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Understanding Knee Pain: Part 2

Path to full recovery


Hi guys! This is Drs. Michael Hauber and Patrick Chandler again. We hope everyone was able to check out our previous blog entry on the knee: “Understanding Knee Pain, Part 1”. If not, check it out here. If instead you would like to jump straight to learning about our step-by-step process to helping our clients solve their knee pain and fully resume the activities they love, then this is the article for you.


First, a disclaimer: if you are dealing with a “hot” knee i.e., severe pain, swelling, and/or inflammation, take action by contacting a health care professional as soon as possible. Contact our office at (913) 396-9726 to schedule a free 15 minute phone consultation and we will help you determine what the best plan of action would be. If you are just trying to learn more about how we treat the knee or are dealing with very minor aches and pains, then this is the article for you.


Step 1: Identify and Remove the Problem


First, recognize that if you are in pain, this is a health problem, not a fitness problem. You need guidance from a healthcare professional. Don’t try to work through the pain by continuing the same activity that is provoking your symptoms. This is like slamming your car door on your finger over and over again. The body has an incredible buffering system and you MIGHT be able to get away with ignoring the problem for a certain period, but eventually something will give in the way of injury. Keep in mind, one of the most common sense recommendations we give to our patients is to first remove the problem. We ask our patients to temporarily remove the activities and exercises from their day that directly cause their pain. The key word is “temporarily”. This could be for a few days, for a couple weeks, or even months. It is all dependent on the context of the situation. Generally, the more severe, irritable and broad the symptoms, the longer it takes to resume the activities that initially caused that pain. This is why it is so important to address even minor problems as soon as possible. The longer you wait, typically the more complex and difficult it becomes to manage that problem.


How does this relate to the knee? If it hurts to squat, take a break from squatting. However, if you can lunge, step, or dead lift without pain or dysfunction, then keep it up! What is dysfunction? Generally, if you can do the movement with good technique, meaning someone is not trying to cover their eyes when they watch you move, then you are probably okay! Part of our job as physical therapists is to educate you about what movements and exercises are safe to continue to train while we protect the site of pain and/or injury. We want you to keep training and being part of your gym community (or virtual community…).


Step 2: Know Your Environment


Once we temporarily remove the problem, then we have to consider how your environment may have contributed or led to it. This requires an honest appraisal of your typical activities. This may include determining how long you sit each day, how you cope with stress, how long and well you sleep each night, the duration, type, and variability of exercise that you choose, etc. Does your day require a lot of repetitive tasks? Is your training specialized? If all you do is run 6 days per week, but lack an appropriate warm-up and cool down, or a focused strength and conditioning program, then we have to teach you how to introduce more balance to your training. If you sit all day and then workout on machines, then we have to reconnect you to the fundamental human movements that keep your body resilient to tackle any fitness pursuit.


Remember, as humans, we are meant to move and age gracefully. We are meant to walk, run, squat, jump, crawl, climb, lift, carry, throw, catch, and balance on all kinds of surfaces with ease. If your environment is lacking some of these fundamentals, then we have to teach you how to re-introduce them. You can still choose running as your primary outlet for fun and fitness, but we may introduce fundamentals into your warmup/cooldown and highly encourage you to adopt a strength and conditioning routine that builds your capacity with these movements. You may even find that a warm-up and strength and conditioning routine that targets your weak links will make you a better runner. Revisiting and applying fundamental human movements also breeds resilience in all your life pursuits.


Also, keep in mind that some of the big rocks to managing pain and inflammation involve how well you cope with stress and recover from your day. Sleep, hydration, diaphragmatic breathing, appropriate nutrition, and gentle, pain free aerobic exercise go a long way to accelerating the healing process. If you are dealing with minor aches and pains in your knee, check how well you are applying each of these big rocks to your day.


Step 3: Assess Your Movement


In physical therapy, we start by assessing how you perform fundamental movements, such as a hinge, squat, lunge, step, and single leg stance. If those movements are dysfunctional, painful, or both, then we break them down into their component parts to see where the weak link is in that pattern. Remember, even though you may be dealing with knee pain, this is rarely the cause of your pain. The body is like a chain link fence - each link works together. The health and function of your knee is dependent on the health and function of everything above and below it. If you have stiff ankles or stiff hips, there is a very good chance they will lead to excess stress and strain on your knees. Once we know what your movement baseline is for each pattern, then we perform a local examination of your knee to determine the pain generator.


