Question: Knee Pain!

Kisar,

you should also provide the opinion from the physician and physical therapist for a more comprehensive picture.

Before proceeding, you should have your client visit her physician for an evaluation. Since you both have identified a specific event (the race) that seems to have precipitated this pain, AND since it remains a year later, an evaluation by a physician is definitely in order before you continue with her training. Our first order of business as trainers is/should be "do no harm," and we can't know if what we're doing is exacerbating a client's problem without first having them evaluated medically.

I hope that this helps.

LaRue, CSCS
www.lecfitness.com
larue.cook@lecfitness.com

The knee pain is the body's way of indicating a problem experienced doing a particular movement which causes aggravation at the joint. Conditioning the surrounding musculature is certainly recommended for strengthening purposes via isolation quad (e.g., leg extensions) and hamstring exercises (e.g., sitting leg curls) but also consider the biomechanical movement patterns. Ensure the knee is tracking during flexion and extension with minimal rotation and genu valgus which is common in women. Also, many runners experience knee pain due to impact forces and this should be taken into consideration as well. The running shoe should be evaluated for shock absorption characteristics.

Defiinitely see a sports orthopaedist for a complete workup. One exercise that may help is the standing hamstring stretch. Place one foot out front and simply do a lumbar flexion to the point of tension, not pain. Hold for 8-10 seconds. The stretch on the hamstrings is significant.

And I agree with Brian that looking at her running shoe is a great idea. If you have access and can do a grid analysis, it would be a great way to get her the best shoe.

Take care.

Hello Kisar,
This may be out of your control and I agree with Karin. Have your clinet see her physician for an evaluation and any recommendations.

Sincerely,
Michael

Have her use a row machine until she gets better - always send and injured client to see their doctor immediately for any pain.

Thank you very much for all of your awesome answers! Yes, she has gone to her Orthopedic doctor and had physical therapy. The therapist noticed a weakness in her hip abductors. We have been working on that and I just want to make sure she is able to surpass those downhill parts of the races. I know downhill can cause a lot of knee pain or discomfort with individuals who have a history of knee pain, but as usual, they still run! We have already picked different legs of the two day relay race that limit the amount of downhill running, but I would like to have some suggestions on some out-of-the-box combo exercises that will work the hip abductors, without putting pressure on that part of the knee that is created from downhill running. Have you worked with those gliding discs? If you have some video references, that would be awesome or articles that you have written.
Thanks,
Kisar

Kisar, an exercise that I use with a lot of my female athletes to help with improving the hip abductors/adductors and glute strength is ankle cuff side-steps. This exercise really targets the gluteus medius (a prime contributor to certain knee issues such as valgus if they are weak).

I hope that this helps.

LaRue, CSCS
www.lecfitness.com
larue.cook@lecfitness.com

I find it interesting that many of you have talked about getting the shoes evaluated, but what about her feet and checking on pronation during gait and running. I've had patellofemoral issues since I was a child and ballet dancer andit all stemmed from my feet and worked it's way up. If she is pronating, it will throw her weight medially all the way up through the knee into the abductors (which you stated were weak). A great exercise to strengthen the inside muscles of the foot and calf comes from Kendall. Have her sit with her legs out straight- keep the knees straight - then flex the feet pulling toes to ceiling, and while flexed inwardly rotate the feet toward each other attempting to touch the bottom of the feet together. Remember, keep the knees straight. Hold isometrically for about 10 seconds and release. Repeat 10-15 times each day. It works wonders for the knees!

I agree with the responses so far: checking her gait pattern, foot assessment, getting checked by specialist, etc. Also, I would like to recommend a stretching/flexibility program for her that would address any issues that may be causing her pain. The program should assess imbalances on each side and then use the appropriate stretches. I've found that performing a lying trunk rotation stretch, hamstring stretching with bands and quadricep stretches performed with a stability ball help a lot in alleviating pain.

Thank you for those suggestions! I tried the abduction exercise with the step up and it worked very well! I have incorporated that into my clients routine and in my own. I recently have been having some knee issues from playing tennis. After doing those exercises that you suggested, I was surprised to see that my knee felt very stable. Thank you very much for these suggestions.

Thanks,
Kisar

Kisar, you might want to have her strengthen her vastus medialis.

Don't perform the movement open chain, perform it closed chain. The vastus medialis fires in the last 30 degrees of knee extension. Remember the SAID principle. She'll need to perform high repetitions as she is runner. Perform it with theraband attached to a fixed object and fastened behind the distal portion of her femur. Flex the knee about 30 degrees and extend it.

You can easily check to see whether her vastus medialis is underdeveloped by looking at the distal portion at the medial aspect of her femur as well as looking at how developed her vastus lateralis is. The vastus lateral is is a much more larger muscle that the vastus medialis and it could be that it is overpower the vastus medialis. Train the vastus medialis so that here is balance between the medial and lateral aspects of the femur so that the patella tracks correctly.

And, yes, she should see her physical therapist. However, I hope this is of help to you.

Best!

I agree with Joanne Duncan-Carnesciali.

Have you checked to see what her feet are doing when she walks or runs? Seems to me like a patella tracking issue . I would start at the joint below and above - ankle and hip- how much mobility they both have and then work on strengthening the Glutes. Usually the knee is in the problem , it's the symptom.

First thing is clearance from her physician.

Then, go simple to complex. Initially stop all aggrevating activity for at least two weeks. I also recommend pre bedtime ritual icing every night to calm the excitability of any over active or over stessed tissues/muscle/neural pathways. Then look at mechanics, if you see something obvious change it. Then trying different shoes or no shoes, does that make a difference? Or Shorter strides? The list is long and I usually get cues from the client that guide me.

Then there is an entire other route that I usually only go down for competitive athletes or clients that view themselves as "runners" and insist on getting back to higher levels/paces of running. This is much more complicated, but also starts out with the simple to complex system. It just includes in training recovery/inflamation modalities and requires much more commitment and adherence from the client (and me as well).

It is something you have to learn. Contact me if you want more guidance if you are still following this question or anyone else that comes across this question.