Off-Topic Knee pain question

[North Coast Miller]

Knee pain insights?
So about 4-5 months ago had an acute flareup of kneepain - more or less fine one day and the next a great deal of pain for about 2-3 minutes immediately following standing up from kneeling. There was no obvious trauma preceding.

Became apparent that it happens when my knee is flexed much more than 90° under load, but not 100% of the time. Bilateral ATG squat reliably produces a small popping/hitching sensation in the knee when coming up, pain that can be rapidly alleviated (somewhat comically) by giving the leg a few quick snap kicks upon standing. If I drop to a bilateral squat and shift to a lunge, either direction, and stand - no problems. Have been doing loaded single leg squats as primary squat exercise, no pain or issues as long as I only go to upper thigh parallel with floor. Condition very slowly improved over two month period and then seemed to stall, when I decided to get medical care.

Ortho could not detect anything obvious - tests for torn meniscus actually made it feel better, no problems with ligaments could be detected, no joint instability, bruising or swelling. Slight sensation of IT band passing over femur on outside of knee on that side, but pain is more centrally felt. When jumping rope I feel slight sensation of discomfort maybe - not pain in the back of the joint center. Radiograph shows slight arthritis in both knees, nothing unusual for my age.

Referred to PT who immediately diagnosed with patellar instability and assigned standard exercises to treat. One month later I stopped doing the exercises as they appeared to have no effect and my symptoms don't sound like textbook description of patellar instability. Continued with my regular routine, avoiding triggers in my day-to-day. Knee has slowly improved on its own, but still has issues with direct ascent from bilateral ATG squat.

Wondering if anyone has experienced a similar issue. Am thinking it might be a form of plica syndrom but really clueless here. Have a follow-up at end of month for possible MRI. I'd be a lot more concerned about it except it isn't really restrictive, just troublesome.

 

[Bauer]

I have experienced something somewhat similar. I could not kneel for a while and the lunging part during TGUs was painful.

Two things helped.
a) I noticed that stress on the straightened leg made it worse. (For example with legs stretched out and propped up on a chair, with one leg on top of the other - or even worse, my kid jumping on it). So I avoided this position.
b) Diaphramatic breathing, core control and head control - and lots of deadbugs. Somehow this relieves pain and clears up movement patterns.

@Geoff Neupert has a program for this, the Sore Knee Solution. Maybe this would be something for you!

 

[ali]

As you say, knee pain is a wide and varied collection of all sorts.
Ruling out medical issues ....a friend of mine had knee issues did all the softer non intrusive stuff and turned out it was a cyst....which you can never really rule out unless given a once over by a doc.

I have no knees. I get flare ups from to time to time, tweaks etc.
What I do....sit in seiza position with cushions to allow relaxed pain free sitting. Knee circles daily. Squat daily. Feldenkrais sessions.

I've neglected Feldenkrais recently mind but that really was the door that opened for me to sort out knee pain.

As you know generally speaking despite no knees it does not affect me athletically as I sprint at a high level.

Feldenkrais is worth exploring. I'd do some general classic stuff first and then explore knees, hips and ankles.

I've had some weird unexpected improvements in overall movement function from it.

There was a lesson that focused on the feet and the movement of your lateral knee fibula insertion point.

Not an area you'd pay much attention to normally....

It's a down to earth approach, free of bollocks. An emphasis too on breathing which in itself may have been a big influence for me but worth exploring.

 

[Bauer]

As you say, knee pain is a wide and varied collection of all sorts.
Ruling out medical issues ....a friend of mine had knee issues did all the softer non intrusive stuff and turned out it was a cyst....which you can never really rule out unless given a once over by a doc.

I have no knees. I get flare ups from to time to time, tweaks etc.
What I do....sit in seiza position with cushions to allow relaxed pain free sitting. Knee circles daily. Squat daily. Feldenkrais sessions.

I've neglected Feldenkrais recently mind but that really was the door that opened for me to sort out knee pain.

As you know generally speaking despite no knees it does not affect me athletically as I sprint at a high level.

Feldenkrais is worth exploring. I'd do some general classic stuff first and then explore knees, hips and ankles.

I've had some weird unexpected improvements in overall movement function from it.

There was a lesson that focused on the feet and the movement of your lateral knee fibula insertion point.

Not an area you'd pay much attention to normally....

It's a down to earth approach, free of bollocks. An emphasis too on breathing which in itself may have been a big influence for me but worth exploring.

This reminds me of Todd Hargrove.
I've read his book, Better Movement, a couple of years ago and really really liked it. Great insights into pain science and movement quality.

BETTER MOVEMENT

The Better Movement blog by Todd Hargrove. Practical Science on Movement and Pain.

www.bettermovement.org

He used to have free Feldkrais session on his webpage, not sure if they are still there.

 

[ali]

+1 to that.
My entry route too. He has a new book aswell but not read that.
Yeah, you can download a few lessons to supplement the book. Well worth it.
I bought some lessons from various places and had in person classes.
A lot of resources out there.
A donation page here. Some really wonderful stuff.....massive carry over to anything and everything.