Step 4: Draw a Map from Point A to Point B


Identifying the pain generator helps us determine your prognosis and prescribe interventions specific to helping that structure heal. Ultimately, it allows us to draw your map to becoming pain free and resilient to resume the activities you love. For the knee, you may need knee-specific interventions like joint mobilizations, cross-friction and soft tissue massage, and stabilization exercises. You may need ankle and hip mobilizations, core strengthening, and improved static and dynamic balance. You may need to address asymmetries and weaknesses on your opposite leg. Remember, interventions should be specific to the person and context of the situation. Be cautious if you are ever given a generic sheet of exercises to solve your problem. Each person is unique and requires specific interventions.


Step 5: Develop Tools for Self-Management


As physical therapists, we are movement guides. We may provide hands-on treatment, but our role is primarily centered around empowering you with the tools to stay healthy and fit long-term. We believe that a large percentage of the problems that we see in physical therapy could be prevented by taking action more quickly, programming appropriately, and staying attuned to your environment. We want you to have feedback tools to know how well you are moving and where you should focus your efforts when taking action. If you can recognize when you are not moving well, then it is far easier to chart a path to immediately addressing that dysfunction than letting it potentially lead to pain or injury.


How You Can Take Action:


If you are dealing with minor aches and pains in your knees, what should you do? Go through the steps below.

1. Temporarily, take a break from the movements that are painful.

2. Make a list of your typical daily activities and fitness pursuits. If you are doing too much of one thing, whether it is sitting or specializing in one form of fitness, try introducing more balance to your environment. Unless you are an elite athlete, specialization is rarely beneficial or effective to moving and aging gracefully.

3. Assess your movement. Putting the lens on ourselves is difficult because we are inherently biased and often lack the ability to fully view how we move. However, if you know the standards of how to optimally perform some of the fundamental lower body movements, then this is a good starting point. Here are some examples from Dr. Tim:

a. Squat

b. Lunge

c. Step Up

d. For other examples, check out the “Ready to Run” standards on the Restore/Thrive YouTube page.

Take a video of yourself from the front and side as you try to perform these movements. At the least, this will set your movement baseline.

4. Draw a Map from Point A to Point B

If you know your movement baseline, then you can start to draw a map from Point A (where you are now) to Point B (where you want to be). If you want to run, but don’t meet any of the “Ready to Run” standards, then start practicing the movements prescribed in those videos on a daily basis and retest how far you are from meeting those standards. Keep applying them until you meet them.

5. Develop Tools for Self-Management

a. Work on your weaknesses daily: if you have gaps in your standards, then work on them every day. If you struggle to perform a deep squat, then work on it, or its component parts every single day as outlined in the Restore/Thrive videos.

If you need some extra help to improve your mobility, acquire a mobility start-up kit: foam roller, monster band, and lacrosse ball. If you need help on when or how to apply these tools, explore the Restore/Thrive YouTube page. Regardless, keep your tissues and joints healthy by taking care of them every day, even for 10 minutes.

b. Check your readiness to train on a daily basis. This is a simple, but effective tool to see how well you are recovering from the previous day’s work or training, and how primed you are for today’s workout or tasks. Rate each of the following on a 1 (awful) to 5 (excellent) scale:

i. Sleep

ii. Mood

iii. Energy

iv. Stress

v. Soreness

Divide your total score by 25 to find your readiness score. For example, 10/25 = 0.4, or a readiness score of 4/10. If you score significantly lower than the previous day, this would be a good time for active rest and recovery, not a high intensity workout.


Now what if you tried all of these steps and your knee pain was the same or only marginally changed? If that’s the case, then we encourage you to reach out to a healthcare professional. Contact us at (913) 396-9726 and we will schedule a free 15 minute phone consultation to determine what the best next step would be to help you resolve your pain and rebuild your resilience with performing the activities you love.


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