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//Min

Help pls: Exercise for knee strengthening

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Hi I need some help please. 

 

I have some weak knees (not diagnosed) where when I jump it seems to want to buckle and has some slight tinge or strain when I land. I use to play badminton agressively so it was probably very hard on my knees. Now I try jogging a little but feel cautious still, even with say jumping jacks and high knees. I went to a PT for a while but she pushed me too hard I nearly went back to square one cause of the pain so I don’t really want to go to a professional.

 

I am currently eating well and doing gentle strength exercise to slowly take off the weight and load  (currently at 69kg on a 169cm height after 7kg weight loss since Jan) I want to get get back to being able to jump and running but don’t really know how to go about it cause of my knees. I wish to have explosive power in my legs... I know you’re suppose to strengthen muscles around the knee or something? but I have been doing squats and backward lunges to do so and it doesn’t seem to be helping so much. (though maybe i’m still too weak)

 

Are there any ideas what I should do or look into to help with lessening the knee strain yet still being able to work out? and what work outs should I do to help the knee? 

 

Thank you.

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5 hours ago, //Min said:

Hi I need some help please. 

 

I have some weak knees (not diagnosed) where when I jump it seems to want to buckle and has some slight tinge or strain when I land. I use to play badminton agressively so it was probably very hard on my knees. Now I try jogging a little but feel cautious still, even with say jumping jacks and high knees. I went to a PT for a while but she pushed me too hard I nearly went back to square one cause of the pain so I don’t really want to go to a professional.

 

I am currently eating well and doing gentle strength exercise to slowly take off the weight and load  (currently at 69kg on a 169cm height after 7kg weight loss since Jan) I want to get get back to being able to jump and running but don’t really know how to go about it cause of my knees. I wish to have explosive power in my legs... I know you’re suppose to strengthen muscles around the knee or something? but I have been doing squats and backward lunges to do so and it doesn’t seem to be helping so much. (though maybe i’m still too weak)

 

Are there any ideas what I should do or look into to help with lessening the knee strain yet still being able to work out? and what work outs should I do to help the knee? 

 

Thank you.

 

Hi Min,

 

Heavy barbell back squats helped strengthen and thicken the muscles in my knees and calves. But to see any changes in muscle and strength, you need to go heavy enough. Heavy relates to how many reps you can do before failure, not to a specific number on the scale. So if you're squatting a weight that you can do for 20 reps, it's light and you won't gain strength and muscle as fast as you could with a heavier weight. Maybe pick a weight you can lift no more or fewer than 5-8 times. Just make sure that you increase the weight weekly (or however often you need to/are able to) as you get stronger so that you're usually close to, but not right at, the limits of what you can do. 

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Hey @//Min.

 

Sorry to hear about the pain.

 

Normal advice is usually that you see a PT in these situations, and that advice is not wrong. That said, I’ve also been in a position of needing to rehab my knees myself, so I understand where you’re coming from.

 

2 hours ago, Harriet said:

Heavy barbell back squats helped strengthen and thicken the muscles in my knees and calves. But to see any changes in muscle and strength, you need to go heavy enough.


This makes me a little nervous because //Min mentioned she’s been treated by a PT about this in the past, which means there’s some underlying pathology going on that we don’t yet know the nature of. Squatting heavy is a great goal, but it may not be a good way to treat that condition. Putting the knee under heavy loads may make things worse. Even exercise itself is not always the best answer for all knee conditions.

 

//Min, I think in order to help you effectively we would need to know what you were diagnosed with. Can you post that, and possibly a little more detail on what your PT had you do?

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Two links for you from GMB.

The first is on how to jump.If you aren't jumping properly, your knees will hurt, no matter how strong they are

second is on how to strengthen your knees.

And my advice is to start slow and build up. When I started, I couldn't even jump rope without my knees and ankles hurting.

https://gmb.io/jump-tutorial/

https://gmb.io/knee-health/

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7 hours ago, PaulG said:

This makes me a little nervous because //Min mentioned she’s been treated by a PT about this in the past, which means there’s some underlying pathology going on that we don’t yet know the nature of. Squatting heavy is a great goal, but it may not be a good way to treat that condition. Putting the knee under heavy loads may make things worse. Even exercise itself is not always the best answer for all knee conditions.


For sure. Since Min said she was already squatting I thought she might not have any specific pain or injury that prevents barbell squatting. But most def do not proceed without advice if you're worried about this, Min.

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5 hours ago, Harriet said:


For sure. Since Min said she was already squatting I thought she might not have any specific pain or injury that prevents barbell squatting. But most def do not proceed without advice if you're worried about this, Min.


That’s a great point. I read the original post to mean that pain is happening again as @//Minhas started squatting again, and when I looked at her challenge thread I saw she is doing HIIT, so probably just bodyweight squats or light dumbbells. The idea of pain with bodyweight squatting is what was making me nervous about her increasing the weight. Hopefully //Min can clarify what’s going on with her currently for us, and whether she’s still in pain.

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I'm going to side with the 'go see a professional' end of things here: knees are too easy to injure if you don't know where/what the pain/instability is coming from. Going heavy without any context or working up to it can just as easily cause permanent damage.

 

IMO @//Min I think you need to speak to a physiotherapist, and/or a trainer with a strong rehab/kinesiology background to discuss your symptoms and what will be safe for you to work on, in order to improve the situation without putting yourself at risk.

 

 

 

 

Side note:

On 6/25/2020 at 7:45 AM, Harriet said:

it's light and you won't gain strength and muscle as fast as you could with a heavier weight

Harriet, absolute strength isn't always the most important metric  -  I have added more info below to clarify.