Home - Feldenkrais Project

Welcome to The FP! A content guide for our 50+ free Feldenkrais lessons is below. Further down you’ll find What’s New and our other service, the pay-what-you-can FP Weekly Zoom Class I’m New Reduce pain and stress Learn to move, move to learn Free Lessons: Getting Oriented Today’s Lesson One...

feldenkraisproject.com

The ones I've done and repeatedly done have all been rich and rewarding
Very popular for musicians and dancers.

It's my chosen soft practice.

 

[ShawnM]

Knee pain insights?
So about 4-5 months ago had an acute flareup of kneepain - more or less fine one day and the next a great deal of pain for about 2-3 minutes immediately following standing up from kneeling. There was no obvious trauma preceding.

Became apparent that it happens when my knee is flexed much more than 90° under load, but not 100% of the time. Bilateral ATG squat reliably produces a small popping/hitching sensation in the knee when coming up, pain that can be rapidly alleviated (somewhat comically) by giving the leg a few quick snap kicks upon standing. If I drop to a bilateral squat and shift to a lunge, either direction, and stand - no problems. Have been doing loaded single leg squats as primary squat exercise, no pain or issues as long as I only go to upper thigh parallel with floor. Condition very slowly improved over two month period and then seemed to stall, when I decided to get medical care.

Ortho could not detect anything obvious - tests for torn meniscus actually made it feel better, no problems with ligaments could be detected, no joint instability, bruising or swelling. Slight sensation of IT band passing over femur on outside of knee on that side, but pain is more centrally felt. When jumping rope I feel slight sensation of discomfort maybe - not pain in the back of the joint center. Radiograph shows slight arthritis in both knees, nothing unusual for my age.

Referred to PT who immediately diagnosed with patellar instability and assigned standard exercises to treat. One month later I stopped doing the exercises as they appeared to have no effect and my symptoms don't sound like textbook description of patellar instability. Continued with my regular routine, avoiding triggers in my day-to-day. Knee has slowly improved on its own, but still has issues with direct ascent from bilateral ATG squat.

Wondering if anyone has experienced a similar issue. Am thinking it might be a form of plica syndrom but really clueless here. Have a follow-up at end of month for possible MRI. I'd be a lot more concerned about it except it isn't really restrictive, just troublesome.

Sorry for the knee pain. It sounds like how my knee pain started 14-15 years ago while in Iraq. I had the same torn meniscus tests and that went fine but the pain persisted. I took a month off from training and things got better but came back when I did tough lower body work. It turned out after an MRI a few years later that I did have a meniscus tear and had ground down everything in my knee to dust and now have very bad OA in both knees. I would get an MRI and find out for sure what your problem is so you don't go down the road I'm traveling now. I need both knees replaced but have managed to keep it off the last few years.

Not trying to be a downer man, just being honest with you.

 

[North Coast Miller]

Sorry for the knee pain. It sounds like how my knee pain started 14-15 years ago while in Iraq. I had the same torn meniscus tests and that went fine but the pain persisted. I took a month off from training and things got better but came back when I did tough lower body work. It turned out after an MRI a few years later that I did have a meniscus tear and had ground down everything in my knee to dust and now have very bad OA in both knees. I would get an MRI and find out for sure what your problem is so you don't go down the road I'm traveling now. I need both knees replaced but have managed to keep it off the last few years.

Not trying to be a downer man, just being honest with you.

This is good advice well received.

Having gone through similar with my wrists, resulting in a fusion recovery. I'll stay on it till I get the MRI.

It does continue to improve, but only up to a point, which is a red flag something more needs to be done - my left knee was the good one...

 

[ShawnM]

This is good advice well received.

Having gone through similar with my wrists, resulting in a fusion recovery. I'll stay on it till I get the MRI.

It does continue to improve, but only up to a point, which is a red flag something more needs to be done - my left knee was the good one...

My knee pain came and went for about 7 more years until I had an osteophyte break off and then went my right knee. Check out knee physical therapy programs online and add glute work to your warm ups. Sounds crazy as most of us are swinging like crazy and have for years but my glutes were still weak until I prioritized them. Single leg work like step ups and kick stand deadlifts help me as well. Hope this helps and that you are doing better soon!

 

[North Coast Miller]

So an interesting observation and maybe the PT wasn't as far off-base as I thought.

Dropped into a ATG squat and held it as a prying goblet squat. Did half dozen pulses raising my butt with only movement at the knee.

Without really feeling or hearing anything I was able to come straight up with no hitching or discomfort. Am going to add this to the daily.

 

[Steve Freides]

Bilateral ATG squat reliably produces a small popping/hitching sensation in the knee when coming up, pain that can be rapidly alleviated (somewhat comically) by giving the leg a few quick snap kicks upon standing.

I have no answer for you, but the "quick snap kicks" are something I do almost every morning - they seem to right the ship for me and afterwards, not just knees, but hips and ankles work better.

