Tuesday, October 6, 2009

An eye opener

Warning: Long Post Ahead

Knee History:
I am writing this for my reference - so feel free to skim or skip over this portion. :)

February - I started getting some seriously painful pains in my knee when running 2-3 miles - all following a glorious 7 mile run one day. I "cut-back" on running to 2-3 miles about 3 times a week and then finally made the decision to see a PT. He asked a few questions, checked the strength of some of my muscles, checked my flexibility, and sent me on my way with a sheet full of exercises and stretching routines to do 2 times a day for a week. I went back and got a few more exercises and then was on my own. At this time, things were better.

May /June - I was still only able to run no more than 3 miles. I started playing sand volleyball 2 nights a week (about 3 hours) and 2 hours of softball one night - following sand volleyball. During softball one night, I did something to my knee that hurt really bad. It was located more so on the inside of the knee and the back of the knee. When I wasn't working out or playing sports, it was more of a dull pain that rain down the outside of my leg.

July - Pain was pretty much gone and I was able to pull through with a 5 mile run at one point. I finished my first triathlon with no pain what-so-ever.

August - struggled with running again, but a different kind of knee issue. Now, after only completing 1-2 miles, my knee would get tight on the upper outside of the knee causing more discomfort than anything. This happened right around the time that I was tapering for my next triathlon. Needless to say, I walked through most of that triathlon.

September - after a few runs the first week of September, I decided to take a few weeks off. I ran once, only a mile or so a week ago and came home in tears. The same pain/discomfort/tightening of the knee was present. It was time to make a move and see someone.

Next Step:
For the past month or so I have thought long and hard about who I was going to bring this "issue" to: a physical therapist, chiropractor, or orthopaedic? I finally made a decision about my knee and called to schedule an appointment with a physical therapist yesterday. Since I wasn't too thrilled with my PT from last February, I tried getting in with a guy that was recommended by two coworkers. The receptionist said he wasn't taking any "new" patients, but would check with him to see if he would still be willing to see me and get back to me. To my excitement, he was willing to squeeze me in, and I was able to get in TODAY!

The Results of the PT Session:
A little over an hour with a new, and very professional PT, I was able to leave that room on a more positive note than when I went in. He did a number of things such as watched the way I walked, looked at my arches, rotated my ankles, knees and hips, put my legs in positions I didn't think they could go, had me do lunges, etc. From all of the above, he was able to determine a few things that are probably causing my knee to act the way it's acting:

1. Arches - He said that based on how my feet look, it would seem as if there are no concerns with my arches but there is a slight concern with the part of my arch where it meets the ball of my foot.

The solution? - He gave me over-the-counter orthodics and cut out a piece of the orthodic to better suit my feet.

2. Hyperextended Knees - When he said this, I wasn't totally shocked. This basically means that I am able to enxtend my knee in the oposite direction, and too far. He asked me to stand and noticed right away that I was standing with my knees locked. I stand like this a lot. This puts a lot of pressure on the knee cap and something behind the knee (forgot the name). In addition, standing with my knees locked gives my thighs a break from supporting my body.

In addition to this, The PT said that he thinks there may have been a knee injury at one point, whether it was a week ago or 10 years ago, there are reminents of that injury. I think what happened during softball in June is the real cause of this issue and I think I should have seen him then. When he checked the "flexibility of my knee, bending it from side to side, you can see a bone/ligament on the inside of the knee that bends. I was totally disgusted and he said it just proves that it is a bit more loose than the other knee.

Also, there is some damage to the under part of the knee cap, causing some grinding. It is not painful, but the knee cap is rubbing and putting pressure on something (a protective fluid sac of some sort, I think?).

The solution? Be more mindful of how I stand, refraining from locking my knees, and it will help tell my legs muscles to support my body and making them stronger. Also, there are some stretches and exercises that are not good for my knees and I need to be mindful of these. The PT showed me some exercises that I could do in replace of them, making sure I am not locking my knees. I cannot do the hamstring stretch where you stand and pull your foot up behind you to your butt; it puts too much stress on the knee.

