nagging knee problem from studying martial arts

[TA Baracus]

Hello everyone.

About five years ago I was diagnosed with patellofemoral syndrome in both my knees. Since then I've had two lateral releases to loosen up my kneecap. I have been relatively pain free the last couple years, except for an occassional time when they start hurting.

Just recently I started studying jow gar kung fu (after taking about 10 years off since I last studying martial arts / tae kwon do). The art comprised of a lot of strong and low stances, and my right knee has been bothering me since starting. It is usually pretty sore after class.

Does any one know the best way to strengthen my knee? I feel my legs and knees will get stronger over time as i progress through the art, but what can I do outside of my practising to strengthen my knee? The pain is mostly on the outside and lower part of my knees.

Thanks for the help!

[Bill Hartman]

Standard posterior chain strengthening to start (box squats at 50-60% 1 RM, step-ups, hypers, reverse hypers, RDLs,etc.). Keep volume low (5 reps on average) and intensity to best effort -1 or 2 reps.

Because your patella will be hypermobile you've got a couple options that I would try, but I can't tell you what to do...experiment time.

Options:

Isometric holds for time in squats, static lunges, and your stances progressing the depth as you tolerate it. Pain should be respected or you're surgery will be wasted.

Pederson step-ups - a low, side step-up (to start about 4-6") with the load initially through the ball of your foot. As your knee reaches full extension to foot becomes flat on the step.

Give that a try and see how it goes.

Bill

P.S. Check your pelvic position as you lower yourself into your stances. If it tilts forward (back will arch) or your knee drifts inside the alignment of your foot, you need to consciously bring it back to neutral. If you can't hold it stable, you may need some abdominal strengthening. The anterior tilt of the pelvis will affect the knee position and the loading on the knee.

[bryanc]

Our standard protocol for PFPS is with eccentric strengthening. Both the evidence and our experience with the protocol (which has been in place for about 3 years here) have shown good results. Our program consists of 3 sets of 10 reps of drop squats, done 5 days a weeks for 4 weeks with increasing weight each week. This is followed by one week of lunges (3x10) and then two weeks of one legged drop squats.

[TA Baracus]

Thanks for all of the information, Bill and Bryan. Since I am just starting in this art my back isn't always as straight as it should, this has been pointed out to me many times.

Bill, you mentioned some exercises to do. Can you explain each exercises a bit further and kind of layout a basic program to help strengthen my knee? The only exercises that I am familiar with are step-ups....not quite sure about the others.

I have Alwyn's new book on martial arts conditioning and I am planning on starting that program soon, I just feel my knee isn't quite strong enough yet. Thanks again for all of your help, it is truly appreciated!

[Bill Hartman]

Originally posted by Travis Sinquefield:
I have Alwyn's new book on martial arts conditioning and I am planning on starting that program soon, I just feel my knee isn't quite strong enough yet. Thanks again for all of your help, it is truly appreciated!

A lot of the exercises in Alwyn's book fall along the lines of the one's indicated. The intial program is solid as far as resolving some issues you may have. Try out the first month's program and see how things begin to feel.

Bill

[TA Baracus]

Thanks for the insight, Bill. Yeah his program looks like it has a lot of good exercises for strengthening the legs and knees, since having a strong base is very fundamental to all branches of the martial arts.

Another question, in your application of active release therapy, have you shown it helpful for those of us who suffer from patellofemoral syndrome? Thanks again!

[Bill Hartman]

If there's ever something that I feel may have an impact on strength or mechanics I certainly give it a shot. Sometimes it works exceptionally well, sometimes not at all.

Unfortunately, it would be situational and I couldn't give you a specific application that would work on everyone.

Bill