Recovering from an injury.

[Query]

Before Christmas, I injured doing jumps badly.

I don't think it is an acute injury. It's one of those things where the pain shows up a few hours later. It goes away and comes back again. I think that is supposed to be a sign that the pain is caused by inflammation, though, as mentioned below, I may now have a differential muscle length/tension issue that is causing off-center kneecap tracking.

My coach had said I was landing wrong. My landing foot would touch down too close to the side of my body, so my knee would bend outwards (laterally) as the landing completed. It sounds like all I had to do was to put the foot down farther from the body, so the knee could go down without lateral bend. For some reason, probably too much incorrect practice, this proved difficult.

Fortunately, my muscles are short enough to protect my ligaments inside the knee. I believe what stretched was the line of surface muscle from the ankle, over the knee, to next to the glut, because that is where I feel tension if I push the knee that way. I feel the injury near the glut. I can also clearly feel more muscle tension on the outside (lateral side) of the leg then on the inside (medial side). If I use my hands to pull the muscles shorter on the inside, and longer on the outside, the pain goes away, so I think the injured muscle has somehow partially healed shorter, and turned this into a knee tracking problem, something I already had a tendency towards.

I haven't felt it safe to jump since. I even feel a painful stretch if I try to wind up for a spin, or drive (my car seat doesn't adjust back enough, and positions me so my knee is pushed a little to the outside when it is on the accelerator). I've stayed out of private lessons, but have kept up Adult Synchro practice.

I tried resting for a couple weeks. Then I tried "theraputic exercise", including mild stretches, mild exercise, hot and cold baths (or the equivalent in a hot tub and swimming pool, though the pool isn't really ice water), even Ibuprofen (I hate drugs). When I'm not in pain, I've tried leg presses on a weight machine.

And it works - for a few hours. But by next morning, I start to feel pain again when I get out of bed, or an hour or two later.

I'm running out of ideas. I don't understand kinesio-taping. Maybe a little athletic tape, on the leg or a knee brace, could pull the knee cap towards the inside of the leg, but I'm hesitant to do so without expert guidance.

Anyone have any ideas? Is is this a problem that needs a good PT?

And do any of you know a good Sports PT near Washington, DC? I think someone mentioned one near the University of Delaware. I need someone who can work without requiring an MRI, which I can't afford.

[jjane45]

Good luck finding a great PT and have a speedy recovery...

[Query]

First off, I'm still looking for a good DC area sports PT. Anyone know one, please?

I've been carefully feeling the tensions in my leg, and starting to think I have it completely wrong. I think there is no injury, that it is all muscle imbalance.

The other two times I had clear signs of inflammation, Ibuprofen took it down almost immediately. This time it had no effect whatsoever.

What I feel in the right leg is muscle tension all over the right (outside) part of the leg. I now think that jumping with the outwards bent knee strengthened those leg muscles. On top of that, my coach had me strengthening those muscles more, by doing leg lifts in a 45 degree back and sideways direction.

None of the exercises or weight machines I've used strengthen the inner leg muscles.

So I think this is a simple muscle imbalance. I need to strengthen the muscles on the inside of the thigh and down the inside of the lower leg. The only way I can think to do that with what I have available is to use stretch bands and a chair, to pull inwards against the stretch band. And I may need to work on stretching the outside muscles of the leg. It looks like the standard stretches in which the right leg is carried over the left part of the body might do that. I could try jumping with the knee bent inwards - but I don't like that idea, because there are lots of places that say jumping and weight support in general with inwards or outwards bent knee is potentially dangerous.

The other leg is more symmetric in tension, but doesn't have the strong tension at all.

That doesn't explain why there is pain in those outside muscles. But there are people in the strength training community who claim that rapidly strengthened muscles should hurt. Jumping with that knee bent outwards probably was rapidly strengthening those muscles. Other books I've read, from the Certified Athletic Trainer community, claim that prolonged muscle pain (which it called DOMS  = Delayed Onset Muscle Soreness) shouldn't happen if you train right, but maybe the strength training community actually has these things at least partly right.

If selective muscle strengthening and stretching works, I won't need a good PT. What is more, the sideways muscle tension is exactly what the good sports PT I visited in upstate NY said I needed to eliminate knee tracking problems that occur when I do one-leg deep knee bends.

If the strengthens and stretches doesn't work, then I really need a good sports PT.

[Skittl1321]

Ask your primary care provider for a PT referal.  

For both my knee and hip (we are pretty sure I have a tear in my hip) the PT has not ordered imaging.  I won't get surgery, and her treatment is no different if it is a tear vs presenting itself as a tear.

Ultra-sound and massage worked wonders on both.
Taping helped a lot when she did it, but even with lessons, I couldn't duplicate the results (she doesn't kinesiotape though- she uses leukotape)  I can't tape anymore though because ,y skin was reacting to the cover roll, and pre-wrap does not allow the tape to work correctly.

