Re: Do I Have It? Possible hamstring imbalance

[Guest guest]

Seeing your an athlete I can feel for your predicament.

There is something that popped in my brain and not sure you wrote it

correctly: You said your patella tracks laterally when flexed. Do you

mean extension or flexion? There is a difference in accordance which

muscles that are responsible for correct mechanics for both flexion

and extension of the knee.

I'm going to take you on your word you meant flexion since if your vmo

is strong that wouldn't preclude your flexing muscles where your prob

exist. Although it's unusual for a runner to have problem with

flexion since they typically have stronger hip extensors, hamstrings,

than knee extensors, vmo.

btw, after writing all this there's one simple test to determine if

you have cp known as the compression test. It's difficult to do one

yourself but you lay your legs down with feet point up, relax your

quads while someone holds your patella in place with the cup of hand

then you flex your quads. If have a defect on the bottom of your

patella you'll feel the pain quickly from it rubbing against your

femoral trochlear.

Something else I almost hate to say but perhaps your doc is wrong with

your patella pulling laterally. God knows I was fed loads of wrong

info for years from my docs and physical therapists. I would get a

couple more opinions since something doesn't sound right if your vmo

is strong and yet it pulls laterally. Although it could also depend

how he administered the test to determine your tracking. If he had

you squat really deep and while going down, flexion, there are some

muscles, if strong, that would cause out-wardly movement and again

these would be typically strong in runners but they're the Biceps

Femoris Short Head and Long Head, these rotate laterally when the leg

is flexed. Now there's another set of hamstrings that promote

internal rotation when flexed but it would be odd if your hams had

this imbalance although then again I had an odd imbalance. But your

other hams are the Semitendinosus and Semimembranosus both medial

rotate your leg during flexing so if your patella is going laterally

when flexed these later hamstrings I would think should be

strengthened to counter the outward movement. Either way I would get

some more opinions.

> > > Hi,

> > >

> > > I started getting an itching feeling near the tops of both knee

> > caps about

> > > 15 yrs ago while (over)training for a 20K run. Since then, I

> > experience the

> > > same itching feeling after only a few miles of running.

> > >

> > > Recently, the itching feeling occurs anytime I am sitting and it

> > sometimes

> > > progresses into pain -- like my knee caps are on fire! The pain

> > gets worse

> > > after activity. Sometimes it just feels like pricking needles.

> > Ice and

> > > anti-inflammatory don't seem to help much.

> > >

> > > I was certain I had chondromalacia, so I joined this group and

> > scheduled an

> > > appointment with my doctor. I just returned he said I do NOT

> have

> > > chondromalacia or Patella Femoral Pain Syndrome, but rather, he

> > thinks I

> > > have patellar bursitis. He thinks so because he had me isolate

> my

> > VMO and

> > > did a strength test. He said my VMO is strong. He also

> > acknowledged that

> > > my patellae track to the outside, but said that simply aggravates

> > the

> > > patellar bursitis.

> > >

> > > I'm curious what you think.

> > >

> > > Thanks,

> > >

> > >

> > >

> > >

[Guest guest]

Just wanted to add one thing that hip extension and knee flexion are

one in the same thing when it applies to the hamstrings.

> > > > Hi,

> > > >

> > > > I started getting an itching feeling near the tops of both knee

> > > caps about

> > > > 15 yrs ago while (over)training for a 20K run. Since then, I

> > > experience the

> > > > same itching feeling after only a few miles of running.

> > > >

> > > > Recently, the itching feeling occurs anytime I am sitting and it

> > > sometimes

> > > > progresses into pain -- like my knee caps are on fire! The pain

> > > gets worse

> > > > after activity. Sometimes it just feels like pricking needles.

> > > Ice and

> > > > anti-inflammatory don't seem to help much.

> > > >

> > > > I was certain I had chondromalacia, so I joined this group and

> > > scheduled an

> > > > appointment with my doctor. I just returned he said I do NOT

> > have

> > > > chondromalacia or Patella Femoral Pain Syndrome, but rather, he

> > > thinks I

> > > > have patellar bursitis. He thinks so because he had me isolate

> > my

> > > VMO and

> > > > did a strength test. He said my VMO is strong. He also

> > > acknowledged that

> > > > my patellae track to the outside, but said that simply aggravates

> > > the

> > > > patellar bursitis.

