardio on a bike improved a lot as well - his knee hasn't. He can't run half a mile, though walking only hurts one out of four days instead of one out of two.

He recently went to the doctor again and ask to refereed to a specialist, which the doctor said wasn't necessary ("just exercise more").

He and I have talked about that he should start ignoring the pain just slightly, and do 3x5 squats with a empty bar (30 pounds) every second time we work out for a month or so, and see if we can't get a slight improvement. He tried that and definitely can't do them down to full parallel or his knee give in under him.

Any suggestions on exercises that can help the knee a bit, without destroying it completely? Keep in mind that "see a doctor" is sadly exhausted, as his doctor wont refer him to a specialist. We also considered that he might try changing doctor, but for other reasons, that's a last ditch thing.

Edit late: Just noticed a error, 85 pounds != 85 kg. Corrected now.
Last edited by Ulc on Thu Jun 23, 2011 6:50 am UTC, edited 1 time in total.
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Zapheod
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Re: Knee's gone bad

Postby Zapheod » Wed Jun 22, 2011 7:01 pm UTC

It might be that he does not have the strength in the supporting muscles to keep his form correct while lifting/running etc.. I would definitely reccomend doing more ab/back/core work.

http://sportsmedicine.about.com/od/abdominalcorestrength1/ss/Quick-Core-Workout.htm is a good list of core exercises that will probably help. Maybe add in some side leg lifts to build the external hip muscles(used quite a bit in leg stabilization).

As always.. I am not a doctor, but this type of work really helped solve my knee problems when I first started running lots of hills.

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savanik
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Re: Knee's gone bad

Postby savanik » Thu Jun 23, 2011 2:28 pm UTC

Core strength can't hurt, but if it's in just one knee, that's a little odd.

Is this pain in his muscles, his tendons, or his knee joint itself? They're fairly distinct. Also, check to see if he's ever injured his knee before. I injured my elbow way back in high school and I still get twinges in my tendons when I'm putting a lot of load on it. Trying to strengthen those up.

If it's the muscles, those just need to be toughened up a bit. Back off on the weight and do exercises that'll stabilize the joint - lunges with no extra weights is always an option.

If it's the tendons, there are some exercises you can do to strengthen them - they resemble stretches with small amounts of load, like resistance bands.

If the joints, then there could be some more serious problems going on. He really ought to see a specialist about it.

Also, you can always go and see a specialist, it's just most people go through their doctor to find one because they don't know who's a 'joint specialist' in the area. These days, we have the internet. :) There's usually a 'sport clinic' in most major areas that deals with football injuries, that sort of thing - they could be quite helpful for this situation. Usually they're walk-in, too.
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Ulc
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Re: Knee's gone bad

Postby Ulc » Thu Jun 23, 2011 2:48 pm UTC

savanik wrote:If the joints, then there could be some more serious problems going on. He really ought to see a specialist about it.

Also, you can always go and see a specialist, it's just most people go through their doctor to find one because they don't know who's a 'joint specialist' in the area. These days, we have the internet. :) There's usually a 'sport clinic' in most major areas that deals with football injuries, that sort of thing - they could be quite helpful for this situation. Usually they're walk-in, too.


It's the joint itself.

And the thing about the doctor is that we have free healthcare here in Denmark, but this is only covered at a specialist if your normal doctor have given you a reference - making it horrible expensive.
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Enuja
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Re: Knee's gone bad

Postby Enuja » Mon Jun 27, 2011 4:33 am UTC

Your friend might consider looking for an affordable physical therapist who works on a cash basis. You don't necessarily need a doctor for the necessary expertise.

Knee pain is something that needs to be paid attention to: it's really easy to further injure knees if you don't pay attention to the pain. I've had some knee problems, and using the machine where you sit and lift a bar with your shins, to work your quadraceps, is probably the way to go for your friend right now. I know most of the people who post in this forum aren't a big fan of machines, but it's much easier to get good form with a machine, good form is very important to prevent injury, and you've said your friend can't do squats because of the knee. Strengthening the muscles helps keep the joint in the correct position, so that the joint doesn't get further injured and has a chance to recover. If he starts with the good knee, pays attention to good form, and lifts low enough weights that he can do it on his painful knee without pain, he should be able to strengthen his quadraceps without further injuring his knee.

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Nath
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Re: Knee's gone bad

Postby Nath » Mon Jun 27, 2011 5:26 am UTC

Enuja wrote:Knee pain is something that needs to be paid attention to: it's really easy to further injure knees if you don't pay attention to the pain. I've had some knee problems, and using the machine where you sit and lift a bar with your shins, to work your quadraceps, is probably the way to go for your friend right now. I know most of the people who post in this forum aren't a big fan of machines, but it's much easier to get good form with a machine, good form is very important to prevent injury, and you've said your friend can't do squats because of the knee.

