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Dr. Stoll, is it ok to lift weights while I let my
knees heal assuming I eschew all excercises whihc actively
involve the knees, viz. squats, deadlifts, etc?
...Thank You...
In Reply to: weight lifting = "weight bearing" posted by Jeff C. on March 11, 2001 at 13:24:23:
What's wrong with your knees?
Rich 1
In Reply to: weight lifting = "weight bearing" posted by Jeff C. on March 11, 2001 at 13:24:23:
are very difficult on knees. If you can, I would make an appointment with a physical therapist to show you what is safe and what is not. A long time ago I was given a serious of knee exercises, etc. AND stretches that when my knee acts up, I also go back to in order to rebuild strength.
In Reply to: some of those (e.g. squats)... posted by LisaT on March 11, 2001 at 15:36:25:
Squats - done properly - are actually used by some of the more enlightened physical therapists for knee rehab. That's not to say squats are indicated right after knee surgery, but I know many people with repaired or arthritic knees who use squats to help maintain and improve knee stability and integrity.
In Reply to: Re: weight lifting = posted by Rich 1 on March 11, 2001 at 14:37:13:
*sigh*...unfortunately the GRRRRADUAL onset of
chrondomalacia, I suppose.
I had an orthopedist look at them who said it was quite
normal and nothing to really worry about. "Just don't
squat," was the summation of his adivce. I wish something
that simplistically proactive would/had work(ed). That was
4-5 months ago, and while they haven't gotten too much
worse, they certainly haven't gotten better. It still
doesn't really hurt to climb stairs, extend the joint, bend
the joint for long times, etc., but I can sometimes notice
the "roughness" if I place my hand on the patella and extend
it repeatedly to "test" it.
My sport for the past two years has been martial arts, and
while it isn't any where near as high impact as something
like running, I supose the low stances have been enough to
induce it on someone as seemingly genetically prone to it as
me. My only other activty is weight lifting, and I don't
squat (though I wish to the high heavens I could) or
deadlift, etc.
I also had my Rolfer check them out (well, I'm not sure if
he's EXACTLY a rolfer, per se, but he is an L.M.T. and knew
everything about rolfing and its applications). He checked
everything, and said the structures around the knew were
fine, the spine was fine, the hips were not anteriorly
tiltes, etc., in addition to studying my gait, which was all
good news. HE postulated (being also a friend of the family
and knowing something about us) that even though I'm 20, I
had probably gone through, or was going through, a last
growth spurt in which the bones in the leg had slightly
outgrown the tissue surround it causing an abnormal, tight
pull. I've never heard that theory before, so I'm not sure
if it's a viable one, or one he just guessed since
everythign seemed fine structurally. Unfortunatley, he said
being as honest ethically as he was, that there would be
little more he could do for me concerning repeated visits,
short of the relaxtion effect of the massages, and that to
be fair, many rolfers were sued for doing and claiming to do
things that were really not possible.
So needless to say, I'm trying to do my best to have a
fortunate outcome on this. I've decided I will unfortunately
need some time off, probably 6-12 months. I have begun to
study AT, although not a single teacher lives in NW
Louisiana and every damn book says you HAVE to have a
teacher (the WHY did you write the book?!) The most
important aspect of recovery, I feel, is the SR, which I try
to religiously do at least two times a day, as per the doc's
instructions. I take MSM as well (I've heard Glucosamine
lowers insulin sensitivity, so that worries me) and will get
some capsules of Flax seed oil (the real stuff taste
nasty--blech!)
Well, that's my story in a nutshell. It's depressing to feel
limited, so to speak, but hopefully I am taking the correct
road to permanent recovery. Thanks for your interest, friend.
In Reply to: Squats and knees posted by Lincoln on March 11, 2001 at 17:36:51:
I would be suprised if Dr. Stoll agrees with that. I think
someone where he said in the archives that squats are the
LAST thing you should do if you have knee problems. Oh well...
In Reply to: some of those (e.g. squats)... posted by LisaT on March 11, 2001 at 15:36:25:
Thanks for the tips, but I really have no desire of seeing a
PT. After reading through all the archives and everything
else I have seen, I have yet to hear of one person who was
completely cured of PFS via strength training methods. In
fact, many of those, e.g. stair-stepping, may only cause
things to be worse. It is my conclusion (as of now) that
quad building as a means of reversing this disorder was
something that Orthopedists and the like knew a priori but
that didn't always work in the real world (probably because
it does not account for chronic bracing.)
