Bad knees...

iVillage Member
Registered: 04-03-2003
Bad knees...
12
Mon, 04-14-2003 - 11:39am
I've posted this message on other boards and gotten conflicting advice... was hoping maybe one of you has had similar problems and can give advice. I'm sorry for my long "woe is me" saga but I am getting so frustrated and confused by different things I'm reading.

About 16 months ago (at age 28) I was diagnosed with patellofemoral pain in both knees... the orthopedic surgeon told me that it was likely caused by a combination of old injury that wasn't treated properly, weak/underused quads/hamstrings, and a congenitally high-riding kneecap. I spent about 6 months doing exercises that he prescribed, esp. slow leg raises to target inner quads and inner thighs. During that time I went from horrible and debilitating pain to chronic dull pain that got worse when I did things like rise from a chair, go down stairs, etc. I was super careful not to do activities with any kind of impact, but walking seemed to help a lot.

Last summer I started doing strength training with a trainer (note: my insurance had lapsed at this point so I didn't have a PT, just a trainer at my gym who came highly recommended by a friend with bad knees). Together we worked out a weights routine for me that targeted the big muscle groups in my legs -- leg press, leg extension, leg curl, and the inner thigh machine (which normally I wouldn't bother with but it duplicates some of the leg lift exercises the doc had me doing but with more resistance). Squat were out since I can't squat to anywhere near 90 degrees without severe pain.

I worked with weights for about three months, and noticed slow improvement. Even when it was painful to do the exercises themselves, it was just the normal daily pain I had from going up and down stairs, etc. I felt better after exercising, never felt like I was overstressing my knees.

By the time I moved here (to Kosovo) in November 2002, my knees were feeling much better... but then it took me months before I found a decent gym and the pain crept back. Now I've been back on my weights for about a month and having intermittent success -- the more exercise I get, the better my knees feel, in general. I was just laid down for 3 days with the flu and boy, did they feel bad after 3 days in bed! But no big improvements, and I have some days where it's just as excruciating as ever.

There's no decent medical care here, and the trainers at my gym have no real credentials or training, just guys who have a lot of free time & are in really good shape. After being told that I didn't want to lift heavy weights or I'd "get big" (this when I wanted to go over 7 kilos for a bicep curl!) I don't trust their advice.

I've been doing some more reading about rehab exercises for this type of problem, and I'm starting to read some really conflicting things about the exercises I've been doing, esp. the leg extension machine. I'm starting to wonder if I'm not really helping the problem, and the gains I get from increased quad strength are undermined by exercises that put bad stress on my knees. I have read mixed things about doing squats, but I still can't squat worth a damn anyway so that might be a pipe dream.

Sorry for running on for SO long, but have any of you had to deal with this type of knee problem? Any idea what exercises are/are not recommended? I am loath to give up my current workout because I KNOW my leg muscles are in MUCH better shape than before (esp. the hamstrings), but then again, I don't want to exacerbate my problem with exercises that put the wrong kind of force on my knees.

Thanks so much for reading this far! I remain ever hopeful that with the right exercise (and some weight loss), I can get these cranky knees into shape!

~ Vanessa

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iVillage Member
Registered: 03-20-2003
In reply to: habsatu
Mon, 04-14-2003 - 11:50am
Knee pains are awful and I know so many people, including myself, with them. Have you been to Dr. Nadya's (Ask the Fitness Doctor) message board? She's a sports medicine doctor who works with female athletes. She hasn't been around in a few days, but she's usually very responsive. I've worked with my knee pains, but it's probably different than yours and I'd hate to tell you the wrong thing. Sorry, I can't help more, but I think Dr. Nadya is a good person to ask.

http://messageboards.ivillage.com/iv-fbwomensport






iVillage Member
Registered: 03-25-2003
In reply to: habsatu
Mon, 04-14-2003 - 12:02pm
As a former basketball player, I've had my share of knee injuries and recoveries. Don't despair; there's hope. I've had 3 knee surgeries including an ACL Reconstruction that took almost a full year to recover from. I've been where you are and probably worse. First, I'm not a doctor, have no medical training, and would advise you to consult with a healthcare professional before taking my advice. Based on my personal experience, squatting is very taxing on the knees, especially if you're squating with weights on your shoulders. I would recommend AGAINST squatting right now. You'll know when the time is right; when you're virtually pain-free.