> > > >

> > > > I'm curious what you think.

> > > >

> > > > Thanks,

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Hi Bucko

The cmp test you mention is quite good and my sports injury

specialist did a similar test to me about a year ago. In fact he did

2 tests:

1. Lie on couch with legs straight out, toes pointing up quads

relaxed. Then he cupped my knee cap with his hand and progressively

applied weight to them. Pain = cmp.

2. A variation of the above. Lie on couch legs straight out, ties

pointing up quads completely relaxed. Then he used the palm of his

hand to apply pressure to the top edge of the knee cap, pushing it

towards my toes. Then I contract my quads. Pain = cmp.

For me no 1. was painless and no 2. produced a sharp pain in my right

knee cap.

It's easy to do no 2. on yourself:

2(. Sit on the edge of a chair, legs stretched out straight in

front of you, heels on the floor, toes resting upwards, quads

COMPLETELY relaxed. With the palm of your hand press down (towards

your toes) along the top edge of the knee cap. Then contract your

quads SLOWLY AND CAREFULLY.

I say slowly and carefully because this can cause excruciating pain

if you're not very careful.

My sports injury specialist said I probably didn't have cmp and when

I asked him about the sharp pain I got from test no 2. he said this

was scar tissue (?). Anyway that was a year ago. I've improved

considerably since then, but test no 2. still causes quite bad pain,

though possibly not so bad as before.

Be very careful with both of these tests guys.....

Joe

> > > > Hi,

> > > >

> > > > I started getting an itching feeling near the tops of both

knee

> > > caps about

> > > > 15 yrs ago while (over)training for a 20K run. Since then, I

> > > experience the

> > > > same itching feeling after only a few miles of running.

> > > >

> > > > Recently, the itching feeling occurs anytime I am sitting and

it

> > > sometimes

> > > > progresses into pain -- like my knee caps are on fire! The

pain

> > > gets worse

> > > > after activity. Sometimes it just feels like pricking

needles.

> > > Ice and

> > > > anti-inflammatory don't seem to help much.

> > > >

> > > > I was certain I had chondromalacia, so I joined this group and

> > > scheduled an

> > > > appointment with my doctor. I just returned he said I do NOT

> > have

> > > > chondromalacia or Patella Femoral Pain Syndrome, but rather,

he

> > > thinks I

> > > > have patellar bursitis. He thinks so because he had me

isolate

> > my

> > > VMO and

> > > > did a strength test. He said my VMO is strong. He also

> > > acknowledged that

> > > > my patellae track to the outside, but said that simply

aggravates

> > > the

> > > > patellar bursitis.

> > > >

> > > > I'm curious what you think.

> > > >

> > > > Thanks,

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Yeah the test aren't difficult to implement but like my past message

mentioned, I know it's there and don't need the bonk on the head reminder.

> > > > > Hi,

> > > > >

> > > > > I started getting an itching feeling near the tops of both

> knee

> > > > caps about

> > > > > 15 yrs ago while (over)training for a 20K run. Since then, I

> > > > experience the

> > > > > same itching feeling after only a few miles of running.

> > > > >

> > > > > Recently, the itching feeling occurs anytime I am sitting and

> it

> > > > sometimes

> > > > > progresses into pain -- like my knee caps are on fire! The

> pain

> > > > gets worse

> > > > > after activity. Sometimes it just feels like pricking

> needles.

> > > > Ice and

> > > > > anti-inflammatory don't seem to help much.

> > > > >

> > > > > I was certain I had chondromalacia, so I joined this group and

> > > > scheduled an

> > > > > appointment with my doctor. I just returned he said I do NOT

> > > have

> > > > > chondromalacia or Patella Femoral Pain Syndrome, but rather,

> he

> > > > thinks I

> > > > > have patellar bursitis. He thinks so because he had me

> isolate

> > > my

> > > > VMO and

> > > > > did a strength test. He said my VMO is strong. He also

> > > > acknowledged that

> > > > > my patellae track to the outside, but said that simply

> aggravates

> > > > the

> > > > > patellar bursitis.

> > > > >

> > > > > I'm curious what you think.

