Knee Problems - exercise substitutions

newdawn · 10-30-2008, 09:58 AM

I've just started NROLFW. Had been doing weights machines before that.

I have pronounced crepitus, and pain in my knees when they are bent for a long time (in the car or at the movies) or whenever I bend down close to the floor and come back up. This is not new to me, it's been a problem for years but I've been able to deal with it by limiting impact exercises (treadmill, step) and tending towards low impact (elliptical, AMT, rower.) It was a minimal problem when I was doing Cybex machines for my weights. Now that I've moved over to the free weights, it's more of a problem.

The squats and deadlifts in Stage 1 hurt my knees. What I'm doing for now is using less weights than I probably could. The lunges and step-ups are not so bad.

Where can I get more info on possible replacement exercises for squats and deadlifts?

Here are my answers to the standard injury questions:

1. When did the pain begin? Quite a few years ago, maybe 10. (I am 42 and my dad has always had knee issues as well.)
2. What were you doing at the time? This came on gradually over years. It is in both knees
3. Where, anatomically, is the pain? Just under the knee caps, in the front
4. What does the pain feel like? It is not sharp or dull. It's a slightly sharp achiness.
5. Is the pain constant, or intermittent, or only on certain motions? It hurts mostly when I bend down close to the floor and come up. Going down stairs is worse than going up. Knees bent for long periods causes pain (like at the movies or in the car)
6. What motions make your pain worse? squats, deadlifts when I get down close to the floor. Anytime I walk for a long time, jogging
7. What, if anything, makes your pain better?Straightening my legs
8. Does your pain radiate to any other part of your body? No
9. What things could you do before, that you cannot do now because of your injury? Running, long walks, step class
10. What is your main concern regarding the pain and its consequences? I don't want to eventually need knee replacement, lose the ability to work out.
11. Have you ever injured that part of your body before? No, not that I remember
12. Is your pain getting worse over time? And if so, how much worse over what time period? Not in the past 10 years. I've lost 15 lbs which has ameliorated it somewhat. (I'm now at a healthy weight for my height). I have given up walking long distances or jogging for more than a few minutes at a time

UConnJulie · 10-30-2008, 05:39 PM

It sounds like you might have a chronic tendinosis of the patellar tendon. This is generally brought on by a variety of things, most notably weak or improperly functioning glutes and tight quads.

Things that should help ...
1. Stretch your quads.
2. Work out any trigger points in your quads.
3. Get your glutes working and working properly.

Deadlifts should not hurt ... so I would assume your technique is off ...

I would probably lay off all quad dominant work for a bit to really get your glutes working and decrease the irritation in your patellar tendon.

Hope that helps!

newdawn · 10-30-2008, 09:25 PM

I started with a trainer and she said my technique was right. But I think that the barbell she gave me to use is too close to the ground so I am having to bend down too far to grab it. I may need to put it on a box.

I do have very developed quads and I'm guessing much less so in the glutes. I'm also not very flexible in the quads or hamstrings, but I definitely do spend time stretching both the fronts and backs of my legs after any kind of work out.

I'm going to to doctor so I can stop guessing about my knees and find out what's really wrong with them. It'll be couple weeks though so until them I'll have to modify my deadlifts and squats. It was suggested to me to start the deadlift with my weight at the hip and lower it down to just mid calf and come back up. I think that may work. If not I'll try to put the weight bar on boxes. As for the squats, I think I just have to not go down as low.

Thanks for your input. I'll do some research on chronic tendonitis. I have to ask my dad again what his knee problem was....he's had both operated on (not replaced). That does not sound familiar though.

UConnJulie · 10-31-2008, 10:49 AM

Not tendinitis ... tendinosis .. different physiological processes.

If your quads are well developed then you are very likely among the majority and have some degree of quad dominance. It is correctible ... by what I listed above. Doing rack pulls instead of full deadlifts is probably a good idea. And I would probably sub single leg RDLs for squats. Avoid all quad dominant work at this point and focus exclusively on hip/posterior chain dominant stuff.

Don't be surprised if your doctor doesn't know much ... if you see an orthopedic surgeon, remember that his tool is surgery. Doesn't make him qualified in non-surgical situations. Hopefully you won't find that to be true, and your doctor will be worth his weight in salt.

newdawn · 10-31-2008, 12:33 PM

Thank you once again, Julie. I just got back from the gym. I asked a woman there who I always see who obviously knows what she's doing about the squat. She showed me a large piece of equipment, now I can't remember what it was called. Like a swingset that you stand under and the bar with weights that you put on your shoulders is on a track. She also said I don't need to go down as far in my squat as I am.

As to RDLs... I think those appear later on in the NROLFW program but I'll consider moving them up. Today, the squats didn't hurt my knees. I was so relieved! Could I have built up some strength after only 2 workouts???

Also, I added your "pre-hab" glute exercises except the X-band side step which I'm not familiar with.

Now, next session I'm due for deadlifts again instead of squats (if you're not familiar with NROL, the deadlifts and squats alternate each session) and I'll do them either with the weight elevated, or by starting in the up position and not setting the weight all the way down to the floor with each rep. Since I felt so much better today I have hope that I can "wake up" the right muscles and I'll be OK. I'm stilll going to the doctor though.

