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Knee Pain - How to Address Knee Pain and Avoid Making It Worse



One thing that can be extremely annoying when you just get started on a nice workout streak is knee pain. I know this first hand as I am working on treating my own knee pain at this moment and figured I would let all of you know about the things that I have been doing.


One of the most common causes of acute pain in the front of the knee is an acute tendinopathy or tendinitis. This is usually caused by a sharp increase in the amount of exercise and activity you have been doing. See, tendons don't like sharp increases in workload and force. They tend to get a little cranky from it. Your tendons just want a little bit smoother ramp up. If you give them the time, they will adapt and can handle a lot.


One principal I like to think about is the SAID principal. The SAID principle is like your body's way of learning from exercise. It stands for Specific Adaptation to Imposed Demands. This means when you do a certain kind of exercise, the tissues in your body change and get better at handling that specific exercise. For example, if you do a lot of jumping, the muscles and tendons in your legs get stronger and more flexible to help you jump better and not get hurt. Your body is really smart and changes its muscles, bones, and even tendons based on what you practice. So if you want to make a certain part of your body stronger or better, you need to do exercises that focus on that part.


Start At The Beginning

First, the fire needs to be put out. A lot of people try to skip this step in rehab because they are inpatient. (I am pointing at myself). Regardless of the structure, it is hard to do anything if you don't first reduce the pain.


Now, there are many people who are against the old methods of RICE (rest, ice, compression, elevation) but there are still some components that I use, and that's cause they work.


Compression

The first thing I do when my knee is acting up and is swollen is put on a nice quality compression sleeve. The reduction in swelling seems to drastically impact the pain level of my knee. Make sure its not so tight that its uncomfortable. I like to use the sleeves that have stretch and are more like a dry fit material versus the more bulky neoprene sleeves.


I typically only wear this during the day because it gets annoying to wear at night but if you are into it, you can sleep the night away with compression on.


Ice and Heat

Another great way to reduce acute pain in the knee is ice and or heat. I typically like to alternate and my preferred form of heating is an epsom salt bath. This seems to reduce some of the pain and then I follow that with an ice cup massage. Remember, you don't have to do this forever. You just have to do it the first couple weeks.


Isometrics

Another thing I do when my knee is bothering me is switch up the workouts. Ill do a lot slower movements and hold isometrics and the bottom of the squat or the midpoint of the knee extension. Depending on the structure that is painful, you may want to first avoid isometrics at the point of pain and they slowly work into that painful spot so that it becomes less irritated overall.


Relative Rest

The rest in "RICE" doesn't mean become a couch potato. I typically suggest relative rest or a brief detraining period. This means you can still lift and exercises, just decreased the volume, load, and speed of movement. Then slowly build this back up.


This also means that if your knee is bothering you, you can still train upper body hard. You can still do some modes of cardio. You don't need to completely shut it down.


An Example Application




Let's say someone has anterior knee pain, often related to issues like patellar tendonitis or runner's knee. To help them using the SAID principle, you'd create a specific exercise program that gradually strengthens and adapts their knee tissues over time. Here's how it might look:


Weeks 1-2: Pain Management and Light Activity

  • Goal: Reduce inflammation and pain.

  • Activities: Range-of-motion exercises, stretching, walking, and isometric exercises (like quad sets) to maintain muscle without straining the knee.

Weeks 3-4: Begin Strengthening

  • Goal: Start building strength around the knee.

  • Activities: Introduce low-impact exercises like body weight squats, and seated leg presses with light resistance. Focus on proper form to ensure you are not irritating the knee.

Weeks 5-6: Moderate Strengthening

  • Goal: Increase tissue strength and endurance.

  • Activities: Gradually increase resistance in leg presses, add step-ups, and light squats. Include non-weight bearing exercises like swimming or cycling to enhance cardiovascular fitness without strain.

Weeks 7-8: Functional Training

  • Goal: Improve the knee's ability to handle real-life activities.

  • Activities: Incorporate more dynamic exercises like lunges and controlled jumping jacks. Begin gentle jogging or walking on varied terrain if possible.

Weeks 9-10: Sports-Specific or Activity-Specific Training

  • Goal: Prepare the knee for specific sports or activities.

  • Activities: Depending on the person's goals, include movements and exercises that mimic their sport or activity. For a runner, this might mean interval training; for a soccer player, lateral movements and sprints.

Throughout this process, the exercises specifically target the muscles, tendons, and other tissues around the knee, encouraging them to adapt and strengthen in a way that supports knee health and reduces pain. The key is to progress slowly, allowing the tissues to adapt without overloading them, and to continually assess and adjust the program based on the individual's pain and progress. This way, the SAID principle is used to gradually build back the strength and functionality of the knee, helping alleviate anterior knee pain over time.


If you want someone to help you out with your recovery process, one of our experts would love to help guide you through this process.




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