> > > > >

> > > > > Thanks,

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Hey Bucko!

I was wondering, what is your response to the cmp test? Also, what

is your current level of physical activity? I seem to remember that

you are actually very active right now.

Personally, as I said I can get really bad pain in my right knee from

one variation of the test you mentioned. However, over the past year

my overall pain levels have dropped considerably and I'm pretty

active on my feet these days, walking up and down stairs, kneeling,

squatting etc. For the past month I've been decorating my house and

it's involved quite a lot of kneeling, squatting, shuffling around on

my knees, bending, standing, walking and going up and down stairs

etc. This would have been absolutely unimaginable a year ago. In

fact a year ago the thought of doing a simple lunge would make me

just about faint. The past 2 days my knees started aching, but as I

say it's taken some time to get this ache.

How active are you these days and how much pain do you get from the

cmp test? Just thought I'd compare notes....

Thanks

Joe

> > Hi Bucko

> >

> > The cmp test you mention is quite good and my sports injury

> > specialist did a similar test to me about a year ago. In fact he

did

> > 2 tests:

> >

> > 1. Lie on couch with legs straight out, toes pointing up quads

> > relaxed. Then he cupped my knee cap with his hand and

progressively

> > applied weight to them. Pain = cmp.

> >

> > 2. A variation of the above. Lie on couch legs straight out,

ties

> > pointing up quads completely relaxed. Then he used the palm of

his

> > hand to apply pressure to the top edge of the knee cap, pushing

it

> > towards my toes. Then I contract my quads. Pain = cmp.

> >

> > For me no 1. was painless and no 2. produced a sharp pain in my

right

> > knee cap.

> >

> > It's easy to do no 2. on yourself:

> >

> > 2(. Sit on the edge of a chair, legs stretched out straight in

> > front of you, heels on the floor, toes resting upwards, quads

> > COMPLETELY relaxed. With the palm of your hand press down

(towards

> > your toes) along the top edge of the knee cap. Then contract

your

> > quads SLOWLY AND CAREFULLY.

> >

> > I say slowly and carefully because this can cause excruciating

pain

> > if you're not very careful.

> >

> > My sports injury specialist said I probably didn't have cmp and

when

> > I asked him about the sharp pain I got from test no 2. he said

this

> > was scar tissue (?). Anyway that was a year ago. I've improved

> > considerably since then, but test no 2. still causes quite bad

pain,

> > though possibly not so bad as before.

> >

> > Be very careful with both of these tests guys.....

> >

> > Joe

> >

[Guest guest]

Both my knee docs told me that the worst thing you can do for CM and torn

meniscus is squat and kneel.

Ann

Re: Do I Have It? Possible hamstring

imbalance

Hey Bucko!

... over the past year

my overall pain levels have dropped considerably and I'm pretty

active on my feet these days, walking up and down stairs, kneeling,

squatting etc. For the past month I've been decorating my house and

it's involved quite a lot of kneeling, squatting, shuffling around on

my knees, bending, standing, walking and going up and down stairs

etc. This would have been absolutely unimaginable a year ago. In

fact a year ago the thought of doing a simple lunge would make me

just about faint. The past 2 days my knees started aching, but as I

say it's taken some time to get this ache.

[Guest guest]

Ouch, the thought of squatting makes me cringe. I'm working on a minor squat to

pick up files at work. After both my arthoscopys to clean my kneecaps, I was

told to leave CAN work because I should not be squatting and kneeling. Kneeling

on my knees makes me want to pass out.

Re: Do I Have It? Possible hamstring

imbalance

Hey Bucko!

... over the past year

my overall pain levels have dropped considerably and I'm pretty

active on my feet these days, walking up and down stairs, kneeling,

squatting etc. For the past month I've been decorating my house and

it's involved quite a lot of kneeling, squatting, shuffling around on

my knees, bending, standing, walking and going up and down stairs

etc. This would have been absolutely unimaginable a year ago. In

fact a year ago the thought of doing a simple lunge would make me

just about faint. The past 2 days my knees started aching, but as I

say it's taken some time to get this ache.

