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Old 12-03-2009, 10:12 PM   #51
Nick Hunter
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Hey Steven,

I read that. I'm interested in a fair bit of it. Funny thing is that with my bone spurs, I barefoot walk in the barefoot running gait. My feet often land in the middle or front, and my heels leave soon after.

The valgus tendency of my knee IS due to flattening of the arch during dorsiflexed movements. At 23, would you say, assuming I got rid of these spurs, that I'm young enough to retrain better stronger foot-leg movement patterns and structures?

Also, why is it that in therapy, I can do no resisted leg extensions at all, but I can do resisted hamstring curls relatively pain free? Does this have to do with the hamstring's pull on the lower leg not being channeled through the patella?

It seems most people's descriptions of PFPS pain are dull or achey pains after activity or while doing activity. Mine is acute and severe. If it lasted any longer than the instant it takes to buckle me, I would need to be on a morphine drip.

Also, since this is cartilage irritation, would it make sense to just go ahead and start taking a joint complex again? G/C/MSM?

Thanks for the link, some great stuff to think about in there.

Nick
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Old 12-04-2009, 09:01 AM   #52
Steven Low
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Quote:
Originally Posted by Nick Hunter View Post
Hey Steven,

I read that. I'm interested in a fair bit of it. Funny thing is that with my bone spurs, I barefoot walk in the barefoot running gait. My feet often land in the middle or front, and my heels leave soon after.

The valgus tendency of my knee IS due to flattening of the arch during dorsiflexed movements. At 23, would you say, assuming I got rid of these spurs, that I'm young enough to retrain better stronger foot-leg movement patterns and structures?
Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.

Quote:
Also, why is it that in therapy, I can do no resisted leg extensions at all, but I can do resisted hamstring curls relatively pain free? Does this have to do with the hamstring's pull on the lower leg not being channeled through the patella?
Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.

Quote:
It seems most people's descriptions of PFPS pain are dull or achey pains after activity or while doing activity. Mine is acute and severe. If it lasted any longer than the instant it takes to buckle me, I would need to be on a morphine drip.
If it gets bad enough it can be like that.

Quote:
Also, since this is cartilage irritation, would it make sense to just go ahead and start taking a joint complex again? G/C/MSM?

Thanks for the link, some great stuff to think about in there.

Nick
I would definitely suggest that.
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Old 12-04-2009, 02:36 PM   #53
Nick Hunter
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Quote:
Originally Posted by Steven Low View Post
Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.
Compressing arch. I think it' just forced to the ground as the ankles pronate and the tibia rotates to avoid the spurring.



Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).
How does quad strength relate to ACL protection?

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.
This has got to be the source of the pain, yes?


If it gets bad enough it can be like that.
Is there anywhere I can read about treatment of cases of PFPS that are like mine?


I would definitely suggest that.
Started on it today. Taking 3 pills (1 serving) twice to three times per day.
in bold...

My physical therapy went like this today:

HEAT + weighted extension: 10mins
Upright bike: 10mins
Hack Machine 1/4 Squats: 3x15 (super painful if further than 1/4)
TKE: 4x10 (did these with good intensity)
Waist band forward leaning 1leg 1/4 squats: 3x15
Hamstring curl machine: 3x15 (moved up in weight)
Bosu step up/down: 3x15 (leg dumps rather than lowers)
Bulgarian Split DB 1/4 Squats: 3x15
Circle-to-circle 1leg jumps: 3x10
Raised Ladder sidestep: 1x10 (down and back)
Mild stretching
Kneecap manipulation
Ice
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Old 12-09-2009, 02:55 PM   #54
Nick Hunter
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Knee freaked and bailed in therapy today. Despite the stretching. Only thing that makes sense to me at this point is that it happened after I'd done a bunch of quad stuff. Maybe the quad couldn't hold it together. Whatever.

If nobody can figure this shit out I'm going back to church.
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Old 12-18-2009, 01:07 PM   #55
Nick Hunter
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3 weeks therapy and no change. Better quad strength, better hamstring strength, better flexibility, and no change at all in pain.

Therapist says my kneecap tracks laterally and the lateral structures are very tight. When my quad flexes the kneecap actually seems to jump over the condyle. Like a quarter sitting on the edge of a table. I have a doctor's visit monday, and my therapist is reccomending that my doctor consider debridement, cleanup, or lateral release.

Possible that this lateral riding of the kneecap combined with heavy sports and heavy squatting over a long period has produced this pain. Make sense, as the weightbearing pain happens at a point almost precisely above a parallel squat. Who knows. I am scared of more surgery, but at this point I'll never play sports, bodyweight squat, or wlak up stairs right again. No other choice.
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Old 12-21-2009, 04:00 PM   #56
Nick Hunter
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Scope scheduled for January 5th.
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Old 12-25-2009, 07:42 AM   #57
Steven Low
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Yooo, I apologize for forgetting about your log. I definitely would've tried to help you out here the past few weeks.

Quote:
Originally Posted by Nick Hunter View Post
Hey Steven,

I'm due for another operation on the 5th of January. Something I wanted to run by you though, is this:

I have noticed during therapy that whenever I do hamstring curls in therapy I do not have knee pain. These are done relatively heavy (10RM) for multiple sets with just the injured leg, are through a FULL ROM, and produce no pain. If there is structural damage causing this pain how could it not present during this full ROM exercise? You've been helpful so far. Thought I'd throw that at you.
If you do indeed have some patellofemoral syndrome/chondromalacia patella (if I remember correctly), then the tightening of the hammies during leg curls is going to take pressure off of the patella-femur articulation. Thus, no pain.