3. Gluteas Muscles - My PT thinks that if I work on strengthening my glutes, I will see a huge difference. He also told me that the majority of women that come in for knee issues have week glutes and just working on their glutes alone have made a huge impact on their knees. Wow.

The Solution? Strengthen the glutes with a few PT exercises using resistance bands.

Overall Results/Recommendations:

  • PT says surgery isn't necessary. - thank god.
  • No MRI necessary - at this time.
  • I can still run, but need to ease back into it. PT couldn't tell me if I would be able to run more than 3 miles down the road, or even if I should try. He wants me to wait... and see how things go.
  • Perform the handful of PT exercises with shoes on and orthodics given - a few times a week.
  • Run with shorter strides and if on a treadmill increase the incline to 1-2% to create less direct pressure on the knees.
  • When outside, run on a level surface, no sand, trails, or cement (hard to to in ND).
  • Refrain from any sort of speed work. Maybe a little fartlek here and there, but no 800's and especially stay away from smaller tracks that require 10-12 laps for a mile - this is a no brainer as I hate tracks anyway.
  • Refrain from standing with knees locked.
  • Refrain from the following stretches, exercises, or strengthening routines - too-deep of lunges, both leg and single leg quad machine, hamstring stretch (unless knees are not locked), and bent knee quadricep stretch.
  • Modify stretches - especially ones that require knee locking such as this calf stretch - do not lock knee of back leg. and hip flexor stretch - making sure the pelvic is rotated forward.
  • Call PT with any further questions or concerns, and/or schedule a time to go over some other exercises if necessary in the next couple of weeks.

I feel good about this. Real good. Time to try to turn this injury around. Baby steps... baby steps.


Unknown said...

sounds encouraging. :-)

Badgergirl said...

Glad to hear you've got some ideas of what might be going on with your knee! I hope the exercises the PT gave you help!

Runner Leana said...

Yay, I am so glad to hear that he gave you some good answers! I'm keeping my fingers crossed for you that you will be back running!!!

Marci said...

Great news that no sugery is required. It seems so many injuries occur when there is a weak muscle. Hubs had an IT issue caused by weak hamstrings.

Kelly said...

I'm glad you took the plunge and got some answers! It certainly sounds hopeful!

J said...

With my hip exercises the PT makes me do glutes exercises too cause they told me the same thing. You need basically strong muscles in your hips and butt to keep your knees happy! Good luck with everything. Hopefully you will be pain free soon!

Anonymous said...

Glad you were able to get in with a good PT. Hope the exercises help and that you are able to run painfree very soon!!

Nat said...

Your PT is right, most women have weak leg muscles. I am just hooked now on weight training. I had knee problems all the way through high school. I haven't had them now for years. So exciting things are getting a little better for you!

Marlene said...

Sounds like a successful appointment and a big step in the right direction. Good luck!

Wes said...

yea, that's some good stuff! Smart!! Let's get it done!! :-)

Lily on the Road said...

WOW, it pays to go to someone who knows what they are talking about. I'm so glad that there is light at the end of the tunnel and you can work at rectifying the knee issue. Throw in cycling and you're good to go!

Anne said...

Sounds like you got some great advice that will be easy to follow. May you soon reap its benefits.

Jess said...

Glad you finally got some constructive stuff from the PT! The orthotics and exercises sound promising!

Carolina John said...

the bonus is... with all that glute work you'll get the nice bouncy booty!! rock it girl.

Holly said...

Sounds like you got a lot of answers! I hope all this information helps!

Jess said...

Glad you got the answers you needed, as well as plan for moving forward!

Sarah said...

Isn't it great to get that feedback and some direction? I had a very similar issue and have a list of PT exercises to help strengthen the glutes and hip flexors.

Aron said...

yay! love the baby steps... you will get there!

Unknown said...

Glad you got some answers! Hope you start seeing improvements!!!

X-Country2 said...

Sounds like you've found a great PT and have a solid plan. Good luck!!

Kelly said...

Just saw your post that you are rooting for the Twins. I know my blog says "Red Sox" cap but now that we are out I am officially a Twins fan!

Stef0115 said...

This sounds excellent. Just excellent!

Really hope this plays out to the end result being a healthy knee, no pain, and lots of running PRs!!