T Nation

Odd Knee Rehab

So, in Feb., I got my knee smashed between my motorcycle and a Mercury Sable. Cracked my tibia right at the top of it (no surgery, thank God), and apparently messed up the cartilage behind my patella. I’m in therapy for it, but it’s not really helping much.

Here’s the thing: They told me that I could lift as long as I didn’t go past 90 degrees. So yesterday, I did some deadlifts with 95, just to see how it would feel. Two sets, and I’m done.

I then proceeded to walk back up the stairs with NO PAIN whatsoever! I had to walk back down and back up again to make sure I wasn’t imagining it. I even did some unweighted squats to see what my mobility was like. (not perfect, but a lot better)

This morning, my knee is hurting me again. No worse, but no better. Anyone have any idea what the hell is going on with this?

Since I was just thinking about this, I’ll take a stab at it. I’ve experienced this several times over the years.

When you do lower body lifts (correctly, that is) like squats or deads you are sending the load to the hips (glutes and hammies). Just exactly where it should be.

Now, there is a weird synergism that happens when you get injured – your mechanics break down and you move hinky. This means that you are using just about anything but the right muscles to move. Having trained well at the gym, you will tend to do it right in a workout and this resets your mechanics.

One last thing. I’ve had all sorts of lower body problems (torn ACL, sprains in knees and ankles, hip surgery) so I’ve run into a lot of rehab and most of it is very good for getting you started on the road to recovery, but often very bad at getting you back in training. Prime example is the leg extension machine. This is great for the first 3 weeks post injury but is apt to give you knee pain if you use it longer than that. (Eventually work up to doing one-legged squats. I had knee pain for years following the advice of PTs and only when I read a good article by coach Boyle (who advocates one-legged squats) did the light go on. Haven’t had knee pain really since.)

And I could just be full of shit as usual…

– jj

it’s called warm up. You know an injury is healed when you don’t feel it in the morning. Not after doing some light work at the gym

Interesting theory, jj, and thanks for the reply. I’ll present this same question to my PT in the morning and see what he thinks. I’m also going to try it again today.

I’m just a little worried. I have the frame of mind that if something suddenly starts hurting /making noise/vibrating then there’s something wrong. Likewise, when it suddenly stops, there’s probably something wrong, too. (think kids, cars, etc.)

Hopefully he’ll tell me to start lifting as part of my therapy.

P.S. I know what warming up is. I do it before each workout and before each physical therapy session. I’m only a newbie when it comes to this forum. Thanks.

I also have damaged cartilage behind the patella due to a condition called chondromalacia patella. In my case, my kneecaps track too much laterally so I’ve basically had to realign my kinetic chain from the feet up to get things in order. Not easy. But one thing that my PT’s have stressed is glutes and hips. It’s important that your glutes are not only strong but also “activated”, meaning they “fire” at the correct time and manner in common movements such as walking and even standing to take the strain off the knees.

So lifting is important for strength, but you need to train for activation as well. In other words this basically means that you need to establish a constant “mind to muscle” connection with those muscles. This is what you briefly get after training, as jj correctly pointed out. The goal is to get this effect all the time.

Your PT should already be helping you towards this goal with simple activation exercises like bridges and bird dogs for starters, and if he isn’t then you need to find a new one.

Good luck with your rehab.

[quote]JayPierce wrote:
Interesting theory, jj, and thanks for the reply. I’ll present this same question to my PT in the morning and see what he thinks. I’m also going to try it again today.

I’m just a little worried. I have the frame of mind that if something suddenly starts hurting /making noise/vibrating then there’s something wrong. Likewise, when it suddenly stops, there’s probably something wrong, too. (think kids, cars, etc.)

Hopefully he’ll tell me to start lifting as part of my therapy.

P.S. I know what warming up is. I do it before each workout and before each physical therapy session. I’m only a newbie when it comes to this forum. Thanks.[/quote]

If you’re not already,make sure your VMO (vastus Medialis Oblquus) is also activated and working to stabilize the position of your kneecap. Injury and pain inhibit it from firing and may not always come back online automatically.

Use of a surface EMG monitor during exercise/therapy lets you know if its working. Many, but not all PTs have these in their clinics, they arte a great aid in re-learning recruitment of inhibited muscles. just my 2 cents,from an old PT.

Did you get it checked to make sure there is no damage like torn meniscus or ligament damage…?

x-rays and MRI look good. PT didn’t have an explanation, but I did so well today that they’re sending me back to work tomorrow. I did three times as much work today with only some minor aching. None of the stabbing pain that I’ve been having.

This is good news JayPierce. Glad that you didn’t rip anything.

A lot of pain people have is not in the joint, but muscles, ligaments and tendons. A good indicator of that is if moving makes the pains go away. In real arthritis (I suffered mightily from it at one point) movement tends to increase pain. If your mobility drops during the course of a workout and you have joint pain, you should head for a doctor asap. I’m saying this since a lot of times people have no way to label pain in the joints except as “arthritis” or some other condition and knowing what the real disease tends to do is a useful bit of information.

Rest is exactly what you need to recover from injuries, but – and again this is my untutored experience – after you heal up, you can still hurt for no other reason than inactivity. Then doing what you are doing right now, viz., moving and using your body is what you need. Knowing when to just rest and when to get back in the swing of things is a really tough choice nobody can help you with since we can’t feel what you feel.

Of course, always be prepared to back off. Take some time to get back into it since to start going for high performance means you must trust your body to do the right thing. That will only come with time. The maxim that you should “give days to get weeks” is a good one.

And I could just be full of shit as usual…

– jj

Thanks for the advice, guys. I’ll definitely ease back into lifting with it. I feel much better not having a midget following me around with an icepick, though. Stabby little bastid.

Jay Pierce,glad all is on the upswing,good luck for continued recovery.