Training with injury question and life story

losingforgood120

Hi,

I've received some instruction from a physical therapist. I'm planning on switching therapists and will get a second opinion but I'd also like some general advice/opinion from a personal trainer point of view.

Background: I've been a runner for over 10 years. I really enjoyed it, I loved it when nurses took my resting heart rate at checkups and made comments about how low it was. I also feel that running helped me improve my emotional health and sleep.

I had a baby 2 years ago and had several months of post-partum depression, sleep deprivation, etc. I ended up gaining 50 pounds after my baby was born. I had a healthy well-balanced diet before but due to stress, lack of time and depression my diet changed to mostly sugary treats with very little protein during that time.
My weight loss journey started out with lots of bad starts like I tried to go vegan twice... (made me feel pretty bad) tried a cleanse. I found MFP and it's helped. Except I started out at 1200 calories and gave up. Then I came back read more and figured out 1200 calories was wrong for me. Since getting my calories right I've lost 10 pounds VERY SLOWLY (in 6 months). Because I usually go over my deficit and eat closer to maintenance. (Not a logging problem just a willpower problem.) And while my protein has been going up steadily I'm still not at 1g per lb of LBW.

I started running again last year and I've had knee pain since then. It got worse while trying to do 30ds. I stopped exercising for 6 months. I started again in January this year. I learned about the importance of strength training. (Which I had done a tiny bit of before and didn't enjoy it.) I tried it again this year- started with SL5x5 and loved it! I've read NRL4W... interesting read. Anyway- I really want to do strength training. But then the knee pain started again with the exercise.

I went to an orthopedic doctor, got x-rays, and I have misaligned kneecaps and arthritis in my knees. Doc said most likely I was born with slightly misaligned kneecaps that wouldn't have been a problem until I was older except that I ran while overweight. His instructions were to NEVER run again. And to lose weight. (So... yeah, I cried all night.) He also said to stop lower body weight lifting "for now." So, now a few weeks later, I'm at peace with no more running. He said swimming was ok and I think I can receive the same benefit from swimming that I got from running without resulting in knee surgery. But I am concerned about lower body strength training.

He recommended physical therapy. So I asked the physical therapist about strength training in the future. Here's what she said about squats. She told me once I finish physical therapy I can resume doing squats but only doing to 90 degrees (not full parallel). And that I shouldn't lift heavy but focus on more reps, lighter weights.

So back to the point- any thoughts on this?? And can I just say I'm so sad that I gained the weight in the first place and if I'd known I was going to ruin my knees I would have been more careful.

Thanks in advance for any thoughts, comments.

Sarauk2sf

Swimming is an excellent exercise that is gentle on joints.

With regard to squats, I would definitely get a second opinion - generally, going to at least parallel is easier on the knees - however, your physical therapist has your specific medical issues and can examine you and as such I would go with what they say (assuming the PT second opinion concurs).

I would also ask them what lower body exercises you can do that will not put a strain on your knees - there are a lot of ones that can be done.

When you see the second PT, you may want to show them this extract from Mark Rippetoe's Starting Strength for discussion:

"Squats are not "bad for the knees". They are, in fact, good for the knees. Properly performed, they evenly and proportionately strengthen all muscles which stabilize and control the knee (in addition to strengthening the muscles of the hip and posterior chain, upper back, shoulder girdle, etc.). When the hips are lowered in a controlled fashion below the level of the top of the patella, full hip flexion has occurred, and this will activate the hamstrings and glutes. In doing so, the hamstrings are stretched at the bottom of the motion and they pull the tibia backwards (toward da' butt) which counteracts the forward-pulling force the quadriceps apply during the motion. As a result, the stress on the knee tendons is lessened since the hamstrings assist the patellar tendon in stabilization of the knee. A muscle supporting a tendon which supports the kneecap is going to be better than the tendon having to take up the entirety of the strain by itself..

Think about Olympic lifters. They squat VERY deep (almost ridiculously deep) all the time, frequently 5 or 6 times weekly, with very heavy weight. If deep squats were so bad for their knees, they wouldn't be able to squat that deep, that often, and that heavy.

Partial squats, however, will NOT activate the hamstrings, and the amount of shearing force on the patellar tendon increases exponentially. What WILL happen if you do partial squats is that your quadriceps will become disproportionately strong as compared to your hamstrings, and the following are likely results:

In partial squats, the hamstrings aren't activated, which means the patellar tendon takes up all the strain/stress/pull during squats. As a result, fatigue and damage to the tendon can accumulate because tendons recover MUCH slower than muscles. Any type of action involving knee bend can then cause further stress and strain during daily activity. This is asking for trouble. If the hamstring is strong, it drastically reduces the amount of stress on the patellar tendon. Full squats make the hamstrings strong. Partial squats allow the hamstrings to become weak. Weak hamstrings are bad Bad BAD.