About the leg extensions... That's another exercise that's hard on the knees and you should modify the exercises to accomodate your level. You don't want pain while lifting. It's probably best not to do the full extension but set the machine so that you can only straighten your leg maybe 125 or 150 degrees. Don't go all the way straight until you're ready. Or, set the machine so that you can't bend your leg very far and just work on the top part of the extention. Do whatever feels best and causes no pain.

Ham strings shouldn't hurt you that much. I don't have any modifications for you there.

Can you do leg press instead of squats? Try doing a few sets with your toes turning outwards. That will give you a good inner thigh workout too.

It takes a long time to come back from a knee injury. In the meantime, ice your knee after every workout. Massage your knee cap several times a day. Thera Bands are great if you have any. Try using them to build strength in your knees and do a few wall sits too. (If you don't know what some of these things are, let me know and I'll explain them more to you.) Walking is good but do you have access to an elipical crosstrainer? If you do, that is a great machine to use in your recovery. Try "pedaling" backwards, it works your quads even more. Take it easy; have patience; and prepare for a mental battle when it comes to knee problems. I was on crutches for 4 months and then the REAL work began. There's no quick answer. You just have to wait it out and work your knee slowly. You have to build endurance slowly and don't even think about running right now. Take your time because your knee will certainly take its time.

iVillage Member
Registered: 03-25-2003
In reply to: habsatu
Mon, 04-14-2003 - 12:04pm
Another thing that might help is the supplement Glucosamine. It took about a year of taking it before I noticed a difference but now I can tell that it has helped me.
iVillage Member
Registered: 03-26-2003
In reply to: habsatu
Mon, 04-14-2003 - 12:20pm
I'm sorry that you've had such a run-around. I'm afraid that I'm thoroughly useless in giving any advice, however I would like permission to print your post to take to my trainer to see if anything jumps out at her. She has a medical background and worked as a physical therapist for sports injuries for several years before becoming a personal trainer. She loves things like this and may have something to add. I do not, however, want to print your post to share without permission.

~K~

~Kiervin~

Co-author of:  MONSTER'S INK HORROR ANTHOLOGY By Cyber-Pulp Press

iVillage Member
Registered: 04-03-2003
In reply to: habsatu
Mon, 04-14-2003 - 1:19pm
THANK YOU!! Seriously, thank you all so much for reading through my long and whiney post, let alone responding so quickly and thoughtfully.

Kiervin (ack! I may have gotten your name wrong), please feel free to print my post... I'd love to hear what your trainer had to say.

The more I read about PF syndrome, the more I worry that I started in with the machines and weights too quickly... a lot of sports medicine and PT articles seem to imply that the pain should go away in a few months if you keep up the leg lifts and other non-resistance exercises, and that you should be relatively pain free before starting other exercises. But now I'm addicted to the weight training and I don't want to stop unless I have to!

Thanks again! I'm so grateful for your advice and feedback....

~ Vanessa

Avatar for soleilune
iVillage Member
Registered: 03-26-2003
In reply to: habsatu
Mon, 04-14-2003 - 3:36pm
Before I offer my two cents, I am not a medical professional, I am a health/fitness pro. I am not particularly familiar w/ your specific problem but have had rheumatoid arthritis in my knees (along w/ many other joints) for more than 2 decades & have done my share of damage to my knees when I was a dancer (& studying to be one). Despite this my knees no longer bother me & I can outsquat/lunge/leg press any women I know & quite a few men. I usually offer professional advice here, but I don't know you & your condition well enough to be doing that so here's my personal, rather than professional feedback. In dealing w/ my own knee problems & that of clients the first & foremost exercise I was given/use has been leg extentions. This is not neccessarily done through the full range of motion & not at all if it causes pain. I start folks w/ unweighted extentions & then progress to ones using elastic resistance (a band tied just above the ankles). If these progress well & without pain then move to weighted leg extentions. The reason this exercise is important is because it focuses on the quadriceps which attach around the knees. The stronger these muscles & attachments (tendons) are the stronger & more stable the knees. Also, the stronger quad is able to help w/shock absorption lessening the amount of impact on the actual structures of the knees.