The good doc's prescription is the amalgum of SR (often with
imagery healing), Rest, AT, Oils, Glucosamine, MSM,
underwater excercise, etc. I would not be surpised if the
doc's patients experience better recovery through this
method than with their "run 'o the mill" doc.
In Reply to: Re: Squats and knees posted by Jeff C. on March 11, 2001 at 17:43:36:
physical therapist has told me. But then again, that might be true for MY knees. Maybe there are some conditions where they are indicated......
In Reply to: Re: some of those (e.g. squats)... posted by Jeff C. on March 11, 2001 at 17:50:32:
that there is something to keeping the muscles around the knee, thighs and calves toned to help support the knee in working properly. I think that anything like squats, stair stepping, etc. can be dangerous. I know that simple yoga often will suffice. I have a diagnosis much like yours in one of my knees and it doesn't bother me as long as I'm doing my yoga consistently.
I just re-read your message and clearly I didn't read it right -- was thinking you were asking about squats, etc. -- silly me.
In Reply to: that's what every doctor and more importantly... posted by LT on March 11, 2001 at 18:01:32:
I can see strengthening the muscles important--obviously.
But, if the patella is tracking laterally and thus
destroying the lateral side of the articular cartilage, then
it seems to me that squatting is only going to increase that
pressure, and thus the destruction, by an even higher degree.
In Reply to: Re: that's what every doctor and more importantly... posted by Jeff C. on March 11, 2001 at 18:30:21:
I don't think I'm communicating well -- I'm talking about exercises *other* than squats or stair steps to maintain tone, so the muscles can help address the tracking problem.
In Reply to: you're right... posted by LT on March 11, 2001 at 18:35:09:
Ah yes...my apologies if I misinterpreted...Yeah, I've tried
stick to stiff leg lifts--sometimes it's hard to isolate the
quads from the hip muscle, much less focusing on Vastus
Medialis for vastus Lateralis--but I haven't really seen
improvement by it. I will probably include non-impact
excercises like that into my recovery--couldn't hurt!
In Reply to: Re: weight lifting = posted by Jeff C. on March 11, 2001 at 17:41:12:
What exactly IS chondromylacia?
Rich 1
P.s. There is a possibility of glucosamine doing this but there are not solid studies to confirm. You could also try Cetyl Myristoleate which has a lubricating effect. Shark Cartilage may be a better option than glucosamine. It contains hundreds of sulfates including glucosamine but in optimal amounts. Lane Labs makes the best (Benefin).
In Reply to: Re: weight lifting = posted by Rich 1 on March 11, 2001 at 19:08:58:
Chrondomalacia, aka "runner's knee," is softening of the
articular cartilage of the patello-femoral joint due to
lateral tracking and excessive pressure of the patella over
the cartilage. It happens to be one of those mysterious
disorders where many books say its cause is "for some reason
or another..." That "reason," I am beginning to believe, is
chronic bracing unaccounted for.
In Reply to: Re: you're right... posted by Jeff C. on March 11, 2001 at 18:44:04:
In Reply to: Re: weight lifting = posted by Jeff C. on March 11, 2001 at 19:22:29:
with my knee I found that a quality glucosamine/chodroitin product helped (OsteoBiFlex or Cosamin), but it literally took MONTHS. Msm seems to help also. For my shoulder I just started Ligaplex II (for ligaments and joints), and I think it is helping my knees...
In Reply to: I do think... posted by LT on March 11, 2001 at 18:05:41:
I have read on a Dr's site that the knee pain I had that
was below my knee cap mainly when walking down stairs or
an incline was from weak or an imbalance in the thigh muscles
and leg raising exercises would help it. I am lifting
weights but Natrol MSM gets rid of it pretty fast.
VF
In Reply to: Re: weight lifting = posted by Jeff C. on March 11, 2001 at 19:22:29:
In my opinion, I think good old fasion rest is the best things for this. You can walk but don't run. Go easy on the climbing stairs and I would NOT weight lift. Give your body a chance to heal a bit. Take nutrients that stimulate the growth of cartilage (Shark cartilage, MSM, Arthred Hydrolyzed Collagen Protein, Cetyl Mysristoleate, Sea Cucumber, Boswellia) After a few months, I would try to start doing some light jogging but on a softer surface than concrete.