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8 hours ago, Defining said:

Harriet this is not borne out in any of the recent studies on strength - load is less important than reaching close to failure in the lift.


Really? I'm interested in this. Can you recommend a source?

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1 hour ago, Harriet said:

Really? I'm interested in this. Can you recommend a source?

 

Spoiler

As we've discussed before, there are many flaws and limitations in fitness & nutritional studies, so it's all with a grain of salt.

The study I was thinking of, when I said that there's no significant difference in experienced lifters: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00154.2016

 

To support the opposite idea, that heavy loads will improve strength more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131226/

 

To show that in novice lifters it probably doesn't matter that much: https://journals.lww.com/acsm-msse/Fulltext/2003/03000/A_Meta_analysis_to_Determine_the_Dose_Response_for.12.aspx 

older study that shows similar results: http://files.atividadefisicaesaudebh.webnode.com/200000010-a55aaa6550/The effects of 4 and 10 repetition maximum.pdf

In favour of periodisation: https://www.frontiersin.org/articles/10.3389/fphys.2019.00013/full

 

Just to complicate things, lifting speed can also affect strength gains: https://pubmed.ncbi.nlm.nih.gov/11447355/

 

Examples of sex-specific strength adaptations: https://journals.lww.com/nsca-jscr/Fulltext/2020/05000/Sex_Differences_in_Resistance_Training__A.30.aspx?context=FeaturedArticles&collectionId=1

 

Overall discussion: https://sci-fit.net/scientific-recommendations-1/


If we are taking this at face value, my previous statement is wrong: lifting heavier stuff generally makes you better at lifting heavier stuff, vs lifting lighter stuff. But in a more nuanced way, 'strength' isn't only benefitted by lifting heavy, but through intentional periodisation of different loads, rep ranges, and volumes. This type of variety is also beneficial to prevent nervous system burnout, for long-term strength gain.

 

I will also correct myself in that getting close to failure has more benefit for hypertrophy vs strength; sorry for the incorrect statement above, that was absolutely my mistake. That being said, I still have strong misgivings around making a blanket statement like 'you need to lift heavy to get stronger', especially since the statistical difference between heavier or lighter loads is not always significant, and is heavily dependent on individual factors. Essentially: no, you don't have to lift heavy to get stronger, and yes you can achieve both muscle and strength gains in higher rep ranges.

 

Details in spoiler, so I don't take over the OP thread any more than I already have. Cliff notes: your body gets better at what you ask it to do often (ie. principle of specificity), so when you work closer to your 1RM you get better at lifting close to your 1RM. That being said, strength is not an independent principle from hypertrophy, any more than it is from neural adaptions. Also, the lifter's experience can affect how they may respond to different intensity, frequency, and volume (not to mention sex, gender, hormone levels, and genetic predisposition).

 

'Strength', especially when talking about joint stability (ie. knees) isn't just about the absolute load you can move, but also endurance, range of motion, and the connective tissue itself. As it stands, I'd still hesitate to recommend working with heavier loads for novice lifters, especially when there's a concern around joint instability or potential injury. Hence the original suggestion to go talk to a professional first.

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38 minutes ago, Defining said:

 

  Hide contents

As we've discussed before, there are many flaws and limitations in fitness & nutritional studies, so it's all with a grain of salt.

The study I was thinking of, when I said that there's no significant difference in experienced lifters: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00154.2016

 

To support the opposite idea, that heavy loads will improve strength more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131226/

 

To show that in novice lifters it probably doesn't matter that much: https://journals.lww.com/acsm-msse/Fulltext/2003/03000/A_Meta_analysis_to_Determine_the_Dose_Response_for.12.aspx 

older study that shows similar results: http://files.atividadefisicaesaudebh.webnode.com/200000010-a55aaa6550/The effects of 4 and 10 repetition maximum.pdf

In favour of periodisation: https://www.frontiersin.org/articles/10.3389/fphys.2019.00013/full

 

Just to complicate things, lifting speed can also affect strength gains: https://pubmed.ncbi.nlm.nih.gov/11447355/

 

Examples of sex-specific strength adaptations: https://journals.lww.com/nsca-jscr/Fulltext/2020/05000/Sex_Differences_in_Resistance_Training__A.30.aspx?context=FeaturedArticles&collectionId=1

 

Overall discussion: https://sci-fit.net/scientific-recommendations-1/

 

 

Thanks. That's a lot for me to go through, but I will. 

 

38 minutes ago, Defining said:

'strength' isn't only benefitted by lifting heavy, but through intentional periodisation of different loads, rep ranges, and volumes. This type of variety is also beneficial to prevent nervous system burnout, for long-term strength gain.

 

Yep, sounds good.

 

38 minutes ago, Defining said:

I will also correct myself in that getting close to failure has more benefit for hypertrophy vs strength; sorry for the incorrect statement above, that was absolutely my mistake. That being said, I still have strong misgivings around making a blanket statement like 'you need to lift heavy to get stronger', especially since the statistical difference between heavier or lighter loads is not always significant, and is heavily dependent on individual factors. Essentially: no, you don't have to lift heavy to get stronger, and yes you can achieve both muscle and strength gains in higher rep ranges.

 

I just thought strength and hypertrophy adaptations were better below 15 reps, and that reps higher than15-20 start achieving more adaptation for endurance? The first study you linked showed that 20-25 rep sets increased strength and hypertrophy, though. So now I'm confused, given everything else I've read. One thing, though. I would find it really hard to take a 25 rep set close to failure. For me, the higher the reps, the more 'fuzzy' failure becomes... I don't fail absolutely so much as I just hate the set more and more until I give up. But it's definitely nice to know that lighter weights could still promote strength and hypertrophy (given that gyms are closed and all I have is kettlebells).