[Guest guest]

Hi and Ann

Yes it's incredible. I can kneel. I injured my knees over 2 years

ago by heavy gym work. 2 years ago I was in constant pain and

literally felt as if I had been in a car accident. My knees hurt all

over and my ankles burnt too. At the time I couldn't even STEP UP

ONTO A KERB (pavement, sidewalk etc!!) without incurring burning

pains for days afterwards. I could do no knee-bending which involved

load-bearing at all. The thought of squatting or kneeling, or even

getting up out of a chair without using my hands was utterly

inconceivable at the time. In fact for nearly a year I never even

bent my legs. I would sleep at night on my back with my legs

straight. Physiotherapy didn't seem to help much over this initial

period.

1 year ago I started physiotherapy yet again, after seeing a sports

injury specialist. He started me on a program of stretching and

massage. After a while I dropped the massage and added in load-

bearing excercises. I have done these every single night since, only

perhaps missing 3 or 4 nights over the past year. But it has helped

enormously. Recently (the last 2 months I suppose) I progressed to

do a single squat as part of my nightly regime. Now I can do 10

squats. I can also walk up and down stairs and kneel. It seems that

by doing these things I am actually getting better. But obviously I

can't overdo it or I get the pain again.

My experience with stretching and excercise is that when I started,

it caused me a LOT of pain for the week afterwards. This was really

disturbing, but the sports injury guy (Dr Simon Petrides - i've

mentioned him before) kept reassuring me it would be ok. I backed

off with the excercise and the pain backed off. Then I returned to

the same excercises and this time the pain wasn't nearly so bad. So

it has been every time - 2 steps forward / 1 step back. I regularly

get pain and then back off. After a few days, maybe a week I restart

the excercises and the pain is a lot better.

I don't know, it seems to work for me. I am a real beleaver in

stretching and excercise now. Joints need excercise to repair

themselves. But in moderation. It's a difficult line to tread,

doing sufficient to improve the joint whilst not doing too much and

inflaming or aggravating it. In the first year it was almost

impossible to tread this line.

Ann - thanks for the warning and I'm interested to hear what you are

saying. I will take it easy! However, for me, once I get into a

kneeling position with my legs relaxed, it's very much like doing a

stretch and actually feels quite pleasant (now). I realise that this

might NOT apply to others on this board - it depends on each

individual person and their state of rehab. So be careful guys with

the kneeling!

I've rambled a bit, but I hope this info might help some of you.

Don't give up!

Joe

> Ouch, the thought of squatting makes me cringe. I'm working on a

minor squat to pick up files at work. After both my arthoscopys to

clean my kneecaps, I was told to leave CAN work because I should not

be squatting and kneeling. Kneeling on my knees makes me want to

pass out.

>

>

> Re: Do I Have It? Possible

hamstring

> imbalance

>

>

> Hey Bucko!

>

> ... over the past year

> my overall pain levels have dropped considerably and I'm pretty

> active on my feet these days, walking up and down stairs,

kneeling,

> squatting etc. For the past month I've been decorating my

house and

> it's involved quite a lot of kneeling, squatting, shuffling

around on

> my knees, bending, standing, walking and going up and down

stairs

> etc. This would have been absolutely unimaginable a year ago.

In

> fact a year ago the thought of doing a simple lunge would make

me

> just about faint. The past 2 days my knees started aching, but

as I

> say it's taken some time to get this ache.

>

>

>

>

[Guest guest]

Have you actually been definitively diagnosed with CM? (MRI or arthrosopic

peeking?)

What were the exercises/stretching that you did?

Thanks.

Ann

Re: Do I Have It? Possible hamstring

imbalance

Hi and Ann

Yes it's incredible. I can kneel. I injured my knees over 2 years

ago by heavy gym work. 2 years ago I was in constant pain and

literally felt as if I had been in a car accident. My knees hurt all

over and my ankles burnt too. At the time I couldn't even STEP UP

ONTO A KERB (pavement, sidewalk etc!!) without incurring burning

pains for days afterwards. I could do no knee-bending which involved

load-bearing at all. The thought of squatting or kneeling, or even

getting up out of a chair without using my hands was utterly

inconceivable at the time. In fact for nearly a year I never even

bent my legs. I would sleep at night on my back with my legs

straight. Physiotherapy didn't seem to help much over this initial

period.