This same thing happened to a firend of mine about 2 years ago. She REFUSED to stop working out. Well, 2 years later, she is STILL going for physical therapy. I think this is your body's way of telling you to chill out on this sport.
Rich
In Reply to: What I would do................ posted by Rich 1 on March 12, 2001 at 11:22:02:
I think you missed the original reaon of my post. Why would
lifting weights be bad if I don't use excercises that
involve the knees?
In Reply to: Re: Squats and knees posted by Jeff C. on March 11, 2001 at 17:43:36:
"I would be suprised if Dr. Stoll agrees with that. "
So would I. However, most doctors have no idea how to properly perform a squat nor what the mechanics and benefits are. Typically, standard General Practitioner 'advice' for knee problems amounts to nothing much more than a recommendation to let the leg muscles atrophy, which is no solution at all.
So, if you believe muscle atrophy is a BAD idea for long-term knee problems - which is what I happen to believe - then the question becomes, "What is the BEST leg exercise for building leg muscles?" It's not swimming (too little range of motion.) It's not leg extensions (too much shearing force on the knee and too much of an isolation exercise.) It's not yoga (very inefficient and ineffective at building strength.) It's not running (too much impact and repetitive motion strain on the knees, hips, and ankles.) No, the single best leg exercise is the classic flat-footed deep knee bend.
In Reply to: What I would do................ posted by Rich 1 on March 12, 2001 at 11:22:02:
Jogging is one of the worst things you can do for the knees. The impact force is quite high, often exceeding several times bodyweight.
BTW, the difference between running and jogging? Jogging is just like running but with bad technique. Running is smooth, jogging is abusive.
In Reply to: butting in....... posted by LT on March 11, 2001 at 21:01:57:
What's the story behind yours?
In Reply to: Re: What I would do................ posted by Jeff C. on March 12, 2001 at 11:40:43:
nmi
In Reply to: If it doesn't involve the knees, go for it.......nmi posted by Rich 1 on March 12, 2001 at 23:19:42:
.
In Reply to: Squats and knees posted by Lincoln on March 11, 2001 at 17:36:51:
Hi, Lincoln.
I would truly be interested in seing any research showing that squats were anything but damaging to knees. Just because some physical therapists use them is NO indication that they know what they are doing.
For the last at least 40 years, medical education has consistantly derided squats.
I stand ready to be educated.
Walt
In Reply to: weight lifting = "weight bearing" posted by Jeff C. on March 11, 2001 at 13:24:23:
Actually, Jeff.
Doing leg lifts with weights on the ankles (sitting with the knees bent), is a very good exercise for your rehabilitation.
Walt
In Reply to: Re: weight lifting = "weight bearing" posted by Walt Stoll on March 13, 2001 at 09:16:11:
Really?
If I read you correctly, you're speaking of leg extensions (knees bent at 90 deg. and then extended), right? I remember in Dr. Fox's "Save Your Knees" where he said the bottom half of leg extensions and leg curls were bad for the knees. Maybe he's wrong. Maybe I misread. To be fair though, my grandfather was appartenly able to alleviate his poor tracking through the leg extension. I will have to invest some time into this as a strength builder. I do appreceate your time. Thank you again, Dr. Stoll.
In Reply to: Re: Squats and knees (???) posted by Walt Stoll on March 13, 2001 at 09:14:05:
Dr. Stoll, you yourself deride many of the mantras of traditional medical education. For those same 40 years, knowledgeable weightlifters have derided medical opinions on squatting, just as they derided the all-too-common medical advice of bed rest for back problems. (We now know that bed rest is NOT good for back problems - activity is.) Doctors are well-trained in how to prescribe drugs (thanks to the pharmacy lobby) and perform surgery. Doctors are not taught squat(s).
Some of this mis-information about squats orginated from a study done by Keith Klein many years ago on the alleged dangers to the knees of squatting. That study, thought oft repeated, has since been shot through with so many holes as to be the laughing stock of the exercise community. The sad part is that it keeps getting repeated, like many of the sacred cows of the medical monopoly. If you are truly curious about this subject, you should look up Klein's study and then try to learn why it has been so derided. I'd be more trusting of your opinion if I felt you were at least aware the points of controversy involved.
