Knee issues

[Andy T]

Since we have the rotator cuff thread, I wanted to see if people have suggestions for knees. I am in my early 40s. A few years ago I started rucking with a 30 or 50lb pack for about 7 miles, once every other week or every week.
This summer after attending a 2 day pistol course - and spending most of the time standing, I went rucking. I didn't finish my usual route due to persistent left knee pain. The next morning my left knee felt "frozen" and hurt like an SOB walking up/down stairs.
The doc said I have early onset arthritis (based on X-ray) and I did PT for left knee. I did go back to rucking but usually without any weight or with 20lbs.
Last week, I was "running" up the stairs at home and after landing on my right foot, immediately felt something off. There was intense pain on the inside of the knee cap. The pain even wakes me up at night. Even sitting as a passenger in a car is uncomfortable.
According to the doc, I may have stretched/inflamed my ACL and also have early arthritis (based on X-ray), now on my effing right knee. PT is scheduled for next week.
For my job, I sit, although the desk has a standing option. I also have some kettlebells that I have been working with before my most recent knee issue.

Are there any other suggestions from exercise/nutrition/supplements to help contain the knees, and hopefully allow me to, if not ruck, than just walk around for long periods.

[RevolverRob]

The first is to follow the PT regime for your knees to the T and get them healthy. Including taking time off of rigorous training/hiking/rucking to get healed. Healing is what you need first.

The second is, once healed, to evaluate your footwear carefully. You may even need a podiatrist to evaluate your feet. Knee pain is nothing new for wearing/carrying heavy things, but a lot of it can be driven by inappropriate support at the foot level when walking/hiking/running. Also, make sure your ruck is right and is putting the load on your shoulders and hips, not on your lower back and knees.

The third thing is, once healed, to wear supporting braces or garments. To be honest, even the most basic compression sleeve helps me with knee pain.

I have a mass of scar tissue on my right LCL from a non-surgically repaired/not properly healed tear when I was younger. It has resulted in bone overgrowth and some pretty good arthritis for someone who is 35. It's awesome...I can always tell when the weather is changing. - Anyways compression sleeves help when I'm hiking or even just hitting the leg press at the gym.

Get yourself healed first, then focus on supporting your knees with a systematic approach from the foot on up, use the exercises your get from PT and combine that with strength training. Don't forget to focus on core strength. The stronger your core, the less you have to rely on your appendages for work.

Finally - DO NOT OVER DO IT or push too hard, too fast, during recovery.

[P30]

Some years ago, I had a paramotor accident, in which my right knee was quite damaged. Now it's stronger than before. The team doctor of one of Germany's most famous soccer teams helped me. And then physiotherapy, mainly specific gymnastic exercises.

What I learned:
Stretching exercises are very important. The point is: If the tendons (and more generally: the fascias) are too short, then there is too much pressure in the knee. So the bones put to much pressure on the cartilage. And then in motion, the bones plan down the cartilage over time. Don't get me wrong: Motion is healthy, but the tendons should not be too short.

Two of my favorite stretching exercises for the knees (posted them before):





The first exercise stretches the tendons on the front side of the leg above the knee, the second stretches the back side of the leg. There are some fine points in order to make the exercises work best. In Germany, we have physiotherapists who can show and explain it very well. I suppose, you have physiotherapists in the US too. I highly recommend visiting a good one. The first exercise can also be done lying on the belly. This is how I usually do it.

PS:
You asked about nutrition/supplements:
Omega-3 oil reduces inflammation. The best brand I know is "Udo's Choice". It's produced in Canada and consists mainly of linseed oil. It's important that the oil is kept in the fridge. If it tastes like nuts, it's fresh. If it tastes like fish, it's bad. And don't heat up the omega-3 oil, then it would become trans fat which is very unhealthy. Eat it cold. I eat it together with a half banana. 2 teaspoons oil, a half banana. I press the banana into the oil. I like it for breakfast.

[trailrunner]

CAVEAT: I am not a medical doctor. But I've been a runner and cyclist for several decades and have suffered through a few injuries.

First of all, I hope that you got your diagnosis from an orthopedic doctor, and not a GP.

You might have cartilage problems, such as a meniscus tear. I've torn the meniscus on both knees. I think there was some underlying damage from being a kid that finally wound up giving way when I was older, during and after a run (the second time it happened it was likely aggravated by snowboarding, which involves a lot of deep bending of the knee). The good news is that it relatively easy to fix with arthroscopic surgery. The first time I had my knee scoped (in 1992), I was running two weeks later), and the second time I had my knee scoped (2009) I was on my bike trainer the next day. In my cases, both time the knee swelled up a lot with synovial fluid.

ACL and LCL damage usually seems to come from a more traumatic injury. But see my caveat above.

Another possibility is an ITB problem. That is usually remedied by stretching. I had that once, but it resolved very quickly. Your symptoms don't sound like that, but you might look into it.