1 year ago I started physiotherapy yet again, after seeing a sports

injury specialist. He started me on a program of stretching and

massage. After a while I dropped the massage and added in load-

bearing excercises. I have done these every single night since, only

perhaps missing 3 or 4 nights over the past year. But it has helped

enormously. Recently (the last 2 months I suppose) I progressed to

do a single squat as part of my nightly regime. Now I can do 10

squats. I can also walk up and down stairs and kneel. It seems that

by doing these things I am actually getting better. But obviously I

can't overdo it or I get the pain again.

My experience with stretching and excercise is that when I started,

it caused me a LOT of pain for the week afterwards. This was really

disturbing, but the sports injury guy (Dr Simon Petrides - i've

mentioned him before) kept reassuring me it would be ok. I backed

off with the excercise and the pain backed off. Then I returned to

the same excercises and this time the pain wasn't nearly so bad. So

it has been every time - 2 steps forward / 1 step back. I regularly

get pain and then back off. After a few days, maybe a week I restart

the excercises and the pain is a lot better.

I don't know, it seems to work for me. I am a real beleaver in

stretching and excercise now. Joints need excercise to repair

themselves. But in moderation. It's a difficult line to tread,

doing sufficient to improve the joint whilst not doing too much and

inflaming or aggravating it. In the first year it was almost

impossible to tread this line.

Ann - thanks for the warning and I'm interested to hear what you are

saying. I will take it easy! However, for me, once I get into a

kneeling position with my legs relaxed, it's very much like doing a

stretch and actually feels quite pleasant (now). I realise that this

might NOT apply to others on this board - it depends on each

individual person and their state of rehab. So be careful guys with

the kneeling!

I've rambled a bit, but I hope this info might help some of you.

Don't give up!

Joe

[Guest guest]

Yes and No!

The first OS I saw 2 years ago listened to me describe my symptoms,

sat me on his couch, had me raise my left leg, listened to and felt

the crepitus and said " I'm convinced " . The examination took a few

seconds and although he didn't actually say " CP " he felt I had wear

and tear behind the knee-cap. His examination took about 10 seconds.

I have seen other OS's who were not so convinced however, and I have

had X-rays, MRI and bone-scan which were basically negative, ie

didn't show much unusual.

However, I had a great deal of pain and massive disability, as I

described. It's a lot better now though. The jury is out on CP, but

I believe in fact I have a bit of everything, soft-tissue damage,

scar tissue, cartilage damage. It's slowly getting better.

Strangely, my right knee isn't too noisy while my left knee is very

crunchy. But both knees give me similar problems, and in fact the

right one is slightly worse than the left.

So yes and no! I don't know if i have CP or not, but I'd be VERY

surprised if they scoped me and there was no damage in there.

Joe

> Have you actually been definitively diagnosed with CM? (MRI or

arthrosopic

> peeking?)

>

> What were the exercises/stretching that you did?

>

> Thanks.

>

> Ann

>

[Guest guest]

Ann

I have to dash right now but will get back to you on the stretches

and strength excercises. I've posted most of these somewhere before

but will do so again for you in a day or two. In the meantime see

message #2967 for some stretches.

I also did various strength excercises, including very mini-squats on

each leg, use of a thing called a " theraband " , mini-lunges, steps

(stepping onto and off a telephone directoty) etc. Gradually

building up the amount of load i could take. It was very slow.

When I have more time i'll post a little more!

Joe

> Have you actually been definitively diagnosed with CM? (MRI or

arthrosopic

> peeking?)

>

> What were the exercises/stretching that you did?

>

> Thanks.

>

> Ann

>

>

[Guest guest]

Joe,

I've always and I mean always tested positive for cp since I got the

injury although I haven't been tested in some years. I know it's still

there and don't need doc to whack me over my head to say, " see your

knee has that defect! " <g>

As for activity, yes it's getting better, more intense, more time with

more duration with less discomfort. I'm currently doing around 12

hours on the bike but mostly on those strange cranks I mentioned

before where you have to pull up as well push down or the crank arms

fall down. In other words both crank arms work independently of each

other. Freaking hard as more stress on the knee I'd have to imagine.

I could do more time if my hamstrings and hip flexors were feeling

fatigued from these cranks but as days, weeks go by I can do more time

as they become accustomed to the unique stress.