 

38 minutes ago, Defining said:

'Strength', especially when talking about joint stability (ie. knees) isn't just about the absolute load you can move, but also endurance, range of motion, and the connective tissue itself. 


Sure. I was assuming hypertrophy would actually be excellent for knee stability? My knees have actually gotten noticeably thicker from squatting, which I assume is good.

 

45 minutes ago, Defining said:

I'd still hesitate to recommend working with heavier loads for novice lifters, especially when there's a concern around joint instability or potential injury. Hence the original suggestion to go talk to a professional first.

 

Fair enough. I imagine 5s or 8s are fine for most novices without injuries, but if Min has an injury, they should be more cautious and get advice for sure.

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2 minutes ago, Harriet said:

I just thought strength and hypertrophy adaptations were better below 15 reps, and that reps higher than15-20 start achieving more adaptation for endurance? The first study you linked showed that 20-25 rep sets increased strength and hypertrophy, though. So now I'm confused, given everything else I've read. One thing, though. I would find it really hard to take a 25 rep set close to failure. For me, the higher the reps, the more 'fuzzy' failure becomes... I don't fail absolutely so much as I just hate the set more and more until I give up. But it's definitely nice to know that lighter weights could still promote strength and hypertrophy (given that gyms are closed and all I have is kettlebells).

It's all so much more nebulous than that, there are no full stops or lines between different types of adaption. Truthfully, any repetitive action we do with our bodies will result in changes. And I agree, 25+ reps are miserable sets. IMO the 'safe' range for most folks is often 5-12, but it totally depends on the individual.

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Hello, thank you everyone so so much for replying, I need to slow read them over a few times to digest and internalise and see what applies. I'm a slow reader.

 

Don't worry about taking over the thread @Defining, I think any info is helping and interesting. 

 

@PaulG I think you wanted to know a bit more bout my situation? This is the long long story of my knee which I didn't put in initially cause it's an essay. Not sure if this will help paint the picture and also my aversion to professionals. 

 

Nov 2018 - after a particularly aggressive session of badminton my right knee started hurting, especially when I climbed stairs. Pretty sure it wasn’t a tear of anything though since there wasn’t a sharp sudden pain and figured it was overuse and rest should be enough.

 

Feb 2019 - Pain hadn’t subsided, I could walk slowly but couldn’t climb stairs and was wearing a knee guard everywhere I went. I went to a doctor (I had other ailments I wanted to see the doc as well) who was terrible and tried turning me away cause I “had too many symptoms” for a 15 min consult - I could only tell him about my knee in one sentence. Pissed me off majorly (what’s the point of me paying good money). Went to a pharmacy who gave free advice over the counter for half an hour and got an anti-inflammation gel for my knee which barely helped so I just avoided stairs altogether. Sufficient to say I started avoiding doctors cause I knew all they would tell me is to rest it or overprescribed strong painkillers.

 

May 2019 - I started being able to climb stairs finally without pain (though knee was still  ginger) but my left hip started to ache which I believe was in response to constantly putting my weight on the opposite side of my body to prevent strain on the knee.

 

Jul 2019 - After 2 months of hip ache getting progressively worse, I decided to see a physio for it, he said my ache was in a weird place he couldn’t find the muscle for it… wth... after 6 sessions it was too expensive to continue without seeing any results so I stopped. Knee pain at this point only if I ran, so the physiology didn't do much about it. Maybe my body adopted to transferring my weight and pain to my left hip.

 

Nov 2019 - Had to suffer the daily hip ache for about 4 months (higher discomfort but not sharp pain), till I went on a 2 week vacation where I walked so much and even did a small trek that the hip ache went away but I strained both my calf muscles so badly that it hurt to jog/run for two months till I finally learnt the foam rolling helped with my calves. By this time, my knee was fine on stairs and I had basically avoided running and jumping and most stairs for a full year so my muscles were probably very weak.

 

Feb 2020 - I went to a PT (once a week) and told her my objective was to build a stronger overall body to prevent knee injuries (shared with her the history above) with a preference for body weight and free weight exercises first cause I was so weak. At this time my knee and hip and calves seemed mostly fine, but I would still avoid running and jogging as I would start to feel aches on these areas whoever that was strain - this is why I wanted to lose weight, to reduce the strain. She didn’t diagnose anything with my knee, rather would prescribe exercises that didn’t involve jumping. She gave warm up like inch worms, around the world, dead bugs, and main exercises of compound movements with light kettle bells (squats, swings, deadlift/snatch) and landmines (+variations like backward lunges). My knee would ache / feel tender at the weirdest exercises though - on forward lunges, one arm dumbbell row on bench, planking/push ups. It appeared that certain weight bearing at certain angles (not sure which) would cause it to flare up. She was able to see my form was correct on these exercises so it wasn’t due to incorrect form. She was pretty good but then started to push for harder variants / weight of these exercises which I felt and told her I wasn’t ready for (my heart rate would shoot through the roof to the point my chest hurt, my whole body was very very shaky during exercises) that my sessions were starting to feel less effective cause half my session was spent resting from overexertion and I’d be too tired in between the week to do another session myself. (i.e. reduced overall exercising). I would test a tiny tiny jog (10m?) here and there to see how my knee felt and my knee would feel a strained. 

