I was diagnosed with the afformentioned condition, which basicaly sucks but there you have it.
now, the doc, told me for a month to a month and a half to do isometric quad excersises, and open kinetic chain quad excercises (extentions mainly) that do not bend the knee more than 30 degrees.
he also told me that sprints do not directly affect the problem but could be harmfull.
qustion is, how do i modify my training to heal but not end up slower than a dead slug?
for excample my regular lifting routing is this:
cleans
front squats
back squats (->im still learning the FS so i dont put much weight thus, im doing the back squats )
bench
pull up
good morning
rotator cuff excersises / military press
i can do everything besides the squats and cleans. Im thinging of substituting cleans with hang power cleans, does that sound reasonable?
but what about sprinting? Ill do no block work, and ill try to minimize running tempos, ill try to access a pool or something, though, i REALLY cant swim properly:( Ill do my best anyway.
what do i do with speed work though? i really cant tell, any sugestions on how to at least maintain my speed?
(stats are these:
100m->11.8
squat->140kg 1 rep
bench->95kg 1 rep
clean->95 kg
1.79 m, 86 kg 14% bf currently loosing, slowly though:P)
I’m sure that other people here can give you more complete answers, but if I were you I would not front squat or clean. If I’m having any knee issues either of these movements would tend to aggravate them. I’d substitute high pulls for the cleans so you could get explosive triple extension without the catch (that’s what aggravates my knees, wrists, and elbows).
There was an article not too long ago in the american journal of sports med. It was a prospective study where they looked at a bunch of asymptomatic athletic young people. They followed them for several years and then retested them on a number of measures. A certain percentage of these subjects developed anterior knee pain during the study. The major differences noted were that the subjects who developed anterior knee pain had tighter quads and gastrocnemius than those who didn’t.
In other words, stretch your quads and gastrocs.
I’ve yet to treat anyone with anterior knee pain that didn’t also have hip weakness on the same side. Glute max and glute medius activation/strengthening. Start with simple isolation exercises and progress to shallow single leg exercises with an opposite leg reach to front side and rear (activates hip muscles). 0-30 degress is usually not painful.
Rehab VMO if it has developed stretch weakness. The horizontal fibers of VMO will tend to be weaker if the hip is weak.
TFL can also be overactive especially if your psoas is weak. There is a slip of you ITB that attaches to the patella that can affect tracking. TFL attaches to ITB. If glutes are weak, hip will internally rotate when loaded and alter patellar tracking.
Test your psoas. Sit on a low bench with hips slightly lower than knees. Knees are bent greater than 90 degress. hands behind back. Maintain neutral spine (hands can monitor this). Raise one knee and then the other. Identify weakness by inability to raise knee significantly without altering back position.
If psoas is weak, iliacus becomes more dominant. Because it has no influence above the pelvis like the psoas, anterior tilt increases. Couple that with TFL overactivity. Anterior tilt promotes internal hip rotation and lateral patellar tracking.
If weak, strengthen psoas.
If you’ve ever sprained the ankle on the knee pain side, check your fibularis muscles (AKA peronei…name change recently in texts to avoid getting mixed up with peroneum) for tenderness and tightness. This will cause eversion at the ankle and internal rotation of the tibia and promote lateral tracking of patella.
Foam roller everything or get some serious soft-tissue work.
yeah i will OBVIOUSLY not squat:p and ill try to do power cleans without droping to much for the catch, but doing just the triple extention, i mean that would literaly destroy my soulders:p, that is if i have to drop the bar again down.
coolcoolj:
yes thats prety much the case, but my question is, what do i do to maintain speed?
Epote,
You may be able to still squat if you use a box and sit back past perpendicular. If my knees are sore I can still do dynamic squats in this fashion without pain. The dynamic squats would also help to maintain your speed.
When i had this problem i used EMS on my quads and within 3 weeks i had no more pain. I guess it is because it allows you to contract the entire quad in 1 go. Perhaps something to think about?
To answer your questions, with any anterior knee pain, you can generally perform any exericise that does not cause pain. Generally two leg squatting will be a problem. Most anterior knee pain ( chondromalacia, patella -femoral syndrome etc.) emanates from the hip. Think hip-down for a cure. Forget your knee. Soft tissue work on the glute medius and hip rotators is essential, as is the development of femoral control. Powers work at USC has clearly established a link between anterior knee pain and hip abductor weakness. Forget the quads sets etc. That is ancient history rehab. Work on glute max, glute med and hip rotators with a hip dominant strategy while maintaining a pain free approach. Remember, “does it hurt” is a yes /no question. Answers like “after I warm-up” etc. are all yes answers. Training must be pain free. Training with pain is like scratching the scab on a cut.
When i had this problem i used EMS on my quads and within 3 weeks i had no more pain. I guess it is because it allows you to contract the entire quad in 1 go. Perhaps something to think about?
yes i sould give it a try. Now if only i could afford/find an EMS machine:p
kelly:
thanks, ill try it
mboyle:
thats true, but the itch deep inside that says “next time it will be better” is tough to beat, no seriously, i came at point which i could actually FEEL my work outs sucking prety bad so…
ill try to access the facilities required for your proposals, but i have no idea how to do them on my own, so its gonna be a bit tougher. Greece is bit behind on all those things, and i aint excactly rich:)
actually my pain is not well localized, though acording to the doctor that is expected, so i cant definitly say its anterior knee pain, i can feel it also on the behind or deeper in the knee. though is not meniscus and/or crusiate problems
Interesting… come to think about it I was also doing ems on my glutes and hamstrings at that time. I just assumed the quad work was responsible for my improvement.
