Help my knee
May 23, 2013 10:44 AM   Subscribe

I hurt my knee about a year ago. It still isn't fully better. Can you help?

I injured my knee in the gym about a year ago. Cause of injury was repetitive use, namely, repeatedly jumping off my one leg while working on a climbing problem. I was diagnosed with patellofemoral pain syndrome. I saw an orthopedist and he prescribed physical therapy, which I completed.

I still don't have total recovery a year later. I have full range of motion, and I'm comfortable doing full squats in the gym. I can't, for example though, sit in a pistol squat position on the injured knee. This causes pain, and the pain gets worse if I try to push myself up with the one leg. Or, for example, if I'm seated on the floor and try to push up with my injured leg, again this will be uncomfortable. I still have a nagging soreness in the knee that comes and goes and which makes me need to stretch the joint out. And lastly, if you hold your hand on my knee, you can still feel a clicking when I contract my knee (crepitus, as my PT called it). I'm also concerned about whether this clicking is damaging my bones / joint.

I'm wondering if there are any mobilizations / exercises ala Mobility WOD that would help me get my knee back to its previous level. Or if not, what my options are.
posted by prunes to Health & Fitness (8 answers total) 6 users marked this as a favorite
What happens if you do the exercises you were given in physical therapy? If you repeat the treatment at home/at the gym on your own, do you get any relief from the recurring symptoms?
posted by elizardbits at 10:49 AM on May 23, 2013

I'm not sure about the clicking, but I also have patellofemoral pain syndrome and am a runner. I did about 3-4 months of physical therapy 2x a week a couple years ago for this and we worked on specifically hip strength (the currently accepted medical theory re: patellofemoral pain being that weak hips can't track your knee properly).

At that time I did the exercises ~5-6 days / week and my hips got a lot stronger. Now I do them for maintenance, roughly 1x per week or 2-3x if my knee gets a bit sore. Here was roughly my regimen:

- bodyweight squats, making sure your knees never go over your ankles
- standing on the left/right edge of a raised platform, just until your free foot brushes the ground. It's really important to make sure your knee is tracking correctly here -- it should stay in line with your hip and foot, and not cave in at all (doing this one in front of a mirror helps)
- sitting on the floor, one leg bent with foot on the floor in front of you, other leg straight out in front, and lifting it up and down
- lying on your side and lifting the top leg straight up and down
- lying on your stomach and lifting your legs straight up and down (kind of like a superman, but one leg at a time.)
- You can also get a stretchy band to put around your ankles and then step/squat sideways -- this got me way stronger way fast

- hamstring stretch lying down on your back (like this)
- quad stretch (like this)
- lunge stretch (like this)
- seated glute stretch (best one!!! like this)

When I do this routine at home (e.g. not doing formal PT) I would give about 20-30 mins to it.

The most important thing about all the exercises was getting the form correctly, so that you were strengthening the weak muscles. After a couple weeks I felt like I was using totally different muscles just to walk around.

And as far as getting back to full recovery goes -- I know it's slow and frustrating, but it takes an obnoxiously long time. After initially injuring my knee I never felt like I was back to completely normal just from waiting, but time + this physical therapy stretching stuff makes me feel like 95% normal nowadays. I had to work up from running like, half a mile or something, but you can train up and I ran a half marathon a couple months ago with no knee trouble. So you can do it!

Finally, I would recommend finding a really good sports medicine doctor if possible in your area. That really helped me understand what was going on, how to improve, and what any random weird things (e.g. your clicking) might be.

Sorry that knees suck, and good luck!
posted by mokudekiru at 11:09 AM on May 23, 2013 [4 favorites]

After my broken knee healed, I was left with a permanently-clicking knee. The knee cap did not heal properly and no longer "tracks" or moves in its old, correct alignment when bent. This causes me little to no pain, but I am wearing down the meniscus a bit more every time it clicks, so it will be a problem one day. PT did not fix this for me, but, apparently, it can be fixed for others. Perhaps try another round of PT with a different therapist.
posted by Blazecock Pileon at 11:14 AM on May 23, 2013

Response by poster: I never felt like the PT exercises helped with my crepitus and when I voiced my concern to my PT he seemed to shrug his shoulders about what would heal it. I also don't feel like I suffer from lack of strength. I follow a lifting routine that includes backsquats and deadlifts.
posted by prunes at 11:17 AM on May 23, 2013

I had a similar (but not exactly the same) problem with my patella recently and the person checking me out said my vastus medialis was weaker than its counterpart on the other side (vastus medialis is 1/4 of your quad, the part on the inner side of your knee).

When it's weaker -- or, similarly, when the outer one is stronger than it, let's just say when they're unequal -- it causes your patella to do all kinds of funky stuff. She said mine was practically on the other side of my knee from where it should be, it was so wonky.

Her suggestion: seated leg lifts, but only the upper 10-15% range of the motion. In other words, bring the weight up, then keep it up and only move through the top part of the range of motion. You can feel (and see) that section of the quad moving in near-isolation if you're doing it right. She said if I put some effort into building it up, the knee problems would resolve better and faster.

I'm only just now getting to the point where it isn't so inflamed that I can do the exercise well (for a few weeks going down stairs was particularly agonizing, and LOUD-clicky), so I can't give a full report on how well this works yet, but if nothing else, it might be worth trying.
posted by at 12:04 PM on May 23, 2013

I've got one leg squats as my main therapy - I get crepitus primarily when my knee isn't tracking properly and it's doing that because my muscles are unbalanced (compensating with one leg for the bad one and different muscles around the bad knee). The one leg thing is to assist balance, work the muscles that have been failing me and stop me compensating with the other leg in weird ways.

But the crepitus won't go away - it's already damaged (surgery when I was younger) and it's just how my knee sounds now. I loathe it, but short of some non-guaranteed surgery, it won't change.
posted by geek anachronism at 3:44 PM on May 23, 2013

I also got patellofemoral syndrome, in my case from cycling. Did months of physio, probably spent a couple thousand dollars on that, and saw very little improvement. That was three years ago and I still can't really cycle much, though almost everything else is painless.

Hope you have better luck (and/or physiotherapist) than me!
posted by vasi at 2:52 AM on May 24, 2013

Echoing mokudekiru's answer.

Something I've learned from all my PT is that it doesn't heal your injury, it helps you focus on areas where your musculature is under developed, which may have contributed to the injury in the first place. Working on those muscles (especially core muscles) takes some stress off your injued knee. I've had a few knee injuries and LOVE going to PT. It really helped me learn proper form and what muscles to engage when doing different exercises. I will probably have to keep doing PT exercises if I want to avoid arthritis in my knees later in life, so I like to check in with my PT every few years to see what areas of my body could use some work.

If I were you, I'd get recommendations for a good PT in your area, because it sounds like your previous one wasn't very invested in helping you reach your fitness goals.
posted by stompadour at 7:50 AM on May 24, 2013

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