T Nation

Doug, how do you work legs with the knee issues?

Doug, you mentioned that you could not be a SEAL because of your knee problems. Do you still have problems? If so, how do you get around it and work your legs? I’ve been contending with a knee problem for about a year and all I can do is just maintain. I too played a lot of tennis on hardcourts, but I never had any problems until overdid it on heavy squats.

The first thing I did was go through about 6 months of heavy massage work, stretching, balancing drills, and weight training aimed specifically at correcting a hefty amount of imbalances (abduction to adduction strength, quad to ham strength, weak soleus) My problem stemmed from not only the pounding of the hard courts, but also bad running form (I was a toe-runner, ie my heel never touched the ground). Put all these problems together, and I had some pretty major pain. Through the therapy I cured the tendinitis that caused most of the pain, but the tissue damage will be there forever most likely. MRIs revealed no cartilage regrowth after 4 months on a glucosamine/chondroitin/fish oil stack. After all the therapy, I’m at the point where I can train my legs at near full strength with some mild painkillers (one Aleve every other day). I still have problems occassionally, but I’ve learned to deal with it pretty well. My biggest problem has been the strength imbalance. My left leg is much, much smaller than my right due to the injury, so I’m spending a lot of time on balancing the two out.

It doesn't sound like you've suffered a chronic, overuse injury, but rather something acute caused specifically by a squatting. Your form may have been off, or you could have an imbalance (possibly related to the tennis) or neural impingement which inhibits your ability to fire motor units in the correct sequence and balance. Either way, I'd seek out a massage therapist and an ART therapist asap. From talking with my massage therapist, there seems to be a ton of nagging knee and hip injuries that can be quickly cured from simply releasing tension in the IT band (it certainly helped me). I'm not sure that Dr. Leahy certifies people on the lower extremities yet, so you may have to go directly to the man himself for ART treatment. Whatever you decide to do, don't just sit on it. The problem won't go away until you actively treat it. The bullshit about taking long layoffs when you're injured is just that... bullshit.

This is not Doug, but I used to have terrible knee problems from playing basketball…summer on blacktop at least 4-5 days a week for hours at a time and at least 2-3 days a week the rest of the year on wooden indoor courts. I couldn’t sleep through the night w/out getting up to bend my knees through a complete range of motion several times a night and riding in a car for over 15 minutes or so practically had me in tears. My solution was to start doing full squats. I had been doing more of a powerlifting style squat which I believe made things worse. I started doing the full range of motion very slowly holding onto a rack upright and progressed to full squats with very light weights…my power squat poundages and full squat poundages are worlds apart so you can’t have much of an ego. I just slowly moved up in weight over a six month period until I was handling about half of what I was doing in a power squat. By that time my pain was gone and I still do full squats years later and the pain has never returned…even when I play basketball. I will say that I never had an injury just patella pain…never diagnosed specifically (I feel it was a muscle imbalance since the pain went away very quickly after I started doing 1 and 1/4 squats emphasizing the deep position…my vastus medialis grew visibly and voila! the pain was gone)…if you have an actual injury to the knee, this may not be very helpful. Good luck!

Thanks for the advice, Doug and Ben. You know one of the things I miss about the military is the health care. No kidding, man. I’ve heard some horrible stories about Navy medicine, but it was terrific compared to the HMO I’m dealing with now. The doctor I have seen so far just does not want to any surgery on me. MRI’s have come back with my knee in great condition, EXCEPT for a small void on the lateral condyle of my left knee. He didn’t believe that it was the cause, but I don’t see how one could be missing a part of a joint and not affect the joint. They always ask if the injury was work related. I guess they get reimbursed by my company if the injury was work related, and they’d get right on it to fix it no matter the cost. As much as I’d like to get further treatment elsewhere, I can’t afford it. Oh well, I guess I’ll deal with it for a while. I can at least walk without pain–it could be worse. My knee hurts really badly when it is flexed about to the middle of the range of motion. The pain is right smack in the middle of the joint. Sometimes, while I’m doing stiff-legged deadlifts, I’d hear a pop and my knee would be pain-free for a couple of articulations. Strange. If it persists any longer, I’m going to have to be more forceful with my doctor. Again, thanks for the insight/shared experiences, guys.