For knee tracking, I use a plunger on my knees to encourage mobility.  Weird, but it works.  A sink plunger, not a big one.  Strengthening the inner quad is important to knee tracking, most skaters have overdeveloped outer quads.

Feel better.

[fsk8r]

I'm sure others better qualified can explain this better. But I've always been told that my knee should be over my toes (or lined up with them). It shouldn't ever be turned out or turned in when landing. The only points in the leg which can rotate are the ankle and the hip joints. The knee is a straight up and down hinge.

I think I would go back and work with your coach to train the landing position and then go back to starting to jump again. I do wonder about your statement about your foot being too close to your body. As far as I was aware I couldn't really move how far out my leg is from my body but I can control which way my top half is leaning in relation to where my legs are. I want my weight to be passing through my landing leg.

And you quite possibly have a muscular imbalance in the leg. There seem to be quite a few of us who have something similar. But then there are two issues here, one being your landing position and the other your quad strength.

[SK8N]

I also have knee issues.  Mine is a muscle imbalance.  I am slightly knock-kneed, so my kneecap tends to sit to the outside naturally.  Add the fact that my outer quads are stronger than my inner quads (since skating strengthens the outer quads) and it pulls my kneecap out even farther. 

My PT gave me exercises to do, but after a few weeks, I wasn't seeing results.  The exercises were general thigh and hamstring exercises, most of which I already did.  I did my own online research and started doing more inner thigh exercises and IT band stretching and the pain went away.   I think the one exercise that helped the most was 1 foot leg lifts.  I used the leg lift machine (the one for quads) and used a light weight.  I turned my foot out slightly when lifting.  It really isolated the inner quad muscle near the knee.

[Skittl1321]

and IT band stretching and the pain went away.   

A foam roller on the IT band has been a miracle for my knee pain.  (Also for my calves.  I couldn't skate without my foam roller.)

[Query]

Well - if you think of it, if the skate touches down at just the right place, a properly aligned knee bend can absorb all the horizontal momentum, which is supposed to be the healthiest thing for most of our bodies. If it touches down to close too close (laterally) to the body, the knee will bend laterally (outwards, as in supination). Likewise if it lands too far from the body, the knee will bend medially (inwards, as in pronation). It's just another way of thinking about being at the wrong landing edge depth, or about knee alignment.

But the important thing for me is that landing too close forces the muscles on the outside of the knee to stop the motion, which means it strengthens those muscles. I'm a little surprised that a few weeks of jumps should be enough to strengthen anything to the point of imbalance, but the concept makes a lot of sense. Maybe it just nudged an imbalance that was already there, because all figure skaters are taught to stroke pushing outwards, not inwards.

I've been doing a few different exercises using stretch bands and leg weight, to strengthen the inner quads and hamstrings, and the other muscles that affect knee alignment, to try to create a more balanced muscle tension, that will force good stable centered tracking. I don't know yet whether it will work - two days hasn't been enough.

I've been advised that landing jumps with poor knee alignment in the opposite direction, while it might strengthen the right muscles, would not be a safe idea.

However, while the clearly unequal muscle tension accounts for knee pain from tracking problems, it doesn't explain to me why the muscle with the greater tension should feel sore. So I may have to talk to a PT if this doesn't fix it.

[techskater]

Why not look into a personal trainer?  I started working with one recently who doesn't have a background working with skaters, but is very good at detecting muscle imbalances and devising torture exercises to help work through the imbalances and creating strength.  She's also a yoga instructor and gives me yoga poses that work the muscles that are tight. 

[Skate@Delaware]

Don't discount the physical therapy/sports department of the local university. They might be able to help you out for a discount or even for free. At the very least, they might be able to point you to someone (PT or sports trainer) in your area that works with athletes and doesn't charge a lot.

[Query]

Don't discount the physical therapy/sports department of the local university.

What a cool idea!

Will do. There are lots of local colleges and universities to try...

[Query]

The problem seems to have mostly gone away.

I think the exercises helped, but it might just be not jumping. Cuz when I tried to jump again, it got sore for a while. I could NOT make myself land correctly, at least not quickly.

Tried jumping off-ice. I can keep the knee aligned off-ice, and it wasn't a problem. Maybe it's practice: I haven't practiced jumping much off-ice, so I don't have anything to unlearn.

But maybe I'm too old to jump.

[Doubletoe]

Jumping on the floor sounds like a good idea.  Also, Skittle1321 had an excellent suggestion.  Did you buy a foam roller yet?  It definitely sounds like your IT band is tight and pulling on the knee, which is a very common problem among skaters.

A foam roller on the IT band has been a miracle for my knee pain.  (Also for my calves.  I couldn't skate without my foam roller.)