 

Apr 2020 - Lockdown from covid happened and I started working from home and PT stopped as I didn’t have access to the gym. I decided to start exercising daily in my room bare feet on a yoga mat with mainly standing workouts with body weight and very light weights by following some youtube videos (e.g. squats, kicks, leg raises, high knees - without the jumping, backward lunge, reverse fly, overhead press). I noticed that if the exercise was more weight baring or lasted more than a min, my knee would start to to feel strained a little, so I would hold back till I got the hang of the exercise. Hip ache came and went which was a sign to me I was being ginger on my knee to me. After a month or so, I did notice my leg muscles are slightly stronger than before with the help of a stronger core (my backward lunges are less shaky) which seem to help my knee, though any exercise the moment my knee so much as twinge I’d stop. I would also try to exercise on pressure mats to help absorb some of the shocks. The only problem is progress is sooooooo incredibly slow and I don’t know if I could be doing other things to help it apart from repeated progression exercises. The weight loss from eating well has helped certainly, I don’t feel like I’m luging around so much, but its not enough.

 

Okay that's where I am now haha.

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12 hours ago, //Min said:

I think you wanted to know a bit more bout my situation? This is the long long story of my knee which I didn't put in initially cause it's an essay. Not sure if this will help paint the picture and also my aversion to professionals. 

 

Thanks, that detailed look at what's happened to your knee so far was really helpful. I'll try to give a thoughtful reply with some real information in return.

 

Let's start with your experience with the medical field.

 

12 hours ago, //Min said:

I went to a doctor (I had other ailments I wanted to see the doc as well) who was terrible and tried turning me away cause I “had too many symptoms” for a 15 min consult - I could only tell him about my knee in one sentence. Pissed me off majorly (what’s the point of me paying good money). Went to a pharmacy who gave free advice over the counter for half an hour and got an anti-inflammation gel for my knee which barely helped so I just avoided stairs altogether.

 

With the PCP you saw, it sounds like you ran into the perennial problem with PCPs: a lot of them view their own jobs, if they're not playing the role of a walking prescription pad, as a triage system. People come to them with all manner of complaints, and if it's not something that can be solved with a quick doctor's note or a relatively simple, one-time treatment, their main job is to choose a doctor in another specialty to refer you to. This PCP should have referred you to a physical therapist as soon as they knew you'd been had pain with movement for over a month. Not everyone is good at their job, I guess.

 

With the pharmacy, sounds like what you dealt with was a combination of trying to get help from a salesman (they are not really there to solve your problem, they're there to choose decide which medication to sell you) and the adage that when you're a hammer, everything you see looks like a nail. If your friend had told you to skip the pharmacy and go to a chiropractor, the chiro would probably have told you your hips were misaligned and needed adjustment, and you would have spent a thousand bucks to take a few trips on a traction table that probably wouldn't have helped you for very long. If you had seen a massage therapist, they would have told you your TFL or psoas was tight, and you would have spent that money hanging out on a massage table for a few hours.

 

You did do the right thing by eventually going to a physical therapist. Physios are generally best at diagnosing and treating musculoskeletal injuries based on the body's movement. Your issue -- an acute knee injury from a physical activity, that caused pain with specific movements -- is something for which a physio has a lot to bring to the table.

 

12 hours ago, //Min said:

Jul 2019 - After 2 months of hip ache getting progressively worse, I decided to see a physio for it, he said my ache was in a weird place he couldn’t find the muscle for it… wth... after 6 sessions it was too expensive to continue without seeing any results so I stopped. Knee pain at this point only if I ran, so the physiology didn't do much about it. Maybe my body adopted to transferring my weight and pain to my left hip.

 

You're probably right. After an injury, especially when it's lived with for that long a time, it's entirely likely that you learned to compensate for that knee condition by using your other leg in a new way. That would put additional stress on the other leg and eventually cause a problem in that hip, which adds yet another layer of complexity to your condition.

 

It does concern me a little that the physio you saw couldn't accurately diagnose your hip issue, and may not have been making much effort to get to the bottom of your knee. From a good physio's perspective, both need to be solved. Of course, you didn't give the physio a ton of time to solve those mysteries -- you only went to 6 visits.

 

The experience you had with your personal trainer doesn't surprise me at all. They were not equipped to solve the problem you wanted to fix. Most personal trainers, especially of the type that work at gyms, have the same level of experience that you would if you'd just graduated college, you were lucky enough to look good in gym clothes, and you'd taken a physical education class or two to fill the requirements for your BA in art history. You can rely on a trainer to have enough knowledge and experience to sort of understand the articles in a bodybuilding mag. Generally, that makes them qualified enough to help your average accountant or soccer mom get back in shape after the big divorce. They generally do not have the experience or education necessary to actually understand good form in an exercise, and they definitely are not qualified to understand, diagnose or treat medical issues.

 

I'm kind of busting on that trainer here, but I think it's important to acknowledge that it's not really their fault. Their job is to push reluctant clients into exercising for a couple months to lose a little holiday weight, and you needed something much more involved. It's entirely reasonable that they pushed you too hard, and that you found it wasn't helping you.

 

To give you some context, here's where I come from on rehabbing knees: I have dealt with occasional issues in my left knee spanning most of my adult life. I spent a good chunk of my twenties practicing parkour, meaning lots of high loads on the knees; so I've dealt with minor meniscus pain, I've hyperextended that knee, and I've had lots of pain in various parts of my quad and patellar tendons. I've seen PTs and orthopedists about most of those issues, and unfortunately they haven't always been able to help. After getting medical advice from a few people that added up to "stop jumping off of things", I eventually decided to simply use what physical therapists had shown me and strengthen my legs by working myself up to doing pistol squats. It took a while, but by the time I had them, voila, I'd rehabbed my legs so thoroughly that a lot of my knee issues went away.