For example, what is the angle of knee flexion that puts the most strain on the joint? How does this relate to squat depth? What is the relationship between the the quad-to-hamstring ratio and how does this supposedly relate to knee tracking? How does the force vector change in a squat position as the thigh transitions from above parallel to below parallel? How does this relate to strain on the knee joint? What are the advantages/disadvantages of strength training (rehab as well as general conditioning) in a limited range of motion? How does this apply to a limited range of knee motion exercise like swimming versus a deep knee bend? What muscles are involved in the squat and at what squat depth are these muscles activated (or not activated?) How does one properly perform a squat?
I woud recommend examining the N.S.C.A. position paper on squats: http://www.nsca.com/publications/SQTforWeb.pdf The best quotes are, "1. Squats, when performed correctly and with appropriate supervision, are not only safe, but may be a significatn deterrent to knee injuries... 4. The squat exercise is not detrimental to knee joint stability when performed correctly." Dr. Stoll, I can assure the N.S.C.A. did not come up with this position statement casually and without due diligence.
I've also mentioned in the past that you should examine Paul Chek's "Scientific Back Training" video series. Chek does a lot of therapy work and if his patients can walk, they squat. It is an excellent and highly technical seminar.
Read Chiropractor Ken Leistner's article on "The Squatting Controversy Put To Rest." http://www.net1.net/users/trigg/squatcontroversy.html Dr. Ken squatted 407 lbs. for 23 reps at a bodyweight of 165 lbs. Dr. Ken, age fifty-something, has had several surgeries due to old football injuries and other accidents. Best quote, "I believe too that one has to squat if they can, as it is the most difficult and demanding exercise one can do. If this is so, it also becomes the most potentially productive exercise one can do."
There are more articles and studies, such as a recent study on the low incidence of injury in Olympic-style weightlifting (lots and lots of squatting) compared to other sports, but I do not remember the sources off the top of my head. I encourage you to do your own research and tell us what you learn.
In Reply to: Re: weight lifting = "weight bearing" posted by Jeff C. on March 13, 2001 at 14:57:38:
The highest stress on the knee is at the 90 degree angle, which may be why Dr. Fox doesn't like the bottom half of the motion of leg extensions. However, Fox may be referring to leg extension MACHINES, which typically put a load on the knee/leg throughout the range of motion, including 90 degrees. Dr. Stoll's recommendation - strapping on a weight to the ankle - would put no strain on the knee AT THE 90 DEGREE angle. Stoll's recommendation would generate an ever increasing load until the maximum load at full extension of the knee.
While that approach may or may not have some use with a very de-conditioned or atrophied rehab patient, I think it is highly unlikely anyone could strap on enough weight to elicit a significant training effect in a healthy individual.
In Reply to: Re: butting in....... posted by Jeff C. on March 12, 2001 at 23:08:09:
they've always been wierd...
when I was in 4th grade, the plates or something hadn't closed and I kept collapsing -- they double casted me for 6 weeks -- I don't know what the diagnosis was....can you believe that my parents didn't keep any records????? (geez!) All that they can tell me is that it was usually seen in boys and that they don't put casts on the legs any more.
My knees always hurt and were always fairly painful until I starting running. In grad school though I had lots of problems with pain -- but I was also on 2 intramural B-Ball teams, playing raquetball, and running. I was diagnosed with chondro-whatever, and they said it was a tracking problem. My knees would be sore, but the worse part was the aching at night when I was trying to sleep. Very heat sensitive, the pain sometimes was severe. Stretching helped. Even today, if they start hurting, I know I'm not doing enough yoga.
First they gave me orthotics for my shoes (which helped), then I went to physical therapy for a long time (which helped), but then it got worse -- MRI said cartilage tear. Went in for arthroscopic surgery -- turned out I had a cyst the size of a golf ball in the joint of my knee! And they couldn't see it on the MRI!! Actually, I think the cyst formed because of all the physical therapy, which is ironic. That knee gives me minimal problems if I keep in shape -- but the other is much more painful -- working diagnosis is the chondro-whatever, but I think it's cuz they don't know and I'm not about to let them find out :-). I do think I've found the right balance of supplements, but just have to work on getting in a bit better shape so that the muscles can support the knees better.