Also doing three sessions a week of plyometrics with 215 to 270

contacts, jumps per leg, that have progressed where I'm doing those

jumps on one leg on concrete stairs with either one or steps for each

jump. I usually do 35 jumps for one leg when doing one step and 20-25

when doing one leg with jumping two steps. And the idea behind plyos

is doing them quickly and with good form so I break down those 200+

jumps into sets. I haven't ever had any knee flare up with my plyos

thankfully and these really motivate me to tell the truth, to think I

can do these without discomfort gives me great hope which I've been

feeding from.

But I did have two flare ups last week. After a couple hours on the

indoor trainer instead of doing my usual plyos I wanted to see how my

legs would do with weighted stair work. Although I added a something

extra to that with each step was something of hop not a jump but made

sure each time I stepped there was a bit of hop to each step. I also

added the same regiment while going down the stairs so that each step

I hopped just a bit and immediately popped off to the lower step, mind

you with 18lb in the back pack. The great part being the knee felt

fine though out the fifty minutes of doing this over and over on 9

flights of concrete stairs, up and down, but the next day I decided to

push and seek my limit again and found it.

Immediately my knee ached from the initial step and intermittently

though out the session and felt I should bail after 25 minutes so the

residual pain wouldn't reside though out preceding days so I could

still ride. I returned to the same stairs with same weight three days

later but for 30 minutes with no discomfort. So I obviously if I start

with less time and work up I can do these more often.

I also had another flare up when I had my bike hooked to the indoor

trainer as usual using those funky pull up cranks. I slated to myself

to ride in moderate big gear non-stop for 2 hours 45 min where during

that time for 45 minutes use a pretty big gear that would sap my legs

even more, which I did. But at about 32 minutes the knee began to

knock on that familiar door but instead of being abrupt the discomfort

onset was gradual, which ran warning bells. In the past this gradual

onset has routinely meant it won't go away like other types of

sensations I recieve. Fortunately the time I allotted for that gear

was up since but I suspected if I kept it up the knee would've filed a

formal protest and since I dialed it down to bit easier gear the

discomfort went away. The next few days saw no episodes of discomfort.

Besides those two minor episodes everything else has been great.

Thankfully my biggest prob is my recovery since my joint is doing so

well I'm able to really push myself every day my legs and body are

frequently tired but it's tired I'm familiar with and know I can push

myself a little more. I'd rather I have this prob than my joint

dictating regiments.

Obviously the more exercise time I log the less frequently the joint

flares up.

> > > Hi Bucko

> > >

> > > The cmp test you mention is quite good and my sports injury

> > > specialist did a similar test to me about a year ago. In fact he

> did

> > > 2 tests:

> > >

> > > 1. Lie on couch with legs straight out, toes pointing up quads

> > > relaxed. Then he cupped my knee cap with his hand and

> progressively

> > > applied weight to them. Pain = cmp.

> > >

> > > 2. A variation of the above. Lie on couch legs straight out,

> ties

> > > pointing up quads completely relaxed. Then he used the palm of

> his

> > > hand to apply pressure to the top edge of the knee cap, pushing

> it

> > > towards my toes. Then I contract my quads. Pain = cmp.

> > >

> > > For me no 1. was painless and no 2. produced a sharp pain in my

> right

> > > knee cap.

> > >

> > > It's easy to do no 2. on yourself:

> > >

> > > 2(. Sit on the edge of a chair, legs stretched out straight in

> > > front of you, heels on the floor, toes resting upwards, quads

> > > COMPLETELY relaxed. With the palm of your hand press down

> (towards

> > > your toes) along the top edge of the knee cap. Then contract

> your

> > > quads SLOWLY AND CAREFULLY.

> > >

> > > I say slowly and carefully because this can cause excruciating

> pain

> > > if you're not very careful.

> > >

> > > My sports injury specialist said I probably didn't have cmp and

> when

> > > I asked him about the sharp pain I got from test no 2. he said

> this

> > > was scar tissue (?). Anyway that was a year ago. I've improved

> > > considerably since then, but test no 2. still causes quite bad

> pain,

> > > though possibly not so bad as before.

> > >

> > > Be very careful with both of these tests guys.....

> > >

> > > Joe

> > >