Another possibility is chondromalacia patellae. I've only read about that and don't have any first-hand experience.

[Sal Picante]

I'm 43. I have moderate arthritis in my right knee due to prior leg/knee injuries.

The stretching and footwear choices here really are huge. If it gets too bad (pain), don't be afraid to get a cortisone - it helps inflammation for a bit and is a short-term solution, but it helps calm things down so you can stretch, get rest, etc...

Accept that you're probably not going to do crazy squats and that weighted rucks might not be the best for you... Go slower, go lower(weight) and do be afraid of a pre-and-post-Advil.
Can I preach to you the gospel of the exercise bike?

I'll add that losing significant weight has been some of the best "medicine" for my arthritis.

Be well, take care of it...

[Joe in PNG]

Part of getting older is that this is when your body begins to pay you back for all the abuse you put it through during your younger years.

Once you hit 40, pain is no longer "weakness leaving your body", but a warning to back off, because things are wearing out and prone to breakage.

[TheNewbie]

My knees hurt often, especially when I would squat. Doctor told me to do squats with dumbbells.


Instead I started squatting more often and heavier, with the barbell. No my knees bother me less. I am not saying you should squat or lift heavy, but that's what worked for me.


I am only 34, so that probably is some factor in it, but as I got stronger I felt better.


Eating healthy would probably help too. Less sugar and other crap always makes me feel better.

[BillSWPA]

I am 50, and I’ve had osteoarthritis for a few years now.

If you have not done so already, find an orthopedic surgeon that specializes in knees, and treats athletes at the college or professional level. These are the people who will be the most conservative in your treatment.

Physical therapy is critical. Again, find the physical therapists that treat athletes at the college or professional level. They will be better at recognizing the small differences in your therapy that make a big difference, as well as having higher expectations for the results.

Once you are done with physical therapy, if you need to do quick maintenance, I have found the most effective therapy exercises to be single leg, bodyweight squats, as well as balancing on one leg on a Bosu balancer.

I continue to weight train as before. Be sure to include exercises for the abductors and adductors, since these are critical for knee stability.

For cardio, even though I am still capable of running, I have given that up to avoid doing further damage. I now do my cardio by biking and by swimming when the temperature is too cold for biking.

Your condition may be different from mine, so keep that in mind as you read the following. In most cases of osteoarthritis in the knee,the cartilage in the knee between the femur and tibia narrows the most on the inside of the knee, and is the widest on the outside. To correct this, orthotic shoe inserts in the form of heel wedges are often prescribed, lifting up the outer edge of the heel. I have tried these, and they are a bad idea. What I have found helps is an orthotic shoe insert that replaces the insole, and provides a larger arch support. In my case, which is of course a sample size of one, the knee problems were partially caused by collapsing arches. The arch, when properly supported, allows the ball of the foot to better do its job, which will align the femur and tibia for the least amount of trauma to the knee. You may need to find a chiropractor that sells Foot Levelers in order to get the best orthotics, but you can find Walmart stores that have a measuring device that you can step on, and buy less expensive shoe inserts they are depending on what the measuring device recommends.

Hope this helps.


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[srcochran49]

I have a long term history of knee issues. Previous surgeries on both knees, and am currently 5 weeks post op from a total knee replacement on the right knee.

I strongly recommend the PT you have scheduled. Most of the current therapists are excellent, and will be able to provide you with exercises you can do both to strengthen your knee as well as help with pain you have. If you have not seen an orthopedic surgeon, get a reccomendation from the physical therapist and make an appointment. You may want to consider a cortisone injection after consulting with the orthopedist. This will provide temporary relief from the pain and inflammation.

Strengthening your knees will help with the pain issues, but I would be very careful about considering squats and deadlifts unless you have proper instruction on how to perform those movements safely.

[Wake27]

I haven’t had time to read all of this but in my left knee, I’ve had three separate partial MCL tears and later, a dislocated knee cap that tore up the cartilage on the back of my knee cap. It took over a year for me to run without significant pain after the last one, though I didn’t let it rest for much of that time. So, biggest recommendations are to allow rest when it hurts and be very diligent in warming up and cooling down. Hip flexors, IT bands, and quads all get tight easily and there is significantly more pain when they’re tight. Lastly, be very careful rucking and running. It took some serious work for me to change my bad habits that contributed to my injuries and while most people may know that heel-striking can be dangerous, over striding is also a serious though lesser acknowledged issue.

For context, I turn 30 in a month and most of my knee injuries have been while playing sports and wearing cleats. I’m at the point where I’d rather eat shit from slipping than lock my foot into the ground with a cleat and blow my knee out again. But I’m still active and went to airborne just over a year ago and now have seven jumps so it’s not like I can avoid some damage. I do use a standing desk and think that it’s helped overall health.

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