Interesting…
But the question here is the source of knee pain. I am not an expert, but I think chondromalacia is because rotation of femur on the tibia (they are not aligned correctly) so there is rubbing of the tibial/femur bone on patelle… Other source can be misaligment of patele due stregth-leght relations (muscle imbalance) between vastus lateralis et medialis! To solve first problem fix the hip (rotatores et addutores), and to fix second source fix muscles imbalances via EMS or isometric work! We must have wholistic approach… in most time single joit is not the source but rathe kinetic chain! Just thought! I hope I helped…
ok, now what i simply have to do is learn how to do all those things, because where i live literaly no one even remotely knows how to adress any of these issues.
btw, how the hell do you strengthen hip rotators? I was hoping that would be a colateral effect of sprinting or smt
Hip rotators can be strengthened by unsupported uni-lateral training to some degree. My feeling is that some semi-isolated work may be necessary. I like a standing internal/ external roation at the hip done while standing on low box. The key is to internally and externally rotate at the hip while keeping the big toe of the foot on the ground. Many will compensate for lack of internal rotation at the hip by moving at the ankle. Some will call this a “balance” drill. My current feeling is that what we like to call balance may have a great deal to do with the function of the hip. We need to give the hip cuff ( hip external rotators) the same degree of respect and attention that we have showered on the rotator cuff of the shoulder.
Indeed physios in the UK are mad for glute work however our athletes continue to have problems regardless of the huge amount of prehab work they do. Why is this? Is it because our world class athletes only get 2 massages a week tops or because thier training is wrong. And if thier training (e.g. track work - because the prehab work is already a large degree of it) is wrong what is it specifically that is the problem?
Is it also possible to overtrain the glutes by low intensity work such as supine bridges and bent leg/straight leg hip ABduction?
I don’t know if you can overtrain the glute max with these types of “prehab” exercises but, I think you can overtrain the glute med. More importantly in any of these exercises it is all about execution. I continue to be amazed at how well an athlete can compensate in simple movements. My professional clients seem to figure out a compensation strategy as quick as I can think of an exercise. I still think there is a lot of work to be done in this area.
With patella-femoral syndromes,as with any overuse injury, the underlying cause is always the training program. Vern Gambetta used to say “any non-traumatic injury is a mistake in your training program”. Years ago I took this very much to heart. Much of what I do today is a direct result of that thought process. I need to take responsibility for overuse injuries in my athletes whether it is a patella-femoral pain, a shoulder pain or a back pain. Thinking this way has made me a better coach. I never blame bad luck with overuse, I blame myself.
This is what my instincts tell me. While I have seen very fast improvements from athletes that stop track training (running fast) and perform exercises to improve glute firing, I have also seen a lot of problems come back quickly despite prehab.
I am wondering if these athletes then continue with prehab exercises to strengthen the glute med but at the same time are overstressing them through normal training (the biomechanical or planning issue is not directly addressed) we land ourselves in a situation where the glute meds are overtrained rather than strengthened.
With patella-femoral syndromes,as with any overuse injury, the underlying cause is always the training program. Vern Gambetta used to say “any non-traumatic injury is a mistake in your training program”. Years ago I took this very much to heart. Much of what I do today is a direct result of that thought process. I need to take responsibility for overuse injuries in my athletes whether it is a patella-femoral pain, a shoulder pain or a back pain. Thinking this way has made me a better coach. I never blame bad luck with overuse, I blame myself.
very true! We all blame you for overuse syndromes:D
actually, this is very reasonable, if not painfully (pun intended) obvious, i started training with my coach, a couple of months ago, before that i was training on my own and was for the most part pain free. I had some low achiles issues which i dealt with in a matter of weeks with small training adjustments.
in the two months im training with her, my shins are killing me, i mean pain, lots and lots of pain, my knees hurt, even my low back hurts. She has produced only ONE good athlete, a girl that made it to the nationals in 3000m which is full of overuse innjuries for the past two years, having no good competitions.
For strengthening hip rotatores, you can use elastic bands! You can connetc them to the foot while standing or sitting. Also you can lie on you stomach, bent the leg in the knee and connetct the foor with elastic band and easy rotate!
I am thinking that one-leg medball throwing are also great for the tiny mucles at the hip (rotatores, add, abd etc). Thoughts!
Tc, can you expand please what are thoe exercises that when use too mucj can overuse med gluteuse? Tnx!
With patella-femoral syndromes,as with any overuse injury, the underlying cause is always the training program. Vern Gambetta used to say “any non-traumatic injury is a mistake in your training program”.
True in some cases. Don’t forget underlying congenital bone shape, leg length, patella postion, femoral torsion, foot and hip mechanics, etc…
Can’t eliminate all injuries/pain even with sound training program. If all your athletes are going to do is train, then they won’t get hurt. Especially if you don’t put them in a position to get hurt. If they are going to compete in sport, which creates and reinforces imbalances, they will get injured. Particulary in acyclical sport.