Rehabbing my VMO
I started physical therapy three weeks ago for knee pain. From everything I've read, I don't doubt my PT's diagnosis or his approach to rehab. I'm just wondering if there are any other ideas out there as to what I could to streamline recovery. (I know it's a long haul.)
I'll include the symptoms below for fun, but again, I think the diagnosis is correct. Here it is: It seems as if I had an injury to my VMO several months ago that caused it to basically shut down. Over the next few months, I thought rest would be enough to allow the injury to heal, so I did and then tried working up my activity again, mostly running and working through New Rules of Lifting for Women. (I started New Rules a week or so after the initial injury.) Apparently, during that time, the rest of my quad muscles picked up the slack of the atrophying VMO. However, it's my understanding that the VMO is crucial to the tracking of the patella in the femoral groove, so as the rest of my quad muscles strengthened, they started messing up the tracking of my patella and I started getting soreness due to the rubbing of the patella. After starting PT, I noticed that during that time, I had managed to favor my other leg for almost everything.
So, now I've been doing a lot of rehab exercises in an unsupported sitting positions, like a squat (with thighs about horizontal). There are several variations, like oscillating around horizontal, moving side to side without standing up, holding that squat with back against wall, etc. Those are alternated with hamstring exercises. There are some limited ROM single leg presses, too, and sometimes leg extensions.
He did some e-stim on the VMO. It took a few sessions before I really felt my VMO fire during the e-stim. It was obvious to me when that started happening, in fact it was a bit frightening at first! After workouts, I ice and take ibuprofen.
Anyway, I'd appreciate any rehab ideas you have. Thanks!!
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1. When did the pain begin?
Early January 2009, about 5 months before I started with the PT.
2. What were you doing at the time? Or did the pain come on gradually over time?
The VMO pain increased over the course of about a week. I do not know of any distinct injury. The knee pain developed over a month or so.
3. Where, anatomically, is the pain?
The initial (VMO) pain was on the medial side of my left knee. That subsided then the pain was felt deep behind my knee and on the upper side of my patella. Now, I only feel it on the upper side of my patella.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
The inital pain was dull, but intense (maybe that is sharp?!?). The subsequent pain is dull... not usually particularly intense, but enough for me to avoid that leg.
I can feel a click from my patella when I extend my knee. It happens at an angle between calf and ham of about 135degrees.
5. Is the pain constant, or intermittent, or only on certain motions?
Certain motions make it worse.
6. What motions make your pain worse?
Side-to-side or twisty motions used to hurt, but now seem to be ok. Knee extensions and stairs can cause soreness. Getting up from a seated position sometimes causes pain, but less so in the past couple weeks.
7. What, if anything, makes your pain better?
Resting for weeks.
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?
I haven't tried it since then, but about three weeks after the initial pain, I tried to swim (scissor kick) and the pain was intense. I have stopped running for now, assuming that the rubbing isn't good. Also, I have stopped squatting ATG for now.
10. What is your main concern regarding the pain and its consequences?
Since it seems so persistent, I'm concerned about the long-term fate of my knee, including the potential for arthritis in the future due to the patella rubbing.
11. Have you ever injured that part of your body before? If so, how?
No, although I did strain my quad (not just the VMO) last summer.
12. Is your pain getting worse over time? And if so, how much worse over what time period?
If I don't rest and go about my regular workout routine (lifting + running), it gets worse to the point that I'm limping and I have to manually move my leg in certain positions.
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