In Reply to: That depends posted by Lincoln on March 13, 2001 at 18:19:07:
I know my quads are not "very deconditioned or atrophied"
merely by the demands put upon them by my sport. So, if
light weight extensions with ankle weights will produce only
minimal effects then what--full leg extensions or semi-arc
leg extensions, etc?
In Reply to: (And therefore)... posted by JEff C. on March 13, 2001 at 20:08:13:
I don't know the pathology of your particular knee problem; it is not possible for ME to determine the best course of action for YOU.
I am not a fan of leg extensions for several reasons -
One: is the shearing force they exert on the knee at all angles
Two: is the lack of recruitment of other leg muscles, i.e. they do not work the glutes, the hamstrings, and the stabilizing muscles.
Three: I have not found them to be as effective at building leg strength as other exercises
Four: many leg extension machines do not have enough resistance to accomodate moderately strong or stronger men.
Five: doing leg extensions only teaches the trainee how to be better at leg extensions; the carry-over to real life functionality is very low.
I will say this: that to strengthen the muscles associated with the knee, you'll have do an exercise that BENDS THE KNEE BECAUSE THAT IS WHAT THOSE MUSCLES DO. I think this should be an obvious point, but apparently to many it is not.
Full range of motion would be best, unless there is a particular range that causes pain. Partial range of motion only strengthens that range of motion.
Full range squats - butt-on-calves - are the best leg exercise in my opinion, but you need to be taught how to do them correctly. Many trainees do not have the flexibility to start with full range of motion squats, either. The best way to learn is to get someone with experience to show you how or get a video on squatting technique. Paul Chek at http://www.paulchekseminars.com/ has a very good squatting video.
Deadlifts are a little easier to learn and almost as effective as squats. If I could only do one exercise, I might pick deadlifts. Technique, again, is very important. The book "Power to the People!" by Pavel Tsatsouline has an excellent program and description of how to properly perform the deadlift.
Lunges are a great exercise, but perhaps a bit much to start with for someone with poor proprioception due to injury.
In Reply to: Articles, references, studies posted by Lincoln on March 13, 2001 at 15:24:57:
Thanks, Lincoln.
I noticed one statement you made about this, in passing (a few days ago): "Flat footed (heels touching the ground) squats". That would make a big difference! I admit that I am not an expert on squats but I do know that how most people DO squats is dangerous to the knee.
I stand ready to be educated.
Namasate`
Walt
P.S. By the way, present medical practice is conventional. NOT traditional.
In Reply to: Re: Articles, references, studies (Archive in knees.) posted by Walt Stoll on March 15, 2001 at 09:06:59:
:"Flat footed (heels touching the ground) squats". That would make a big difference! :
Absolutely! I was hoping you would catch that. It completely changes the mechanics - keeping the feet flat on the ground forces the shins into a more desirable upright position and requires (or encourages, depending on how you look at it) greater flexibility in the hips.
Weightlifters stopped doing light squats on the toes and started heavy flat footed squats back in the first quarter of the last century. (Heavy and light are all relative, of course.) This small change radically improved the results. Read the book "Super Squats" by Randall Strossen, PhD. for details.
:I admit that I am not an expert on squats but I do know that how most people DO squats is dangerous to the knee.:
Right again. Squats require instruction.
Properly done, the knees should track in line with the second toe and do not extend out much beyond the feet. The center of gravity should be just slightly forward of the heel and NOT on the balls of the feet. The torso remains in an upright, non-rounded position. The stance should be shoulder width or wider, depending on individual preference and flexibility. The toes should point out slightly - the wider the stance, the more outward they point. Forward lean will occur but should be minimized. The hips go down and back - the idea is to squat BETWEEN the legs. The depth of the squat should be as low as the individual's flexibility allows (i.e. until forward lean gets excessive or the low back starts to round) Ideally this would be butt-to-calves, not the quarter squats one sees performed in most commercial gyms by the unenlightened.
From a non-medical perspective, you might be interested in the link below pointing to Dan John's lifting web site. Dan is a highly respected competitive Olympic lifter, discus thrower, and coach with several interesting articles. "The Overhead Squat" and "Four Reasons To Olympic Lift" are two of his best articles. None of this "pumping and toning" crap the commercial gym industry loves to push - this is results oriented stuff, not bodybuilding or membership sales fluff. Note, however that this is TRAINING information, not rehab.
