Thread: Knee Rehab: The last 10%

So here's the abbreviated background story. In July 2008 a buddy and I were climbing in Montana and I ended up kicking steps in trail runners up about 2000 feet of snowfield. I limped my way back to the car and couldn't walk the next day.

After limping around for a few weeks without improvement, I went to a Sports Physician in Seattle and she said that I bruised the back of my kneecap and had petello-femoral syndrome. I did PT and things resolved to about 90% by November. I started running again and it sent me back to square one. I ended up seeing another Sports Physician in March. He said that basically my kneecap wasn't tracking correctly. Through a bunch more PT I am back to 90% recovered.

I worked a lot on strengthening my VMO and gluteus medius and improving hamstring/quad/IT band flexibility. I have been able to be pretty active (50 mile road rides, 10 miles of hikes, etc) and it seems to be fine during activity--in fact activity brings relief to the discomfort. But, there is always a twinge and when I am sitting at a desk or driving all day it gives me a lot of discomfort. Most of the discomfort is concentrated in the tendon(?) connecting the VMO to the kneecap and the patellar tendon.

Anyway, does anyone have that magic exercise to get me through this final 10%? Currently, I do a lot of single leg squats and stationary side leg extensions with a theraband.

With my IT band annoyance (symptoms presented in a similar way), the two tools I hadn't thought of were the use of a foamy roller/2 L bottle for stretching out the quads and adding arch support to my shoes, eventually in the form of green Superfeet with extra spacers under the arch. Phil Rowe (a PT at the University of Washington Hall Health center) had excellent guidance for me.

Most days, I'm 99% back. Once I realized that skinning uphill helped the pain/twinge the most, I never looked back.

If you have tendinitis it can stick around for awhile. Try ice massage on the affected area. I had a really really bad bout of patellar tendinitis due to mis-tracking and an underfunctioning VMO. Once I got the tracking settled a bit better the tendinitis stuck (still have it 10 years later, but it's manageable now). However, once my PT basically said she couldn't do anything to help me anymore, I was still in pain, and found that I needed more than ice massage. An osteopathic doctor friend of mine suggested I do this: put a bucket of ice water in the bathroom. Sit beside the tub. Grab two towels. Put one in the ice bucket and the other under the faucet in the bathtub with water as hot as you can stand. Put the warm towel on the knee, hold for a minute. Put the cold towel on the knee, hold for a minute. Repeat for 10-15 minutes total. This simple treatment was what got me over the hump of "I'm in pain and it's keeping me from doing stuff" to an almost negligible amount of pain, except for when I'm just being stupid.

Stabilizing exercises may be able to help too... foam blocks and those blue/purple disk things during modified squats and lunges can help.

I'll definitely give your suggestions a shot. Thanks again for helping me clear up what amounts to an annoyance compared to many of the stories you read in this section.

You could try some single-leg deadlifts. It takes a little bit to get up to some decent weights, but it's worth a shot. If you can use more weight with the single leg squats without irritation, then do it. Doing both of these exercises as my prime leg exercises has been helping a lot with my IT and hip issues. I've been trying to really push the weights. I've been doing backwards lunges off of a 3" block instead of single leg squats. I don't know what all hits what when it comes to those. I do suggest trying the 1-leg deadlifts. You may need to start with a block on which to put the weights at the bottom. You could also try some direct hip flexor work.

Nice work--thank you for sharing-
Thanks so much for this. I appreciate the effort. It really helps a lot.
Glad to hear you're using this: I plan to keep it much more aggressively up-to-date than has been the case in the past, but don't hesitate to let me know if you find errors or need clarifications.