Knee Injury

[fsk8r]

I finally saw the PT about pain I've been having in my landing knee for the last couple of months. She's diagnosed a mild sprain of the Medial Cruciate Ligament. I broke the patella in this knee about 10 years ago and I get odd twinges every now and then. This is just the longest I've been stuck with the pain as it normally clears up on its own.

Two questions:
I'm thinking the current problems are all skating related, but I've not worked out what it could be as I've not had any falls recently. My current theory is too many loop jumps (I'm working on it for the test, whereas before I've always limited the numbers I do because I've never thought it felt good on a slightly weaker knee).

The PT has given me some exercises to help strengthen around the knee and the quads (particularly the inner ones), which I'm doing religiously. Does anyone have any suggestions on other exercises that could help?

[Skittl1321]

Inner quads seem to be the key to all my knee problems.  I have major tracking issues due to imbalance.

I limit loops as well due to them being on my weaker leg.  I'm thinking of asking my coach if we can skip loop for the next test and just see if I can get a flip instead.  I need loop for my LTS freestyle level, but I don't really care about that...

I would stick to the exercises that the PT gives you- adding your own may counter-act what she is trying to do. If you feel the routine is too easy, you should ask her for more.  My PT also has me using a foam roller on my IT band and quads, to help keep the muscles above the knee loose.  (I also wear a jumpers knee strap- but I have patellar tendonitis too, so that might not help you, and I mobilize the knee cap with a sink plunger- but that also doesn't sound like an issue related to a sprain, so I wouldn't recommend it, unless you have bad tracking- but ask first.)

[fsk8r]

When you talk about tracking are you meaning the movement of the knee cap? I've been told mine is stuck on the outside. She suspects it's been there since I broke it and she's asked me to try to wiggle it around. So it sounds like we might have similar issues. Can you explain what you're doing with the sink plunger? As I tried moving it on my own and I couldn't although I could after she'd loosened it first.

I think I'll stick to her exercises for the next week (I'm competing in a week), but after next week I'm taking a two week break from skating (business travel) so I'm happy then to start thinking about extra exercises to help sort the imbalance out then.

[Skittl1321]

yes- tracking is the movemenet of the knee cap, mine tilts way too far to the outside and gets stuck there.  The PT works a lot with mobilization to get it to move back to the correct center position.

A sink plunger is a tiny plunger that is only a little bit bigger than the knee cap.  You suction it over the knee cap, and then move it up and down vertically along the leg, to start some movement, then pull it towards the inside of the leg, to help encourage the knee to move back.  It sounds ridiculous, but it has really helped me.  I got mine on amazon for only a few dollars (http://www.amazon.com/WM-Harvey-090350-Designer-Plunger/dp/B000H5SIOI - mine is blue, but red is cheaper right now) This is the exact plunger that my PT has in her office.



The other thing she has me doing is squats, using a balance ball against the wall to take some of the weight off the knee.  I've worked really hard to get my squats balanced between my left and right leg- the right leg used to do all the work, because my left is so weak, which also leads to the knee problems.

[fsk8r]

Interesting how amazon recommend a sink plunger with biofreeze. Apparently everyone's buying them for their knees and not their sinks!

I've been recommended squats and my pilates instructor (who works with the PT) has recommended an exercise where I stretch out the leg and turn it out, while balancing on my backside (other leg held bent in the air). I could feel it working my inner thigh so hopefully that one helps.

What is it with bodies falling apart?

[Skittl1321]

What is it with bodies falling apart?

I've already started planning for early retirement- because if my body is acting this way when I haven't hit 30 yet, I'm terrified of what "middle age" will be like.

[lindafmb]

The PT has given me some exercises to help strengthen around the knee and the quads (particularly the inner ones), which I'm doing religiously. Does anyone have any suggestions on other exercises that could help?

Muscles don't functionally work in isolation when we skate, so it doesn't make sense to try to isolate for rehab purposes either. It's not *really* possible to, for example, isolate the vastus medialis ("inner quad") from the rectus femoris, they work together to perform the joint action of knee extension. Any squat activity is appropriate for strengthening, and I really recommend using a shuttle or Total Gym type of apparatus, especially when you're rehabbing, because you can control the amount of body weight, have better control over the degree of knee flexion and can add propulsion safely, mimicking the way we use the knee, especially for loop jump take-offs.

If you've not seen them yet, I have several functional strength training for figure skaters videos on my youtube channel that contain exercises that are appropriate for what you're describing. You can find them under the "Off-Ice Conditioning For Figure Skaters" playlist:

http://www.youtube.com/lindafmb

[rsk8d]

Muscles don't functionally work in isolation when we skate, so it doesn't make sense to try to isolate for rehab purposes either. It's not *really* possible to, for example, isolate the vastus medialis ("inner quad") from the rectus femoris, they work together to perform the joint action of knee extension.

Thank you Linda for pointing out that statement!  There are so many PTs who still believe that you can strengthen the VMO, and you can't isolate it.  (This is a pet peeve of mine).  One cause (of several) for lateral tracking is the actual angle of attachment of the VMO on the patella.  If the VMO attachment is too high up on the patella, its medial pull may not balance the lateral pull of the VL, which causes it to track laterally.

In regards to the poster's questions about exercises: stick to functional, body weight resisted exercises that are specific to your strength imbalances.

[fsk8r]

Thank you Linda for pointing out that statement!  There are so many PTs who still believe that you can strengthen the VMO, and you can't isolate it.  (This is a pet peeve of mine).  One cause (of several) for lateral tracking is the actual angle of attachment of the VMO on the patella.  If the VMO attachment is too high up on the patella, its medial pull may not balance the lateral pull of the VL, which causes it to track laterally.

In regards to the poster's questions about exercises: stick to functional, body weight resisted exercises that are specific to your strength imbalances.

Thanks for that. I'm sticking to those recommended by the PT given that she's seen the knee. I was just wondering if there were any other variants for variety.

As a non-medical person I don't understand why anyone would think you can strengthen anything on it's own. Unless you're going to take a muscle off the body, strengthen it and replace it, there's always going to be something else attached. And with the way my brain works I'll be asked to point my toes and I'll point my fingers as well!