In Reply to: Re: Articles, references, studies (Archive in knees.) posted by Lincoln on March 15, 2001 at 12:47:32:
Hey Lincoln,
Is that you in the photo? :o)
Joanie
In Reply to: Re: Articles, references, studies (Archive in knees.) posted by Joanie on March 15, 2001 at 12:56:04:
yeah, couple years ago. Got a haircut since then...
In Reply to: photo posted by Lincoln on March 15, 2001 at 14:37:50:
It's nice to put a face to a name. Wouldn't it be neat if we all posted pictures of ourselves? Although I wouldn't have a clue as to how to do it.
Do you always do your workouts barefoot?
Namaste'
Joanie
In Reply to: Re: photo posted by Joanie on March 15, 2001 at 14:45:51:
No, but squatting barefoot increases the flexibility required and enhances proprioception (the body's sense of where it is.) I'm currently do all of my squatting with weightlifting shoes, which have a small stiff heel. Normal gym shoes, especially anything with gel shock absorbsion, have too much 'give'. Squatting does not generate shock but it does help to have a solid 'grasp' of the floor, thus running shoes or basketball shoes are totally inappropiate. Bowling shoes and dance shoes are actully pretty good squatting shoes! Note that I'm squatting in a power rack with safety rails (at home!) which obviates any concern for dropping the weights on the floor or my feet.
In Reply to: Re: Articles, references, studies (Archive in knees.) posted by Lincoln on March 15, 2001 at 12:47:32:
Thanks, Lincoln.
Is that you?
Namaste`
Walt
In Reply to: footwear posted by Lincoln on March 15, 2001 at 15:10:33:
Interesting about this since that was something that I lost
and sure caused many accidents and harder work doing simple
things. Since I have started lifting and trying to get back
to fixing and building things I need to learn any tricks
since even though I am much better I still have some
problems.
VF
In Reply to: footwear posted by Lincoln on March 15, 2001 at 15:10:33:
Lincoln,
where did you get the squating rack and what do they cost?
I have a desire to build one and feel I have it pretty well
figured out. Don't think I would go for a Smith machine.
Lifting list members claim that they make you move in an
unnatural way and can do damage.. In case they are right I
figured in a little play in the guiding rails since I want
the rack in case I loose my balance which I do with the
weights free.
VF
In Reply to: Re: Articles, references, studies (Archive in knees.) posted by Walt Stoll on March 17, 2001 at 09:14:28:
.
In Reply to: propriception posted by Vince F on March 17, 2001 at 10:52:16:
Since your proprioception is bad, that is what you need to work on most! That means 'trickier' exercise with lighter weights, rather than 'easy-to-perform' exercises that allow you to use heavy weights. Exercises that seriously challenge your balance and coordination, instead of exercises that primarily challenge your strength level. Thus, smith machines are strictly out - they do all the balance and stabilization for the trainee. You don't want that. You want exercises that are challenging to the nervous system yet done is such a manner that you can occasionally safely drop things, lose your balance, etc.
In Reply to: Re: propriception posted by Lincoln on March 19, 2001 at 12:50:02:
Lincoln,
I have been active doing things when needed to and I am
single with 2 hounds in a small, cluttered house and just
became able to work out since any physical activity had me
hurting bad for days from a possible circulation problem but
fining new suppliments that made other ones i took for the
pains not necessary any more and even lifting doen't make
me hurt at all except for strains. I do ache though not
like before when fixing something and I Guess I strain
harder than lifting at my limit when trying to loosen a
rusted bolt or something that Won't budge that i am
determined to.
I am thinking that more strength may help with balance
and coordination and maybe also with propriception since
that is fairly rare now unless I am tired. I guess I am
saying that they are the main problems now. when the PP
shows up like it did last week I guess I remember it and
wonder if it is still around. Guess everything is related
and hard to tell what is happeing some times.
I have some lofty goals with lifting after being a wreck
for 13yrs and I rarely lifted before even though I had
weights because I was always so busy and active doing
physical things that i did hard. Now I want strength just in
case the speed doesn't return and I can change my style and
still feel good and i need to tone up my body and feel that
the workouts may inprove circulation. I had to get my BP
down and did soon after working out and loosing some weight.
VF
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