 

I stopped exercising for a good three years or so and of course, the pain came back during that time. I've tested myself and my best guess is that I have some latent patellar tendinopathy. One of the tricks about tendinopathy is it does not really go away with rest -- it tends to stick around pretty much permanently if you don't exercise the affected tendons. The only known treatment for tendinopathy that has consistently good results is rehabbing it through physical therapy-style exercise. So currently I'm back on the horse, working myself back up to a pistol squat, hoping that will solve the pain again. So far it appears to be working, as my knee is functioning better and is far less painful than it was in March, when I first started.

 

Now, as tempting as it would be to say you have a tendinopathy issue in your knees and that you should do the same thing I'm doing... the fact is that even if I (or any of us) saw you in person, there's no way we could tell you what's actually going on with you. We're just not qualified (except the couple of folks on here that ARE physical therapists, and they rightly know better than to try and give an official diagnosis over the internet). One of the hallmarks of chronic tendinopathy is pain with specific movements, especially movements that tend toward overuse injuries (like running), and that the pain doesn't go away with rest. But there are lots of other knee problems that present with a lot of those same characteristics, like a meniscal or ligament tear; and if you are having a different issue, it may not be a good idea to try to exercise your way out of it.

 

And if you are set on rehabbing it yourself, you're essentially playing the role of your own physical therapist. If you think this reply is overlong and boring, try reading a few articles on physical therapy theory, programming and exercises. Oof. And you'd need to do quite a bit of reading, with no guidance from a professional.

 

I respect and understand that you didn't feel the physical therapist you saw was helping you, and they frankly may not have been very good at their job. If I were seeing a physical therapist for a month and they still couldn't tell me what was actually wrong, I would find a better physical therapist. But I think you may not have given the treatment itself a fair shake. PT is a progressive treatment plan through exercise, essentially a workout plan designed to heal you. You can't expect big results in 6 sessions, any more than you can expect big results for your strength from 6 workouts. And bumps in the road do happen, sometimes it takes some experimentation over time to find the actual root of your problem, and sometimes extra problems (like your hip) crop up along the way. But the evidence does show that rehabilitative exercise is a very effective treatment for lots of musculoskeletal injuries, far more effective than passive treatments (things like chiropractic, massage, acupuncture, pain medication, therapeutic ultrasound, laser therapy).

 

If I were you, I would do some research to find a physical therapist near you, someone who advertises themselves as having some experience with athletes and sports injuries. I would go in and get myself tested and diagnosed, so I had a good idea of what the problem is and how severe it is. I'd do some additional research on that diagnosis myself, too. And then I'd make my own decision about how long I actually need to see them for: if they are able to give me an exercise plan right away, and the problem's not severe, I might only need a couple visits to make sure I'm progressing appropriately, and then I'd be good to keep exercising on my own.

 

It's good that you say that even with some twinges and pain, your exercising has been making your knee more functional. That's an encouraging sign that you're probably not reinjuring it. I think it's likely that if you see a good PT, they'll be able to give you a couple of extra exercises to work into your workout, you might need a couple of follow-ups, and then you'll have the tools you need to kick the knee pain to the curb in short order.

 

If you want to do some reading to help you decide how you should move forward, here's an article by Steven Low (a doctor of physical therapy and former gymnast) on how rehab is programmed. It's specifically for tendinopathy, and not other conditions, but I found it an interesting and helpful read for myself.

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I will also chime in with my own recent physio experiences: I was rear-ended in the early spring, and am still dealing with some nerve issues as a result of the whiplash. Bodies are very unique, and even our muscles & nerves don't always insert in the same places. Different skeletal systems can also compensate in different ways (eg. women, whom often have wider hips, may be more prone to valgus collapse). Pain is also sometimes referred from other areas - so where you're FEELING it may not be what's actually causing the issue.

 

Echoing Paul, none of us are qualified to help you diagnose the issue, and while I understand your hesitance in working with a physical therapist when your last experience wasn't productive, I still think having a professional help you with troubleshooting may be beneficial. Maybe one visit every 2-4 weeks to discuss changes/new exercises to try?

 

In the meantime, reverse lunges are often touted to be safer for your knees, which it sounds like you're already trying. And pretty much everyone can benefit from some extra work on the posterior chain (hamstrings & glutes mostly), since we all sit too much. Hip thrusts and other activation exercises are generally very low risk and have good potential to help strengthen your core & posture muscles as well. You can also look at a split squat or goblet vs a bodyweight squat, as a way to focus on alignment. Also heel & toe raises, plus seated/prone leg raises, are a nice gentle way to get things moving without too much load on the joints. 

 

At any rate, I hope you find success with your goals, and let us know how it all goes! :)

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@Harriet

 

Thank you, I will look into reading about barbell squares and reps before failure. I had a quick search as a start and its good information to know. And the follow up from defining is a bit over my head at the moment but still good to read.

 

@Elastigirl

 

Thank you! I think this tutorial is very useful! I didn’t know there was a way to jump properly. I think that’s important, this is definitely going into my mental library.

 

@PaulG

 

I guess I hadn’t much experience with docs in the past, I didn’t realise he should refer me to a specialist. I generally try to avoid docs cause (1) they are always so overloaded and (2) they generally give me very rush diagnosis I find them very very questionable. I recalled a few years back I fell and the doc I visited said it was an ankle sprain and to rest. It took about 2-3 months to heal and three years later it flared up badly so I decided to to straight for a private MRI and it showed the “sprain” had been a partial ligament tear. I figured the flare up was stiff cross section scar tissue and basically self massage my way out of pain thankfully. I was angry at this doc bout my knee because I had made sure I had all my information on hand to help him and he was really rude to me and I have seen other patients be in there for an hour. I didn’t make a fuss because I figured he could be having a bad day and let it be.