Have a fun with your kids tonight!

Gwynn · 10-31-2008, 03:11 PM

Hey there,

I have crazy knees also and my problems sound exactly like yours. What is working for me is strengthening hams in relation to glutes. I am in stage 4 and am squatting lower and lower without pain, and my allover pain has decreased for the first time ever, since I started lifting.

What is really working for me is squatting low, but I started out at a very low weight and only increased it a little at a time. I still have not squatted more than 85lbs, but when I started I couldn't squat at all without pain. If you decide to keep squatting and squat past parallel, make sure you use your hams to drive your body up, make double sure that your weight is on your heels. Even lift your toes if you have to.

Good luck and I hope it helps!

-Gwynn

newdawn · 10-31-2008, 08:59 PM

HI Gwynn. 85 lbs! Right now I'm using 25 for squats. But that's OK, it feels challenging enough and I don't want to blow it with my knees. Also, the first time I did the squats with the barbell on my shoulders I felt quite unbalanced and vulnerable. Today I absolutely did not, even with a bit more weight.

Did you also have pain with the deadlifts? How did you resolve that?

I was quite sore after my first two sessions. So perhaps I did actually get some muscle moving. I'm not sure if this is true, but I suspect that when you're already a fit person, the muscles respond faster. I'd been working on cybex machines since May. So the free weights are somewhat new, but not completely.

I find it amazing that I can work out hard, 90-95% of my max HR on any low impact cardio machine (elliptical, AMT, rower, occasional treadmill) and my knees don't hurt. Then, I go on a shopping spree with Mom and DD and SIL and my knees hurt for a week after. From walking. It's gotta be the impact on hard ground.

Gwynn · 11-01-2008, 08:32 PM

Hey I started my squats at 25 lbs! I have not had pain on deadlifts, and I don't bend my knees to the point where I would normally have pain to do deadlifts - my knees don't usually hurt until around 90 degrees. And these days they usually don't hurt at all as long as I have good hip flexion and no spinal flexion, so I can connect to my hamstrings to take most of the load. In other words, the more my low back can keep its natural arch, the better my knees feel when I'm lifting. How is it for you to deadlift from a higher place?

As far as shopping vs. training goes, in my experience when I am training, whether it be gym, dojo or dance studio, I'm focused on body awareness. Other times, not so much. Have you tried the Feldenkrais Method? It improves your proprioception and kinesthetic sense dramatically.

newdawn · 11-01-2008, 09:15 PM

I never heard of that Feldenkrais Method...I'll google it, thanks.

Yes, my plan for next time I do deadlifts is to either place the weight on boxes so it's higher, or to start the lift from standing and only drop it as far as is comfortable.

I need to learn more about how to use the glutes and hams more and quads less I think.

missjane · 11-02-2008, 08:20 AM

Quote:

Originally Posted by agymrat

Thank you once again, Julie. I just got back from the gym. I asked a woman there who I always see who obviously knows what she's doing about the squat. She showed me a large piece of equipment, now I can't remember what it was called. Like a swingset that you stand under and the bar with weights that you put on your shoulders is on a track. She also said I don't need to go down as far in my squat as I am.

That machine is called The Smith Machine. I don't think it's a good idea for you to learn the proper mechanics of the squat on the Smith Machine. It's just not the same movement plane as when you naturally squat. There are a ton of threads on it here in the forum if you do a search. Here's one:

Smith Machine or no Smith Machine? Holy War!

newdawn · 11-02-2008, 09:19 AM

Hey, MissJane, thanks for the link, will definitely read through that!

newdawn · 11-03-2008, 01:50 PM

Just a quick update. Did deadlifts today for the second time. This time I started with holding the weights while standing rather than on the floor. B/w reps I did not touch the weight to the floor but brought it just down far enough before my knees started to hurt. Much better. Not worrying about my knees as much I was able to get more out of the exrecise. Thanks again for the advice!

missjane · 11-03-2008, 02:04 PM

Quote:

Originally Posted by agymrat

Just a quick update. Did deadlifts today for the second time. This time I started with holding the weights while standing rather than on the floor. B/w reps I did not touch the weight to the floor but brought it just down far enough before my knees started to hurt. Much better. Not worrying about my knees as much I was able to get more out of the exrecise. Thanks again for the advice!

Sounds like a Romanian Deadlift instead of a CDL.

newdawn · 11-03-2008, 02:24 PM

Well, not quite. Looking at my book here, the RDL has a straight back and knees. In this case I bent my legs like a squat. I just didn't bend them far enough to set the barbell on the floor. (it's only 30 lbs so the disks on the end are small)

I could probably use a bit more weight, but not sure about 40 lbs. I'll try it next session when I only have to do 12 reps. I did find some little magnetic weights to stick on the end of the 30lb barbell today but they could only have been a pound a piece.

UConnJulie · 11-03-2008, 02:25 PM

That's why rack pulls would be ideal for you. Do you know how to do those?

newdawn · 11-03-2008, 02:38 PM

Not a clue, Julie! Does it involve something like the smith machine? See how I tossed that out there...I know what a Smith Machine is now!