I'm one of those people who keeps talking about how free weights are better than machines. I do think rehab is one of the few valid reasons to use a machine, but you seem to be referring to leg extensions, which are more stressful to the knees than squats. (A few articles on the subject: Cressey, Horrigan, Mercer.)

I'd completely lay off the running, and get a coach to fix his squat form. I'll bet his knees are caving in or tracking too far forward; the fix in either case is for someone to yell "knees out" on every rep. Look into Dan John's stuff; he has many good cues and teaching methods for the squat-challenged (goblet squats, elbows sliding against inside of knees etc.). Your friend can do these sorts of things without added weight until the pain is manageable, though some people find it easier to hit good form with a little added resistance. Some light knee wraps might help as well (not the heavy-duty kind that geared powerlifters use).

If for some reason single-leg exercises don't bother the knee as much, he could do step-ups or lunges, with or without weight.

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Enuja
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Re: Knee's gone bad

Postby Enuja » Mon Jun 27, 2011 5:50 am UTC

Well, hopefully your suggestion to pay someone to show Ulc's friend how to squat probably, and your suggestion that the friend squat with no added weight (no empty bar!), will work. But the load on a the knee when a 187lb person does squats is much heavier than the lightest load possible with a leg extension, so it's possible that Ulc's friend just can't squat, and can do leg extensions. By all means, the friend should switch to squats when he's strong and heathy enough to do them, but if you can't squat, you can't squat. And those "articles" are all non-academic opinion pieces, citing many of the same studies, that don't address the issue of what to do to rehab a knee when someone can't squat.

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Nath
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Re: Knee's gone bad

Postby Nath » Mon Jun 27, 2011 6:11 am UTC

Enuja wrote:Well, hopefully your suggestion to pay someone to show Ulc's friend how to squat probably, and your suggestion that the friend squat with no added weight (no empty bar!), will work. But the load on a the knee when a 187lb person does squats is much heavier than the lightest load possible with a leg extension, so it's possible that Ulc's friend just can't squat, and can do leg extensions. By all means, the friend should switch to squats when he's strong and heathy enough to do them, but if you can't squat, you can't squat. And those "articles" are all non-academic opinion pieces, citing many of the same studies, that don't address the issue of what to do to rehab a knee when someone can't squat.

It's true that with squats, you have to squat at least bodyweight; that's a good point. But if you need to scale down even more, leg presses seem like a better bet than leg extensions, since they can be scaled down arbitrarily as well while avoiding some of the mechanical problems of leg extensions.

And yes, those are non-academic articles. Rigorous scientific papers on this sort of thing are nearly non-existent.

gfile-destroyer
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Re: Knee's gone bad

Postby gfile-destroyer » Fri Jul 15, 2011 10:32 pm UTC

I had tendonitis in my left knee and I found it extremely painful to do squats or anything resembling jumping. What I did was stop knee/leg activity completely until I didnt feel pain walking on it (though my knee did feel weak) then worked out with a physical therapist who showed me some exercises that strengthened my legs/knee a lot without hurting them. Eventually he did get me to start doing squats, and that worked for about a month but then he started to get a little overenthusiastic and I hurt myself again, but I just waited a few weeks and the pain went away, and now my legs are much stronger. Im swimming now to continue to recover since its so low impact and doing great. Strangely enough biking was hurting my knee. Who knows this might work the same way for your friend.

caje
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Re: Knee's gone bad

Postby caje » Sun Jul 17, 2011 4:09 am UTC

How does your friend squat?
High-bar or low bar?
How wide does he place his feet?
Feet angled out or straight?
Does he keep his knees from caving in when he squats?
How low does he go? Does the top of his thighs go parallel to the ground?

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VectorZero
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Re: Knee's gone bad

Postby VectorZero » Mon Jul 18, 2011 4:51 am UTC

Enuja wrote:Your friend might consider looking for an affordable physical therapist who works on a cash basis. You don't necessarily need a doctor for the necessary expertise.

This. A physiotherapist will be able to diagnosis a mechanical disorder and advise on appropriate exercises for strengthening. If a specialist opinion is required, ask the physiotherapist to write a letter to your local doctor to discuss their examination findings (and keep a copy.)
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Spase_Elevator
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Re: Knee's gone bad

Postby Spase_Elevator » Wed Jul 27, 2011 1:34 am UTC

A similar thing happened to me when I started heavy exercise after a period of bed rest because of an illness. While I desperately wanted to get in better shape, my knee wasn't having it. What I believe it came down to in my case was that I had only focused on the exercise, and forgotten about recovery and nutrition. What I did was stop exercising all together for a few weeks and worked on flexibility, balance, and stabilizing muscles. If your friend has the initiative to rebuild his body like this he could do well, and pardon my saying so but don't half-ass it.


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