 

With the personal trainer, a nice lady who gave pretty detailed explanations on form, I didn’t expect her to diagnose me but I figured she might have seen enough people with a knee issues and would know which exercises to help strengthen my legs (my vague idea about helping the knee).  Maybe not the best idea lol. Towards the end she was also pushing for me to have more sessions more frequently (more $$) and harder exercises so it was a good thing I had an excuse to stop.

 

With the physio, he was a pretty nice guy, but I think I lost faith in him cause (1) He asked me to come weekly and charged me $150 a session of 45 mins (2) He kept insisting that my hip ache was in a weird place and he couldn’t tell which muscle, even after I suggest it was related to my knee. So I had spent $900 in a month and a half (didn’t realise there should be a planned rehab programme) and seeing no improvement or none the wiser bout my ailments so I stopped. And this clinic was recommended by a family friend. I did consider looking for someone else but have no idea what to look for when I “researched” for someone (I find it hard to believe online reviews too) and the $$ was out of my own pocket. So your information of what to look out for is useful thank you. I’m still really wary what to expect though. How long can a rehab take? And what did you mean by exercise plan, like a long term one they actually tell you? My physio spent the first session discussing my issues and then basically told me to do 3-4 exercises each week and would tell me very similar ones the week after. He did some cold gel therapy thing on my hip and knee I recall.

 

Thank you for sharing your experience, it is very useful to me. I don’t think your answer is over long at all. I’m also really glad you managed to find a way out of your own knee issues - something like hope haha. There are also a lot of new terminology you raised that I’m definitely going to read up (e.g. tendinopathy)

 

@Defining

 

Man that’s horrible! I’m sorry to hear bout you getting rear ended. Whiplash is horrid - I had it mildly once on a roller coaster so can’t imagine a bigger one. I hope you feel better soon.

 

That’s a good point, sometimes where you’re feeling isn’t the cause of the issue. and yea, I don’t dare do forward lunges yet cause of the strain. I just googled the exercises you mentioned with less load (split squat, global squat, heel & toe raises, plus seated/prone leg raises), they look very doable so thank you for the recs.

 

As for the physio, can I visit every 2-4 weeks? My last physio asked me to come every week so I thought that was a norm.

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21 minutes ago, //Min said:

As for the physio, can I visit every 2-4 weeks? My last physio asked me to come every week so I thought that was a norm.

One of the challenges with chronic injury/pain like what you've described is that it CAN take a while to figure out where the issue is coming from. Hell, even with my injury where we KNOW what was affected, we're still not actually sure where the nerve is being directly affected, and we're still experimenting with different exercises to manage/improve symptoms. The other unfortunate reality is that sometimes injuries don't fully heal, and running/jogging may be too high impact for yourself.

 

A good physio should be giving you exercises to do in between sessions, yes; the goal should always be that you can manage the condition yourself long-term. It would be reasonable IMO to say that you want to take the opportunity to really focus on the exercises, unless you find that hands-on therapy makes a big difference for you right away. Part of having more time between sessions may help because it gives the strength training a chance to take effect. It can take months to truly start seeing real results in some cases, for reference re: timelines. 

 

I also avoid medical treatment unless absolutely necessary, but in the doctor's defense re: your ankle - there really aren't many reliable ways to confirm damage in the connective tissues without a MRI (which would typically be considered unnecessary if there aren't other symptoms, as far as I know) and the inflammation from the initial injury is often enough to mask additional symptoms for the first few weeks. So beyond knowing that you likely didn't break something, assuming it's a sprain was probably reasonable. The doc for your knee though was there to help you - even if they're having a bad day.

 

This is an area of your life where it's really important for you to advocate for yourself, and communicate your expectations and concerns; even if that's uncomfortable to do. I'd also be sure to disclose all of the things you've mentioned: ankle, knee, and hip - changing your gait (ie. how you walk) can absolutely be interrelated with all of the areas you've mentioned.

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1 hour ago, //Min said:

@Harriet

 

Thank you, I will look into reading about barbell squares and reps before failure. I had a quick search as a start and its good information to know. And the follow up from defining is a bit over my head at the moment but still good to read.

 

 

No worries. I think Defining was just saying you don't need to go heavy/low rep in order to get stronger knees. You can get strength and especially muscle with high rep/lighter weights, provided you take the set close to failure. The reason this might be relevant to you is that going heavy could be dangerous if you have an injury. You might be safer doing light/high rep work. Sorry, I should have read your comment more closely and noticed the injury. 

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On 6/27/2020 at 9:30 PM, //Min said:

I was angry at this doc bout my knee because I had made sure I had all my information on hand to help him and he was really rude to me and I have seen other patients be in there for an hour. I didn’t make a fuss because I figured he could be having a bad day and let it be.

 

Oh no. Nope. Absolutely not. Never, ever,  allow good manners or some kind of misguided patience convince you to keep quiet and accept sub-par treatment from a doctor. This is your body and your health - you can't replace your knee joint under warranty if something is seriously wrong with it.

 

When you are paying a medical professional for their time, the deal is that they give you their full attention, take you seriously, and treat you with respect, in return for taking your money. That's called basic professionalism, and if the average barista or gas station attendant can manage that with every single customer that comes into their store, then someone who successfully graduated from medical school absolutely should be able to do so as well.

 

Make a fuss. No one else in that examination room is going to do it for you.