UConnJulie · 11-03-2008, 04:12 PM

Here's a decent description ... and a video of them in action.

newdawn · 11-04-2008, 06:41 AM

Thanks Julie! Looks like that wouldn't be a problem for me...hardly any knee bend at all. But bending that little, will it work glutes and hams? Maybe I can set up the bar a little lower. I'll look for that rack at my gym. I could start with just the oly bar. That's 45 lbs, right?

OK, these gals obviously know what they're doing, but is it necessary to wear a scarf while lifting? the mom in me wants to scream..."not safe, not safe!"

UConnJulie · 11-06-2008, 06:32 PM

Ha ha!! Scarf is optional ...

It's okay if your knees don't bend. Keep them "soft" (ie not locked out straight) and drive the movement from your hips.

newdawn · 11-07-2008, 07:27 AM

OK on the "soft" knees. I'm back to deadlifts today. I did look around the gym last workout (squats day) and didn't see anything like that rack that's in the video, but maybe I can ask someone. I also have an appt. today to, hopefully, get a referral to finally get a diagnosis for my knees. then I can do some specific research.

newdawn · 11-07-2008, 10:57 AM

Update:

Doc says I have classic signs of "patellofemoral syndrome." So, as much as I hate to, I'm going to PT. I have my doubts about this Dx. My reading says it can be caused by weak quadriceps. I have well developed quads due to years of running, step class, cheerleading (I was young), swimming, and cardio machines such as elliptical and AMT. But it does sound like I have the symptoms....pain under the knee cap in the front, pain with impact exercise, pain with extended sitting.

eta: It also says tight hamstrings can contribute...definitely have that!

UConnJulie · 11-07-2008, 12:49 PM

Keep in mind that "patellofemoral syndrome" can be a catch-all term for anterior knee pain of any variety. Most current thought says that it is not caused by weak quads, but more likely weak/inefficient hips. If your therapist does not seem to "get this" and just prescribes you some basic generic exercises without really fully assessing your entire body to figure out what is going on, then find a different therapist.

newdawn · 11-07-2008, 01:33 PM

Yes M'am!! Thanks so much for the advice!

Catherine · 11-12-2008, 12:22 AM

This sounds very similar to like my knee issues too!! Thanks for giving a name to the sound that I hear in my right knee. I just looked up crepitus and it indicated that the cartilage was involved. Is that right? It has me concerned again.

newdawn · 11-12-2008, 06:30 AM

Catherine, I think that the term crepitus is just a description of the distinctive sound but can be caused by several different things. My doctor said that the sound alone doesn't even indicate anything is wrong and can be present in a normal knee. But the only way to know is to go to the doctor and get evaluated, right? I found a PT practice that has a specialist in sports (and works with my insurance) so I'm going to make an appt. with them today.

Catherine · 11-12-2008, 09:59 PM

Thanks ... my knees are certainly healthier than they were 6 months ago, but I'm still requiring a lot from them in training and want to be sure they will hold up long term. I am considering visiting a PT again not only for my knees, but for a few other nagging issues too. Nothing serious, but want to be sure I'm taking care of this body.

newdawn · 11-17-2008, 02:16 PM

HI All,

Had my first PT today, and Julie, I did "rack pulls" for the first time. I finally got up the nerve to use the power cage. I set the side bars to the lowest setting, which is right under my knees, and did the modified deadlifts that way. That also allowed me to use the oly bar. That's 45#, right? The barbell I was using was 40# and I wasn't sure I was ready for 50#.

I think I could probably go a little deeper than the rack pulls allowed, but then I'm back to the same issue of how to prop up the oly bar, or be limited to the barbells which stand off the ground at least a little.

PT said my outer quads are dominant. It does make sense, my legs are quite big there. Encouraged me to do some biking in my cardio. One-legged quad lifts (on the weights machines, the leg extenders), leg presses with a ball b/w my knees, and the adductor machine, not the abductor.

UConnJulie · 11-17-2008, 02:56 PM

So the PT is going the whole "strengthen the VMO" route ...

I'd add in a crapload of posterior chain strengthening on my own if I were you as that is more likely to eliminate the pain permanently. That and find and eliminate any trigger points in the quads ... and stretch your quads, hip flexors, and ITB/TFL a lot.

newdawn · 11-17-2008, 06:49 PM

OK, I'll do the exercises you (or someone) gave me for glutes and hamstrings...bridges and such. My quads and hamstrings are very tight so I do spend a good deal of time trying to ameliorate that, but I don't know that I make much progress. He did show me how to stretch some long tendon on the outer hip and thigh (ITB I think.)

UConnJulie · 11-18-2008, 09:11 PM

Quote:

Originally Posted by agymrat

OK, I'll do the exercises you (or someone) gave me for glutes and hamstrings...bridges and such. My quads and hamstrings are very tight so I do spend a good deal of time trying to ameliorate that, but I don't know that I make much progress. He did show me how to stretch some long tendon on the outer hip and thigh (ITB I think.)

This is in all liklihood a major source of your pain ... work out the trigger points first and the stretching will be more successful.