Partial squats develop the quads and neglect the hamstrings. Weak hamstrings coupled with strong quads result in hamstring pulls while sprinting, starting or stopping suddenly, playing sports, etc.. They frequently occur as the result of muscular imbalances across the knee joint. Strong quadriceps and weaker hamstrings result in a knee joint that is unstable during rapid acceleration and slowing, and the hamstrings are unable to counteract the powerful forces that occur during sudden stops and starts. In other words, you do a sprint with extra-strong quads and weak hammies, and you are begging for a pulled hamstring because your hamstring isn't as strong as the quads and isn't able to perform an adequate eccentric contraction to keep your knee joint from hyperextending during a sprint. As a result, you strain the hamstring because, although it isn't strong enough to do the job, it will hurt itself trying.

In sports, your acceleration will be weak, as will your jumping ability, as a result of underdeveloped hamstrings and hips. Poor speed/acceleration = poor performance

You will end up using stupidly heavy weights in the partial squat due to the mechanical advantage afforded by partial squats, and you put your back and even shoulder girdle at risk due to the extreme loading of the spine."

aylajane

*This is just my experience* but it highlights I think what Sara is saying above.

I also had/have knee pain all my life due to my knee caps being slightly misaligned. I was told it was "growing pains" as a kid/teen, then "arthritis" in my 20s (though xrays showed plenty of cushion in joint), then "runner's knee" (never ran in my life) later. All said nothing you can do. A few gave me an exercise or two to try. I even had a handicapped parking sticker for awhile when they were really bad.

Now at 42 years old, I hired a personal trainer and told him I had "bad knees" (yeah, really crunchy kind). Fast forward a few months later and my knees do not hurt for the first time in my life. He had me switch to barefoot shoes (I use Merrell ones a lot) mainly for weights (regular cushioned tennis shoes are not good for weight lifting). My knees felt so much better I switched to wearing ONLY barefoot shoes all the time. He then spent a month concentrating on balancing out the muscles in my upper legs, making sure he could see the separation between the 3 main ones, and teaching me how to use the foam roller on every inch of my upper leg (hamstrings, quads, IT band and whatever that little one is on the upper inside of your knee).

By evening out the huge muscle imbalance I had (quads were awesome, IT band non existent, hamstrings average, inner little guy missing) and getting rid of the heel lift in tennis shoes, my knees are now absolutely perfect for me. They are still a little noisy but nothing like before, and I have no problems with 100+ pound full squats (on the first day I told him I would never be able to do a squat!). He even got me running up to 2 miles! I have to watch the surface a bit, but I can do it

amflautist

Listen to your body. Listen to a sports trainer. Half-listen to your PT. He/she may or may not know depending on experience. The group moderator above has good advice. Usually, a Dr knows squat.

My daughter is an Olympic athlete with a couple of golds. She has been through more knee injuries than you can shake a stick at. Even to the point of walking on crutches and not being able to drive. Once i had to move to a national training center and chauffer her around to dr appointments and pt sessions because she couldnt even use that knee enough to drive. She recovered every time with good sports trainers and won her golds after recovery. You can do this. She would tell you to listen to your body but don't give up training.

My knees improved immensely when I lost weight. Lots of things are going to change as you lose weight. Listen to your body as #1.

amflautist

PS. You did not wreck your knees by gaining weight. You can fully recover from this. Love your body and gently but firmly proceed with your training. You can't imagine all the injuries I saw in that squad of Olympic women. You can succeed!

212019156

Before taking that advice from the physical therapist I would try and find a physical therapist that has actually legitimately done squats. Most of them say stuff like that.

losingforgood120

Thank you so much for the replies and encouragement! Sara, that quote was very helpful and I will share that with my next PT.

The PT has suggested lower body exercises but they are more like pilates than heavy lifting (example: leg lifts while lying down) and the other exercises she has me do in therapy are like standing on one foot for a few minutes. So, I'm doing them but I'm hoping to do exercises that will lead to large strength gains in the future like squats would. This is something else I'll ask the next PT- if there are any other lower body exercises I can do now.

Aylajane, sounds like your personal trainer knew what he was doing and really helped you. I'm so glad things worked out for you! I don't understand what you did with the foam roller? Anyway, maybe when I'm done w/ PT I should look for a personal trainer who can help w/ muscle imbalance.

Amflautist, thanks so much for the encouragement. :happy:

Thanks again!

losingforgood120

Before taking that advice from the physical therapist I would try and find a physical therapist that has actually legitimately done squats. Most of them say stuff like that.

Yes, this was my concern. She made other comments about full squats only being for bodybuilders. I thought it was odd.

JTick

I have subluxation of the patella, to the point that my kneecap dislocated. Both my sports doc and PT said that squats were absolutely necessary for kneecap stability.

I lift heavy, and squat over 200 lbs on my heavy days. I did have to modify my stance...wide stance and point my toes out a bit more than normal, making sure that my knees track in the same direction as my toes. I can definitely tell if I've been slacking on the squats...my kneecap will start moving more than it should and I'll have more knee pain.

Obviously, take my experience with a grain of salt. FWIW, my kneecap would dislocate to the outside, so quad strength is crucial to keep it pulled to the inside where it should be. If yours is tracking too far in, then it could be different for you.

losingforgood120

I have subluxation of the patella, to the point that my kneecap dislocated. Both my sports doc and PT said that squats were absolutely necessary for kneecap stability.

