T Nation

Knee Rehab Help

I suffer from anterior knee pain and have done for the last year or so.

Its not particularly debilitating in day-to-day life but it does put me off lower body workouts and cardio and I’d really rather be without it, so I’m going to try to do a comprehensive rehab routine and try to sort it out.

Currently I have it mildly constantly and it comes on intensely for a few days after any kind of leg exercise. The worst things for it are sprints and squats, but everything else hurts too.

I have read a lot in articles and on forums about knee rehab and I have thought through what could be causing it for me. I have read a lot about poor ankle and hip mobility causing anterior knee pain, and I know my ankle mobility is good so I think it could be due to hip mobility. I also have completely flat feet which I know can cause it and I have poor glute activation as well which can be linked.

I am aware that its possible only one of these is causing my pain but I am taking the approach that too much is better than too little and so I am trying to improve all areas.

Here is my rehab workout routine:

Hip circles (not sure proper name - look like a dog peeing) 3x10
Leg swings front to back 3x10
Leg swings side to side 3x10
Glute bridge (glute act.) 3x20
Mini-band side steps (glute act.) 2x10
TKE - step up on platform (2x10)
Barbell hip thrust (strength) 3x5
Upper body exercises

I do this 3 times per week.

Other general things I do to help are I wear knee sleeves whenever I do anything that puts extra weight through my knees and I do all my lower body rehab stuff barefoot (meant to help with flat feet).

I would just like to know if I have missed out anything important or if I am doing anything stupid? And also any info on people with similar experiences.

Any help at all would be greatly appreciated. Thank you for your time.

Nice approach you have!..If you had one month with the pain, but one year? As with all health issues, it is ggod to know the first aids and way to train AROUND a pain or injury, but if knee keeps hurting after 12 months, it is more than obvious that you have something bigger that can not be fixed with just ice, self myoofascial work and self prescribed prehab/rehab routines. Seek for a good doctor who is used to treat atheletes and understand their needs. Money goes and comes; body tissues once they are gone won´t come.

Have you seen a doctor? If you haven’t yet you need to do so. The first step in solving knee pain is finding out what causes it (duh!). He will do some tests to check for torn ligaments and damage to the meniscus etc. Then he will probably refer you to a physical therapist.

Having undergone ACL reconstructive surgery and meniscsectomy on my right leg last year, I have had my share of PTs. Hopefully you will get a good one right off the bat. I didn’t.

What kind of pain is it? Where in the anterior part of your knee does it hurt? Are your hamstrings/quads/glutes balanced in strength? Does your knee “click” whenever you walk, straighten or flex it?

As a general rule of thumb, pain right in the front of the knee is often caused by the patella not tracking properly. This will also often make the knee “click”. Weak quads are often the blame. Unbalanced strength in the leg muscles can also cause this.

Your exercises are ok. I would add lunges (if the pain allows it) and some 1 legged balance exercises. If it hurts don’t go so deep.

When your doing squats/lunges etc. it’s important that the knee(s) track over the foot. Knee collapsing inwards is bad. Aim to keep your feet as straight as possible. Also never let your knees go past your feet. This is a big one. Keeping the shin vertical is a good rule to remember this.

This turned out a bit longer than planned. Some of these tips are kinda general and not specifically for your knee pain. However keeping all this in mind will keep your knees healthy and prevent injury.

Thanks a lot for the help.

My pain is in a U shape on the sides and bottom of both patellas. My knees click sometimes but not constantly.

I went to see a Dr but in the UK they seem really bad with musculoskeletal issues - standard response is to prescribe ibuprofen and tell you to rest which doesn’t solve anything really. I have seen a physio privately and they helped with glute activation stuff but it was too expensive to continue long term.

I don’t think I have any ligament damage as I haven’t suffered any trauma and I don’t play any sports, it feels more like a long term degradation type of thing.

Hmm that’s a tough one… It’s hard to figure this stuff over the internet. Your right, It does not sound like a ligament issue. My guess is the meniscus. But it can be all sorts of things… I would get an MRI taken, thats the best tool for figuring out whats wrong in there.

Hi Furo,

Flat feet … see a podiatrist ASAP. The effect that they can have on your knees is astounding. I paid for custom orthotics and these have seriously helped my knees. Until you get them try squating with your toes really trying to grip the floor, this may arch your foot into a better position.

Other things to try:

  1. Bulgarian squats or some other unilateral exercise. Personally I find the Bulgarians a great knee tonic and I cant reccomend them highly enough.
  2. Jumping. Read CT’s stuff on jumping. A big recent help for me and something that I now include ona regular basis.
  3. Read the article on ‘How to bullet proof your knees’. Really good stuff in there.

Best of luck.