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On 6/27/2020 at 8:30 PM, //Min said:

 

With the physio, he was a pretty nice guy, but I think I lost faith in him cause (1) He asked me to come weekly and charged me $150 a session of 45 mins (2) He kept insisting that my hip ache was in a weird place and he couldn’t tell which muscle, even after I suggest it was related to my knee. So I had spent $900 in a month and a half (didn’t realise there should be a planned rehab programme) and seeing no improvement or none the wiser bout my ailments so I stopped. And this clinic was recommended by a family friend. I did consider looking for someone else but have no idea what to look for when I “researched” for someone (I find it hard to believe online reviews too) and the $$ was out of my own pocket.

 

That's totally valid -- $900 is a ton of money to spend on someone who isn't able to give you any answers after a few sessions.

 

A planned rehab program is basically 90% of what a good PT should be doing for you. In my estimation, it sounds like the PT you were referred to was not very good, or very interested in your problem. Given what you've told me, I probably would have abandoned that PT too.

 

I've taken a few days to reply in order to organize my thoughts on what's most useful to tell you, since it sounds like you're not very experienced looking for sports injury care. I'll try to put here what I wish I'd been able to tell my past self when I had my first couple of injuries.

 

I guess first I should say that even though I think a PT is a really good idea, and worth the money, not everyone can afford to budget out $150 or $300 for that treatment (especially these days). You didn't mention whether you have insurance that can cover PT, or whether the cost of medical care is prohibitive for you. Insurance or not, if you can swing it, I think you should: trying to diagnose yourself and DIY some exercises is not a good idea, especially if no one's ever given you a decent diagnosis on what the problem actually is. That said... testing out a couple of very careful, very well-researched DIY exercises is better than doing nothing and just ignoring the problem. So if going to a PT is truly something you can't do, then I do think reading the article I linked previously on tendinopathy, and researching some physical tests for meniscus and ligament problems, might not be a bad idea.

 

That said, since a PT is the best option, here are my ideas on bad PT vs good.

 

Not all physical therapists are created equal. Some PTs genuinely care about your problem and mainly follow a rehab model of treatment, diagnosing what movements may have contributed to an injury, then helping you to strengthen weak muscles or train you in better movement patterns to fix the injury. However, that model doesn't typically make much money, because it doesn't require you to visit them many times before you're reasonably healed. So some PTs use a different model that generates more revenue: along with the therapeutic exercises, they ask for a lot more visits (often weekly) and offer additional services beyond exercises, like massage, e-stimulation with TENS units, therapeutic ultrasound, heat/cold treatments, low-level laser therapy, and many others. Each of those additional services costs extra, and between that and the extra visits, a PT office can make a lot more money per patient this way.

 

The problem with these types of therapies is that the vast majority of them don't actually do much. Massage, e-stim, laser therapy and ultrasound are all commonly offered; but reviews of clinical evidence have shown that for many injuries, there is either very mixed or unfavorable evidence that they improve long-term function. Evidence showing their effect on pain and short-term function is stronger; but you still need to address whatever caused your injury in the first place (which is usually a functional deficit, like an overactive set of muscles, or a range-of-motion deficit). If you don't, all that massage is just a temporary band-aid.

 

Personally, I question the efficacy of those kinds of treatment at all, especially for sports injuries. Sure, if you're in constant pain that's interfering with your life, or severe pain that's driving you to distraction, then maybe you need some palliative treatment just to get you to a point that you can focus on rehabilitation; but especially with sports injuries, most of us are just not in that position. We're dealing with pain caused by specific movements. I think it makes much more sense to focus entirely on rehab exercises. It's much more effective and means you will have a much smaller bill at the end -- even if you go to a PT that charges more per hour.

 

On 6/27/2020 at 8:30 PM, //Min said:

So your information of what to look out for is useful thank you. I’m still really wary what to expect though. How long can a rehab take? And what did you mean by exercise plan, like a long term one they actually tell you? My physio spent the first session discussing my issues and then basically told me to do 3-4 exercises each week and would tell me very similar ones the week after. He did some cold gel therapy thing on my hip and knee I recall.

 

It really depends on your specific issue. If you go in and get diagnosed with a meniscus issue or ligament tear, then I really have no idea. But for what it's worth (#notworthmuch #notadoctor), some kind of low-level tendinopathy is more likely, and in those cases you can often get away with just a couple of visits, once every couple of weeks, if you actually do the exercises they give you.

 

As an example, one of the best PTs I ever went to was a referral from an orthopedist. I went in to the ortho with some shoulder pain, knowing I should probably see a physical therapist but without the first idea who to see. However, a friend had recently given me some of the best advice I've ever been given: "ask who's the doctor who works on your local high school or college's football team." So I asked, and it immediately set the tenor of the conversation. The ortho told me those PTs weren't taking new patients, but that he did know of an excellent one about 90 minutes out of town who mostly worked on dancers.

 

When I saw the PT, she ran about 15 minutes worth of tests and quizzed me in detail on my history with that arm, and in about half an hour she had found a couple of problems (a weak right tricep and weak right-handed grip, among others) that gave her a working theory of what my issue was. In about an hour total, I had a detailed diagnosis and a couple of exercises to work into my workout (which she cleared me to restart slowly).

 

In total, I believe I saw her three times over about a two-month period. The last two visits were check-ins to retest the problem areas we'd found, and make sure they were progressing. I was fortunate in that I had insurance, so I never saw the full bill; but I would be very surprised if it went as high as $900. And as a result of those visits, I know a ton more about my shoulders and how to keep them healthy.


If I were searching for a PT from scratch right now, I would find someone to ask that same "football team" question, even if it's just Google. Serious sports and athletic communities often have the best leads on which PTs in your area know what they're doing. Then I would do some of my own homework, and make sure that when I walk in, I have as much detailed information for them as possible on what movements I'm having problems with, exactly where the pain is; and that I know enough to advocate for myself and ask for the treatments that I think are effective.