As for squats it is a misconception that they must be done to 90 degrees or greater. Try doing UNweighted squats as described below. Stand w/ your feet hip width or very slightly wider apart. Keeping the knees lined up over the ankles, spine long - w/o arching or hunching, press the hips back bending through the knees. Go only as deep as you can comfortably go keeping your knees behind your toes, w/o allowing them to roll inwards. A woman's centre of gravity is in her pelvis, so if you're using good form you should feel your weight shift into your heels. Imagine being in a filthy public washroom, you have to use the toilet, but don't want to sit on the seat, you need to sit down & back to pee in the bowl, so you don't get it on the seat, floor or yourself (a lovely image, I know). Breathe through it, perform it slowly & carefully, w/o bouncing/springing out of it.

If you had a good trainer that helped you establish a good base of good form & understanding of what you're doing you should be able to resume doing the exercises you were doing before. Start slow, easy & light & listen to your body. If anything hurts, don't do it.

Please don't feel like you were whining or running on. You have a problem & some legitimate questions. The better the info you give the better you should be able to get. I hope the feedback you got from everyone helps.

Good luck & take care.

Soleilune
iVillage Member
Registered: 04-03-2003
In reply to: habsatu
Thu, 04-17-2003 - 4:38am


Update on my knees... I have been following everyone's advice and I am more optimistic that I can keep up my workout & still gain strength while not causing pain!

Yesterday I did a full lower body workout on the machines and was completely pain free. I modified the leg extension so I was starting from a less acute angle (I have no problem with the full extension and I've read that the top part of the exercise gives you the greatest benefit anyway). I also modified the setting on the leg press so I was starting out with my legs slightly straighter (not 90 degrees), placed my feet at the top of the foot rest and used a wider stance with my toes turned slightly outwards (as someone suggested). I was able to do full sets of both exercises with absolutely no pain in my knees... and was able to do them at a higher weight than I had been using since I had been letting the knee pain dictate how much weight I was attempting. I really felt it in my quads.

I've also been icing my knees diligently after I workout, and I think that's helping. I know I have a long way to go, but I am just so happy that I can still working on strengthening my quads & other supporting muscles w/o working through pain & possibly doing greater damage to my knees. I plan to keep doing the exercises like I did last night, progressivly working towards greater ROM. I'll let you know how it goes but I just wanted to thank everyone again for all of the excellent advice I received!

~ Vanessa

Avatar for cl_alanagreenberg
iVillage Member
Registered: 03-21-2003
In reply to: habsatu
Thu, 04-17-2003 - 7:55am
I have not read the other responses but when I read you were doing the leg extention machine alarms went off in my head... Many trainers tell their clients to stay away from that machine because it causes THE MOST stress on the knee joint, more than any other strength move or machine you do.

Alana

iVillage Member
Registered: 04-03-2003
In reply to: habsatu
Thu, 04-17-2003 - 10:01am
I know! That's what got me concerned. When I first started working out, I basically followed the advice of my trainer and listened to my body, didn't do anything if it caused too much pain. Read some stuff, but nothing too alarming. Lately I've been taking it more seriously and also trying to educate myself a bit more... and suddenly I start reading all of these alarming things about leg extensions and shear force and how they are terrible for your knees. Yet there are still experts who absolutely recommend them for strengthening quads in general and even for rehab.

The thing is, the leg extensions weren't hurting my knee more than leg presses or mini squats (and when I say "squat," I should come clean: the most I can manage is a little curtsey). Now that I've modified the starting position, they don't hurt my knee at ALL. I think I'm going to keep doing the exercises the way I did them last night, but I'm going to keep reading... if I find anything particularly enlightening, I will definitely share it with you guys. Please do the same!

On an unrelated note, I liked WWGRD! I'm going to start using that as a motivational technique. :)

~ Vanessa

iVillage Member
Registered: 03-20-2003
In reply to: habsatu
Thu, 04-17-2003 - 11:31am
Yea, glad your knees are feeling better! This is minor, compared to all the lifting you're doing, but wall sits are a great way to strengthen the muscles around the knees, too. It's something easy to do at home while you're watching TV. As you do it longer, you can gently lift one leg so your weight is completely on the other.






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