Possible Knee Injury

Bigger Stronger Leaner Injuries and Rehab
5

[quote]BHOLL wrote:

[quote]trivium wrote:

[quote]56x11 wrote:

[quote]trivium wrote:
I want to preface this by saying that I do have a medical background. I am just looking for guidance from professionals and guys who have had this happen to them.

So early in December 2013 I was doing stiff leg deadlifts. Due to my great ideas, I was doing them with hyperextended knees. The next day I had bad pain in my right knee. It should be noted that I played football with no problems after the lift and never had any pops or pain during the actual lifts. I did take a big hit to my knee during the game, but I was not injured at the time.

The next day I was able to do leg curls with minimal discomfort after a warm up.

I have had minor pain with some portions of my set up for various lifts and moving about the house, but never doing any of the lifts themselves after that.

I have since deadlifted 395x6, and squatted 365x4 in the last week with no pain during any of the lifts.

Today after sitting in the car for a while, that pain was present in my knee again. It is definitely present with hyperextension in some situations, but It is not present with any tests that I can do on myself (posterior drawer, anterior drawer, varus/valgus stress). This has been the case since that day when I did stiff legs and played football. Same exact pain.

I have dropped stiff legs altogether from my routine. I still do Squats, leg presses, deadlifts, and leg curls. I do not use any wraps on my knees for these lifts. I am pretty sure I have a hyperextension injury.

There is no pain with knee flexion while standing. There is some pain in my knee with knee flexion while sitting at the extreme of my ROM. Upon straightening in the seated position after the pain, there is an audible/palpable pop. This is not a bilateral phenomenon.

Any suggestions? It isn’t normal. Should I see ortho/PT or try to rehab it on my own. Is there any way of telling exactly what it is or the grade of the sprain without imaging?

I do not want to have to halt my training. Is it possible this is just some tendonitis?

Please ask questions! I want to answer them and try to do this the best I can!

Thank you in advance. Any help is appreciated.[/quote]

Here is the time line as you describe it:

  1. performed stiff legged deads with hyperextended knees

  2. felt pain the following day but ignored it and played football

  3. during the game, you took a hit to the knee that was in pain

  4. the pain, though noticeable, was not debilitating, so you resumed training

It reads like a classic case of not addressing a problem when it was a relatively small one. Now that problem has grown.

I’m rather curious why you chose to perform stiff leg deads on hyperextended knees. A bit of Monday-morning quarterbacking on my part; however, suffice it to say, I advise not taking the stiff-leg deads to its literal extreme from this point on. I’ve always cringed whenever I saw anyone doing these with locked knees you provide a real-world example as to why.

RDLs would be a good option when you’re healthy enough to resume training.

You did not mention the location of the hit you took on the knee when playing football.

The audible/palpable pop as well as other descriptions make me suspect damage to the acl, mcl, or both. This is just a theory and in no way shape or form should you infer this as a diagnosis.

The tests you perform on yourself has one significant flaw: it lacks objectivity. Despite your medical background, you’re also a lifter at heart and want to get back in the game asap. This desire will creep into and pollute any self-examination scenario. Therefore, I recommend an exam by an objective party who specializes in such cases. You can take advantage of the fact that you’re in the profession and discreetly ascertain which ones are good and which ones just treat the patient as their next house payment.

They’ll most likely run tests other than the ones you performed (the results of which I have reservations with) such as Lachmans or the pivot shift. Again, I strongly suspect there has been some damage to the connective tissue (such as the acl/mcl). For your sake, I hope I’m mistaken.

I do recommend imaging to confirm or disprove what the manual tests show.

And I give the strongest admonition against training with challenging load/movements until you know what you’re dealing with. If you ignore this, you may get away with it for a while as your body learns to move weight around the injury. However, sooner or later, these compensatory actions will create new problems for the inescapable fact that your kinetic chain is currently not working in ideal synchronicity.

[/quote]

Thank you for the response!

The problem isn’t getting worse. It is just not going away. I have added 30 lbs to my 5 rep max squat since the injury without any discomfort.

Here is the timeline:

  1. Stiff leg deadlifts with terrible form at 10 pm. (No pain.)
  2. Football 2 hours later. (No pain or limitations.)
  3. An hour into the game I took a hit to the lateral aspect of my right knee. (No pain. Immediately jumped up and got back into the game. I scored a touchdown on the next play running a fade route.)
  4. An hour after the game I walked back to the dormitories. (No pain.)
  5. Woke up the next day with a sore knee.
  6. about 18 hours after my last lift, I went to do leg curls. (Was sore getting set up and going up and down stairs, but was able to lift without holding back. I felt like once I was warm, I was good to go with the small isolation lift.)
  7. I have since been through almost 2 months of heavy leg days with no pain during any lifts, however I do notice that when I sit on the couch or am just moving about, every now and then I get a small stabbing pain in my knee 2-3/10 without radiations.