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@Defining  @Scalyfreak

 

I took some time to reflect, and I think I didn’t assert myself in front of the professionals because 1) my pain didn’t seem high at that time = not so pressing in my mind and 2) I’m used to solving my own problems and when someone doesn’t look like they can help me (esp with $ involve), I move on or retreat. In this case I didn’t know who to move on to and didn’t have enough info of what to expect backing me to press forward either. That said, thank you for stepping behind me. I think I’m going to give professionals another try, at the very least to at least first eliminate whether there is any serious injury by going to take more conclusive tests (e.g. x-rays/ MRI)

 

@Harriet

 

That makes sense. That’s probably the route I’m going to go, high reps/low weight. Muscles~

 

@Machete

 

Mmm my ankle dorsiflexion seems alright?  I can only do that video test (with my feet flat on the floor) with legs and feet apart though, I can’t do it when my legs and feet are together. Maybe my dorsiflexion can be better haha. 

 

@PaulG

 

This info is invaluable to me. You’re so thoughtful I nearly teared, thank you.

 

Just a bit of background on my country’s health system that I’ve managed to summarise after some reflection. I have public system - where the fees are subsidised by the govt but the general practitioners give you hurried diagnosis (and the referral to specialists I guess) and the wait time to see specialists can be a month/s and you can’t really choose your doctor/professional unless you know of someone in particular - and there is private - where wait time is much less and you can choose your doc but the fees are much higher (like my physio and I assume there are sports therapists around).

 

Insurance here is also funny, you either get covered by work which covers outpatient and hospitalisation and surgical, or you can get your own which only covers hospitalisation (warded) and surgical. There is no outpatient insurance you can buy on your own. Since everything I want to do (like tests and physio) is all considered outpatient expenses, I am paying it out of my own pocket unless I make a claim at work which only covers the expense partly if I went public and covers me minimally if I went private. Yea my work place insurance isn’t that great, there are other companies with better coverage and a panel of docs, but I'm not there lol. SO, basically it’s very expensive for me to get medical help at the moment. I’m but a young working adult haha

 

That said, after reflecting on everything here (I’m still going to go back to re-read your posts to be prepared before I see anyone), I am going to give my public system a try (less $) to get a referral to a physio and will just have to be patient with the wait times. At the very least I want to eliminate if there is any serious cause of concern that only certain medical tests can tell, even if my pain level is low currently. And I think this time I’ll be going in with a better idea. At the same time, I’m going to research private sport focus physical therapists and have that on the ready if the public physio doesn’t work out. And if that doesn't work out, I'll regroup and keep moving along till I find something that works. Yea, that's going to be my game plan. 

 

Thank you everyone for your comments, I'm really grateful. Muah˜

 

giphy.gif

 

 

 

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1 hour ago, //Min said:

I think I’m going to give professionals another try, at the very least to at least first eliminate whether there is any serious injury by going to take more conclusive tests (e.g. x-rays/ MRI)

 

I think this is a great idea. Just to throw in a last two cents here, you may actually be okay without an MRI. PTs are trained in a wide battery of tests, which they should run through in their first physical exam, that will often show if you have a serious injury.

 

My hope, of course, is that the tests show that a major injury is unlikely, in which case they'll probably diagnose you with some kind of minor soft tissue injury and give you exercises. At least in the US, PTs almost never recommend MRIs unless you've done rehab for a month or two and had no improvement. (For my part, I've gone to a PT for several different injuries, but never had an MRI until I re-sprained an ankle that I was already rehabbing.)


The one final pointer I have for you that I wish I'd heard years ago, because none of my PTs ever mentioned it to me in my visits: it has helped me a lot to start reading about modern pain science and how it works. Pain (which is something you will probably be experiencing, hopefully rarely, for as long as you exercise) is a complex system that doesn't always actually mean that your body is being damaged. Right now I'm reading Explain Pain, by David Butler, PT. Not far enough into it to impart much wisdom, but I feel it's worth mentioning, because I do know that aside from eccentric-focused rehab exercises, pain education is the other main treatment that's been shown to have a verifiable positive effect on soft tissue injury outcomes. So for whatever it's worth, something to look into if you have the time. :)

 

2 hours ago, //Min said:

That makes sense. That’s probably the route I’m going to go, high reps/low weight. Muscles~

 

I think you have the right idea. At a certain point, strength = muscle mass, more or less; you eventually tap out the vast majority of your strength potential with the muscle you have. But that takes a good amount of time, well past the point that you're doing things like pistol squats and lots of pullups, so gaining strength without causing injury is a far better thing to focus on.

 

I am not particularly a fan of taking scientific studies on strength training at face value, because from what I've seen, the studies themselves have a lot of problems. But the general idea that they've led us to on this thread is not wrong; higher rep ranges, working up to the 3x12-15 range, will usually minimize the chance of injuring yourself.

 

2 hours ago, //Min said:

Mmm my ankle dorsiflexion seems alright?  I can only do that video test (with my feet flat on the floor) with legs and feet apart though, I can’t do it when my legs and feet are together. Maybe my dorsiflexion can be better haha.

 

Depends on what you're going for. If you wanted to do a pistol squat, I'd be saying sooner or later your feet need to get together. And I do think pistol squats are a great goal if what you want is knee and leg health. They really force you to tackle a lot of muscle imbalances that can cause knee problems.

 

But though having good ankle dorsiflexion has worked out well for me personally, I've never seen great info that says it's the key to knee problems. Machete might have a different reason he was asking, though.

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