I lift heavy, and squat over 200 lbs on my heavy days. I did have to modify my stance...wide stance and point my toes out a bit more than normal, making sure that my knees track in the same direction as my toes. I can definitely tell if I've been slacking on the squats...my kneecap will start moving more than it should and I'll have more knee pain.

Obviously, take my experience with a grain of salt. FWIW, my kneecap would dislocate to the outside, so quad strength is crucial to keep it pulled to the inside where it should be. If yours is tracking too far in, then it could be different for you.

Thank you, that's encouraging. My PT is really young and new to the field and that's partially why I'm switching. I just think her instructions were wrong. My kneecaps also track to the outside.

aylajane

Aylajane, sounds like your personal trainer knew what he was doing and really helped you. I'm so glad things worked out for you! I don't understand what you did with the foam roller? Anyway, maybe when I'm done w/ PT I should look for a personal trainer who can help w/ muscle imbalance.

Yes, my trainer is awesome at understanding how all the muscles coordinate and work together! If anything hurts, he always figures out which muscle to work and fixes it.

The foam roller is to help the muscles relax. Having an overtight quad or IT band will cause other muscles to not engage... I.e if your IT band is doing ALL the work, there is no need for the other muscles to have to "help" and they get weak and lazy... or something like that. So daily I work out all the kinks and knots to make sure they are relaxed and all of them have to work together to make me move. It has helped my squats a ton, and especially if my knee is "wonky" that day, its a sure bet one of those muslces has a knot. As soon as I work it out, knee pain is gone and I can continue doing my workout.

You can check youtube for leg work with a roller. Best time and money you will ever spend! ~$20 for a good stiff roller. Hurts like hell the first few times, but soooo worth it.

Sarauk2sf

Before taking that advice from the physical therapist I would try and find a physical therapist that has actually legitimately done squats. Most of them say stuff like that.

Yes, this was my concern. She made other comments about full squats only being for bodybuilders. I thought it was odd.

That is a load of bullsh!t. I would definitely get another PT, one who has (as suggested by the prior poster) actually done squats ('proper' ones).

212019156

Regarding my previous suggestion about finding a PT who actually has done squats, good luck. Most of them haven't and this includes doctors (including orthopedics, chiropractors), and even individuals with grad degrees in kinesiology.

There was a great web article I found about the origins of deep squats being bad for the knees myth. I wish I could find it. Essentially there was only one poorly constructed study that stated this, but everyone has latched on to this notion. Boggles my mind.

You are more likely to have back issues than knee issues from deep squatting. This has to do with the level of hip mobility you have or lack there of. If you lack mobility you will experience butt wink the lower you go down.

losingforgood120

Regarding my previous suggestion about finding a PT who actually has done squats, good luck. Most of them haven't and this includes doctors (including orthopedics, chiropractors), and even individuals with grad degrees in kinesiology.

There was a great web article I found about the origins of deep squats being bad for the knees myth. I wish I could find it. Essentially there was only one poorly constructed study that stated this, but everyone has latched on to this notion. Boggles my mind.

You are more likely to have back issues than knee issues from deep squatting. This has to do with the level of hip mobility you have or lack there of. If you lack mobility you will experience butt wink the lower you go down.

I have a PT in mind- he's a family friend and works part time for the local high school working with athletes. He's also in fantastic shape so I assume he'll know more. I just went to the PT my doctor recommended first (a therapy office he's financially invested in...) I'm glad to be switching now.

Thanks for the feedback everyone. It has been helpful.

DopeItUp

Before taking that advice from the physical therapist I would try and find a physical therapist that has actually legitimately done squats. Most of them say stuff like that.

Yes, this was my concern. She made other comments about full squats only being for bodybuilders. I thought it was odd.

That is a load of bullsh!t. I would definitely get another PT, one who has (as suggested by the prior poster) actually done squats ('proper' ones).

The funny thing is, even just that one statement is very telling. It's bodybuilders who are generally notorious for only doing half squats. Full squats are for powerlifters and olympic lifters and such

212019156

That's good. I found a PT for my son who used to play college baseball. He is way more knowledgeable than most of the other PTs that I have spoken with.

Good luck.

Regarding my previous suggestion about finding a PT who actually has done squats, good luck. Most of them haven't and this includes doctors (including orthopedics, chiropractors), and even individuals with grad degrees in kinesiology.

There was a great web article I found about the origins of deep squats being bad for the knees myth. I wish I could find it. Essentially there was only one poorly constructed study that stated this, but everyone has latched on to this notion. Boggles my mind.

You are more likely to have back issues than knee issues from deep squatting. This has to do with the level of hip mobility you have or lack there of. If you lack mobility you will experience butt wink the lower you go down.

I have a PT in mind- he's a family friend and works part time for the local high school working with athletes. He's also in fantastic shape so I assume he'll know more. I just went to the PT my doctor recommended first (a therapy office he's financially invested in...) I'm glad to be switching now.

Thanks for the feedback everyone. It has been helpful.

Carlyannabelle

Bumping for later.