I cannot evoke any symptoms on my own unless I am sitting. I had almost completely forgotten about the injury until yesterday when it was sore from sitting still in the car for a long time.

I am going to make an appointment with an ortho guy for as soon as possible, but I am going to take my chances with training on it until then. Maybe it will not be a problem and it is a bit of tendonitis.

Any other recommendations would be welcomed.[/quote]

  1. You probably don’t need imaging, a proper physical exam will suffice
  2. Its not tendonitis, which is an overuse syndrome, you have one isolated event pointing towards your symptoms.
  3. A hit coming from the lateral aspect could injure the MCL but your symptoms point more to either a.) a bone bruise or b.) a meniscal bruise

[/quote]

trivium, do yourself a huge favor and get the imaging. This is YOUR body we’re talking about. Leave no stone unturned.

And why should you listen to me and not bholl…?

Here is a perfect example from another member on this subforum.

http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_injuries/shoulder_injury_identification

The OP in this case suffered from shoulder issues. bholl gave the following advice:

[quote]BHOLL wrote:
Dont need ART, sounds like classic supraspinatus tendonitis, does not seem like a SLAP, REST, ice, NSAIDS, light rotator cuff work and rowing. [/quote]

And he followed up with:

[quote]BHOLL wrote:

[quote]irfhdah wrote:
Thanks for the great responses! I was starting to get really worked up after reading all those slap tear articles.

One last question: back squats are a little uncomfortable because they get my arm right in that angle/position that it doesnt like so I assume I should just lay off of them like everything else for the moment. Can I still deadlift though? I dont feel any pain when I do that. [/quote]

Front squat

Deadlift is ok[/quote]

Do you see what’s going on here…? In an effort to come off as the smartest kid in the room, bholl irresponsibly implies that an in person examination is unnecessary. In fact, NOT ONCE in the entire thread did he tell the OP to do what is basic common sense: find a doctor in the area who is relatively fluent in english and get your shoulder checked out thoroughly.

Well, guess what happened when the OP returned to the thread? Here is his most recent post:

[quote]irfhdah wrote:
My wife finally made me go get an MRI. The doctor said I have a less than 25% tear in my rotator cuff (it is right at the top of the subscapulus where it meets the superscapulus. He said just dont raise my arm laterally above my shoulder, avoid inward pressing movements and rest for 3 months. If it still hurts come back and see him.

So, what does that mean about exersizes I can perform? I did a pretty nasty deadlift session this morning with some light front squatting afterwards and my shoulder seemed ok. It is hard to tell though. When I work out I think my adrenaline takes over because my shoulder usually stops hurting at all. About an hour or two later it gets sore again. Would deadlift, front squat, decline bench, seated rows, triceps pushdown, biceps curls all be ok? They avoid the motions the doc told me to stay away from. [/quote]

So let’s see here…Instead of a tendonitis as bholl surmised, it turns out to be a 25% tear.

Imagine if this OP had ignored his wife because some smart-sounding guy on the internet told him - and I quote - “…sounds like classic supraspinatus tendonitis.”

Now, trivium, if your imaging shows up negative, what have you lost really? If something does turn up, then it was definitely worth it.

And remember, I specifically stated the acl/mcl is just a theory and that further testing - including imaging - is what I recommend.

Take it from a guy who works with people when they’re done with the ortho, and done with the PT visits. I build that bridge to help them get back to where they want to be. Talk to most people who suffered serious injuries and, more often than not, they’ll tell you that once the PT visits stopped, they really didn’t progress. Often the pain actually returned. Until, of course, they learned to train in an intelligent manner.

I’m that guy who leads them to the promised land. And one of the fundamentally important things that I’ve learned is that, first and foremost, an injured person needs an in depth exam.

If we met for a lifting session, I can assure you that you will be impressed with not only my knowledge but the fact that I am genuinely strong and injury free.

So when you get an in person exam, leave no stone unturned. And, yes, this includes imaging to rule out any possible mistakes the ortho may make in his hands-on testing. Orthos are people, and people are fallible. Hedge the odds in your favor.

As for you, bholl, I don’t have the time nor the inclination to police this forum. However, be advised that if you challenge what I tell someone - especially regarding things such as imaging - I will gladly take you to task.

So unless you are willing to send trivium your PT license number/full name and let him officially know that you do not advise imaging, you’d be wise to tone it down.