Let's be brutally honest here....knee pain really sucks. It affects so many different aspects of your life. It aches, it stabs, and it burns.
Your knee pain may have started pretty subtlety. Maybe you felt a little "tight" and "crunchy" after a workout. You didn't think much about it though because it cleared up pretty quickly.
The "tightness" after the workout then turned to "tightness and pain" during the workouts. This wasn't a big deal though because as soon as you started moving, your pain disappeared.
That is until it didn't. Your knee pain is starting to bother you a little more. It takes longer to disappear during your workouts and the pain has gradually intensified after your workouts. You found your solution though, 5mm neoprene knee sleeves and some voodoo floss! Wow. Makes the world of difference. Your knees may be a little sore before, but you hit them with the voodoo floss and throw your knee sleeves on and you feel like a new athlete. You still have pain after the workouts, but you can live with that since you just hit a squat PR!
This solution "works" for a while....until your knee pain gets worse. Now it aches at your desk. Aches in the car. Aches at dinner. Aches in the movies. It hurts when you squat (knee sleeves and voodoo floss stoped working for you). It hurts when you run. It hurts going down stairs and when you take a knee. You cannot squat the weight you want to any more. And on top of everything, it's starting to wake you up at night. You try resting for a while and you avoid squatting for the next month. Your pain just does not get better though. Thoughts go through your head... "Will I ever be able to squat again?" "Will I need surgery?" "Will I have pain forever?" "Do I need imaging?" "Should I get a shot?" "I heard PRP injects work sometimes?" You go see your primary care provider. He/she says you might have tendonitis, your knee cap is misaligned, and you have arthritis (the knees of a 80 year old!). They say just to ice it , rest, and to "Stop squatting". "You'll probably have knee pain for the rest of your life. You're going to need a knee replacement in 10 years."
You try to rest it and ice it, but your knee pain is still there! You are frustrated and are not sure what to do. It feels "ok" if you don't do any kind of squatting. However; you want to squat, run, and jump again but your knee pain is just too bad!
This is a common story I hear from many of the athletes I work with who experience knee pain!
Here are the facts:
The good news is you CAN squat again.
Rest and Ice most likely are not going to fix your knee pain.
Pain Injections are temporary.
Squatting and running are NOT bad for the knees.
You can be pain free, regardless of what the imaging says (read the evidence here!)
You're most likely not going to need surgery in 10 years.
Why do my knees hurt?
If your knee pain matches the story above, most likely you are experiencing some kind of tendinopathy (Patellar or Quadriceps) or patellar-femoral syndrome. This injury is most commonly the result of poor movement patterns (Squatting, running, jumping), mobility deficits (ankle, hip) , stability deficits (hip, midline) , too much volume (more is not better), and too little rest.
What do I do about it?
With chronic knee pain, rest is not the answer! We actually need to load the tendon to decrease pain and encourage healing. This is not an overnight process! It takes weeks and sometimes months to fully resolve your problem.
How do we "Load" the tendon?
The first thing we need to do is remove excessive stresses on the knee. This means taking away the movements which trigger pain during your workouts. Once we remove the excessive stresses on the knee, we then need to LOAD the knee in a controlled manner. We do this through isometric holds, tempo squatting, and tempo lunging. We give the knee enough stress so you experience a little bit of pain (3/10 on the pain scale), but not enough stress that your pain doesn't return to baseline within 24 hours. If you return to baseline in 24 hours, thats great! It means your body is recovering and adapting to the stress we are placing on it. If you have an increase in symptoms, then we threw too much stress at it and you have had a negative adaptation to the exercise (your body wasn't able to recover from the stress placed on it.) You then repeat this process over the coming days and weeks. Trust the process and eventually you're able to squat heavy, run fast, and live your life without the knee pain you're experiencing!
Are there other treatments that could speed the process?
There are some other treatments which can help speed the process. Blood flow Restriction Therapy and Dry Needling can help improve healing and decrease pain. KT tape can also help decrease your knee pain. This doesn't speed the healing process, just makes your pain more manageable during it. The important thing to remember though is that these are adjuncts to help speed the process! They are not replacements for loading the tendon. Systematically loading the tendon is the way you're going to resolve your knee pain for good!
How long does this process take?
Well, this depends. There are a lot of factors to consider and it's an impossible question to answer correctly. Every individual is different. But, the process does work!
If you are experience chronic knee pain, find a clinician who understands the rehab process and understands your goals to help you get back to the activities and sports you love. They will guide you along your journey, let you know what's normal and what's not normal, and they will get you back to the things you love in the quickest most efficient manner possible!
Do you have lingering knee pain? Does your knee tend to "flare up" a few times a year? Do you fear hurting your knee again? Does this fear prevent you from living life fully, and training without limitations? I have good news for you, you don't need to live in fear of knee pain any longer!
The solution? Bulletproof your knee by fixing your foundational movement patterns and building strength within those movement patterns! Build resilience, lift heavy weight, and live your life without pain or worry.
Here at Ground to Overhead Physical Therapy, we help athletes all over the country resolve their chronic pain. We do this with in person appointments for athletes local to our clinic. Remotely, we help athlete through individualized training programs designed to resolve the athletes pain and achieve their goals. We coach the athletes through electronic communication, video analysis, and video calls; guiding them step by step along the process of eliminating their chronic pain.
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