-S-

 

[coachnathanwhite]

@North Coast Miller

I've worked with many over the years experiencing some type of knee pain and here is what I have found -

1) Bodyweight - I'm assuming yours if fine, but being overweight over time can make the knees hurt.
2) Feet - Specifically the big toe. I have found that foot / ankle / gait dysfunction almost always travels upstream into the knees.
3) Ankle - Many are walking around on locked ankles and don't even know it.
4) Hamstrings - Even active people who deadlift and swing kettlebells need some type of focused hamstring work.
5) Diaphragmatic breath practice
6) Psoas release
7) As tolerated with knee pain, training the glutes in multiple planes of motion. Using a suspension trainer such as the TRX can help.

 

[North Coast Miller]

@North Coast Miller

I've worked with many over the years experiencing some type of knee pain and here is what I have found -

1) Bodyweight - I'm assuming yours if fine, but being overweight over time can make the knees hurt.
2) Feet - Specifically the big toe. I have found that foot / ankle / gait dysfunction almost always travels upstream into the knees.
3) Ankle - Many are walking around on locked ankles and don't even know it.
4) Hamstrings - Even active people who deadlift and swing kettlebells need some type of focused hamstring work.
5) Diaphragmatic breath practice
6) Psoas release
7) As tolerated with knee pain, training in glutes in multiple planes of motion. Using a suspension trainer such as the TRX can help.

Had my gait assessed not the first time, its fine.
The strange thing is how specific the mechanics that trigger it. Am doing skater squats w/120lbs on my back and no issues. Come up quick from ATG bodyweight squat and problems. Also the issue came on rapidly but without obvious trigger, though at 53 yrs old that sort of thing happens with increasing regularity...

 

[Anna C]

Also the issue came on rapidly but without obvious trigger, though at 53 yrs old that sort of thing happens with increasing regularity...

Also 53 here, so I can relate.

I heard a quote from Mark Rifkind, recently, something like "You know you're old when you go to bed healthy and wake up injured." ?

 

[ShawnM]

Also 53 here, so I can relate.

I heard a quote from Mark Rifkind, recently, something like "You know you're old when you go to bed healthy and wake up injured." ?

Good Lord that’s the truth!

 

[Steve Freides]

Also 53 here, so I can relate.

I heard a quote from Mark Rifkind, recently, something like "You know you're old when you go to bed healthy and wake up injured." ?

Yeah, that’s not a good thing. Waking up stiff and needing a little time to loosen up is a different thing, though, and should be fine for most people - and this will happen as you age.

-S-

 

[North Coast Miller]

Update, I've been making good progress on this. I continued to do single leg squat, for a quad specific exercise I now use a variation of a skater squat - drop into a single leg low squat, and simply straighten the leg, keeping the body locked from hip to shoulder - basically a very knee friendly leg extension. The hips go up, upperbody rotates around the shoulder axis. Have also begun doing these bilateral with a sandbag hanging low down my back so the load is just above my hips.

Additionally have done a lot of ATG squats, turning in either direction and coming up in a lunge. The knee still has some pain, but the hitching is almost 100% gone and overall stiffness has improved dramatically. I may have dodged another of father time's bullets here.

 

[Don Fairbanks]

Try tissue smashing your TFL's and calves. Long static stretching ( 1-2 minute holds per stretch ) for lower body or full body to remove tension. One or both of your ankles could be spending a lot of time in plantar or dorsi flexion from sheets/blankets during sleep. This can add up over time and cause some lower leg unexplained issues.

 

[ShawnM]

Update, I've been making good progress on this. I continued to do single leg squat, for a quad specific exercise I now use a variation of a skater squat - drop into a single leg low squat, and simply straighten the leg, keeping the body locked from hip to shoulder - basically a very knee friendly leg extension. The hips go up, upperbody rotates around the shoulder axis. Have also begun doing these bilateral with a sandbag hanging low down my back so the load is just above my hips.

Additionally have done a lot of ATG squats, turning in either direction and coming up in a lunge. The knee still has some pain, but the hitching is almost 100% gone and overall stiffness has improved dramatically. I may have dodged another of father time's bullets here.

I do a lot of pistols down to a chair, cooler, ect.. This has provided a good lower body movement without killing my knees and has added in stability over time.

 

[Dam]

I have a bad knee too, started feelling pain while squatting a few years ago.
I could feel it every time the knee has to travel to the side.
No problem when moving with the knee in a straight line (lunge, pistol squat...)
If i remember right, the diagnosis was the knee was moving outside of its "sheath" (not sure about the english word) which would inflame the surrounding area.
I ve had to be careful for a few years about my movements for this knee.
It feels much better today, but i could not say with precision what worked over the years.
I just noticed one day i did not feel any discomfort anymore, and now i can squat without any pain.
Crawling, bodyweight hack squat and riding bycicle (picturing pushing through the ground for both) seems to have help the most.