For most people (1) strengthenin the hammies is one of the critical things to strengthen to rehab patellofemoral including (2) getting the knee tracking right over the toes, and (3) vertical during squats (box squats) to get proper hamstring involvement and lessen the load on the quads which is why Kelly Starrett recommends this if you've seen his vids.

This should definitely be a part of your rehab, although since you have had an ACL surgery you don't want the quad/hams to get too out of balance since you have a lot of quad atrophy. Basically, you're going to have to work in the last 20-30 degrees of ROM a lot to help strengthen that VMO with your quad work, and keep working the hammies. IMO.

Basically, if it were me I'd put off your surgery more and JUST do strengthening in the latter 10-20 degrees on ROM like TKEs (this feel fine correct?). Also, since you're probably getting a lot of lateral quad/tight IT band and TFL contribution, we'd start having you do some partial squats with a band around your knee to help get the glutes activated during the movement.

I would strongly suggest adding some specific glute work as well as using manual massage to loosen up any tender/trigger points in your vastus lateralis, IT band, and TFL.
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Last edited by Steven Low : 12-25-2009 at 07:46 AM.
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Old 12-25-2009, 07:57 AM   #58
Steven Low
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Quote:
Quote:
Originally Posted by Steven Low View Post
Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.
Compressing arch. I think it' just forced to the ground as the ankles pronate and the tibia rotates to avoid the spurring.

Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).
How does quad strength relate to ACL protection?

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.
This has got to be the source of the pain, yes?

If it gets bad enough it can be like that.
Is there anywhere I can read about treatment of cases of PFPS that are like mine?

I would definitely suggest that.
Started on it today. Taking 3 pills (1 serving) twice to three times per day.
OK so...

1. Yeah, that's the definition of valgus. IMO it would probably be better to get surgery for THAT rather than the femoral pain. I stated why in the article, but I'll go over it again. When your knee goes valgus the lateral quads, TFL and IT band are recruited strongly to help stabilize the knee. BECAUSE they are getting strengthened and tightened, your glutes and VM/VMO are suffering badly. So your kneecap is tracking off to the side as the imbalanace grows bigger.

Basically, if you can't get any good ROM in your ankles, and you keep going valgus that is the problem. Not the stuff at the knees.

2. Before the ACL ruptures, the body makes everything tight (quads, TFL, ITband, hammies, etc.) to protect it from damage. However, after it ruptures and depending on what kind of surgery they did, there's going to be major atrophy of the quad because of the trauma.

3. Yep, PFPS/CP is the source of the pain, but not the source of the dysfunction as we explained.

4. Add in .5g/10 lbs of fish oil as well. If you're not getting a lot of vitamin K from veges then supplement some as well (because of the blood thinning issue).

There's a crapton of inflammation, so you need some strong anti-inflams like fish oil. Depending on how it goes you may want to add in some NSAIDs as well. Combined extremely strong anti-inflam effects.

Are you eating Paleo?


Quote:
in bold...

My physical therapy went like this today:

HEAT + weighted extension: 10mins
Upright bike: 10mins
Hack Machine 1/4 Squats: 3x15 (super painful if further than 1/4)
TKE: 4x10 (did these with good intensity)
Waist band forward leaning 1leg 1/4 squats: 3x15
Hamstring curl machine: 3x15 (moved up in weight)
Bosu step up/down: 3x15 (leg dumps rather than lowers)
Bulgarian Split DB 1/4 Squats: 3x15
Circle-to-circle 1leg jumps: 3x10
Raised Ladder sidestep: 1x10 (down and back)
Mild stretching
Kneecap manipulation
Ice
Full ROM extensions won't help you at this point. Like I said earlier you're gonna have to work VM/VMO a lot... maybe even get some e-stim on it while you're holding each contraction to help get them active and stronger quicker. TKEs et al in that ROM are going to be the best.

If you're going valgus during any of these exercises that's a no-no. I'd rather you not do an exercise than go valgus because anytime you go valgus that's exacerbating your problem.

If I was your PT I'd probably hammer your VL, TFL, and IT band with massage every time to loosen them up. At least 20 minutes most likely of massage there.


Of course, I'm not even in PT school yet so what do I know...
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Old 01-20-2010, 12:09 AM   #59
Nick Hunter
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Nick vs. Surgery, Knee Edition: Round 2

My new doc seems heaps more comfortable in his diagnoses. He suspects cartilage lesions and plicas, and in his experience the MRI isn't good at finding those. His reputation is phenomenal, so I'm feeling good about this. One week to go.
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Old 01-21-2010, 05:44 PM   #60
Nick Hunter
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At least I'm putting on some muscle. Will ramp up # of sets now that I've found ones I want to focus on. Surgery shouldn't complicate anything as all of it's upper body so far.

Bench Press: 165x10 :will up to 3 sets at highest weight
Lat Pulldown: 145x10 :will up to 4 sets at highest weight
Prone Rear Delt Laterals: 12x15 :will up to 4 sets
Reverse Hyper: 160x15 :will up to 4 sets

Neck Harness: 35x15 :will up to 4 sets
Wheel Rollouts: BWx20: will up to 4 sets
External Rotations: 15x20: will up to 4 sets
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