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I have been diagnosed to have chronic plica syndrome and instructed not to do full squats, deadlifts, knee extensions or lunges. (I have no pain except temporary pain when I do full squats, etc., so the doctor advised that the problem is too mild for surgery, but it is still too serious to continue doing full squats. The problem became painful for about 15 minutes in the last week of phase 3 of Ian King's Limping Program. Before then, there was a light snap in only my right leg whenever I lowered past 90 degrees--nothing during the concentric phase. I first noticed the snapping many years ago when I first began exercising.)
If I do only partial squats and partial leg presses for my quads or knee dominant exercise, will I be causing some problematic muscle imbalances? Are there any addition exercises that I should do for quads? (I am presuming hamstrings and glutes will be easier to deal with: stiff leg deads, good mornings, leg curls, hypers, reverse hypers, etc. were not proscribed.)
Any other suggestions would be appreciated. (The doctor also recommended glucosomine/chondroitin.)
The snap is just a fold in the synovium (plica) rubbing most likely over bone. Do it enough and with enough frequency of load, it gets inflammed thus the pain.
It's not uncommon to rehab such a condition with the same execises that irritate it (after the inflammation calms down) such as squat variations, step-ups, etc. The issue is depth of squat, degree of knee bend, and frequency of such exercises to prevent the irritation.
Not sure what you're referring to by muscle imbalances? Imbalances for a specific activity? For a specific range of motion? For a specific speed of movement? Because recruitment patterns and tension produced will be different based on each parameter. Or are you just talking muscle size??
Glucosamine/Chondroitin for plica? Hmmm...it won't do much for the soft-tissues but if you've got some wear and tear on the cartilage (the plica can actually rub a groove in the bone) it may preserve what's remaining.
I just reread your post. Are you saying you had pain for only 15 minutes, on one occasion?
Bill, I've got the same condition, and it acts up from time to time. With me, I've been told that my lack of a lateral meniscus and the resulting screwed-up biomechanics tend to irritate the plica during some activities. In my case, it usually happens before or after deep knee squats. Anyway, that may be what he is meaning as an imbalance. ?
Despite my promise to BryanC, I will give you a bit of advice Smokey...if it gets pretty irritated and clicks a lot, lay off of it until it settles down or you could get into a vicious cycle. In my case, the exercise that Bill described that helped me get past it and strengthen the knee was cycling, where you can control the load to and angle of the joint and strengthen the associated knee muscles in a relatively safe environment (or so I've been told). Anyway, that's what worked in my case.
This is close to, but not quite, the first time I squatted. For about four years, I was using a leg press machine (about double my bodyweight). In the last four months, I have done Ian King's bulking program (with squats) and limping program (with squats), taking rest weeks about every fourth week and doing deep squats.
I ran into the problem while deep squatting in the last week of the third month of Ian King's limping program, after raising the weight comfortably throughout the month.
Yes, the pain went away after 15 minutes and has not really returned. I took a few weeks off and squatted again today using quarter squats. I felt some oddness, but not really pain in my right knee.
Most of what I have read about treats the problem as a temporary injury (requiring rehabilitation), but I really have what I think Kaiser is referring to: screwed up biomechanics that "improved form" will not cure. My right knee snaps at 90 degrees, which the doctor said was typical.
My doctor also said that continuing to squat to 90 degrees and beyond would risk further problems that would not go away after 15 minutes. He also said that I actually have the problem in both legs even though only the right one snaps. Therefore, he recommended quarter leg presses, adduction machines and a few PT-type exercises (back of the knee on a towel and press down, etc.). That is, he is not regarding this as a rehabilitation issue, but as a chronic problem that will get worse with "improper" use.
The imbalance question is both a functional and an aesthetic one. I am concerned that, by doing only partial squats, my quads will be too weak in certain parts leading to possible injury in unrelated activities.
Incidentally, Kaiser I appreciate your reply and, while bryanc's posts are typically quite interesting, please don't let him dissuade you from giving any sort of advice. My doctor actually recommended that cycling was a good exercise. Having spent about four years exercising on a stationary bicycle and leg machines with limited results, I have to confess that I was looking forward to focusing on squatting.
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